Julia Sanders, Christy Barlow, Peter Brocklehurst, Rebecca Cannings-John, Susan Channon, Judith Cutter, Billie Hunter, Mervi Jokinen, Fiona Lugg-Widger, Sarah Milosevic, Chris Gale, Rebecca Milton, Leah Morantz, Shantini Paranjothy, Rachel Plachcinski, Michael Robling
{"title":"产前浸水后在水中或水外自然阴道分娩的产妇和新生儿结局：POOL 队列研究。","authors":"Julia Sanders, Christy Barlow, Peter Brocklehurst, Rebecca Cannings-John, Susan Channon, Judith Cutter, Billie Hunter, Mervi Jokinen, Fiona Lugg-Widger, Sarah Milosevic, Chris Gale, Rebecca Milton, Leah Morantz, Shantini Paranjothy, Rachel Plachcinski, Michael Robling","doi":"10.1111/1471-0528.17878","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>Warm water immersion during labour provides women with analgesia and comfort. This cohort study aimed to establish among women using intrapartum water immersion analgesia, without antenatal or intrapartum risk factors, whether waterbirth is as safe for them and their babies as leaving the water before birth.</p><p><strong>Design: </strong>Cohort study with non-inferiority design.</p><p><strong>Setting: </strong>Twenty-six UK NHS maternity services.</p><p><strong>Sample: </strong>A total of 73 229 women without antenatal or intrapartum risk factors, using intrapartum water immersion, between 1 January 2015 and 30 June 2022. The analysis excluded 12 827 (17.5%) women who received obstetric or anaesthetic interventions before birth.</p><p><strong>Methods: </strong>Non-inferiority analysis of retrospective and prospective data captured in NHS maternity and neonatal information systems.</p><p><strong>Main outcome measures: </strong>Maternal primary outcome: obstetric anal sphincter injury (OASI) by parity; neonatal composite primary outcome: fetal or neonatal death, neonatal unit admission with respiratory support or administration of antibiotics within 48 hours of birth.</p><p><strong>Results: </strong>Rates of the primary outcomes were no higher among waterbirths compared with births out of water: rates of OASI among nulliparous women (waterbirth: 730/15 176 [4.8%] versus births out of water: 641/12 210 [5.3%]; adjusted odds ratio [aOR] 0.97, one-sided 95% CI, -∞ to 1.08); rates of OASI among parous women (waterbirth: 269/24 451 [1.1%] versus births out of water 144/8565 [1.7%]; aOR 0.64, one-sided 95% CI -∞ to 0.78) and rates of the composite adverse outcome among babies (waterbirth 263/9868 [2.7%] versus births out of water 224/5078 [4.4%]; aOR 0.65, one-sided 95% CI -∞ to 0.79).</p><p><strong>Conclusion: </strong>Among women using water immersion during labour, remaining in the pool and giving birth in water was not associated with an increase in the incidence of adverse primary maternal or neonatal outcomes.</p>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":null,"pages":null},"PeriodicalIF":4.7000,"publicationDate":"2024-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Maternal and neonatal outcomes among spontaneous vaginal births occurring in or out of water following intrapartum water immersion: The POOL cohort study.\",\"authors\":\"Julia Sanders, Christy Barlow, Peter Brocklehurst, Rebecca Cannings-John, Susan Channon, Judith Cutter, Billie Hunter, Mervi Jokinen, Fiona Lugg-Widger, Sarah Milosevic, Chris Gale, Rebecca Milton, Leah Morantz, Shantini Paranjothy, Rachel Plachcinski, Michael Robling\",\"doi\":\"10.1111/1471-0528.17878\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>Warm water immersion during labour provides women with analgesia and comfort. This cohort study aimed to establish among women using intrapartum water immersion analgesia, without antenatal or intrapartum risk factors, whether waterbirth is as safe for them and their babies as leaving the water before birth.</p><p><strong>Design: </strong>Cohort study with non-inferiority design.</p><p><strong>Setting: </strong>Twenty-six UK NHS maternity services.</p><p><strong>Sample: </strong>A total of 73 229 women without antenatal or intrapartum risk factors, using intrapartum water immersion, between 1 January 2015 and 30 June 2022. The analysis excluded 12 827 (17.5%) women who received obstetric or anaesthetic interventions before birth.</p><p><strong>Methods: </strong>Non-inferiority analysis of retrospective and prospective data captured in NHS maternity and neonatal information systems.</p><p><strong>Main outcome measures: </strong>Maternal primary outcome: obstetric anal sphincter injury (OASI) by parity; neonatal composite primary outcome: fetal or neonatal death, neonatal unit admission with respiratory support or administration of antibiotics within 48 hours of birth.