Normal First Stage of Labor in Women Undergoing Trial of Labor After Cesarean Delivery
Normal First Stage of Labor in Women Undergoing Trial of Labor After Cesarean Delivery
复制标题
DOI：
10.1097/aog.0b013e31824c096c
复制
发表时间：
2012-04-01
影响因子：
7.2
通讯作者：
Cahill, Alison G.
中科院分区：
文献类型：
--
作者：
Graseck, Anna S.;Odibo, Anthony O.;Cahill, Alison G.
目的：比较剖宫产后试产(TOLAC)和未剖宫产妇女的第一产程模式，探讨子宫疤痕是否会改变这一产程。方法：对连续分娩的足月顶点单胎进行回顾性队列研究。宫颈检查和产科结果从医疗记录中收集。使用重复测量分析构建了那些自发劳动的人的劳动曲线，按TOLAC身份分层。结果：在5388例连续足月分娩中，2 021例自然分娩纳入研究对象。将1881名从未剖腹产的临产妇女与140名接受TOLAC手术的妇女进行了比较。两组间宫颈扩张率无显著差异。TOLAC组扩张4~10 cm的中位时间为3.0小时，非TOLAC组为2.8小时(P=.52)。随机抽样后的样本量计算(α=0.05)显示，在固定样本量的情况下，90%的力量可以检测到0.4小时的中位数差异。结论：接受TOLAC和未进行剖宫产的妇女在第一产程曲线和宫颈扩张率方面没有显著差异。有子宫疤痕和没有子宫疤痕的人应该按照类似的标准诊断分娩障碍。(Obstet Gyneol 2012；119：732-6)doi：10.1097/AOG.0b013e31824c096c
OBJECTIVE: To compare first-stage labor patterns in women undergoing trial of labor after cesarean delivery (TOLAC) and those without a previous cesarean to explore whether a uterine scar alters this stage of labor.METHODS: A retrospective cohort study was conducted of consecutive term vertex singletons who reached the second stage of labor. Cervical examinations and obstetric outcomes were collected from medical records. Labor curves of those laboring spontaneously, stratified by TOLAC status, were constructed using a repeated-measures analysis. Interval-censored regression was used to estimate duration of labor, centimeter by centimeter, stratified by TOLAC status and adjusted for race, obesity, macrosomia, and previous vaginal delivery.RESULTS: Of 5,388 consecutive term births, 2,021 labored spontaneously and were included. The 1,881 laboring women with no previous cesarean delivery were compared with 140 women undergoing TOLAC. There was no significant difference in rates of cervical dilation between the groups. The median time for dilation from 4 to 10 cm was 3.0 hours for TOLAC and 2.8 hours for non-TOLAC (P=.52). A post hoc sample size calculation (alpha=0.05) shows 90% power to detect a median difference of 0.4 hours with the fixed sample size available.CONCLUSION: There was no significant difference in first-stage labor curves or cervical dilation rate between women undergoing TOLAC and those without a previous cesarean. Diagnoses of labor disorders should be made with similar standards between those with and without a uterine scar. (Obstet Gynecol 2012;119:732-6) DOI: 10.1097/AOG.0b013e31824c096c