Myles Thomas D, Santolaya Joaquin
Department of Obstetrics and Gynecology, Saint Louis University, St. Mary's Health Center, St. Louis, Missouri 63117, USA.
Obstet Gynecol. 2003 Jul;102(1):52-8. doi: 10.1016/s0029-7844(03)00400-9.
To determine risk factors for a prolonged second stage of labor and evaluate the maternal and neonatal outcomes of such pregnancies.
We reviewed all 7818 patients who delivered at the University of Illinois at Chicago from 1996 to 1999. Excluding nonvertex and multiple gestations, 6791 reached the second stage. Group 1 (n = 6259) consisted of patients with a second stage of 120 minutes or less; group 2, greater than 120 minutes (n = 532 [7.8%]); group 2A, 121-240 minutes (n = 384 [5.7%]); and group 2B, greater than 240 minutes (n = 148 [2.2%]). We compared pregnancy outcomes for these groups with respect to maternal and neonatal morbidity factors using chi(2), Student t, and Wilcoxon rank-sum tests (significance, P <.05).
Vaginal delivery rates were 98.7% (group 1), 84.0% (group 2), 90.2% (group 2A), and 65.5% (group 2B). Group 2 had higher rates of perineal trauma, episiotomy usage, chorioamnionitis, postpartum hemorrhage, and operative vaginal delivery than group 1 (P <.001, all comparisons). Group 2B had higher rates of episiotomy usage, operative vaginal deliveries, and perineal trauma than group 2A (P <.001, all comparisons). The neonatal morbidity rates were similar for the three groups. Diabetes, preeclampsia (P <.023), macrosomia, nulliparity, chorioamnionitis, oxytocin usage, and labor induction were each independently associated with an increased risk of a prolonged second stage (all but preeclampsia, P <.001).
A prolonged second stage is associated with a high rate of vaginal delivery, but a high rate of maternal, though not neonatal, morbidity was observed. Certain antenatal and intrapartum conditions are associated with a prolonged second stage of labor.
确定第二产程延长的危险因素，并评估此类妊娠的母婴结局。
我们回顾了1996年至1999年在伊利诺伊大学芝加哥分校分娩的所有7818例患者。排除非头位和多胎妊娠后，6791例进入第二产程。第1组（n = 6259）由第二产程为120分钟或更短的患者组成；第2组，超过120分钟（n = 532 [7.8%]）；第2A组，121 - 240分钟（n = 384 [5.7%]）；第2B组，超过240分钟（n = 148 [2.2%]）。我们使用卡方检验、学生t检验和威尔科克森秩和检验比较了这些组在母婴发病因素方面的妊娠结局（显著性，P <.05）。
阴道分娩率分别为98.7%（第1组）、84.0%（第2组）、90.2%（第2A组）和65.5%（第2B组）。第2组的会阴创伤、会阴切开术使用率、绒毛膜羊膜炎、产后出血和阴道助产率均高于第1组（所有比较，P <.001）。第2B组的会阴切开术使用率、阴道助产率和会阴创伤率高于第2A组（所有比较，P <.001）。三组的新生儿发病率相似。糖尿病、先兆子痫（P <.023）、巨大儿、初产、绒毛膜羊膜炎、缩宫素使用和引产均与第二产程延长风险增加独立相关（除先兆子痫外，所有P <.001）。
第二产程延长与高阴道分娩率相关，但观察到产妇发病率高，而新生儿发病率不高。某些产前和产时情况与第二产程延长有关。
