胎儿窘迫不同分娩方式围生期相关影响因素及结局的研究  

Study on perinatal related factors and outcomes of fetal distress in different delivery modes

作　　者：潘怡霞 王健 王保旭 卫婵 李春芳 田改彦 白桂芹[1] 王慰敏[1] PAN Yixia;WANG Jian;WANG Baoxu;WEI Chan;LI Chunfang;TIAN Gaiyan;BAI Guiqin;WANG Weimin(Department of Obstetrics and Gynecology,First Affiliated Hospital of Xi′an Jiaotong University,Xi′an,Shannxi 710061,China;Department of Obstetrics and Gynecology,Xianyang Municipal Central Hospital,Xianyang,Shannxi 712000,China;Changan District Maternal and Child Health Family Planning Service Center,Xi′an,Shannxi 710100,China)

机构地区：[1]西安交通大学第一附属医院妇产科,西安710061 [2]陕西省咸阳市中心医院妇产科,712000 [3]陕西省西安市长安区妇幼保健计划生育服务中心,710100

出　　处：《重庆医学》2022年第10期1714-1718,共5页Chongqing medicine

基　　金：陕西省重点研发计划一般项目-社会发展领域(2022SF-055);西安市科技计划项目一般项目-社会发展领域(21YXYJ0108);西安交通大学第一附属医院医院科研发展基金自由探索与创新项目(2021ZYTS-16)。

摘　　要：目的分析胎儿窘迫孕妇不同分娩方式的围生期相关影响因素,明确中转剖宫产、直接剖宫产和经阴道分娩的影响因素和结局。方法选取2013年1月1日至2018年5月30日在西安交通大学第一附属医院产科以“胎儿窘迫”为诊断收住入院并分娩的孕妇948例作为研究对象,根据分娩方式的不同将孕妇分为引产中转剖宫产组(332例)、引产后经阴道分娩组(283例)和直接剖宫产组(333例)3组。收集与分娩方式选择相关影响因素的数据和资料,采用软件Epidata3.1进行数据录入,利用SPSS 24.0进行数据分析。结果中转剖宫产组、经阴道分娩组及直接剖宫产组3组研究对象的产前数据(孕周、产次、胎儿双顶径、股骨长、腹围、羊水指数、S/D比值)差异均有统计学意义(P<0.05)。3组间的产时数据胎盘和羊水情况比较差异有统计学意义(P<0.05),脐带情况差异无统计学意义(P>0.05)。3组间新生儿的1-5-10 min Apgar评分、新生儿体重、是否转科及出院时间差异均有统计学意义(P<0.05)。结论应重视胎儿窘迫的诊断和处理,尤其要重视产前胎儿情况和羊水量的充分评估,加强产程中的胎儿监护,选择更合理的分娩方式,在保证母儿安全的前提下降低剖宫产率。Objective To analyze the related factors of different delivery modes in pregnant women with fetal distress,and to clarify the influencing factors and outcomes of conversion to cesarean section,direct cesarean section and vaginal delivery.Methods A total of 948 pregnant women with the diagnosis of fetal distress and delivery in the obstetrics and gynecology department of the First Affiliated Hospital of Xi′an Jiaotong University from January 1,2013 to May 30,2018 were selected as the research subjects.According to the different delivery methods,they were divided into the induced labor converting to cesarean section group(332 cases),the vaginal delivery after induced labor group(283 cases)and direct cesarean section group(333 cases).The data related to the delivery mode were collected,the data input was conducted by adopting the Epidata3.1 software,and the data analysis was performed by SPSS 24.0.Results There were significant differences in the prenatal data(gestational weeks,parity,fetal biparietal diameter,femoral length,abdominal circumference,amniotic fluid index,S/D ratio)among the three groups of the induced labor converting to cesarean section,vaginal delivery after labor induction group and direct cesarean section group(P<0.05).In the delivery data,the placenta and amniotic fluid condition had no statistically significant differences among the three groups(P<0.05)and the umbilical cord condition had no statistical difference(P>0.05).The newborn Apgar score at 1,5,10 min,newborn weight,whether transferring to another department and discharge time all had statistically significant difference among 3 groups(P<0.05).Conclusion It is necessary to pay attention to the diagnosis and management of fetal distress,especially to the sufficient evaluation of prenatal fetal condition and amniotic fluid volume,strength the fetal monitoring during labor process,select more reasonable delivery mode and on the premise of ensuring the maternal and newborn safety to reduce the secerean section rate.

关 键 词：胎儿窘迫 直接剖宫产 中转剖宫产 阴道分娩 

分 类 号：R714.7[医药卫生—妇产科学]