Iizuka Yukie, Masaoka Naoki, Ohashi Kazutomo
Division of Health Sciences, Osaka University Graduate School of Medicine, Osaka, Japan.
Department of Maternal and Fetal Medicine, Tokyo Women's Medical University Yachiyo Medical Center, Chiba, Japan.
J Obstet Gynaecol Res. 2018 Jul;44(7):1243-1251. doi: 10.1111/jog.13660.
To assess two discomfort aspects of pain in labor, physical pain intensity and psychological stress state, we analyzed the association between the two parameters.
Twenty-nine pregnant Japanese women with a singleton in 37-40 weeks of gestation were analyzed. Physical pain intensity was examined by the Numeric Rating Scale (NRS). Psychological stress state was measured by chromogranin A (CgA) in saliva. Data were collected thrice during labor (at 4-6 cm and 10 cm of cervical dilatation and immediately after delivery) and were accumulated from 4-6 cm and 10 cm of cervical dilatation. The study was approved by the Ethics Committees of Osaka University and Tokyo Women's Medical University.
The median NRS score (10, IQR = 10-18) and the median CgA in saliva (8.0, IQR = 4.3-12.0) pmol/mg at 10 cm of cervical dilatation were significantly higher than those at the other two time points (P < 0.05). Although there were no correlations between NRS scores and concentrations of CgA in saliva at the three time points, there was a significant correlation between accumulated NRS and accumulated CgA in saliva (r = 0.68, P = 0.000). There was a significant difference in the accumulated NRS scores (P = 0.005) but not in the accumulated concentrations of CgA between primiparae and multiparae.
Women in labor perceived severe pain and psychological stress with similar patterns during labor. However, these parameters were independent and need to be measured to evaluate these two discomfort aspects.
为评估分娩疼痛的两个不适方面，即身体疼痛强度和心理应激状态，我们分析了这两个参数之间的关联。
对29名妊娠37 - 40周的单胎日本孕妇进行分析。采用数字评分量表（NRS）检查身体疼痛强度。通过检测唾液中的嗜铬粒蛋白A（CgA）来测量心理应激状态。在分娩期间（宫颈扩张4 - 6 cm、10 cm时以及分娩后即刻）进行三次数据收集，并汇总宫颈扩张4 - 6 cm和10 cm时的数据。该研究获得了大阪大学和东京女子医科大学伦理委员会的批准。
宫颈扩张10 cm时，NRS评分中位数（10，四分位间距 = 10 - 18）和唾液中CgA中位数（8.0，四分位间距 = 4.3 - 12.0）pmol/mg显著高于其他两个时间点（P < 0.05）。尽管三个时间点的NRS评分与唾液中CgA浓度之间无相关性，但唾液中累积NRS与累积CgA之间存在显著相关性（r = 0.68，P = 0.000）。初产妇和经产妇在累积NRS评分上存在显著差异（P = 0.005），但在CgA累积浓度上无显著差异。
分娩中的女性在分娩过程中感受到的剧痛和心理应激呈现相似模式。然而，这些参数是独立的，需要分别测量以评估这两个不适方面。
