Reassessing the labor curve in nulliparous women
Reassessing the labor curve in nulliparous women
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DOI：
10.1067/mob.2002.127142
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发表时间：
2002-10-01
影响因子：
9.8
通讯作者：
Yancey, MK
中科院分区：
文献类型：
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作者：
Zhang, J;Troendle, JF;Yancey, MK
目的：我们的目的是研究现代产科实践中未产妇分娩进展的模式。研究设计：我们提取了1329例足月、单胎、头位胎儿正常的初产妇的详细分娩资料，排除了剖宫产，我们使用了一个10阶多项式函数的重复测量回归来发现当代实践下的平均劳动力曲线。与使用一个区间删失回归与对数正态分布，我们还计算了预期的时间间隔的子宫颈达到下一厘米，预期的宫颈扩张率在每个阶段的劳动力，和劳动力的持续时间为胎儿下降在各个station.RESULTS：我们的平均劳动力曲线显着不同的弗里德曼曲线。宫颈扩张在活跃期明显减慢。从4 cm到10 cm大约需要5.5小时，而弗里德曼曲线下为2.5小时。我们没有观察到减速阶段。7 cm前宫颈扩张2小时以上无明显变化者并不少见。第5次宫颈扩张速度均在1cm/h以下。第二阶段胎儿从+1/3到+2/3下降的时间间隔的第95百分位数为3小时。结论：我们的结果表明，当代实践中的产程进展模式与弗里德曼曲线显着不同。产程延长和停搏障碍的诊断标准对初产妇可能过于严格。
OBJECTIVES: Our purpose was to examine the pattern of labor progression in nulliparous parturients in contemporary obstetric practice.STUDY DESIGN: We extracted detailed labor data from 1329 nulliparous parturients with a term, singleton, vertex fetus of normal birth weight after spontaneous onset of labor, Cesarean deliveries were excluded, We used a repeated-measures regression with a 10th-order polynomial function to discover the average labor curve under contemporary practice. With use of an interval-censored regression with a log normal distribution, we also computed the expected time interval of the cervix to reach the next centimeter, the expected rate of cervical dilation at each phase of labor, and the duration of labor for fetal descent at various stations.RESULTS: Our average labor curve differs markedly from the Friedman curve. The cervix dilated substantially slower in the active phase. It took approximately 5.5 hours from 4 cm to 10 cm, compared with 2.5 hours under the Friedman curve. We observed no deceleration phase. Before 7 cm, no perceivable change in cervical dilation for more than 2 hour was not uncommon. The 5th percentiles of rate of cervical dilation were all below 1 cm per hour. The 95th percentile of time interval for fetal descent from station +1/3 to +2/3 was 3 hours at the second stage.CONCLUSION: Our results suggest that the pattern of labor progression in contemporary practice differs significantly from the Friedman curve. The diagnostic criteria for protraction and arrest disorders of labor may be too stringent in nulliparous women.