Alexander James M, Sharma Shiv K, McIntire Donald D, Leveno Kenneth J
Department of Obstetrics and Gynecology, The University of Texas Southwestern Medical Center at Dallas, 75390-9032, USA.
Obstet Gynecol. 2002 Jul;100(1):46-50. doi: 10.1016/s0029-7844(02)02009-4.
To estimate the effect of epidural analgesia on the Friedman labor curve.
This study was a secondary analysis of a previously reported randomized trial of the effects of patient-controlled epidural analgesia during labor compared with patient-controlled meperidine on cesarean delivery rate. All subjects had a singleton, cephalic, nonanomalous fetus at or beyond 37 weeks' gestation. This secondary analysis was limited to women who had cervical dilatation commencing of at least 3 cm (ie, active phase of labor).
A total of 459 women were randomized. Twenty-five women were excluded for a cervix less than 3 cm dilated, leaving 220 women allocated to patient-controlled epidural analgesia and 214 to patient-controlled intravenous meperidine available for analysis. There were no significant demographic differences between the two groups, including age, race, gestational age, and cervix on admission. The active phase of labor was 1 hour longer in the epidural-treated group (6.0 +/- 3.2 hours versus 5.0 +/- 3.2 hours, P <.001). The rate of cervical dilation was significantly less with epidural analgesia (1.4 cm/h versus 1.6 cm/h, P <.002). The duration of the second stage tended to be longer in the epidural group (1.1 +/- 1.5 hours versus 0.9 +/- 1.0 hours, P =.079).
Epidural analgesia prolonged the active phase of labor by 1 hour compared with Friedman's original criteria.
评估硬膜外镇痛对弗里德曼产程曲线的影响。
本研究是一项对先前报道的随机试验的二次分析，该试验比较了分娩期间患者自控硬膜外镇痛与患者自控哌替啶对剖宫产率的影响。所有受试者均为单胎、头位、非畸形胎儿，孕周在37周及以上。本次二次分析仅限于宫颈扩张至少3 cm（即产程活跃期）开始的女性。
共有459名女性被随机分组。25名宫颈扩张小于3 cm的女性被排除，剩余220名被分配至患者自控硬膜外镇痛组，214名被分配至患者自控静脉注射哌替啶组可供分析。两组在年龄、种族、孕周和入院时宫颈情况等人口统计学特征上无显著差异。硬膜外镇痛组的产程活跃期长1小时（6.0±3.2小时对5.0±3.2小时，P<.001）。硬膜外镇痛时宫颈扩张速度明显较慢（1.4 cm/h对1.6 cm/h，P<.002）。硬膜外组第二产程持续时间有延长趋势（1.1±1.5小时对0.9±1.0小时，P=.079）。
与弗里德曼的原始标准相比，硬膜外镇痛使产程活跃期延长了1小时。
