Seijmonsbergen-Schermers Anna, van den Akker Thomas, Beeckman Katrien, Bogaerts Annick, Barros Monalisa, Janssen Patricia, Binfa Lorena, Rydahl Eva, Frith Lucy, Gross Mechthild M, Hálfdánsdóttir Berglind, Daly Deirdre, Calleja-Agius Jean, Gillen Patricia, Vika Nilsen Anne Britt, Declercq Eugene, de Jonge Ank
Department of Midwifery Science, AVAG, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands.
Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands.
BMJ Open. 2018 Jan 10;8(1):e017993. doi: 10.1136/bmjopen-2017-017993.
There are growing concerns about the increase in rates of commonly used childbirth interventions. When indicated, childbirth interventions are crucial for preventing maternal and perinatal morbidity and mortality, but their routine use in healthy women and children leads to avoidable maternal and neonatal harm. Establishing ideal rates of interventions can be challenging. This study aims to describe the range of variations in the use of commonly used childbirth interventions in high-income countries around the world, and in outcomes in nulliparous and multiparous women.
This multinational cross-sectional study will use data from births in 2013 with national population data or representative samples of the population of pregnant women in high-income countries. Data from women who gave birth to a single child from 37 weeks gestation onwards will be included and the results will be presented for nulliparous and multiparous women separately. Anonymised individual level data will be analysed. Primary outcomes are rates of commonly used childbirth interventions, including induction and/or augmentation of labour, intrapartum antibiotics, epidural and pharmacological pain relief, episiotomy in vaginal births, instrument-assisted birth (vacuum or forceps), caesarean section and use of oxytocin postpartum. Secondary outcomes are maternal and perinatal mortality, Apgar score below 7 at 5 min, postpartum haemorrhage and obstetric anal sphincter injury. Univariable and multivariable logistic regression analyses will be conducted to investigate variations among countries, adjusted for maternal age, body mass index, gestational weight gain, ethnic background, socioeconomic status and infant birth weight. The overall mean rates will be considered as a reference category, weighted for the size of the study population per country.
The Medical Ethics Review Committee of VU University Medical Center Amsterdam confirmed that an official approval of this study was not required. Results will be disseminated at national and international conferences and published in peer-reviewed journals.
人们越来越关注常用分娩干预措施使用率的上升。在有指征时，分娩干预对于预防孕产妇和围产期发病及死亡至关重要，但在健康妇女和儿童中常规使用这些干预措施会导致可避免的孕产妇和新生儿伤害。确定理想的干预率可能具有挑战性。本研究旨在描述世界各地高收入国家常用分娩干预措施的使用差异范围，以及初产妇和经产妇的结局差异。
这项跨国横断面研究将使用2013年出生数据以及高收入国家全国人口数据或孕妇代表性样本数据。纳入妊娠37周及以后单胎分娩妇女的数据，并将结果分别呈现给初产妇和经产妇。将对匿名的个体层面数据进行分析。主要结局是常用分娩干预措施的发生率，包括引产和/或加强宫缩、产时抗生素使用、硬膜外麻醉和药物镇痛、阴道分娩时会阴切开术、器械助产（真空吸引或产钳）、剖宫产以及产后缩宫素使用。次要结局是孕产妇和围产期死亡率、5分钟时阿氏评分低于7分、产后出血和产科肛门括约肌损伤。将进行单变量和多变量逻辑回归分析，以调查各国之间的差异，并对产妇年龄、体重指数、孕期体重增加、种族背景、社会经济地位和婴儿出生体重进行校正。总体平均发生率将被视为参考类别，并根据每个国家研究人群的规模进行加权。
阿姆斯特丹自由大学医学中心医学伦理审查委员会确认，本研究无需官方批准。研究结果将在国内和国际会议上公布，并发表在同行评审期刊上。
