剖宫产术后尝试经阴道分娩且新生儿结局正常的女性的分娩模式。
Labor patterns in women attempting vaginal birth after cesarean with normal neonatal outcomes.
作者信息
Grantz Katherine L, Gonzalez-Quintero Victor, Troendle James, Reddy Uma M, Hinkle Stefanie N, Kominiarek Michelle A, Lu Zhaohui, Zhang Jun
机构信息
Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD.
Department of Obstetrics and Gynecology, University of Miami School of Medicine, Miami, FL.
出版信息
Am J Obstet Gynecol. 2015 Aug;213(2):226.e1-6. doi: 10.1016/j.ajog.2015.04.033. Epub 2015 Apr 30.
OBJECTIVE
We sought to describe labor patterns in women with a trial of labor after cesarean (TOLAC) with normal neonatal outcomes.
STUDY DESIGN
In a retrospective observational study at 12 US centers (2002 through 2008), we examined time interval for each centimeter of cervical dilation and compared labor progression stratified by spontaneous or induced labor in 2892 multiparous women with TOLAC (second delivery) and 56,301 nulliparous women at 37 0/7 to 41 6/7 weeks of gestation. Analyses were performed including women with intrapartum cesarean delivery, and also limiting only to women who delivered vaginally.
RESULTS
Labor was induced in 23.4% of TOLAC and 44.1% of nulliparous women (P < .001). Cesarean delivery rates were 57.7% in TOLAC vs 19.0% in nulliparous women (P < .001). Oxytocin was used in 52.4% of TOLAC vs 64.3% of nulliparous women with spontaneous labor (P < .001) and 89.8% of TOLAC vs 91.6% of nulliparous women with induced labor (P = .099); however, TOLAC had lower maximum doses of oxytocin compared to nulliparous women: median (90th percentile): 6 (18) mU/min vs 12 (28) mU/min, respectively (P < .001). Median (95th percentile) labor duration for TOLAC vs nulliparous women with spontaneous labor from 4-10 cm was 0.9 (2.2) hours longer (P = .007). For women who entered labor spontaneously and achieved vaginal delivery, labor patterns for TOLAC were similar to nulliparous women. For induced labor, labor duration for TOLAC vs nulliparous women from 4-10 cm was 1.5 (4.6) hours longer (P < .001). For women who achieved vaginal delivery, labor patterns were slower for induced TOLAC compared to nulliparous women.
CONCLUSION
Labor duration for TOLAC was slower compared to nulliparous labor, particularly for induced labor. By improved understanding of the rates of progress at different points in labor, this new information on labor curves in women undergoing TOLAC, particularly for induction, should help physicians when managing labor.
目的
我们试图描述剖宫产术后阴道试产（TOLAC）且新生儿结局正常的女性的产程模式。
研究设计
在一项对美国12个中心（2002年至2008年）进行的回顾性观察研究中，我们检查了宫颈每扩张1厘米的时间间隔，并比较了2892例有TOLAC（第二次分娩）的经产妇和56301例妊娠37⁰/₇至41⁶/₇周的初产妇按自然分娩或引产分层的产程进展情况。分析包括了产时剖宫产的女性，也仅限于阴道分娩的女性。
结果
23.4%的TOLAC产妇和44.1%的初产妇接受了引产（P <.001）。TOLAC产妇的剖宫产率为57.7%，而初产妇为19.0%（P <.001）。52.4%的TOLAC产妇和64.3%的自然分娩初产妇使用了缩宫素（P <.001），89.8%的TOLAC产妇和91.6%的引产初产妇使用了缩宫素（P =.099）；然而，TOLAC产妇的缩宫素最大剂量低于初产妇：中位数（第90百分位数）分别为6（18）mU/分钟和12（28）mU/分钟（P <.001）。TOLAC产妇与自然分娩初产妇从4至10厘米宫颈扩张的产程持续时间中位数（第95百分位数）长0.9（2.2）小时（P =.007）。对于自然发动分娩并实现阴道分娩的女性，TOLAC的产程模式与初产妇相似。对于引产，TOLAC产妇与初产妇从4至10厘米宫颈扩张的产程持续时间长1.5（4.6）小时（P <.001）。对于实现阴道分娩的女性，引产的TOLAC产程模式比初产妇慢。
结论
与初产妇相比，TOLAC的产程持续时间较慢，尤其是引产时。通过更好地了解产程不同阶段的进展速度，这些关于TOLAC女性产程曲线的新信息，特别是引产方面的信息，应有助于医生在处理产程时做出决策。
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