Association Between Time of Day and the Decision for an Intrapartum Cesarean Delivery.
Association Between Time of Day and the Decision for an Intrapartum Cesarean Delivery.
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DOI：
10.1097/aog.0000000000003707
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发表时间：
2020-03
影响因子：
7.2
通讯作者：
Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network
中科院分区：
文献类型：
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作者：
Son M;Lai Y;Bailit J;Reddy UM;Wapner RJ;Varner MW;Thorp JM Jr;Caritis SN;Prasad M;Tita ATN;Saade G;Sorokin Y;Rouse DJ;Blackwell SC;Tolosa JE;Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network
检查是否执行产时剖宫产的决定和指征随时间而变化。我们对115,502例分娩（2008-2011年）的多中心观察队列进行了二次分析，其中包括足月、单胎、非异常顶位活产并尝试分娩的未经产妇女。那些试图在家分娩，或接受剖宫产计划或决定入院后不到30分钟被排除在外。一天中的时间被定义为剖宫产分娩的决定时间和阴道分娩的分娩时间，按24小时的每小时分类。主要结局是决定进行剖宫产和剖宫产指征（难产，胎儿状态不安全，或其他指征）。次要结局包括难产适应症是否符合降低剖宫产率的标准。分别使用χ2和Kruskal-Wallis检验对分类和连续结局进行双变量分析，使用平滑样条的广义加性模型探索非线性相关性，而无需调整其他因素。36，014名合格妇女中有7，956五十六人（22.1%）接受了剖宫产。剖宫产率（P<0.001）从午夜（21.2%）到早晨逐渐下降，10：00达到最低点（17.9%），21：00达到最高点（26.2%）。难产的剖宫产率也与一天中的时间显著相关（P<0.001），这一模式反映了剖宫产的总体情况。在因难产而进行的剖宫产中（n= 5，274），在扩张小于5 cm时决定剖宫产（P<0.001），从扩张5 cm到决定剖宫产的中位时间（P= 0.003），以及从完全扩张到决定剖宫产的中位时间（P= 0.014）都在一天中的不同时间有显著差异。不安全的胎儿状态和“其他”指征的频率与一天中的时间没有显著相关性（P> 0.05）。在足月分娩的初产妇中，决定进行剖宫产，特别是难产，随时间而变化。其中一些差异与分娩管理的差异有关，因为潜伏期剖宫产的频率和活跃期的中位数时间发生了变化。
To examine whether the decision and indications for performing intrapartum cesarean delivery vary by time of day. We conducted a secondary analysis of a multicenter observational cohort of 115,502 deliveries (2008–2011), including nulliparous women with term, singleton, nonanomalous live gestations in vertex presentation who were attempting labor. Those who attempted home birth, or underwent cesarean delivery scheduled or decided less than 30 minutes after admission were excluded. Time of day was defined as cesarean delivery decision time among those who delivered by cesarean and delivery time among those who delivered vaginally, categorized by each hour of a 24-hour day. Primary outcomes were decision to perform cesarean delivery and the indications for cesarean delivery (labor dystocia, nonreassuring fetal status, or other indications). Secondary outcomes included whether a dystocia indication adhered to standards promoted to reduce cesarean delivery rates. Bivariate analyses were performed using χ2 and Kruskal-Wallis tests for categorical and continuous outcomes, respectively, and generalized additive models with smoothing splines explored nonlinear associations without adjustment for other factors. Seven thousand nine hundred fifty-six (22.1%) of 36,014 eligible women underwent cesarean delivery. Decision for cesarean delivery (P<.001) decreased from midnight (21.2%) to morning, reaching a nadir at 10:00 (17.9%) and subsequently rising to peak at 21:00 (26.2%). The frequency of cesarean delivery for dystocia also was significantly associated with time of day (P<.001) in a pattern mirroring overall cesarean delivery. Among cesarean deliveries for dystocia (n=5,274), decision for cesarean delivery at less than 5 cm dilation (P<.001), median duration from 5 cm dilation to cesarean delivery decision (P=.003), and median duration from complete dilation to cesarean delivery decision (P=.014) all significantly differed with time of day. The frequency of nonreassuring fetal status and “other” indications were not significantly associated with time of day (P>.05). Among nulliparous women who were attempting labor at term, the decision to perform cesarean delivery, particularly for dystocia, varied with time of day. Some of these differences correlate with labor management differences, given the changing frequency of latent phase cesarean delivery and median time in active phase.