Continued reduction in the incidence of birth trauma and birth asphyxia related to instrumental deliveries after the study period: Was this the Hawthorne effect?
Continued reduction in the incidence of birth trauma and birth asphyxia related to instrumental deliveries after the study period: Was this the Hawthorne effect?
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DOI：
10.1016/j.ejogrb.2006.02.013
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发表时间：
2007-02-01
期刊：
影响因子：
--
通讯作者：
Lao, T. T.
中科院分区：
文献类型：
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作者：
Leung, W. C.;Chan, B. C. P.;Lao, T. T.
背景：1998-1999年，我们产科与器械分娩相关的产伤和出生窒息的发生率很高（2.8%）。2000年进行了一项研究，以确定风险因素。出乎意料的是，研究期间发生率（0.6%）显著降低。我们把这种现象归因于著名的霍桑效应（由于意识到被研究而有提高业绩的倾向）。目的是研究在研究后阶段，与器械分娩相关的产伤和出生窒息的发生率是否持续降低（2001-2003），并调查除了霍桑效应之外的潜在混杂因素的存在。比较研究前期间医院产科统计数据（1998-1999年）、研究期（2000年）和研究后时期（2001-2003年），特别是与器械分娩有关的产伤和出生窒息的发生率、器械分娩率、剖腹产总比率、产后无进展的剖腹产比率，结果：产伤发生率、新生儿窒息发生率与器械助产有关，产伤发生率与器械助产有关，产伤发生率与新生儿窒息发生率与器械助产有关研究期间（2000年）（0.6%）显著低于研究前期间（1998-1999年; RR 0.27，95% CI 0.11-0.70）（2.8%）。这种现象持续到研究后阶段（2001-2003年），当时的发生率为1.0%，与研究前阶段的发生率相似（RR 0.35，95% CI 0.20-0.64）。在研究后阶段，工具性分娩率进一步下降（13.5%）与研究中相比，（16.6%）和研究前（19.5%）（RR 0.81，95% CI 0.75-0.89和RR 0.69，95% CI 0.65-0.74），在研究后阶段，直接第二阶段剖腹产率显著增加（7.1%）与研究中的患者相比，（0.4%）和研究前（0.7%）（RR 15.9，95% CI 5.05-49.73和RR 9.77，95% CI 5.28-18.08）。产科实践的变化被确定，这可能解释了在研究后阶段与器械分娩相关的产伤和出生窒息发生率的持续下降。(c)2006爱思唯尔爱尔兰有限公司保留所有权利。
Background: The incidence of birth trauma and birth asphyxia related to instrumental deliveries in our obstetric unit was high (2.8%) in 1998-1999. A study was performed in 2000 to identify the risk factors. Unexpectedly, the incidence (0.6%) was reduced significantly during the study period. We attributed this phenomenon to the famous Hawthorne effect (tendency to improve performance because of awareness of being studied).Objectives: The objectives were to study whether there is a continued reduction in the incidence of birth trauma and birth asphyxia related to instrumental deliveries in the post-study period (2001-2003) and to investigate the presence of underlying confounding factors apart from the Hawthorne effect.Method: To compare the hospital obstetric statistics among the pre-study period (1998-1999), the Study period (2000) and the post-study period (2001-2003), in particular the incidence of birth trauma and birth asphyxia related to instrumental deliveries, the instrumental delivery rate, the overall Caesarean section rate, the Caesarean section rate for no progress of tabour, the incidence of failed instrumental delivery, the incidence of attempted instrumental delivery in the operating theatre, and incidence of direct second-stage Caesarean sections.Results: The incidence of birth trauma and birth asphyxia related to instrumental deliveries (0.6%) during the study period (2000) was significantly lower than that (2.8%) during the pre-study period (1998-1999; RR 0.27, 95% CI 0.11-0.70). This phenomenon continued into the post-study period (2001-2003) when the incidence of 1.0% was similarly lower than that in the pre-study period (RR 0.35, 95% CI 0.20-0.64). The instrumental delivery rate decreased further in the post-study period (13.5%) compared with those in the study (16.6%) and prestudy (19.5%) periods (RR 0.81, 95% CI 0.75-0.89 and RR 0.69, 95% CI 0.65-0.74, respectively), There was a marked increase in the direct second-stage Caesarean section rate in the post-study period (7.1 %) compared to those in the study (0.4%) and pre-study (0.7%) periods (RR 15.9, 95% CI 5.05-49.73 and RR 9.77, 95% CI 5.28-18.08, respectively).Conclusion: A change in obstetric practice was identified that may explain the continued reduction in the incidence of birth trauma and birth asphyxia related to instrumental deliveries in the post-study period. (c) 2006 Elsevier Ireland Ltd. All rights reserved.