与剖宫产率相比，阴道顺产率是一项质量指标：人口数据库定量分析。

IF 2 Q2 OBSTETRICS & GYNECOLOGY

Journal of obstetrics and gynaecology Canada Pub Date : 2024-10-16 DOI:10.1016/j.jogc.2024.102693

Geoffrey W. Cundiff MD , Paramdeep Kaur PhD , Gillian E. Hanley PhD , Patti Janssen PhD

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引用次数: 0

摘要

目的：本研究的目的是比较阴道无并发症分娩率（VUD）和剖宫产率，前者的定义是所有阴道分娩（包括产钳和真空助产）均未出现产妇或新生儿不良分娩结局，后者则是一项绩效指标。该辖区的大多数产科医生都从事产科咨询工作，重点支持初级产科护理。结果：我们报告了 210 名产科医生的 16 620 例分娩，阴道分娩率为 39.6%，其中 36.6%为阴道手术分娩。总的AD率为9.9%，总的VUD率为34%。结论：产科质量保证必须在有限数据的基础上平衡两位患者的需求。我们的数据显示了现行绩效指标 CD 率的缺陷，它与孕妇或婴儿的分娩结果并不相关。宫内节育率提供了一个既能评估分娩方式又能评估分娩结果的替代指标。目的：本研究旨在比较无并发症阴道分娩率（CVDR）与剖腹产率这一绩效指标，前者定义为无不良孕产妇或新生儿结局的阴道分娩（包括产钳或真空）比例，后者定义为无不良孕产妇或新生儿结局的阴道分娩比例。方法：这是一项回顾性队列分析，从省级数据库中提取了产科医生一年内所有足月分娩的数据，其中不包括阻碍活跃产程的诊断。该省的大多数产科医生都有产科咨询业务，主要提供初级产科护理。我们研究了以不良后果指数（AOI）衡量的分娩不良事件（AEs）发生率与剖腹产率和 VBAC 发生率之间的相关性。结果：我们记录了 210 名产科医生的 16,620 例分娩，阴道分娩率为 39.6%；在这些阴道分娩中，36.6% 为助产分娩。总体AE率为9.9%；总体VBAC率为34%。结论：产科质量保证必须在有限数据的基础上平衡两位患者的需求。我们的数据显示了剖腹产率作为主要绩效指标的不足之处，因为该比率与产妇或新生儿的预后无关。更好的办法是采用顺产率，因为它既能评估分娩方式，又能评估分娩结果。通过剖宫产率的棱镜来审视护理质量，将为孕妇及其婴儿的最佳结果提供更好的指标。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

查看原文本刊更多论文

Vaginal Uncomplicated Delivery Rate as a Quality Indicator Compared to Cesarean Delivery Rate: A Quantitative Analysis of a Population Database

Objectives

The objective of this study is to compare the vaginal uncomplicated delivery (VUD) rate, defined as all vaginal deliveries (including forceps and vacuum) without an adverse maternal or neonatal labour outcome, to the cesarean delivery (CD) rate, as a performance indicator.

Methods

This is a retrospective cohort analysis from a provincial database of all term deliveries by an obstetrician in a single year, excluding diagnoses preventing active labour. Most obstetricians in this jurisdiction practice consultative obstetrics, focused on supporting primary maternity care. We investigated the association of adverse delivery (AD), measured by the adverse outcome index, with CD and VUD rates.

Results

We report 16 620 deliveries by 210 obstetricians, with a vaginal delivery rate of 39.6%, of which 36.6% were operative vaginal delivery. The overall AD rate was 9.9%, and the overall VUD rate was 34%. While the CD and VUD both correlated with the mode of delivery, only the VUD rate was correlated to the AD rate.

Conclusions

Quality assurance in obstetrics must balance the needs of 2 patients based on limited data. Our data shows the shortcomings of the prevailing performance indicator, CD rate, which does not correlate with birth outcomes for the pregnant patient or infant. The VUD rate provides an alternative that assesses both mode of delivery and labour outcomes. Shifting the quality lens to focus on the VUD rate will provide a better metric that measures optimal outcomes for pregnant people and their babies.

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来源期刊

Journal of obstetrics and gynaecology Canada OBSTETRICS & GYNECOLOGY-

CiteScore

3.30

自引率

5.60%

发文量

302

审稿时长

32 days

期刊介绍： Journal of Obstetrics and Gynaecology Canada (JOGC) is Canada"s peer-reviewed journal of obstetrics, gynaecology, and women"s health. Each monthly issue contains original research articles, reviews, case reports, commentaries, and editorials on all aspects of reproductive health. JOGC is the original publication source of evidence-based clinical guidelines, committee opinions, and policy statements that derive from standing or ad hoc committees of the Society of Obstetricians and Gynaecologists of Canada. JOGC is included in the National Library of Medicine"s MEDLINE database, and abstracts from JOGC are accessible on PubMed.