A Novel Classification of Labor Dystocia: Developing a Physiologic Understanding to Facilitate Precision in Diagnosis and Individualized Management

难产的新分类：建立生理学理解以促进精确诊断和个体化管理

• 批准号: 9757580
• 负责人: Katherine Kissler
• 金额: $ 3.58万
• 依托单位: UNIVERSITY OF COLORADO DENVER
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-05-01 至 2021-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9757580
• 关键词: Accounting; American College of Obstetricians and Gynecologists; Amniotic Fluid; Biological Markers; Blood capillaries; Caring; Cervical; Cesarean section; Characteristics; Classification; Development; Diagnosis; Dystocia; Evaluation; Fatigue; Fellowship; Fetal Distress; Fingers; Frequencies; Functional disorder; Future; Glucose; Goals; Graph; Health Care Costs; Healthy People 2020; High Risk Woman; Hour; Infant; Intervention; Labor augmentation; Lead; Length; Maternal-fetal medicine; Measurement; Measures; Membrane; Methods; Monitor; Mothers; Myometrial; National Research Service Awards; Outcome; Pattern; Phenotype; Physiological; Pitocin; Postpartum Hemorrhage; Research; Research Training; Rest; Resuscitation; Risk; Rupture; Safety; Societies; Sodium Bicarbonate; Techniques; Tocolytic Agents; Training Programs; Translations; United States; Uterine Contraction; Uterus; Vagina; Vaginal delivery procedure; Woman; accurate diagnosis; clinical application; clinical investigation; conventional therapy; density; fetal; improved; infant morbidity/mortality; infant outcome; innovation; intrapartum; maternal morbidity; myometrium; novel; novel marker; novel strategies; personalized diagnostics; personalized management; point of care; pre-doctoral; prevent; prospective; public health priorities; tool; trend; uterine contractility

Project Summary/Abstract The Healthy People 2020 goals prioritize reduction of the cesarean rate by 10% for low-risk women. Labor dystocia accounts for almost 50% of cesarean deliveries (CD) in the United States (MICH-07.1). The American College of Obstetricians and Gynecologists and the Society for Maternal and Fetal Medicine identified accurate diagnosis of labor dystocia and the judicious use of CD for this indication as an opportunity to reduce the overall CD rate.1 In the United States, nearly half of all labors are augmented using Pitocin; however this augmentation has not been found to reduce the risk for CD. Moreover, some women with labor dystocia do not respond to Pitocin. The applicant seeks to contribute to understanding the pathophysiology of labor dystocia to find novel approaches to reducing the unnecessary use of Pitocin augmentation and CD. Elevated amniotic fluid lactate (AFL) and increased median Power Density Spectrum (PDS) frequency, a measure of the electrical activity of the uterine muscle during labor, recently were found to be associated with labor dystocia and CD. AFL and median PDS frequency monitoring have been proposed separately as tools for identifying women at risk for arrest of labor and CD. The proposed research will characterize labor dystocia phenotypes by AFL concentrations and median PDS frequency to improve diagnostic precision labor dystocia. Improving diagnostic precision for dystocia will allow for individualized management that reduces unnecessary CD and optimizes fetal and maternal outcomes. The applicant has synthesized research findings to classify labor dystocia by rate of cervical dilation graphed on a partograph, then by adequacy of uterine contractions, and AFL. The proposed research will contribute to a better understanding of the pathophysiology of labor dystocia to generate future research hypotheses that contribute to the development of the proposed phenotypic classification of labor dystocia. In addition, the proposed research will evaluate the correlation between point- of-care capillary lactate collected by maternal finger stick and AFL. Evaluation of AFL is limited as it can only be collected non-invasively following ruptured membranes. If point-of-care capillary lactate is predictably correlated with AFL, it may be used as an alternative biomarker beginning in early labor to identify abnormal labor patterns, from which an appropriate management plan is determined. Instead of uniform use of Pitocin augmentation, innovative interventions that rest and restore uterine contraction may be indicated, including tocolytics, dextrose, or sodium bicarbonate.

项目摘要/摘要 健康人2020年的目标将低风险女性的剖宫产率降低了10％。劳动 在美国占剖宫产（CD）的近50％（MICH-07.1）。美国人 产科医生和妇科医生学院以及孕产妇和胎儿医学协会确定了准确的 诊断劳动力障碍和明智地使用CD作为减少这种迹象的机会 总体CD速率。1在美国，使用pitocin的所有劳动中有将近一半是增强的；但是这个 尚未发现增加降低CD的风险。此外，一些劳动力不断的女性不会 回应皮托素。申请人试图为理解劳动力不良的病理生理学做出贡献 查找新的方法来减少pitocin增强和CD的不必要使用。羊水升高 流体乳酸（AFL）和中位功率密度光谱（PDS）频率增加，这是对 子宫肌肉在分娩过程中的电活动最近发现与劳动力不良有关 和CD。 AFL和中位PDS频率监视已被单独提议作为识别的工具 有被捕的劳动和CD风险的妇女。拟议的研究将表征劳动力不衰的表型 通过AFL浓度和中位PDS频率，以改善诊断精度劳动力不足。改进 诊断性障碍的诊断精度将允许个性化管理，以减少不必要的CD和 优化胎儿和产妇结局。申请人综合了研究结果以对劳动进行分类 按宫颈扩张率绘制的宫颈扩张率，然后通过子宫收缩的是否足够 AFL。拟议的研究将有助于更好地理解劳动力不足的病理生理学 为了产生未来的研究假设，有助于发展提出的表型的发展 劳动力不断的分类。此外，拟议的研究将评估点 - 由母体手指棒和AFL收集的护理毛细血管乳酸。 AFL的评估是有限的，因为它只能 膜破裂后无侵入性收集。如果可以预见的是护理毛细血管乳酸 与AFL相关，可以用作早期劳动开始的替代生物标志物来识别异常 劳动模式，从中确定适当的管理计划。而不是统一使用皮托素 可以指出，可以表明增加休息和恢复子宫收缩的创新干预措施，包括 糖尿病，葡萄糖或碳酸氢钠。