Handa V L, Laros R K
Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California School of Medicine, San Francisco.
Obstet Gynecol. 1993 May;81(5 ( Pt 1)):758-63.
To identify clinical variables associated with cesarean delivery for active-phase arrest with hypotonic labor.
We reviewed all deliveries at our institution from September 1975 through March 1989. Data were collected from medical records and a computerized data base. Nulliparas with active-phase arrest were identified and those with hypotonic labor (defined as less than 180 Montevideo units) were selected. The clinical characteristics of each parturient were examined. A linear logistic regression analysis was used to examine the incidence of cesarean delivery as a function of clinical variables.
The incidence of active-phase arrest was 4.9%, and hypotonic forces were diagnosed in 81% of the cases managed with an intrauterine pressure catheter. Despite the consistent use of oxytocin in hypotonic labor, the cesarean rate was 60%. Four factors correlated with cesarean delivery in this setting: estimated fetal weight, station at the time of arrest, duration of ruptured membranes, and year of delivery.
After an active-phase arrest, cesarean delivery increased when there was suspected cephalopelvic disproportion. In addition, we observed a strong correlation between cesarean delivery and the year of delivery, which suggests a change in physician behavior over time, independent of all other risk factors for cesarean.
确定与低张性宫缩活跃期停滞剖宫产相关的临床变量。
我们回顾了1975年9月至1989年3月在我院的所有分娩情况。数据从病历和计算机数据库中收集。确定初产妇活跃期停滞情况，并选择宫缩乏力（定义为低于180蒙氏单位）的产妇。检查每位产妇的临床特征。采用线性逻辑回归分析，以临床变量为函数来检查剖宫产的发生率。
活跃期停滞的发生率为4.9%，在使用宫内压力导管处理的病例中，81%被诊断为宫缩乏力。尽管在宫缩乏力时持续使用催产素，但剖宫产率仍为60%。在此情况下，有四个因素与剖宫产相关：估计胎儿体重、停滞时的胎头位置、胎膜破裂持续时间和分娩年份。
活跃期停滞后，怀疑头盆不称时剖宫产率增加。此外，我们观察到剖宫产与分娩年份之间存在强烈相关性，这表明医生的行为随时间发生了变化，独立于所有其他剖宫产危险因素。
