背景:剖宫产率上升的主要原因之一是产程进展异常。发布了新的指导方针,以促进从弗里德曼到张的劳动曲线的不断变化的范式。然而,缺乏证据证明其安全性以及对剖腹产率的影响不明确,这对其采用提出了挑战.
目的:比较符合弗里德曼标准的妇女和符合张氏标准的妇女在母婴结局和新生儿结局方面的差异。
方法:回顾性,2015年1月1日至2016年12月31日在三级医院进行的单中心队列研究.
方法:早产或多次分娩,妇女没有进入积极的劳动阶段,定期剖腹产。妇女分为3组:正常进展,根据弗里德曼的标准或张氏的标准逮捕劳工。孕产妇发病率包括血栓形成,出血性,创伤性,传染性,和“总计”(任何以前的发病率)。对新生儿不良结局进行综合评估。使用单变量和多变量逻辑回归来获得各组和按产程划分的奇数比(ORs)。统计显著性阈值设定为0.05。
结果:从5051次交付中,该研究包括3665例分娩,2839与正常的分娩进展,根据弗里德曼的标准,有426人被劳动逮捕,根据张的标准,有400人被逮捕。关于新生儿结局,没有观察到显著差异。与正常劳动相比,劳动逮捕与更高的产妇总发病率显著相关(对于弗里德曼标准3.04;95%置信区间,2.26-4.09;或对于Zhang\的标准3.59;2.68-4.80),产妇出血性(OR为弗里德曼标准2.87;1.81-4.55;OR为张标准2.80;1.75-4.49)和感染性发病率(OR为弗里德曼标准3.56;2.44-5.18;OR为张标准4.77;3.34-6.80)。校正混杂因素后,结果仍然显著。比较弗里德曼和张的标准,在母婴结局和新生儿结局方面未发现显著差异.
结论:在我们的研究人群中,将劳动逮捕标准从弗里德曼改变为Zhang改变与更多的产妇发病率或更差的新生儿结局无关。从弗里德曼的劳动逮捕标准改为张的劳动逮捕标准可能会降低剖腹产率,而不会显着增加孕产妇和新生儿的发病率。
BACKGROUND: One of the main reasons for the rising caesarean section rate is labor progression abnormalities. New guidelines were released promoting the changing paradigm from Friedman to Zhang\'s labor curves. However, the lack of evidence of its safety and the unclear effect on caesarean section rates have been challenging its adoption.
OBJECTIVE: Comparison between women with Friedman\'s criteria of arrested labor and women with Zhang\'s in terms of maternal and neonatal outcomes.
METHODS: Retrospective, single-center cohort study in a tertiary hospital between January 1st 2015 and December 31st of 2016.
METHODS: preterm or multiple deliveries, women without entering the active stage of labor, scheduled caesarean deliveries. Women were classified into 3 groups: normal progress, labor arrest by Friedman\'s criteria or by Zhang\'s criteria. Maternal morbidity included thrombotic, hemorrhagic, traumatic, infectious, and \"total\" (any of the previous morbidities). Adverse neonatal outcomes were assessed as a composite. Single and multivariable logistic regression was used to obtain the odd ratio (ORs) of each group and by stage of labor. Statistical significance threshold was set at 0,05.
RESULTS: From a total number of 5051 deliveries, 3665 deliveries were included in the study, 2839 with normal labor progression, 426 with labor arrest according to Friedman\'s criteria and 400 according to Zhang\'s criteria. Regarding neonatal outcomes, no significant differences were observed. Compared to normal labor, labor arrest was significantly associated with higher total maternal morbidity (OR for Friedman\'s criteria 3.04; 95% confidence interval, 2.26-4.09; OR for Zhang\'s criteria 3.59; 2.68-4.80), maternal hemorrhagic (OR for Friedman\'s criteria 2.87; 1.81-4.55; OR for Zhang\'s criteria 2.80; 1.75-4.49) and infectious morbidity (OR for Friedman\'s criteria 3.56; 2.44-5.18; OR for Zhang\'s criteria 4.77; 3.34-6.80). Results were still significant after adjustment for confounders. Comparing Friedman\'s and Zhang\'s criteria, no significant differences regarding maternal and neonatal outcomes were verified.
CONCLUSIONS: Changing criteria of labor arrest from Friedman\'s to Zhang\'s was not associated with more maternal morbidity in our study population nor worse neonatal outcomes. Changing labor arrest criteria from Friedman\'s to Zhang\'s may reduce caesarean section rates without an important increase in maternal and neonatal morbidities.