头位分娩评分法在3988例孕妇分娩过程中的应用  

Application of scoring in cephalic presentation in 3988 pregnant women during delivery

作　　者：钟晓翠 董晓静[1] 周艳秋 姚蓉 袁小岚 徐迎亚 石晛 ZHONG Xiao-cui;DONG Xiao-jing;ZHOU Yan-qiu;YAO Rong;YUAN Xiao-lan;XU Ying-ya;SHI Xian(Department of Obstetrics and Gynecology The Second Ajfiliated Hospital of Chongffing Medical University,Chongqing 400000,China)

机构地区：[1]重庆医科大学附属第二医院妇产科,重庆400000

出　　处：《中国实用妇科与产科杂志》2021年第7期749-752,共4页Chinese Journal of Practical Gynecology and Obstetrics

基　　金：重庆市卫生适宜技术推广项目-新产程的临床运用(2020jstg006);重庆医科大学附属第二医院“宽仁英才”项目。

摘　　要：目的验证头位分娩评分法在新产程管理下的应用价值。方法回顾性分析2016年1月1日至2017年12月31日在重庆医科大学附属第二医院分娩的3988例孕妇头位分娩评分与最终分娩方式、产后出血量、新生儿结局的相关性。结果剖宫产率与头位分娩评分呈负相关,头位分娩评分越高,剖宫产率越低(P<0.001)。其中因头位难产实施剖宫产161例(4.0%),评分8分者试产后均以剖宫产终止妊娠,评分10分者试产后超过50%孕妇以剖宫产终止妊娠。头位分娩评分越低,总产程平均时间越长,主要表现在潜伏期越长(P<0.001)。头位分娩评分越低,产后2h出血量越多(P<0.001),新生儿结局无显著差异。因难产导致剖宫产首位指征为胎头下降停滞。结论头位分娩评分法可预测阴道分娩概率,头位分娩评分10分为重要临界分数,低于10分者阴道分娩概率较低,在已调节胎方位、产力至合适情况下评分仍≤10分者,警惕难产结局。在鼓励阴道分娩,降低首次剖宫产率及新产程应用下,头位分娩评分法值得推广应用。Objective To verify the application value of scoring in cephalic presentation under new labor management.Methods We retrospectively analyzed the correlation of the different scoring in cephalic presentation in 3988 pregnant women,who gave birth in the Second Affiliated Hospital of Chongqing Medical University from January 1,2016 to December 31,2017,with the final delivery mode,postpartum hemorrhage and neonatal outcomes.Results The mode of delivery was negatively correlated with the cephalic presentation score.The higher the score,the lower the cesarean section rate(P<0.001).Among them,161 cases(4.0%)received cesarean section due to head dystocia.Those who were scored 8 were all terminated by cesarean section,and more than 50%of pregnant women who scored 10 were terminated by cesarean section.The lower the cephalic score,the longer the average time of total labor,which was mainly manifested in the longer incubation period(P<0.001).The lower the cephalic-score,the more bleeding in 2 hours after delivery(P<0.001),and there was no significant difference in neonatal outcomes.The first indicator of cesarean section due to dystocia was that fetal head drop stopped.Conclusions The scoring in cephalic presentation can initially predict the probability of vaginal delivery.The score of 10 is an important critical score.Those with a score lower than 10 have a lower probability of vaginal delivery.The cephalic presentation scoring emphasizes the overall assessment.Those with a lower score when the fetus position and expulsive force are appropriate should be alert to dystocia.With the policy of encouraging vaginal delivery and reducing the rate of first cesarean section conducted,the use of cephalic presentation scoring is worth promotion and application.

关 键 词：头位分娩评分法 骨盆测量 难产 

分 类 号：R714.44[医药卫生—妇产科学]