Bernitz Stine, Øian Pål, Rolland Rune, Sandvik Leiv, Blix Ellen
Department of Obstetrics and Gynaecology, Østfold Hospital Trust, PO Box 24, 1603 Fredrikstad, Norway.
Department of Obstetrics and Gynaecology, University Hospital of North Norway, Tromsø, Norway; Women's Health and Perinatology Research Group, Department of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway.
Midwifery. 2014 Mar;30(3):364-70. doi: 10.1016/j.midw.2013.03.010. Epub 2013 May 17.
augmented and not augmented women without dystocia were compared to investigate associations between oxytocin and adverse birth outcomes. Augmented women with and without dystocia were compared, to investigate associations between dystocia and adverse birth outcomes.
a cohort of low-risk nulliparous women originally included in a randomised controlled trial.
the Department of Obstetrics and Gynaecology, Østfold Hospital Trust, Norway.
the study population consists of 747 well defined low-risk women.
incidence of oxytocin augmentation, and associations between dystocia and augmentation, and mode of delivery, transfer of newborns to the intensive care unit, episiotomy and postpartum haemorrhage.
of all participants 327 (43.8%) were augmented with oxytocin of which 139 (42.5%) did not fulfil the criteria for dystocia. Analyses adjusted for possible confounders found that women without dystocia had an increased risk of instrumental vaginal birth (OR 3.73, CI 1.93-7.21) and episiotomy (OR 2.47, CI 1.38-4.39) if augmented with oxytocin. Augmented women had longer active phase if vaginally delivered and longer labours if delivered by caesarean section if having dystocia. Among women without dystocia, those augmented had higher body mass index, gave birth to heavier babies, had longer labours if vaginally delivered and had epidural analgesia more often compared to women not augmented.
in low-risk nulliparous without dystocia, we found an association between the use of oxytocin and an increased risk of instrumental vaginal birth and episiotomy.
careful attention should be paid to criteria for labour progression and guidelines for oxytocin augmentation to avoid unnecessary use.
比较未使用缩宫素增强宫缩及使用缩宫素增强宫缩且未发生难产的女性，以研究缩宫素与不良分娩结局之间的关联。比较发生难产和未发生难产的使用缩宫素增强宫缩的女性，以研究难产与不良分娩结局之间的关联。
一组最初纳入随机对照试验的低风险初产妇队列。
挪威东福尔郡医院信托妇产科。
研究人群包括747名明确界定的低风险女性。
缩宫素增强宫缩的发生率、难产与缩宫素增强宫缩之间的关联、分娩方式、新生儿转入重症监护病房、会阴切开术和产后出血。
在所有参与者中，327名（43.8%）使用了缩宫素增强宫缩，其中139名（42.5%）不符合难产标准。对可能的混杂因素进行校正后的分析发现，未发生难产的女性若使用缩宫素增强宫缩，则器械助产阴道分娩（比值比3.73，可信区间1.93 - 7.21）和会阴切开术（比值比2.47，可信区间1.38 - 4.39）的风险增加。发生难产的女性若经阴道分娩，使用缩宫素增强宫缩后活跃期更长；若行剖宫产分娩，产程更长。在未发生难产的女性中，使用缩宫素增强宫缩的女性相比未使用缩宫素的女性，体重指数更高，分娩的婴儿更重，经阴道分娩时产程更长，且更常使用硬膜外镇痛。
在未发生难产的低风险初产妇中，我们发现使用缩宫素与器械助产阴道分娩和会阴切开术风险增加之间存在关联。
应密切关注产程进展标准和缩宫素增强宫缩的指南，以避免不必要的使用。
