Résumé
OBJECTIVE: Despite the general information of vaginal birth after cesarean section (VBAC), little is known about the duration of active labor in women attempting VBAC. The aim of this study was to compare the time length of active labor in women attempting VBAC compared with nulliparas or multiparas, and then, provide further insight for better management of labor. METHODS: From January 1999 to December 2003, a total of 444 patients with VBAC were entered into the study. Women with two or more history of caesarean section or previous vaginal delivery were all excluded from the study. Time length of active labor in these patients was compared with 335 nulliparas and 218 multiparas consecutively visiting our unit for delivery in 2003. RESULTS: For patients with VBAC, the duration of active and second phase were 184.8+/-115.7, and 25.1+/-15.2 minutes, which was significantly shorter than nulliparas (p<0.05), but longer than multiparas (p<0.05). To eliminate confounding factors affecting the duration, 374 women without use of vacuum, oxytocin, or epidural anesthesia were selected for analysis. Consistently, the time length of active and second phase in women with VBAC was significantly shorter than in nulliparas, but longer than in multiparas (p<0.001) except for active phase compared with nulliparas (p=0.295). CONCLUSION: With regard to the time length of active labor, women attempting VBAC were in the intermediate group when compared with nulliparas or multiparas. Understanding of this unique time interval in women attempting VBAC may help in allowing an appropriate management for labor process.
Sujets)
Femelle , Humains , Grossesse , Anesthésie péridurale , Césarienne , Ocytocine , Vide , Accouchement par voie vaginale après césarienneRésumé
This study was designed to test the effects of a full body massage on uterine contraction, length of labor, type of delivery, and drug intervention for primipara during labor. Data were collected using a quasi-experiment method (nonequivalent control group, pre-post test design) from November 1, 2001 to July 31, 2002. The subjects of this experiment consisted of 28 women in the experimental group and 29 in the control group, out of 57 primipara hospitalized at the U OB & GYN hospital in Inchon. The experimental group was given a 20 minute full body massage for each of the three delivery phases (latent, active, and transition). The control group was given conventional delivery care. Three (3) parameters were analyzed in this experiment. (1) The interval, duration, and strength of uterine contraction, using an electric tocodynamometer (2) The elapsed time for stage 1 and stage 2 labor. (3) The types of deliveries and drug interventions, using postpartum medical records The data collected were analyzed using the repeated measures analysis of variance (ANOVA), t-test, and X(2) test of the SPSS program. The results of the experiment are as follows: 1) Uterine contraction interval was signifi- cantly reduced (F=3.210, p=.050). Duration of uterine contraction showed significant increase only during the transition phase (t=-2.319, p=.023). Strength of uterine contraction showed no significant difference. 2) Total length of labor was significantly shortened (t=-5.245, p=.000). The length of 1st stage labor was signifi- cantly shortened (t=-5.164, p=.000), with latent phase showing (t=-4.709, p=.000), active phase (t=-2.973, p=.005), and transition phase (t=-2.031, p=.047). The length of 2nd stage labor showed no significant difference. 3) The number of natural deliveries were significantly increased (X(2)=13.127, p=.004). 4) The number of drug interventions were significantly fewer (X(2)= 4.493, p=.034). In conclusion, this study shows that a full body massage has a significantly positive effect on uterine contraction interval, length of labor, type of delivery, and drug intervention. Therefore, this study suggests that a full body massage be used clinically to help primipara during labor.