Malone F D, Geary M, Chelmow D, Stronge J, Boylan P, D'Alton M E
Department of Obstetrics and Gynecology, Tufts University School of Medicine, New England Medical Center, Boston, Massachusetts, USA.
Obstet Gynecol. 1996 Aug;88(2):211-5. doi: 10.1016/0029-7844(96)00185-8.
To define factors causing prolonged labor in nulliparous women undergoing active management of labor.
We included all nulliparas delivered during 1990-1994 with spontaneous onset of labor lasting more than 12 hours, singleton gestation, cephalic presentation, and labor at greater than 37 weeks. Each patient was matched with the next nulliparous woman who delivered with a labor lasting less than 12 hours and who fulfilled the same inclusion criteria. Subjects were managed according to the previously described active management of labor protocol from The National Maternity Hospital, Dublin.
In the 5-year period, 9018 nulliparas met inclusion criteria, with 147 (1.6%) having prolonged labor. Prolonged labor was due to inefficient uterine action in 65%, persistent occipitoposterior position in 24%, and cephalopelvic disproportion in 11% of cases. Univariate analysis showed statistically significant (P < .05) differences in maternal body mass index, cervical dilation on admission, oxytocin use, epidural use, placement of epidural at less than 2 cm of dilation, and birth weight between these study groups. On multivariate conditional logistic regression analysis, the following were significant independent predictors for having a prolonged labor (odds ratios with 95% confidence intervals presented): 3.1 (1.3-7.3) for cervical dilation less than 2 cm on admission, 42.7 (7.5-242.0) for early epidural placement, 5.1 (1.9-13.7) for epidural placement at greater than or equal to 2 cm, and 10.2 (3.6-29.4) for birth weight greater than 4000 g.
Less-advanced cervical dilation on admission and epidural use, especially when placed early, are strongly associated with prolonged labor.
确定在接受产程积极管理的初产妇中导致产程延长的因素。
我们纳入了1990年至1994年期间分娩的所有初产妇，她们自然发动分娩，产程持续超过12小时，单胎妊娠，头先露，且孕周大于37周。将每位患者与下一位分娩的初产妇进行匹配，后者产程持续少于12小时且符合相同的纳入标准。研究对象按照都柏林国家妇产医院先前描述的产程积极管理方案进行管理。
在这5年期间，9018例初产妇符合纳入标准，其中147例（1.6%）产程延长。产程延长的原因中，子宫收缩乏力占65%，持续性枕后位占24%，头盆不称占11%。单因素分析显示，这些研究组之间在产妇体重指数、入院时宫颈扩张程度、缩宫素使用、硬膜外麻醉使用、宫颈扩张小于2 cm时进行硬膜外麻醉以及出生体重方面存在统计学显著差异（P < 0.05）。多因素条件逻辑回归分析显示，以下因素是产程延长的显著独立预测因素（列出比值比及95%置信区间）：入院时宫颈扩张小于2 cm为3.1（1.3 - 7.3），早期进行硬膜外麻醉为42.7（7.5 - 242.0），宫颈扩张大于或等于2 cm时进行硬膜外麻醉为5.1（1.9 - 13.7），出生体重超过4000 g为10.2（3.6 - 29.4）。
入院时宫颈扩张程度较低以及使用硬膜外麻醉，尤其是早期使用，与产程延长密切相关。