</p><p><strong>Results: </strong>Rates of the primary outcomes were no higher among waterbirths compared with births out of water: rates of OASI among nulliparous women (waterbirth: 730/15 176 [4.8%] versus births out of water: 641/12 210 [5.3%]; adjusted odds ratio [aOR] 0.97, one-sided 95% CI, -∞ to 1.08); rates of OASI among parous women (waterbirth: 269/24 451 [1.1%] versus births out of water 144/8565 [1.7%]; aOR 0.64, one-sided 95% CI -∞ to 0.78) and rates of the composite adverse outcome among babies (waterbirth 263/9868 [2.7%] versus births out of water 224/5078 [4.4%]; aOR 0.65, one-sided 95% CI -∞ to 0.79).</p><p><strong>Conclusion: </strong>Among women using water immersion during labour, remaining in the pool and giving birth in water was not associated with an increase in the incidence of adverse primary maternal or neonatal outcomes.</p>\",\"PeriodicalId\":50729,\"journal\":{\"name\":\"Bjog-An International Journal of Obstetrics and Gynaecology\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":4.7000,\"publicationDate\":\"2024-06-10\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Bjog-An International Journal of Obstetrics and Gynaecology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1111/1471-0528.17878\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"OBSTETRICS & GYNECOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Bjog-An International Journal of Obstetrics and Gynaecology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1111/1471-0528.17878","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"OBSTETRICS & GYNECOLOGY","Score":null,"Total":0}
引用次数: 0
摘要
目的分娩过程中的温水浸泡可为产妇提供镇痛和舒适感。这项队列研究旨在确定在没有产前或产期风险因素的情况下使用产中浸水镇痛的产妇中，水中分娩是否与分娩前离开水中分娩一样对她们和婴儿安全：设计：队列研究，非劣效性设计：地点：英国国家医疗服务体系的 26 家产科服务机构：样本：2015 年 1 月 1 日至 2022 年 6 月 30 日期间，共有 73 229 名无产前或产中风险因素的产妇使用了产中浸水疗法。分析排除了 12 827 名（17.5%）在分娩前接受产科或麻醉干预的产妇：对国家医疗服务体系产科和新生儿信息系统中采集的回顾性和前瞻性数据进行非劣效性分析：孕产妇主要结局：产科肛门括约肌损伤（OASI）（按奇偶数统计）；新生儿综合主要结局：胎儿或新生儿死亡、出生后48小时内因呼吸支持或使用抗生素而入住新生儿病房：结论：在使用水中分娩的产妇中，水中分娩的不良结局发生率（水中分娩：269/24 451 [1.1%]对非水中分娩：144/8565 [1.7%]；aOR 0.64，单侧 95% CI -∞ to 0.78）和婴儿的综合不良结局发生率（水中分娩：263/9868 [2.7%]对非水中分娩：224/5078 [4.4%]；aOR 0.65，单侧 95% CI -∞ to 0.79）均高于非水中分娩（水中分娩：269/24 451 [1.1%]对非水中分娩：144/8565 [1.7%]；aOR 0.64，单侧 95% CI -∞ to 0.78）：结论：在使用水中分娩的产妇中，留在水池中分娩与产妇或新生儿不良预后发生率的增加无关。
Maternal and neonatal outcomes among spontaneous vaginal births occurring in or out of water following intrapartum water immersion: The POOL cohort study.
Objective: Warm water immersion during labour provides women with analgesia and comfort. This cohort study aimed to establish among women using intrapartum water immersion analgesia, without antenatal or intrapartum risk factors, whether waterbirth is as safe for them and their babies as leaving the water before birth.
Design: Cohort study with non-inferiority design.
Setting: Twenty-six UK NHS maternity services.
Sample: A total of 73 229 women without antenatal or intrapartum risk factors, using intrapartum water immersion, between 1 January 2015 and 30 June 2022. The analysis excluded 12 827 (17.5%) women who received obstetric or anaesthetic interventions before birth.
Methods: Non-inferiority analysis of retrospective and prospective data captured in NHS maternity and neonatal information systems.
Main outcome measures: Maternal primary outcome: obstetric anal sphincter injury (OASI) by parity; neonatal composite primary outcome: fetal or neonatal death, neonatal unit admission with respiratory support or administration of antibiotics within 48 hours of birth.
Results: Rates of the primary outcomes were no higher among waterbirths compared with births out of water: rates of OASI among nulliparous women (waterbirth: 730/15 176 [4.8%] versus births out of water: 641/12 210 [5.3%]; adjusted odds ratio [aOR] 0.97, one-sided 95% CI, -∞ to 1.08); rates of OASI among parous women (waterbirth: 269/24 451 [1.1%] versus births out of water 144/8565 [1.7%]; aOR 0.64, one-sided 95% CI -∞ to 0.78) and rates of the composite adverse outcome among babies (waterbirth 263/9868 [2.7%] versus births out of water 224/5078 [4.4%]; aOR 0.65, one-sided 95% CI -∞ to 0.79).
Conclusion: Among women using water immersion during labour, remaining in the pool and giving birth in water was not associated with an increase in the incidence of adverse primary maternal or neonatal outcomes.
期刊介绍：
BJOG is an editorially independent publication owned by the Royal College of Obstetricians and Gynaecologists (RCOG). The Journal publishes original, peer-reviewed work in all areas of obstetrics and gynaecology, including contraception, urogynaecology, fertility, oncology and clinical practice. Its aim is to publish the highest quality medical research in women''s health, worldwide.
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