当前位置:科学网首页 > 小柯机器人 >详情
以患者为中心的决策支持工具对剖宫产术后阴道试产率无影响
作者:小柯机器人 发布时间:2020/6/3 16:56:30

美国西北大学William A. Grobman联合加州大学Miriam Kuppermann团队分析了使用以患者为中心的决策支持工具对头胎剖宫产女性阴道试产的影响。2020年6月2日,该研究发表在《美国医学会杂志》上。

在美国,降低剖宫产率是一项重要的公共卫生目标。尽管有证据表明剖宫产后再次阴道分娩的安全性,但大多数二胎孕妇仍被安排再次剖宫产。决策支持工具可帮助提高阴道试产率。

为了分析以患者为中心的决策支持工具对一胎剖宫产后再次妊娠的女性阴道试产率、阴道分娩率及决策质量的影响,2016年1月至2019年1月,研究组在波士顿、芝加哥和旧金山湾地区进行了一项多中心、随机、平行分组的临床试验,招募了1485名说英语或西班牙语的孕妇,她们一胎均为剖宫产,且没有分娩禁忌症。将其随机分组,其中742名孕妇在孕25周前使用基于平板电脑的决策支持工具(干预组),743名仅接受常规护理(对照组)。

1485名孕妇的平均年龄为34.0岁,其中1470例完成了试验,并被纳入分析。干预组和对照组的阴道试产率分别为43.3%和46.2%,无显著差异。两组的阴道分娩率均为31.8%,其他6项母婴临床指标亦无显著差异。两组间在5个决策质量评分中也没有显着差异。

总之,对于头胎剖宫产的女性,与常规护理相比,使用决策支持工具并没有显著提高阴道试产率。

附:英文原文

Title: Effect of a Patient-Centered Decision Support Tool on Rates of Trial of Labor After Previous Cesarean Delivery: The PROCEED Randomized Clinical Trial

Author: Miriam Kuppermann, Anjali J. Kaimal, Cinthia Blat, Juan Gonzalez, Mari-Paule Thiet, Yamilee Bermingham, Anna L. Altshuler, Allison S. Bryant, Peter Bacchetti, William A. Grobman

Issue&Volume: 2020/06/02

Abstract: Importance  Reducing cesarean delivery rates in the US is an important public health goal; despite evidence of the safety of vaginal birth after cesarean delivery, most women have scheduled repeat cesarean deliveries. A decision support tool could help increase trial-of-labor rates.

Objective  To analyze the effect of a patient-centered decision support tool on rates of trial of labor and vaginal birth after cesarean delivery and decision quality.

Design, Setting, and Participants  Multicenter, randomized, parallel-group clinical trial conducted in Boston, Chicago, and the San Francisco Bay area. A total of 1485 English- or Spanish-speaking women with 1 prior cesarean delivery and no contraindication to trial of labor were enrolled between January 2016 and January 2019; follow-up was completed in June 2019.

Interventions  Participants were randomized to use a tablet-based decision support tool prior to 25 weeks’ gestation (n=742) or to receive usual care (without the tool) (n=743).

Main Outcomes and Measures  The primary outcome was trial of labor; vaginal birth was the main secondary outcome. Other secondary outcomes focused on maternal and neonatal outcomes and decision quality.

Results  Among 1485 patients (mean age, 34.0 [SD, 4.5] years), 1470 (99.0%) completed the trial (n=735 in both randomization groups) and were included in the analysis. Trial-of-labor rates did not differ significantly between intervention and control groups (43.3% vs 46.2%, respectively; adjusted absolute risk difference, –2.78% [95% CI, –7.80% to 2.25%]; adjusted relative risk, 0.94 [95% CI, 0.84-1.05]). There were no statistically significant differences in vaginal birth rates (31.8% in both groups; adjusted absolute risk difference, –0.04% [95% CI, –4.80% to 4.71%]; adjusted relative risk, 1.00 [95% CI, 0.86-1.16]) or in any of the other 6 clinical maternal and neonatal secondary outcomes. There also were no significant differences between the intervention and control groups in the 5 decision quality measures (eg, mean decisional conflict scores were 17.2 and 17.5, respectively; adjusted mean difference, –0.38 [95% CI, –1.81 to 1.05]; scores >25 are considered clinically important).

Conclusions and Relevance  Among women with 1 previous cesarean delivery, use of a decision support tool compared with usual care did not significantly change the rate of trial of labor. Further research may be needed to assess the efficacy of this tool in other clinical settings or when implemented at other times in pregnancy.

DOI: 10.1001/jama.2020.5952

Source: https://jamanetwork.com/journals/jama/article-abstract/2766634

期刊信息

JAMA-Journal of The American Medical Association:《美国医学会杂志》,创刊于1883年。隶属于美国医学协会,最新IF:51.273
官方网址:https://jamanetwork.com/
投稿链接:http://manuscripts.jama.com/cgi-bin/main.plex