Dickinson Jan E, Paech Michael J, McDonald Susan J, Evans Sharon F
Department of Obstetrics and Gynaecology, University of Western Australia, Australia.
Aust N Z J Obstet Gynaecol. 2002 Feb;42(1):59-66. doi: 10.1111/j.0004-8666.2002.00065.x.
To determine if nulliparous women intending to have epidural analgesia have a similar labour profile and delivery outcome to women who intend to have their labour managed using alternative forms of pain relief.
A prospective randomised controlled clinical trial conducted at a tertiary obstetric institution. Nulliparous women intending to deliver vaginally with a term singleton fetus were eligible for recruitment.
1159 women were recruited, of whom 992 were subsequently randomised to receive continuous midwifery support (CMS) or epidural analgesia (EPI) on presentation for delivery. The duration of labour was shorter in the CMS group compared with EPI (10.7 hours (inter quartile (IQ) 7.0,15.2) versus 11.4 hours (IQ 8.2,15.2), p = 0.039). The median duration of the first stage was 8.9 hours (IQ 6,12.5) versus 9.5 hours (IQ 7,12.7) (p = 0.069), and the median duration of the second stage was 1.33 hours (IQ 0.6,2.5) versus 1.48 hours (IQ 0.77,2.6) (p = 0.034). The requirement for oxytocin augmentation in spontaneous labour was 39.8% CMS versus 46.2% EPI (p = 0.129). There was no significant difference in the caesarean section rates. The need for any operative delivery was significantly lower in CMS (43.9% CMS versus 51.5% EPI, p = 0.019).
Nulliparous women have a high usage of epidural analgesia, regardless of their prelabour intentions. In women who do not intend to use epidural analgesia, the temporal delay in insertion compared with those who use epidural analgesia as their primary analgesic modality is associated with a small but statistically significant reduction in overall labour duration and operative delivery rates.
确定计划采用硬膜外镇痛的未产妇与计划采用其他疼痛缓解方式进行分娩管理的产妇是否具有相似的产程和分娩结局。
在一家三级产科机构进行的一项前瞻性随机对照临床试验。计划经阴道分娩单胎足月胎儿的未产妇符合入选条件。
招募了1159名妇女，其中992名随后被随机分为两组，一组在分娩时接受持续助产支持（CMS），另一组接受硬膜外镇痛（EPI）。CMS组的产程比EPI组短（10.7小时（四分位间距（IQ）7.0,15.2）对11.4小时（IQ 8.2,15.2），p = 0.039）。第一产程的中位持续时间为8.9小时（IQ 6,12.5）对9.5小时（IQ 7,12.7）（p = 0.069），第二产程的中位持续时间为1.33小时（IQ 0.6,2.5）对1.48小时（IQ 0.77,2.6）（p = 0.034）。自然分娩中催产素加强的需求在CMS组为39.8%，在EPI组为46.2%（p = 0.129）。剖宫产率无显著差异。CMS组任何手术分娩的需求显著更低（CMS组为43.9%，EPI组为51.5%，p = 0.019）。
无论产前意向如何，未产妇硬膜外镇痛的使用率都很高。在不打算使用硬膜外镇痛的妇女中，与以硬膜外镇痛作为主要镇痛方式的妇女相比，插入延迟与总产程和手术分娩率的小幅但具有统计学意义的降低相关。
