Zondag Dirkje C, Gross Mechthild M, Grylka-Baeschlin Susanne, Poat Angela, Petersen Antje
Midwifery Research and Education Unit, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
Faculty of Health and Social Care, University of Hull, Hull, HU6 7RX, UK.
Arch Gynecol Obstet. 2016 Nov;294(5):967-977. doi: 10.1007/s00404-016-4110-1. Epub 2016 May 19.
To investigate the association of analgesia, opioids or epidural, or the combination of both with labour duration and spontaneous birth in nulliparous women.
A secondary data analysis of an existing cohort study was performed and included nulliparous women (n = 2074). Durations of total labour and first and second labour stage were calculated with Kaplan-Meier estimation for the four different study groups: no analgesia (n = 620), opioid analgesia (n = 743), epidural analgesia (n = 482), and combined application (n = 229). Labour duration was compared by Cox regression while adjusting for confounders and censoring for operative births. Logistic regression was used to investigate the association between the administration of different types of analgesia and mode of birth.
Most women in the combined application group were first to receive opioid analgesia. Women with no analgesia had the shortest duration of labour (log rank p < 0.001) and highest chance of a spontaneous birth (p < 0.001). If analgesia was administered, women with opioids had a shorter first stage (p = 0.018), compared to women with epidural (p < 0.001) or women with combined application (p < 0.001). Women with opioids had an increased chance to reach full cervical dilatation (p = 0.006). Women with epidural analgesia (p < 0.001) and women with combined application (p < 0.001) had a prolonged second stage and decreased chance of spontaneous birth compared to women without analgesia.
Women with opioids had a prolonged first stage, but increased chance to reach full cervical dilatation. Women with epidural analgesia and women with both opioid and epidural analgesia had a prolonged first and second stage and a decreased chance of a spontaneous birth.
探讨镇痛、阿片类药物或硬膜外麻醉，或两者联合使用与初产妇产程及自然分娩之间的关联。
对一项现有队列研究进行二次数据分析，纳入初产妇（n = 2074）。采用Kaplan-Meier估计法计算四个不同研究组的总产程、第一产程和第二产程的时长：未镇痛组（n = 620）、阿片类药物镇痛组（n = 743）、硬膜外麻醉镇痛组（n = 482）和联合应用组（n = 229）。通过Cox回归比较产程，同时对混杂因素进行校正并对手术分娩进行删失处理。采用逻辑回归研究不同类型镇痛措施的使用与分娩方式之间的关联。
联合应用组中的大多数女性首先接受阿片类药物镇痛。未镇痛的女性产程最短（对数秩检验p < 0.001），自然分娩的几率最高（p < 0.001）。若实施镇痛，与接受硬膜外麻醉的女性（p < 0.001）或联合应用的女性（p < 0.001）相比，接受阿片类药物镇痛的女性第一产程较短（p = 0.018）。接受阿片类药物镇痛的女性宫颈完全扩张的几率增加（p = 0.006）。与未镇痛的女性相比，接受硬膜外麻醉镇痛的女性（p < 0.001）和联合应用的女性（p < 0.001）第二产程延长，自然分娩的几率降低。
接受阿片类药物镇痛的女性第一产程延长，但宫颈完全扩张的几率增加。接受硬膜外麻醉镇痛的女性以及同时接受阿片类药物和硬膜外麻醉镇痛的女性第一产程和第二产程均延长，自然分娩的几率降低。
