Elliott J P, Russell M M, Dickason L A
Phoenix Perinatal Associates, AZ, USA.
Am J Obstet Gynecol. 1997 Jul;177(1):139-43. doi: 10.1016/s0002-9378(97)70452-6.
Our purpose was to determine the benefits of an acuity-adjusted labor management tool.
A retrospective review was performed of all deliveries at Good Samaritan Regional Medical Center in Phoenix, Arizona, for a 1-year period from Jan. 1 to Dec. 31, 1994. All physicians with > or = 20 deliveries were included in the analysis. Patients with indications for which most practitioners would perform a cesarean delivery were removed from consideration. Physicians were then compared with respect to labor management in the remaining patients without relative contraindications to vaginal delivery.
The total number of deliveries (n = 6062) was performed by 47 attending obstetricians, 9 perinatologists, an obstetrics-gynecology clinic, and a family practice clinic. The "raw" cesarean section rate was 20.1%. Those at high risk for cesarean delivery (n = 534) were excluded, leaving 684 cesarean sections performed in 5528 patients (12.4%) who were appropriate to labor. Differences were observed between the nulliparous cesarean section rate (16%) compared with that for parous patients (10.1%) (p < 0.0001 by Fisher's exact test (two-tailed) but not between attending obstetrician-gynecologists (12.4%) and perinatologists (13.8%) (not significant).
A labor-adjusted cesarean section rate is more appropriate than just "raw" data. Medical, obstetric, and fetal factors affect a "raw" rate that is out of the control of the obstetrician. This method of assessing the labor and delivery skills of each practitioner and hospital would allow meaningful comparison with others.
我们的目的是确定一种根据病情严重程度调整的分娩管理工具的益处。
对1994年1月1日至12月31日在亚利桑那州凤凰城的撒玛利亚人区域医疗中心进行的所有分娩进行回顾性研究。所有分娩量≥20例的医生纳入分析。将大多数从业者会进行剖宫产的指征患者排除在外。然后比较在其余无阴道分娩相对禁忌证患者中的分娩管理情况。
分娩总数（n = 6062）由47名产科主治医师、9名围产医学专家、一个妇产科诊所和一个家庭医疗诊所完成。“原始”剖宫产率为20.1%。将剖宫产高风险患者（n = 534）排除后，在5528名适合分娩的患者中进行了684例剖宫产（12.4%）。初产妇剖宫产率（16%）与经产妇剖宫产率（10.1%）之间存在差异（Fisher精确检验（双侧）p < 0.0001），但产科主治医师（12.4%）和围产医学专家（13.8%）之间无差异（无统计学意义）。
根据分娩情况调整后的剖宫产率比仅用“原始”数据更合适。医学、产科和胎儿因素会影响产科医生无法控制的“原始”剖宫产率。这种评估每位从业者和医院分娩技能的方法能够与其他机构进行有意义的比较。
