Falzone S, Chauhan S P, Mobley J A, Berg T G, Sherline D M, Devoe L D
Department of Obstetrics and Gynecology, Medical College of Georgia, Augusta, USA.
J Reprod Med. 1998 Aug;43(8):676-80.
To compare the route of delivery among nulliparous parturients with and without an engaged vertex in the early, active phase of labor.
Prospectively, the position of the fetal head was ascertained among nulliparous women at 37 weeks' gestation or more in early, active labor (cervical dilation > or = 4 cm with adequate contractions). Sixteen variables, including maternal demographics, obstetric complications and intrapartum course, were examined using chi 2 and logistic regression analysis.
Among the 77 patients, 33 (42.8%) had an unengaged vertex and 44 (57.2%) had an engaged vertex in active labor. Of the 22 cesarean deliveries for arrest disorder, 2 were in the engaged and 20 in the unengaged group (P < .001). The mean birth weight was similar among those who had vaginal (3,211 +/- 416 g) and cesarean delivery (3,400 +/- 489 g, P = .08). Univariate analysis indicated that chorioamnionitis (relative risk [RR] 2.6, 95% confidence interval [CI] 1.4-4.9) and unengaged vertex (RR 13.3, CI 3.3-53.0) were associated with cesarean delivery for arrest disorders. When entered into a multiple logistic model, only unengagement was a risk factor for cesarean delivery. The following were not associated with cesarean delivery: maternal demographics, gestational age, estimate of fetal weight, presence or absence of meconium, preeclampsia, diabetes mellitus, private obstetric care or use of epidural anesthesia.
Among nulliparous parturients, an unengaged vertex is a significant risk factor for cesarean delivery for arrest disorders.
比较初产妇在产程活跃早期胎头衔接与未衔接情况下的分娩方式。
前瞻性地确定妊娠37周及以上处于产程活跃早期（宫颈扩张≥4 cm且宫缩良好）的初产妇的胎头位置。使用卡方检验和逻辑回归分析对包括产妇人口统计学、产科并发症及产程中的16个变量进行研究。
77例患者中，33例（42.8%）在活跃期胎头未衔接，44例（57.2%）胎头衔接。在22例因产程停滞而行剖宫产的患者中，2例为胎头衔接组，20例为胎头未衔接组（P<0.001）。经阴道分娩者的平均出生体重（3211±416 g）与剖宫产者（3400±489 g，P=0.08）相似。单因素分析表明，绒毛膜羊膜炎（相对危险度[RR] 2.6，95%可信区间[CI] 1.4 - 4.9）和胎头未衔接（RR 13.3，CI 3.3 - 53.0）与因产程停滞而行剖宫产有关。纳入多因素逻辑模型后，只有胎头未衔接是剖宫产的危险因素。以下因素与剖宫产无关：产妇人口统计学、孕周、胎儿体重估计、有无胎粪、子痫前期、糖尿病、私人产科护理或硬膜外麻醉的使用。
在初产妇中，胎头未衔接是因产程停滞而行剖宫产的一个重要危险因素。
