Kenny Tiffany H, Fenton Bradford W, Melrose Erica L, McCarroll Michele L, von Gruenigen Vivian E
a Department of Obstetrics and Gynecology , Summa Health System , Akron , OH , USA and.
b SSM Medical Group , St. Louis , MO , USA.
J Matern Fetal Neonatal Med. 2016;29(1):148-53. doi: 10.3109/14767058.2014.991710. Epub 2014 Dec 30.
History of fast labor is currently subjectively defined and inductions for non-medical indications are becoming restricted. We hypothesized that women induced for a history of fast labor do not have faster previous labors and do not deliver more quickly.
A retrospective case-control cohort design studied multiparas undergoing elective induction at one high risk center. Outcomes of dyads electively induced for a history of previous fast labor indication (PFast) were compared to controls with a psychosocial indication.
A total of 612 elective inductions with 1074 previous deliveries were evaluated: 81 (13%) PFast and 531 (87%) control. PFast had faster previous labors (median 5.5 h, IQR: 4.5-6) versus. control (10 h, IQR: 9-10.5; p < 0.001). Subsequent delivery time from start to expulsion was shorter for PFast (median 7 h, IQR: 5-9, p < 0.001) than controls with and without a previous labor <5.5 h (8.6 h, IQR: 6-14 and 9.5 h, IQR: 7-15, respectively). PFast were less likely to have a serious maternal complication. Neonatal complications were similar.
Patients induced for a history of fast labor do have faster previous labors, suggesting a significant history of fast labor can be defined as <5.5 h. These women deliver more quickly and with lower morbidity than controls when subsequently induced, therefore the benefit may warrant the risk for a select number of women with a history of a prior labor length <5.5 h.
目前，急产史是通过主观定义的，且针对非医学指征的引产正受到限制。我们推测，因急产史而引产的女性既往分娩并不更快，且此次分娩也不会更快。
采用回顾性病例对照队列设计，研究在一个高危中心接受择期引产的经产妇。将因既往急产指征（PFast）而接受择期引产的母婴结局与有心理社会指征的对照组进行比较。
共评估了612例择期引产及1074次既往分娩：81例（13%）为PFast，531例（87%）为对照组。PFast既往分娩更快（中位数5.5小时，四分位间距：4.5 - 6小时），而对照组为（10小时，四分位间距：9 - 10.5小时；p < 0.001）。PFast从开始到分娩的后续分娩时间（中位数7小时，四分位间距：5 - 9小时，p < 0.001）比既往分娩时间<5.5小时和≥5.5小时的对照组（分别为8.6小时，四分位间距：6 - 14小时和9.5小时，四分位间距：7 - 15小时）更短。PFast发生严重母体并发症的可能性较小。新生儿并发症相似。
因急产史而引产的患者既往分娩确实更快，提示急产史可定义为<5.5小时。这些女性在随后引产时分娩更快且发病率低于对照组，因此对于既往分娩时长<5.5小时的部分女性而言，获益可能值得冒此风险。
