背景:2017年,法国国家卫生当局发布了国家指南,以支持生理劳动并减少医疗干预。这项研究的主要目的是评估这些指南的发表与IIb型围产期中心的阴道分娩率之间的关系。次要目标是评估这些准则的执行情况,他们与劳动时间的联系,产后出血率及新生儿不良结局。
方法:A前后,回顾性,单中心研究比较“前”组(2016年)和“后”组(2018年),建议发表一年后。如果妇女没有先前的剖宫产,并且在妊娠37周后以自发分娩后的头颅表现分娩了单胎胎儿,则符合资格。分析按平价分层。
结果:两个时期之间的催产素给药减少(48%vs35%,P<0.0001),羊膜切开术(人工破膜)的频率(39.5%vs27.7%,P<0.0001)。分娩时间显着延长(360vs390分钟,P<0.0001),特别是在未分娩妇女中(465分钟vs562分钟,P<0.0001)。阴道分娩的频率在两个时期之间上升(94.6%vs96%,P=0.05),产后出血率下降(6%vs4.5%,P=0.04)。脐动脉pH<7.10的新生儿和新生儿转移的数量也减少。
结论:产程中积极干预措施的减少与产程的延长和剖宫产率的降低有关,产后出血,和新生儿转移。
BACKGROUND: In 2017, the French national authority for health issued national guidelines to support physiologic labor and reduce medical interventions. This study\'s primary aim was to evaluate the association between the publication of these guidelines and the vaginal delivery rate in a type IIb perinatal center. The secondary objectives were to evaluate the implementation of these guidelines, their association with the duration of labor, and the rates of postpartum hemorrhage and adverse neonatal outcomes.
METHODS: A before-and-after, retrospective, single-center study comparing a \"before\" group (2016) and an \"after\" group (2018), one year after the recommendations were published. Women were eligible if they had no prior cesarean delivery and gave birth after 37 weeks of gestation to a singleton fetus in cephalic presentation after spontaneous labor. The analysis was stratified by parity.
RESULTS: Oxytocin administration decreased between the two periods (48% vs 35 %, P < 0.0001), as did the frequency of amniotomies (artificial rupture of membranes) (39.5 % vs 27.7 %, P < 0.0001). The duration of labor was significantly prolonged (360 vs 390 min, P < 0.0001), especially in nulliparous women (465 min vs 562 min, P<0.0001). The frequency of vaginal delivery rose between the two periods (94.6 % vs 96 %, P = 0.05), and the postpartum hemorrhage rate fell (6 % vs 4.5 %, P = 0.04). The numbers of neonates with an umbilical artery pH< 7.10 and of neonatal transfers also decreased.
CONCLUSIONS: The reduction of active interventions during labor is associated with a longer duration of labor and a decrease in the rates of cesarean births, postpartum hemorrhages, and neonatal transfers.