Trujillo J L, Gonzalez N L, Parache J
Abteilung für Gynäkologie und Geburtshilfe, Kanarische Universitätsklinik, Teneriffa/Spanien.
Z Geburtshilfe Perinatol. 1993 Jul-Aug;197(4):172-8.
An analysis was performed of 5187 intra-amniotically measured labor pressure curves in 40 births with spontaneous labour (20 primiparae and 20 multiparae) and 40 births births in which labor was induced with oxytocin (20 primiparae and 20 multiparae). The dilatation of the os uteri was divided into three phases--Phase 1, dilatation of the cervix to 2 cm; Phase 2, dilatation of the cervix from 2 to 4 cm, and Phase 3, dilatation from 4 cm onwards until complete. During the active phase, from 2 cm until dilatation of the os uteri was complete, no differences were observed between induced and spontaneous labor with regard to frequency and amplitude of contractions. In the induced-labor cases, the parameters for uterine activity, maximum contraction and dilatation speed were higher in all three phases of labor, and those for total duration of labor lower than in the spontaneous labor cases. The contraction/dilatation speed is an important parameter for monitoring the effect of drug-induced stimulation of labor. In the latency phase in spontaneous labor, more contractions were observed in multiparae than in primiparae. This fact which should be reason enough to intensify monitoring of both mother and fetus during this phase. In light of these results it would appear advisable, in the absence of progress in labor, to make a clear distinction between the goals of cervical maturity and promotion of uterine activity, and to institute different drug therapy accordingly.
对40例自然分娩(20例初产妇和20例经产妇)和40例催产素引产分娩(20例初产妇和20例经产妇)的5187条羊膜腔内测量的产程压力曲线进行了分析。子宫口扩张分为三个阶段——阶段1,宫颈扩张至2厘米;阶段2,宫颈从2厘米扩张至4厘米;阶段3,从4厘米开始直至完全扩张。在活跃期,从2厘米直至子宫口完全扩张,引产分娩和自然分娩在宫缩频率和幅度方面未观察到差异。在引产分娩病例中,子宫活动参数、最大宫缩和扩张速度在产程的所有三个阶段均较高,而总产程参数低于自然分娩病例。宫缩/扩张速度是监测药物引产效果的一个重要参数。在自然分娩的潜伏期,经产妇比初产妇观察到更多的宫缩。鉴于这一事实,在此阶段加强对母亲和胎儿的监测是很有必要的。根据这些结果,在产程无进展的情况下,似乎建议明确区分宫颈成熟和促进子宫活动的目标,并相应地采取不同的药物治疗。