Labour dystociaurisk of recurrence and instrumental delivery in following labourua population-based cohort study
Labour dystociaurisk of recurrence and instrumental delivery in following labourua population-based cohort study
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DOI：
10.1111/j.1471-0528.2012.03502.x
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发表时间：
2012-12-01
影响因子：
5.8
通讯作者：
Stephansson, O.
中科院分区：
文献类型：
--
作者：
Sandstrom, A.;Cnattingius, S.;Stephansson, O.
Sandstrom A, Cnattingius S, Wikstrom A, Stephansson O.：一项基于人群的队列研究。问卷2012;119:16481656。目的探讨首次分娩后二次分娩难产复发的危险及分娩方式，并结合胎儿和产妇的特点。设计：基于人群的队列研究。设置1992年至2006年的瑞典医疗出生登记册。共有239 953名妇女在妊娠37周头位分娩第一胎和第二胎单胎，分娩时有自然发生。方法采用logistic回归分析估计粗比值比和校正比值比。主要观察指标产程难产及二产程分娩方式。结果有难产史的女性中难产率仅为12%。无论采用何种分娩方式，有过难产史的妇女第二次分娩时难产的发生率高于无过难产史的妇女，但有过剖腹产史的妇女难产率更高（34%）。对难产风险评分组（危险因素为妊娠间隔长、产妇年龄=35岁、肥胖、产妇身材矮小、非同居和足月妊娠）的分析显示，随着既往难产和风险评分的增加，第二次分娩的风险增加。在既往难产且风险评分为3分或以上的剖宫产后试产妇女中，66%（分别为17%和49%）进行了阴道辅助分娩或剖宫产。在无难产史且风险评分为0的剖宫产后试产妇女中，相应的风险为32%（分别为14%和18%）。结论既往难产可增加后产难产的发生风险。在评估难产和辅助分娩的风险时，将首次分娩、胎儿和母体的特征考虑在内是很重要的。
Please cite this paper as: Sandstrom A, Cnattingius S, Wikstrom A, Stephansson O. Labour dystociarisk of recurrence and instrumental delivery in following laboura population-based cohort study. BJOG 2012;119:16481656. Objective To investigate risk of recurrence of labour dystocia and mode of delivery in second labour after taking first labour and fetal and maternal characteristics into account. Design A population-based cohort study. Setting The Swedish Medical Birth Register from 1992 to 2006. Population A total of 239 953 women who gave birth to their first and second singleton infants in cephalic presentation at =37 weeks of gestation with spontaneous onset of labour. Methods We used logistic regression analysis to estimate crude and adjusted odds ratios. Main outcome measures Labour dystocia and mode of delivery in second labour. Results Overall labour dystocia affected only 12% of women with previous dystocia. Regardless of mode of first delivery, rates of dystocia in the second labour were higher in women with than without previous dystocia, but were more pronounced in women with previous caesarean section (34%). Analyses with risk score groups for dystocia (risk factors were long interpregnancy interval, maternal age =35 years, obesity, short maternal stature, not cohabiting and post-term pregnancy) showed that risk of instrumental delivery in second labour increased with previous dystocia and increasing risk score. Among women with trial of labour after caesarean section with previous dystocia and a risk score of 3 or more, 66% had a vaginal instrumental or caesarean delivery (17 and 49%, respectively). In women with trial of labour after caesarean section without previous dystocia and a risk score of 0, corresponding risk was 32% (14 and 18%, respectively). Conclusion Previous labour dystocia increases the risk of dystocia in subsequent delivery. Taking first labour and fetal and maternal characteristics into account is important in the risk assessments for dystocia and instrumental delivery in second labour.