Yee Lynn M, Liu Lilly Y, Grobman William A
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL.
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL.
Am J Obstet Gynecol. 2014 Dec;211(6):692.e1-6. doi: 10.1016/j.ajog.2014.06.003. Epub 2014 Jun 4.
The objective of the study was to investigate the relationship between physician coping skills, need for cognition, tolerance of ambiguity, and anxiety and their patients' mode of delivery.
Ninety-four obstetricians were surveyed using 5 standardized psychometric scales: Reflective Coping, Proactive Coping, Multiple Stimulus Types Ambiguity Tolerance-II, Need for Cognition (measures learner motivation and engagement in cognitive efforts), and State-Trait Anxiety Inventory. Psychometric test scores were analyzed by quartile. Data regarding route of delivery were collected on 3488 nulliparous, term, cephalic, nonanomalous singleton deliveries performed by participating physicians. χ(2) tests and random-effects logistic regression analyses were used to examine the relationship between the obstetrician cognitive traits and type of delivery.
Sixty-one percent of the women were delivered by spontaneous vaginal delivery, 15.5% by operative vaginal delivery, and 23.5% by cesarean delivery. Random-effects multivariable logistic regression adjusting for patient characteristics demonstrated that physicians with the most reflective coping (ie, highest quartile) were significantly less likely (adjusted odds ratio, 0.70; 95% confidence interval, 0.50-0.98) to perform operative vaginal delivery. However, lower anxiety and higher ambiguity tolerance were associated with an increased risk of chorioamnionitis and postpartum hemorrhage, respectively. There were no identified differences in adverse neonatal outcomes by physician cognitive or affective traits.
There is a decreased risk of operative vaginal delivery for patients delivered by providers with better adaptive decision-making traits. Other cognitive and affective traits were associated with a greater chance of chorioamnionitis and hemorrhage. Further work is required to elucidate whether training in these cognitive and affective traits can alter obstetric outcomes.
本研究的目的是调查医生的应对技能、认知需求、对模糊性的耐受性、焦虑情绪与他们患者的分娩方式之间的关系。
使用5种标准化心理测量量表对94名产科医生进行调查：反思性应对、主动性应对、多种刺激类型模糊耐受性-II、认知需求（测量学习者动机和认知努力参与度）以及状态-特质焦虑量表。心理测量测试分数按四分位数进行分析。收集了参与研究的医生进行的3488例初产、足月、头位、无异常单胎分娩的分娩途径数据。采用χ²检验和随机效应逻辑回归分析来检验产科医生认知特质与分娩类型之间的关系。
61%的女性通过自然阴道分娩，15.5%通过手术阴道分娩，23.5%通过剖宫产分娩。对患者特征进行调整的随机效应多变量逻辑回归分析表明，采用最具反思性应对方式（即最高四分位数）的医生进行手术阴道分娩的可能性显著降低（调整后的优势比为0.70；95%置信区间为0.50 - 0.98）。然而，较低的焦虑水平和较高的模糊耐受性分别与绒毛膜羊膜炎和产后出血风险增加相关。医生的认知或情感特质在不良新生儿结局方面未发现差异。
由具有更好适应性决策特质的提供者接生的患者，手术阴道分娩风险降低。其他认知和情感特质与绒毛膜羊膜炎和出血的可能性增加相关。需要进一步开展工作以阐明对这些认知和情感特质的培训是否能改变产科结局。
