Amin Pina, Zaher Summia, Penketh Richard, Cherian Sobha, Collis Rachel E, Sanders Julia, Bhal Kiron
a Department of Obstetrics and Gynaecology , Child Health and Women's Health Clinical Board, University Hospital of Wales , Cardiff , UK.
b Department of Child Health, Child Health and Women's Health Clinical Board , University Hospital of Wales , Cardiff , UK.
J Matern Fetal Neonatal Med. 2019 Aug;32(15):2475-2480. doi: 10.1080/14767058.2018.1439006. Epub 2018 Feb 19.
To evaluate caesarean section (CS) rates and moderate to severe hypoxaemic ischaemic encephalopathy (HIE) rates with other core intra-partum outcomes following reconfiguration of maternity services in Cardiff, South Wales, UK.
Cohort study of births from 2006 to 2015.
A University tertiary referral centre for foetal and maternal medicine with 6000 births/year, University Hospital of Wales, United Kingdom.
Data relating to births from 1 January 2006 to 31 December 2015 were extracted from the computerized maternity database on a yearly basis. Case notes of all mothers and babies for the same duration were hand searched for documentation of HIE. HIE data was also collected prospectively by neonatologist (SC) and obstetrician (PA).
Incidence of caesarean section births, babies with moderate to severe HIE, instrumental vaginal births, obstetric anal sphincter injuries (OASIS) associated with instrumental delivery, and major post-partum haemorrhage (MPPH) of 2500 mL or more.
During this 10-year period, a downward trend in emergency CS rate was seen from 15.6% in 2006 to 10.5% in 2015, reducing total CS rate from 25.5% in 2006 to 21.2% in 2015. A downward trend in the incidence of moderate and severe HIE was seen over the same period. There was an increase in operative vaginal births (OVB) from 12.8% to 15%. The rate of spontaneous vaginal births (SVB) remained stable. The incidence of OASIS remained constant and MPPH rate has fallen.
Following amalgamation of two medium sized obstetric units and the opening of a Midwifery Led Unit (MLU), core intrapartum outcomes have improved. Contributing factors are the introduction of regular multidisciplinary training with enhanced team working, compulsory education for obstetricians and midwives on cardiotocograph (CTG) interpretation, increased consultant presence on delivery suite, robust risk management systems and broad multidisciplinary agreement on clinical guidelines promoting vaginal birth.
评估在英国南威尔士卡迪夫市孕产妇服务重新配置后，剖宫产（CS）率、中度至重度缺氧缺血性脑病（HIE）率以及其他核心产时结局。
对2006年至2015年出生情况的队列研究。
英国威尔士大学医院，一家每年有6000例分娩的胎儿与母亲医学大学三级转诊中心。
每年从计算机化的孕产妇数据库中提取2006年1月1日至2015年12月31日期间的分娩数据。对同一时期所有母亲和婴儿的病历进行人工查阅，以获取HIE的记录。HIE数据也由新生儿科医生（SC）和产科医生（PA）前瞻性收集。
剖宫产分娩的发生率、患有中度至重度HIE的婴儿、器械助产分娩、与器械助产相关的产科肛门括约肌损伤（OASIS）以及2500毫升及以上的严重产后出血（MPPH）。
在这10年期间，急诊剖宫产率呈下降趋势，从2006年的15.6%降至2015年的10.5%，总剖宫产率从2006年的25.5%降至2015年的21.2%。同期，中度和重度HIE的发生率呈下降趋势。手术助产分娩（OVB）从12.8%增加到15%。自然阴道分娩（SVB）率保持稳定。OASIS的发生率保持不变，MPPH率有所下降。
在合并两个中型产科单位并开设助产主导单元（MLU）后，核心产时结局得到改善。促成因素包括引入定期多学科培训并加强团队协作、对产科医生和助产士进行胎心监护仪（CTG）解读的义务教育、分娩套房中会诊医生人数增加、强大的风险管理系统以及在促进阴道分娩的临床指南方面达成广泛的多学科共识。
