Byrd J E, Lytton D E, Vogt S C, Raczek J A
Department of Family Medicine and Practice, University of Wisconsin, Madison.
J Fam Pract. 1988 Dec;27(6):595-9.
Cephalopelvic disproportion has been identified as making an important contribution to the rising cesarean birth rate. O'Driscoll and colleagues in Dublin, Ireland, have suggested replacement of cephalopelvic disproportion by the term dystocia for failure of labor to progress and have defined two major subcategories: (1) true cephalopelvic disproportion, and (2) inefficient uterine action. A chart audit of reported indications for cesarean birth in a family practice residency population was done, and patients were classified using the O'Driscoll et al diagnostic criteria for dystocia. When reclassified, the percentage of cesarean births in this population for true cephalopelvic disproportion did not differ significantly from that reported from Dublin (6.1 as compared with 8.8), while the percentage done for inefficient uterine action was significantly greater (35.4 as compared with 4.2). This finding suggests there is a set of labors amenable to a management strategy that could result in a decrease in the cesarean birth rates if efficient uterine action is assured with adequate use of oxytocin.
头盆不称已被确认为剖宫产率上升的一个重要因素。爱尔兰都柏林的奥德里斯科尔及其同事建议用“难产”一词取代头盆不称，用以指产程进展失败，并定义了两个主要子类：（1）真性头盆不称，以及（2）子宫收缩乏力。对一家家庭医疗住院医师培训人群中报告的剖宫产指征进行了图表审核，并使用奥德里斯科尔等人的难产诊断标准对患者进行分类。重新分类后，该人群中因真性头盆不称进行剖宫产的比例与都柏林报告的比例相比无显著差异（分别为6.1%和8.8%），而因子宫收缩乏力进行剖宫产的比例显著更高（分别为35.4%和4.2%）。这一发现表明，存在一组可采用管理策略的产程，如果通过充分使用缩宫素确保有效的子宫收缩，可能会降低剖宫产率。
