The effect of sequential use of vacuum and forceps for assisted vaginal delivery on neonatal and maternal outcomes
The effect of sequential use of vacuum and forceps for assisted vaginal delivery on neonatal and maternal outcomes
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DOI：
10.1067/mob.2001.117309
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发表时间：
2001-10-01
影响因子：
9.8
通讯作者：
Critchlow, C
中科院分区：
文献类型：
--
作者：
Gardella, C;Taylor, M;Critchlow, C
目的：研究设计：使用华盛顿州出生证明数据与医院出院记录，我们比较了3741例真空和产钳阴道分娩，3741例真空分娩和3741例产钳分娩与11,223例自然阴道分娩。与自然阴道分娩相比，顺序使用真空和产钳分娩的颅内出血率明显更高（相对风险[RR]，3.9; 95%置信区间[CI]，1.5 - 10.1），臂丛神经（RR，3.2; 95% CI，1.6 - 6.4），面神经损伤（RR，13.3; 95% CI，4.7 - 37.7），癫痫发作（RR，13.7; 95% CI，2.1 - 88.0），5分钟Apgar评分降低（RR，3.0; 95% CI，2.2 - 4.0），辅助通气（RR，4.8; 95% CI，2.1 - 11.0），4度（RR，11.4; 95% CI，在经产女性中为6.4 - 20.1）和其他撕裂伤、血肿（RR，6.2; 95% CI，在经产妇女中为2.1至18.1）和产后出血（RR，1.6; 95% CI，1.3至2.0）。顺序真空和镊子使用的相对风险大于颅内出血，面神经损伤，癫痫发作，血肿，会阴和阴道撕裂伤的每种仪器的个体相对风险的总和。结论：顺序使用真空和镊子与新生儿和产妇损伤的风险增加。
OBJECTIVE: To determine the risk of neonatal and maternal disease associated with the sequential use of vacuum and forceps compared with spontaneous vaginal delivery.STUDY DESIGN: Using Washington state birth certificate data linked to hospital discharge records, we compared 3741 vaginal deliveries by both vacuum and forceps, 3741 vacuum deliveries, and 3741 forceps deliveries to 11,223 spontaneous vaginal deliveries.RESULTS: Compared with spontaneous vaginal deliveries, deliveries by sequential use of vacuum and forceps had significantly higher rates of intracranial hemorrhage (relative risk [RR], 3.9; 95% confidence interval [CI], 1.5 to 10.1), brachial plexus (RR, 3.2; 95% Cl, 1.6 to 6.4), facial nerve injury (RR, 13.3; 95% Cl, 4.7 to 37.7), seizure (RR, 13.7; 95% Cl, 2.1 to 88.0), depressed 5-minute Apgar score (RR, 3.0; 95% Cl, 2.2 to 4.0), assisted ventilation (RR, 4.8; 95% Cl, 2.1 to 11.0), fourth-degree (RR, 11.4; 95% Cl, 6.4 to 20.1 among multiparous women) and other lacerations, hematoma (RR, 6.2; 95% Cl, 2.1 to 18.1 among multiparous women), and postpartum hemorrhage (RR, 1.6; 95% Cl, 1.3 to 2.0). The relative risk of sequential vacuum and forceps use was greater than the sum of the individual relative risks of each instrument for intracranial hemorrhage, facial nerve injury, seizure, hematoma, and perineal and vaginal lacerations.CONCLUSION: Sequential use of vacuum and forceps is associated with increased risk of both neonatal and maternal injury.