McNiven P S, Williams J I, Hodnett E, Kaufman K, Hannah M E
McMaster University Midwifery Education Programme, St. Joseph's Hospital, Hamilton, Ont., Canada.
Birth. 1998 Mar;25(1):5-10. doi: 10.1046/j.1523-536x.1998.00005.x.
Approximately 31 percent of cesarean deliveries in the United States and Canada are performed for dystocia. The aim of this study was to determine the effectiveness of early labor assessment to reduce cesarean birth rates for low-risk nulliparous women.
Two hundred and nine low-risk nulliparous women were randomly allocated to either the early labor assessment group or the direct admission to hospital group. Women in the early labor assessment group were evaluated and, if found to be in false or latent labor, were encouraged to go home or walk before admission to the labor unit. Those in the direct admission group were admitted to the labor unit without an assessment. Data were collected and analyzed about method of delivery, duration of labor, intrapartum interventions, and neonatal well-being. Women completed an evaluation of their experience in the early postpartum period.
Significant decreases occurred in duration of labor, use of epidural analgesia for pain, and use of oxytocin to augment labor in the early labor assessment group. These women evaluated their labor and birth experience more positively than women in the direct admission group. No significant differences were found in the frequency of cesarean section or instrumental vaginal delivery for the two groups.
Early labor assessment has the potential to reduce the number of women receiving oxytocin for augmentation, the rate of epidural analgesia for pain relief, and the duration of the active and second stages of labor, and to improve women's evaluations of their labor and birth experiences.
在美国和加拿大，约31%的剖宫产是因难产而进行的。本研究的目的是确定早期产程评估对降低低风险初产妇剖宫产率的有效性。
209名低风险初产妇被随机分配到早期产程评估组或直接入院组。早期产程评估组的妇女接受评估，若被发现处于假临产或潜伏期，则在进入产房前被鼓励回家或走动。直接入院组的妇女未经评估即进入产房。收集并分析了有关分娩方式、产程持续时间、产时干预措施及新生儿健康状况的数据。妇女们完成了产后早期对自身经历的评价。
早期产程评估组的产程持续时间、使用硬膜外镇痛缓解疼痛以及使用缩宫素加强宫缩的情况均显著减少。与直接入院组的妇女相比，这些妇女对其产程和分娩经历的评价更为积极。两组在剖宫产或器械助产阴道分娩的发生率方面未发现显著差异。
早期产程评估有可能减少接受缩宫素加强宫缩的妇女数量、缓解疼痛的硬膜外镇痛使用率以及活跃期和第二产程的持续时间，并改善妇女对其产程和分娩经历的评价。
