西澳大利亚州（2015 - 2016年）计划在分娩时采用水中分娩的女性的产科和新生儿结局：临床结局的回顾性审计

Obstetric and neonatal outcomes for women intending to use immersion in water for labour and birth in Western Australia (2015-2016): A retrospective audit of clinical outcomes.

作者信息

Lewis Lucy, Hauck Yvonne L, Butt Janice, Hornbuckle Janet

机构信息

School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia.

Department of Nursing and Midwifery Education and Research, King Edward Memorial Hospital, Subiaco, Western Australia, Australia.

出版信息

Aust N Z J Obstet Gynaecol. 2018 Oct;58(5):539-547. doi: 10.1111/ajo.12758. Epub 2018 Jan 17.

DOI:10.1111/ajo.12758

PMID:29344940

Abstract

BACKGROUND

Research supports water immersion for labour if women are healthy, with no obstetric or medical risk factors.

AIMS

To evaluate the obstetric and neonatal outcomes of women intending to use immersion in water for labour or birth.

METHODS

Retrospective audit of clinical outcomes for women intending to labour or birth in water conducted between July 2015 and June 2016, at a tertiary maternity hospital in Western Australia. Obstetric and neonatal data were collected from medical records. Multivariable logistic regression was utilised to investigate women who laboured in water stratified by those who birthed in water.

RESULTS

A total of 502 women intended to labour or birth in water; 199 (40%) did not and 303 (60%) did. The majority of women using water immersion (179 of 303; 59%) birthed in water. Multiparous women were more likely than primparous to birth in water (73% vs 46%; P < 0.001). Women who birthed in water were at increased odds of: a first stage labour ≤240 min (odds ratio (OR) 2.56, 95% CI 1.34-4.87, P = 0.004); a second stage ≤60 min (OR 3.53, 95% CI 1.82-6.84, P < 0.000); a third stage labour of 11-30 min (OR 2.15, 95% CI 1.23-3.78, P = 0.008); and having an intact perineum (OR 3.10, 95% CI 1.70-5.64, P < 0.000).

CONCLUSION

Not all women who set out to labour and birth in water achieve their aim. There is a need for high-quality collaborative research into this option of labour and birth, so women can make an informed choice around this birth option.

摘要

背景

研究表明，如果女性身体健康，没有产科或医学风险因素，分娩时可采用水浸法。

目的

评估打算在分娩或生产时采用水浸法的女性的产科和新生儿结局。

方法

对2015年7月至2016年6月期间在西澳大利亚一家三级妇产医院打算在水中分娩或生产的女性的临床结局进行回顾性审计。从病历中收集产科和新生儿数据。采用多变量逻辑回归分析对在水中分娩的女性与在水中待产的女性进行分层研究。

结果

共有502名女性打算在水中分娩或生产；199名（40%）未采用，303名（60%）采用了。大多数采用水浸法的女性（303名中的179名；59%）在水中分娩。经产妇比初产妇更有可能在水中分娩（73%对46%；P<0.001）。在水中分娩的女性出现以下情况的几率增加：第一产程≤240分钟（优势比（OR）2.56，95%置信区间1.34 - 4.87，P = 0.004）；第二产程≤60分钟（OR 3.53，95%置信区间1.82 - 6.84，P < 0.000）；第三产程11 - 30分钟（OR 2.15，95%置信区间1.23 - 3.78，P = 0.008）；以及会阴完整（OR 3.10，95%置信区间1.70 - 5.64，P < 0.000）。