小柯机器人

英国伦敦卫生与热带医学院Jennifer Jardine团队评估了初产妇和经产妇足月复杂分娩的风险。2020年10月1日，该研究发表在《英国医学杂志》上。

为了根据美国国立卫生研究院的产前护理指南，来确定低危女性（无既往病史、重要产科病史或孕期并发症）足月妊娠的复杂分娩率，并通过考虑均等性和风险因素的数量来评估是否可改善风险分类，研究组使用孕妇的电子记录进行了一项队列研究。

2015年4月至2016年3月，研究组在英国87家NHS医院信托基金招募了276766名足月单胎分娩女性，复杂分娩的综合结局定义为使用器械分娩、剖腹产、肛门括约肌损伤、产后出血或五分钟内Apgar评分为7分及以下。

无剖腹产史的经产女性复杂分娩率最低，从无特定危险因素的8.8%到有三项及以上危险因素的21.8%不等。初产妇的复杂分娩率较高，相应的比率从43.4％到64.3％不等；在进行过剖腹产的经产妇中最高，相应的比率从42.9％到66.3％不等。

研究结果表明，无危险因素的初产妇复杂分娩率显著高于无剖腹产史的经产妇，即使后者有多种危险因素。

附：英文原文

Title: Risk of complicated birth at term in nulliparous and multiparous women using routinely collected maternity data in England: cohort study

Author: Jennifer Jardine, Andrea Blotkamp, Ipek Gurol-Urganci, Hannah Knight, Tina Harris, Jane Hawdon, Jan van der Meulen, Kate Walker, Dharmintra Pasupathy

Issue&Volume: 2020/10/01

Abstract:

Objectives To determine the rate of complicated birth at term in women classified at low risk according to the National Institute for Health and Care Excellence guideline for intrapartum care (no pre-existing medical conditions, important obstetric history, or complications during pregnancy) and to assess if the risk classification can be improved by considering parity and the number of risk factors.

Design Cohort study using linked electronic maternity records.

Participants 276766 women with a singleton birth at term after a trial of labour in 87 NHS hospital trusts in England between April 2015 and March 2016.

Main outcome measure A composite outcome of complicated birth, defined as a birth with use of an instrument, caesarean delivery, anal sphincter injury, postpartum haemorrhage, or Apgar score of 7 or less at five minutes.

Results Multiparous women without a history of caesarean section had the lowest rates of complicated birth, varying from 8.8% (4879 of 55426 women, 95% confidence interval 8.6% to 9.0%) in those without specific risk factors to 21.8% (613 of 2811 women, 20.2% to 23.4%) in those with three or more. The rate of complicated birth was higher in nulliparous women, with corresponding rates varying from 43.4% (25 805 of 59413 women, 43.0% to 43.8%) to 64.3% (364 of 566 women, 60.3% to 68.3%); and highest in multiparous women with previous caesarean section, with corresponding rates varying from 42.9% (3426 of 7993 women, 41.8% to 44.0%) to 66.3% (554 of 836 women, 63.0% to 69.5%).

Conclusions Nulliparous women without risk factors have substantially higher rates of complicated birth than multiparous women without a previous caesarean section even if the latter have multiple risk factors. Grouping women first according to parity and previous mode of birth, and then within these groups according to presence of specific risk factors would provide greater and more informed choice to women, better targeting of interventions, and fewer transfers during labour than according to the presence of risk factors alone.

DOI: 10.1136/bmj.m3377

Source: https://www.bmj.com/content/371/bmj.m3377

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