胎儿窘迫原因及分娩方式与围产儿结局的相关性

Causes of fetal distress and correlation between delivery mode and perinatal fetus outcomes

目的探讨足月妊娠临产进入活跃期后胎儿窘迫的原因及采取不同分娩方式时围产儿的结局。方法回顾性分析了2年内在陕西省核工业215医院分娩的胎儿资料,统计胎儿窘迫发生例数,并根据其最终分娩方式分为剖宫产组和阴道分娩组。分析胎儿窘迫发生的危险因素,比较不同分娩方式胎儿并发症发生率。结果 4 928例胎儿中,发生胎儿窘迫者278例（5.64%）,其中采取剖宫产者162例（58.27%）,采取经阴道分娩者116例（41.73%）;母体、胎儿、胎盘、脐带、羊水和产程为胎儿发生窘迫的危险因素;胎儿窘迫多发生于第一产程（80.9%）,发生率高于第二产程（19.1%）。糖尿量异常可造成加速期和减速期胎儿窘迫发生率增高（χ^2值分别为14.057、57.140,均P〈0.001）;早破水可使减速期和第二产程胎儿窘迫发生率增高（χ^2值分别为16.444、11.735、,均P〈0.01）;产程异常可造成最大加速期、减速期和第二产程胎儿窘迫发生率增高（χ^2值分别为7.610、26.135、13.318,均P〈0.001）。剖宫产组新生儿并发症总发生率明显低于阴道分娩组（χ^2=8.603,P=0.003）。结论初产妇足月妊娠活跃期后出现胎儿窘迫时采取不同分娩方式能够取得良好的围产儿结局,最关键的是早期诊断、正确处理,根据产程进展、胎儿缺氧程度选择合适的分娩方式,才能降低围产儿发病率和死亡率。

Objective To study the causes of fetal distress after active labor phase of full-term pregnancy and the perinatal outcomes of different delivery modes. Methods The fetal data within 2 years in Nuclear Industry 215 Hospital in Shaanxi Province were analyzed retrospectively,and the cases of fetal distress were analyzed. The cases were divided into cesarean section group and vaginal delivery group based on final delivery modes. Risk factors of fetal distress were analyzed and the incidence of fetal complications was compared in different delivery modes. Results Among 4 928 cases,278 cases（ 5. 64%） of fetal distress occurred,among which 162 cases（ 58. 27%） were taken by cesarean section and 116 cases（ 41. 73%） were taken by vaginal delivery. The mother,fetus,placenta,umbilical cord,amniotic fluid and labor stage were the risk factors of fetal distress. Most fetal distress occurred in the first stage with incidence of 80. 9%,which was higher than that of the second stage of labor（ 19. 1%）. Diabetes abnormalities could lead to the increase of fetal distress occurrence in acceleration and deceleration phase（ χ^2value was 14. 057 and 57. 140 respectively,both P〈0. 001）. Premature rupture of water increased labor fetal distress rate in the deceleration stage and the second stage（ χ^2value was 16. 444 and 11. 735,respectively,both P〈0. 01）.Abnormal birth process could cause maximum increase of fetal distress in acceleration,deceleration stage and the second stage（ χ^2value was 7. 610,26. 135 and 13. 318,respectively,all P〈0. 001）. Neonatal complication rate in cesarean section group was significantly lower than that in vaginal delivery group（ χ^2= 8. 603,P = 0. 003）. Conclusion For fetal distress after active period in primipara with fullterm pregnancy,different delivery modes can help to achieve good perinatal outcomes. The key factors for reducing perinatal morbidity and mortality are early diagnosis,correct treatment and choosing of proper delivery mode based on labor stage and fetal hypoxia degree.