水中出産は安全か? 合併症のない妊婦にとって水中出産は産前に水から出るのと同じくらい安全。(Are waterbirths safe?New research confirms that for women with an uncomplicated pregnancy, having a waterbirth is as safe as leaving the water before birth.)

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2024-06-11 カーディフ大学

87,000人以上の女性を対象とした研究で、無合併症の妊娠中に水中での分娩が母親と赤ちゃんにとって安全であるかを調査しました。研究は2015年から2022年にかけて、英国とウェールズの26のNHS機関で行われました。結果、母親と赤ちゃんにおける重度の裂傷や新生児の抗生物質必要性、呼吸補助の必要性、および死亡率は、水中分娩と陸上分娩でほぼ同等であることが示されました。水中での分娩は安全であり、特に初産婦や既産婦において低い帝王切開率が確認されました。この結果は、毎年多くの女性に影響を与えると考えられます。

<関連情報>

水中または水外で行われた自然経膣分娩のうち、分娩時水中浸漬後の母体および新生児の転帰: POOLコホート研究 Maternal and neonatal outcomes among spontaneous vaginal births occurring in or out of water following intrapartum water immersion: The POOL cohort study

Julia Sanders, Christy Barlow, Peter Brocklehurst, Rebecca Cannings-John, Susan Channon, Judith Cutter, Billie Hunter, Mervi Jokinen, Fiona Lugg-Widger, Sarah Milosevic, Chris Gale …
BJOG: An International Journal of Obstetrics & Gynaecology  Published: 10 June 2024
DOI:https://doi.org/10.1111/1471-0528.17878

水中出産は安全か? 合併症のない妊婦にとって水中出産は産前に水から出るのと同じくらい安全。(Are waterbirths safe?New research confirms that for women with an uncomplicated pregnancy, having a waterbirth is as safe as leaving the water before birth.)

Abstract

Objective
Warm water immersion during labour provides women with analgesia and comfort. This cohort study aimed to establish among women using intrapartum water immersion analgesia, without antenatal or intrapartum risk factors, whether waterbirth is as safe for them and their babies as leaving the water before birth.

Design
Cohort study with non-inferiority design.

Setting
Twenty-six UK NHS maternity services.

Sample
A total of 73 229 women without antenatal or intrapartum risk factors, using intrapartum water immersion, between 1 January 2015 and 30 June 2022. The analysis excluded 12 827 (17.5%) women who received obstetric or anaesthetic interventions before birth.

Methods
Non-inferiority analysis of retrospective and prospective data captured in NHS maternity and neonatal information systems.

Main outcome measures
Maternal primary outcome: obstetric anal sphincter injury (OASI) by parity; neonatal composite primary outcome: fetal or neonatal death, neonatal unit admission with respiratory support or administration of antibiotics within 48 hours of birth.

Results
Rates of the primary outcomes were no higher among waterbirths compared with births out of water: rates of OASI among nulliparous women (waterbirth: 730/15 176 [4.8%] versus births out of water: 641/12 210 [5.3%]; adjusted odds ratio [aOR] 0.97, one-sided 95% CI, -∞ to 1.08); rates of OASI among parous women (waterbirth: 269/24 451 [1.1%] versus births out of water 144/8565 [1.7%]; aOR 0.64, one-sided 95% CI -∞ to 0.78) and rates of the composite adverse outcome among babies (waterbirth 263/9868 [2.7%] versus births out of water 224/5078 [4.4%]; aOR 0.65, one-sided 95% CI -∞ to 0.79).

Conclusion
Among women using water immersion during labour, remaining in the pool and giving birth in water was not associated with an increase in the incidence of adverse primary maternal or neonatal outcomes.

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