新产程模式下不同高危孕产妇的第二产程时限与母儿结局  

Duration of second stage and maternal and neonatal outcomes in high risk gravidas populations after application of new partogram

作　　者：赵瑞芬[1] 范玲[1] Zhao Ruifen Fan Ling.(Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China)

机构地区：[1]首都医科大学附属北京妇产医院产科,100026

出　　处：《中华围产医学杂志》2016年第11期836-841,共6页Chinese Journal of Perinatal Medicine

摘　　要：目的 探讨新产程管理模式下高危人群[妊娠期高血压疾病、妊娠并糖代谢异常（包括妊娠期糖尿病和糖尿病合并妊娠）及高龄初产]和普通人群第二产程时限与母儿结局的关系。方法 回顾性分析2014年10月1日至2015年3月31日在首都医科大学附属北京妇产医院分娩的第二产程持续时间≥2 h的单胎足月头先露初产妇病例279例（研究组）的临床资料。279例中，妊娠期高血压疾病（高血压研究组）25例，妊娠合并糖代谢异常（糖代谢异常研究组）46例，高龄初产（高龄初产研究组）35例，其余177例为普通研究组。根据第二产程持续时间，将普通研究组分为3个亚组，即≥2~〈2.5 h亚组（90例），≥2.5~〈3 h亚组（51例）和≥3 h亚组（36例）。另随机抽取同期本院产房试产且第二产程持续时间〈2 h者340例为对照组，包括妊娠期高血压疾病（高血压对照组）24例，妊娠合并糖代谢异常（糖代谢异常对照组）61例，以及高龄初产（高龄初产对照组）41例；其余226例为普通对照组。分析2组产妇及新生儿结局。采用秩和检验、χ^2检验或Fisher精确概率法对所获得数据进行统计学分析。结果（1）与糖代谢异常对照组相比，糖代谢异常研究组第一产程持续时间延长，自然分娩率降低，产钳助产率升高[M（P25~P75），分别为11.88（8.42~16.06）与8.17（5.00~14.12） h、67.4%（31/46）与91.8%（56/61）和30.4%（14/46）与8.2%（5/61），P值均〈0.05]。与高龄初产对照组相比，高龄初产研究组第一产程持续时间延长，产程干预率上升，自然分娩率降低，产钳助产率升高[分别为12.33（7.17~20.50）与7.50（4.00~15.12） h、61.8%（21/34）与36.6（15/41）、60.0%（21/35）与90.2%（37/41），以及34.3%（12/35）与9.8%（4/41），P值均〈0.05]。分别与普通对照组比较发现，普通研究组、≥2~〈2.5 h亚组、≥2.5~〈3 h亚组和≥3 h�Objective To investigate the association between the duration of second stage of labor and maternal and neonatal outcomes in pregnant women complicated with hypertensive disorders, dysglycaemia （including gestational diabetes mellitus and diabetes mellitus complicating pregnancy） or primipara-in-advanced-age, and in normal pregnant women after implementation of new partogram.Methods A retrospective analysis was performed on all nulliparous women with the duration of second stage of labor≥ 2 h at Beijing Obstetrics and Gynecology Hospital, Capital Medical University between October 1, 2014 and March 31, 2015. Women with preterm labor, multiple gestation, noncephalic presentations, fetal malformations, placenta previa, or induction of labor after fetal death were excluded. And 279 women who met the inclusion criteria served as study group. Among the 279 women, 25 had hypertensive disorders （hypertension group）, 46 had dysglycaemia （dysglycaemia group）, and 35 had primipara-in-advanced-age （primipara-in-advanced-age group）, and the remaining 177 women served as ordinary study group. According to the duration of second stage, the ordinary study group was divided into three subgroups： ≥2-〈2.5 h （n=90）, ≥2.5-〈3 h （n=51） , and ≥3 h （n=36）. And 340 women with the duration 〈2 h were selected randomly as control group, including 24 with hypertensive disorders （hypertension control group）, 61 with dysglycaemia （dysglycaemia control group）, and 41 with primipara-in-advanced-age （primipara-in-advanced-age control group）; the remaining 226 women served as ordinary control group. Maternal and neonatal outcomes in these two groups were analyzed with Rank sum test, Chi-square test or Fisher＇s exact test.Results （1） Dysglycaemia group had a longer first stage of labor, lower rate of spontaneous labor and higher rate of forcep-assisted delivery than its counterpart control group [11.88（8.42-16.06） vs 8.17（5.00-14.12） h, 67.4%（31/46） vs 91.8%（56/61）, and 3

关 键 词：产程 第二 妊娠结局 高血压 妊娠性 葡萄糖代谢障碍 产次 

分 类 号：R714.7[医药卫生—妇产科学]