Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux, and the Clinical Research Center, Angers University Hospital, Angers, France.
Obstet Gynecol. 2022 May 1;139(5):833-845. doi: 10.1097/AOG.0000000000004746. Epub 2022 Apr 5.
To assess severe short-term maternal and neonatal morbidity and pelvic floor disorders at 6 months postpartum after attempted operative vaginal delivery according to the instrument used.
We conducted a prospective study of women with live, singleton, term fetuses in vertex presentation. Patients attempted operative vaginal delivery in a French tertiary care university hospital from December 2008 through October 2013. We used multivariable logistic regression and propensity score methods to control for indication bias and compare outcomes associated with vacuum-assisted or forceps- or spatula-assisted delivery. Severe maternal and neonatal morbidity were composite primary endpoints. Symptoms of urinary incontinence (UI) and anal incontinence (AI) were assessed 6 months after delivery by validated self-administered questionnaires.
Among 2,128 attempted operative vaginal deliveries, 30.7% (n=654) used vacuum and 69.3% (n=1,474) used forceps or spatulas. Severe maternal morbidity occurred in 5.4% (n=35; 95% CI 3.8-7.4) of vacuum attempts and 10.5% (n=154; 95% CI 8.3-12.1) of forceps or spatula attempts (P<.001); severe neonatal morbidity occurred in 8.4% (n=55; 95% CI 6.4-10.8) and 10.2% (n=155; 95% CI 8.7-11.8), respectively (P=.2). Although attempted operative vaginal deliveries with forceps or spatula were significantly associated with more frequent severe maternal morbidity (adjusted odds ratio [aOR] 1.99 95% CI 1.27-3.10) in the multivariable logistic regression analysis, this association was no longer significant after propensity score matching (aOR 1.46 95% CI 0.72-2.95). Attempted operative vaginal deliveries with forceps or spatula were not significantly associated with more frequent severe neonatal morbidity after multivariable logistic regression or propensity score matching. Among the 934 women (43.9%) who responded to questionnaires at 6 months, the prevalence of symptoms of UI and AI were 22.7% and 22.0%, respectively, with no significant differences between the groups.
In singleton term pregnancies, neither severe short-term maternal or neonatal morbidity nor UI or AI were more frequent after attempted operative vaginal delivery by forceps or spatulas than by vacuum after controlling for indication bias with a propensity score analysis.
根据使用的器械，评估试图经阴道分娩的产妇严重短期母婴发病率和盆底功能障碍，并在产后 6 个月进行评估。
我们进行了一项前瞻性研究，纳入了法国一家三级保健大学医院的具有活产、单胎、头位的产妇。患者于 2008 年 12 月至 2013 年 10 月期间尝试经阴道分娩。我们使用多变量逻辑回归和倾向评分方法来控制适应证偏倚，并比较与真空辅助、产钳或匙形助产器分娩相关的结局。严重母婴发病率为复合主要终点。在产后 6 个月，通过经过验证的自我管理问卷评估尿失禁（UI）和肛门失禁（AI）的症状。
在 2128 例试图经阴道分娩的病例中，30.7%（n=654）使用了真空，69.3%（n=1474）使用了产钳或匙形助产器。真空尝试的严重产妇发病率为 5.4%（n=35；95%CI 3.8-7.4），产钳或匙形助产器尝试的严重产妇发病率为 10.5%（n=154；95%CI 8.3-12.1）（P<.001）；严重新生儿发病率分别为 8.4%（n=55；95%CI 6.4-10.8）和 10.2%（n=155；95%CI 8.7-11.8）（P=.2）。尽管在多变量逻辑回归分析中，使用产钳或匙形助产器的尝试性经阴道分娩与更频繁的严重产妇发病率显著相关（调整优势比[aOR]1.99，95%CI 1.27-3.10），但在倾向评分匹配后，这种相关性不再显著（aOR 1.46，95%CI 0.72-2.95）。多变量逻辑回归或倾向评分匹配后，使用产钳或匙形助产器的尝试性经阴道分娩与更频繁的严重新生儿发病率无关。在 934 名（43.9%）在 6 个月时回复问卷的女性中，UI 和 AI 的症状发生率分别为 22.7%和 22.0%，两组之间无显著差异。
在单胎足月妊娠中，经阴道分娩时使用产钳或匙形助产器与使用真空相比，在控制适应证偏倚的倾向评分分析后，产妇严重短期母婴发病率以及 UI 或 AI 并无更高的发生率。
