胎儿体位对第二产程时长及分娩结局的影响。
Effect of fetal position on second-stage duration and labor outcome.
作者信息
Senécal Julie, Xiong Xu, Fraser William D
机构信息
Department of Obstetrics and Gynaecology, Laval University.
出版信息
Obstet Gynecol. 2005 Apr;105(4):763-72. doi: 10.1097/01.AOG.0000154889.47063.84.
OBJECTIVE
To evaluate the effect of fetal position on 1) second-stage labor duration and 2) indicators of maternal and neonatal morbidity.
METHODS
A retrospective cohort study was conducted using a database from a previously reported randomized clinical trial. The data set includes 210 women with the fetus in a posterior position, 200 women with the fetus in a transverse position, and 1,198 women with the fetus in an anterior position. Mean durations of the second stage of labor for different fetal positions were compared using Tukey studentized test. A multivariate logistic regression model was performed to examine the determinants of prolonged second-stage duration (>or= 3 hours). Kaplan-Meier survival curves were used to graph and compare the duration of the second stage of labor for spontaneous delivery according to the fetal position at full dilatation and study group.
RESULTS
Fetal malposition at full dilatation was associated with a significantly increased risk of instrumental vaginal delivery, cesarean delivery, oxytocin administration before full cervical dilatation, episiotomy, severe perineal laceration, and maternal blood loss of more than 500 mL (all P values < .01). Compared with the occiput anterior positions, there were significant differences in the duration of the second stage of labor, with a mean of 3.1 hours (95% confidence interval [CI] 3.0-3.2) for occiput anterior positions, 3.6 hours (95% CI 3.3-3.9) for occiput transverse positions (P < .05), and 3.8 hours (95% CI 3.5-4.1) for occiput posterior positions (P < .05) in the delayed pushing group. For the early pushing group, means were 2.2 hours (95% CI 2.1-2.3) for occiput anterior positions, 2.5 hours (95% CI 2.3-2.8) for occiput transverse positions (P < .05), and 3.0 hours (95% CI 2.7-3.3) for occiput posterior positions (P < .05).
CONCLUSION
Fetal malposition at full dilatation results in a higher risk of prolonged second stage of labor and increases maternal morbidity indicators.
LEVEL OF EVIDENCE
II-2.
目的
评估胎位对1）第二产程时长以及2）孕产妇和新生儿发病指标的影响。
方法
采用先前报道的一项随机临床试验数据库进行回顾性队列研究。数据集包括210例胎儿为后位的女性、200例胎儿为横位的女性以及1198例胎儿为前位的女性。使用Tukey学生化检验比较不同胎位的第二产程平均时长。采用多因素逻辑回归模型检验第二产程延长（≥3小时）的决定因素。根据宫口开全时的胎位和研究组，使用Kaplan-Meier生存曲线绘制并比较自然分娩的第二产程时长。
结果
宫口开全时胎位异常与器械助产阴道分娩、剖宫产、宫颈未开全时使用缩宫素、会阴切开术、严重会阴裂伤以及孕产妇失血超过500 mL的风险显著增加相关（所有P值<0.01）。与枕前位相比，第二产程时长存在显著差异，延迟用力组中枕前位平均为3.1小时（95%置信区间[CI] 3.0 - 3.2），枕横位为3.6小时（95% CI 3.3 - 3.9）（P < 0.05），枕后位为3.8小时（95% CI 3.5 - 4.1）（P < 0.05）。在早期用力组中，枕前位平均为2.2小时（95% CI 2.1 - 2.3），枕横位为2.5小时（95% CI 2.3 - 2.8）（P < 0.05），枕后位为3.0小时（95% CI 2.7 - 3.3）（P < 0.05）。
结论
宫口开全时胎位异常导致第二产程延长的风险更高，并增加孕产妇发病指标。
证据级别
II - 2
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