Muraca Giulia M, Sabr Yasser, Lisonkova Sarka, Skoll Amanda, Brant Rollin, Cundiff Geoffrey W, Joseph K S
School of Population and Public Health, University of British Columbia, Vancouver, BC; Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC; BC Children's Hospital Research Institute, Vancouver, BC.
BC Children's Hospital Research Institute, Vancouver, BC; Department of Obstetrics and Gynaecology, King Saud University, King Khalid University Hospital, Riyadh, Saudi Arabia.
J Obstet Gynaecol Can. 2019 Mar;41(3):327-337. doi: 10.1016/j.jogc.2018.06.018. Epub 2018 Oct 23.
This study sought to quantify perinatal and maternal morbidity and mortality associated with forceps and vacuum delivery compared with Caesarean delivery in the second stage of labour and to estimate whether these associations differed by pelvic station.
The investigators conducted a population-based, retrospective cohort study of term singleton deliveries by operative delivery with prolonged second stage of labour in Canada (2003-2013) using national hospitalization data. The primary study outcomes were severe perinatal morbidity and mortality (i.e., seizures, assisted ventilation, severe birth trauma, and perinatal death) and severe maternal morbidity and mortality (i.e., severe postpartum hemorrhage, cardiac complication, and maternal death). Logistic regression was used to estimate adjusted odds ratios (aOR) and 95% confidence intervals (CI) after stratifying by indication (dystocia or fetal distress). The Breslow-Day chi-square test for heterogeneity in ORs was used to test effect modification by pelvic station (outlet, low, or midpelvic).
There were 61 106 deliveries included in the study. Among women with dystocia, forceps and vacuum deliveries were associated with higher rates of perinatal morbidity and mortality compared with Caesarean delivery (forceps: aOR 1.56; 95% CI 1.13-2.17; vacuum: aOR 1.44; 95% CI 1.06-1.97). Vacuum delivery was associated with lower rates of maternal morbidity and mortality compared with Caesarean delivery (dystocia: aOR 0.64; 95% CI 0.51-0.81; fetal distress: aOR 0.43; 95% CI 0.32-0.57). Pelvic station did not significantly modify the associations between forceps or vacuum and perinatal or maternal morbidity and mortality.
Forceps and vacuum delivery is associated with increased rates of severe perinatal morbidity and mortality compared with Caesarean delivery among women with dystocia, whereas vacuum delivery is associated with decreased rates of severe maternal morbidity and mortality.
本研究旨在量化与剖宫产相比，产钳和真空吸引助产在第二产程中导致的围产期及孕产妇发病率和死亡率，并评估这些关联是否因骨盆平面而异。
研究人员利用加拿大全国住院数据，开展了一项基于人群的回顾性队列研究，纳入2003年至2013年因第二产程延长而行手术助产的足月单胎分娩病例。主要研究结局为严重围产期发病率和死亡率（即惊厥、辅助通气、严重产伤和围产期死亡）以及严重孕产妇发病率和死亡率（即严重产后出血、心脏并发症和孕产妇死亡）。在按指征（难产或胎儿窘迫）分层后，采用逻辑回归估计校正比值比（aOR）和95%置信区间（CI）。使用Breslow-Day卡方检验对OR的异质性进行检验，以评估骨盆平面（出口、低位或中骨盆）对效应的修正作用。
本研究共纳入61106例分娩病例。在难产妇女中，与剖宫产相比，产钳和真空吸引助产导致的围产期发病率和死亡率更高（产钳：aOR 1.56；95% CI 1.13 - 2.17；真空吸引：aOR 1.44；95% CI 1.06 - 1.97）。与剖宫产相比，真空吸引助产导致的孕产妇发病率和死亡率更低（难产：aOR 0.64；95% CI 0.51 - 0.8l；胎儿窘迫：aOR 0.43；95% CI 0.32 - 0.57）。骨盆平面并未显著改变产钳或真空吸引助产与围产期及孕产妇发病率和死亡率之间的关联。
在难产妇女中，与剖宫产相比，产钳和真空吸引助产导致严重围产期发病率和死亡率升高，而真空吸引助产导致严重孕产妇发病率和死亡率降低。
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