导乐陪伴分娩对剖宫产率影响的临床研究

Clinical study of influence of Doula delivery on cesarean section morbidity

目的 探讨导乐陪伴分娩对剖宫产率的影响。方法 对 796例导乐陪伴分娩和 80 0例非导乐陪伴分娩的剖宫产原因、剖宫产率、难产率及新生儿窒息率进行比较。结果 两组剖宫产的主要原因均为胎儿窘迫、头盆不称及胎位异常、宫缩乏力等。导乐陪伴分娩组的剖宫产率 ( 2 4 37% )显著低于非导乐陪伴分娩组 ( 38 2 5% )(P <0 0 1 ) ,前者因宫缩乏力剖宫产的比率显著低于后者 ,因胎儿窘迫剖宫产的比率显著高于后者 (P均 <0 0 5) ,前者经阴道分娩的难产率 ( 6 0 0 % )显著低于后者 ( 9 72 % ,P <0 0 5)。两组新生儿窒息率也无显著性差异 (P >0 0 5)。结论 导乐陪伴分娩可显著降低剖宫产率且不增加新生儿窒息率 ,是一种值得推广的方法。

Objective To discuss the influence of Doula delivery and non-Doula delivery on cesarean section(CS) morbidity. Methods 796 cases with Doula delivery and 800 cases with non-Doula delivery were compared in CS morbidity, CS causes, dystocia morbidity in vaginal delivery and neonatal distress. Results The main causes of CS in both groups were fetal distress, fetal malposition and cephalopelvic disproportion and uterine inertia(problems of 'power'), The CS morbidity in Doula delivery group(24 37%) was significantly lower than that in non-Doula group(38 25%) (P<0 01). In Doula delivery, CS due to uterine inertia was significantly less than that in non-Doula delivery(P<0 05). However, CS rate due to fetal distress was higher in the former group(P<0 05). In the vaginal delivery cases of the two groups, dystocia morbidity in Doula delivery group(6 00%) was statistically lower than that in non-Doula delivery group(9 72%)(P<0 05). The rates of neonatal distress in the two groups were not significantly different(P>0 05). Conclusion Doula delivery can decrease the CS morbidity without increasing the rate of neonatal distress. Therefore,Doula delivery is worth administering in clinical practice.