Obstetrics and Gynecology, New York University Langone Medical Center, New York, NY, USA.
Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA.
J Perinat Med. 2020 Oct 12;49(1):17-22. doi: 10.1515/jpm-2020-0343.
In 2014, the American College of Obstetrics and Gynecology published guidelines for diagnosing failed induction of labor (FIOL) and arrest of dilation (AOD) to prevent cesarean delivery (CD). The objectives of this study were to determine the rate of adherence to these guidelines and to compare the association of guideline adherence with physician CD rates and obstetric/neonatal outcomes.
Retrospective cohort review of singleton primary cesarean deliveries for FIOL and AOD at a single academic institution from 2014 to 2016. Univariate and multivariate analyses were used to compare adherence to the guidelines with physician CD rates and obstetric/neonatal outcomes.
Of the 591 cesarean deliveries in the study, 263 were for failed induction, 328 for AOD and 79% (468/591) were not adherent to the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine (ACOG/SMFM) guidelines. Of the failed inductions, 82% (215/263) and of the AODs 77% (253/328) were not adherent. There was no difference between adherent and non-adherent CDs with regard to maternal characteristics, or obstetric/neonatal outcomes. Duration of oxytocin use after rupture of membranes, dilation at time of CD, and birth weight were statistically higher in adherent CDs. On multivariate linear regression, physician CD rates were inversely correlated with adherence to ACOG/SMFM guidelines (p<0.0001), gestational age (p=0.007), and parity (p=0.003).
Our study shows that physician non-compliance with ACOG guidelines was high. Adherence to these guidelines was associated with lower physician CD rates, without an increase in obstetric or neonatal complications.
2014 年，美国妇产科医师学会（ACOG）发布了诊断引产失败（FIOL）和扩张停滞（AOD）的指南，以预防剖宫产（CD）。本研究的目的是确定这些指南的遵循率，并比较指南遵循与医生 CD 率和产科/新生儿结局的关系。
对单家学术机构 2014 年至 2016 年间因 FIOL 和 AOD 行单胎初次剖宫产的病例进行回顾性队列研究。采用单变量和多变量分析比较指南的遵循情况与医生 CD 率和产科/新生儿结局。
在研究的 591 例剖宫产中，263 例因引产失败，328 例因 AOD，79%（468/591）不符合 ACOG 和母胎医学学会（SMFM）的指南。在失败的引产中，82%（215/263）和 AOD 中 77%（253/328）不符合。在母亲特征或产科/新生儿结局方面，符合与不符合指南的 CD 之间没有差异。破膜后催产素使用时间、CD 时的扩张程度和出生体重在符合指南的 CD 中统计学上更高。在多元线性回归中，医生 CD 率与 ACOG/SMFM 指南的遵循呈负相关（p<0.0001）、与胎龄（p=0.007）和产次（p=0.003）呈负相关。
我们的研究表明，医生对 ACOG 指南的不遵守率很高。遵循这些指南与医生 CD 率降低相关，而不会增加产科或新生儿并发症。
