分娩阶段对多产妇母婴不良结局的影响：一项回顾性队列研究。
The impact of stage of labor on adverse maternal and neonatal outcomes in multiparous women: a retrospective cohort study.
机构信息
Department of Obstetrics and Gynecology, Hebei General Hospital, Hebei Medical University, Shijiazhuang, 050051, China.
Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA.
出版信息
BMC Pregnancy Childbirth. 2020 Oct 7;20(1):596. doi: 10.1186/s12884-020-03286-z.
BACKGROUND
The correlation between stage of labor and adverse delivery outcomes has been widely studied. Most of studies focused on nulliparous women, it was not very clear what impact the stage of labor duration had on multiparous women.
METHODS
A retrospective cohort study was conducted among all the multiparous women of cephalic, term, singleton births, who planned vaginal delivery. The total stage of labor covered the first stage and the second stage in this study, and they were divided into subgroups. Adverse maternal outcomes were defined as referral cesarean delivery, instrumental delivery, postpartum hemorrhage, perineal laceration (III and IV degree), hospitalization stay ≥90th, and adverse neonatal outcomes as NICU, shoulder dystocia, Apgar score ≤ 7(5 min), neonatal resuscitation, assisted ventilation required immediately after delivery.
RESULTS
There were 7109 parturients included in this study. The duration of first stage was 6.2(3.6-10.0) hours, the second stage was 0.3(0.2-0.7) hour, the total stage was 6.9(4.1-10.7) hours in multiparous women. At the first stage, the rates of overall adverse outcome were 21, 23.4, 28.8, 35.5, 38.4% in subgroups < 6 h, 6-11.9 h, 12-17.9 h, 18-23.9 h, ≥24 h, which increased significantly (X = 57.64, P < 0.001), and ARR (95% CI) were 1.10 (0.92,1.31), 1.33 (1.04,1.70), 1.80 (1.21,2.68), 2.57 (1.60,4.15) compared with subgroup < 6 h (ARR = 1); At the second stage, the rates of overall adverse outcome were 20.0, 30.7, 38.5, 61.2, 69.6% in subgroups < 1 h, 1-1.9 h, 2-2.9 h, 3-3.9 h, ≥4 h (X = 349.70, P < 0.001), and ARR (95% CI) were 1.89 (1.50, 2.39), 2.22 (1.55, 3.18), 10.64 (6.09, 18.59), 11.75 (6.55, 21.08) compared with subgroup < 1 h (ARR = 1)). At the total stage, the rates of overall adverse outcome were 21.5, 30.8, 42.4% in subgroups < 12 h, 12-23.9 h, ≥24 h (X = 84.90, P < 0.001), and ARR (95% CI) were 1.41 (1.16,1.72), 3.17 (2.10,4.80) compared with subgroup < 12 h (ARR = 1).
CONCLUSIONS
The prolonged stage of labor may lead to increased adverse outcomes in multiparous women, it was an independent risk factor of adverse maternal and neonatal outcomes.
背景
分娩阶段与不良分娩结局之间的相关性已被广泛研究。大多数研究都集中在初产妇身上，对于经产妇来说，分娩阶段持续时间对其有何影响尚不清楚。
方法
本研究采用回顾性队列研究，纳入所有计划阴道分娩的经产妇，胎头位、足月、单胎分娩。本研究中的总产程包括第一产程和第二产程，将其分为亚组。不良母婴结局定义为转剖宫产、器械助产、产后出血、会阴裂伤（III 和 IV 度）、住院时间≥90 天、不良新生儿结局包括新生儿重症监护病房（NICU）、肩难产、Apgar 评分≤7（5 分钟）、新生儿复苏、需要立即辅助通气。
结果
本研究共纳入 7109 名产妇。经产妇第一产程持续 6.2（3.6-10.0）小时，第二产程持续 0.3（0.2-0.7）小时，总产程持续 6.9（4.1-10.7）小时。在第一产程中，<6 小时、6-11.9 小时、12-17.9 小时、18-23.9 小时和≥24 小时亚组的总不良结局发生率分别为 21%、23.4%、28.8%、35.5%和 38.4%，差异有统计学意义（X²=57.64，P<0.001），ARR（95%CI）分别为 1.10（0.92，1.31）、1.33（1.04，1.70）、1.80（1.21，2.68）和 2.57（1.60，4.15），与<6 小时亚组相比（ARR=1）。在第二产程中，<1 小时、1-1.9 小时、2-2.9 小时、3-3.9 小时和≥4 小时亚组的总不良结局发生率分别为 20.0%、30.7%、38.5%、61.2%和 69.6%，差异有统计学意义（X²=349.70，P<0.001），ARR（95%CI）分别为 1.89（1.50，2.39）、2.22（1.55，3.18）、10.64（6.09，18.59）和 11.75（6.55，21.08），与<1 小时亚组相比（ARR=1）。在总产程中，<12 小时、12-23.9 小时和≥24 小时亚组的总不良结局发生率分别为 21.5%、30.8%和 42.4%，差异有统计学意义（X²=84.90，P<0.001），ARR（95%CI）分别为 1.41（1.16，1.72）和 3.17（2.10，4.80），与<12 小时亚组相比（ARR=1）。
结论
延长产程可能导致经产妇不良结局增加，是母婴不良结局的独立危险因素。
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