Ould El Joud D, Bouvier-Colle M-H
Direction de la Planification, Coopération et Statistiques, Ministère de la Santé et des Affaires Sociales, Nouakchott, Mauritanie.
J Gynecol Obstet Biol Reprod (Paris). 2002 Feb;31(1):51-62.
The MOMA study is a prospective population-based follow-up study of 20,326 pregnant women in West Africa. Due to the likely diagnostic and recall bias for home deliveries, risk factors for dystocia were analyzed only for deliveries in health facilities. A total of 16,318 deliveries were analyzed.
The incidence of dystocia was 18.3% (95%CI: 17.7-18.9). Multivariate analysis using stepwise logistic regression disclosed the following significant risk factors: short stature, scarred uterus, nulliparity. Positive predictive values were very low for both univariate and multivariate analysis.
The incidence of dystocia, which occurs mainly at delivery, is high in West Africa. Consequences are often dramatic, both for the fetus and the mother. None of the risk factors studied, even when used in combination, provided a good prediction of dystocia. All pregnant women should therefore be considered at risk of dystocia. Efforts should be made to detect dystocia during labor (partography) and to provide good-quality emergency obstetric care. Emergency obstetric care must be made available to all pregnant women. This goal can be achieved in most of the major West African cities. More facilities offering good-quality cesarean section must be made available.
1）测量西非六个城市和一个农村地区难产的发生率。2）确定难产的风险因素，并分析它们之间的相互关系，以期利用这些因素识别参加产前检查的高危孕妇。（3）评估这些因素作为孕期难产预测指标的有效性。
MOMA研究是一项基于人群的前瞻性随访研究，对西非20326名孕妇进行了研究。由于家庭分娩可能存在诊断和回忆偏差，仅对医疗机构分娩的难产风险因素进行了分析。共分析了16318例分娩。
难产发生率为18.3%（95%CI：17.7-18.9）。采用逐步逻辑回归进行多变量分析，发现以下显著风险因素：身材矮小、子宫瘢痕、初产。单变量和多变量分析的阳性预测值都很低。
难产发生率在西非较高，主要发生在分娩时。对胎儿和母亲的后果往往都很严重。所研究的风险因素，即使联合使用，也不能很好地预测难产。因此，所有孕妇都应被视为有难产风险。应努力在分娩期间（产程图）检测难产，并提供高质量的紧急产科护理。必须为所有孕妇提供紧急产科护理。这一目标在大多数西非主要城市都可以实现。必须提供更多能进行高质量剖宫产的设施。
