不同分娩方式对第二产程延长母婴结局的分析

Influence of different delivery mode on maternal and neonatal outcomes with prolonged second stage of labor

目的探讨第二产程延长产妇不同分娩方式对母婴结局的影响。方法对2011年1月至2012年12月在四川省妇幼保健院住院分娩的131例第二产程延长产妇,按照不同分娩方式分成3组:自然分娩组、阴道助产组和剖宫产组,比较3组分娩方式第二产程时间、产后出血率及新生儿结局情况,并探讨不同分娩方式中第二产程延长原因。结果在131例孕妇中,自然分娩79例(60.3%),阴道助产24例(18.3%),剖宫产28例(21.4%)。3种分娩方式第二产程延长时间无显著性差异(F=4.9,P>0.05),产后出血率无显著性差异(x^2=0.6,P>0.05),新生儿体重无显著性差异(F=0.5,P>0.05),新生儿出生后的Apgar评分无显著性差异(F=9.1,P>0.05)。导致第二产程延长的原因中,阴道分娩组(自然分娩组和阴道助产组)第二产程延长主要原因为宫缩乏力,而剖宫产组主要原因为胎位异常和胎头下降停滞,两组差异有统计学意义(x^2值分别为55.1、18.9、43.1,均P<0.05),而导致第二产程延长原因中的巨大儿、胎儿窘迫两组间比较,差异均无统计学意义(x^2值分别为0.8、3.7,均P>0.05)。结论第二产程延长不是阴道助产或剖宫产指征,对母婴预后无不良影响,不可机械遵守第二产程时限,以提高自然分娩率。

Objective To discuss the influence of different delivery mode on maternal and neonatal outcomes of women with prolonged second stage of labor. Methods Totally 131 women with prolonged second stage of labor delivering in Maternal and Child Care Hospital of Sichuan Province during the period of January 2011 to December 2012 were selected, and they were divided into three groups ： spontaneous labor group, assisted vaginal delivery group and cesarean section group. The time of second stage of labor, the rate of postpartum hemorrhage and neonatal outcomes were compared among three groups. The causes of prolonged second stage of labor in different delivery mode were analyzed. Results Of 131 women, the rate of spontaneous labor, assisted vaginal delivery and cesarean section was 60.3% （79 cases）, 18.3% （24 cases） and 21.4% （28 cases）, respectively. There were no significant differences in the time of second stage of labor （ F = 4.9,P 〉 0.05 ）, the rate of postpartum hemorrhage （χ^2 = 0.6,P 〉 0.05 ）, neonatal weight （ F = 0.5,P 〉 0.05 ）, and neonatal Apgar score （ F = 9. 1, P 〉 0.05 ）. Uterine inertia was the major cause of prolong second stage of labor in vaginal delivery group （spontaneous labor group and assisted vaginal delivery group） , while abnormal fetal position and protracted descent were the causes in cesarean section group. The difference in three groups was significant （χ^2 value was 55.1, 18.9 and 43.1, respectively, all P 〈0.05 ）. However, the causes of maerosomia and fetal distress were not significantly different in two groups （χ^2 value was 0. 8 and 3. 7, respectively, both P 〉 0.05 ）. Conclusion Prolonged second stage of labor is not the indication of assisted vaginal delivery and cesarean section delivery, which has no adverse influence on mother and neonates. The rate of spontaneous labor can be increased if the time of second stage of labor is not simply obeyed.