Bofill J A, Vincent R D, Ross E L, Martin R W, Norman P F, Werhan C F, Morrison J C
Department of Obstetrics and Gynecology, Wright State University School of Medicine, Dayton, Ohio, USA.
Am J Obstet Gynecol. 1997 Dec;177(6):1465-70. doi: 10.1016/s0002-9378(97)70092-9.
Our purpose was to examine the effect of epidural analgesia on dystocia-related cesarean delivery in actively laboring nulliparous women.
Active labor was confirmed in nulliparous women by uterine contractions, cervical dilatation of 4 cm, effacement of 80%, and fetopelvic engagement. Patients were randomized to one of two groups: epidural analgesia or narcotics. A strict protocol for labor management was in place. Patients recorded the level of pain at randomization and at hourly intervals on a visual analog scale. Elective outlet operative vaginal delivery was permitted.
One hundred women were randomized. No difference in the rate of cesarean delivery for dystocia was noted between the groups (epidural 8%, narcotic 6%; p = 0.71). No significant differences were noted in the lengths of the first (p = 0.54) or second (p = 0.55) stages of labor or in any other time variable. Women with epidural analgesia underwent operative vaginal delivery more frequently (p = 0.004). Pain scores were equivalent at randomization, but large differences existed at each hour thereafter. The number of patients randomized did not achieve prestudy estimates. A planned interim analysis of the results demonstrated that we were unlikely to find a statistically significant difference in cesarean delivery rates in a trial of reasonable duration.
With strict criteria for the diagnosis of labor and with use of a rigid protocol for labor management, there was no increase in dystocia-related cesarean delivery with epidural analgesia.
我们的目的是研究硬膜外镇痛对活跃期分娩的初产妇难产相关剖宫产的影响。
通过子宫收缩、宫颈扩张4厘米、消退80%以及胎头入盆来确认初产妇处于活跃期。患者被随机分为两组之一：硬膜外镇痛组或使用麻醉剂组。制定了严格的分娩管理方案。患者在随机分组时以及之后每小时使用视觉模拟量表记录疼痛程度。允许进行选择性出口产钳助产。
100名女性被随机分组。两组之间难产相关剖宫产率没有差异（硬膜外镇痛组8%，麻醉剂组6%；p = 0.71）。第一产程（p = 0.54）或第二产程（p = 0.55）的时长以及任何其他时间变量均无显著差异。接受硬膜外镇痛的女性更频繁地接受产钳助产（p = 0.004）。随机分组时疼痛评分相当，但此后每小时都存在很大差异。随机分组的患者数量未达到研究前的估计值。对结果进行的计划中期分析表明，在合理时长的试验中，我们不太可能在剖宫产率上发现具有统计学意义的差异。
采用严格的分娩诊断标准并使用严格的分娩管理方案，硬膜外镇痛并不会增加难产相关剖宫产的发生率。
