The Relationship Between Uterine Activity, Oxytocin Dosing, Labor Progress, and Mode of Birth in Nulliparas with Obesity: Minimal Usefulness of Montevideo Unit Measurement.

IF 1.9 4区 医学 Q2 NURSING
Biological research for nursing Pub Date : 2023-07-01 Epub Date: 2023-01-07 DOI:10.1177/10998004221150798
Katherine J Kissler, Teri L Hernandez, Nicole Carlson
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Abstract

Background: Maternal obesity and cesarean birth disproportionately affect Black parturients; thus, prevention of cesarean birth is a key modifiable factor to improve pregnancy outcomes and reduce disparities. The primary driver of unplanned cesarean birth among people with higher body mass index is prolonged labor duration. However, strategies to optimize outcomes in these situations have not been established. We aimed to evaluate the influence of oxytocin augmentation on uterine activity and labor progression in nulliparas with obesity.

Methods: This secondary analysis involved nulliparas with obesity (BMI ≥30 kg/m2) who had spontaneous labor onset followed by oxytocin augmentation and an intrauterine pressure catheter. Using Linear Mixed Models, we evaluated relationships between uterine activity measured in Montevideo units (MVU), oxytocin dose, and rate of cervical dilation normalized by labor duration.

Results: In this diverse sample (35.6% Caucasian, 16.11% African American, 40.2% Hispanic) of nulliparas with obesity (n = 87; BMI 35.54 ± 4.38 kg/m2), 31% ended labor with cesarean birth. Among those with vaginal birth, only 13% had MVU ≥200 prior to the final 2 hours of labor. MVUs were only minimally responsive to oxytocin dose and were not associated with labor progression nor birth route.

Conclusion: MVU measurements may not be useful to diagnose labor arrest in nulliparas with obesity. Optimizing care for birthing people with obesity is essential for improving perinatal outcomes and for reducing racial health disparities.

肥胖无子宫产妇的子宫活动度、催产素用量、产程进展和分娩方式之间的关系:蒙得维的亚单位测量的最小效用。
背景:孕产妇肥胖和剖宫产对黑人产妇的影响尤为严重;因此,预防剖宫产是改善妊娠结局和减少差异的关键因素。在体重指数较高的人群中,非计划剖宫产的主要驱动因素是产程延长。然而,在这种情况下优化分娩结局的策略尚未确立。我们的目的是评估催产素对肥胖的无产妇子宫活动和产程进展的影响:这项二次分析涉及肥胖(体重指数≥30 kg/m2)的无子宫妊娠者,她们在自然分娩后使用催产素和宫内压力导管。我们使用线性混合模型评估了以蒙得维的亚单位(MVU)测量的子宫活动度、催产素剂量和宫颈扩张率之间的关系,并以产程为标准进行了归一化:在这一不同样本(35.6% 白种人、16.11% 非裔美国人、40.2% 西班牙裔)的肥胖无痛分娩者(n = 87;BMI 35.54 ± 4.38 kg/m2)中,31% 以剖宫产结束分娩。在经阴道分娩的产妇中,只有 13% 的产妇在分娩的最后 2 小时之前 MVU ≥200。MVU对催产素剂量的反应很小,与产程进展和分娩途径无关:结论:MVU测量值可能无法用于诊断肥胖无子宫产妇的产程停止。优化对肥胖产妇的护理对于改善围产期结局和减少种族健康差异至关重要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
5.10
自引率
4.00%
发文量
58
审稿时长
>12 weeks
期刊介绍: Biological Research For Nursing (BRN) is a peer-reviewed quarterly journal that helps nurse researchers, educators, and practitioners integrate information from many basic disciplines; biology, physiology, chemistry, health policy, business, engineering, education, communication and the social sciences into nursing research, theory and clinical practice. This journal is a member of the Committee on Publication Ethics (COPE)
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