Defining failed induction of labor.
Defining failed induction of labor.
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DOI：
10.1016/j.ajog.2017.11.556
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发表时间：
2018-01
影响因子：
9.8
通讯作者：
Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network
中科院分区：
文献类型：
--
作者：
Grobman WA;Bailit J;Lai Y;Reddy UM;Wapner RJ;Varner MW;Thorp JM Jr;Leveno KJ;Caritis SN;Prasad M;Tita ATN;Saade G;Sorokin Y;Rouse DJ;Blackwell SC;Tolosa JE;Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network
虽然有公认的标准来诊断活跃期分娩停滞，但“失败”的引产定义仍然不太确定。诊断失败的诱导的一种方法是基于潜伏期的持续时间。然而，一个标准的最低持续时间，引产的潜伏期应继续，没有急性产妇或胎儿剖宫产指征，仍然缺乏。本研究的目的是要确定的频率不良的孕产妇和围产期的结果作为一个功能的潜伏期在未经产的妇女进行引产。这项研究基于2008-2011年在美国25家医院分娩的产科女性队列的数据。足月单胎妊娠头位的未产妇，如果进行了引产，则有资格进行这项分析。与先前的研究一致，一旦宫颈成熟结束，催产素开始使用，发生胎膜破裂（ROM），潜伏期就确定为开始，一旦达到5 cm扩张，潜伏期就确定为结束。剖宫产的频率，以及不良产妇（例如，剖宫产、产后出血、绒毛膜炎）和围产期结果（例如，癫痫发作、脓毒症、骨或神经损伤、脑病或死亡的复合频率）作为潜伏期持续时间的函数进行比较（以连续测量和以3小时增量分类的时间进行分析）。共有10 677名妇女可供分析。在绝大多数（96.4%）妇女中，活跃期在15小时内达到。女性潜伏期越长，她最终接受剖宫产的机会就越大（P<0.001，时间作为连续和分类自变量），尽管超过40%的潜伏期持续18小时或更长时间的女性仍然有阴道分娩。随着潜伏期的延长，产妇的几种疾病，如产后出血（P < 0.001）和绒毛膜炎（P < 0.001）的发生率也增加。相反，随着时间的推移，大多数不良围产期结局的频率在统计学上是稳定的。绝大多数接受引产的妇女在催产素开始使用和发生胎膜破裂后15小时进入活跃期。随着潜伏期时间的延长，母体不良结局在统计学上变得更加频繁，尽管频率的绝对增加相对较小。这些数据表明，剖宫产不应该进行在潜伏期前至少15小时后催产素和破膜发生。超过这一点后继续分娩的决定应该是个性化的，并可能考虑到其他因素，如分娩进展的证据。
While there are well-accepted standards for the diagnosis of arrested active-phase labor, the definition of a “failed” induction of labor remains less certain. One approach to diagnosing a failed induction is based on the duration of the latent phase. However, a standard for the minimum duration that the latent phase of a labor induction should continue, absent acute maternal or fetal indications for cesarean delivery, remains lacking. The objective of this study was to determine the frequency of adverse maternal and perinatal outcomes as a function of the duration of the latent phase among nulliparous women undergoing labor induction. This study is based on data from an obstetric cohort of women delivering at 25 U.S. hospitals from 2008–2011. Nulliparous women who had a term singleton gestation in the cephalic presentation were eligible for this analysis if they underwent a labor induction. Consistent with prior studies, the latent phase was determined to begin once cervical ripening had ended, oxytocin was initiated and rupture of membranes (ROM) had occurred, and was determined to end once 5 cm dilation was achieved. The frequencies of cesarean delivery, as well as of adverse maternal (e.g., cesarean delivery, postpartum hemorrhage, chorioamnionitis) and perinatal outcomes (e.g., a composite frequency of either seizures, sepsis, bone or nerve injury, encephalopathy, or death), were compared as a function of the duration of the latent phase (analyzed with time both as a continuous measure and categorized in 3-hour increments). A total of 10,677 women were available for analysis. In the vast majority (96.4%) of women, the active phase had been reached by 15 hours. The longer the duration of a woman’s latent phase, the greater her chance of ultimately undergoing a cesarean delivery (P<0.001, for time both as a continuous and categorical independent variable), although more than forty percent of women whose latent phase lasted for 18 or more hours still had a vaginal delivery. Several maternal morbidities, such as postpartum hemorrhage (P < 0.001) and chorioamnionitis (P < 0.001), increased in frequency as the length of latent phase increased. Conversely, the frequencies of most adverse perinatal outcomes were statistically stable over time. The large majority of women undergoing labor induction will have entered the active phase by 15 hours after oxytocin has started and rupture of membranes has occurred. Maternal adverse outcomes become statistically more frequent with greater time in the latent phase, although the absolute increase in frequency is relatively small. These data suggest that cesarean delivery should not be undertaken during the latent phase prior to at least 15 hours after oxytocin and rupture of membranes have occurred. The decision to continue labor beyond this point should be individualized, and may take into account factors such as other evidence of labor progress.
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影响因子：
9.8
作者：
Ananth CV;Schisterman EF
通讯作者：
Schisterman EF
影响因子：
9.8
作者：
Zhang, J;Troendle, JF;Yancey, MK
通讯作者：
Yancey, MK
DOI：
10.1016/0002-9378(54)90311-7
发表时间：
1954-01-01
影响因子：
9.8
作者：
FRIEDMAN, EA
通讯作者：
FRIEDMAN, EA
影响因子：
9.8
作者：
Rhinehart-Ventura, Jessica;Eppes, Catherine;Davidson, Christina
通讯作者：
Davidson, Christina
影响因子：
7.2
作者：
FRIEDMAN, EA
通讯作者：
FRIEDMAN, EA