Vause S, Congdon H M, Thornton J G
Department of Obstetrics and Gynaecology, North Manchester General Hospital, UK.
Br J Obstet Gynaecol. 1998 Feb;105(2):186-8. doi: 10.1111/j.1471-0528.1998.tb10050.x.
To test the hypothesis that a policy of delaying active pushing in nulliparous women with epidural analgesia in labour reduces operative vaginal deliveries.
A randomised controlled trial.
The delivery suite at Leeds General Infirmary.
One hundred and thirty-five nulliparous women with an effective epidural in labour.
The women were randomised to early pushing (commencement of pushing within one hour of the diagnosis of full dilatation) or delayed pushing (delaying pushing for a maximum of three hours from the time of diagnosis of full dilatation, unless the vertex was visible at the introitus sooner.
Rate of instrumental vaginal delivery.
There was a nonsignificantly increased rate of instrumental vaginal delivery with early pushing (odds ratio 1.31, 95% CI 0.62-2.78). No adverse effects were noted.
Although delayed pushing was associated with fewer instrumental vaginal deliveries, the size of the effect may have occurred by chance and the evidence does not, at present, justify a general recommendation towards either early or delayed pushing.
检验以下假设，即对分娩时接受硬膜外镇痛的初产妇采取延迟主动用力的策略可减少阴道助产分娩。
一项随机对照试验。
利兹总医院产房。
135名分娩时硬膜外镇痛有效的初产妇。
将这些产妇随机分为早期用力组（宫口开全诊断后1小时内开始用力）或延迟用力组（从宫口开全诊断之时起最多延迟3小时用力，除非胎头更早出现在阴道口）。
阴道助产分娩率。
早期用力组阴道助产分娩率有非显著性升高（优势比1.31，95%可信区间0.62 - 2.78）。未观察到不良反应。
虽然延迟用力与较少的阴道助产分娩相关，但这种效果大小可能是偶然出现的，目前证据并不足以支持对早期或延迟用力给出一般性建议。
