Objective

To examine the prevalence of exposure and perinatal outcomes associated with in utero exposure to methoxyflurane.

Design, Setting and Population

Whole-population ambulance data in Western Australia (WA) were linked to the statutory perinatal data collection to identify pregnant women transferred by ambulance between 2000 and 2016. The proportion of neonates in WA exposed to methoxyflurane, fentanyl or no analgesia during an ambulance transfer was calculated. Perinatal outcomes of pregnancies exposed to methoxyflurane (n=1579) were compared to those exposed to fentanyl (n=203) or no analgesia (n=10524) using multivariable logistic regression modelling. Perinatal outcomes were considered overall and by trimester of exposure.

Main Outcome Measures

Primary outcomes were the prevalence of in utero methoxyflurane exposure and Apgar score on the day of delivery.

Results

In the study period, 0.4% of all neonates born in WA were exposed to methoxyflurane in utero. Methoxyflurane exposure on the day of delivery (n=657) was not associated with an increased likelihood of a low Apgar score at five minutes compared with no analgesia (n=2667) (OR 1.23, 95% CI 0.91-1.67). Whereas fentanyl exposure (n=22) was associated with an increased likelihood of low Apgar score compared with methoxyflurane (OR 3.67, 95% CI 1.18-11.48).

Conclusions

Methoxyflurane is commonly used by ambulance services to treat pain in pregnant women in WA. While not recommended for use in pregnancy, pregnancies exposed to methoxyflurane did not have an increased risk of adverse perinatal outcomes in this study.

中文翻译：

---

宫内暴露于院前紧急甲氧氟烷后的患病率和围产期结局：一项 17 年回顾性队列研究

客观的

检查与子宫内甲氧氟醚暴露相关的暴露流行率和围产期结局。

设计、环境和人口

西澳大利亚州 (WA) 的全人口救护车数据与法定围产期数据收集相关联，以识别 2000 年至 2016 年期间由救护车转移的孕妇。在救护车转移期间，西澳大利亚州新生儿接触甲氧氟醚、芬太尼或未使用镇痛剂的比例为计算出来的。使用多变量逻辑回归模型将暴露于甲氧氟醚（n = 1579）的妊娠与暴露于芬太尼（n = 203）或无镇痛（n = 10524）的妊娠的围产期结果进行比较。围产期结局被考虑整体和暴露的三​​个月。

主要观察指标

主要结果是分娩当天子宫内甲氧氟醚暴露率和 Apgar 评分。

结果

在研究期间，在西澳出生的所有新生儿中有 0.4% 在子宫内接触过甲氧氟醚。与未使用镇痛剂 (n=2667) 相比，分娩当天 (n=657) 的甲氧氟醚暴露与五分钟时 Apgar 评分低的可能性增加无关 (OR 1.23, 95% CI 0.91-1.67)。而与甲氧氟醚相比，芬太尼暴露 (n=22) 与低 Apgar 评分的可能性增加有关 (OR 3.67, 95% CI 1.18-11.48)。

结论

救护车服务通常使用甲氧氟醚来治疗西澳孕妇的疼痛。虽然不建议在妊娠期使用，但在本研究中，暴露于甲氧氟醚的妊娠并未增加围产期不良结局的风险。