无医疗干预初产妇自然分娩的妊娠结局分析

The natural delivery outcome of primipara without interventions

目的:探讨无医疗干预初产妇自然分娩的妊娠结局。方法:将2013年1月至2014年12月在山东大学齐鲁医院住院分娩的3000例初产妇根据有无产程干预分为观察组和对照组,观察组1500例孕妇自然分娩,第一产程自由活动、饮食、休息,第二产程自主用力、自由体位分娩、无会阴保护、自然娩肩,第三产程延迟断脐、胎盘自然娩出;对照组1500例孕妇给予不同程度的医疗干预。比较两组孕妇的最终分娩方式及母儿结局。结果:观察组的自然分娩率、会阴完整率、新生儿评分高于对照组,而会阴切开率、会阴二度裂伤率、剖宫产率、产后出血量、羊水污染率明显低于对照组,差异有统计学意义(P<0.05)。两组孕妇的孕周、总产程、新生儿出生体重、新生儿入住NICU率、羊水量、脐带绕颈等方面比较,差异无统计学意义(P>0.05)。结论:对于低危初产妇,减少医疗干预,促进自然分娩,可获得较好的母儿结局。

Objective： To explore the natural delivery outcome of primipara without medical interventions. Methods： 3000 primipara who had delivery in Qilu Hospital of Shandong University from Jan. 2013 to Dec. 2014 were divided into two groups according to the delivery approach： observing group,1500 cases without medical intervention,who had free activities,food,rest in the first labor stage and independent labor force,free position without perineal protection delivery,waiting for shouders natural delivery in the second stage and delayed umbilical cord clamping after pulsation loss,natural delivery of placenta in the third stage; other 1500 cases with different medical interventions were taken as control group. Mode of delivery and pregnancy outcomes were compared between the two groups. Results： The natural delivery rate,intact perineum rate and apgar score at the 1st min after birth were higher in the observing group than that in the control group. The episiotomy rate,perineal second degree laceration rate,cesarean section rate,postpartum bleeding,amniotic fluid pollution rate in the observing group were lower than that in control group（ P〈 0. 05）. There were no significant differences in gestational weeks,total labor stage,amnitic fluid volume,neonatal weight and the number of newborn transferred to NICU between the two group（ P 〉0. 05）. Conclusions： For low-risk primipara,we can gain better outcome of pregnancy by reducing medical intervention and promoting natural delivery.