Boujenah Jérémy, Carbillon Lionel, Banh Pauline, Sibony Olivier, Korb Diane
Department of Obstetrics, Gynaecology Bondy, France Assistance Publique-Hôpitaux de Paris, Paris, France; Medical University Department of North Paris France.
Department of Obstetrics, Gynaecology Bondy, France Assistance Publique-Hôpitaux de Paris, Paris, France; Medical University Department of North Paris France.
Eur J Obstet Gynecol Reprod Biol. 2020 Mar;246:181-186. doi: 10.1016/j.ejogrb.2020.01.012. Epub 2020 Jan 14.
To study the mode of delivery in a well selected cohort of short nulliparous women.
Hospitals-based cohort study between 2010-2018. The threshold (150 cm, i.e 2,3°p), for the short stature was chosen before the analysis by corresponding to - 2SD of the average population size distribution of all women who delivered over the same period: 2010-2018. Were included nulliparous women with a heigh ≤ 150 cm in term spontaneous labor with a single livung fetus in vertex presentation without malformation. Exclusion criteria were: multiparous, scarred uterus, twin pregnancy, induced labor, preterm delivery (< 37 W P), non-vertex pregnancy, medical termination of pregnancy, stillbirth, severe fetal malformations, pre-labor cesarean, and late dating ultrasound. The main outcome was the mode of delivery. Univariate and multivariate analysis adjusted on potential confounding variable were performed to investigate the risk of intrapartum CS.
178 nulliparous women were included. The mean height was 148 cm. The rate of spontaneous vaginal delivery, operative vaginal delivery a nd intrapartum CS were :35,4 %, 35,4 % and 29,2 % respectively. Intrapartum CS was performed during the first stage labor in 15 (28, 8 %) women and during the second stage in 37 (71, 2 %) women. An arrest of labor was significantly more frequent in the active labor than the early labor stage: 62,1 % vs. 33.3 % (p = 0, 02). In univarate analysis were associated with intrapartum CS : Gestational diabetes, birthweight> 3,5 kg, individual adjusted birthweight >90°p, occiput posterior, oxytocin use, cephalic circumference. After adjustment on birthplace and overweight (BMI over 25), only a birthweight > 3,5 kg remains associated with the risk of intrapartum CS (aOR4.3 ;95 %CI 1.96-10.2).
An attempt of vaginal birth is a reasonable option for short stature women. Maternal height could be included in the selection criteria for planned birth center or home birth. The customized gestational-related optimal weigh could be useful to identify large of gestational age fetus.
研究精心挑选的初产短身材女性的分娩方式。
2010年至2018年基于医院的队列研究。在分析前，将身高阈值设定为150厘米（即第2.3百分位数），该阈值对应于2010年至2018年同期所有分娩女性总体身高分布的-2标准差。纳入的初产妇身高≤150厘米，足月自然临产，单活胎头先露且无畸形。排除标准为：经产妇、瘢痕子宫、双胎妊娠、引产、早产（<37孕周）、非头先露妊娠、人工流产、死产、严重胎儿畸形、临产前剖宫产及晚期超声孕周推算。主要结局为分娩方式。进行单因素和多因素分析，并对潜在混杂变量进行校正，以研究产时剖宫产的风险。
纳入178例初产妇。平均身高为148厘米。自然阴道分娩率、阴道助产率和产时剖宫产率分别为35.4%、35.4%和29.2%。15例（28.8%）产妇在第一产程行产时剖宫产，37例（71.2%）在第二产程行产时剖宫产。活跃期产程停滞明显多于潜伏期：62.1%对33.3%（p = 0.02）。单因素分析中，与产时剖宫产相关的因素有：妊娠期糖尿病、出生体重>3.5千克、个体校正出生体重>第90百分位数、枕后位、使用缩宫素、头围。在校正出生地和超重（BMI>25）后，仅出生体重>3.5千克仍与产时剖宫产风险相关（调整后比值比4.3；95%置信区间1.96 - 10.2）。
对于身材矮小的女性，尝试经阴道分娩是一种合理的选择。产妇身高可纳入计划分娩中心或家庭分娩的选择标准。定制的与孕周相关的最佳体重可能有助于识别孕周较大的胎儿。
