National Maternity Hospital, Holles St, Dublin, Ireland.
Eur J Obstet Gynecol Reprod Biol. 2013 Nov;171(1):40-3. doi: 10.1016/j.ejogrb.2013.08.015. Epub 2013 Aug 14.
To examine rates and outcomes of operative vaginal delivery over a 20-year study period and the changing preference for various instruments during this period.
This retrospective analysis of prospectively gathered data was carried out at a large tertiary referral center from 1991 to 2010. All cases of operative vaginal delivery during the study period were recorded. The rates of instrumental delivery, as well as neonatal outcomes and instrument preference, were compared for individual 5-year epochs.
During the study period there were 156,130 deliveries of which 17,841 were operative vaginal deliveries, an incidence of 11.4/100 deliveries and 13.6/100 vaginal deliveries. There was an increase in the rate of operative vaginal delivery across the 20-year period (P < 0.0001; R(2) = 0.85; Slope = 0.42). When individual 5-year epochs were compared, the incidence of instrumental delivery increased from 7.3% (2340/31,937) in the first five years, 1991-1995, to 13.7% (6179/45,177) in the final five years, 2006-2010 (P < 0.0001; OR 2.34, 95% CI = 2.23-2.47). The perinatal mortality rate in cases of instrumental delivery was decreased when these time periods were compared (7.3/1000 (17/2340) vs. 1.8/1000 (11/6179); P = 0.003, OR 0.24, 95% CI = 0.11-0.52). The choice of instrument also varied, with 68.2% (1596/2340) of instrumental deliveries in 1991-1995 being carried out with forceps compared to 32.9% (2033/6179) in 2006-2010 (P < 0.001).
Rates of operative vaginal delivery have increased over the 20-year study period. The rate of perinatal mortality in infants who had an assisted vaginal delivery was decreased in the 5-year epoch at the end of the study compared with the period at the beginning. The rate of forceps delivery has fallen significantly, with vacuum delivery now being the choice of the majority of clinicians.
在 20 年的研究期间，检查阴道分娩的发生率和结局，并在此期间检查各种器械的使用偏好的变化。
本研究回顾性分析了 1991 年至 2010 年在一家大型三级转诊中心前瞻性收集的数据。在此期间记录了所有阴道分娩的病例。比较了各个 5 年时期的器械分娩率、新生儿结局和器械使用偏好。
在研究期间，有 156130 例分娩，其中 17841 例为阴道分娩，发生率为 11.4/100 分娩和 13.6/100 阴道分娩。在 20 年的研究期间，阴道分娩的比例呈上升趋势（P <0.0001；R(2) = 0.85；斜率 = 0.42）。当比较各个 5 年时期时，器械分娩的发生率从第一个 5 年（1991-1995 年）的 7.3%（2340/31937）增加到最后一个 5 年（2006-2010 年）的 13.7%（6179/45177）（P <0.0001；OR 2.34，95%CI = 2.23-2.47）。当比较这些时间段时，器械分娩的围产儿死亡率降低（7.3/1000（17/2340）与 1.8/1000（11/6179）；P = 0.003，OR 0.24，95%CI = 0.11-0.52）。器械的选择也有所不同，1991-1995 年 68.2%（1596/2340）的器械分娩采用产钳，而 2006-2010 年 32.9%（2033/6179）采用产钳（P <0.001）。
在 20 年的研究期间，阴道分娩的比例有所增加。与研究开始时相比，在研究结束时的 5 年期间，接受辅助阴道分娩的婴儿的围产儿死亡率有所下降。产钳分娩的比例显著下降，现在真空分娩成为大多数临床医生的选择。
