入院时宫颈扩张与足月自发性分娩母婴结局。

Cervical Dilation on Admission in Term Spontaneous Labor and Maternal and Newborn Outcomes.

机构信息

Obstetrics Clinical Outcomes Assessment Program, part of the Foundation for Health Care Quality, Washington State, the U.S. Department of Veterans Affairs Puget Sound Health Care System, Health Services Research and Development, and the Department of Health Services, University of Washington School of Public Health, Seattle, Washington.

出版信息

Obstet Gynecol. 2016 Mar;127(3):481-488. doi: 10.1097/AOG.0000000000001294.

DOI:10.1097/AOG.0000000000001294

PMID:26855106

Abstract

OBJECTIVE

To examine associations between cervical dilation on admission and maternal and newborn outcomes in term spontaneous labor.

METHODS

This is a retrospective cohort study of 11,368 singleton, term (37-43 6/7 weeks of gestation) spontaneously laboring women delivering in 14 hospitals in Washington State between 2012 and 2014 using chart abstracted data from the Obstetrics Clinical Outcomes Assessment Program. Women with prior cesarean delivery or ruptured membranes on admission were excluded. Pregnancy history, cervical dilation on admission, and outcomes were analyzed. Associations between early (less than 4 cm cervical dilation) and late (4 cm or greater cervical dilation) admission and outcomes were examined using general linear models with a log-link stratifying by parity. Results were reported as adjusted relative risks (RRs) with 95% confidence intervals (CIs).

RESULTS

Early admission compared with late admission was associated with increased epidural use of 84.8% compared with 71.8% in nulliparous women and 66.3% compared with 53.1% in multiparous women (nulliparous RR 1.18, 95% CI 1.13-1.24; multiparous RR 1.25, 95% CI 1.18-1.32); oxytocin augmentation in 58.5% compared with 36.6% in nulliparous women and 45.9% compared with 20.7% in multiparous women (nulliparous RR 1.56, 95% CI 1.50-1.63; multiparous RR 2.14, 95% CI 1.87-2.44); and cesarean delivery of 21.8% compared with 14.5% in nulliparous women and 3.7% compared with 1.9% in multiparous women (nulliparous RR 1.50, 95% CI 1.32-1.70; multiparous women RR 1.95, 95% CI 1.47-2.57). Early admission was associated with increased neonatal intensive care unit admission for newborns of nulliparous women only (RR 1.38, 95% CI 1.01-1.89). Between 2012 and 2014, late admission increased 14.6% for nulliparous patients and 10.1% for multiparous patients, and the cesarean delivery rate decreased from 10.5% to 7.9% (P<.001) for all.

CONCLUSION

Early admission (less than 4 cm cervical dilation) is a risk factor for increased medical intervention and cesarean delivery.

摘要

目的

探讨足月自然分娩产妇入院时宫颈扩张程度与母婴结局的关系。

方法

这是一项回顾性队列研究，纳入了 2012 年至 2014 年期间华盛顿州 14 家医院的 11368 例单胎、足月（37-43 6/7 周）自然分娩的产妇。排除了有既往剖宫产史或入院时胎膜早破的产妇。分析了妊娠史、入院时宫颈扩张程度和结局。采用一般线性模型，以逻辑回归为基础，按产次分层，分析了早期（宫颈扩张小于 4cm）和晚期（宫颈扩张 4cm 或以上）入院与结局之间的关系。结果以调整后的相对风险（RR）及其 95%置信区间（CI）表示。

结果

与晚期入院相比，早期入院时初产妇使用硬膜外麻醉的比例较高，分别为 84.8%和 71.8%，经产妇为 66.3%和 53.1%（初产妇 RR 1.18，95%CI 1.13-1.24；经产妇 RR 1.25，95%CI 1.18-1.32）；初产妇催产素增强的比例较高，分别为 58.5%和 36.6%，经产妇为 45.9%和 20.7%（初产妇 RR 1.56，95%CI 1.50-1.63；经产妇 RR 2.14，95%CI 1.87-2.44）；初产妇剖宫产率较高，分别为 21.8%和 14.5%，经产妇为 3.7%和 1.9%（初产妇 RR 1.50，95%CI 1.32-1.70；经产妇 RR 1.95，95%CI 1.47-2.57）。仅初产妇的新生儿重症监护病房入院率增加（RR 1.38，95%CI 1.01-1.89）。2012 年至 2014 年期间，初产妇晚期入院率增加了 14.6%，经产妇增加了 10.1%，剖宫产率从 10.5%降至 7.9%（均 P<.001）。