Seitchik J, Holden A E, Castillo M
Am J Obstet Gynecol. 1987 Jan;156(1):125-30. doi: 10.1016/0002-9378(87)90221-3.
The details of clinical management were examined in 96 nulliparous patients with functional dystocia who had spontaneous rupture of the membranes before admission and were treated with oxytocin in the first stage of labor. It was our hypothesis that if the allegedly "high" rate of cesarean sections was the result of mediocre or flawed practices, these should be most evident in patients delivered abdominally. A group of 59 patients delivered vaginally were compared with 37 patients delivered by cesarean section. The means of many variables were not statistically different. The cesarean section group was characterized by smaller stature, a lesser cervical dilatation rate both before and after oxytocin administration, a larger maximum oxytocin dose, a longer period of oxytocin administration, more frequent cessation of oxytocin administration or dose reduction because of hypercontractility or an abnormal fetal heart rate or both, and a higher incidence of intra-amniotic infection. We conclude that the decision to perform cesarean section in nulliparous women with functional dystocia arises from disabilities of the patient and not from differences in the application of our management principles, services, or treatments.
对96例初产妇功能性难产患者的临床处理细节进行了研究，这些患者入院前胎膜自然破裂，在第一产程中接受了缩宫素治疗。我们的假设是，如果所谓的高剖宫产率是由于操作不当或有缺陷造成的，那么这些情况在经腹分娩的患者中应该最为明显。将一组59例经阴道分娩的患者与37例剖宫产患者进行了比较。许多变量的均值在统计学上没有差异。剖宫产组的特点是身材较矮小，缩宫素给药前后宫颈扩张率较低，最大缩宫素剂量较大，缩宫素给药时间较长，因宫缩过强或胎儿心率异常或两者兼有而更频繁地停止缩宫素给药或减少剂量，以及羊膜腔内感染发生率较高。我们得出结论，初产妇功能性难产行剖宫产的决定是由患者自身的不利因素引起的，而非我们的管理原则、服务或治疗应用方面的差异所致。
