Cohen Wayne R, Friedman Emanuel A
Department of Obstetrics and Gynecology, University of Arizona College of Medicine, 4841 North Valley View Road, Tucson, AZ 85718, USA, Tel.: 646-270-5518, Fax: 520-505-4213, E-mail:
Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA, USA.
J Perinat Med. 2018 Jan 26;46(1):1-8. doi: 10.1515/jpm-2017-0018.
In the 1930s, investigators in the US, Germany and Switzerland made the first attempts to quantify the course of labor in a clinically meaningful way. They emphasized the rupture of membranes as a pivotal event governing labor progress. Attention was also placed on the total number of contractions as a guide to normality. Beginning in the 1950s, Friedman determined that changes in cervical dilatation and fetal station over time were the most useful parameters for the assessment of labor progress. He showed all normal labors had similar patterns of dilatation and descent, differing only in the durations and slopes of their component parts. These observations led to the formulation of criteria that elevated the assessment of labor from a rather arbitrary exercise to one guided by scientific objectivity. Researchers worldwide confirmed the basic nature of labor curves and validated their functionality. This system allows us to quantify the effects of parity, analgesia, maternal obesity, prior cesarean, maternal age, and fetal presentation and position on labor. It permits analysis of outcomes associated with labor aberrations, quantifies the effectiveness of treatments and assesses the need for cesarean delivery. Also, dysfunctional labor patterns serve as indicators of short- and long-term risks to offspring. We still lack the necessary translational research to link the physiologic manifestations of uterine contractility with changes in dilatation and descent. Recent efforts to interpret electrohysterographic patterns hold promise in this regard, as does preliminary exploration into the molecular basis of dysfunctional labor. For now, the clinician is best served by a system of labor assessment proposed more than 60 years ago and embellished upon in considerable detail since.
20世纪30年代，美国、德国和瑞士的研究人员首次尝试以具有临床意义的方式对产程进行量化。他们强调胎膜破裂是决定产程进展的关键事件。同时也将宫缩总数作为判断产程是否正常的指标。从20世纪50年代开始，弗里德曼确定宫颈扩张和胎先露下降随时间的变化是评估产程进展最有用的参数。他指出，所有正常分娩都有相似的扩张和下降模式，只是各组成部分的持续时间和斜率有所不同。这些观察结果促使人们制定了相关标准，将产程评估从相当随意的操作提升为以科学客观性为指导的评估。世界各地的研究人员证实了产程曲线的基本性质并验证了其功能。该系统使我们能够量化产次、镇痛、产妇肥胖、既往剖宫产史、产妇年龄以及胎儿先露和胎位对分娩的影响。它可以分析与产程异常相关的结局，量化治疗效果并评估剖宫产的必要性。此外，产程异常模式可作为子代短期和长期风险的指标。我们仍然缺乏必要的转化研究来将子宫收缩力的生理表现与扩张和下降的变化联系起来。近期对子宫电图模式的解读研究在这方面很有前景，对产程异常的分子基础的初步探索也是如此。目前，临床医生最好采用60多年前提出并在此后不断完善的产程评估系统。
