Epidural and spinal anesthesia use during labor: 27-state reporting area, 2008.
Epidural and spinal anesthesia use during labor: 27-state reporting area, 2008.
复制标题
分娩时硬膜外麻醉和脊髓麻醉的使用：27 个州报告区，2008 年。
DOI：
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发表时间：
2011
影响因子：
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通讯作者：
Joyce A. Martin
中科院分区：
文献类型：
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作者：
M. Osterman;Joyce A. Martin
目标
本报告提供了 2008 年硬膜外麻醉和脊髓麻醉接收数据，这些数据是在 2003 年美国标准活产证明上收集的。本报告的目的是描述分娩妇女的特征以及使用硬膜外麻醉或脊髓麻醉减轻阴道分娩疼痛的分娩情况。
方法
描述性统计数据提供了截至 2008 年 1 月 1 日已实施 2003 年美国标准活产证明的 27 个州居民 2008 年出生的描述性统计数据。分析仅限于 27 个州报告区域内发生的阴道分娩单胎分娩，不能推广到整个美国。
结果
总体而言，2008 年，27 个州中 61% 的阴道单胎分娩妇女接受了硬膜外麻醉或脊髓麻醉；非西班牙裔白人女性比其他种族群体更常接受硬膜外麻醉或脊髓麻醉（69%）。在西班牙裔群体中，波多黎各女性最有可能接受硬膜外麻醉或脊髓麻醉（68%）。硬膜外麻醉或脊髓麻醉的治疗水平随着母亲年龄的增长而降低。随着母亲受教育程度的提高，这一水平也随之提高。及早开始产前护理会增加接受硬膜外麻醉或脊髓麻醉的可能性，由医生接生也是如此。与自然阴道分娩（60%）相比，硬膜外麻醉或脊髓麻醉在产钳辅助阴道分娩（84%）或真空吸引术（77%）中更常见。当婴儿在妊娠 34 周之前出生或体重低于 1,500 克时，使用硬膜外麻醉或脊髓麻醉的可能性较小。与没有妊娠危险因素的女性相比，患有慢性妊娠糖尿病的女性更有可能接受硬膜外麻醉或脊髓麻醉。仓促分娩（少于 3 小时）与硬膜外麻醉或脊髓麻醉的接受减少有关。第二产程较长，胎儿窘迫（与静脉注射或注射阿片类药物的妇女相比）(1,5,6)。严重头痛、产妇低血压、产妇发烧和尿潴留也与硬膜外/脊髓麻醉有关 (5)。本报告研究了硬膜外/脊髓麻醉接受与 27 个州报告地区的母亲和阴道分娩的选定特征之间的关系，如 2003 年美国标准活产证明中所报告的那样。
OBJECTIVES
This report presents 2008 data on receipt of epidural and spinal anesthesia as collected on the 2003 U.S. Standard Certificate of Live Birth. The purpose of this report is to describe the characteristics of women giving birth and the circumstances of births in which epidural or spinal anesthesia is used to relieve the pain of labor for vaginal deliveries.
METHODS
Descriptive statistics are presented on births occurring in 2008 to residents of 27 states that had implemented the 2003 U.S. Standard Certificate of Live Birth as of January 1, 2008. Analyses are limited to singleton births in vaginal deliveries that occurred in the 27-state reporting area only and are not generalizable to the United States as a whole.
RESULTS
Overall, 61 percent of women who had a singleton birth in a vaginal delivery in the 27 states in 2008 received epidural or spinal anesthesia; non-Hispanic white women received epidural or spinal anesthesia more often (69 percent) than other racial groups. Among Hispanic origin groups, Puerto Rican women were most likely to receive epidural or spinal anesthesia (68 percent). Levels of treatment with epidural or spinal anesthesia decreased by advancing age of mother. Levels increased with increasing maternal educational attainment. Early initiation of prenatal care increased the likelihood of epidural or spinal anesthesia receipt, as did attendance at birth by a physician. Use of epidural or spinal anesthesia was more common in vaginal deliveries assisted by forceps (84 percent) or vacuum extraction (77 percent) than in spontaneous vaginal deliveries (60 percent). Use of epidural or spinal anesthesia was less likely when infants were born prior to 34 weeks of gestation or weighed less than 1,500 grams. Women with chronic and gestational diabetes were more likely to receive an epidural or spinal anesthesia than women with no pregnancy risk factors. Precipitous labor (less than 3 hours) was associated with decreased epidural or spinal anesthesia receipt. longer second stage of labor, and fetal distress (compared with women who receive opiates intravenously or by injection) (1,5,6). Severe headache, maternal hypotension, maternal fever, and urinary retention have also been associated with epidural/spinal anesthesia receipt (5). This report examines the relationship between epidural/spinal anesthesia receipt and selected characteristics of the mother and of labor among vaginal deliveries in the 27-state reporting area as reported on the 2003 U.S. Standard Certificate of Live Birth.