Risk factors for asphyxia associated with substandard care during labor
Risk factors for asphyxia associated with substandard care during labor
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DOI：
10.3109/00016340903418751
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发表时间：
2010-01-01
影响因子：
4.3
通讯作者：
Cnattingius, Sven
中科院分区：
文献类型：
--
作者：
Berglund, Sophie;Grunewald, Charlotta;Cnattingius, Sven
Objective.确定与新生儿窒息和与不合格护理相关的孕产妇、妊娠、分娩和婴儿特征。设计和设置。瑞典全国范围的病例对照研究。人口1990年至2005年出生的婴儿，胎龄≥ 33周，自发或引产。方法.病例是177名先前确定的患有窒息引起的脑病的婴儿，在分娩期间怀疑护理不合格，并提出经济赔偿要求。对照组是从基于人口的瑞典医学出生登记处确定的，5分钟时的阿普加评分为10分，28天龄时存活。主要结果指标。分娩期间护理不合格导致严重窒息。结果与窒息相关的母亲和分娩因素包括母亲年龄>= 30岁，母亲身材矮小（< 159 cm），既往剖宫产，孕前胰岛素依赖型糖尿病和妊娠期糖尿病，引产和夜间分娩，调整后的比值比（OR）范围为2 - 4倍。与非难产分娩相比，难产分娩的OR高5倍，如果使用硬膜外麻醉或阿片类药物，则进一步增加。当分娩过程中护理不达标时，小于胎龄和大于胎龄的婴儿、足月（>= 42周）分娩、双胞胎和臀位分娩的窒息风险增加3至8倍。结论难产，特别是如果使用了镇静剂和/或阿片类药物，是与不合格护理相关的最强风险因素，导致分娩期间严重窒息。
Objective. To identify maternal, pregnancy, delivery and infants characteristics related to neonatal asphyxia and associated with substandard care. Design and setting. A nation-wide case-control study in Sweden. Population. Infants born between 1990 and 2005 with a gestational age >= 33 weeks and a spontaneous or induced onset of labor. Methods. Cases were 177 previously identified infants suffering from encephalopathy caused by asphyxia where there was suspected substandard care during labor, and where claims for financial compensation were filed. Controls were identified from the population-based Swedish Medical Birth Register, had an Apgar score of 10 at five minutes, and were alive at 28 days of age. Main outcome measures. Severe asphyxia associated with substandard care during childbirth. Results. Maternal and delivery factors associated with asphyxia included maternal age >= 30 years, short maternal stature (< 159 cm), previous cesarean delivery, insulin-dependent diabetes before pregnancy and gestational diabetes, induced deliveries and delivery at night, with adjusted odds ratios (ORs) ranging from a two- to fourfold increase in risk. Compared with non-dystocic deliveries, the OR for dystocic deliveries was fivefold higher, and was further increased if epidural anesthesia or opioids were used. Small- and large-for-gestational age infants, post-term (>= 42 weeks) births, twins and breech deliveries had a three- to eightfold increase in risk of asphyxia when there was substandard care during labor. Conclusion. Dystocia of labor, especially if epidurals and/or opioids are used, is the strongest risk factor associated with substandard care causing severe asphyxia during labor.