Satin A J, Leveno K J, Sherman M L, Brewster D S, Cunningham F G
Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas.
Obstet Gynecol. 1992 Jul;80(1):111-6.
The number of cesarean births for dystocia has increased dramatically in the United States. Central to the management of dystocia is correction of ineffective labor by oxytocin administration, and contemporary obstetric practice is to stimulate labor with a low-dose oxytocin regimen. We prospectively compared a low-dose oxytocin regimen (1-mU/minute dosage increments) with a high-dose regimen (6-mU/minute dosage increments) in 2788 consecutive singleton cephalic pregnancies. The low-dose regimen was used first for 5 months in 1251 pregnancies, and the high-dose regimen in 1537 pregnancies during the subsequent 5 months. Indications for oxytocin stimulation were divided into augmentation (N = 1676) and induction (N = 1112). Labor stimulation was more than 3 hours shorter (P less than .0001) with the high-dose oxytocin regimen and associated with a reduction in neonatal sepsis (0.2 versus 1.3%; P less than .01). Uterine hyperstimulation was more common (55 versus 42%; P less than .0001) with the high-dose regimen, but no adverse fetal effects were observed. High-dose augmentation resulted in significantly fewer forceps deliveries (12 versus 16%; P = .03) and fewer cesareans for dystocia (9 versus 12%; P = .04). Similarly, failed induction was less frequent with high-dose compared with low-dose oxytocin (14 versus 19%; P = .05). Although the high-dose induction regimen was associated with a significantly increased cesarean incidence for fetal distress (6 versus 3%; P = .05), the incidence of umbilical artery cord blood acidemia was not increased in this subset. Induction of labor with high-dose oxytocin is problematic because of risk-benefit considerations. Although induction failed less frequently with the high-dose regimen, cesarean for fetal distress was performed more frequently. In contrast, high-dose oxytocin to augment ineffective spontaneous labor minimized the number of cesareans done for dystocia.
在美国，因难产而行剖宫产的数量急剧增加。催产素给药纠正无效产程是难产管理的核心，当代产科实践是采用低剂量催产素方案来刺激产程。我们对2788例连续的单胎头位妊娠患者进行前瞻性研究，比较了低剂量催产素方案（剂量以每分钟1毫单位递增）和高剂量方案（剂量以每分钟6毫单位递增）。低剂量方案首先在1251例妊娠中使用了5个月，随后的5个月里，1537例妊娠使用了高剂量方案。催产素刺激的指征分为产程增强（N = 1676）和引产（N = 1112）。高剂量催产素方案使产程刺激时间缩短超过3小时（P <.0001），并降低了新生儿败血症的发生率（0.2%对1.3%；P <.01）。高剂量方案中子宫过度刺激更为常见（55%对42%；P <.0001），但未观察到对胎儿有不良影响。高剂量产程增强导致产钳助产显著减少（12%对16%；P =.03），因难产而行剖宫产的情况也减少（9%对12%；P =.04）。同样，与低剂量催产素相比，高剂量引产失败的情况较少（14%对19%；P =.05）。尽管高剂量引产方案与胎儿窘迫导致的剖宫产发生率显著增加有关（6%对3%；P =.05），但该亚组中脐动脉血酸血症的发生率并未增加。由于风险效益的考虑，高剂量催产素引产存在问题。虽然高剂量方案引产失败的情况较少，但因胎儿窘迫而行剖宫产的情况更为频繁。相比之下，高剂量催产素用于增强无效的自然产程可使因难产而行剖宫产的数量降至最低。
