Care Delivery Research, Allina Health Clinics, Minnesota Perinatal Physicians, and Mother Baby Clinical Service Line, Allina Health, Minneapolis, Health Partners Institute, Minneapolis, Tri-County Health Care, Wadena, Health Partners Medical Clinic, St. Paul, and Measurement and Analysis Health Catalyst, Minneapolis, Minnesota.
Obstet Gynecol. 2020 Oct;136(4):707-715. doi: 10.1097/AOG.0000000000003956.
To compare neonatal intensive care unit (NICU) or special care nursery admission for deliveries with water immersion compared with deliveries in the matched control group without water immersion. Secondary outcomes included adverse neonatal diagnoses, maternal infections, and perineal lacerations.
We conducted a retrospective study using electronic health record data (2014-2018) from two health systems (eight hospitals), with similar clinical eligibility, associated with low risks of intrapartum complications, and implementation policies for waterbirth. The water immersion group included women intending waterbirth. Water immersion was recorded prospectively during delivery. The comparison population were women who met the clinical eligibility criteria for waterbirth but did not experience water immersion during labor. Comparison cases were matched (1:1) using propensity scores. Outcomes were compared using Fischer's exact tests and logistic regression with stratification by stage of water immersion.
Of the 583 women with water immersion, 34.1% (199) experienced first-stage water immersion only, 65.9% (384) experienced second-stage immersion, of whom 12.0% (70) exited during second stage, and 53.9% (314) completed delivery in the water. Neonatal intensive care unit or special care nursery admissions were lower for second-stage water immersion deliveries than deliveries in the control group (odds ratio [OR] 0.3, 95% CI 0.2-0.7). Lacerations were lower in the second-stage immersion group (OR 0.5, 95% CI 0.4-0.7). Neonatal intensive care unit or special care nursery admissions and lacerations were not different between the first-stage immersion group and their matched comparisons. Cord avulsions occurred for 0.8% of second-stage water immersion deliveries compared with none in the control groups. Five-minute Apgar score (less than 7), maternal infections, and other adverse outcomes were not significantly different between either the first- or second-stage water immersion groups and their control group.
Hospital-based deliveries with second-stage water immersion had lower risk of NICU or special care nursery admission and perineal lacerations than matched deliveries in the control group without water immersion.
比较与未浸水分娩的匹配对照组相比，浸水分娩的新生儿重症监护病房（NICU）或特别护理病房入院率。次要结局包括新生儿不良诊断、产妇感染和会阴裂伤。
我们使用来自两个医疗系统（八家医院）的电子健康记录数据（2014-2018 年）进行了一项回顾性研究，这些数据具有相似的临床准入标准，与低风险的分娩期并发症相关，并实施了水中分娩政策。浸水组包括打算水中分娩的女性。在分娩过程中，浸水情况会被前瞻性记录。对照组为符合水中分娩临床准入标准但分娩过程中未浸水的女性。通过倾向评分匹配比较病例（1:1）。使用 Fischer 确切检验和逻辑回归（按浸水阶段分层）比较结局。
在 583 名浸水的女性中，34.1%（199 名）仅经历了第一阶段浸水，65.9%（384 名）经历了第二阶段浸水，其中 12.0%（70 名）在第二阶段退出，53.9%（314 名）在水中完成分娩。与对照组相比，第二阶段浸水分娩的新生儿重症监护病房或特别护理病房入院率较低（比值比[OR]0.3，95%置信区间 [CI]0.2-0.7）。第二阶段浸水组的裂伤发生率较低（OR0.5，95%CI0.4-0.7）。第一阶段浸水组与匹配对照组比较，新生儿重症监护病房或特别护理病房入院率和裂伤发生率无差异。第二阶段浸水分娩的脐带脱垂发生率为 0.8%，而对照组均未发生。第二阶段浸水组与对照组的 5 分钟 Apgar 评分（<7）、产妇感染和其他不良结局无显著差异。
与未浸水分娩的匹配对照组相比，第二阶段浸水分娩的医院分娩的新生儿重症监护病房或特别护理病房入院率和会阴裂伤风险较低。
