Department of Maternal, Child and Adolescent Health, School of Public Health, Fudan University, Shanghai, China.
Department of Nursing, Obstetrics & Gynaecology Hospital of Fudan University, Shanghai, China.
BMC Pregnancy Childbirth. 2020 Jul 2;20(1):386. doi: 10.1186/s12884-020-03072-x.
There is an increasing global trend towards the widespread over-medicalisation of labour and childbirth. The present study aimed to investigate pregnant women's clinical characteristics, intrapartum interventions, duration of labour and its associated factors; and to compare the differences of these variables between nulliparas and multiparas in China.
A multi-center cross-sectional study was carried out in three tertiary hospitals of Fudan University in Shanghai, China. A total of 1523 participants were approched and assessed for eligibility. Data on women's sociodemographic characteristics, intrapartum interventions, and duration of labour were measured and collected. Kaplan-Meier survival analysis was performed to present the curves of total duration of labour by parity. After z-transformation of labour duration, multivariable linear regression was used to control for confounding and to identify independent associations between potential associated factors and the primary outcome of labour duration.
Overall, 1209 eligible women agreed to participate and were investigated. Rates of different intrapartum interventions were 27.4% in use of amniotomy, 37.9% in use of oxytocin, 53.0% in continuous electronic fetal monitoring, and 52.9% in epidural use, respectively. The curve of total duration of labour was significantly different between nulliparas and multiparas (P < .001). Of the 1209 participants, 983 (81.3%) women eventually achieved successful vaginal birth while 226 (18.7%) women ended in intrapartum caesarean section. The median duration of total stage of labour was significantly longer in the nulliparous group [9.38 (6.33,14.10) hours] than that in the multiparous group [5.08 (3.00,7.83) hours] (P < .001). The following factors were independently associated with longer duration of total stage of labour: epidural analgesia (P < .001), primiparity (P < .001), continuous electronic fetal monitoring (P = .035), and increased birth weight (P = .005).
Intrapartum medical interventions become common obstetric practices in urban China. Multifactorial variables independently associated with longer duration of labour were identified, including epidural analgesia, primiparity, continuous electronic fetal monitoring, and increased birth weight. Further research is required to validate these variables and to determine the modifiable factors for labour management. And models of care with lower intervention rates such as midwife-led models of care should be developed and implemented in China.
全球范围内，劳动和分娩的过度医疗化趋势日益明显。本研究旨在调查孕妇的临床特征、产程干预措施、分娩持续时间及其相关因素，并比较中国初产妇和经产妇之间这些变量的差异。
本研究采用多中心、横断面研究方法，在中国上海复旦大学的 3 所三级医院进行。共纳入 1523 名符合条件的参与者，并对其进行评估。收集了女性的社会人口学特征、产程干预措施和分娩持续时间的数据。采用 Kaplan-Meier 生存分析展示产程总持续时间的曲线。对分娩持续时间进行 z 转换后，采用多变量线性回归控制混杂因素，并确定潜在相关因素与主要结局（分娩持续时间）之间的独立关联。
总体而言，1209 名符合条件的女性同意参与并接受了调查。不同产程干预措施的使用率分别为：人工破膜 27.4%、缩宫素使用 37.9%、连续电子胎心监护 53.0%、硬膜外麻醉使用 52.9%。初产妇和经产妇的总分娩持续时间曲线差异有统计学意义（P<0.001）。在 1209 名参与者中，983 名（81.3%）女性最终成功经阴道分娩，226 名（18.7%）女性在产程中转剖宫产。初产妇组的总产程持续时间中位数明显长于经产妇组[9.38（6.33，14.10）小时]（P<0.001）。与总产程持续时间较长相关的独立因素包括：硬膜外镇痛（P<0.001）、初产妇（P<0.001）、连续电子胎心监护（P=0.035）和出生体重增加（P=0.005）。
产程中的医疗干预在城市中国已成为常见的产科实践。确定了与分娩持续时间较长相关的多因素变量，包括硬膜外镇痛、初产妇、连续电子胎心监护和出生体重增加。需要进一步研究来验证这些变量，并确定可改变的分娩管理因素。应该在中国开发和实施干预率较低的护理模式，例如助产士主导的护理模式。
