Hsieh David C, Smithers Lisa G, Black Mairead, Lynch John W, Dekker Gustaff, Wilkinson Chris, Stark Michael J, Mol Ben W
Department of Obstetrics and Gynaecology, Lyell McEwin Hospital, Adelaide, South Australia, Australia.
School of Public Health, University of Adelaide, Adelaide, South Australia, Australia.
Aust N Z J Obstet Gynaecol. 2019 Oct;59(5):677-683. doi: 10.1111/ajo.12952. Epub 2019 Feb 7.
Vaginal instrumental delivery is a common obstetrical intervention, but its effect on children's later development is not well known.
To determine if vaginal instrumental delivery is associated with adverse neurodevelopment as measured by school achievement.
We performed a whole-of-population study involving linkage of routinely collected perinatal data with school assessments among children born in South Australia from 1999 to 2008. Participants were singleton children born by forceps (n = 5494), ventouse (n = 6988), or normal delivery (n = 80 803). School achievement was measured through performance on the National Assessment Program in Literacy and Numeracy (NAPLAN), at around eight years of age. This assessment involved five domains and scores were categorised according to performing at or above National Minimum Standards (NMS). Effects of instrumental versus normal vaginal delivery were analysed via augmented inverse probability weighting (AIPW), taking into account a variety of maternal, perinatal and sociodemographic characteristics.
In unadjusted analyses, instrumental delivery was not associated with poor NAPLAN scores. AIPW analyses also suggested that instrumental delivery had minimal adverse effect on NAPLAN scores, with the largest difference being lower spelling scores among forceps-delivered children (-0.022 (95% CI -0.0053-0.009)) compared with spontaneous vaginal births. The findings were consistent among exploratory subgroup analyses involving births in the absence of prolonged labour, with APGAR ≥ 9, and among normotensive and non-diabetic mothers.
In singleton children born at term, instrumental delivery does not have an adverse effect on neurodevelopment as measured by NAPLAN performance at age eight.
阴道器械助产是一种常见的产科干预措施，但其对儿童后期发育的影响尚不明确。
通过学业成绩来确定阴道器械助产是否与不良神经发育有关。
我们进行了一项全人群研究，将1999年至2008年在南澳大利亚出生的儿童常规收集的围产期数据与学校评估数据相联系。参与者为通过产钳助产（n = 5494）、真空吸引助产（n = 6988）或顺产（n = 80803）出生的单胎儿童。在儿童大约8岁时，通过全国读写和算术能力评估计划（NAPLAN）的表现来衡量学业成绩。该评估涉及五个领域，分数根据达到或高于国家最低标准（NMS）进行分类。通过增强逆概率加权法（AIPW）分析器械助产与正常阴道分娩的效果，同时考虑各种母亲、围产期和社会人口学特征。
在未经调整的分析中，器械助产与NAPLAN成绩不佳无关。AIPW分析还表明，器械助产对NAPLAN成绩的不良影响最小，与自然阴道分娩相比，产钳助产儿童的拼写分数差异最大（-0.022（95%CI -0.0053 - 0.009））。在无产程延长、阿氏评分≥9的分娩以及血压正常和非糖尿病母亲的探索性亚组分析中，结果一致。
对于足月出生的单胎儿童，器械助产对8岁时通过NAPLAN表现衡量的神经发育没有不良影响。
