Bofill J A, Rust O A, Perry K G, Roberts W E, Martin R W, Morrison J C
Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson, USA.
Obstet Gynecol. 1996 Dec;88(6):1007-10. doi: 10.1016/s0029-7844(96)00328-6.
To document operative vaginal delivery rates of ACOG Fellows and to stratify practice patterns with regard to mid-pelvic delivery and deep transverse arrest by the time elapsed since residency.
A survey was mailed to a random sample of 1600 ACOG Fellows. Of the 597 respondents (37%), 558 who still practice obstetrics formed the study group. Selection bias regarding recipients of the survey was reduced by randomization by an uninvolved third party. The length of time since residency was categorized as 10 years or fewer ("recent," 31%), 11-20 years ("intermediate," 43%), and more than 20 years ("remote," 26%).
The majority of respondents (338 of 558, 61%) reported an operative vaginal delivery rate of 15% or less. One hundred forty-two (25%) use only forceps, whereas 78 (14%) use vacuum extraction exclusively. More than half have abandoned mid-pelvic operative vaginal deliveries, and of the 41% who still perform these operations, about half use forceps. In cases of deep transverse arrest, about 25% perform cesarean delivery, whereas 26% and 42% use forceps or vacuum, respectively. Resident training and practice in vacuum delivery were more common in the recently trained groups (recent > intermediate > remote; P < .001). There were no differences among the groups with respect to attempting mid-pelvic operative vaginal delivery (P = .29), but the remote group was more likely to use forceps, whereas the recent group was more likely to use vacuum (P = .039). A large disparity existed among the groups regarding the management of deep transverse arrest, with vacuum use associated with group assignment (P < .001).
The majority of respondents have an operative vaginal delivery rate of no more than 15%. Most respondents have abandoned mid-pelvic operative vaginal delivery. Practice patterns reflect differences in residency training; the more recently trained Fellows more often were taught and use vacuum for delivery.
记录美国妇产科医师学会（ACOG）会员的手术阴道分娩率，并根据住院医师培训结束后的时间，对中骨盆分娩和胎头深横阻滞的实践模式进行分层。
向1600名ACOG会员随机抽样邮寄调查问卷。在597名受访者（37%）中，558名仍从事产科工作的人员组成了研究组。由第三方随机化减少了调查对象的选择偏倚。住院医师培训结束后的时间分为10年及以内（“近期”，31%）、11 - 20年（“中期”，43%）和20年以上（“远期”，26%）。
大多数受访者（558人中的338人，61%）报告手术阴道分娩率为15%或更低。142人（25%）仅使用产钳，而78人（14%）仅使用真空吸引术。超过一半的人已放弃中骨盆手术阴道分娩，在仍进行这些手术的41%的人中，约一半使用产钳。在胎头深横阻滞的情况下，约25%的人进行剖宫产，而分别有26%和42%的人使用产钳或真空吸引术。在近期接受培训的组中，住院医师培训期间真空吸引分娩的培训和实践更为常见（近期＞中期＞远期；P＜0.001）。在尝试中骨盆手术阴道分娩方面，各组之间没有差异（P = 0.29），但远期组更可能使用产钳，而近期组更可能使用真空吸引术（P = 0.039）。在胎头深横阻滞的处理上，各组之间存在很大差异，真空吸引术的使用与分组有关（P＜0.001）。
大多数受访者的手术阴道分娩率不超过15%。大多数受访者已放弃中骨盆手术阴道分娩。实践模式反映了住院医师培训的差异；近期接受培训的会员更常接受真空吸引分娩的培训并使用该方法。
