Department of Obstetrics and Gynaecology (Muraca, Boutin, Lisonkova, John, Joseph), University of British Columbia, Vancouver, BC; Clinical Epidemiology Unit, Department of Medicine (Muraca, Razaz), Solna, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden; Department of Pediatrics (Boutin), Université Laval, Québec City, Quebec; School of Population and Public Health (Lisonkova, Joseph); Division of Neonatology, Department of Pediatrics (Ting), University of British Columbia, Vancouver, BC; Department of Obstetrics and Gynaecology (Scott), Dalhousie University and the IWK Health Centre, Halifax, NS; Departments of Epidemiology and Occupation Health and of Pediatrics (Kramer), McGill University, Montréal, Que.
CMAJ. 2022 Jan 10;194(1):E1-E12. doi: 10.1503/cmaj.210841.
Operative vaginal delivery (OVD) is considered safe if carried out by trained personnel. However, opportunities for training in OVD have declined and, given these shifts in practice, the safety of OVD is unknown. We estimated incidence rates of trauma following OVD in Canada, and quantified variation in trauma rates by instrument, region, level of obstetric care and institutional OVD volume.
We conducted a cohort study of all singleton, term deliveries in Canada between April 2013 and March 2019, excluding Quebec. Our main outcome measures were maternal trauma (e.g., obstetric anal sphincter injury, high vaginal lacerations) and neonatal trauma (e.g., subgaleal hemorrhage, brachial plexus injury). We calculated adjusted and stabilized rates of trauma using mixed-effects logistic regression.
Of 1 326 191 deliveries, 38 500 (2.9%) were attempted forceps deliveries and 110 987 (8.4%) were attempted vacuum deliveries. The maternal trauma rate following forceps delivery was 25.3% (95% confidence interval [CI] 24.8%-25.7%) and the neonatal trauma rate was 9.6 (95% CI 8.6-10.6) per 1000 live births. Maternal and neonatal trauma rates following vacuum delivery were 13.2% (95% CI 13.0%-13.4%) and 9.6 (95% CI 9.0-10.2) per 1000 live births, respectively. Maternal trauma rates remained higher with forceps than with vacuum after adjustment for confounders (adjusted rate ratio 1.70, 95% CI 1.65-1.75) and varied by region, but not by level of obstetric care.
In Canada, rates of trauma following OVD are higher than previously reported, irrespective of region, level of obstetric care and volume of OVD among hospitals. These results support a reassessment of OVD safety in Canada.
如果由经过培训的人员进行操作，阴道分娩（OVD）被认为是安全的。然而，OVD 的培训机会减少了，考虑到这些实践上的转变，OVD 的安全性尚不清楚。我们估计了加拿大 OVD 后创伤的发生率，并通过器械、地区、产科护理水平和机构 OVD 量来量化创伤发生率的变化。
我们对 2013 年 4 月至 2019 年 3 月期间加拿大除魁北克以外的所有单胎足月分娩进行了队列研究。我们的主要结局指标是产妇创伤（例如，产科肛门括约肌损伤，阴道高位撕裂）和新生儿创伤（例如，帽状腱膜下血肿，臂丛神经损伤）。我们使用混合效应逻辑回归计算了调整和稳定的创伤率。
在 1326191 次分娩中，有 38500 次（2.9%）尝试使用产钳分娩，110987 次（8.4%）尝试使用真空分娩。产钳分娩后的产妇创伤率为 25.3%（95%置信区间 [CI] 24.8%-25.7%），新生儿创伤率为每 1000 例活产 9.6（95%CI 8.6-10.6）。真空分娩后的产妇和新生儿创伤率分别为 13.2%（95%CI 13.0%-13.4%）和每 1000 例活产 9.6（95%CI 9.0-10.2）。在调整混杂因素后，产钳的产妇创伤率仍高于真空（调整后的率比 1.70，95%CI 1.65-1.75），且创伤率因地区而异，但与产科护理水平无关。
在加拿大，OVD 后创伤的发生率高于以前的报告，无论地区、产科护理水平和医院 OVD 量如何。这些结果支持重新评估加拿大 OVD 的安全性。
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