Department of Women, Children, and Family Health Science, University of Illinois at Chicago College of Nursing, Chicago, IL, USA.
Department of Health Systems Science, University of Illinois at Chicago College of Nursing, Chicago, IL, USA.
Birth. 2020 Jun;47(2):220-226. doi: 10.1111/birt.12482. Epub 2020 Jan 30.
The cesarean birth rate in the United States is 32%, and there is discussion about the cause of high surgical birth rates. Our purpose was to determine whether mode of birth is influenced by maternal, nurse, and system factors.
Secondary analysis of a data set of 163 women having postdates labor induction with oxytocin. Kaplan-Meier survival curves were calculated to compare the time for patients to reach an infusion rate of 6 mU/min, consistent with endogenous oxytocin levels in active labor. We used the log-rank test to evaluate survival curve differences. Multiple logistic regression and Cox proportional hazards models were conducted and included covariates that had statistically significant bivariate relationships with the time variable, or were clinically meaningful.
The mean time to reach 6 mU/min was longer for women who birthed by cesarean (172.5 minutes) than for women who had vaginal birth (125.0 minutes, P = .024). The mean time to reach 6 mU/min was also longer for women admitted on night shift (147.0 minutes) than day shift (110.2 minutes, P = .018). No maternal characteristics were significantly related to the time to reach a rate of 6 mU/min.
Even during the initial hours of labor induction, it is important that the oxytocin infusion is titrated appropriately to aid women in achieving timely vaginal birth. Intrapartum nurses should receive education about the pharmacokinetics of intravenous oxytocin to understand proper administration of this high-alert medication.
美国的剖宫产率为 32%，人们对高剖宫产率的原因展开了讨论。我们的目的是确定分娩方式是否受产妇、护士和系统因素的影响。
对 163 名接受缩宫素引产且过期妊娠的女性进行数据集的二次分析。计算 Kaplan-Meier 生存曲线，以比较患者达到 6 mU/min 输注率的时间，这与活跃分娩时内源性催产素水平一致。我们使用对数秩检验评估生存曲线差异。进行多因素逻辑回归和 Cox 比例风险模型，并纳入与时间变量具有统计学显著的双变量关系或具有临床意义的协变量。
行剖宫产的女性达到 6 mU/min 的平均时间（172.5 分钟）长于行阴道分娩的女性（125.0 分钟，P =.024）。上夜班（147.0 分钟）的女性达到 6 mU/min 的平均时间也长于白班（110.2 分钟，P =.018）。没有产妇特征与达到 6 mU/min 的时间显著相关。
即使在引产的最初几小时内，适当调整催产素输注量以帮助女性及时进行阴道分娩也很重要。产程中的护士应接受关于静脉内催产素药代动力学的教育，以了解这种高警示药物的正确给药。
