PDF(Pubmed)
Abstract：
Little is known about the latent phase of labor, including whether its duration influences subsequent labor processes or birth outcomes.
This study aimed to describe the duration of the latent phase of labor from self-report of the onset of painful contractions to a cervical dilation of 5 cm in a large, Swedish population and evaluate the association between the duration of the latent phase of labor and perinatal processes and outcomes that occurred during the active phase of labor, second stage of labor, birth and immediately after delivery, stratified by parity.
This was a population-based cohort study of 67,267 pregnancies with deliveries between 2008 and 2020 in the Stockholm-Gotland Regions, Sweden. Nulliparous and parous women without a history of cesarean delivery in spontaneous labor with a term (≥37 weeks of gestation), singleton, live, and vertex fetus without major malformations were included. Imputation was used if the notation of the end of the latent phase of labor (ie, cervical dilation of 5 cm) was missing in the partograph. Multivariable logistic regression was used to estimate the association with adjusted odds ratios and 95% confidence intervals, controlling for potential covariates.
Including the time from painful contraction onset to a cervical dilation of 5 cm, the median durations of the latent phase of labor were 16.0 (interquartile range, 10.0-26.6) hours for nulliparous women and 9.4 (interquartile range, 5.9-15.3) hours for multiparous women. The durations of the latent phase of labor beyond the median were associated with increased odds of labor dystocia diagnosis during the first stage active phase or second stage of labor and interventions commonly associated with dystocia (amniotomy, oxytocin augmentation, epidural, and cesarean delivery). The duration of the latent phase of labor of ≥90th percentile vs less than the median in nulliparous women demonstrated an increased risk of adverse neonatal outcomes (Apgar score of <7 at 5 minutes and neonatal intensive care unit admission), chorioamnionitis, and fetal occiput posterior. In multiparous women, longer duration of the latent phase of labor was associated with an increased risk of neonatal intensive care unit admission and chorioamnionitis but was not associated with an Apgar score of <7 at 5 minutes. The duration of the latent phase of labor was not associated with additional markers of maternal risk.
The duration of the latent phase of labor in nulliparous women was longer than that of multiparous women at each point of distribution. A longer duration of the latent phase of labor was associated with more frequent dystocia diagnoses and related interventions during the first stage active phase or second stage of labor, including cesarean delivery, nulliparous fetal occiput posterior position, chorioamnionitis, and markers of neonatal morbidity. More research is needed to identify potential mediating paths between the duration of the latent phase of labor and neonatal morbidity.
This study aimed to describe the duration of the latent phase of labor from self-report of the onset of painful contractions to a cervical dilation of 5 cm in a large, Swedish population and evaluate the association between the duration of the latent phase of labor and perinatal processes and outcomes that occurred during the active phase of labor, second stage of labor, birth and immediately after delivery, stratified by parity.
This was a population-based cohort study of 67,267 pregnancies with deliveries between 2008 and 2020 in the Stockholm-Gotland Regions, Sweden. Nulliparous and parous women without a history of cesarean delivery in spontaneous labor with a term (≥37 weeks of gestation), singleton, live, and vertex fetus without major malformations were included. Imputation was used if the notation of the end of the latent phase of labor (ie, cervical dilation of 5 cm) was missing in the partograph. Multivariable logistic regression was used to estimate the association with adjusted odds ratios and 95% confidence intervals, controlling for potential covariates.
Including the time from painful contraction onset to a cervical dilation of 5 cm, the median durations of the latent phase of labor were 16.0 (interquartile range, 10.0-26.6) hours for nulliparous women and 9.4 (interquartile range, 5.9-15.3) hours for multiparous women. The durations of the latent phase of labor beyond the median were associated with increased odds of labor dystocia diagnosis during the first stage active phase or second stage of labor and interventions commonly associated with dystocia (amniotomy, oxytocin augmentation, epidural, and cesarean delivery). The duration of the latent phase of labor of ≥90th percentile vs less than the median in nulliparous women demonstrated an increased risk of adverse neonatal outcomes (Apgar score of <7 at 5 minutes and neonatal intensive care unit admission), chorioamnionitis, and fetal occiput posterior. In multiparous women, longer duration of the latent phase of labor was associated with an increased risk of neonatal intensive care unit admission and chorioamnionitis but was not associated with an Apgar score of <7 at 5 minutes. The duration of the latent phase of labor was not associated with additional markers of maternal risk.
The duration of the latent phase of labor in nulliparous women was longer than that of multiparous women at each point of distribution. A longer duration of the latent phase of labor was associated with more frequent dystocia diagnoses and related interventions during the first stage active phase or second stage of labor, including cesarean delivery, nulliparous fetal occiput posterior position, chorioamnionitis, and markers of neonatal morbidity. More research is needed to identify potential mediating paths between the duration of the latent phase of labor and neonatal morbidity.
