Midwifery Research and Education Unit, Department of Obstetrics and Gynaecology, Hannover Medical School, Carl-Neuberg-Str 1, 30625 Hannover, Germany.
Midwifery. 2011 Dec;27(6):e267-73. doi: 10.1016/j.midw.2010.10.017. Epub 2010 Dec 13.
To describe the timing and frequency of interventions during labour, and in addition to compare the timings of the interventions against the partogram action lines.
Longitudinal prospective and retrospective cohort study.
47 Hospitals in Lower Saxony, Germany.
3963 Births of nulliparae and multiparae with singletons in vertex presentation giving birth between April and October 2005. The participation rate for the prospectively recruited sample (n = 1169) was 4.7%.
Time intervals until intrapartal interventions were calculated by Kaplan-Meiers estimation. Outcome variables were duration of labour and mode of birth.
Multiparae had slightly longer median time intervals between the onset of labour and the beginning of care by the midwife than nulliparae. With regard to the intervals between the onset of labour and the occurrence of interventions, multiparae had shorter median durations than nulliparae in respect of amniotomy, oxytocin augmentation and neuraxial analgesia. By three hours after onset of labour 8.4% of nulliparae had received oxytocin augmentation, 10.7% neuraxial analgesia and 8.9% an amniotomy. Of multiparae, 9.1% had received oxytocin augmentation but only 5.6% neuraxial analgesia; 20.0% had had an amniotomy. The median time interval before the initiation of water immersion and massage was between three and four hours; that before the initiation of vertical positioning was 1.8 hours.
Current German practice without the use of partogram action lines reveals that early interventions were performed before the partogram action lines were met. Interventions applying midwifery care techniques such as vertical positioning preceded more invasive medical interventions during the process of childbirth.
描述分娩过程中干预的时间和频率，并比较干预时间与产程图行动线的关系。
纵向前瞻性和回顾性队列研究。
德国下萨克森州的 47 家医院。
2005 年 4 月至 10 月间足月、头位、初产妇和经产妇的 3963 例单胎分娩。前瞻性招募的样本（n=1169）参与率为 4.7%。
通过 Kaplan-Meier 估计计算产程中干预措施的时间间隔。结局变量为产程时间和分娩方式。
与初产妇相比，经产妇的产程开始至助产士开始护理的中位数时间间隔略长。就产程开始至干预发生的时间间隔而言，与初产妇相比，经产妇的羊膜穿刺术、催产素增强和椎管内镇痛的中位数持续时间更短。产程开始后 3 小时，8.4%的初产妇接受了催产素增强，10.7%接受了椎管内镇痛，8.9%接受了羊膜穿刺术。经产妇中，9.1%接受了催产素增强，但只有 5.6%接受了椎管内镇痛，20.0%接受了羊膜穿刺术。开始水中浸泡和按摩的中位数时间间隔在 3 至 4 小时之间；开始垂直体位的中位数时间间隔为 1.8 小时。
本研究显示，在不使用产程图行动线的情况下，德国当前的实践表明，早期干预在产程图行动线出现之前就已经进行。在分娩过程中，应用助产护理技术（如垂直体位）的干预措施先于更具侵入性的医疗干预措施。
