Paterson C M, Saunders N S, Wadsworth J
Academic Department of Obstetrics and Gynaecology, Imperial College of Science Technology and Medicine, St. Mary's Hospital Medical School, London, UK.
Br J Obstet Gynaecol. 1992 May;99(5):377-80. doi: 10.1111/j.1471-0528.1992.tb13752.x.
To define the contemporary characteristics of the second stage of labour in one Health Region.
Retrospective analysis of a regional obstetric database.
Seventeen maternity units in the North West Thames Health Region.
Selected from 36,727 consecutive singleton deliveries in 1988. The analysis was confined to the 25,069 women delivered of an infant of at least 37 weeks gestation with a cephalic presentation following the spontaneous onset of labour.
Second stage duration, obstetric intervention and maternal and fetal morbidity.
The duration of the second stage and the use of operative intervention were strongly negatively associated with parity and positively associated with the use of epidural analgesia. Maternal age, fetal birthweight and maternal height were also independently associated with the duration of the second stage. There were small but significant differences in the characteristics of women using epidural analgesia and those using alternative methods of pain relief. Parous women using epidural analgesia behaved in a similar manner to nulliparae without epidurals. Despite the longer second stages observed in women using epidural analgesia there appeared to be no significant increase in fetal morbidity. Within the region the epidural rate in individual units positively correlated with the overall forceps rate, the rate of caesarean section in the second stage of labour and the duration of the second stage.
In our study the duration of the second stage in women not using epidural analgesia was similar to previous findings, but in those using epidural analgesia, the duration of the second stage was longer than has been reported previously, possibly reflecting a more conservative approach to operative intervention. Survival analysis indicates that in multiparae not using epidural analgesia the likelihood of spontaneous vaginal delivery after 1 h in the second stage was low, but in those multiparae using epidural analgesia and in all nulliparae there was no clear cut-off point for expectation of spontaneous delivery in the near future; they continue to give birth at a steady rate over several hours. While maternal and fetal conditions are satisfactory, intervention should be based on the rate of progress rather than the elapsed time since full cervical dilatation.
明确某一健康区域第二产程的当代特征。
对区域产科数据库进行回顾性分析。
西北泰晤士健康区域的17个产科单位。
从1988年连续的36,727例单胎分娩中选取。分析仅限于25,069例妊娠至少37周、头先露且自然发动分娩的产妇。
第二产程时长、产科干预措施以及母婴发病率。
第二产程时长和手术干预的使用与产次呈强烈负相关，与硬膜外镇痛的使用呈正相关。产妇年龄、胎儿出生体重和产妇身高也与第二产程时长独立相关。使用硬膜外镇痛的产妇与使用其他止痛方法的产妇在特征上存在微小但显著的差异。经产妇使用硬膜外镇痛的表现与未使用硬膜外镇痛的初产妇相似。尽管使用硬膜外镇痛的产妇第二产程较长，但胎儿发病率似乎没有显著增加。在该区域内，各单位的硬膜外使用率与总体产钳使用率、第二产程剖宫产率以及第二产程时长呈正相关。
在我们的研究中，未使用硬膜外镇痛的产妇第二产程时长与先前的研究结果相似，但使用硬膜外镇痛的产妇，其第二产程时长比先前报道的更长，这可能反映出对手术干预采取了更保守的方法。生存分析表明，未使用硬膜外镇痛的经产妇在第二产程1小时后自然阴道分娩的可能性较低，但使用硬膜外镇痛的经产妇和所有初产妇在近期内没有明确的自然分娩预期截止点；她们会在数小时内持续稳定分娩。当母婴状况良好时，干预应基于产程进展速度而非宫颈完全扩张后的 elapsed 时间。 （注：elapsed 此处可能是录入错误，推测原文想表达的是 elapsed time，即“经过时间”，但按照要求未做修改）
