A Novel Classification of Labor Dystocia: Developing a Physiologic Understanding to Facilitate Precision in Diagnosis and Individualized Management

项目总结/摘要 2020年健康人目标优先考虑将低风险妇女的剖宫产率降低10%。劳动 在美国，难产几乎占剖宫产分娩（CD）的50%（MICH-07.1）。美国 妇产科医师学院和产妇和胎儿医学协会确定了准确的 诊断产程难产，并明智地使用CD作为减少 1在美国，近一半的分娩使用催产素;然而， 没有发现隆乳可以降低CD的风险。而且，有些难产的妇女不会 对催产素有反应申请人寻求有助于理解难产的病理生理学， 找到新的方法来减少不必要的使用Pitocin增强和CD。羊水升高 液体乳酸盐（AFL）和增加的中位功率密度谱（PDS）频率，测量 分娩过程中子宫肌的电活动，最近被发现与难产有关 和CD。AFL和PDS中位数频率监测已被单独提出作为识别 妇女面临分娩和慢性阻塞性肺病的风险。拟议的研究将描述分娩难产的表型 通过AFL浓度和PDS中位数频率来提高难产诊断的准确性。改善 难产的诊断精度将允许个体化管理，减少不必要的CD， 优化胎儿和母亲的结果。申请人综合了研究结果， 难产：在产程图上记录宫颈扩张率，然后记录子宫收缩是否充分，以及 劳联。拟议的研究将有助于更好地了解难产的病理生理 产生未来的研究假设，有助于发展拟议的表型 难产的分类。此外，拟议的研究将评估点之间的相关性- 通过母亲手指针刺和AFL收集的护理前毛细血管乳酸。AFL的评估是有限的，因为它只能 在破膜后非侵入性地收集。如果即时毛细血管乳酸盐浓度 与AFL相关，它可以作为一种替代的生物标志物，在早期分娩开始，以确定异常 劳动模式，从中确定适当的管理计划。而不是统一使用Pitocin 隆乳、休息和恢复子宫收缩的创新干预措施可能适用，包括 安胎药、葡萄糖或碳酸氢钠。

Project Summary/Abstract The Healthy People 2020 goals prioritize reduction of the cesarean rate by 10% for low-risk women. Labor dystocia accounts for almost 50% of cesarean deliveries (CD) in the United States (MICH-07.1). The American College of Obstetricians and Gynecologists and the Society for Maternal and Fetal Medicine identified accurate diagnosis of labor dystocia and the judicious use of CD for this indication as an opportunity to reduce the overall CD rate.1 In the United States, nearly half of all labors are augmented using Pitocin; however this augmentation has not been found to reduce the risk for CD. Moreover, some women with labor dystocia do not respond to Pitocin. The applicant seeks to contribute to understanding the pathophysiology of labor dystocia to find novel approaches to reducing the unnecessary use of Pitocin augmentation and CD. Elevated amniotic fluid lactate (AFL) and increased median Power Density Spectrum (PDS) frequency, a measure of the electrical activity of the uterine muscle during labor, recently were found to be associated with labor dystocia and CD. AFL and median PDS frequency monitoring have been proposed separately as tools for identifying women at risk for arrest of labor and CD. The proposed research will characterize labor dystocia phenotypes by AFL concentrations and median PDS frequency to improve diagnostic precision labor dystocia. Improving diagnostic precision for dystocia will allow for individualized management that reduces unnecessary CD and optimizes fetal and maternal outcomes. The applicant has synthesized research findings to classify labor dystocia by rate of cervical dilation graphed on a partograph, then by adequacy of uterine contractions, and AFL. The proposed research will contribute to a better understanding of the pathophysiology of labor dystocia to generate future research hypotheses that contribute to the development of the proposed phenotypic classification of labor dystocia. In addition, the proposed research will evaluate the correlation between point- of-care capillary lactate collected by maternal finger stick and AFL. Evaluation of AFL is limited as it can only be collected non-invasively following ruptured membranes. If point-of-care capillary lactate is predictably correlated with AFL, it may be used as an alternative biomarker beginning in early labor to identify abnormal labor patterns, from which an appropriate management plan is determined. Instead of uniform use of Pitocin augmentation, innovative interventions that rest and restore uterine contraction may be indicated, including tocolytics, dextrose, or sodium bicarbonate.