以新产程标准为指导的产程处理对分娩结局的影响研究  

Effect of Labor Treatment Guided by the New Labor Standard on the Delivery Outcome

作　　者：钱夏柳[1] 詹泽森 覃惠凤 

机构地区：[1]中山大学附属第三医院产科,广东省广州市510630

出　　处：《中国全科医学》2017年第15期1845-1848,共4页Chinese General Practice

摘　　要：目的探讨以新产程标准为指导处理产程对分娩结局的影响。方法以2015年1—8月于中山大学附属第三医院实施新产程标准的709例初产妇为研究组,以2014年1—8月本院实施传统产程标准的819例初产妇为对照组,比较两组分娩方式、产后出血发生率、新生儿不良结局(Apgar评分异常、脐动脉血气p H值<7.0、羊水粪染)发生率、产程时间;观察研究组中传统产程标准诊断为产程曲线异常初产妇的分娩结局。结果研究组自然分娩率高于对照组,剖宫产率低于对照组(P<0.01);两组产妇产后出血发生率、1 min Apgar评分异常发生率、脐动脉血气pH值<7.0发生率、羊水粪染发生率比较,差异无统计学意义(P>0.05);两组5 min Apgar评分均无异常;研究组第一产程、第二产程、总产程时间长于对照组(P<0.05)。研究组中按传统产程标准诊断为潜伏期延长(>16 h)、活跃期延长(>8 h)、第二产程延长(>2 h)的初产妇自然分娩率分别为45.8%(11/24)、69.2%(9/13)、84.1%(37/44)。结论以新产程标准为指导处理产程,能降低剖宫产率,促进自然分娩,不增加产后出血、产钳助产、新生儿不良结局等风险。Objective To explore the effect of labor treatment guided by the new labor standard（proposed by ZHANG and others in 2010） on the delivery outcome.Methods This study was carried out between two sample groups,the study group（709 primiparas who received labor treatment guided by the new labor standard in the Third Affiliated Hospital,Sun Yat-sen University between January and August 2015）,and the control group〔819 primiparas who received labor treatment guided by the traditional labor standard（developed by FRIEDMAN in the 1950s） in the same hospital between January and August 2014〕.We compared the delivery mode,postpartum hemorrhage rate,incidence of adverse neonatal outcomes（abnormal Apgar score,percentage of neonates with umbilical cord blood pH value〈7.0,incidence of meconium stained amniotic fluid）,and duration of labor between the two groups.And we observed the delivery outcome of the primiparas in the study group who were diagnosed with abnormal labor curve by the traditional labor standard but treated with the new labor standard during labor.Results Compared with the control group,the study group had higher spontaneous labor rate,and lower cesarean section rate（P〈0.01）.No significant differences were found between the groups in the postpartum hemorrhage rate,proportion of neonates with low 1-min Apgar scores,percentage of neonates with umbilical cord blood pH value 〈7.0 and incidence of meconium stained amniotic fluid（P〉0.05）;two groups of 5-min Apgar scores were not abnormal.The study group had longer first stage of labor,second stage of labor,and overall duration of labor than the control group（P〈0.05）.The spontaneous labor rate of three kinds of primiparas in the study group who were diagnosed with prolonged latent phase of labor（〉16 h）,prolonged active stage of labor（〉8 h） and prolonged second stage of labor（〉2 h） by the traditional labor standard but treated with the new labor standard during labor was 45.8%（11/24）,69.2%（9/13）,84.1%（37

关 键 词：分娩 产道 剖宫产术 自然分娩 产后出血 新生儿窒息 

分 类 号：R339.2[医药卫生—人体生理学]