评估难产的修改定义和自然分娩期间不同干预时间对催产素使用率及其对分娩结局的影响。
我们比较了采用新方案管理自发分娩前后催产素的使用和分娩结局。按协议,使用催产素和/或人工破膜仅限于宫颈扩张≥1h和/或完全扩张时胎儿下降≥1h无进展的病例.主要结果指标是催产素的使用率。次要结果标准是对分娩的后果(分娩时间,快速收缩和子宫过度刺激,胎心率异常,剖宫产率)和新生儿结局。
从2015年(69.2%)到2016年(39.8%;P<0.01)和2017年(31.9%;P<0.01),催产素的使用大大减少。异常FHR率同时下降(分别为52%,37%et29%,P<0.05),以及子宫过度刺激(分别为33.6%,21.3%et23.0%;P<0.05)。从2015年(11.5%)到2016年(8.4%;NS),剖宫产率没有显着变化,但从2015年到2017年下降(11.5%至2.6%,分别;P<0.05)。产后出血率或新生儿结局无差异。与2015年相比,2017年分娩的女性的分娩时间明显更长(372分钟对306分钟,分别;P<0.05)。经过多变量分析,仅在2017年,FHR异常减少(aOR0.65IC95%[0.49-0.86])以及分娩期间的剖宫产(aOR0.5IC95%[0.26-0.97]),与2015年的参考年相比。
难产和分娩期间所需的干预措施的简单易用的定义使得分娩期间催产素的使用大大减少,随后的益处如降低FHR异常的发生率。子宫过度刺激和剖宫产,以有限的劳动延长为代价,主要是在未产妇女。
To assess the effect of a modified definition of dystocia and of a different timing of interventions during spontaneous labor on the rate of oxytocin use and on its consequences on labor outcome.
We compared oxytocin use and labor outcome before and after the introduction of a new protocol for the management of spontaneous labor. By protocol, oxytocin use and/or artificial rupture of the membranes was restricted to cases without progress in cervical dilatation for≥1h and/or no progress of fetal descent for≥1h at full dilatation. The main outcome measure was the rate of oxytocin use. Secondary outcome criteria were the consequences on labor (duration of labor, tachysystole and uterine hyperstimulation, abnormal fetal heart rate, cesarean delivery rate) and neonatal outcome.
Oxytocin use was strongly reduced from 2015 (69.2%) to 2016 (39.8%; P<0.01) and 2017 (31.9%; P<0.01). Abnormal FHR rates decreased simultaneously (respectively 52%, 37% et 29%, P<0.05), as well as uterine hyperstimulation (respectively 33.6%, 21.3% et 23.0%; P<0.05). The cesarean delivery rate did not vary significantly from 2015 (11.5%) to 2016 (8.4%; NS) but it decreased from 2015 to 2017 (11.5% to 2.6%, respectively; P<0.05). No difference was found in postpartum hemorrhage rates or in neonatal outcome. The duration of labor was significantly longer for women who delivered in 2017, compared with 2015 (372 minutes versus 306 minutes, respectively; P<0.05). After multivariate analysis, FHR abnormalities were reduced (aOR 0.65 IC 95% [0.49-0.86]) as well as cesarean deliveries during labor (aOR 0.5 IC 95% [0.26-0.97]) in 2017 only, compared with the reference year 2015.
A simple and easy-to-use definition of dystocia and of interventions required during labor allowed a strong reduction of oxytocin use during labor with subsequent benefits such as reduced rates of FHR abnormalities, uterine hyperstimulations and cesarean deliveries, at the cost of a limited prolongation of labor, mainly in nulliparous women.