Department of Obstetrics, Oslo University Hospital Ulleval, Norway.
Acta Obstet Gynecol Scand. 2012 Apr;91(4):476-82. doi: 10.1111/j.1600-0412.2012.01360.x. Epub 2012 Feb 28.
To study whether special guidelines for low-risk parturients combined with increased awareness of risk category affect the management of labor.
Hospital-based registry study.
Two identical birth units in one university hospital in Oslo, Norway.
All low-risk parturient women in the years 2001-2009; a total of 28 533 deliveries.
From September 2005, a special protocol for management of low-risk labors was introduced in one of the units. Data were obtained from standardized patient records, routinely recorded electronically. Outcomes were extracted for each year, and for the years 2006-2009 the outcomes for the two units were compared. Logistic regression was used to study factors associated with spontaneous vaginal delivery.
Delivery method, use of electronic fetal monitoring, use of oxytocin, duration of labor and Apgar score at five minutes.
For nulliparas, the unit with special guidelines had a slightly higher rate of spontaneous vaginal deliveries (76 vs. 72.5%, p=0.006), lower use of oxytocin (48.8 vs. 56.1%, p<0.001) and electronic fetal monitoring (63.8 vs. 69.4%, p<0.001) and longer duration of labor. In multiparas, there was a small difference (15.5 vs. 18.4%, p=0.003) in the use of oxytocin. In a logistic regression, spontaneous vaginal delivery in nulliparas was negatively associated with use of oxytocin and electronic fetal monitoring, but not with the birth unit.
A special protocol to increase awareness of risk category led to a small, although statistically significant, increase in the rate of spontaneous vaginal delivery in nulliparous, but not in parous low-risk parturients.
研究低危产妇的特殊指导方针与增强对风险类别的认识是否会影响分娩管理。
医院为基础的注册研究。
挪威奥斯陆一所大学医院的两个相同的分娩单位。
2001 年至 2009 年所有低危产妇；共有 28533 例分娩。
从 2005 年 9 月开始，在其中一个单位引入了管理低危分娩的特殊方案。数据来自标准化的患者记录，以电子方式常规记录。每年提取结果，并比较 2006 年至 2009 年两个单位的结果。使用逻辑回归研究与自然分娩相关的因素。
分娩方式、电子胎儿监护、催产素使用、产程时间和 5 分钟时的 Apgar 评分。
对于初产妇，有特殊指导方针的单位自然分娩率略高（76%比 72.5%，p=0.006），催产素使用率较低（48.8%比 56.1%，p<0.001），电子胎儿监护使用率较低（63.8%比 69.4%，p<0.001），产程时间较长。对于经产妇，催产素使用率略有差异（15.5%比 18.4%，p=0.003）。在逻辑回归中，初产妇自然分娩与催产素和电子胎儿监护的使用呈负相关，但与分娩单位无关。
增加对风险类别的认识的特殊方案导致初产妇的自然分娩率略有增加，但经产妇的自然分娩率没有增加。
