Port-Royal Maternity Unit, Department of Obstetrics, Cochin Broca Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris, and INSERM UMR 1153, Obstetrical, Perinatal and Paediatric Epidemiology Research Team (Epopé), Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), DHU Risks in Pregnancy, Paris Descartes University, Paris, France.
Obstet Gynecol. 2020 Feb;135(2):436-443. doi: 10.1097/AOG.0000000000003618.
To evaluate whether the decrease in the frequency of oxytocin administration and artificial rupture of membranes observed between the 2010 and 2016 French Perinatal Surveys was associated with a change in the frequency of cesarean delivery or cesarean delivery indications among women who entered labor spontaneously.
This cross-sectional study included women who participated in the 2010 and 2016 French National surveys who had singleton pregnancies and who gave birth at at least 37 weeks of gestation after spontaneous labor to a liveborn neonate in cephalic presentation. To test whether the observed decrease of oxytocin administration and artificial rupture of membranes between the two study years was explained by the women's individual characteristics and maternity units' organizational characteristics change, multivariable analyses were performed. The same strategy was applied for the change in intrapartum cesarean delivery rates between the 2 years. These analyses were repeated in nulliparous, low obstetric risk women, multiparous low obstetric risk women, and women with a previous cesarean delivery. The cesarean delivery indications were compared in 2010 and 2016.
Oxytocin administration decreased significantly from 58.3% in 2010 to 45.2% in 2016 (adjusted odds ratio [aOR] 0.51; 95% CI 0.47-0.55), as did artificial rupture of membranes, from 52.4% to 42.6% (aOR 0.66; 95% CI 0.62-0.71). The intrapartum cesarean delivery rate remained stable-6.9% compared with 6.6% (aOR 0.93; 95% CI 0.82-1.06). The same patterns were observed in low risk groups and women with a previous cesarean delivery. The cesarean delivery indications were similar in both years.
The significant decrease in oxytocin administration and artificial rupture of membranes in 2016 compared with 2010 was not accompanied by an increase in the intrapartum cesarean delivery rate for women in France who entered labor spontaneously. These results support the recent international guidelines.
评估 2010 年至 2016 年法国围产儿调查中催产素使用频率和人工破膜频率的下降是否与自发性临产妇女剖宫产率或剖宫产指征的变化有关。
本横断面研究纳入了参加 2010 年和 2016 年法国全国调查的单胎妊娠、至少 37 周自发性临产、头位分娩的活产新生儿的妇女。为了检验这两年间观察到的催产素使用和人工破膜减少是否可以用妇女个体特征和产科单位组织特征的变化来解释，我们进行了多变量分析。同样的策略也应用于这两年间产时剖宫产率的变化。在初产妇、低产科风险妇女、多产妇、低产科风险妇女和有剖宫产史的妇女中重复了这些分析。比较了 2010 年和 2016 年的剖宫产指征。
催产素使用率从 2010 年的 58.3%显著下降至 2016 年的 45.2%（调整后的优势比[aOR]0.51；95%置信区间[CI]0.47-0.55），人工破膜率从 52.4%降至 42.6%（aOR 0.66；95%CI 0.62-0.71）。产时剖宫产率保持稳定-6.9%与 6.6%（aOR 0.93；95%CI 0.82-1.06）。低危组和有剖宫产史的妇女也呈现相同的模式。两年间剖宫产指征相似。
与 2010 年相比，2016 年催产素使用和人工破膜显著减少，但法国自发性临产妇女的产时剖宫产率并未增加。这些结果支持最近的国际指南。
