Incidence and outcomes of dystocia in the active phase of labor in term nulliparous women with spontaneous labor onset
Incidence and outcomes of dystocia in the active phase of labor in term nulliparous women with spontaneous labor onset
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DOI：
10.1080/00016340902811001
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发表时间：
2009-01-01
影响因子：
4.3
通讯作者：
Dykes, Anna-Karin
中科院分区：
文献类型：
--
作者：
Kjaergaard, Hanne;Olsen, Jorn;Dykes, Anna-Karin
目标。估计无明显合并症的未产妇女难产的发生率，并检查难产后母体和胎儿的短期预后。设计。一项前瞻性收集数据的多中心队列研究。设置。9个产科，年出生率在850至5,400之间。人口。低风险无产妇女足月自然分娩与单胎胎儿头位表现。方法。采用自填问卷和临床记录对2810名无症状者进行随访。难产标准。第一产程4小时宫颈扩张2cm或第二产程下降期2小时（硬膜外镇痛3小时）无下降或第二产程排出期1小时无进展。纳入调查于2004年5月至2005年7月期间进行。主要结果测量。难产、产妇和胎儿结局的发生率。结果。难产的累计发生率为37%，其中61%的诊断发生在产程第二阶段。与未诊断难产的妇女相比，接受增强术治疗的难产妇女有更多的剖宫产和静脉分娩，更多的羊水不清，更多的产后出血，她们的孩子通常获得较低的1分钟新生儿Apgar评分。结论。无引产或择期剖宫产指征的健康无产足月难产发生率为37%。产妇和新生儿的不良结局可能与难产的原因有关，也可能与产程增加有关，这一问题有待进一步研究。
Objective. To estimate the incidence of dystocia among nulliparous women without apparent co-morbidity and to examine maternal and fetal short-term outcomes after dystocia. Design. A multi-center cohort study with prospectively collected data. Setting. Nine obstetric departments with annual birth rates between 850 and 5,400. Population. Low-risk nulliparous women in term spontaneous labor with a singleton fetus in cephalic presentation. Methods. Follow-up of 2,810 nulliparas using self-administered questionnaires supplemented with clinical records. Criteria for dystocia. Cervical dilatation 2 cm over four hours during the first stage of labor or no descent during two hours (three hours with epidural analgesia) in the descending phase of second stage or no progress for one hour during the expulsive phase of the second stage. Inclusion took place between May 2004 and July 2005. Main outcome measures. Incidences of dystocia, maternal, and fetal outcomes. Results. The cumulative incidence of dystocia was 37% and of the diagnoses 61% were given in the second stage of labor. Women with dystocia treated by augmentation had more cesarean and ventouse deliveries, more often non-clear amniotic fluid, more post-partum hemorrhage and their children were more often given low one-minute neonatal Apgar scores as compared to women delivered without a diagnosis of dystocia. Conclusions. A dystocia incidence of 37% was found in healthy term nulliparas with no indication for induction or elective cesarean delivery. The adverse maternal and neonatal birth outcomes may be related to the cause of dystocia or to augmentation of labor and this question calls for further studies.