Department of Obstetrics and Gynaecology, Østfold Hospital Trust, Grålum, Norway; Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway.
Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway.
Midwifery. 2020 Feb;81:102578. doi: 10.1016/j.midw.2019.102578. Epub 2019 Nov 18.
To investigate labour duration in different phases of labour when adhering to Zhang's guideline for labour progression compared with the WHO partograph.
A secondary analysis of a cluster randomised controlled trial.
Fourteen Norwegian birth care units, each with more than 500 deliveries per year constituted the clusters.
A total of 7277 nulliparous women with singleton foetus in a cephalic presentation and spontaneous onset of labour at term were included.
Seven clusters were randomised to the intervention group that adhered to Zhang's guideline (n = 3972) and seven to the control group that adhered to the WHO partograph (n = 3305) for labour progression.
The duration of labour from the first registration of cervical dilatation (≥ 4 cm) to the delivery of the baby and the duration of the first and second stages of labour; the time-to-event analysis was used to compare the duration of labour between the two groups after adjusting for baseline covariates.
The adjusted median duration of labour was 7.0 h in the Zhang group, compared with 6.2 h in the WHO group; the median difference was 0.84 h with 95% confidence interval [CI] (0.2-1.5). The adjusted median duration of the first stage was 5.6 h in the Zhang group compared with 4.9 h in the WHO group; the median difference was 0.66 h with 95% CI (0.1-1.2). The corresponding adjusted median duration of the second stage was 88 and 77 min; the median difference was 0.18 h with 95% CI (0.1-0.3).
The women who adhered to Zhang's guideline had longer overall duration and duration of the first and second stages of labour than women who adhered to the WHO partograph.
Understanding the variations in the duration of labour is of great importance, and the results offer useful insights into the different labour progression guidelines, which can inform clinical practice.
与世界卫生组织产程图相比，当遵循张的产程进展指南时，研究不同产程阶段的分娩持续时间。
一项集群随机对照试验的二次分析。
每个都有超过 500 次分娩的 14 个挪威分娩护理单位构成了集群。
总共纳入了 7277 名初产妇，具有单胎头位和足月自发性分娩。
7 个集群被随机分配到干预组，该组遵循张的指南（n=3972），7 个集群被随机分配到对照组，该组遵循世界卫生组织产程图（n=3305）以进行产程进展。
从宫颈扩张（≥4cm）首次记录到婴儿分娩的分娩持续时间以及第一和第二产程的持续时间；使用时间事件分析比较两组之间的分娩持续时间，调整基线协变量后。
张组的调整后中位分娩持续时间为 7.0 小时，而世界卫生组织组为 6.2 小时；中位数差异为 0.84 小时，95%置信区间[CI]（0.2-1.5）。张组第一产程的调整后中位数为 5.6 小时，而世界卫生组织组为 4.9 小时；中位数差异为 0.66 小时，95%CI（0.1-1.2）。相应调整后的第二产程中位数为 88 和 77 分钟；中位数差异为 0.18 小时，95%CI（0.1-0.3）。
遵循张的指导原则的女性的总分娩持续时间以及第一和第二产程的持续时间均长于遵循世界卫生组织产程图的女性。
了解分娩持续时间的变化非常重要，结果为不同的产程进展指南提供了有用的见解，可以为临床实践提供信息。
