Department of Obstetrics & Gynaecology, St Michael's Hospital, Bristol, UK.
BJOG. 2013 Nov;120(12):1526-32. doi: 10.1111/1471-0528.12398. Epub 2013 Aug 7.
To compare the maternal and neonatal morbidity associated with alternative instruments used to perform a mid-cavity rotational delivery.
A prospective cohort study.
Two university teaching hospitals in Scotland and England.
Three hundred and eighty-one nulliparous women who had a mid-cavity rotational operative vaginal delivery.
A data collection sheet was completed by the research team following delivery.
Postpartum haemorrhage, third- and fourth-degree perineal tears, low cord pH, neonatal trauma, and failed or sequential operative vaginal delivery.
One hundred and sixty-three women (42.8%) underwent manual rotation followed by non-rotational forceps delivery, 73 (19.1%) had a rotational vacuum delivery, and 145 (38.1%) delivered with the assistance of rotational (Kielland) forceps. The rates of postpartum haemorrhage were similar when comparing manual rotation with rotational vacuum (adjusted OR 1.42, 95% CI 0.66-3.98), and when comparing manual rotation with Kielland forceps (adjusted OR 1.22, 95% CI 0.71-2.88). The results were comparable for third- and fourth-degree perineal tears (adjusted OR 0.85, 95% CI 0.13-1.89; adjusted OR 0.94, 95% CI 0.39-1.82), low cord pH (adjusted OR 1.76, 95% CI 0.44-6.91; adjusted OR 1.12, 95% CI 0.44-2.83), neonatal trauma (adjusted OR 0.50, 95% CI 0.16-1.55; adjusted OR 3.25, 95% CI 0.65-16.17), and admission to the neonatal intensive care unit (adjusted OR 1.47, 95% CI 0.45-4.81; adjusted OR 1.04, 95% CI 0.49-2.19). The sequential use of instruments was less likely with manual rotation and forceps than with rotational vacuum delivery (0.6 versus 36.9%, OR 0.01, 95% CI 0.002-0.090).
Maternal and perinatal outcomes are comparable with Kielland forceps, vacuum extraction, and manual rotation, with few serious adverse outcomes. With appropriate training mid-cavity rotational delivery can be practiced safely, including the use of Kielland forceps.
比较用于行中骨盆旋转式分娩的不同助产器械相关的母婴发病率。
前瞻性队列研究。
苏格兰和英格兰的两所大学教学医院。
381 例初产妇行中骨盆旋转式经阴道助产。
研究团队在分娩后完成数据采集表。
产后出血、Ⅲ度和Ⅳ度会阴撕裂伤、脐血 pH 值降低、新生儿损伤以及失败或连续行经阴道助产。
163 例产妇（42.8%）行手法旋转联合非旋转产钳助产，73 例（19.1%）行旋转式真空吸引助产，145 例（38.1%）使用旋转式（Kielland）产钳助产。手法旋转联合旋转式真空吸引助产与手法旋转联合产钳助产相比，产后出血发生率相似（校正比值比 1.42，95%置信区间 0.66-3.98），手法旋转联合 Kielland 产钳助产与手法旋转联合产钳助产相比，产后出血发生率相似（校正比值比 1.22，95%置信区间 0.71-2.88）。Ⅲ度和Ⅳ度会阴撕裂伤（校正比值比 0.85，95%置信区间 0.13-1.89；校正比值比 0.94，95%置信区间 0.39-1.82）、脐血 pH 值降低（校正比值比 1.76，95%置信区间 0.44-6.91；校正比值比 1.12，95%置信区间 0.44-2.83）、新生儿损伤（校正比值比 0.50，95%置信区间 0.16-1.55；校正比值比 3.25，95%置信区间 0.65-16.17）和新生儿重症监护病房收治率（校正比值比 1.47，95%置信区间 0.45-4.81；校正比值比 1.04，95%置信区间 0.49-2.19）差异均无统计学意义。与旋转式真空吸引助产相比，手法旋转联合产钳或联合 Kielland 产钳助产更可能需要连续使用器械（0.6%比 36.9%，比值比 0.01，95%置信区间 0.002-0.090）。
Kielland 产钳、真空吸引助产和手法旋转助产的母婴结局相当，严重不良结局少见。经适当培训后，中骨盆旋转式分娩可安全实施，包括 Kielland 产钳的使用。