摘要：
背景：对分娩的潜伏期知之甚少，包括其持续时间是否影响后续分娩过程或分娩结果。
目的：这项研究旨在描述从自我报告的疼痛性收缩发作到宫颈扩张5厘米的大范围内的潜伏期。瑞典人口，并评估分娩的潜伏期与围产期过程的持续时间以及在分娩的活跃阶段发生的结局之间的关联，第二阶段的劳动，出生和分娩后立即，按平价分层。
方法：这是一项基于人群的队列研究，对斯德哥尔摩-哥得兰地区2008年至2020年期间分娩的67,267例孕妇进行了研究，瑞典。在足月（妊娠≥37周）的自然分娩中，无剖宫产史的未产妇和产妇，单身人士,活,包括无主要畸形的顶点胎儿。如果使用潜在劳动阶段结束的符号（即，宫颈扩张5厘米）在排位图中缺失。使用多变量逻辑回归来估计与调整后的比值比和95％置信区间的关联。控制潜在的协变量。
结果：包括从疼痛收缩开始到宫颈扩张5厘米的时间，潜伏期的中位持续时间为16.0(四分位距，10.0-26.6）小时，未产妇和9.4（四分位数范围，5.9-15.3）小时。超过中位数的潜伏期的持续时间与第一阶段活跃期或第二阶段产程和通常与难产相关的干预措施（羊膜切开术，催产素增强,硬膜外,和剖宫产)。在未分娩妇女中，潜伏期产程的持续时间≥90百分位数与小于中位数显示出新生儿不良结局的风险增加（5分钟时Apgar评分<7，新生儿重症监护病房入院），绒毛膜羊膜炎,和胎儿枕骨后部。在多产妇女中，潜伏期延长与新生儿重症监护病房入院和绒毛膜羊膜炎风险增加相关,但与5分钟Apgar评分<7无相关性.潜伏期的持续时间与母体风险的其他标志物无关。
结论：在每个分布点，未产妇女的潜在产程持续时间均长于经产妇女。在第一产程活跃期或第二产程期间，潜伏期的持续时间较长与更频繁的难产诊断和相关干预相关。包括剖腹产,未产胎儿枕骨后位置，绒毛膜羊膜炎,和新生儿发病的标志。需要更多的研究来确定潜在产程持续时间和新生儿发病率之间的潜在中介路径。
目的：这项研究旨在描述从自我报告的疼痛性收缩发作到宫颈扩张5厘米的大范围内的潜伏期。瑞典人口，并评估分娩的潜伏期与围产期过程的持续时间以及在分娩的活跃阶段发生的结局之间的关联，第二阶段的劳动，出生和分娩后立即，按平价分层。
方法：这是一项基于人群的队列研究，对斯德哥尔摩-哥得兰地区2008年至2020年期间分娩的67,267例孕妇进行了研究，瑞典。在足月（妊娠≥37周）的自然分娩中，无剖宫产史的未产妇和产妇，单身人士,活,包括无主要畸形的顶点胎儿。如果使用潜在劳动阶段结束的符号（即，宫颈扩张5厘米）在排位图中缺失。使用多变量逻辑回归来估计与调整后的比值比和95％置信区间的关联。控制潜在的协变量。
结果：包括从疼痛收缩开始到宫颈扩张5厘米的时间，潜伏期的中位持续时间为16.0(四分位距，10.0-26.6）小时，未产妇和9.4（四分位数范围，5.9-15.3）小时。超过中位数的潜伏期的持续时间与第一阶段活跃期或第二阶段产程和通常与难产相关的干预措施（羊膜切开术，催产素增强,硬膜外,和剖宫产)。在未分娩妇女中，潜伏期产程的持续时间≥90百分位数与小于中位数显示出新生儿不良结局的风险增加（5分钟时Apgar评分<7，新生儿重症监护病房入院），绒毛膜羊膜炎,和胎儿枕骨后部。在多产妇女中，潜伏期延长与新生儿重症监护病房入院和绒毛膜羊膜炎风险增加相关,但与5分钟Apgar评分<7无相关性.潜伏期的持续时间与母体风险的其他标志物无关。
结论：在每个分布点，未产妇女的潜在产程持续时间均长于经产妇女。在第一产程活跃期或第二产程期间，潜伏期的持续时间较长与更频繁的难产诊断和相关干预相关。包括剖腹产,未产胎儿枕骨后位置，绒毛膜羊膜炎,和新生儿发病的标志。需要更多的研究来确定潜在产程持续时间和新生儿发病率之间的潜在中介路径。
