初产妇第一产程的时间与围产结局的关系。

Length of the first stage of labor and associated perinatal outcomes in nulliparous women.

机构信息

Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, California, USA.

出版信息

Obstet Gynecol. 2010 Nov;116(5):1127-35. doi: 10.1097/AOG.0b013e3181f5eaf0.

DOI:10.1097/AOG.0b013e3181f5eaf0

PMID:20966698

Abstract

OBJECTIVE

To estimate whether length of the first stage of labor is associated with adverse maternal and neonatal outcomes.

METHODS

This is a retrospective cohort study of nulliparous women with term, singleton gestations delivered in one academic center between 1990 and 2008. The length of the first stage was stratified into three subgroups: less than the 5th percentile, 5th to 95th percentile, and greater than the 95th percentile. Maternal and neonatal outcomes were compared using the χ test. Multivariable logistic regression models were used to control for confounders.

RESULTS

Of the 10,661 nulliparous women meeting study criteria, the median (50th percentile) length of the first stage was 10.5 hours. Compared with women with a first stage between 2.8 and 30 hours (5th to 95th percentile thresholds), the risk of cesarean delivery was higher (6.1% compared with 13.5%; adjusted odds ratio [OR], 2.28, 95% confidence interval [CI], 1.92-2.72) in women with a first stage longer than 30 hours (greater than the 95th percentile). These women also had higher odds of chorioamnionitis (12.5% compared with 23.5%; adjusted OR, 1.58; 95% CI, 1.25-1.98) and neonatal admission to the neonatal intensive care unit (4.7% compared with 9.8%; adjusted OR, 1.53; 95% CI, 1.18-1.97) but no other associated adverse neonatal outcomes.

CONCLUSION

Women with a prolonged first stage of labor have higher odds of cesarean delivery and chorioamnionitis, but their neonates are not at risk of increased morbidity.

LEVEL OF EVIDENCE

II.

摘要

目的

评估第一产程的长短是否与产妇和新生儿不良结局有关。

方法

这是一项回顾性队列研究，纳入了 1990 年至 2008 年在一家学术中心分娩的初产妇、单胎足月妊娠。将第一产程分为三组：小于第 5 百分位数、第 5 至 95 百分位数和大于第 95 百分位数。使用 χ 检验比较产妇和新生儿结局。采用多变量逻辑回归模型控制混杂因素。

结果

在符合研究标准的 10661 名初产妇中，第一产程的中位数（50 百分位数）为 10.5 小时。与第一产程在 2.8 至 30 小时（第 5 至 95 百分位数的阈值）之间的女性相比，第一产程超过 30 小时（大于第 95 百分位数）的女性剖宫产率更高（6.1%比 13.5%；调整后的优势比[OR]，2.28，95%置信区间[CI]，1.92-2.72）。这些女性患绒毛膜羊膜炎的风险也更高（12.5%比 23.5%；调整后的 OR，1.58；95% CI，1.25-1.98），新生儿入住新生儿重症监护病房（NICU）的风险也更高（4.7%比 9.8%；调整后的 OR，1.53；95% CI，1.18-1.97），但新生儿其他不良结局没有增加。