Department of Obstetrics and Gynecology, Oslo University Hospital, Oslo, Norway.
Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway.
PLoS One. 2024 Mar 22;19(3):e0298046. doi: 10.1371/journal.pone.0298046. eCollection 2024.
This systematic scoping review was conducted to 1) identify and describe labor curves that illustrate cervical dilatation over time; 2) map any evidence for, as well as outcomes used to evaluate the accuracy and effectiveness of the curves; and 3) identify areas in research that require further investigation.
A three-step systematic literature search was conducted for publications up to May 2023. We searched the Medline, Maternity & Infant Care, Embase, Cochrane Library, Epistemonikos, CINAHL, Scopus, and African Index Medicus databases for studies describing labor curves, assessing their effectiveness in improving birth outcomes, or assessing their accuracy as screening or diagnostic tools. Original research articles and systematic reviews were included. We excluded studies investigating adverse birth outcomes retrospectively, and those investigating the effect of analgesia-related interventions on labor progression. Study eligibility was assessed, and data were extracted from included studies using a piloted charting form. The findings are presented according to descriptive summaries created for the included studies.
Of 26,073 potentially eligible studies, 108 studies were included. Seventy-three studies described labor curves, of which ten of the thirteen largest were based mainly on the United States Consortium on Safe Labor cohort. Labor curve endpoints were 10 cm cervical dilatation in 69 studies and vaginal birth in 4 studies. Labor curve accuracy was assessed in 26 studies, of which all 15 published after 1986 were from low- and middle-income countries. Recent studies of labor curve accuracy in high-income countries are lacking. The effectiveness of labor curves was assessed in 13 studies, which failed to prove the superiority of any curve. Patient-reported health and well-being is an underrepresented outcome in evaluations of labor curves. The usefulness of labor curves is still a matter of debate, as studies have failed to prove their accuracy or effectiveness.
本系统范围综述旨在：1）确定并描述随时间推移描述宫颈扩张的产程曲线；2）绘制评估曲线准确性和有效性所使用的任何证据和结果；3）确定需要进一步研究的研究领域。
截至 2023 年 5 月，我们进行了三步系统文献检索，检索了 Medline、Maternity & Infant Care、Embase、Cochrane Library、Epistemonikos、CINAHL、Scopus 和 African Index Medicus 数据库中描述产程曲线的研究，评估其改善分娩结局的效果，或评估其作为筛查或诊断工具的准确性。纳入了原始研究文章和系统评价。我们排除了回顾性研究不良分娩结局的研究，以及研究镇痛相关干预对产程进展影响的研究。评估了研究的纳入标准，并使用经过验证的图表记录表格从纳入研究中提取数据。根据纳入研究的描述性总结呈现研究结果。
在 26073 项可能符合条件的研究中，有 108 项研究被纳入。73 项研究描述了产程曲线，其中 13 项最大的研究中有 10 项主要基于美国安全分娩队列联盟。69 项研究的产程曲线终点为 10cm 宫颈扩张，4 项研究的终点为阴道分娩。26 项研究评估了产程曲线的准确性，其中 1986 年以后发表的所有 15 项研究均来自中低收入国家。缺乏高收入国家产程曲线准确性的最新研究。13 项研究评估了产程曲线的有效性，均未能证明任何曲线具有优越性。患者报告的健康和幸福感是评估产程曲线时代表性不足的结果。产程曲线的有用性仍然存在争议，因为研究未能证明其准确性或有效性。
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