超重和肥胖对初产妇产程影响的分析

Effect of overweight and obesity on stage of labor in primiparas

目的探讨肥胖或超重对初产妇产程的影响。方法采用回顾性分析方法,选取2012年5月至2013年4月在杭州市江干区人民医院门诊进行产前检查并住院分娩的超重或肥胖的单胎初产妇161例为观察组,其中肥胖组42例,超重组119例;选取同时期的正常产妇139例为对照组,比较两组的产程、催产素使用量及剖宫产率的差异。结果肥胖组和超重组平均孕周明显高于对照组(t=9.362,P<0.01);肥胖组和超重组催产素引产使用剂量及使用率均高于对照组(t值分别为8.540、9.390,x值分别为8.899、9.452,均P<0.05);肥胖组和超重组剖宫产发生率分别与对照组相比差异均具有统计学意义(x^2值分别为7.545、6.899,均P<0.05);肥胖组和超重组产妇宫口扩张4~10cm的平均持续时间均明显长于对照组(t值分别为2.230、2.390,均P<0.05);第二产程平均时间肥胖组和超重组分别与对照组比较差异均无统计学意义(t值分别为0.530、0.230,均P>0.05)。结论超重或肥胖主要引起第一产程潜伏期的延长,应重新评估此类人群的产程图,采取正确措施,降低该类群体剖宫产的发生率。

Objective To explore the effect of overweight and obesity on stage of labor in primiparas. Methods A retrospective study was performed from May 2012 to April 2013 on 161 overweight or obesity single pregnancy primiparas （observation group） taking prenatal examination in outpatient department of Jianggan District People＇ s Hospital of Hangzhou and being admitted for delivery, including 42 cases in obesity group and 119 eases in overweight group. Another 139 normal primiparas were selected at the same period in control group. Labor progression, oxytocin use and cesarean section rate were compared between two groups. Results The average gestational week of the obesity group and the overweight group was significantly higher than that in the control group （ t = 9. 362, P 〈 0.01 ） , and the oxytocin dosage and usage of the former groups were higher than those of the control group （ t value was 8. 540 and 9. 390, respectively, χ^2 value was 8. 899 and 9. 452, respectively, both P 〈 0.05 ）. The cesarean section rate of the obesity group and the overweight group was significantly different from that of the control group （χ^2 value was 7. 545 and 6. 899, respectively, both P 〈 0.05 ）. The average duration for dilatation from 4 to 10 cm in the obesity group and the overweight group was significantly longer than that of the control group （ t value was 2. 230 and 2. 390, respectively, all P 〈 0.05 ）, but there was no significant difference in the second stage of labor （ t value was 0. 530 and 0.230, respectively, both P 〉 0.05 ）. Conclusion Overweight and obesity mainly lead to extend of the first labor stage. The labor progression in these population should be re-evaluated so as to make proper decisions and reduce cesarean section rate.