Ranta P, Jouppila P, Jouppila R
Department of Anaesthesiology, Oulu University Hospitial, Finland.
Acta Obstet Gynecol Scand. 1996 Mar;75(3):250-4. doi: 10.3109/00016349609047096.
The purpose of the current study was to investigate differences in pain experiences and requirements for pain control in parturients with different birth experience. Previous studies have shown that the labor pain experience is significantly less intense in multiparas than in primiparas and requirements for analgesic treatment have therefore been assumed to be minimal in this group.
The pain experience during labor was assessed by 70 consecutive grand multiparas (a minimum of five previous deliveries) compared to that of primiparous (n=70) and II-V parous women (n=70). Pain intensity was repeatedly assessed on a pain intensity scale (0-10) according to the progress of cervical dilatation at the first and second stage of labor.
During the latent phase of cervical dilatation (0-3 cm) grand multiparas had a median pain score of 3 compared to 4 in II-V paras and 6 in primiparas (p<0.001). At the end of the first stage and during the second stage the intensity of pain in grand multiparas was significantly higher compared to that in primiparas (median scores 7 to 8 vs 6 to 7, p<0.05). Epidural blocks were administered to 40% of primiparas, 3% of II-V paras and to no grand multiparas (p<0.0001). Twenty-one percent of grand multiparas rated their pain as intolerable (pain scores 9-10) during the second stage compared to 10% of primiparas (p<0.05%). On the third day after delivery, 47% of grand multiparas regarded their analgesia insufficient.
The majority of parturients, including grand multiparas, suffered from intense pain during labor. After delivery, a significant number of grand multiparas felt that they had received insufficient pain relief.
本研究旨在调查有不同分娩经历的产妇在疼痛体验及疼痛控制需求方面的差异。以往研究表明，经产妇的分娩疼痛体验明显轻于初产妇，因此认为该组产妇对镇痛治疗的需求极小。
连续纳入70例经产妇（既往至少有5次分娩经历），将其分娩时的疼痛体验与初产妇（n = 70）及经产2 - 5次的产妇（n = 70）进行比较。根据产程中宫颈扩张程度，在第一产程和第二产程中多次使用疼痛强度量表（0 - 10分）评估疼痛强度。
在宫颈扩张潜伏期（0 - 3 cm），经产妇的疼痛评分中位数为3分，经产2 - 5次的产妇为4分，初产妇为6分（p < 0.001）。在第一产程末及第二产程中，经产妇的疼痛强度明显高于初产妇（中位数评分7至8分 vs 6至7分，p < 0.05）。40%的初产妇接受了硬膜外阻滞，经产2 - 5次的产妇中这一比例为3%，经产妇无人接受硬膜外阻滞（p < 0.0001）。第二产程中，21%的经产妇认为疼痛难以忍受（疼痛评分9 - 10分），初产妇中这一比例为10%（p < 0.05%）。产后第三天，47%的经产妇认为镇痛效果不佳。
大多数产妇，包括经产妇，在分娩过程中遭受剧烈疼痛。产后，相当数量的经产妇感觉疼痛缓解不足。
