护理模式与自然阴道分娩机会：北莱茵-威斯特法伦前瞻性、多中心配对分析。
Model of care and chance of spontaneous vaginal birth: a prospective, multicenter matched-pair analysis from North Rhine-Westphalia.
机构信息
Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
Department of Medical Biometry, Informatics and Epidemiology, Faculty of Medicine, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
出版信息
BMC Pregnancy Childbirth. 2021 Dec 30;21(1):849. doi: 10.1186/s12884-021-04323-1.
BACKGROUND
Advantages of midwife-led models of care have been reported; these include a higher vaginal birth rate and less interventions. In Germany, 98.4% of women are giving birth in obstetrician-led units. We compared the outcome of birth planned in alongside midwifery units (AMU) with a matched group of low-risk women who gave birth in obstetrician-led units.
METHODS
A prospective, controlled, multicenter study was conducted. Six of seven AMUs in North Rhine-Westphalia participated. Healthy women with a singleton term cephalic pregnancy booking for birth in AMU were eligible. For each woman in the study group a control was chosen who would have been eligible for birth in AMU but was booking for obstetrician-led care; matching for parity was performed. Mode of birth was chosen as primary outcome parameter. Secondary endpoints included a composite outcome of adverse outcome in the third stage and / or postpartum hemorrhage; higher-order obstetric lacerations; and for the neonate, a composite outcome (5-min Apgar < 7 and / or umbilical cord arterial pH < 7.10 and / or transfer to specialist neonatal care). Statistical analysis was by intention to treat. A non-inferiority analysis was performed.
RESULTS
Five hundred eighty-nine case-control pairs were recruited, final analysis was performed with 391 case-control pairs. Nulliparous women constituted 56.0% of cases. For the primary endpoint vaginal birth superiority was established for the study group (5.66%, 95%-CI 0.42% - 10.88%). For the composite newborn outcome (1.28%, 95%-CI -1.86% - -4.47%) and for higher-order obstetric lacerations (2.33%, 95%-CI -0.45% - 5.37%) non-inferiority was established. Non-inferiority was not present for the composite maternal outcome (-1.56%, 95%-CI -6.69% - 3.57%). The epidural anesthesia rate was lower (22.9% vs. 41.1%), and the length of hospital stay was shorter in the study group (p < 0.001 for both). Transfer to obstetrician-led care occurred in 51.2% of cases, with a strong association to parity (p < 0.001). Request for regional anesthesia was the most common cause for transfer (47.1%).
CONCLUSION
Our comparison between care in AMU and obstetrician-led care with respect to mode of birth and other outcomes confirmed the superiority of this model of care for low-risk women. This pertains to AMU where admission and transfer criteria are in place and adhered to.
背景
已报道助产士主导模式的护理的优势；这些优势包括更高的阴道分娩率和更少的干预。在德国，98.4%的女性在产科医生主导的单位分娩。我们比较了计划在助产士主导单位（AMU）分娩的产妇与在产科医生主导单位分娩的低风险产妇的分娩结果。
方法
进行了一项前瞻性、对照、多中心研究。北莱茵-威斯特法伦州的 7 个 AMU 中有 6 个参与了该研究。符合条件的健康单胎足月头位妊娠产妇可在 AMU 预约分娩。为研究组中的每一位妇女选择了一名对照组妇女，这些妇女本应符合 AMU 的分娩条件，但预约了产科医生主导的分娩；采用配对的方法进行了比较。分娩方式为主要观察指标。次要终点包括第三产程和/或产后出血不良结局的复合结局；高级别产科裂伤；对于新生儿，复合结局（5 分钟 Apgar<7 且/或脐动脉 pH<7.10 且/或转至专科新生儿护理）。统计分析采用意向治疗。进行了非劣效性分析。
结果
共招募了 589 例病例对照，最终分析了 391 例病例对照。初产妇占 56.0%。对于主要结局，研究组的阴道分娩具有优势（5.66%，95%CI 0.42%–10.88%）。对于新生儿复合结局（1.28%，95%CI -1.86%–-4.47%）和高级别产科裂伤（2.33%，95%CI -0.45%–5.37%），则确立了非劣效性。对于产妇复合结局，非劣效性未成立（-1.56%，95%CI -6.69%–3.57%）。研究组硬膜外麻醉率较低（22.9% vs. 41.1%），住院时间较短（均<0.001）。51.2%的病例需要转至产科医生主导的护理，与产次密切相关（p<0.001）。要求区域麻醉是转科最常见的原因（47.1%）。
结论
我们比较了 AMU 与产科医生主导的护理模式在分娩方式和其他结局方面的差异，证实了这种低风险产妇护理模式的优越性。这适用于 AMU，在 AMU 中，入院和转科标准得到了执行。
Zotero 插件