Oxytocin Augmentation in Spontaneously Laboring, Nulliparous Women: Multilevel Assessment of Maternal BMI and Oxytocin Dose.
Oxytocin Augmentation in Spontaneously Laboring, Nulliparous Women: Multilevel Assessment of Maternal BMI and Oxytocin Dose.
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DOI：
10.1177/1099800417701831
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发表时间：
2017-07
影响因子：
2.5
通讯作者：
Lowe NK
中科院分区：
文献类型：
--
作者：
Carlson NS;Corwin EJ;Lowe NK
人工合成的催产素是增加产程的主要手段，但在肥胖女性中效果较差，导致更多的意外剖宫产，导致产程缓慢。目前尚不清楚肥胖妇女是否需要更高剂量的催产素，是因为与母亲肥胖有关的母体、胎儿或分娩因素。本研究有两个主要目的：1)检查肥胖妇女从增强术开始到阴道分娩时，母亲体重指数（BMI）对每小时催产素剂量的影响；2)检查其他母体、胎儿和分娩因素对肥胖妇女每小时催产素剂量的影响。对健康、未生育、自然分娩的肥胖女性（BMI≥30 kg/m2）进行纵向研究（N = 136），这些女性接受了催产素增强并实现了阴道分娩。我们进行了反复的多水平分析，以检查母亲BMI和其他因素对每小时催产素剂量的影响。在控制母体、胎儿和分娩特征影响的多水平模型中，母体BMI解释了16.56% （95% CI [13.7-20.04], p < 0.001）的每小时催产素剂量方差。产妇年龄、胎龄、入院时羊膜状况、入院子宫颈扩张检查无显著性差异；然而，新生儿出生体重和催产素起始时宫颈扩张是这些妇女每小时催产素剂量的显著预测因子（p < 0.001）。即使当分娩准备已经足够进行自然分娩时，仍然可能存在一些肥胖相关的子宫肌收缩能力减弱和对用于增强催产素的反应。
Synthetic oxytocin, the primary tool for labor augmentation, is less effective among obese women, leading to more unplanned cesarean deliveries for slow labor progress. It is not known if obese women require higher doses of oxytocin due to maternal, fetal, or labor factors related to maternal obesity. This study had two main objectives: 1) Examine the influence of maternal body mass index (BMI) on hourly doses of oxytocin from augmentation initiation until vaginal delivery in obese women; and 2) Examine the influence of other maternal, fetal, and labor factors on hourly doses of oxytocin in obese women. Longitudinal study of a cohort (N = 136) of healthy, nulliparous, spontaneously laboring obese women (BMI ≥ 30 kg/m2) who received oxytocin augmentation and achieved vaginal delivery. We performed iterative multilevel analyses to examine the influence of maternal BMI and other factors on hourly oxytocin doses. Maternal BMI explained 16.56% (95% CI [13.7-20.04], p < 0.001) of the variance in hourly oxytocin doses received in a multilevel model controlling for influence of maternal, fetal, and labor characteristics. Maternal age, gestational age, status of amniotic membranes at hospital admission, and admission cervical dilation examination were not significant; however, neonatal birthweight and cervical dilation at oxytocin initiation were significant predictors of hourly oxytocin dose in these women (p < 0.001). Even when parturition preparation has progressed adequately for spontaneous labor initiation, there still may be some obesity-related blunting of myometrial contractility and response to oxytocin used for augmentation.
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影响因子：
2.6
作者：
Siggelkow, W.;Boehm, D.;Koelbl, H.
通讯作者：
Koelbl, H.
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Buhimschi, CS;Buhimschi, IA;Weiner, CP
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通讯作者：
Consortium on Safe Labor
影响因子：
7.2
作者：
Zaki, Mary N.;Hibbard, Judith U.;Kominiarek, Michelle A.
通讯作者：
Kominiarek, Michelle A.
影响因子：
5.5
作者：
Smith, RD;Babiychuk, EB;Wray, S
通讯作者：
Wray, S