Department of Obstetrics and Gynecology, School of Medicine, Catholic University of Daegu, Daegu 42472, Republic of Korea.
Medicina (Kaunas). 2024 Jan 12;60(1):143. doi: 10.3390/medicina60010143.
: Long and ineffective labor causes hardships for mothers and doctors and increases the rate of cesarean sections and medical comorbidities. Several factors contribute to effective and less painful labor, including maternal age, parity, fetal characteristics, and the medications or procedures that obstetricians use for labor. We aimed to study the factors that affect labor duration and identify those that make labor more effective. : This retrospective study included 141 patients who underwent normal vaginal deliveries at the Daegu Catholic University Medical Center between April 2013 and April 2022. Among the 141 patients, 44 received pethidine intravenously, 88 received oxytocin intravenously, and 64 received epidural anesthesia. The duration of the active phase and second stage of labor were recorded according to the findings of a manual examination of the cervix and continuous external electronic monitoring. We analyzed maternal and neonatal medical records and performed binomial logistic regression to identify the factors associated with a shorter active phase of labor. The clinical outcomes in mothers and neonates were also evaluated. : Among the various clinical factors, multiparity (odds ratio of parity 0.325) and the use of pethidine (odds ratio 2.906) were significantly associated with shortening the active phase of labor to less than 60 min. The use of epidural anesthesia or oxytocin was not significantly associated with reducing the active phase of labor. When patients were divided into two groups based on whether a pethidine injection had been used during labor, the duration of the active phase was shorter in the pethidine injection group than in the control group for both nulliparas and multiparas. No significant differences in the duration of the second stage of labor were observed between the pethidine injection and control groups. There were no significant differences in pregnancy outcomes, including the need for mechanical ventilation of neonates, Apgar scores, neonatal intensive care unit admissions, number of precipitous deliveries, maternal adverse side effects of drugs, or duration of maternal hospitalization between the two groups. : Pethidine can be safely administered to women during labor to help reduce the duration of the active phase by promoting dilatation of the cervix and preventing complications that may result from prolonged labor. Pethidine may be helpful, especially for those who cannot receive epidural anesthesia or who cannot afford it. However, large-scale randomized controlled studies are required to evaluate the efficacy and safety of this drug during labor. Furthermore, it would be helpful if various studies were conducted depending on the timing of administration and indications for delivery.
长而无效的分娩会给母亲和医生带来困难，并增加剖腹产和医疗合并症的发生率。几个因素有助于实现有效且痛苦减轻的分娩，包括母亲年龄、产次、胎儿特征以及产科医生用于分娩的药物或程序。我们旨在研究影响分娩持续时间的因素，并确定哪些因素使分娩更有效。
本回顾性研究纳入了 2013 年 4 月至 2022 年 4 月期间在大邱天主教大学医疗中心接受正常阴道分娩的 141 名患者。在这 141 名患者中，44 名患者静脉注射哌替啶，88 名患者静脉注射催产素，64 名患者接受硬膜外麻醉。根据宫颈手动检查和连续外部电子监测的结果，记录活跃期和第二产程的持续时间。我们分析了母亲和新生儿的病历，并进行了二项逻辑回归分析，以确定与活跃期分娩时间缩短至 60 分钟以下相关的因素。还评估了母亲和新生儿的临床结局。
在各种临床因素中，多胎产（产次的优势比为 0.325）和使用哌替啶（优势比为 2.906）与缩短活跃期至 60 分钟以下显著相关。使用硬膜外麻醉或催产素与缩短活跃期无关。当根据分娩期间是否使用哌替啶将患者分为两组时，与对照组相比，哌替啶注射组的活跃期在初产妇和经产妇中都较短。哌替啶注射组和对照组的第二产程持续时间无显著差异。两组新生儿需要机械通气、阿普加评分、新生儿重症监护病房入院、急产数量、药物的母亲不良反应或母亲住院时间等妊娠结局无显著差异。
哌替啶可在分娩期间安全地给予女性，以通过促进宫颈扩张和预防因产程延长而可能导致的并发症来帮助缩短活跃期。哌替啶可能会有所帮助，尤其是对于那些不能接受硬膜外麻醉或无法负担硬膜外麻醉的人。然而，需要进行大规模的随机对照研究来评估该药在分娩过程中的疗效和安全性。此外，如果根据给药时间和分娩指征进行各种研究，将会有所帮助。
