Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.
Division of Obstetrics, Department of Women's Health, Karolinska University Hospital, Stockholm, Sweden.
Sci Rep. 2023 Aug 2;13(1):12569. doi: 10.1038/s41598-023-39480-0.
Prior evidence evaluating the benefits and harms of expectant labour duration during active first stage is inconclusive regarding potential consequences for the neonate. Population-based cohort study in Stockholm-Gotland region, Sweden, including 46,040 women (Robson 1), between October 1st, 2008 and June 15th, 2020. Modified Poisson regression was used for the association between active first stage of labour duration and adverse neonatal outcomes. 94.2% experienced a delivery with normal neonatal outcomes. Absolute risk for severe outcomes increased from 1.9 to 3.0%, moderate outcomes increased from 2.8 to 6.2% (> 10.1 h). Compared to the reference, (< 5.1 h; median), the adjusted relative risk (aRR) of severe neonatal outcome significantly increased beyond 10.1 h (> 90th percentile) (aRR 1.53, 95% CI 1.26, 1.87), for moderate neonatal outcome the aRR began to slowly increase beyond 5.1 h (≥ 50 percentile; aRR 1.40, 95% CI 1.24, 1.58). Mediation analysis indicate that most of the association was due to a longer active first stage of labour, 13% (severe neonatal outcomes) and 20% (moderate neonatal outcomes) of the risk was mediated (indirect effect) by longer second stage of labour duration. We report an association between increasing active first stage duration and increased risk of adverse neonatal outcomes. We did not observe a clear labour duration risk threshold.
先前评估活跃第一产程期间期待分娩持续时间的益处和危害的证据，对于新生儿潜在后果的结论并不明确。这是一项基于人群的队列研究，在瑞典斯德哥尔摩-哥德堡地区进行，纳入了 46040 名女性（Robson 1），时间为 2008 年 10 月 1 日至 2020 年 6 月 15 日。采用修正泊松回归分析活跃第一产程持续时间与不良新生儿结局之间的关系。94.2%的产妇分娩结局正常。严重结局的绝对风险从 1.9%增加到 3.0%，中度结局的绝对风险从 2.8%增加到 6.2%（>10.1 小时）。与参考值（<5.1 小时；中位数）相比，严重新生儿结局的调整后相对风险（aRR）在超过 10.1 小时（>90 百分位数）时显著增加（aRR 1.53，95%CI 1.26，1.87），中度新生儿结局的 aRR 在超过 5.1 小时（≥50 百分位数；aRR 1.40，95%CI 1.24，1.58）时开始缓慢增加。中介分析表明，大多数关联归因于活跃第一产程的延长，13%（严重新生儿结局）和 20%（中度新生儿结局）的风险（间接效应）是由第二产程的延长所介导的。我们报告了活跃第一产程持续时间的增加与不良新生儿结局风险增加之间的关联。我们没有观察到明确的产程持续时间风险阈值。
