法国产程干预滥用的频率及其决定因素：一项基于人群的研究。
Frequency and determinants of misuse of augmentation of labor in France: A population-based study.
机构信息
INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics, FHU PREMA, Université de Paris, Paris, France.
Maternité Port Royal, AP-HP, Hôpital Cochin, FHU PREMA, Paris, France.
出版信息
PLoS One. 2021 Feb 9;16(2):e0246729. doi: 10.1371/journal.pone.0246729. eCollection 2021.
INTRODUCTION
While use of augmentation of labor (AL) is appropriate for labor dystocia, it is frequently used inadequately and unnecessarily. The objective was to assess at a national level, the frequency and determinants of misuse of augmentation of labor (AL).
MATERIAL AND METHODS
Women of the French perinatal survey of 2016 with a singleton cephalic fetus, delivering at term after a spontaneous labor were included. "Misuse of AL" was defined by artificial rupture of the membranes (ROM) and/or oxytocin within one hour of admission and/or duration between ROM and oxytocin of less than one hour. Women, labor and maternity unit's characteristics were compared between the "misuse of AL" and "no misuse of AL" groups by bivariate analysis. To identify the determinants of misuse of AL, a multivariable multilevel logistic regression was performed taking into account the data's hierarchical structure (first level: women, second level: maternity units).
RESULTS
Among the 7196 women included, 1524 (21.2%) had a misuse of AL. The determinants of misuse of AL were middle school educational level (reference high school), aOR = 1.21; 95%CI[1.01-1.45], gestational age at delivery ≥41weeks (reference 39-40 weeks), aOR = 1.19; 95%CI[1.00-1.42], cervical dilation ≥6cm at admission (reference <3cm), aOR = 1.39; 95%CI[1.10-1.76], epidural analgesia aOR = 1.63; 95%CI[1.35-1.96], delivery in a private hospital (reference public teaching hospital), aOR = 2.25; 95%CI[1.57-3.23]; and maternity units with <1000 deliveries/year and 1000-1999 deliveries/year (reference ≥3000 deliveries/year), respectively aOR = 1.52; 95%CI[1.11-2.08] and aOR = 1.42; 95%CI[1.05-1.92]. Less than 3% of the variance was explained by women characteristics, and 24.17% by the maternity units' characteristics.
CONCLUSIONS
In France, one spontaneous laboring woman among five is subject to misuse of AL. The misuse is mostly explained by maternity unit's characteristics. The determinants identified in this study can be used to implement targeted actions in small and private maternity units.
介绍
虽然引产（AL）的使用适用于分娩困难，但它经常被不恰当地和不必要地使用。本研究的目的是在全国范围内评估引产（AL）的误用频率和决定因素。
材料和方法
纳入了 2016 年法国围产期调查中，在自然分娩后，足月分娩且单胎头位的妇女。“AL 误用”的定义为入院后 1 小时内人工破膜（ROM）和/或催产素，或 ROM 与催产素之间的时间少于 1 小时。通过单变量分析比较“AL 误用”和“无 AL 误用”组的妇女、分娩和产科单位的特征。为了确定 AL 误用的决定因素，我们进行了多变量多层次逻辑回归分析，考虑了数据的层次结构（第一层：妇女，第二层：产科单位）。
结果
在纳入的 7196 名妇女中，有 1524 名（21.2%）存在 AL 误用。AL 误用的决定因素为中学教育水平（参考高中），比值比（OR）=1.21；95%可信区间（CI）[1.01-1.45]，分娩时的胎龄≥41 周（参考 39-40 周），OR=1.19；95%CI[1.00-1.42]，入院时宫颈扩张≥6cm（参考<3cm），OR=1.39；95%CI[1.10-1.76]，硬膜外镇痛，OR=1.63；95%CI[1.35-1.96]，在私立医院分娩（参考公立教学医院），OR=2.25；95%CI[1.57-3.23]；以及分娩量<1000 例/年和 1000-1999 例/年的产科单位（参考≥3000 例/年），OR 分别为 1.52；95%CI[1.11-2.08]和 1.42；95%CI[1.05-1.92]。妇女特征仅解释了不到 3%的方差，而产科单位特征解释了 24.17%。
结论
在法国，每 5 名自然分娩的妇女中就有 1 名存在 AL 误用。这种误用主要是由产科单位的特征所解释。本研究确定的决定因素可用于在小型和私立产科单位实施有针对性的行动。
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