Using malpractice claims to identify risk factors for neurological impairment among infants following non-reassuring fetal heart rate patterns during labour.
Using malpractice claims to identify risk factors for neurological impairment among infants following non-reassuring fetal heart rate patterns during labour.
复制标题
利用医疗事故索赔来识别分娩期间胎心率模式不可靠的婴儿神经损伤的危险因素。
DOI：
10.1111/j.1365-2753.2009.01148.x
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发表时间：
2010
影响因子：
2.4
通讯作者：
Studdert,DavidM
中科院分区：
文献类型：
--
作者：
Kesselheim,AaronS;November,MartinT;Lifford,KarenL;McElrath,ThomasF;Puopolo,AnnL;Orav,EJohn;Studdert,DavidM
基本原理、目的和目的：我们试图使用一种新的病例选择方法来确定分娩过程中胎儿心率模式不稳定后与新生儿神经损伤相关的产前或产时危险因素。方法采用双因素和多因素条件logistic回归的回顾性病例对照设计。病例是出生时电子胎儿监护（EFM）显示不可靠的模式，婴儿有神经功能障碍。对照组是那些EFM不可靠但婴儿出生时健康的婴儿。我们从1985年至2001年间向马萨诸塞州一家责任保险公司提交的医疗事故索赔中确定了36例，并随机选择了70例对照，按医院、出生日期和胎龄将其与病例进行匹配。结果产前阴道出血较多（P= 0.004），第一产程潜伏期延长或扩张期延长（P= 0.03），第二产程下降期延长或扩张期延长（P= 0.01）。更多的病例在入院时（P= 0.02）和第二阶段（P= 0.02）的EFM变化也很小。多因素分析强调了复杂分娩后神经损伤的三个重要预测因素：产前阴道出血（OR = 27.1）、第一阶段潜伏期延长或扩张期延长（OR = 4.0）和第一阶段EFM表现出最小的可变性（OR = 4.3）。结论：这些有希望的初步研究结果表明，未来对伴有不稳定心率模式的复杂分娩结局的研究应侧重于产妇阴道出血史、缓慢分娩史和最小的EFM变异性。
Rationale, Aims and ObjectivesWe sought to use a novel case‐selection methodology to identify antenatal or intrapartum risk factors associated with neonatal neurological impairment following non‐reassuring fetal heart rate patterns during labour.MethodWe used a retrospective case–control design with bivariate and multivariate conditional logistic regression. Cases were births in which electronic fetal monitoring (EFM) showed non‐reassuring patterns and the infant had neurological disability. Controls were births in which EFM was non‐reassuring but the infant was born healthy. We identified 36 cases from among malpractice claims filed with a liability insurer in Massachusetts between 1985 and 2001 and randomly selected 70 controls, matching them to cases by hospital, birth date and gestational age.ResultsMore cases had maternal antenatal vaginal bleeding (P= 0.004), a prolonged latent phase or protracted dilation during the first stage of labour (P= 0.03), and protracted descent or prolonged second stage (P= 0.01). More cases also had minimal variability on EFM on admission (P= 0.02) and during the second stage (P= 0.02). Multivariate analysis highlighted three significant predictors of neurological injury following complicated labour: antenatal vaginal bleeding (OR = 27.1), prolonged latent phase or protracted dilation in the first stage (OR = 4.0) and EFM showing minimal variability in the first stage (OR = 4.3).ConclusionThese promising initial findings suggest that future research into outcomes from complicated labour with non‐reassuring heart rate patterns should focus on maternal history of vaginal bleeding, slow labour and minimal variability on EFM.