Matta Payal, Turner Jessica, Flatley Christopher, Kumar Sailesh
Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.
Mater Research Institute, University of Queensland, Brisbane, Queensland, Australia.
Aust N Z J Obstet Gynaecol. 2019 Aug;59(4):555-560. doi: 10.1111/ajo.12935. Epub 2018 Dec 21.
Prolonged second stage of labour is known to be associated with higher caesarean section rates. However, the association between prolonged second stage of labour (PSSL) and adverse neonatal outcomes remains contradictory. The aim of this study was to assess the association between prolonged second stage of labour and obstetric and neonatal outcomes.
This was a retrospective cohort study of women with term, singleton pregnancies at the Mater Mother's Hospital, Brisbane. Intrapartum, maternal and neonatal outcomes were assessed and stratified according to prolonged second stage of labour.
Of 48 352 women, 9.7% had PSSL. Women with PSSL were more likely to be nulliparous and have received oxytocin for augmentation of their labour (P < 0.001), less likely to have an epidural or have undergone induction of labour (P < 0.001). Women with PSSL were less likely to achieve a spontaneous vaginal delivery (adjusted odds ratio (aOR) 0.13, 95%CI 0.12-0.14, P < 0.001), more likely to undergo an instrumental delivery (aOR 3.93, 95%CI 3.62-4.25, P < 0.001) or emergency caesarean section (aOR 9.08, 95%CI 8.00-10.29, P < 0.001). PSSL was associated with shoulder dystocia (aOR 1.61, 95%CI 1.42-1.81, P < 0.001), and postpartum haemorrhage (aOR 1.37, 95%CI 1.16-1.60, P < 0.001). Univariate analysis demonstrated prolonged second stage of labour was associated with low five-minute Apgar score, acidosis and neonatal intensive care admission. However, after adjusting for potential confounders only five-minute Apgar scores ≤3 remained significantly increased (aOR 2.36, 95% CI 1.36-4.09, P = 0.002).
PSSL is associated with increased operative birth and maternal morbidity.
已知第二产程延长与剖宫产率升高有关。然而，第二产程延长（PSSL）与不良新生儿结局之间的关联仍存在矛盾。本研究的目的是评估第二产程延长与产科及新生儿结局之间的关联。
这是一项对布里斯班马特母亲医院足月单胎妊娠女性进行的回顾性队列研究。在分娩期间，根据第二产程延长情况对孕产妇和新生儿结局进行评估和分层。
在48352名女性中，9.7%有第二产程延长。第二产程延长的女性更可能为初产妇且接受过缩宫素引产（P<0.001），硬膜外麻醉或引产的可能性较小（P<0.001）。第二产程延长的女性自然阴道分娩的可能性较小（校正比值比[aOR]0.13，95%可信区间[CI]0.12 - 0.14，P<0.001），器械助产（aOR 3.93，95%CI 3.62 - 4.25，P<0.001）或急诊剖宫产（aOR 9.08，95%CI 8.00 - 10.29，P<0.001）的可能性更大。第二产程延长与肩难产（aOR 1.61，95%CI 1.42 - 1.81，P<0.001）和产后出血（aOR 1.37，95%CI 1.16 - 1.60，P<0.001）有关。单因素分析显示第二产程延长与5分钟阿氏评分低、酸中毒及新生儿重症监护病房收治有关。然而，在对潜在混杂因素进行校正后，仅5分钟阿氏评分≤3仍显著升高（aOR 2.36，95%CI 1.36 - 4.09，P = 0.002）。
第二产程延长与手术分娩增加及孕产妇发病率增加有关。
