产程标准变化对分娩影响的临床病例分析

Influence of changes in labor standards on delivery

关键词:  新产程  旧产程  阴道分娩  初产妇  剖宫产

Key words:  new labor process  old labor process  vaginal delivery  nulliparous women  cesarean section

摘要:

目的　探讨新旧产程标准对分娩的影响。　方法　回顾性分析大连市中心医院2014年6月至2015年2月间以旧产程标准判定为异常的单胎、头位、足月、自然临产、未行硬膜外麻醉的初产妇100例。将其分为新产程组：应用新产程标准进行管理，50例；旧产程组：应用旧产程标准进行管理，50例。对比两组分娩方式、产程时间、产科干预及母婴并发症发生率等。 　结果　　两组采用会阴侧切术、手取胎盘术、手转胎头术、胎头吸引术情况及产后出血、新生儿窒息、会阴裂伤程度比较，差异均无显著性意义（P>0.05）。应用新产程管理后减少了催产素的使用（P<0.05）。新产程组第二产程的第95百分位数160.7 min，＞2 h，并未增加产妇及新生儿并发症的风险。新产程组较旧产程组剖宫产减少5例（10%），旧产程组以潜伏期延长为指征行剖宫产的有3例（6%），以胎头下降停滞为指征的有2例（4%）。未出现明显的活跃期晚期宫颈扩张减速现象。 　结论　新产程标准对于活跃期起点及第二产程时限的修改，未增加产科干预、产妇及新生儿并发症的风险。新产程应用降低了因产程异常为剖宫产指征的剖宫产率。

Abstract:

Objective To investigate the influence of the old and new labor standards on delivery. Methods A retrospective cohort study was performed in the Dalian Central Hospital from June 2014 to February 2015. Detailed labor and delivery information was reviewed from electronic medical records. Objects included nulliparous women, who had singleton term gestation, vertex presentation, spontaneous delivery and no epidural anesthesia for painless labor. According to the old labor standards, women with abnormal delivery were selected and managed based on new and old labor standards. The patients were divided into two groups: the new labor group and the old labor group with 50 cases in each. The two groups were compared in the mode of delivery, delivery time, obstetrics intervention and the incidence of maternal and infant complications. Results Lateral episiotomy, manual removal of placenta, manual rotation of the fetal occiput, vacuum assisted operative vaginal delivery, postpartum hemorrhage, neonatal asphyxia and the degree of perineal laceration had no significant difference between the new and the old labor group (P>0.05). Use of oxytocin reduced after application of the new labor standards (P<0.05). Furthermore, the 95th percentile of the 2nd stage labor in the new labor group was 160.7 min, more than 2 hours, which was not associated with poor maternal and neonatal outcome. Compared with the old labor group, the cesarean delivery rate of the new labor group was reduced by 5 cases (10%). Surgery indications in the old labor group included prolonged latent phase in 3 cases (6%) and arrested descent in 2 cases (4%). Finally, there was no obvious slowdown phenomenon of cervical dilatation in the late active phase. Conclusions The new labor standards revised starting point of active period and the second stage of labor duration, which does not increase risk of obstetric interventions, maternal and neonatal complications. The rate of cesarean section is reduced by the application of new labor standards.