新产程标准对妊娠期糖尿病初产妇分娩结局的影响

Effect of new labor standards on gestational diabetes mellitus primipara delivery outcome

目的 通过比较新产程标准及Friedman产程图在妊娠期糖尿病初产妇产程中的应用,探讨新产程标准对妊娠期糖尿病初产妇产程干预及分娩结局的影响.方法 选取2015年5-11月使用新产程标准管理产程的319例单胎头位足月妊娠期糖尿病初产妇为观察组;2014年11月至2015年4月使用Friedman产程图管理产程的292例单胎头位足月妊娠期糖尿病初产妇为对照组.比较2组产程进展、缩宫素使用情况、分娩方式、产后出血及新生儿窒息情况.结果 2组产妇在产后出血率、新生儿低血糖发生率、新生儿窒息率及入住儿科率比较差异无统计学意义（P〉0.05）.观察组总产程、第一产程及第二产程分别为（10.73±4.00）、（9.97±3.89）、（0.60±0.38）h,对照组分别为（8.86±3.09）、（8.19±3.00）、（0.53±0.31）h,差异有统计学意义（t=18.184、17.799、6.798,P〈0.01）;观察组产程中人工破膜率、缩宫素使用率及剖宫产率分别为22.57%（72/319）、16.93%（54/319）、5.64%（18/319）,对照组分别为28.77%（84/292）、22.95%（67/292）、9.59%（28/292）,差异有统计学意义（χ^2=3.079、3.476、3.410,P〈0.05）;观察组会阴侧切率仅29.47%（94/319）,较对照组51.37%（150/292）相比,差异有统计学意义（χ^2=30.490,P〈0.01）.结论 ＂新产程标准及处理＂管理妊娠期糖尿病初产妇产程,在不增加母婴不良结局的基础上,有效地减少产程中的干预,降低产程中剖宫产率、会阴侧切率,有助于促进产妇生殖健康,促进自然分娩.

Objective To explore the effect of new labor standards on the intrapartum interventions and delivery outcome for gestational diabetes mellitus primiparas in labor by comparing with materal who were in accordance with the Friedman standards. Methods From May to November 2015, 319 singleton and full-term gestational diabetes mellitus primiparas whose labor treatment was according to new labor standards were selected as observation group. From November 2014 to April 2015, materal in accordance with the Friedman standards were selected as control group, a total of 292 cases, and then progress of labor, the usage of oxytocin, delivery way, postpartum hemorrhage, neonatal hypoglycemia and asphyxia were all observed. Results There was no significant difference between two groups in the rate of postpartum hemorrhage, neonatal hypoglycemia, neonatal asphyxia and neonatal mobidities （P〉0.05）. The total labor stage, the first labor stage and the second labor stage was （10.73 ± 4.00）, （9.97 ± 3.89）, （0.60 ± 0.38） h in observation group and （8.86 ± 3.09）, （8.19 ± 3.00）, （0.53 ± 0.31） h in control group, there was significant difference between two groups （t=18.184, 17.799, 6.798, all P〈0.01）. The incidence of artificial rupture, the usage of oxytocin, caesarean section was 22.57%（72/319）, 16.93%（54/319）, 5.64%（198/319） in observation group, and 28.77%（84/292）, 22.95%（67/292）, 9.59%（28/292） in control group, and there was significant difference between two groups（χ2=3.079, 3.476, 3.410, all P〈0.05）. The incidence of episiotomy was only 29.47% （94/319） in observation group, significantly less than that in control group, which was 51.37% （150/292）, there was significant difference （χ2=30.490, P〈0.01）. Conclusions For gestational diabetes mellitus primipara, the new labor standards effectively reduce intrapartum interventions, the rate of cesarean sections and episiotomy, and more, less influence on maternal and newborn, which is helpful to promote the maternal reproductive health and natural delivery.