Labor Intervention and Outcomes in Women Who Are Nulliparous and Obese: Comparison of Nurse-Midwife to Obstetrician Intrapartum Care.
Labor Intervention and Outcomes in Women Who Are Nulliparous and Obese: Comparison of Nurse-Midwife to Obstetrician Intrapartum Care.
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DOI：
10.1111/jmwh.12579
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发表时间：
2017-01
期刊：
影响因子：
--
通讯作者：
Lowe NK
中科院分区：
文献类型：
--
作者：
Carlson NS;Corwin EJ;Lowe NK
肥胖妇女的分娩速度比正常体重的妇女慢，对催产素增加和人工破膜等旨在加速分娩进程的干预措施的反应也较低。没有描述这些妇女的最佳分娩管理。这项回顾性队列研究比较了2组倾向评分匹配的健康、未经产、自然分娩和肥胖（体重指数30 kg/m2）女性（N = 360）。从2005年到2012年，分娩由一家医院的注册助产士或产科医生管理。对一系列劳动过程和结果进行了比较。肥胖妇女在分娩过程中接受CNMs护理的可能性降低了87.0%（调整后的比值比[aOR]，0.15; 95%置信区间[CI]，0.06-0.41），发生三度或四度会阴撕裂伤的可能性降低76.3%（aOR，0.31; 95%CI，0.13-0.79）与匹配组的妇女相比，这些妇女肥胖，有相似大小的新生儿，但由产科医生照顾。两组的计划外剖宫产率、产后出血率、产妇产时发热率和新生儿重症监护室入院率相似。CNM患者比产科医生的患者更不可能有分娩麻醉，合成催产素增加，或宫内压力导管。相比之下，CNM患者比产科医生的患者更有可能使用生理性分娩干预，包括间歇性胎儿监护，羊水和水疗。在健康、肥胖、未经产的自发临产女性中，以CNM产时护理为特征的观察等待和使用生理分娩干预措施的结果与肥胖和接触的女性的结果相似或更好。产科医生进行的产时护理为特征的高科技干预措施。在肥胖妇女中，生理性分娩干预对母亲和新生儿都是安全的。
Women who are obese have slower labors than women of normal weight, and show reduced response to interventions designed to speed labor progress like oxytocin augmentation and artificial rupture of membranes. The optimal labor management for these women has not been described. This retrospective cohort study compared 2 propensity score-matched groups of women (N = 360) who were healthy, nulliparous, spontaneously laboring, and obese (body mass index 30 kg/m2). Labors were managed by either a certified nurse-midwife (CNM) or an obstetrician at one hospital from 2005 through 2012. Comparisons were made on a range of labor processes and outcomes. Women who were obese and cared for in labor by CNMs were 87.0% less likely to have operative vaginal birth (adjusted odds ratio [aOR], 0.15; 95% confidence interval [CI], 0.06–0.41) and 76.3% less likely to have third- or fourth-degree perineal lacerations (aOR, 0.31; 95% CI, 0.13–0.79) compared to a matched group of women who were obese and had similarly sized neonates but who were cared for by obstetricians. The rates of unplanned cesarean birth, postpartum hemorrhage, maternal intrapartum fever, and neonatal intensive care unit admission were similar between groups. CNM patients were significantly less likely than patients of obstetricians to have labor anesthesia, synthetic oxytocin augmentation, or intrauterine pressure catheters. By contrast, CNM patients were significantly more likely than patients of obstetricians to use physiologic labor interventions, including intermittent fetal monitoring, ambulation, and hydrotherapy. In women with spontaneous labor onset who were healthy, obese, and nulliparous, watchful waiting and use of physiologic labor interventions, characterizing CNM intrapartum care, were associated with outcomes that were similar to, or better than, those of women who were obese and exposed to more high-technology interventions characterizing intrapartum care by obstetricians. In women who were obese, physiologic labor interventions were safe for both mothers and neonates.
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影响因子：
9.8
作者：
Kominiarek MA;Vanveldhuisen P;Hibbard J;Landy H;Haberman S;Learman L;Wilkins I;Bailit J;Branch W;Burkman R;Gonzalez-Quintero VH;Gregory K;Hatjis C;Hoffman M;Ramirez M;Reddy UM;Troendle J;Zhang J;Consortium on Safe Labor
通讯作者：
Consortium on Safe Labor
DOI：
10.1001/jama.2014.732
发表时间：
2014-02-26
期刊：
JAMA
影响因子：
--
作者：
Ogden CL;Carroll MD;Kit BK;Flegal KM
通讯作者：
Flegal KM
影响因子：
2.3
作者：
Mi MY;Collins JE;Lerner V;Losina E;Katz JN
通讯作者：
Katz JN
影响因子：
8.9
作者：
Poobalan, A. S.;Aucott, L. S.;Bhattacharya, S.
通讯作者：
Bhattacharya, S.
DOI：
10.1016/j.ejogrb.2009.05.022
发表时间：
2009-08-01
影响因子：
2.6
作者：
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通讯作者：
Cedergren, Marie I.