Metz Torri D, Gonzalez Christina, Allshouse Amanda A, Henry Erick, Esplin Sean
University of Colorado, School of Medicine, Aurora, Colorado.
Department of Obstetrics and Gynecology, Denver Health Medical Center, Denver, Colorado.
Am J Perinatol. 2017 Aug;34(10):974-981. doi: 10.1055/s-0037-1601441. Epub 2017 Apr 4.
We aimed to evaluate which patient-level factors influence mode of delivery among candidates for operative vaginal delivery. Cross-sectional study of candidates for operative vaginal delivery from 18 hospitals over 8 years. Probabilities of mode of delivery were estimated using hierarchical logistic modeling adjusting for clustering within physician and hospital. Total 3,771 (64%) women delivered with forceps, 1,474 (25%) vacuums, and 665 (11%) cesareans. Odds of forceps versus vacuum were higher with induction (OR = 2.16, 95% CI: 1.76-2.65), nulliparity (OR = 2.06, 95% CI: 1.59-2.66), epidural (OR = 2.05, 95% CI: 1.19-3.56), maternal indication (OR = 1.53, 95% CI 1.16-2.02), older maternal age (OR 1.18, 95% CI 1.06-1.31 per 5 years), and longer second stage (OR = 1.10, 95% CI: 1.01-1.20 per hour).Odds of cesarean versus operative vaginal delivery were higher with maternal indication (OR = 9.0, 95% CI: 7.23-11.20), a perinatologist (OR = 2.51, 95% CI: 1.09-5.78), longer second stage (OR = 1.79, 95% CI: 1.65-1.93 per hour), older gestational age (OR = 1.10, 95% CI: 1.01-1.20 per week), and longer labor (OR = 1.02, 95% CI: 1.01-1.04 per hour). Patient-level factors influence the decision to proceed with an operative vaginal delivery and the choice of instrument, thereby emphasizing the importance of maintaining availability of both forceps and vacuums.
我们旨在评估哪些患者层面的因素会影响接受阴道助产的产妇的分娩方式。对来自18家医院的8年间接受阴道助产的产妇进行横断面研究。使用分层逻辑模型估计分娩方式的概率，并对医生和医院内部的聚类情况进行了调整。总共有3771名（64%）女性通过产钳助产，1474名（25%）通过真空吸引助产，665名（11%）通过剖宫产。与真空吸引相比，产钳助产的几率在引产时更高（比值比[OR]=2.16，95%置信区间[CI]：1.76-2.65）、初产妇（OR=2.06，95%CI：1.59-2.66）、硬膜外麻醉（OR=2.05，95%CI：1.19-3.56）、产妇指征（OR=1.53，95%CI 1.16-2.02）、产妇年龄较大（每5岁OR 1.18，95%CI 1.06-1.31）以及第二产程较长（每小时OR=1.10，95%CI：1.01-1.20）。与阴道助产相比，剖宫产的几率在产妇指征（OR=9.0，95%CI：7.23-11.20）、围产医学专家参与（OR=2.51，95%CI：1.09-5.78）、第二产程较长（每小时OR=1.79，95%CI：1.65-1.93）、孕周较大（每周OR=1.10，95%CI：1.01-1.20）以及产程较长（每小时OR=1.02，95%CI：1.01-1.04）时更高。患者层面的因素会影响进行阴道助产的决策以及器械的选择，从而强调了同时备有产钳和真空吸引器的重要性。
