Wuitchik M, Bakal D, Lipshitz J
Department of Obstetrics and Gynecology, Foothills Hospital, Calgary, Alberta, Canada.
Obstet Gynecol. 1989 Jan;73(1):35-42.
We examined the relationship between pain and cognitive activity during the latent (less than or equal to 3 cm), mid-active (5-7 cm), and transition (greater than or equal to 8 cm) phases of labor and the concomitant efficiency of the latent, active, and descent phases in 115 nulliparous women. Patients provided subjective pain ratings and described their thoughts during each of the three phases. Higher levels of pain during the latent phase of labor were predictive of longer latent (r = 0.58) and active (r = 0.50) phases of labor. Distress-related thoughts during latent labor were predictive of longer latent (r = 0.31, P less than .01), active (r = 0.67), and second-stage (r = 0.61) labor. We found no relationships between pain and cognitive activity measured during active labor and efficiency of active labor or second stage of labor. Pain and cognitive activity assessed during the latent phase were also prognostic of obstetric outcome. Thirteen of 19 women (68.4%) who reported "horrible" or "excruciating" pain required instrumental delivery, compared with eight of 27 women (29.6%) in the "discomforting" pain group. Subjects in the "distress-related" cognitive group had 2.6 times the incidence of instrumental delivery, five times the incidence of abnormal fetal heart rate patterns, and four times the requirement for pediatric assistance for the neonate than subjects in the "coping" group. We conclude that latent labor is a critical phase in the psychobiology of labor and that pain and cognitive activity during this phase are important contributors to labor efficiency and obstetric outcome.
我们研究了115名初产妇在潜伏期（小于或等于3厘米）、活跃期中期（5 - 7厘米）和过渡期（大于或等于8厘米）分娩过程中疼痛与认知活动之间的关系，以及潜伏期、活跃期和下降期相应的效率。患者提供主观疼痛评分，并描述三个阶段中每个阶段的想法。分娩潜伏期较高的疼痛水平预示着更长的潜伏期（r = 0.58）和活跃期（r = 0.50）。潜伏期与痛苦相关的想法预示着更长的潜伏期（r = 0.31，P < 0.01）、活跃期（r = 0.67）和第二产程（r = 0.61）。我们发现活跃期分娩时测量的疼痛与认知活动和活跃期分娩效率或第二产程之间没有关系。潜伏期评估的疼痛和认知活动也是产科结局的预后指标。报告“极其痛苦”或“剧痛”的19名女性中有13名（68.4%）需要器械助产，而“不适”疼痛组的27名女性中有8名（29.6%）需要器械助产。“与痛苦相关”认知组的受试者器械助产发生率是“应对”组受试者的2.6倍，异常胎儿心率模式发生率是其5倍，新生儿需要儿科辅助的需求是其4倍。我们得出结论，分娩潜伏期是分娩心理生物学中的关键阶段，此阶段的疼痛和认知活动是分娩效率和产科结局的重要影响因素。
