Doussot Mathilde, Barrois Mathilde, Anselem Olivia, Tsatsaris Vassilis
Maternité Port-Royal, Service du diagnostic Anténatal, Groupe Hospitalier Cochin-Broca-Hôtel-Dieu, Université Paris Descartes, Assistance Publique-Hôpitaux de Paris (AP-HP), 123, boulevard de Port Royal, 75014 Paris, France.
Maternité Port-Royal, Service du diagnostic Anténatal, Groupe Hospitalier Cochin-Broca-Hôtel-Dieu, Université Paris Descartes, Assistance Publique-Hôpitaux de Paris (AP-HP), 123, boulevard de Port Royal, 75014 Paris, France.
Gynecol Obstet Fertil Senol. 2022 Feb;50(2):157-163. doi: 10.1016/j.gofs.2021.11.001. Epub 2021 Nov 9.
In the context of a medical termination of pregnancy, prolonged labor may accentuate the difficulty of women's experience and increase the risk of associated complications. The factors associated with prolonged labor are not known. Reducing the duration of labor could limit these complications. Determining the relevant factors associated with prolonged labor defined as a delay between the onset of induction and delivery greater than or equal to 12hours and comparing the complications rates between the two groups.
We conducted a retrospective study at Port Royal Maternity Hospital from 2017 to 2019, including medical terminations of pregnancy by vaginal delivery in the 2nd and 3rd trimesters for fetal or maternal reasons.
Two hundred twenty-seven patients were included and divided into two comparative groups based on the duration of labor: labor <12h (n=173) and labor ≥12h (n=54). The mean maternal age was 33.7 years. Forty-four percent of patients were nulliparous, 15.8 % had a history of cesarean section. The average gestational age was 20+2 weeks of gestation. The average duration of labor was 9.7hours. The duration of labor was greater than 24hours in 3% of cases (7/227). Advanced gestational age (22+3 vs. 20+5 p=0,04) and nulliparity (p=0.01) were associated with prolonged labor. Two other intermediate factors, not independent of the duration of labor, were significant: long time to rupture of membranes (239min vs. 427min p<0,01) and an unfavorable Bishop score at rupture (p=0,003). In both groups, the complications were placental retention and the occurrence of fever during labor.
Two main factors affecting labor duration were identified in this study (term and nulliparity). This knowledge could allow women to be better informed about the expected time of labor and the potential associated risks.
在人工终止妊娠的情况下，产程延长可能会加剧女性的痛苦体验，并增加相关并发症的风险。与产程延长相关的因素尚不清楚。缩短产程可以减少这些并发症。确定与产程延长相关的因素（定义为引产开始至分娩之间的延迟大于或等于12小时），并比较两组之间的并发症发生率。
我们于2017年至2019年在皇家妇产医院进行了一项回顾性研究，纳入因胎儿或母亲原因在妊娠中期和晚期经阴道分娩进行人工终止妊娠的病例。
共纳入227例患者，根据产程长短分为两个比较组：产程<12小时（n=173）和产程≥12小时（n=54）。产妇平均年龄为33.7岁。44%的患者为初产妇，15.8%有剖宫产史。平均孕周为20+2周。平均产程为9.7小时。3%的病例（7/227）产程超过24小时。孕周较大（22+3 vs. 20+5，p=0.04）和初产（p=0.01）与产程延长有关。另外两个并非独立于产程的中间因素也具有统计学意义：胎膜破裂时间长（239分钟 vs. 427分钟，p<0.01）和胎膜破裂时Bishop评分不佳（p=0.003）。两组的并发症均为胎盘滞留和产时发热。
本研究确定了影响产程的两个主要因素（孕周和初产）。这些知识可以让女性更好地了解预期的产程时间以及潜在的相关风险。
