足月单胎经阴道手术助产与剖宫产的围产儿和产妇发病率与死亡率。
Perinatal and maternal morbidity and mortality among term singletons following midcavity operative vaginal delivery versus caesarean delivery.
机构信息
School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver, BC, Canada.
出版信息
BJOG. 2018 May;125(6):693-702. doi: 10.1111/1471-0528.14820. Epub 2017 Aug 21.
OBJECTIVE
To quantify severe perinatal and maternal morbidity/mortality associated with midcavity operative vaginal delivery compared with caesarean delivery.
DESIGN
Population-based, retrospective cohort study.
SETTING
British Columbia, Canada.
POPULATION
Term, singleton deliveries (2004-2014) by attempted midcavity operative vaginal delivery or caesarean delivery in the second stage of labour, stratified by indication for operative delivery (n = 10 901 deliveries; 5057 indicated for dystocia, 5844 for fetal distress).
METHODS
Multinomial propensity scores and mulitvariable log-binomial regression models were used to estimate adjusted rate ratios (ARR) and 95% confidence intervals (95% CI).
MAIN OUTCOME MEASURES
Composite severe perinatal morbidity/mortality (e.g. convulsions, severe birth trauma and perinatal death) and severe maternal morbidity (e.g. severe postpartum haemorrhage, shock, sepsis and cardiac complications).
RESULTS
Among deliveries with dystocia, attempted midcavity operative vaginal delivery was associated with higher rates of severe perinatal morbidity/mortality compared with caesarean delivery (forceps ARR 2.11, 95% CI 1.46-3.07; vacuum ARR 2.71, 95% CI 1.49-3.15; sequential ARR 4.68, 95% CI 3.33-6.58). Rates of severe maternal morbidity/mortality were also higher following midcavity operative vaginal delivery (forceps ARR 1.57, 95% CI 1.05-2.36; vacuum ARR 2.29, 95% CI 1.57-3.36). Among deliveries with fetal distress, there were significant increases in severe perinatal morbidity/mortality following attempted midcavity vacuum (ARR 1.28, 95% CI 1.04-1.61) and in severe maternal morbidity following attempted midcavity forceps delivery (ARR 2.34, 95% CI 1.54-3.56).
CONCLUSION
Attempted midcavity operative vaginal delivery is associated with higher rates of severe perinatal morbidity/mortality and severe maternal morbidity, though these effects differ by indication and instrument.
TWEETABLE ABSTRACT
Perinatal and maternal morbidity is increased following midcavity operative vaginal delivery.
目的
量化与剖宫产相比，中骨盆手术性阴道分娩与严重围产儿和产妇发病率/死亡率的关系。
设计
基于人群的回顾性队列研究。
地点
加拿大不列颠哥伦比亚省。
人群
2004 年至 2014 年间尝试中骨盆手术性阴道分娩或剖宫产分娩的足月、单胎分娩（根据手术分娩的指征分层，n=10901 例分娩；5057 例因难产，5844 例因胎儿窘迫而进行手术）。
方法
采用多项倾向得分和多变量对数二项式回归模型估计调整后的比值比（ARR）和 95%置信区间（95%CI）。
主要结局指标
复合严重围产儿发病率/死亡率（如惊厥、严重分娩创伤和围产儿死亡）和严重产妇发病率（如严重产后出血、休克、败血症和心脏并发症）。
结果
在因难产而行的分娩中，与剖宫产相比，尝试中骨盆手术性阴道分娩与更高的严重围产儿发病率/死亡率相关（产钳 ARR 2.11，95%CI 1.46-3.07；吸引器 ARR 2.71，95%CI 1.49-3.15；序贯 ARR 4.68，95%CI 3.33-6.58）。中骨盆手术性阴道分娩后的严重产妇发病率/死亡率也更高（产钳 ARR 1.57，95%CI 1.05-2.36；吸引器 ARR 2.29，95%CI 1.57-3.36）。在因胎儿窘迫而行的分娩中，尝试中骨盆真空吸引器后严重围产儿发病率/死亡率显著增加（ARR 1.28，95%CI 1.04-1.61），尝试中骨盆产钳分娩后严重产妇发病率增加（ARR 2.34，95%CI 1.54-3.56）。
结论
尝试中骨盆手术性阴道分娩与严重围产儿发病率/死亡率和严重产妇发病率的增加有关，尽管这些影响因指征和器械而异。
推特摘要
中骨盆手术性阴道分娩后围产儿和产妇发病率增加。
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