Neal Jeremy L, Lamp Jane M, Buck Jacalyn S, Lowe Nancy K, Gillespie Shannon L, Ryan Sharon L
J Midwifery Womens Health. 2014 Jan-Feb;59(1):28-34. doi: 10.1111/jmwh.12160. Epub 2014 Feb 11.
The timing of when a woman is admitted to the hospital for labor care following spontaneous contraction onset may be among the most important decisions that labor attendants make because it can influence care patterns and birth outcomes. The aims of this study were to estimate the percentage of low-risk, nulliparous women at term who are admitted to labor units prior to active labor and to evaluate the effects of the timing of admission (ie, preactive vs active labor) on labor interventions and mode of birth.
Data from low-risk, nulliparous women with spontaneous labor onset at term gestation were merged from 2 prospective studies conducted at 3 large Midwestern hospitals. Baseline characteristics, labor interventions, and outcomes were compared between groups using Fisher's exact and Mann-Whitney U tests, as appropriate. Likelihoods for oxytocin augmentation, amniotomy, and cesarean birth were assessed by logistic regression.
Of the sample of 216 low-risk nulliparous women, 114 (52.8%) were admitted in preactive labor and 102 (47.2%) were admitted in active labor. Women who were admitted in preactive labor were more likely to undergo oxytocin augmentation (84.2% and 45.1%, respectively; odds ratio [OR], 6.5; 95% confidence interval [CI], 3.43-12.27) but not amniotomy (55.3% and 61.8%, respectively; OR, 0.8; 95% CI, 0.44-1.32) when compared to women admitted in active labor. The likelihood of cesarean birth was higher for women admitted before active labor onset (15.8% and 6.9%, respectively; OR, 2.6; 95% CI, 1.02-6.37).
Many low-risk nulliparous women with regular, spontaneous uterine contractions are admitted to labor units before active labor onset, which increases their likelihood of receiving oxytocin and giving birth via cesarean. An evidence-based, standardized approach for labor admission decision making is recommended to decrease inadvertent admissions of women in preactive labor. When active labor cannot be diagnosed with relative certainty, observation before admission to the birthing unit is warranted.
在自然宫缩开始后，女性何时入院接受分娩护理可能是分娩护理人员做出的最重要决策之一，因为这会影响护理模式和分娩结局。本研究的目的是估计足月低风险初产妇在活跃期之前入院的比例，并评估入院时间（即活跃期前与活跃期）对分娩干预措施和分娩方式的影响。
来自3家大型中西部医院进行的2项前瞻性研究的数据被合并，这些数据来自足月自然发动分娩的低风险初产妇。根据情况，使用Fisher精确检验和Mann-Whitney U检验对两组之间的基线特征、分娩干预措施和结局进行比较。通过逻辑回归评估催产素引产、人工破膜和剖宫产的可能性。
在216名低风险初产妇样本中，114名（52.8%）在活跃期前入院，102名（47.2%）在活跃期入院。与活跃期入院的女性相比，活跃期前入院的女性更有可能接受催产素引产（分别为84.2%和45.1%；优势比[OR]为6.5；95%置信区间[CI]为3.43 - 12.27），但人工破膜的可能性无差异（分别为55.3%和61.8%；OR为0.8；95% CI为0.44 - 1.32）。活跃期开始前入院的女性剖宫产的可能性更高（分别为15.8%和6.9%；OR为2.6；95% CI为1.02 - 6.37）。
许多有规律自然宫缩的低风险初产妇在活跃期开始前就被收入分娩单元，这增加了她们接受催产素引产和剖宫产的可能性。建议采用基于证据的标准化分娩入院决策方法，以减少活跃期前产妇的意外入院。当无法相对确定地诊断活跃期时，在进入分娩单元前进行观察是必要的。
