接生人员造成产科肛门括约肌损伤的风险

Taniya Walker, Ciara Bryson, Sara Rahman, C. Carter-Brooks
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摘要

导言和假设:产科肛门括约肌损伤(OASI)是5.8%阴道分娩的并发症。我们的目的是评估主要接生者是助产士还是产科医生是否与肛门括约肌损伤有关。方法:我们对安全分娩联合会(Consortium of Safe Labor)进行了二次分析,这是一项多中心、回顾性队列研究。研究对象为 2002 年至 2008 年期间单胎、阴道分娩≥37 周的无阴道分娩产妇。排除肩难产或无助产士接生的产妇。根据情况采用学生 t 检验、卡方分析和费雪精确检验。进行了多变量逻辑回归和倾向得分匹配分析。结果:在 19 个地点的 228,668 名新生儿中,有 3 个地点的 2735 名新生儿符合纳入标准:其中医生接生 1551 例,助产士接生 1184 例。在所有新生儿中,4.2%(n=116)的新生儿因OASI而并发症。医生患者年龄较大,多为白人,有私人保险,体重指数(BMI)较高,合并症较多,有引产/增产经历。助产士患者的胎龄和婴儿出生体重较高(均 p < 0.05)。与助产士分娩相比,医生分娩的产妇更容易发生 OASI(5.9% 对 2.0%,P < 0.0001)。这一差异在多变量逻辑回归中依然存在。在控制产妇心脏病、外阴切开术、产妇年龄增加、产妇体重指数下降、非白人种族和出生体重增加的情况下,由医生接生的产妇发生 OASI 的几率是由助产士接生的产妇的 2.4 倍(95%CI 1.5-3.9)。AUC 为 0.78。在倾向得分匹配的情况下,内科分娩的 OASI 发生率仍然较高(6.6% 对 1.8%,p < 0.0001;aOR 3.8 (95%CI 2.0-7.1))。结论:即使控制了其他相关因素,OASI 在医生分娩中仍比助产士分娩中更为常见。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Risk of Obstetric Anal Sphincter Injury by Delivering Provider
Introduction and Hypothesis: Obstetric anal sphincter injuries (OASIs) complicate 5.8% of vaginal deliveries. Our objective was to assess if the primary delivery provider, a nurse-midwife versus physician obstetrician, is associated with OASIs. Methods: We performed a secondary analysis of the Consortium of Safe Labor, a multicenter, retrospective cohort study. Included were nulliparous women with singleton, vaginal delivery at ≥37 weeks from 2002 to 2008. Women were excluded if delivery was complicated by shoulder dystocia or from sites without midwife deliveries. Student’s t-tests, chi-squared analysis, and Fisher’s exact test were used as appropriate. Multivariable logistic regression and propensity score-matching analyses were performed. Results: Of 228,668 births at 19 sites, 2735 births from 3 sites met the inclusion criteria: 1551 physician and 1184 midwife births. Of all births, 4.2% (n = 116) were complicated by OASIs. Physician patients were older, more often White, privately insured, with higher BMI, more medical co-morbidities, and labor inductions/augmentations. Midwife patients had higher fetal gestational age and infant birth weights (all p < 0.05). OASIs were more common in physician compared to midwife births (5.9% vs. 2.0%, p < 0.0001). This difference persisted in multivariable logistic regression. OASIs were 2.4 (95%CI 1.5–3.9) times more likely with physician delivery when controlling for maternal heart disease, episiotomy, increasing maternal age, decreasing maternal BMI, non-White race, and increasing birthweight. The AUC was 0.78. With propensity score matching, OASI rates remained higher amongst physician births (6.6% vs. 1.8%, p < 0.0001; aOR 3.8 (95%CI 2.0–7.1)). Conclusion: OASIs were more common in physician compared to midwife deliveries even when controlling for other associated factors.
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