The Interdisciplinary Unit of Women's, Children's and Families' Health, the Juliane Marie Centre, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.
The Interdisciplinary Unit of Women's, Children's and Families' Health, the Juliane Marie Centre, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark; Department of Obstetrics, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.
Sex Reprod Healthc. 2023 Jun;36:100855. doi: 10.1016/j.srhc.2023.100855. Epub 2023 May 8.
To identify maternal factors associated with labor dystocia in low-risk nulliparous women.
MEDLINE, Embase, ClinicalTrials.gov, Cochrane, and CINAHL were searched for intervention studies and observational studies published from January 2000 to January 2022. Low-risk was defined as nulliparous women with a singleton, cephalic birth in spontaneous labor at term. Labor dystocia was defined by national or international criteria or treatment. Countries were restricted to OECD members. Two authors independently screened 11,374 titles and abstracts, extracted data, and assessed risk of bias using the Newcastle-Ottawa Scale. Results were presented narratively and by meta-analysis when compatible.
Seven cohort studies were included. Overall, the certainty of the evidence was moderate. Three studies found that higher maternal age was associated with an increased frequency of labor dystocia (relative risk 1.68; 95% CI 1.43-1.98). Further three studies found that higher maternal BMI was associated with increased frequency of labor dystocia (relative risk 1.20; 95% CI 1.01-1.43). Maternal short stature, fear of childbirth, and high caffeine intake were also associated with an increased frequency of labor dystocia, while maternal physical activity was associated with a decreased frequency.
Maternal factors associated with an increased frequency of labor dystocia were mainly maternal age, physical characteristics, and fear of childbirth. Maternal physical activity was associated with a decreased frequency. Intervention studies targeting these maternal factors would need to be initiated before or early in pregnancy to test the causality of the identified factors and labor dystocia.
确定低危初产妇分娩困难的相关因素。
检索 2000 年 1 月至 2022 年 1 月期间发表的干预性研究和观察性研究的 MEDLINE、Embase、ClinicalTrials.gov、Cochrane 和 CINAHL。低危定义为初产妇、单胎、足月、自发性分娩、头位。分娩困难通过国家或国际标准或治疗来定义。研究对象仅限于经合组织成员国。两名作者独立筛选了 11374 篇标题和摘要，提取数据，并使用纽卡斯尔-渥太华量表评估偏倚风险。结果以叙述性和荟萃分析的形式呈现，当结果兼容时使用荟萃分析。
纳入了 7 项队列研究。总体而言，证据的确定性为中度。3 项研究发现，母亲年龄越大，分娩困难的频率越高（相对风险 1.68；95%CI 1.43-1.98）。进一步的 3 项研究发现，母亲的 BMI 越高，分娩困难的频率越高（相对风险 1.20；95%CI 1.01-1.43）。母亲身材矮小、对分娩的恐惧和高咖啡因摄入也与分娩困难的频率增加有关，而母亲的身体活动与分娩困难的频率减少有关。
与分娩困难频率增加相关的产妇因素主要是产妇年龄、身体特征和对分娩的恐惧。产妇身体活动与分娩困难的频率减少有关。需要在妊娠前或早期开始针对这些产妇因素的干预研究，以检验已确定因素与分娩困难之间的因果关系。
