Abstract：
Vacuum-assisted delivery (VAD) is a common and safe obstetric procedure. However, occasionally serious complications may occur. Clinical guidelines and College Statements have been developed to reduce the risk of serious adverse events. The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) College Statement C-Obs 16 has not been evaluated to see if advice improves outcomes.
The aim was to evaluate whether compliance with RANZCOG College Statement C-Obs 16 advice reduced the risk of serious adverse outcomes, specifically clinically significant subgaleal haemorrhage and major birth trauma.
Retrospective audit of VADs in a level five hospital (NSW Maternity and Neonatal capability framework) from January 2020 to 2021.
There were 1960 women who delivered in the study period, of whom 252 (12.8%) delivered by vacuum, and complete data were available from 241 cases. Statement compliance was observed in 81%. The main deviation from Statement compliance was pulls exceeding three. Statement compliance was associated with a significant reduction in the incidence of subgaleal haemorrhage (0% vs 11%, P = 0.0002), major birth trauma (3% vs 22%, P = 0.0001), requirement for neonatal resuscitation (14% vs 35%, P = 0.0026) and Apgar scores at one minute less than six (5% vs 22% P = 0.0006). Statement compliance was associated with a significant reduction in maternal blood loss at delivery (388 mL vs 438 mL, P = 0.01). Noncompliance with Statement advice was observed significantly more often in pregnancy complicated by gestational diabetes (3% vs 15%, P = 0.02) and birth requiring instrument change (4% vs 13% P = 0.031).
Compliance with a College Statement is associated with lower rates of subgaleal haemorrhage and major neonatal trauma. The main deviation from compliance was pulls in excess of three. Keyword: birth trauma, clinical guidelines, quality and safety in healthcare, subgaleal haemorrhage, vacuum delivery.
The aim was to evaluate whether compliance with RANZCOG College Statement C-Obs 16 advice reduced the risk of serious adverse outcomes, specifically clinically significant subgaleal haemorrhage and major birth trauma.
Retrospective audit of VADs in a level five hospital (NSW Maternity and Neonatal capability framework) from January 2020 to 2021.
There were 1960 women who delivered in the study period, of whom 252 (12.8%) delivered by vacuum, and complete data were available from 241 cases. Statement compliance was observed in 81%. The main deviation from Statement compliance was pulls exceeding three. Statement compliance was associated with a significant reduction in the incidence of subgaleal haemorrhage (0% vs 11%, P = 0.0002), major birth trauma (3% vs 22%, P = 0.0001), requirement for neonatal resuscitation (14% vs 35%, P = 0.0026) and Apgar scores at one minute less than six (5% vs 22% P = 0.0006). Statement compliance was associated with a significant reduction in maternal blood loss at delivery (388 mL vs 438 mL, P = 0.01). Noncompliance with Statement advice was observed significantly more often in pregnancy complicated by gestational diabetes (3% vs 15%, P = 0.02) and birth requiring instrument change (4% vs 13% P = 0.031).
Compliance with a College Statement is associated with lower rates of subgaleal haemorrhage and major neonatal trauma. The main deviation from compliance was pulls in excess of three. Keyword: birth trauma, clinical guidelines, quality and safety in healthcare, subgaleal haemorrhage, vacuum delivery.
摘要：
真空辅助分娩（VAD）是一种常见且安全的产科手术。然而,偶尔会出现严重的并发症。已制定临床指南和大学声明以降低严重不良事件的风险。澳大利亚和新西兰皇家妇产科学院（RANZCOG）学院声明C-Obs16尚未进行评估，以查看建议是否可以改善结果。
目的是评估是否遵守RANZCOGCollegeStatementC-Obs16建议可降低严重不良后果的风险，特别是临床上显著的盖下出血和严重的产伤。
从2020年1月至2021年，在五级医院（新南威尔士州产妇和新生儿能力框架）对VAD进行回顾性审核。
有1960名妇女在研究期间分娩，其中252人(12.8%)通过真空输送，完整的数据来自241例病例。81%的人遵守声明。与声明合规性的主要偏差是拉拔超过3。陈述依从性与大脑出血发生率的显著降低相关(0%vs11%,P=0.0002),重大产伤（3%vs22%，P=0.0001),新生儿复苏的要求(14%vs35%，P=0.0026）和一分钟少于6分钟的Apgar得分（5％vs22％P=0.0006）。陈述依从性与分娩时产妇失血量显著减少相关(388mLvs438mL,P=0.01）。在妊娠并发妊娠糖尿病的情况下，观察到不遵守陈述建议的情况更为明显（3％vs15％，P=0.02）和出生需要仪器的变化（4％vs13％P=0.031）。
遵守大学声明与较低的盖层出血和新生儿严重创伤的发生率相关。与合规性的主要偏差是拉动超过3。关键词:产伤,临床指南,医疗保健的质量和安全，延髓下出血,真空输送。
目的是评估是否遵守RANZCOGCollegeStatementC-Obs16建议可降低严重不良后果的风险，
从2020年1月至2021年，在五级医院（新南威尔士州产妇和新生儿能力框架）对VAD进行回顾性审核。
有1960名妇女在研究期间分娩，
遵守大学声明与较低的盖层出血和新生儿严重创伤的发生率相关。
