Liu Xiaohua, Landon Mark B, Cheng Weiwei, Chen Yan
Obstetrics Department, International Peace Maternity and Child Health Hospital, Medical College, Shanghai Jiao Tong University, Shanghai, China.
Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Ohio State University College of Medicine, Columbus, OH, USA.
J Matern Fetal Neonatal Med. 2020 Jan;33(2):307-313. doi: 10.1080/14767058.2018.1490720. Epub 2018 Oct 24.
To compare maternal and neonatal outcomes by forceps vaginal delivery versus cesarean delivery during the second stage of labor. We conducted a retrospective cohort study in a large tertiary maternity center in Shanghai, China through 2007-2016. A total of 7046 women carrying a singleton term nonanomalous fetus with vertex presentation who underwent forceps vaginal delivery, or cesarean delivery from a low station in the second stage of labor were included. Of the 7046 women, 6265 underwent forceps and 781 underwent second stage cesarean delivery. Forceps were associated with lower frequency of maternal infection (2.2 versus 4.7%), but higher incidence of mild postpartum hemorrhage (PPH) (4.3 versus 0.6%). When the procedures were performed for fetal indication, forceps were associated with lower frequency of the composite of perinatal mortality and/or hypoxic ischemic encephalopathy (HIE) (0.5 versus 1.9%; adjusted odds ratio (aOR), 0.24; 95% CI: 0.08-0.75), and also shorter decision to delivery interval (12.3 ± 3.5 versus 19.1 ± 5.0 min). The neonatal infection rate was higher in the forceps group (3.9 versus 2.0%). There were no differences in other neonatal outcomes including birth trauma. In women who had a need for intervention during the second stage with a station of +2 or below, forceps were associated with a lower frequency of maternal infection but a higher rate of PPH. Deliveries performed for nonreassuring status were accomplished faster by forceps and were associated with a lower frequency of the composite of perinatal mortality and HIE.
比较产钳阴道分娩与剖宫产在第二产程中的母婴结局。我们在中国上海一家大型三级妇产中心进行了一项回顾性队列研究，研究时间为2007年至2016年。纳入了7046例单胎足月非畸形胎儿、头先露且在第二产程低位进行产钳阴道分娩或剖宫产的妇女。在这7046例妇女中，6265例行产钳分娩，781例行第二产程剖宫产。产钳分娩与产妇感染发生率较低相关（2.2%对4.7%），但轻度产后出血（PPH）发生率较高（4.3%对0.6%）。当因胎儿指征进行手术时，产钳分娩与围产期死亡率和/或缺氧缺血性脑病（HIE）的综合发生率较低相关（0.5%对1.9%；调整优势比（aOR）为0.24；95%置信区间：0.08 - 0.75），且从决定分娩到分娩的间隔时间也较短（12.3±3.5分钟对19.1±5.0分钟）。产钳组新生儿感染率较高（3.9%对2.0%）。在包括产伤在内的其他新生儿结局方面没有差异。在第二产程中胎头位置在+2或更低且需要干预的妇女中，产钳分娩与产妇感染发生率较低但PPH发生率较高相关。因胎儿情况不稳定进行的分娩，产钳分娩完成得更快，且与围产期死亡率和HIE综合发生率较低相关。
