Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel.
Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Int J Gynaecol Obstet. 2023 Mar;160(3):836-841. doi: 10.1002/ijgo.14367. Epub 2022 Aug 8.
To evaluate the association between fetal head position during prevacuum assessment and adverse outcomes.
This retrospective cohort study included all vacuum-assisted deliveries using the Kiwi Omnicup over 5 years. Primary outcomes were third- or fourth-degree perineal tear, pH < 7.1, and subgaleal hematoma (SGH). AGAR, neonatal intensive care unit admission, cephalohematoma, Erb's palsy, third-stage duration, and postpartum hemorrhage were secondary. Outcomes were compared between the occiput posterior (OP) and occiput anterior (OA) positions.
The study included 1960 patients. OP position was more likely to involve epidural analgesia (311 [82.5%] vs. 1216 [77%], P = 0.020), higher fetal head station (P = 0.001), higher percentage of cup detachments (121 cases [32.1%] vs. 307 [19.4%], P = 0.001), and longer procedure (5.5 ± 3.7 min vs. 4.7 ± 2.8 min, P = 0.001). OP was associated with umbilical cord pH < 7.1 (21 [5.5%] vs. 52 [3.9%], P = 0.032), NICU admissions (16 [4.2%] vs. 38 [2.4%], P = 0.049), SGH (18 [4.8%] vs. 38 [2.4%], P = 0.013), and high-degree perineal tears (12 [3.2%] vs. 26 [1.7%], with borderline significance, P = 0.051). SGH and high-grade tears remained significantly associated with OP position (P = 0.008 and P = 0.016, respectively) after adjusting for maternal age, nulliparity, diabetes, epidural anesthesia, preprocedure head station, and birth weight.
OP position is an independent risk-factor for anal sphincter injury and SGH during vacuum-assisted delivery.
评估负压术前胎儿头位与不良结局的关系。
本回顾性队列研究纳入了 5 年来使用 Kiwi Omnicup 进行的所有真空辅助分娩。主要结局为三度或四度会阴撕裂、pH 值<7.1 和帽状腱膜下血肿（SGH）。次要结局为 AGA 评分、新生儿重症监护病房入院、头颅血肿、臂丛神经损伤、第三产程时长和产后出血。比较枕后位（OP）和枕前位（OA）的结局。
研究纳入了 1960 名患者。OP 位更可能使用硬膜外镇痛（311 例[82.5%]与 1216 例[77%]，P=0.020）、胎先露更高（P=0.001）、杯状脱落更多（121 例[32.1%]与 307 例[19.4%]，P=0.001），且手术时间更长（5.5±3.7 分钟与 4.7±2.8 分钟，P=0.001）。OP 与脐动脉 pH 值<7.1（21 例[5.5%]与 52 例[3.9%]，P=0.032）、NICU 入院（16 例[4.2%]与 38 例[2.4%]，P=0.049）、SGH（18 例[4.8%]与 38 例[2.4%]，P=0.013）和重度会阴撕裂（12 例[3.2%]与 26 例[1.7%]，具有边缘显著性，P=0.051）相关。调整产妇年龄、初产妇、糖尿病、硬膜外麻醉、术前胎先露和出生体重后，OP 位置与 SGH 和高等级撕裂仍显著相关（P=0.008 和 P=0.016）。
OP 位置是负压分娩时发生肛门括约肌损伤和 SGH 的独立危险因素。
