Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY, USA.
Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
BJOG. 2017 Aug;124(9):1365-1372. doi: 10.1111/1471-0528.14553. Epub 2017 Feb 25.
The objectives of this study were to determine temporal trends in forceps and vacuum delivery and factors associated with operative vaginal delivery.
Retrospective cohort.
Population-based study of US birth records.
US births from 2005 to 2013.
This study evaluated forceps and vacuum extraction during vaginal delivery in live-born, non-anomalous singleton gestations from ≥ 36 to < 42 weeks of gestation. The primary outcomes were vacuum, forceps and overall operative delivery. Obstetric, medical and demographic characteristics associated with operative vaginal delivery were analysed. Multivariable logistic regression models were developed to determine factors associated with forceps/vacuum use.
A total of 22 598 971 vaginal deliveries between 2005 and 2013 were included in the analysis. In all, 1 083 318 (4.8%) were vacuum-assisted and 237 792 (1.1%) were by forceps. Both vacuum and forceps deliveries decreased over the study period; vacuum deliveries decreased from 5.8% in 2005 to 4.1% in 2013, and forceps deliveries decreased from 1.4% to 0.9% during the same period. The adjusted odds ratio for forceps delivery was 0.70 (95% CI 0.69-0.72) in 2013 with 2005 as a reference. For vacuum delivery the odds ratio was 0.68 (95% CI 0.67-0.69) comparing the same years.
Forceps and vacuum deliveries decreased during the study period. Low rates of operative delivery pose a challenge for resident education and may limit the degree to which women have access to alternatives to caesarean delivery. Initiatives that allow future generations of obstetricians to develop expertise in performing operative deliveries in the setting of decreased volume are an urgent resident education priority.
Forceps and vacuum delivery decreased significantly in the USA from 2005 to 2013.
本研究旨在确定产钳和真空分娩的时间趋势以及与阴道分娩相关的因素。
回顾性队列研究。
基于人群的美国出生记录研究。
2005 年至 2013 年期间足月至＜42 周妊娠的活产、非异常单胎妊娠。
本研究评估了阴道分娩中产钳和真空吸引的应用，纳入了≥36 周至＜42 周妊娠、足月、非异常的单胎妊娠。主要结局是真空、产钳和总体手术分娩。分析与阴道分娩相关的产科、医学和人口统计学特征。采用多变量逻辑回归模型确定与产钳/真空使用相关的因素。
本研究共纳入 2005 年至 2013 年期间的 22 598 971 例阴道分娩，其中 1083318 例（4.8%）为真空辅助分娩，237792 例（1.1%）为产钳分娩。研究期间，真空和产钳分娩均呈下降趋势；真空分娩从 2005 年的 5.8%下降到 2013 年的 4.1%，同期产钳分娩从 1.4%下降到 0.9%。以 2005 年为参照，2013 年产钳分娩的调整后比值比为 0.70（95%CI 0.69-0.72）。比较同年数据，真空分娩的比值比为 0.68（95%CI 0.67-0.69）。
研究期间，产钳和真空分娩的比例下降。低手术分娩率给住院医生教育带来了挑战，可能限制了女性获得剖宫产替代方案的程度。允许未来几代产科医生在手术量减少的情况下发展手术分娩专业技能的计划是住院医生教育的当务之急。
2005 年至 2013 年期间，美国产钳和真空分娩的比例显著下降。
