Rouse Dwight J, Weiner Steven J, Bloom Steven L, Varner Michael W, Spong Catherine Y, Ramin Susan M, Caritis Steve N, Peaceman Alan M, Sorokin Yoram, Sciscione Anthony, Carpenter Marshall W, Mercer Brian M, Thorp John M, Malone Fergal D, Harper Margaret, Iams Jay D, Anderson Garland D
Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA.
Am J Obstet Gynecol. 2009 Oct;201(4):357.e1-7. doi: 10.1016/j.ajog.2009.08.003.
The purpose of this study was to assess maternal and perinatal outcomes as a function of second-stage labor duration.
We assessed outcomes in nulliparous laboring women who were enrolled in a trial of fetal pulse oximetry.
Of 5341 participants, 4126 women reached the second stage of labor. As the duration of the second stage increased, spontaneous vaginal delivery rates declined, from 85% when the duration was <1 hour to 9% when it was > or =5 hours. Adverse maternal outcomes that were associated significantly with the duration of the second stage of labor included chorioamnionitis (overall rate, 3.9%), third- or fourth-degree perineal laceration (overall rate, 8.7%), and uterine atony (overall rate, 3.9%). Odds ratios for each additional hour of the second stage of labor ranged from 1.3-1.8. Among individual adverse neonatal outcomes, only admission to a neonatal intensive care unit was associated significantly with second stage duration (odds ratio, 1.4).
The second stage of labor does not need to be terminated for duration alone.
本研究旨在评估第二产程时长对孕产妇及围产儿结局的影响。
我们评估了参与胎儿脉搏血氧饱和度试验的初产妇的结局。
在5341名参与者中，4126名女性进入第二产程。随着第二产程时长增加，自然阴道分娩率下降，从时长<1小时时的85%降至≥5小时时的9%。与第二产程时长显著相关的不良孕产妇结局包括绒毛膜羊膜炎（总体发生率3.9%）、三度或四度会阴裂伤（总体发生率8.7%）和子宫收缩乏力（总体发生率3.9%）。第二产程每增加一小时的比值比在1.3至1.8之间。在个体不良新生儿结局中，只有入住新生儿重症监护病房与第二产程时长显著相关（比值比为1.4）。
第二产程不应仅因时长而终止。
