摘要
The purpose of this study was to determine what factors are independently associated with an in creased likelihood of failed operative vaginal delivery.We conducted a popula-tion -based case -control study evaluating maternal,pregnancy,provider,care setting,and fetal factors asso-ciated with failed operative vaginal delivery.Subjects were identified using Washington state b irth certificates for in-fants born between 1992and 2001.Cases(n =1750)were live -born singletons with both labored cesarean de-livery and an operative vaginal deli very("failure")-coded on the birth certificate.Cont rols(n =3500),fre-quency matched by delivery year to th e cases,were ran-domly selected from among singleton s undergoing a suc-cessful operative vaginal delivery.Odds ratios(OR)and associated 95%CI,estimated with Ma ntel -Haenszel methods,measured the association b etween case status and potential risk factors.Failed operative vaginal delivery was associated with increased maternal age,African American race,higher body mass index(BMI ),diabetes,polyhy-dramnios,induction of labor,dysfu nctional labor,and prolonged labor.Case compared with control mothers were more likely to deliver a low -birth we ight or macrosomic infant.Identification of maternal and fetal factors associ-ated with failed operative vaginal d elivery may enable providers to better counsel patient s,and allow improved planning and allocation of surgical resources.
The purpose of this study was to determine what factors are independently associated with an in creased likelihood of failed operative vaginal delivery.We conducted a popula-tion -based case -control study evaluating maternal,pregnancy,provider,care setting,and fetal factors asso-ciated with failed operative vaginal delivery.Subjects were identified using Washington state b irth certificates for in-fants born between 1992and 2001.Cases(n =1750)were live -born singletons with both labored cesarean de-livery and an operative vaginal deli very('failure')-coded on the birth certificate.Cont rols(n =3500),fre-quency matched by delivery year to th e cases,were ran-domly selected from among singleton s undergoing a suc-cessful operative vaginal delivery.Odds ratios(OR)and associated 95%CI,estimated with Ma ntel -Haenszel methods,measured the association b etween case status and potential risk factors.Failed operative vaginal delivery was associated with increased maternal age,African American race,higher body mass index(BMI ),diabetes,polyhy-dramnios,induction of labor,dysfu nctional labor,and prolonged labor.Case compared with control mothers were more likely to deliver a low -birth we ight or macrosomic infant.Identification of maternal and fetal factors associ-ated with failed operative vaginal d elivery may enable providers to better counsel patient s,and allow improved planning and allocation of surgical resources.
