Shmueli Anat, Salman Lina, Orbach-Zinger Sharon, Aviram Amir, Hiersch Liran, Chen Rony, Gabbay-Benziv Rinat
Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, Israel.
The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Birth. 2018 Dec;45(4):377-384. doi: 10.1111/birt.12355. Epub 2018 May 22.
We aimed to describe the length of second stage of labor in a contemporary cohort. We calculated the 5th, 50th, and 95th percentiles for second-stage length stratified by parity and epidural analgesia use and evaluated the effect of labor induction and oxytocin augmentation in our cohort.
We did a retrospective analysis of all live, singleton, term vaginal deliveries in one tertiary hospital. Multivariate linear regression was used to evaluate second-stage duration confounders. First, we calculated the second-stage length and presented it as 5th, 50th, and 95th percentiles stratified by epidural analgesia and parity. Second, we evaluated the effect of labor induction and oxytocin augmentation on second-stage length, and third, we determined the demographic and obstetrical confounders that affected second-stage length.
Overall, 15 500 deliveries were included. Nulliparity, oxytocin augmentation, epidural use, birthweight, labor induction, lower body mass index, and higher maternal age were found to be significantly associated with prolongation of the second stage. Epidural use was associated with an additional 82 minutes for the 95th percentile for both nulliparas and multiparas and tripled the rate of prolonged second stage for the entire cohort. Labor induction was associated with clinically significant prolongation of the second stage in nulliparas with epidural analgesia only. Oxytocin was associated with longer duration of the second stage for nulliparas, regardless of epidural use.
Our findings suggest a significant prolongation of the second stage in women receiving epidural analgesia. Recommendations for management of second stage should be reconsidered by contemporary data.
我们旨在描述当代队列中第二产程的时长。我们计算了按产次和硬膜外镇痛使用情况分层的第二产程时长的第5、第50和第95百分位数，并评估了引产和缩宫素加强宫缩在我们队列中的影响。
我们对一家三级医院所有单胎、足月活产阴道分娩进行了回顾性分析。采用多变量线性回归评估第二产程持续时间的混杂因素。首先，我们计算第二产程时长，并将其表示为按硬膜外镇痛和产次分层的第5、第50和第95百分位数。其次，我们评估引产和缩宫素加强宫缩对第二产程时长的影响，第三，我们确定影响第二产程时长的人口统计学和产科混杂因素。
总体而言，纳入了15500例分娩。发现初产、缩宫素加强宫缩、使用硬膜外麻醉、出生体重、引产、较低的体重指数和较高的产妇年龄与第二产程延长显著相关。对于初产妇和经产妇，使用硬膜外麻醉均使第95百分位数的时长增加82分钟，并使整个队列中第二产程延长的发生率增加两倍。仅在使用硬膜外镇痛的初产妇中，引产与第二产程临床上的显著延长相关。无论是否使用硬膜外麻醉，缩宫素都与初产妇第二产程持续时间较长有关。
我们的研究结果表明，接受硬膜外镇痛的女性第二产程显著延长。当代数据应重新考虑第二产程管理的建议。
