新产程标准下对阴道试产中转剖宫产的影响  

Influence of new standard of labor stage on transferring from vaginal delivery to cesarean section

作　　者：张珊珊[1] 梁旭霞[1] 

机构地区：[1]广西壮族自治区人民医院产科,广西南宁530021

出　　处：《中国妇幼健康研究》2017年第12期1678-1681,共4页Chinese Journal of Woman and Child Health Research

摘　　要：目的回顾性分析新产程标准对阴道试产后中转剖宫产率、剖宫产指征及母婴结局的影响。方法选取2014年7月至2016年8月在广西壮族自治区人民医院产科经阴道试产的孕产妇。按新产程标准处理3 610例孕妇,产程中中转剖宫产298例为研究组;按旧产程标准处理2 783例孕妇,产程中中转剖宫产436例为对照组。结果新产程标准下孕妇产程中中转剖宫产率8.25%(298/3 610)明显低于旧产程标准的15.66%(436/2 783),差异有统计学意义(χ~2=84.22,P<0.01)。研究组中剖宫产指征的顺位前三位依次为胎儿窘迫(46.98%,140/298)、相对头盆不称(32.89%,98/298)、宫内感染(6.71%,20/298),而对照组分别是产程时限异常(40.14%,175/436)、相对头盆不称(27.75%,121/436)、胎儿窘迫(25.23%,110/436)。研究组因产程时限异常所占剖宫产比例较对照组显著下降,差异有统计学意义(χ~2=104.43,P<0.01)。实施新产程标准后胎儿窘迫取代产程时限异常成为中转剖宫产第一手术指征。研究组中转剖宫产孕妇产后出血量(372.93±231.46)mL与对照组的(357.68±146.31)mL相比明显增多,研究组继发性宫缩乏力发生率高于对照组,差异有统计学意义(t=2.17,χ~2=8.70,均P<0.05)。两组在产后出血、产褥感染及新生儿结局方面比较差异均无统计学意义(均P>0.05)。结论使用新产程标准处理产程,降低阴道试产中转剖宫产率,特别是降低产程时限异常所致的剖宫产,但需做好预防产后出血工作。Objective To retrospectively analyze the influence of new standard of labor stage on the transferring rate of vaginal delivery to cesarean section,cesarean section indications,and maternal and neonatal outcomes.Methods Puerperas who underwent trial of vaginal delivery during the period of July 2014 to August 2016 in department of obstetrics of People＇s Hospital of Guangxi Zhuang Autonomous Region were selected.A total of 298 puerperas transferred to cesarean section after vaginal delivery in 3 610 pregnant women treated according to new standard of labor stage were assigned to study group,and 436 puerperas transferred to cesarean section after vaginal delivery in 2 783 pregnant women treated according to traditional standard of labor stage were assigned into control group.Results Cesarean section transferring rate in pregnant women treated according to new standard of labor stage was 8.25%（298/3 610）,which was significantly lower than 15.66%（436/2 783）in patients treated according to old standard of labor stage,and the difference was statistically significant（χ~2=84.22,P〈0.01）.The top three indications for cesarean delivery in study group were fetal distress（46.98%,140/298）,relative cephalopelvic disproportion（32.89%,98/298）,and intrauterine infection（6.71%,20/298）,while those in control group were abnormal time limit in stages of labor（40.14%,175/436）,relative cephalopelvic disproportion（27.75%,121/436）and fetal distress（25.23%,110/436）.Proportion of cecarean section owing to abnormal time limit in stages of labor in study group was significantly lower than that in control group,and difference was statistically significant（χ~2=104.43,P〈0.01）.After implementation of new standard of stages of labor,fetal distress became the first indication of cesarean section instead of abnormal time limit in stages of labor.Postpartum hemorrhage volume of puerperas transferred to cesarean section in study group was 372.93±231.46 mL,which was significantly much than that（357.68±

关 键 词：分娩 剖宫产术 妊娠结局 新产程标准 

分 类 号：R714[医药卫生—妇产科学]