Cummings Kelly F, Helmich Melissa S, Ounpraseuth Songthip T, Dajani Nafisa K, Magann Everett F
Departments of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR.
Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR.
J Obstet Gynaecol Can. 2018 Sep;40(9):1148-1153. doi: 10.1016/j.jogc.2017.12.008. Epub 2018 Jul 11.
Maternal obesity has been associated with an increased risk for an abnormal progression of labour; however, less is known about the length of the third stage of labour and its relation to maternal obesity.
To determine if the length of the third stage of labour is increased in extremely obese women and its possible correlation with an increased risk for postpartum hemorrhage.
This was a retrospective cohort study of deliveries from January 2008 to December 2015 at our university hospital. Women with a BMI ≥40 and a vaginal delivery were compared with the next vaginal delivery of a woman with a BMI <30. There were 147 women with a BMI ≥40 compared with 157 with a BMI <30. Outcomes evaluated the length of the third stage of labour and the risk for postpartum hemorrhage and included antepartum, intrapartum, and perinatal complications.
Subjects in the extreme obese group were more likely to be African American, older, diabetic (pregestational and gestational), hypertensive, pre-eclamptic, had a preterm delivery, and underwent an induction of labour. The overall length of the third stage of labour was significantly longer in the extreme obese group, 5 minutes (3, 8 [25th and 75th percentiles]) compared with 4 minutes (3,7) (P = 0.0374) in the non-obese group. Postpartum hemorrhage occurred more often in the extreme obese group (N = 16/147; 11%) compared with the non-obese group (N = 5/157; 3%) (P = 0.01). There were no differences between groups in respect to the following: gravidity, parity, length of the second stage of labour, birth weight, GA at delivery, Apgar score, cord blood gases, hematocrit change, need for postpartum transfusion, operative delivery, and development of chorioamnionitis. After an adjustment for ethnicity, maternal age, diabetes, preeclampsia, preterm labour, hypertension, and induction/augmentation, the analysis failed to show a significant difference in estimated blood loss and postpartum hemorrhage between the groups.
The length of the third stage of labour is longer in the extreme obese parturient. Postpartum hemorrhage also occurs more often, but after adjustments for confounding variables, it is no longer significant.
孕妇肥胖与产程异常进展风险增加有关；然而，关于第三产程的时长及其与孕妇肥胖的关系，人们了解较少。
确定极度肥胖女性的第三产程时长是否增加，以及其与产后出血风险增加之间的可能关联。
这是一项对2008年1月至2015年12月在我校医院分娩情况的回顾性队列研究。将BMI≥40且经阴道分娩的女性与BMI<30的女性的下一次阴道分娩情况进行比较。BMI≥40的女性有147例，BMI<30的女性有157例。评估的结局包括第三产程的时长和产后出血风险，以及产前、产时和围产期并发症。
极度肥胖组的受试者更可能是非裔美国人、年龄较大、患有糖尿病（孕前和孕期）、高血压、先兆子痫、早产，并接受引产。极度肥胖组第三产程的总时长明显更长，为5分钟（3，8[第25和第75百分位数]），而非肥胖组为4分钟（3，7）（P = 0.0374）。极度肥胖组产后出血的发生率高于非肥胖组（16/147；11%），非肥胖组为（5/157；3%）（P = 0.01）。两组在以下方面无差异：妊娠次数、产次、第二产程时长、出生体重、分娩时的孕周、阿氏评分、脐血气、血细胞比容变化、产后输血需求、手术分娩以及绒毛膜羊膜炎的发生情况。在对种族、产妇年龄、糖尿病、先兆子痫、早产、高血压以及引产/催产进行调整后，分析未显示两组之间在估计失血量和产后出血方面存在显著差异。
极度肥胖产妇的第三产程时长更长。产后出血的发生率也更高，但在对混杂变量进行调整后，这种差异不再显著。
