产前认知辅导对初产妇分娩方式影响的临床观察和探讨

Clinical Observation and Discussion of the Effect of Prenatal Psychology Counseling on the Mode of Delivery

目的观察产前认知辅导对于初产妇分娩方式的影响。方法随机选择2008年9月～2009年7月在杭州市第一人民医院接受定期产前检查并住院分娩的初产妇,随机两组,每组各100例,均从孕31周开始入组,随访到产后7天。干预组本着自愿参加的原则,接受"产前认知辅导训练",对照组仅接受常规产前检查。观察记录两组初产妇的分娩方式和自然分娩的产程进展情况。结果 (1)分娩方式比较:干预组剖宫产率显著低于对照组,差异有统计学意义(χ2=8.62,P<0.01);其中干预组社会因素剖宫产率也显著低于对照组,差异有统计学意义(χ2=13.28,P<0.01)。(2)自然分娩产妇的产程持续时间比较:两组第1产程、第3产程以及总产程的持续时间两两比较无明显差异(第1产程t=1.004,P>0.05,第3产程t=1.325,P>0.05,总产程t=0.283,P>0.05);干预组的第2产程持续时间显著短于对照组,两组比较差异有统计学意义(t=4.905,P<0.01)。结论对初产妇进行产前认知辅导可以有效降低剖宫产率,尤其是社会因素所致的剖宫产率,并有助于缩短第2产程。

Objective To observe the impact of prenatal psychology counseling on the mode of delivery among primipara. Methods Subjects were primipara who received regular prenatal care and prepared to have hospital delivery in our hospital from September 2008 to July 2009. They were randomly divided into two groups with 100 in each. The evaluation began with a gestational age of 31 weeks and followed up to 7 days postpartum. In the intervention group, each subject received training of prenatal cognitive counseling with the principle of voluntary participation. The control group received only routine perinatal care. We recorded the rate of the mode of delivery of the two groups. Results （ 1 ） Comparison of delivery mode ： cesarean section rate of the intervention group was significantly lower than that of the control group,and the difference was statistically signifieant（X^2 = 8.62, P 〈 0.01 ）. The cesarean section rate dominated by social factors was lower than that of the control group,and the difference was statistically significant （X^2 = 13.28, P 〈 0.01 ）. （2） Comparison of the duration of labor in natural delivery mothers： the duration of first stage, third stage and total process of labor had no significant difference between the two group respectively（ the first stage of labor t = 1. 004, P 〉 0.05, third stage of labor t = 1. 325, P 〉 0.05, total delivery process t =0. 283 ,P 〉 0.05） ;Intervention group, the duration of second stage of labor was significantly shorter than that of the control group, and the difference was statistically significant （ t = 4. 905 ,P 〈 0.01 ）. Conclusion Prenatal cognitive counseling plays an important role in reducing cesarean section rate, especially that dominated by social factors. It also can help to shorten the second stage of labor.