活跃期停滞不同分娩方式的妊娠结局分析

Perinatal outcomes in the setting of active phase labor arrest

目的分析产程中活跃期停滞与妊娠结局的关系。方法对2009年1月1日至2009年12月31日期间,在北京大学第一医院诊断为活跃期停滞的足月、单胎、头位初产妇,进行回顾性研究。应用单因素和多因素回归分析等方法,比较活跃期停滞产妇剖宫产分娩组与阴道分娩组的不同特点,比较阴道分娩产妇活跃期停滞组与无活跃期停滞组的不同特点。探讨活跃期停滞、分娩方式与母婴结局之间的关系。结果 417例活跃期停滞产妇被纳入本研究,其中212例(50.8%)经阴道分娩,另外205例(49.2%)经剖宫产分娩。与剖宫产组相比,阴道分娩组产妇分娩前BMI更低,新生儿平均出生体重更小。绒毛膜羊膜炎、产褥感染、产后出血、严重产后出血及输血发生率,在剖宫产组均明显高于阴道分娩组(P<0.05)。这些产妇并发症与剖宫产分娩有相关性。新生儿并发症在两组中差异无统计学意义(P>0.05),也与剖宫产分娩无相关性。结论活跃期停滞发生时尝试阴道分娩,也许可减少与剖宫产分娩相关的并发症,且阴道分娩并不增加新生儿不良事件的发生。

Objective To detect the association between active phase arrest and perinatal outcomes.Methods This was a retrospective study of nulliparous women with term,singleton,cephalic gestations diagnosed with active phase arrest of labor from January 1st 2009 to December 31th 2009.Women with active phase arrest who underwent cesarean delivery were compared to those who delivered vaginally.The association between active phase arrest,mode of delivery and perinatal outcomes was evaluated using univariable and multivariable logistic regression models.Results We identified 417women with active phase arrest：212（50.8%）delivered vaginally and the rest 205（49.2%）cases were delivered by cesarean section.Compared to women who had cesarean delivery,women who delivered vaginally had a lower BMI and smaller infants.Cesarean delivery was associated with an increased risk of chorioamnionitis,puerperal infection,postpartum hemorrhage and severe postpartum hemorrhage（P＆lt;0.05）. There was no difference in adverse neonatal outcomes between the two groups（P＆gt;0.05）.Conclusion Efforts to achieve vaginal delivery in the setting of active phase arrest may reduce the maternal risks associated with cesarean delivery without additional risk to the neonate.