title: The effect of vacuum operator's experience on Apgar scores.
abstract: OBJECTIVE
  To determine the effect of a vacuum operator's experience on Apgar scores.
  
  
  METHODS
  A historical cohort study was conducted. All women who delivered by vacuum extraction between January 2003 and December 2007 at Songklanagarind Hospital were recruited. Vacuum operators were divided into two groups: staff doctors and residents. Comparisons of Apgar scores and rates of low Apgar scores (≤7) between the two groups were studied. A multivariate logistic regression analysis was used to control confounding variables for low Apgar scores.
  
  
  RESULTS
  The percentages for the procedure performed by the staff doctors and residents were 76.9 and 23.1%. At 1 min, the rates of low Apgar scores in the staff and resident groups were 6.7 and 24.1% (p<0.001), and at 5 min, the rates of low Apgar scores were 0.6 and 5.2% (p<0.001). Multivariate logistic regression analysis showed that the operator's experience was an independent risk factor for low Apgar scores. The residents had a 2.9-fold increased risk of low Apgar scores at 1 min compared with the staff doctors (adjusted odds ratio 2.9; 95% confidence interval 1.7-6.8). In the resident group, the third year residents had the lowest risk of low Apgar scores.
  
  
  CONCLUSIONS
  The vacuum operator's experience was an independent risk factor for low Apgar scores. Improvement of the residency training program is mandatory.
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand.
authors.forename: Umawan
authors.initials: U
authors.lastname: Wirapornsawan
authors.forename: Chitkasaem
authors.initials: C
authors.lastname: Suwanrath
authors.forename: Sutham
authors.initials: S
authors.lastname: Pinjaroen
mesh_terms: D000328:Adult; D001034:Apgar Score; D002983:Clinical Competence; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007396:Internship and Residency / Q000592:standards*; D016015:Logistic Models; D008505:Medical Staff, Hospital / Q000592:standards*; D015999:Multivariate Analysis; D007744:Obstetric Labor Complications / Q000628:therapy; D016017:Odds Ratio; D011247:Pregnancy; D012307:Risk Factors; D013785:Thailand; D014620:Vacuum Extraction, Obstetrical / Q000193:education / Q000592:standards*; D055815:Young Adult