381例足月初产妇急产围产结局及其危险因素  

Perinatal outcome and risk factors of precipitate labor in term primipara:an analysis of 381 cases

作　　者：蒋益炯 张丽霞 陈丹青[1] JIANG Yijiong;ZHANG Lixia;CHEN Danqing(Department of Obstetrics,Women’s Hospital,Zhejiang University School of Medicine,Hangzhou 310006,China;Department of Obstetrics,Shengzhou People’s Hospital,Shengzhou 312400,Zhejiang Province,China)

机构地区：[1]浙江大学医学院附属妇产科医院产科,浙江杭州310006 [2]嵊州市人民医院产科,浙江嵊州312400

出　　处：《浙江大学学报（医学版）》2022年第6期724-730,共7页Journal of Zhejiang University(Medical Sciences)

摘　　要：目的:探讨足月初产妇急产的围产结局和危险因素。方法:收集2020年1月1日至12月31日在浙江大学医学院附属妇产科医院住院分娩的足月、单胎妊娠、头位并经阴道分娩的初产妇共6951名,其中发生急产者381例为急产组,按照1∶2随机抽取762名非急产者为对照组。比较两组的围产结局,并采用多因素logistic回归分析初产妇急产的危险因素。结果:经阴道分娩的足月、单胎妊娠、头位初产妇中急产发生率为5.48%(381/6951)。急产组第一产程、第二产程的时长明显短于对照组(均P<0.01),而第三产程的时长两组差异无统计学意义(P>0.05)。与对照组比较,急产组软产道裂伤的发生率明显增加(P<0.01),但在产后出血及新生儿相关围产结局方面与对照组差异无统计学意义(均P>0.05)。多因素logistic回归分析结果显示,急产与孕妇身高(OR=1.038,95%CI:1.010~1.067,P<0.01)、分娩孕周(OR=0.716,95%CI:0.618~0.829,P<0.01)、晚期流产史(OR=1.986,95%CI:1.065~3.702,P<0.05)、临产前发生破膜(OR=1.802,95%CI:1.350~2.406,P<0.01)、宫颈球囊引产(OR=3.230,95%CI:2.027~5.147,P<0.01)、地诺前列酮栓引产(OR=2.332,95%CI:1.632~3.334,P<0.01)、催产素引产(OR=0.291,95%CI:0.219~0.386,P<0.01)相关。结论:初产妇足月分娩时急产的发生率不低,急产会导致会阴裂伤明显增加。产妇身高较高、有晚期流产史、临产前发生破膜、使用宫颈球囊引产、使用地诺前列酮栓引产是足月初产妇急产的危险因素,而催产素引产和较大分娩孕周是足月初产妇急产发生的保护因素。Objective:To investigate the perinatal outcome and risk factors of precipitate labor in term primipara.Methods:A total of 6951 full-term singleton primiparas with cephalic vaginal delivery in Women’s Hospital,Zhejiang University School of Medicine from January 2020 to December 2020 were enrolled,among whom 381cases of precipitate labor were classified as the precipitate labor group and 762 cases of normal labor were randomly selected as the control group.The perinatal outcomes of the two groups were compared,and the risk factors of precipitate labor were analyzed by multivariate logistic regression.Results:The incidence of precipitate labor in full-term,singleton pregnancy and cephalic primiparas was 5.48%(381/6951).The durations of the first and second stages of labor in the precipitate labor group were significantly shorter than that in the control group(P<0.01);while there was no significant difference in the duration of the third stage of labor between the two groups(P>0.05).Compared with the control group,the incidence of soft birth canal laceration in the precipitate labor group was increased(P<0.01).However,there was no significant difference in postpartum hemorrhage and neonatal related perinatal outcomes between the two groups(all P>0.05).Multivariate logistic regression analysis showed that maternal height(OR=1.038,95%CI:1.010–1.067,P<0.01),gestational age at delivery(OR=0.716,95%CI:0.618–0.829,P<0.01),late miscarriage(OR=1.986,95%CI:1.065–3.702,P<0.05),membrane rupture before labor(OR=1.802,95%CI:1.350–2.406,P<0.01),labor induction by transcervical balloon(OR=3.230,95%CI:2.027–5.147,P<0.01),labor induction by propess(OR=2.332,95%CI:1.632–3.334,P<0.01)and labor induction by oxytocin(OR=0.291,95%CI:0.219–0.386,P<0.01)were independently associated with precipitate labor.Conclusions:The incidence of precipitate labor in full-term,singleton pregnancy was not low.Precipitate labor could lead to a significant increase in perineal laceration.Maternal height,history of late miscarriage,membrane

关 键 词：急产 初产妇 足月 围产结局 危险因素 

分 类 号：R714[医药卫生—妇产科学]