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目的 评价第一产程水中分娩对初产妇硬膜外镇痛率和手术分娩率的影响。 设计 随机对照试验。 地点 南英格兰大学教学医院。 参与者 99例低并发症风险的难产(活跃期宫颈扩张<1厘米／小时)初产妇。 干预 浸入分娩池水中或标准处理难产的加强法(羊膜穿破术和静点催产素)。 主要结局测定 第一级:硬膜外镇痛率和手术分娩率。第二级:采用羊膜穿破术和催产素的加强率、产程长度、母婴发病率包括感染、母亲的疼痛分数,以及母亲对护理的满意度。 结果 随机分至水中分娩的妇女较加强组者有较低的硬膜外镇痛率(47％比66％,相对风险0.71[95％可信限0.49-1.01),需治疗的病人数目(NNT)为51。两组的手术分娩率没有差别[49％比50％,0.98(0.65-1.47),NNT98],但前者接受加强法[71％比96％,0.74(0.59-0.88),NNT4]或任何形式的产科干预(羊膜穿破术、催产素、硬膜外或手术分娩)明显减少[80％比98％,0.81(0.67-0.92),NNT5]。水中分娩组有更多的新生儿收入新生儿病房(6比0,P=0.013),但Apgar评分、感染率或脐血pH无差异。 结论 在助产士护理下的水中分娩对产程进展缓慢者也许是一种选择,它可降低对产科干预的需求,并提供了一个可供选择的处理疼痛的方法。
Objective To evaluate the effect of labor in the first stage of labor on epidural analgesia rate and delivery rate of primipara. Design randomized controlled trials. Location University of South England Teaching Hospital. Participants 99 patients with low complication risk of dystocia (active cervical dilatation <1 cm / h) primipara. Interventions in immersion in childbirth water or standard treatment of dystocia (amniocentesis and intravenous oxytocin). The primary outcome measure was first grade: epidural analgesia rate and surgical delivery rate. The second stage: the use of amniocentesis and oxytocin strengthening rate, labor length, maternal and child morbidity, including infection, the mother’s pain score, and the mother’s satisfaction with the care. Results Women with childbirth randomized to water had a lower rate of epidural analgesia (47% vs 66%, relative risk 0.71 [95% confidence limit 0.49-1.01]), and the number of patients requiring treatment (NNT ) Is 51. There was no difference in the rate of surgical delivery between the two groups (49% vs 50%, 0.98 (0.65-1.47), NNT98), but the former underwent intensive procedures (71% vs 96%, 0.74 (0.59-0.88), NNT4 or any form of Obstetric interventions (amniocentesis, oxytocin, epidural or operative delivery) were significantly reduced [80% vs 98%, 0.81 (0.67-0.92), NNT5]. There were more newborns in the water delivery group to the neonatal ward (6 vs 0, P = 0.013), but no differences in Apgar score, infection rate, or umbilical cord blood pH. Conclusions Childbirth in childbirth under midwifery care may be an option for slow progression of labor, reducing the need for obstetric interventions and providing an alternative approach to managing pain.