第二产程延长的原因及第二产程延长后新生儿窒息的高危因素分析

Causes of the Prolonged Second Stage of Labor and the High Risk Factors of Neonatal Asphyxia

目的:探讨致第二产程延长的原因及导致新生儿窒息的高危因素。方法:对我院2002年1月至2008年1月所发生的第二产程延长病例进行回顾性分析。结果:发生第二产程延长共133例,其发生率为2.07%。导致第二产程延长的原因中胎位异常占35.34%,宫缩乏力占19.55%,脐带异常占15.04%,产道异常占8.27%,分别占本次资料的前4位。第二产程延长后伴随胎儿窘迫、脐带异常产妇的新生儿窒息的发生率明显高于无上述因素者(P<0.05);阴道助产者新生儿窒息率明显高于剖宫产及阴道自娩(P<0.05),而伴随胎位异常、宫缩乏力早产、妊娠合并症的产妇新生儿窒息的发生率与无上述因素者差异无统计学意义(P>0.05);不同性别胎儿窒息发生率差异也无统计学意义(P>0.05)。结论:胎位异常、宫缩乏力、脐带异常、产道异常是第二产程延长的主要原因;胎儿窘迫、脐带异常以及阴道助产是第二产程延长后新生儿窒息的高危因素。

Objective：To investigate the causes of prolonged second stage of labor and the high risk factors of neonatal asphyxia. Methods：All of the cases with prolonged second stage of labor in our hospital from Jan 2002 to Jan 2008 were retrospectively reviewed. Results：The total cases of prolonged second stage of labor were 133 and the incidence was 2. 07%. The four major causes were abnormal fetal position （35.34%）, uterine atony （ 19.55% ）, abnormality of umbilical cord （ 15.04% ） and abnormality of birth canal （8.27%）. The incidence of neonatal asphyxia were significantly higher in the patients with fetal distress or abnormality of umbilical cord than the patients without those factors（ P 〈0.05）. The incidence of neonatal asphyxia were also higher in the patients with vaginal midwifery than the patients with cesarean section and vaginal delivery （ P 〈 0.05）. The incidence of neonatal asphyxia was no difference between the patient with abnormal fetal position, uterine atony, preterm delivery, pregnant complication, fetal gender and the patients without those factors （ P 〉0.05）. Conclusions ： The major causes of prolonged second stage of labor are abnormal fetal position, uterine atony, abnormality of umbilical cord and abnormality of birth canal. The high risk factors of the neonatal asphyxia after the prolonged second stage of labor include fetal distress, abhorreality of umbilical cord and vaginal midewifery.