Karalis Elina, Tapper Anna-Maija, Gissler Mika, Ulander Veli-Matti
University of Helsinki, Helsinki University Hospital, Department of Obstetrics and Gynecology, Helsinki, Finland.
University of Helsinki, Helsinki University Hospital, Department of Obstetrics and Gynecology, Helsinki, Finland; University of Helsinki, Hyvinkää Hospital, Hyvinkää, Finland.
Eur J Obstet Gynecol Reprod Biol. 2018 Apr;223:30-34. doi: 10.1016/j.ejogrb.2018.02.007. Epub 2018 Feb 14.
Our aim was to demonstrate the influence of increased number of low-risk deliveries on obstetric and neonatal outcome.
The study hospital was Kätilöopisto Maternity Hospital in Helsinki. Simultaneously, we studied all three delivery units in the Helsinki region in the population-based analysis. The study population was singleton hospital deliveries occurring between 2011 and 2012, and 2014-2015. The study hospital included 11 237 and 15 637 births and the population-based group included 28 950 and 27 979 births. We compared outcome measures in different periods by calculating adjusted odds ratios (AOR). Main outcome measures were induced delivery, mode of delivery, third or fourth degree perineal tear, Apgar score at five minutes <7, umbilical artery pH <7.00, transfer to higher level of neonatal care, neonatal antibiotic treatment, respiratory support of the neonate, hospitalization of the neonate >7 days, and perinatal death.
In the study hospital, induction rate increased from 22.4% to 24.8% (AOR 1.06, 95% CI; 1.00-1.12) while in the population-based analysis the rate decreased from 22.2% to 21.5% (AOR 0.96, 95% CI; 0.92-1.00). Percentage of neonatal transfers, low Apgar scores, and severe perineal tears increased both in study hospital and in population-based group. Changes in operative delivery rate and other adverse perinatal outcomes were statistically insignificant.
Increasing the volume of a delivery unit does not compromise maternal or neonatal outcome. Specific characteristics of a delivery unit affect the volume outcome association.
我们的目的是证明低风险分娩数量增加对产科和新生儿结局的影响。
研究医院为赫尔辛基的凯特洛皮斯托妇产医院。同时，我们在基于人群的分析中对赫尔辛基地区的所有三个分娩单元进行了研究。研究人群为2011年至2012年以及2014年至2015年期间在医院进行的单胎分娩。研究医院的分娩数分别为11237例和15637例，基于人群的组分别为28950例和27979例。我们通过计算调整后的优势比（AOR）来比较不同时期的结局指标。主要结局指标包括引产、分娩方式、会阴三度或四度撕裂、5分钟时阿氏评分<7、脐动脉pH<7.00、转入更高水平的新生儿护理、新生儿抗生素治疗、新生儿呼吸支持、新生儿住院>7天以及围产期死亡。
在研究医院，引产率从22.4%升至24.8%（AOR 1.06，95%可信区间；1.00 - 1.12），而在基于人群的分析中，该率从22.2%降至21.5%（AOR 0.96，95%可信区间；0.92 - 1.00）。研究医院和基于人群的组中，新生儿转院率、低阿氏评分和严重会阴撕裂的百分比均有所增加。手术分娩率和其他不良围产期结局的变化无统计学意义。
增加分娩单元容量不会损害孕产妇或新生儿结局。分娩单元的特定特征会影响容量与结局的关联。
