Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut.
Obstet Gynecol. 2020 Mar;135(3):569-575. doi: 10.1097/AOG.0000000000003709.
To evaluate the association between temporary cessation in oxytocin infusion (oxytocin rest) and mode of delivery in women undergoing induction of labor with a protracted latent phase.
We conducted a retrospective cohort analysis of nulliparous women with term, vertex, singleton gestations who were undergoing induction of labor with continuous oxytocin infusion at a large academic medical center. Episodes of oxytocin rest were identified among patients who were exposed to 8 hours of continuous oxytocin yet remained in latent labor (ie, protracted latent labor). Multivariable logistic regression analysis was performed to estimate the association between duration of oxytocin rest and mode of delivery while adjusting for duration of latent phase, maternal age, gestational age, body mass index, and indications for induction and oxytocin cessation. Maternal and neonatal morbidities were also compared among patients with different durations of oxytocin rest.
From January 2012 to December 2016, 1,193 patients met eligibility criteria. Among these patients, 267 patients (22.4%) underwent an oxytocin rest that lasted at least 1 hour. After adjusting for potential confounders, the odds ratios of cesarean delivery for patients with oxytocin rest compared with those with no oxytocin rest were as follows: 1.12 (95% CI 0.79-1.58) for less than 1 hour, 0.78 (95% CI 0.48-1.27) for 1-2 hours, 0.60 (95% CI 0.35-1.04) for 2-8 hours, and 0.43 (95% CI 0.24-0.79) for 8 hours or more. We did not detect an association between oxytocin rest of more than 8 hours and a composite of maternal or neonatal morbidities.
An oxytocin rest of at least 8 hours is a clinical tool that may reduce the risk of cesarean delivery among women with protracted latent labor without significantly increasing maternal or neonatal morbidity.
评估在产程延长潜伏期行催产素引产的产妇中，临时停止催产素输注（催产素休息）与分娩方式的相关性。
我们对在大型学术医疗中心行持续催产素输注引产的足月、头位、单胎妊娠初产妇进行了回顾性队列分析。在经历了 8 小时持续催产素输注但仍处于潜伏期的产妇（即潜伏期延长）中，确定了催产素休息的发作情况。多变量逻辑回归分析用于估计催产素休息持续时间与分娩方式之间的关联，同时调整潜伏期持续时间、产妇年龄、胎龄、体重指数以及引产和催产素停止的指征。还比较了不同催产素休息持续时间患者的母婴发病率。
2012 年 1 月至 2016 年 12 月，共有 1193 名患者符合入选标准。在这些患者中，267 名（22.4%）患者进行了至少 1 小时的催产素休息。在调整了潜在混杂因素后，与无催产素休息的患者相比，有催产素休息的患者行剖宫产的比值比如下：<1 小时为 1.12（95%可信区间 0.79-1.58），1-2 小时为 0.78（95%可信区间 0.48-1.27），2-8 小时为 0.60（95%可信区间 0.35-1.04），8 小时或以上为 0.43（95%可信区间 0.24-0.79）。我们未发现催产素休息超过 8 小时与母婴发病率的复合结局之间存在关联。
至少 8 小时的催产素休息是一种临床工具，它可能降低产程延长潜伏期产妇行剖宫产的风险，而不会显著增加母婴发病率。
