Ruderman J, Carroll J C, Reid A J, Murray M A
Department of Family and Community Medicine, University of Toronto, Ont.
CMAJ. 1993 Feb 1;148(3):409-15.
To examine trends in obstetric interventions in women at low risk over approximately 3 years. It was postulated that there would be a general reduction in most intervention rates.
Retrospective review of hospital records.
Three downtown hospitals of the University of Toronto, in which academic and nonacademic family physicians and obstetricians practised.
A total of 2365 women in phase 1 (April 1985 to March 1986) and 1277 in phase 2 (May to September 1988) met the inclusion criteria for grade A (pregnancy at no predictable risk) of the Ontario Antenatal Record at the time of admission to hospital.
Rates of artificial rupture of the membranes, induction, augmentation, epidural anesthesia, continuous electronic fetal monitoring (EFM), instrumental delivery, episiotomy and cesarean section.
The family physicians and the obstetricians had significant decreases (p < 0.01) over time in the rates of episiotomy, especially mediolateral, and low forceps delivery. The rate of epidural anesthesia decreased significantly in the obstetrician group. The rates of artificial rupture of the membranes, induction and continuous EFM increased in the two physician groups; the increased rate of EFM was significant in the obstetrician group (p < 0.01). There was no significant change in the rates of augmentation, midforceps delivery, vacuum extraction or cesarean section. All of the trends were found to hold when the intervention rates were analysed according to the women's parity.
Some of the findings reflect recommendations and trends reported in the literature, whereas others are not supported by clear medical evidence. The unpredictable nature of the trends suggests that further study is warranted of the reasons for obstetric trends and for the changes in physicians' practice patterns.
研究低风险女性在约3年时间里产科干预措施的变化趋势。假设大多数干预率会普遍下降。
对医院记录进行回顾性研究。
多伦多大学的三家市中心医院，学术和非学术家庭医生及产科医生在此执业。
共有2365名处于第1阶段（1985年4月至1986年3月）和1277名处于第2阶段（1988年5月至9月）的女性在入院时符合安大略省产前记录A级（无可预测风险的妊娠）的纳入标准。
胎膜人工破膜、引产、产程加强、硬膜外麻醉、连续电子胎儿监护（EFM）、器械助产、会阴切开术和剖宫产的发生率。
随着时间推移，家庭医生和产科医生的会阴切开术发生率显著下降（p<0.01），尤其是中侧切开术和低位产钳助产率。产科医生组的硬膜外麻醉率显著下降。两个医生组的胎膜人工破膜、引产和连续EFM发生率均有所上升；产科医生组EFM发生率的上升具有统计学意义（p<0.01）。产程加强、中位产钳助产、真空吸引或剖宫产的发生率没有显著变化。根据产妇的胎次分析干预率时，所有这些趋势均成立。
一些研究结果反映了文献中报道的建议和趋势，而其他结果则没有明确的医学证据支持。这些趋势的不可预测性表明，有必要进一步研究产科趋势的原因以及医生执业模式的变化。
