Williams M C, Knuppel R A, O'Brien W F, Weiss A, Spellacy W N, Pietrantoni M
Department of Obstetrics and Gynecology, University of South Florida, Tampa.
Obstet Gynecol. 1993 May;81(5 ( Pt 1)):688-94.
To determine whether maternal or fetal factors, other than vacuum-assisted delivery, play a role in neonatal retinal hemorrhage, and whether correlates are similar in retinal hemorrhage after spontaneous vaginal delivery.
A cross-section of assisted deliveries at an urban hospital (n = 156) over 7 months were compared with contemporaneous spontaneous vaginal deliveries (n = 122). A subset of assisted deliveries (n = 87) was prospectively randomized to forceps or vacuum-assisted delivery by sealed envelope. Maternal and neonatal biometric data were collected, and Apgar scores, umbilical artery blood gas analysis, and neonatal ophthalmologic evaluations were performed.
Moderate to severe retinal hemorrhage was found in 18% of spontaneous, 13% of forceps, 28% of vacuum-assisted, and 50% of sequential vacuum and forceps-assisted deliveries. Fetal distress (P < .008), vacuum-assisted delivery (P < .02), decreased birth weight for gestation (P < .004), umbilical artery pH less than 7.20 (P < .004), and second stage of labor less than 30 minutes (P < .05) were most closely associated with increased degrees of retinal hemorrhage. Maternal parity, preeclampsia, length of labor, and head circumference were not correlated with retinal hemorrhage. Vacuum-assisted delivery among low birth weight infants (P < .0001), short second stage of labor (P < .006), fetal acidosis (P < .045), and sequential use of vacuum and forceps for assisted delivery (P < .005) formed a logistic model that correctly predicted 81% of moderate to severe retinal hemorrhage cases. Logistic analysis of the randomized assisted deliveries gave similar results.
Maternal and fetal factors other than vacuum-assisted delivery are significant correlates of moderate to severe retinal hemorrhage. Vacuum-assisted delivery among small for gestational age infants is closely correlated with moderate to severe retinal hemorrhage.
确定除真空辅助分娩外，母体或胎儿因素是否在新生儿视网膜出血中起作用，以及自然阴道分娩后视网膜出血的相关因素是否相似。
将一家城市医院7个月内的辅助分娩病例（n = 156）与同期自然阴道分娩病例（n = 122）进行横断面比较。辅助分娩的一个子集（n = 87）通过密封信封前瞻性随机分为产钳或真空辅助分娩。收集母体和新生儿生物特征数据，并进行阿氏评分、脐动脉血气分析和新生儿眼科评估。
在自然分娩的新生儿中，18%出现中度至重度视网膜出血；产钳分娩的为13%；真空辅助分娩的为28%；顺序使用真空和产钳辅助分娩的为50%。胎儿窘迫（P <.008）、真空辅助分娩（P <.02）、孕周出生体重降低（P <.004）、脐动脉pH值低于7.20（P <.004）以及第二产程少于30分钟（P <.05）与视网膜出血程度增加密切相关。产妇产次、先兆子痫、产程长度和头围与视网膜出血无关。低出生体重儿中的真空辅助分娩（P <.0001）、第二产程短（P <.006）、胎儿酸中毒（P <.045）以及顺序使用真空和产钳进行辅助分娩（P <.005）构成了一个逻辑模型，该模型正确预测了81%的中度至重度视网膜出血病例。对随机辅助分娩进行的逻辑分析得出了类似结果。
除真空辅助分娩外，母体和胎儿因素是中度至重度视网膜出血的重要相关因素。小于胎龄儿中的真空辅助分娩与中度至重度视网膜出血密切相关。
