前瞻性研究产钳分娩相关新生儿眼外伤。

Department of Obstetrics & Gynaecology, United Christian Hospital, Hong Kong.

J AAPOS. 2023 Aug;27(4):196.e1-196.e5. doi: 10.1016/j.jaapos.2023.04.015. Epub 2023 Jul 13.

BACKGROUND

Assisted delivery by forceps is needed to expedite vaginal delivery in certain maternal and fetal conditions. The aim of this study was to evaluate the incidence and the extent of ophthalmological injuries in neonates after forceps delivery.

METHODS

Women with cephalic fetuses delivered vaginally by forceps from July 2020 to June 2022 were recruited prospectively. Ophthalmologists would be consulted when there were signs of external ophthalmic injuries, such as periorbital forceps marks or facial bruising. Demographic data, pregnancy characteristics, delivery details, and perinatal outcomes were evaluated to identify any associated risk factors for neonatal ophthalmological injuries.

RESULTS

A total of 77 forceps deliveries were performed in the study period, in which 20 cases (26%) required ophthalmological consultations. There were more right or left occipital fetal head positions in the group requiring ophthalmological assessment than those that did not require assessment (35% vs 12.3% [P = 0.023]). The degree of moulding of the fetal head was more marked in the former group (65% vs 28% [P = 0.001]). The overall incidence of detectable ophthalmological lesions was 16.9% (13/77). All ophthalmic injuries were mild, and most resolved with conservative management.

CONCLUSIONS

In our study cohort, external ophthalmic injuries were common after forceps delivery. We recommended ophthalmological consultation in newborns delivered by forceps with evidence of compressive trauma to rule out serious ophthalmological trauma.

背景

在某些产妇和胎儿的情况下，需要使用产钳来加速阴道分娩。本研究的目的是评估产钳分娩后新生儿眼科损伤的发生率和程度。

方法

前瞻性招募 2020 年 7 月至 2022 年 6 月期间头位胎儿经产钳阴道分娩的产妇。当有眼外损伤的迹象，如眶周产钳痕迹或面部瘀伤时，会咨询眼科医生。评估人口统计学数据、妊娠特征、分娩细节和围产儿结局，以确定新生儿眼科损伤的任何相关危险因素。

结果

在研究期间共进行了 77 例产钳分娩，其中 20 例（26%）需要眼科会诊。需要眼科评估的组中，右或左枕骨胎儿头位的比例高于不需要评估的组（35%比 12.3%[P=0.023]）。前者组的胎头塑形程度更明显（65%比 28%[P=0.001]）。可检测到的眼科病变总发生率为 16.9%（13/77）。所有眼部损伤均为轻度，大多数经保守治疗后可缓解。