手术分娩与产科和分娩创伤的生态关联。
Ecological association between operative vaginal delivery and obstetric and birth trauma.
机构信息
School of Population and Public Health (Muraca, Lisonkova, Joseph); Department of Obstetrics & Gynaecology (Muraca, Lisonkova, Skoll, Cundiff, Sabr, Joseph), University of British Columbia; BC Children's and Women's Hospital and Health Centre (Muraca, Lisonkova, Skoll, Brant, Cundiff, Joseph); Department of Statistics (Brant), University of British Columbia, Vancouver, BC; Department of Obstetrics and Gynaecology (Sabr), King Saud University, King Khalid University Hospital, Riyadh, Saudi Arabia
School of Population and Public Health (Muraca, Lisonkova, Joseph); Department of Obstetrics & Gynaecology (Muraca, Lisonkova, Skoll, Cundiff, Sabr, Joseph), University of British Columbia; BC Children's and Women's Hospital and Health Centre (Muraca, Lisonkova, Skoll, Brant, Cundiff, Joseph); Department of Statistics (Brant), University of British Columbia, Vancouver, BC; Department of Obstetrics and Gynaecology (Sabr), King Saud University, King Khalid University Hospital, Riyadh, Saudi Arabia.
出版信息
CMAJ. 2018 Jun 18;190(24):E734-E741. doi: 10.1503/cmaj.171076.
BACKGROUND
Increased use of operative vaginal delivery (use of forceps, vacuum or other device) has been recommended to address high rates of cesarean delivery. We sought to determine the association between rates of operative vaginal delivery and obstetric trauma and severe birth trauma.
METHODS
We carried out an ecological analysis of term, singleton deliveries in 4 Canadian provinces (2004-2014) using data from the Canadian Institute for Health Information. The primary exposure was mode of delivery. The primary outcomes were obstetric trauma and severe birth trauma.
RESULTS
Data on 1 938 913 deliveries were analyzed. The rate of obstetric trauma was 7.2% in nulliparous women, and 2.2% and 2.7% among parous women without and with a previous cesarean delivery, respectively, and rates of severe birth trauma were 2.1, 1.7 and 0.7 per 1000, respectively. Each 1% absolute increase in rates of operative vaginal delivery was associated with a higher frequency of obstetric trauma among nulliparous women (adjusted rate ratio [ARR] 1.06, 95% confidence interval [CI] 1.05-1.06), parous women without a previous cesarean delivery (ARR 1.10, 95% CI 1.08-1.13) and parous women with a previous cesarean delivery (ARR 1.11, 95% CI 1.07-1.16). Operative vaginal delivery was associated with more frequent severe birth trauma, but only in nulliparous women (ARR 1.05, 95% CI 1.03-1.07). In nulliparous women, sequential vacuum and forceps instrumentation was associated with the largest increase in obstetric trauma (ARR 1.44, 95% CI 1.35-1.55) and birth trauma (ARR 1.53, 95% CI 1.03-2.27).
INTERPRETATION
Increases in population rates of operative vaginal delivery are associated with higher population rates of obstetric trauma, and in nulliparous women with severe birth trauma.
背景
为了降低剖宫产率，增加产道手术分娩（使用产钳、吸引器或其他器械）的使用已被推荐。我们旨在确定产道手术分娩率与产科损伤和严重分娩损伤之间的关系。
方法
我们对加拿大 4 个省（2004-2014 年）的足月、单胎分娩进行了生态分析，使用的是加拿大健康信息研究所的数据。主要暴露因素为分娩方式。主要结局为产科损伤和严重分娩损伤。
结果
共分析了 1938913 例分娩数据。初产妇的产科损伤率为 7.2%，无剖宫产史和有剖宫产史的经产妇分别为 2.2%和 2.7%，严重分娩损伤的发生率分别为每 1000 例 2.1、1.7 和 0.7 例。产道手术分娩率每增加 1%，初产妇的产科损伤频率就会增加（调整后的比值比[ARR]1.06，95%置信区间[CI]1.05-1.06），无剖宫产史的经产妇（ARR 1.10，95%CI 1.08-1.13）和有剖宫产史的经产妇（ARR 1.11，95%CI 1.07-1.16）也是如此。产道手术分娩与严重分娩损伤的发生频率更高相关，但仅在初产妇中如此（ARR 1.05，95%CI 1.03-1.07）。在初产妇中，连续使用真空吸引器和产钳与产科损伤（ARR 1.44，95%CI 1.35-1.55）和分娩损伤（ARR 1.53，95%CI 1.03-2.27）的发生率增加幅度最大。
解释
产道手术分娩率的增加与产科损伤率的增加相关，与初产妇的严重分娩损伤率增加相关。
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