From the Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts.
Obstet Gynecol. 2010 Sep;116(3):606-611. doi: 10.1097/AOG.0b013e3181eeb968.
To compare the duration and complications of the second stage of labor between women in induced and spontaneous labor.
This was a retrospective cohort study of women with singleton term gestations who reached full dilation at a single institution from 2001 through 2009. Second-stage duration, mode of delivery, and complication rates were compared between women in induced and spontaneous labor using survival analysis, univariable analysis, and multivariable analyses to control for potential confounders.
We identified 14,727 women who reached the second stage; 3,139 (21.3%) were induced and 11,588 (78.7%) were in spontaneous labor. After adjusting for confounders (maternal age, body mass index, epidural use, gestational age, midwifery care, health center care, year of delivery), there was no difference in length of the second stage or risk of a prolonged second stage between women in induced and spontaneous labor. In both groups, risk of complications increased with duration of the second stage, including chorioamnionitis, postpartum hemorrhage, third- or fourth-degree laceration, operative vaginal delivery, and 5-minute Apgar score less than 7. Among nulliparas who reached full dilation, our data suggested an increased odds of cesarean (10.9% compared with 7.2%, adjusted odds ratio [OR]1.32, 95% confidence interval [CI] 1.01-1.71) and postpartum hemorrhage (4.2% compared with 2.0%, adjusted OR 1.62, 95% CI 1.02-2.58) with induction. There was no difference in mode of delivery or rates of complications among multiparas.
Among women who reach full dilation, labor proceeds similarly regardless of induction status. Induced nulliparas may have an increased risk of hemorrhage and cesarean delivery.
II.
比较诱导分娩和自然分娩产妇第二产程的持续时间和并发症。
这是一项回顾性队列研究，研究对象为 2001 年至 2009 年在单一机构达到完全扩张的单胎足月妊娠妇女。使用生存分析、单变量分析和多变量分析比较诱导分娩和自然分娩产妇的第二产程持续时间、分娩方式和并发症发生率，并控制潜在混杂因素。
我们确定了 14727 名达到第二产程的妇女；其中 3139 名（21.3%）为诱导分娩，11588 名（78.7%）为自然分娩。在调整混杂因素（产妇年龄、体重指数、硬膜外麻醉使用、孕周、助产士照护、社区中心照护、分娩年份）后，诱导分娩和自然分娩产妇的第二产程持续时间或延长第二产程的风险无差异。在两组中，随着第二产程的延长，并发症的风险增加，包括绒毛膜羊膜炎、产后出血、三度或四度裂伤、经阴道分娩和 5 分钟 Apgar 评分低于 7。在达到完全扩张的初产妇中，我们的数据表明，与自然分娩相比，剖宫产（10.9%比 7.2%，调整后的优势比[OR]1.32，95%置信区间[CI]1.01-1.71）和产后出血（4.2%比 2.0%，调整后的 OR 1.62，95% CI 1.02-2.58）的风险增加。多产妇的分娩方式和并发症发生率无差异。
在达到完全扩张的产妇中，无论诱导分娩状态如何，分娩过程相似。诱导分娩的初产妇可能有更高的出血和剖宫产风险。
II。
