Midwifery Research and Education Unit, Hannover Medical School, Germany.
Departement of Obstetrics and Gynecology, Bern University Hospital, Switzerland.
Midwifery. 2020 Jun;85:102683. doi: 10.1016/j.midw.2020.102683. Epub 2020 Feb 26.
The primary objective of this study was to examine the association between the first assessed cervical dilatation in a labourward and the use of oxytocin augmentation during labour. Further analysis was performed by examining the actual stage of labour at the point oxytocin was first administered to those women.
Retrospective cohort study with the data collected from the medical records of the hospital.
University Hospital Bern, Switzerland PARTICIPANTS: 1933 term nulliparous and multiparous women with a singleton pregnancy giving birth during the period June 2013 and May 2017, representing Robson groups 1 and 3.
Descriptive statistics and multivariable logistic regression models were performed. It was found that for the entire process of labour, nulliparous and multiparous women (n = 1933) with a first cervical dilatation of 5 or more cm were less likely to be augmented with oxytocin (OR 0.64, 95% CI 0.46; 0.88 and OR 0.56, 95% CI 0.38; 0.82, respectively) compared to women with a first cervical dilatation of less than 5 cm. Out of these augmented women (n = 746) having a first cervical dilatation of 5 or more cm, they had a lower likelihood of being augmented during the first stage of labour compared to women with a first cervical dilatation of less than 5 cm (OR 0.45, 95% CI 0.29; 0.7 for nulliparae and OR 0.32, 95% CI 0.16; 0.6 for multiparae). Additionally, it was observed that other factors contributed to the application of oxytocin. One such example was that epidural analgesia was associated with a high risk of oxytocin augmentation in nulliparae (OR 13.88, 95% CI 9.29; 20.74) and multiparae (OR 15.52, 95% CI 9.94; 24.22). The application of oxytocin was also found to affect the caesarean section rate in nulliparous and multiparous women as it was 20% and 13% respectively for those with oxytocin versus 13% and 4% respectively for those without oxytocin.
Early admission to the labourward is associated with an increased use of oxytocin to augment labour, particularly, during the first stage of labour. Epidural analgesia is a main predictor for oxytocin augmentation in nulliparous and multiparous women.
Pregnant women warrant more appropriate support during early labour, avoiding early maternal exhaustion and excessive obstetrical interventions.
本研究的主要目的是探讨分娩时首次评估的宫颈扩张程度与产程中使用催产素引产之间的关系。进一步的分析是通过检查在首次给予催产素时那些女性的实际产程阶段来进行的。
回顾性队列研究，数据来自医院的病历。
瑞士伯尔尼大学医院。
1933 名足月初产妇和经产妇，单胎妊娠，分娩时间为 2013 年 6 月至 2017 年 5 月，代表 Robson 组 1 和 3。
进行了描述性统计和多变量逻辑回归模型分析。结果发现，对于整个产程，初产妇和经产妇（n=1933）的宫颈扩张度为 5cm 或以上，与宫颈扩张度<5cm 的女性相比，催产素引产的可能性较小（OR 0.64，95%CI 0.46；0.88 和 OR 0.56，95%CI 0.38；0.82）。在这些接受催产素引产的女性（n=746）中，宫颈扩张度为 5cm 或以上的女性，与宫颈扩张度<5cm 的女性相比，在第一产程中接受催产素引产的可能性较低（OR 0.45，95%CI 0.29；0.7 对于初产妇和 OR 0.32，95%CI 0.16；0.6 对于经产妇）。此外，还观察到其他因素也促成了催产素的应用。例如，硬膜外镇痛与初产妇（OR 13.88，95%CI 9.29；20.74）和经产妇（OR 15.52，95%CI 9.94；24.22）使用催产素的风险增加有关。催产素的应用也被发现会影响初产妇和经产妇的剖宫产率，因为使用催产素的产妇的剖宫产率分别为 20%和 13%，而未使用催产素的产妇的剖宫产率分别为 13%和 4%。
早期入院分娩与催产素引产的增加有关，尤其是在第一产程。硬膜外镇痛是初产妇和经产妇使用催产素引产的主要预测因素。
孕妇在早期分娩时需要更多的适当支持，避免早期的产妇疲劳和过多的产科干预。
