Shmueli Anat, Salman Lina, Ashwal Eran, Hiersch Liran, Gabbay-Benziv Rinat, Yogev Yariv, Aviram Amir
a Sackler Faculty of Medicine, Helen Schneider Hospital for Women, Rabin Medical Center, Petah Tikva, Tel-Aviv University , Ramat-Aviv , Israel and.
b Sackler Faculty of Medicine, Lis Maternity Hospital, the Tel-Aviv Sourasky Medical Center, Tel-Aviv University , Ramat-Aviv, Tel Aviv , Israel.
J Matern Fetal Neonatal Med. 2017 Apr;30(8):886-889. doi: 10.1080/14767058.2016.1191066. Epub 2016 Jun 8.
To compare perinatal outcomes of interventions for prolonged second stage of labor.
Retrospective cohort study, in a single, university-affiliate, medical center (2007-2014). Eligibility: singleton gestations at term, diagnosed with prolonged second stage of labor and head station of S + 1 and lower. We compared perinatal outcomes of cesarean deliveries (CD) with vacuum assisted deliveries (VAD).
Of 62 102 deliveries, 3449 (5.6%) were eligible: 356 (10.3%) underwent CD and 3093 (89.7%) underwent VAD. The rate of five-minute Apgar scores <7 was higher in the CD group as well as rates of NICU admission, neonatal asphyxia and composite neonatal adverse outcome. After adjusting for different confounders, CD was associated with adverse neonatal composite outcome (aOR 1.57, 95% CI 1.21-2.05, p = 0.001) and VAD with cephalhematoma (aOR 4.06, 95% CI 2.64-6.25, p < 0.001). No other differences were found between the groups with regards to other traumatic outcomes.
Our data suggests that in deliveries complicated by prolonged second stage, CD yield poorer neonatal outcome than VAD, with no apparent major difference in traumatic composite outcome.
比较产程第二产程延长干预措施的围产期结局。
在一家大学附属医院医疗中心进行回顾性队列研究（2007 - 2014年）。纳入标准：足月单胎妊娠，诊断为第二产程延长且胎头位置在S + 1及以下。我们比较了剖宫产（CD）和真空辅助分娩（VAD）的围产期结局。
在62102例分娩中，3449例（5.6%）符合条件：356例（10.3%）接受剖宫产，3093例（89.7%）接受真空辅助分娩。剖宫产组5分钟阿氏评分<7的发生率更高，以及新生儿重症监护病房入院率、新生儿窒息和新生儿综合不良结局发生率也更高。在对不同混杂因素进行调整后，剖宫产与新生儿综合不良结局相关（校正后比值比1.57，95%可信区间1.21 - 2.05，p = 0.001），真空辅助分娩与头颅血肿相关（校正后比值比4.06，95%可信区间2.64 - 6.25，p < 0.001）。在其他创伤性结局方面，两组之间未发现其他差异。
我们的数据表明，在第二产程延长的分娩中，剖宫产的新生儿结局比真空辅助分娩差，在创伤性综合结局方面无明显主要差异。
