背景:呼吁以妇女为中心的方法来减少劳动干预,特别是初级剖腹产,对更好地了解自然劳动进程重新产生了兴趣。
目的:综合具有正常围产期结局的“低危”妇女自然分娩时宫颈扩张模式的现有数据。
方法:PubMed,EMBASE,CINAHL,POPLINE,全球健康图书馆,和合格研究的参考清单。
方法:观察性研究和其他研究设计。
方法:两位作者提取了以下方面的数据:产妇特征;分娩干预措施;每厘米的分娩持续时间;以及从入院时扩张到10厘米的分娩持续时间。我们使用加权中位数汇总了研究中的数据,并采用了Bootstrap-t方法来生成相应的置信界限。
结果:描述99.971名女性分娩模式的7项观察性研究符合我们的纳入标准。未分娩妇女前进1厘米的中位时间超过1小时,直到达到5厘米的扩张,6厘米后明显快速进展。在产妇中观察到类似的分娩过程模式。两组的第95百分位数表明,一些女性达到10厘米并不少见,尽管在他们第一阶段的大部分劳动中,扩张速率远低于1厘米/小时的阈值。
结论:对于大多数健康的未分娩和分娩妇女来说,在整个第一产程中期望最小宫颈扩张阈值为1厘米/小时是不现实的。我们的发现质疑临床标准的普遍应用,这些标准在概念上是基于对所有女性的线性劳动进步的期望。
背景:开发计划署/人口基金/儿童基金会/卫生组织/世界银行特别研究方案,人类生殖发展与研究培训(HRP),生殖健康与研究部,世界卫生组织,和美国国际开发署(美援署)。
结论:对于大多数妇女来说,整个分娩过程中宫颈扩张阈值为1厘米/小时是不现实的。不管平价。
BACKGROUND: The call for women-centred approaches to reduce labour interventions, particularly primary caesarean section, has renewed an interest in gaining a better understanding of natural labour progression.
OBJECTIVE: To synthesise available data on the cervical dilatation patterns during spontaneous labour of \'low-risk\' women with normal perinatal outcomes.
METHODS: PubMed, EMBASE, CINAHL, POPLINE, Global Health Library, and reference lists of eligible studies.
METHODS: Observational studies and other study designs.
METHODS: Two authors extracted data on: maternal characteristics; labour interventions; the duration of labour centimetre by centimetre; and the duration of labour from dilatation at admission through to 10 cm. We pooled data across studies using weighted medians and employed the Bootstrap-t method to generate the corresponding confidence bounds.
RESULTS: Seven observational studies describing labour patterns for 99 971 women met our inclusion criteria. The median time to advance by 1 cm in nulliparous women was longer than 1 hour until a dilatation of 5 cm was reached, with markedly rapid progress after 6 cm. Similar labour progression patterns were observed in parous women. The 95th percentiles for both parity groups suggest that it was not uncommon for some women to reach 10 cm, despite dilatation rates that were much slower than the 1-cm/hour threshold for most part of their first stage of labours.
CONCLUSIONS: An expectation of a minimum cervical dilatation threshold of 1 cm/hour throughout the first stage of labour is unrealistic for most healthy nulliparous and parous women. Our findings call into question the universal application of clinical standards that are conceptually based on an expectation of linear labour progress in all women.
BACKGROUND: UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, and the United States Agency for International Development (USAID).
CONCLUSIONS: Cervical dilatation threshold of 1 cm/hour throughout labour is unrealistic for most women, regardless of parity.