From the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland; Georgetown University Hospital, MedStar Health, Washington, DC; Intermountain HealthCare and University of Utah, Salt Lake City, Utah; Baystate Medical Center, Springfield, Massachusetts; Maimonides Medical Center, Brooklyn, New York; Cedars-Sinai Medical Center, Los Angeles, California; Summa Health System, Akron City Hospital, Akron, Ohio; University of Texas Health Science Center at Houston, Houston, Texas; MetroHealth Medical Center, Cleveland, Ohio; University of Miami, Miami, Florida; University of Illinois at Chicago, Chicago, Illinois; Christiana Care Health System, Wilmington, Delaware; Indiana University-Clarian Health, Indianapolis, Indiana; and The EMMES Corporation, Rockville, Maryland.
Obstet Gynecol. 2010 Dec;116(6):1281-1287. doi: 10.1097/AOG.0b013e3181fdef6e.
To use contemporary labor data to examine the labor patterns in a large, modern obstetric population in the United States.
Data were from the Consortium on Safe Labor, a multicenter retrospective study that abstracted detailed labor and delivery information from electronic medical records in 19 hospitals across the United States. A total of 62,415 parturients were selected who had a singleton term gestation, spontaneous onset of labor, vertex presentation, vaginal delivery, and a normal perinatal outcome. A repeated-measures analysis was used to construct average labor curves by parity. An interval-censored regression was used to estimate duration of labor, stratified by cervical dilation at admission and centimeter by centimeter.
Labor may take more than 6 hours to progress from 4 to 5 cm and more than 3 hours to progress from 5 to 6 cm of dilation. Nulliparous and multiparous women appeared to progress at a similar pace before 6 cm. However, after 6 cm, labor accelerated much faster in multiparous than in nulliparous women. The 95 percentiles of the second stage of labor in nulliparous women with and without epidural analgesia were 3.6 and 2.8 hours, respectively. A partogram for nulliparous women is proposed.
In a large, contemporary population, the rate of cervical dilation accelerated after 6 cm, and progress from 4 cm to 6 cm was far slower than previously described. Allowing labor to continue for a longer period before 6 cm of cervical dilation may reduce the rate of intrapartum and subsequent repeat cesarean deliveries in the United States.
利用当代劳动力数据来研究美国大型现代产科人群中的劳动力模式。
数据来自安全分娩联合会，这是一项多中心回顾性研究，从美国 19 家医院的电子病历中提取详细的分娩和分娩信息。共选择了 62415 名单胎足月、自发性临产、头位、阴道分娩且围产期结局正常的产妇。采用重复测量分析方法，根据产次构建平均产程曲线。采用区间 censored 回归估计入院时宫颈扩张程度和每厘米厘米的产程持续时间。
从 4 厘米到 5 厘米的进展可能需要超过 6 小时，从 5 厘米到 6 厘米的进展可能需要超过 3 小时。初产妇和经产妇在 6 厘米之前似乎进展速度相似。然而，在 6 厘米之后，经产妇的产程加速速度明显快于初产妇。有无硬膜外镇痛的初产妇第二产程的 95%百分位数分别为 3.6 小时和 2.8 小时。提出了一种针对初产妇的产程图。
在一个大型的当代人群中，宫颈扩张率在 6 厘米后加速，从 4 厘米到 6 厘米的进展速度明显慢于之前的描述。在宫颈扩张 6 厘米之前允许更长时间的分娩可能会降低美国产时和随后重复剖宫产的发生率。
