Division of Maternal Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, Texas.
Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, Texas.
Am J Perinatol. 2019 Jul;36(9):911-917. doi: 10.1055/s-0038-1675154. Epub 2018 Nov 5.
To evaluate the degree of adherence to the new the American College of Obstetricians and Gynecologists/Society for Maternal-Fetal Medicine guidelines in labor arrest management.
A retrospective study of term, live, singleton deliveries with intrapartum primary cesarean delivery solely for failed induction of labor or labor arrest. Adherence was defined according to the 2014 criteria. We evaluated adherence and compared maternal and perinatal outcomes, delivery time frame, and billing provider. Multivariable Poisson regression models with robust error variance were used to calculate adjusted relative risk (aRR) and 95% confidence interval (CI).
Two-hundred six deliveries met the inclusion criteria; 73% were deemed not adherent to the guidelines. The majority of cases were under the care of nonacademic private practice OB/GYN physicians. The adherence rate was higher in the active phase of labor (45%) than in second stage (17%) and latent phase (14%). There were no differences in perinatal outcomes between the two groups. The adherence to guidelines was higher among academic OB/GYN physicians (aRR, 2.24, 95% CI, 1.49-3.36) and during the weekday-night shift (aRR, 1.81, 95% CI, 1.10-2.98).
Despite recent guidelines aimed to reduce the primary cesarean delivery rate, most cesarean deliveries performed for labor arrest disorders were not adherent to the guidelines.
评估在产程停滞管理中，新的美国妇产科医师学会/母胎医学学会指南的遵循程度。
这是一项回顾性研究，纳入了足月、活产、单胎分娩，并仅因引产失败或产程停滞而行剖宫产术。根据 2014 年的标准来定义是否遵循指南。我们评估了遵循情况，并比较了产妇和围产儿结局、分娩时间框架以及计费提供者。采用具有稳健误差方差的多变量泊松回归模型来计算调整后的相对风险（aRR）和 95%置信区间（CI）。
206 次分娩符合纳入标准；73%的病例被认为不符合指南。大多数病例是由非学术性私人执业妇产科医生管理的。在活跃期（45%）产程中，遵循指南的比例高于第二产程（17%）和潜伏期（14%）。两组的围产儿结局没有差异。学术性妇产科医生（aRR，2.24；95%CI，1.49-3.36）和在工作日夜间轮班（aRR，1.81；95%CI，1.10-2.98）时，遵循指南的比例更高。
尽管最近的指南旨在降低因产程停滞而行剖宫产术的比率，但大多数因产程停滞障碍而行的剖宫产术并未遵循指南。
