Department of Obstetrics, Gynaecology and Reproductive Medicine, Hannover Medical School, Germany.
Arch Gynecol Obstet. 2009 Dec;280(6):899-905. doi: 10.1007/s00404-009-0990-7. Epub 2009 Mar 13.
The study aimed to assess the time of labour onset and its symptoms as perceived by women in labour and midwives, and the relationship between these and first stage duration.
A longitudinal cohort study of women with a singleton pregnancy in cephalic presentation was performed in 41 maternity units. The sample comprised 1,170 women, 611 nulliparae (np) and 559 multiparae (mp), who answered two standardized questions on the onset of labour and selected the applicable symptoms of labour onset from a list of eight. A multivariate Cox regression model was computed covering further perinatal factors.
The median durations of the first stage of labour as assessed by the women themselves were 11 (np) and 6.5 h (mp), and as assessed by the midwives 7 (np) and 4 h (mp). Median time intervals between the start of labour onset symptoms as perceived by the women concerned and the midwives' diagnoses varied greatly: the shortest related to watery fluid loss (np = 1.5 h, mp = 0.0 h), the longest to alterations in sleep patterns (np = 11.5 h, mp = 4.5 h). Irregular pain, watery fluid loss and the time between self-diagnosed and professionally diagnosed onset of labour were just as closely associated with the duration of the first stage of labour as perinatal factors. Significant perinatal factors were induction with oxytocin, herbal remedies and PROM.
The perceptions of women in labour are as important as perinatal factors in determining the duration of the first stage of labour and should be taken into account in intrapartum care.
本研究旨在评估产妇和助产士感知的分娩开始时间及其症状，以及这些因素与第一产程持续时间的关系。
在 41 家产科单位进行了一项单胎头位妊娠的纵向队列研究。该样本包括 1170 名妇女，611 名初产妇(np)和 559 名经产妇(mp)，她们回答了两个关于分娩开始的标准化问题，并从一份 8 项分娩开始症状清单中选择了适用的症状。计算了一个多变量 Cox 回归模型，涵盖了其他围产期因素。
产妇自我评估的第一产程中位数为 11(np)和 6.5 小时(mp)，助产士评估的第一产程中位数为 7(np)和 4 小时(mp)。产妇自我感知的分娩开始症状与助产士诊断之间的时间间隔差异很大：最短的与羊水流失有关(np=1.5 小时，mp=0 小时)，最长的与睡眠模式改变有关(np=11.5 小时，mp=4.5 小时)。不规则疼痛、羊水流失和自我诊断与专业诊断分娩开始之间的时间与围产期因素一样与第一产程持续时间密切相关。显著的围产期因素包括催产素引产、草药治疗和胎膜早破。
产妇的感知与围产期因素一样，对第一产程持续时间有重要影响，应在产时护理中考虑到这些因素。
