不同分娩力学测定对所监测母婴的分娩转归

Outcomes of neonate and mother monitored by using different delivery mechanics determination

目的比较体内或体外分娩力学监测对分娩转归的影响。方法随机化对照研究，比较体内或体外分娩力学监测分娩过程中的子宫活动，主要终点为手术分娩率，包括剖宫产和阴道手术助产；次要终点为抗生素应用、入组至分娩时间、不良新生儿预后。结果有1458例妊娠妇女纳入研究，体内分娩力学监测组（IT）735例，体外分娩力学监测组（ET）723例，以手术分娩作为主要研究终点，IT组为233例（31．7％），ET组为215（29．7％），相对危险比（OR）1．102，95％CI：0．91～1．20；次要终点发生率相似。新生儿不良预后率IT组14．4％、ET组16．6％（OR0．95，95％C1：0．74—1．20）。应用子宫内压导管与严重不良事件无关。结论分娩期间采用体内分娩力学监测与体外监测比较，未显著降低手术分娩率或不良新生儿预后。

Objective To compare the effect of internal tocodynamometry （IT） and external tocodynamometry（ET） on birth outcomes. Methods Random control study was carried out to compare the uterine activity monitored with IT or ET during delivery. The primary end point was surgical delivery rate including cesarean section and vaginal surgery midwifery, while the secondary end points were antibiotics application, the time from going into the group to delivery, and adverse neonatal outcomes. Results The study enrolled 1 458 pregnant women, 735 cases monitored with IT（IT group） and 723 cases monitored with ET（ET group）. Taking surgical delivery as end point, there were 233 cases in IT group（31.7% ） and 215 cases in ET group （29.7%）. OR value was 1. 102 （95% CI：O. 91-1.20 ）. The incidence rate of the secondary end point was similar in two groups. The incidence of neonatal adverse outcomes was 14.4% in IT group and 14.4% in ET group（ OR value was 0.95, 95% CI：O. 74-1.20）. Application of intrauterine pressure conduit was not related with serious adverse events. Conclusion To compared with ET, IT during delivery does not reduce surgical delivery rate or adverse neonatal outcomes significantly.