Chadha Y C, Mahmood T A, Dick M J, Smith N C, Campbell D M, Templeton A
Department of Obstetrics and Gynaecology, Aberdeen Maternity Hospital, UK.
Br J Obstet Gynaecol. 1992 Feb;99(2):96-100. doi: 10.1111/j.1471-0528.1992.tb14462.x.
To examine the effect of epidural analgesia on the progress and outcome of spontaneous labour in women with a singleton breech presentation at term (greater than or equal to 37 weeks).
A retrospective study.
Data Bank, Aberdeen Maternity Hospital.
643 women (273 primiparae and 370 multiparae) with a singleton breech presentation and spontaneous onset of labour at term.
Duration of labour; augmentation of labour with oxytocin infusion; caesarean section rates.
Epidural analgesia was associated with a significantly increased need for augmentation of labour with oxytocin infusion (P less than 0.001) and longer duration of labour (P less than 0.001), irrespective of parity. Comparing women who had epidural analgesia with those who did not, there was no significant difference in caesarean section rates in the first stage of labour in primiparae (odds ratio 1.79; 95% CI 0.88-3.63) or multiparae (odds ratio 0.97; 95% CI 0.48-1.96). Epidural analgesia was associated with a significantly increased likelihood of caesarean section in the second stage of labour, both in primiparae (odds ratio 5.43; 95% CI 2.46-11.95) and multiparae (odds ratio 5.37; 95% CI 2.07-13.87). The increased likelihood of caesarean section in the second stage in primiparae with epidurals was independent of the extent of cervical dilatation (less than 3 cm or greater than or equal to 3 cm) on admission. However, in multiparae with epidurals, the difference in second stage caesarean section rate was significant only when initial cervical dilatation was less than 3 cm (odds ratio 3.65; 95% CI 1.14-11.65).
Epidural analgesia was associated with longer duration of labour, increased need for augmentation of labour with oxytocin infusion and a significantly higher caesarean section rate in the second stage of labour.
探讨硬膜外镇痛对足月（大于或等于37周）单胎臀位产妇自然分娩进程及结局的影响。
一项回顾性研究。
阿伯丁妇产医院数据库。
643名单胎臀位且足月自然临产的产妇（273名单产妇和370名经产妇）。
产程时长；使用缩宫素静脉滴注加强宫缩的情况；剖宫产率。
无论产妇胎次如何，硬膜外镇痛均与使用缩宫素静脉滴注加强宫缩的需求显著增加（P<0.001）及产程延长（P<0.001）相关。在单产妇第一产程中，接受硬膜外镇痛者与未接受者相比，剖宫产率无显著差异（比值比1.79；95%可信区间0.88 - 3.63）；经产妇中也是如此（比值比0.97；95%可信区间0.48 - 1.96）。硬膜外镇痛与单产妇及经产妇第二产程剖宫产率显著增加相关，单产妇中（比值比5.43；95%可信区间2.46 - 11.95），经产妇中（比值比5.37；95%可信区间2.07 - 13.87）。单产妇硬膜外镇痛第二产程剖宫产率增加与入院时宫颈扩张程度（小于3 cm或大于或等于3 cm）无关。然而，经产妇硬膜外镇痛时，仅当初始宫颈扩张小于3 cm时，第二产程剖宫产率差异才有统计学意义（比值比3.65；95%可信区间1.14 - 11.65）。
硬膜外镇痛与产程延长、使用缩宫素静脉滴注加强宫缩的需求增加以及第二产程剖宫产率显著升高相关。
