Epidural analgesia and fetal head malposition at vaginal delivery.
Epidural analgesia and fetal head malposition at vaginal delivery.
复制标题
阴道分娩时硬膜外镇痛和胎头异位。
DOI：
10.1016/s0029-7844(00)01230-8
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发表时间：
2001
影响因子：
7.2
通讯作者：
Klebanoff,MA
中科院分区：
文献类型：
--
作者：
Yancey,MK;Zhang,J;Schweitzer,DL;Schwarz,J;Klebanoff,MA
目的探讨使用按需硬膜外镇痛分娩的未产妇在分娩时胎儿顶端位置异常的可能性是否高于在限制使用硬膜外期间分娩的未产妇。方法对在按需分娩硬膜外镇痛前12个月内自然分娩的未产妇与要求硬膜外镇痛后分娩的未产妇进行回顾性队列比较。主要的结局变量是阴道分娩时的非枕骨前位或胎头错位。结果硬膜外使用频率从按需硬膜外镇痛前的0.9%增加到术后的82.9%。阴道分娩前434例中有26例(6.0%)发生胎头错位，而后期511例中有29例(5.7%)发生胎头错位(相对危险度0.95，95%可信区间0.6，1.6)。按分娩方式分层后，胎头错位的发生率无统计学差异(Mantel-Haenszel加权相对危险度0.94，95%可信区间0.6，1.4)。这项研究的样本大小提供了85%的力量来检测与按需硬膜外使用相关的基线比率6%的胎儿错位发生率增加两倍。结论在自然分娩中为未产妇提供按要求分娩硬膜外镇痛并不会导致阴道分娩时胎头错位的发生率在临床上显著增加。
ObjectiveTo determine if nulliparas who delivered with on-demand epidural analgesia are more likely to have malpositioning of the fetal vertex at delivery than women delivered during a period of restricted epidural use.MethodsA retrospective cohort of nulliparous women with spontaneous labor delivered during a 12-month period immediately before the availability of on-demand labor epidural analgesia was compared with a similar group of nulliparas delivered after labor epidural analgesia was available on request. The primary outcome variable was a non-occiput anterior position or malpositioned fetal head at vaginal delivery.ResultsThe frequency of epidural use increased from 0.9% before epidural analgesia became available on demand to 82.9% afterward. Fetal head malpositioning at vaginal delivery occurred in 26 of 434 (6.0%) women delivered in the before period compared with 29 of 511 (5.7%) in the after period (relative risk 0.95, 95% confidence interval 0.6, 1.6). No statistically significant difference in the incidence of fetal head malpositioning was present after patients were stratified by mode of delivery (Mantel–Haenszel weighted relative risk 0.94, 95% confidence interval 0.6, 1.4). The study sample size provided 85% power to detect a two-fold increase in the incidence of fetal malpositioning from a baseline rate of 6% associated with on-demand epidural use.ConclusionProviding on-request labor epidural analgesia to nulliparas in spontaneous labor did not result in a clinically significant increase in the frequency of fetal head malpositioning at vaginal delivery.