Chevreau J, Foulon A, Abou Arab O, Luisin M, Parent C, Sergent F, Gondry J
Department of Obstetrics and Gynecology, University Hospital of Amiens, CHU Amiens Sud, Amiens cedex 1, France; Inserm UMR 1105, GRAMFC (Groupe de Recherches sur l'Analyse Multimodale de la Fonction Cérébrale), Picardie Jules Verne University, CHU Amiens, avenue Laennec, 80054 Amiens, France.
Department of Obstetrics and Gynecology, University Hospital of Amiens, CHU Amiens Sud, Amiens cedex 1, France.
J Gynecol Obstet Hum Reprod. 2018 May;47(5):191-196. doi: 10.1016/j.jogoh.2018.03.001. Epub 2018 Mar 3.
Breech presentation and twin pregnancy are regarded as stressful situations for medical staff. This stress is often associated with an increased likelihood of intervention during labor - especially when the on-shift obstetrician lacks experience.
We performed a 2-year prospective, observational study of cesarean section (CSDs) and assisted vaginal (AVDs) deliveries in a tertiary maternity unit for attempted vaginal deliveries of breech presentations and twin pregnancies. The obstetric management decisions taken by a group of four registrars were compared with those taken by a group of 11 experienced obstetricians. Changes over time in practice were also monitored.
Registrars managed 66 and 52 breech presentations and twin pregnancies respectively (30 and 27 in the experienced group). Groups' neonatal outcomes were similar. There were no intergroup differences in proportions of CSDs for either breech presentations (25 [37.5%] vs. 15 [50%] in the registrar and experienced groups, respectively; P=0.26) or twin pregnancies (11 [21.1%] vs. 6 [22.2%], respectively; P=0.91) or in proportion of AVDs for twin pregnancies (41 [78.8%] vs. 21 [77.8%], respectively; P=0.91). Proportions of CSDs for breech presentation and AVDs for twin pregnancies did not change over time in either group. However, proportion of CSDs for twin pregnancies increased over time in the registrar group (P=0.004).
Well-trained registrars appeared to have acquired the skills required to safely manage an obstetric ward; this pleads to maintain clinical practice during residency to preserve low CSD and AVD rates.
臀位分娩和双胎妊娠被视为医护人员面临的压力情况。这种压力通常与分娩期间干预可能性增加有关——尤其是当值班产科医生缺乏经验时。
我们在一家三级产科单位对臀位分娩和双胎妊娠尝试经阴道分娩的剖宫产（CSD）和阴道助产（AVD）进行了为期2年的前瞻性观察研究。将一组4名住院医师做出的产科管理决策与一组11名经验丰富的产科医生做出的决策进行比较。还监测了实践随时间的变化。
住院医师分别管理了66例臀位分娩和52例双胎妊娠（经验丰富组分别为30例和27例）。两组的新生儿结局相似。无论是臀位分娩（住院医师组25例[37.5%]，经验丰富组15例[50%]；P = 0.26）还是双胎妊娠（分别为11例[21.1%]和6例[22.2%]；P = 0.91）的剖宫产比例，或双胎妊娠的阴道助产比例（分别为41例[78.8%]和21例[77.8%]；P = 0.91），两组之间均无差异。两组中臀位分娩的剖宫产比例和双胎妊娠的阴道助产比例均未随时间变化。然而，住院医师组中双胎妊娠的剖宫产比例随时间增加（P = 0.004）。
训练有素的住院医师似乎已经掌握了安全管理产科病房所需的技能；这表明在住院医师培训期间应保持临床实践，以维持较低的剖宫产和阴道助产率。
