[产钳助产失败：危险因素及对母婴的发病率影响]
[Failed forceps extraction: risk factors and maternal and neonatal morbidity].
作者信息
Langeron A, Mercier G, Chauleur C, Varlet M-N, Patural H, Lima S, Seffert P, Chêne G
机构信息
Département de gynécologie-obstétrique et médecine de la reproduction, hôpital Nord, CHU de Saint-Étienne, avenue Albert-Raimond, Saint-Étienne, France.
出版信息
J Gynecol Obstet Biol Reprod (Paris). 2012 Jun;41(4):333-8. doi: 10.1016/j.jgyn.2011.11.001. Epub 2012 Jan 9.
OBJECTIVES
To evaluate risk factors associated with failed forceps delivery and to compare the maternal and neonatal morbidity.
PATIENTS AND METHODS
In this retrospective case-control study, all failed forceps delivery cases were analyzed from January 2005 to June 2008 and were compared to a successful forceps delivery cohort.
RESULTS
The rate of failed forceps extraction was 4.4% (40/918). Specific risk factors were extraction above a fœtal station of S+2 (OR=43.03; IC 95%: 3.8-475.41), occipito-posterior position (OR=34.64; IC 95%: 4.08-293.5), and biparietal diameter higher than 95mm (OR=10.74; IC 95%: 1.4-82.41). Maternal and neonatal morbidity was few in both groups.
CONCLUSIONS
Diagnosis of presentation level and variety of presentation are necessary before instrumental extraction. A "trial of forceps" should be performed with caution in a setting where a caesarean delivery could follow. Vacuum extraction could be interesting in case of occipito-posterior position.
目的
评估与产钳助产失败相关的危险因素，并比较母婴发病率。
患者与方法
在这项回顾性病例对照研究中，分析了2005年1月至2008年6月期间所有产钳助产失败病例，并与成功的产钳助产队列进行比较。
结果
产钳助产失败率为4.4%（40/918）。具体危险因素包括胎头位置在S+2以上进行助产（比值比=43.03；95%置信区间：3.8-475.41）、枕后位（比值比=34.64；95%置信区间：4.08-293.5）以及双顶径大于95mm（比值比=10.74；95%置信区间：1.4-82.41）。两组母婴发病率均较低。
结论
在器械助产之前，有必要诊断胎头位置和胎位类型。在有可能随后进行剖宫产的情况下，应谨慎进行“产钳试产”。对于枕后位情况，真空吸引助产可能是一种选择。
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