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Abstract：
National Swedish data shows substantial variation in the use of oxytocin for augmentation of spontaneous labour between obstetric units. This study aimed to investigate if variations in the use of oxytocin augmentation are associated with maternal and infant characteristics or clinical factors. We used a cohort design including women allocated to Robson group 1 (nulliparous women, gestational week ≥ 37 + 0, with singleton births in cephalic presentation and spontaneous onset of labour) and 3 (parous women, gestational week ≥ 37 + 0, with singleton births in cephalic presentation, spontaneous onset of labour, and no previous caesarean birth). Crude and adjusted logistic regression models with marginal standardisation were used to estimate risk ratios (RR) and risk differences (RD) with 95% confidence intervals (CI) for oxytocin use by obstetric unit. An interaction analysis was performed to investigate the potential modifying effect of epidural. The use of oxytocin varied between 47 and 73% in Robson group 1, and 10% and 33% in Robson group 3. Compared to the remainder of Sweden, the risk of oxytocin augmentation ranged from 13% lower (RD - 13.0, 95% CI - 15.5 to - 10.6) to 14% higher (RD 14.0, 95% CI 12.3-15.8) in Robson group 1, and from 6% lower (RD - 5.6, 95% CI - 6.8 to - 4.5) to 18% higher (RD 17.9, 95% CI 16.5-19.4) in Robson group 3. The most notable differences in risk estimates were observed among women in Robson group 3 with epidural. In conclusion, variations in oxytocin use remained despite adjusting for risk factors. This indicates unjustified differences in use of oxytocin in clinical practice.
摘要：
瑞典国家数据显示，在产科单位之间使用催产素来增加自发分娩的情况存在很大差异。这项研究旨在调查催产素增强的使用差异是否与母婴特征或临床因素有关。我们使用了队列设计，包括分配到Robson组1的女性(未分娩女性，孕周≥37+0，头部单胎分娩和自发分娩）和3（产妇，孕周≥37+0，头端单胎分娩，自发分娩，并且以前没有剖腹产）。使用具有边际标准化的粗逻辑回归模型和调整逻辑回归模型，以95％置信区间（CI）估计产科单位使用催产素的风险比（RR）和风险差异（RD）。进行了相互作用分析以研究硬膜外的潜在修饰作用。催产素的使用在Robson组1中在47％和73％之间变化，在Robson组3中在10％和33％之间变化。与瑞典其余地区相比，在Robson组1中,催产素增加的风险从低13%(RD-13.0,95%CI-15.5~10.6)到高14%(RD14.0,95%CI12.3~15.8),在Robson组3中从低6%(RD-5.6,95%CI-6.8~4.5)到高18%(RD17.9,95%CI16.5~19.4).在Robson3组硬膜外麻醉的女性中观察到了风险估计的最显著差异。总之,尽管对危险因素进行了调整,但催产素使用的差异仍然存在.这表明在临床实践中使用催产素存在不合理的差异。
