第二产程时限分布及其对妊娠结局的影响  

Duration of second stage of labor and its association with pregnancy outcome

作　　者：朱天颖 马骏楠 李晓红[1] 王名芳 杜明钰[1] 于圣南 刘大锦 马润玫[1,3] Zhu Tianying;Ma Junnan;Li Xiaohong;Wang Mingfang;Du Mingyu;Yu Shengnan;Liu Dajin;Ma Runmei(Department of Obstetrics,the First Affiliated Hospital of Kunming Medical University,Kunming 650032,China;Department of Obstetrics and Gynecology,Chengdu Women's and Children's Central Hospital,Chengdu 610091,China;Department of Obstetrics,Kunming Angel Women&Children's Hospital,Kunming 650031,China)

机构地区：[1]昆明医科大学第一附属医院产科,昆明650032 [2]成都市妇女儿童中心医院妇产科,成都610091 [3]昆明安琪儿妇产医院产科,昆明650031

出　　处：《中华围产医学杂志》2023年第3期186-193,共8页Chinese Journal of Perinatal Medicine

基　　金：云南省科技计划重大科技专项(2018ZF009)。

摘　　要：目的探讨无椎管内分娩镇痛下第二产程时限分布及其对妊娠结局的影响。方法回顾性分析2014年1月1日至2017年12月31日在昆明医科大学第一附属医院行无椎管内分娩镇痛的12789例单胎足月头位孕妇的病历资料。根据产次将研究对象分为初产妇组(9517例)和经产妇组(3272例),采用两独立样本t检验、Mann-Whitney U检验和χ^(2)检验或Fisher精确概率法比较2组基本资料、母婴结局及第二产程时限等;并比较初产妇[分为<1 h组(n=6265)、≥1~2 h组(n=2305)、≥2~3 h组(n=831)及≥3 h组(n=116)]及经产妇[分为<1 h组(n=3144)、≥1~2 h组(n=102)及≥2 h组(n=26)]中不同第二产程时限的母婴结局差异,再以Cramer's V分析随着第二产程延长,母婴结局发生率的总体变化趋势。校正孕妇年龄、分娩孕周、孕前体重指数、妊娠期合并症及新生儿出生体重等混杂因素后再通过二元logistic回归分析第二产程延长与不良结局的关系。结果初产妇和经产妇第二产程时限的第95百分数分别为143 min和52 min。初产妇的阴道分娩、产钳助产、第二产程剖宫产、会阴侧切、会阴3~4度裂伤、产后出血、Ⅱ级产后出血、输血、新生儿脐动脉血气pH<7.15及新生儿转新生儿重症监护病房(neonatal intensive care unit,NICU)治疗均与第二产程时限存在相关性(Cramer's V值分别为0.22、0.23、0.03、0.22、0.05、0.10、0.03、0.03、0.03及0.07,P值均<0.05)。经产妇的阴道分娩、产钳助产、会阴侧切、产后出血、Ⅱ级产后出血、输血、新生儿转NICU治疗也与第二产程时限存在相关性(Cramer's V值分别为0.18、0.19、0.28、0.14、0.09、0.13及0.06,P值均<0.05)。二元logistic回归分析发现,初产妇第二产程超过1 h是会阴侧切术、会阴3~4度裂伤、产钳助产、产后出血、新生儿转NICU治疗及脐动脉血气pH<7.15的独立危险因素[校正后OR值(95%CI)为2.080(1.907~2.268)、1.773(1.080~2.911)、1.625(1.420~1.8Objective To analyze the duration of the second stage of labor without epidural anesthesia and its association with pregnancy outcome.Methods This retrospective study involved 12789 women who delivered without epidural anesthesia in the First Affiliated Hospital of Kunming Medical University from January 1,2014 to December 31,2017.These subjects were divided into primipara group(9517 cases)and multipara group(3272 cases).Demographic characteristics,maternal and neonatal outcomes and the duration of the second stage of labor were compared between the two groups using two independent samples t-test,Mann-Whitney U test and Chi-square test(Fisher's exact test).Differences in the maternal and neonatal outcomes were also analyzed among different subgroups in primiparae[length of second stage:<1 h group(n=6265),≥1-2 h group(n=2305),≥2-3 h group(n=831)and≥3 h group(n=116)]and multiparae[length of second stage<1 h group(n=3144),≥1-2 h group(n=102)and≥2 h group(n=26)].The association between second stage length and pregnancy outcomes was analyzed with Cramer's V.After adjusted for maternal age,gestational weeks at delivery,body mass index before pregnancy,complications during pregnancy and neonatal birth weight,the relationship between the duration of the second stage and adverse outcomes was analyzed by binary logistic regression analysis.Results The 95th percentile of the second-stage labor duration was 143 min for primiparae and 52 min for multiparae.The rates of vaginal delivery,forceps delivery,cesarean section in the second stage,episiotomy,third-or fourth-degree perineal laceration,postpartum hemorrhage,gradeⅡpostpartum hemorrhage,transfusion,umbilical arterial blood gas pH<7.15 and transferring to neonatal intensive care unit(NICU)were all correlated with the duration of second stage in primiparae(Cramer's V values:0.22,0.23,0.03,0.22,0.05,0.10,0.03,0.03,0.03 and 0.07,respectively,all P<0.05),and so did those of vaginal delivery,forceps delivery,episiotomy,postpartum hemorrhage,gradeⅡpostpartum hemorr

关 键 词：产程 第二 麻醉和镇痛 妊娠结局 

分 类 号：R714.3[医药卫生—妇产科学]