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

项目摘要/摘要 健康人2020年的目标优先考虑将低风险女性的剖腹产率降低10%。劳工 在美国，难产占剖腹产(CD)的近50%(密歇根州-07.1)。《美国人》 妇产科医生学院和母婴医学学会确认 产程难产的诊断及合理使用CD作为减少产后出血的机会 总体CD率1在美国，几乎一半的劳动力是使用Pitocin增加的；然而这 目前还没有发现加强治疗可以降低CD的风险。此外，一些难产的妇女不会 对匹托辛有反应。申请人寻求有助于理解难产的病理生理学。 寻找新的方法来减少不必要地使用催产素增强剂和CD。高位羊水 液体乳酸(AFL)和中位功率密度谱(PDS)频率增加，这是一种衡量 最近发现，分娩过程中子宫肌电活动与难产有关。 和CD。AFL和中位数PDS频率监测分别被提出作为识别 妇女面临被逮捕劳工和CD的风险。这项拟议的研究将描述难产的表型。 通过AFL浓度和PDS中位数来提高对难产的诊断准确性。改进 对难产的精确诊断将允许个体化处理，减少不必要的CD和 优化胎儿和产妇的结局。申请人已综合研究成果对劳动进行分类 根据剖宫产术上宫颈扩张率绘制的难产，然后根据子宫收缩是否充分，以及 AFL.建议的研究将有助于更好地理解难产的病理生理学。 以产生有助于所提议的表型发展的未来研究假设 分娩难产的分类。此外，拟议的研究将评价点与 用母体指棒和AFL收集的护理毛细乳酸盐。AFL的评估是有限的，因为它只能 在膜破裂后非侵入性地收集。如果护理点毛细乳酸盐是可预测的 与AFL相关，可作为从分娩早期开始识别异常的替代生物标志物 劳动力模式，根据这些模式确定适当的管理计划。而不是统一使用催产素 增强，可用于休息和恢复子宫收缩的创新干预措施，包括 发酵剂、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.