产前综合干预对降低产妇剖宫产率的效果观察

Clinical efficacy of prenatal comprehensive intervention in reducing the rate of cesarean section

目的探讨产前综合干预对降低剖宫产率的临床效果。方法将632例孕妇随机分为干预组和对照组，每组316例。于孕12～18周建卡后，对照组给予常规孕期体检及知识指导。干预组给予包括孕期知识培训、孕检、孕期锻炼、孕期心理指导、产程指导等为主的综合干预措施，比较两组剖宫产率、剖宫产影响因素和妊娠合并症、并发症情况。结果干预组中孕方要求、胎儿窘迫、妊娠合并症、并发症、产程异常等影响因素所占比例均显著低于对照组（P〈0．05），而骨盆异常、胎位异常等因素差异无统计学意义（P〉0．05）。两组妊娠合并症、并发症中，干预组妊娠期高血压疾病的发生比例显著低于对照组（P〈0．05）。干预组的剖宫产率为33．2％，对照组的剖宫产率为62，7％．显著高于干预组（P〈0．01）。结论通过严格规范的产前检查、知识培训、心理指导、产程指导等综合措施可在一定程度上降低妊娠合并症、并发症的发生，降低剖宫产率，可在临床中推广应用。

Objective To investigate the clinical effects of prenatal comprehensive intervention in reducing the rate of cesarean section. Methods 632 pregnant women were randomly assigned to intervention and control groups （316 cases in each group）. After 12-18 weeks of gestation, the control group was given routine pregnancy examination and knowledge guidance. The intervention group was given comprehensive intervention including training during pregnancy, pregnancy testing, pregnancy exercise, pregnancy psychological guidance and birth process guidance. Rate of cesarean section, cesarean section influencing factors and pregnancy complications and comorbidities of the two groups were observed and com- pared. Results In the intervention group, proportions of influencing factors including pregnant side requirements, fetal dis- tress, pregnancy complications, comorbidities and abnormal birth process were significantly lower than those in the control group （P 〈 0.05）, while factors like pelvis abnormality and fetal position abnormality were not significantly different between the two groups （P 〉 0.05）. Among pregnancy complications and comorbidities, incidence of gestational hypertension in the intervention group was significantly lower than that in the control group （P 〈 0.05）. Cesarean section rate of the intervention group was 33.2% in the control group and was significantly lower than that of 62.7% in the intervention group （P 〈 0.01）. Conclusion Comprehensive measures including strict standard prenatal care, literacy training, psychological guidance and the birth process guidance can reduce pregnancy complications to a certain extent and reduce the rate of cesarean section, thus it is worthy of clinical application.