Intrauterine pressure during the second stage of labor in obese women
Intrauterine pressure during the second stage of labor in obese women
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DOI：
10.1097/01.aog.000102706.84063.c7
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发表时间：
2004-02-01
影响因子：
7.2
通讯作者：
Weiner, CP
中科院分区：
文献类型：
--
作者：
Buhimschi, CS;Buhimschi, IA;Weiner, CP
目的：尽管缺乏客观的研究，肥胖妇女的分娩时间更长，手术分娩频率更高，因为她们是“穷人推动者”的观念仍然存在。我们测试的假设，肥胖妇女产生不足的子宫内压在第二产程。方法：在第二产程的71名妇女的子宫内压进行了前瞻性测量。肥胖定义为体重指数（BMI）大于29（n = 17）。BMI低于25为正常（n = 40）。BMI在26至29之间的女性（n = 14）被视为超重。所有妇女分娩与硬膜外镇痛和警觉和响应整个研究。记录基线收缩力后，在收缩期间进行标准化Valsalva动作。子宫内压曲线下面积（积分）被用来作为子宫收缩力的估计。肥胖、超重和正常妇女的基线子宫收缩力无显著差异，（肥胖1，787 mm Hg/s; 95%置信区间[CI] 1，164，2，742 vs正常1，569 mm Hg/s; 95% CI 718，2，371 vs超重1，770 mm Hg/s; 95% CI 1，305，2，835; P = 0.223）或Valsalva操作期间（肥胖2，831 mm Hg/s; 95% CI 1，771，4，599 vs正常2，637 mm Hg/s; 95% CI 1，240，4，390 vs超重2，813 mm Hg/s; 95% CI 1，209，4，982; P = 0.742）。BMI大于25与催产素增加频率较高相关（P = 0.037）。单变量分析显示产程时间与BMI之间存在相关性（r = 0.299，P = 0.018）。肥胖女性在活动期工作时间更长（单因素方差分析，P = 0.02），但第二阶段持续时间在各组之间相似（单因素方差分析P = 0.44）。肥胖并没有增加会阴裂伤的发生率（P = 0.82）或手术分娩的频率（肥胖与非肥胖的相对危险度= 0.212; 95%CI 0.04，1.05）。结论：肥胖妇女产生的第二阶段子宫内压相当于BMI正常的妇女，虽然他们可能需要催产素增加更频繁。(C)2004年由美国妇产科医师学会。
OBJECTIVE: The perception that obese women have longer labors and a higher frequency of operative delivery because they are "poor pushers" persists despite the absence of objective study. We tested the hypothesis that obese women generate inadequate intrauterine pressure during the second stage of labor.METHODS: Intrauterine pressure was prospectively measured in 71 women during the second stage of labor. Obesity was defined as a body mass index (BMI) greater than 29 (n = 17). A BMI below 25 was normal (n = 40). Women with a BMI between 26 and 29 (n = 14) were considered overweight. All women labored with epidural analgesia and were alert and responsive throughout the study. After recording the baseline contractility, a standardized Valsalva maneuver was performed during contractions. The area under the intrauterine pressure curve (integral) was used as an estimate of uterine contractility.RESULTS: All women delivered vaginally. There were no significant differences in baseline uterine contractility among obese, overweight, and normal women either before (obese 1,787 mm. Hg/s; 95% confidence interval [CI] 1,164, 2,742 versus normal 1,569 mm Hg/s; 95% CI 718, 2,371 versus overweight 1,770 nun Hg/s; 95% CI 1,305, 2,835; P = .223) or during Valsalva maneuver (obese 2,831 mm Hg/s; 95% CI 1,771, 4,599 versus normal 2,637 mm Hg/s; 95% CI 1,240, 4,390 versus overweight 2,813 mm Hg/s; 95% CI 1,209, 4,982; P = .742). A BMI greater than 25 was associated with a higher frequency of oxytocin augmentation (P = .037). Univariate analysis revealed a relationship between labor duration and BMI (r = 0.299, P = .018). Obese women labored longer during the active phase (one-way analysis of variance, P = .02), but second-stage duration was similar among groups (one-way analysis of variance P = .44). Obesity did not increase the incidence of perineal lacerations (P = .82) or frequency of operative delivery (relative risk obese versus nonobese = 0.212; 95% CI 0.04, 1.05).CONCLUSION: Obese women produce second-stage intrauterine pressures equivalent to women with a normal BMI, although they may require oxytocin augmentation more often. (C) 2004 by The American College of Obstetricians and Gynecologists.