新产程标准中第二产程时长对产妇和新生儿结局的影响研究

The effects research of second stage of labor duration in new obstetrics labor standards on maternal and neonatal outcomes

目的探讨新产程标准管理下第二产程时长对产妇和新生儿结局的影响。方法选取新产程标准试行以来于2015年4月至2016年4月在医院分娩且第二产程时长≥2 h的单胎足月头先露初产妇281例作为观察组(A组),依据第二产程时长不同将观察组细分成A1、A2、A3组,其中A1组(183例)第二产程时长≥2 h且<2.5 h,A2组(62例)第二产程时长≥2.5 h且<3 h,A3组(36例)第二产程时长≥3 h。随机抽取280例同期在我院分娩且第二产程时长<2 h的初产妇作为对照组(B组)。对以上两组产妇和新生儿结局临床资料进行回顾性分析。结果 A1组与对照组比较,中转剖宫产率、产钳助产率、产后出血率、会阴侧切率、切口不良愈合率、新生儿窒息发生率、新生儿住院率差异均无统计学意义(P>0.05);但A2组和A3组的中转剖宫产率、产钳助产率、会阴侧切率均显著高于对照组(P<0.05),A2组和A3组的新生儿窒息率、新生儿住院率和对照组相比差异无统计学意义(P>0.05)。结论随着新产程标准中第二产程时限的延长,新生儿窒息率及住院率未见增加;而产妇在第二产程时长超过2.5 h后其不良分娩结局的发生比例会明显增加。

Objective To discuss the effects of second stage of labor duration in new obstetrics labor standards on maternal and neonatal outcomes. Methods Totally 281 women with a singleton term pregnancy and the second stage of labor duration ≥2 h were selected and assigned into the experimental group from April to November,2015 in hospital under the management of new obstetrics labor standards. According to the second stage of labor dura- tion,the experimental group of 281 cases were divided into A1,A2 and A3 with second stage of laborduration of 2 h≤t〈2.5 h,2.5 h≤t〈3 h,and t≥3h,respectively. Another 280 cases delivered during the same period of time and with second stage of labor duration〈2 h were randomly selected as the control group to make a retrospective anal- ysis. Results There were no significant differences between A1 group and the control group on maternal and neonatal outcomes （P〉0.05）;the transferring caesarean section rate,forceps delivery rate and episiotomy rate of A2 group and A3 group were significantly higher than those in the control gronp（P〈0.05）,and there were no significant differences in the incidence of neonatal asphyxia and neonatal hospitalization rate （P〉0.05）. Conclusion No increasing trends in the incidence of neonatal asphyxia and neonatal hospitalization have been found with the extension of second stage of labor in the new labor standards. But the adverse birth outcomes may increase when second stage of labor duration is longer than 2.5 hours.