新旧产程标准下产程中转剖宫产原因分析及结局

Analysis in the Old and New Labor Standard Production Process Causes the Midway Turn and Outcome of Cesarean Section

目的:探讨新旧产程标准下产程中转剖宫产原因分析及结局。方法:选择本院新产程标准实施后2015年1-12月的有阴道试产指征且自愿要求阴道试产的产妇2106例(新标准组),并与旧产程标准下2013年1-12月有阴道试产指征且自愿要求阴道试产的产妇2043例(旧标准组)作比较,比较两组产妇中转剖宫产率、缩宫素使用率、产钳助产及人工破膜发生率,且采用Logistic回归分析对新旧产程标准下产程中转剖宫产的原因进行分析,并观察比较两组的分娩并发症及结局,即比较产妇产后出血率、胎儿宫内窘迫率以及新生儿5 min Apgar评分。结果:新标准组产妇中转剖宫产率为15.10%(318/2106)与旧标准组的18.31%(374/2043)相比明显降低,差异有统计学意义(P<0.05);新标准组缩宫素使用率7.22%(152/2106)低于旧标准组的15.66%(320/2043),且新标准组人工破膜率3.61%(76/2106)低于旧标准组9.45%(193/2043)(P<0.05);但两组产钳助产率比较,差异无统计学意义(P>0.05);Logistic回归分析新旧产程标准下产程中转剖宫产的原因,产程标准是中转剖宫的独立保护因素[β=-1.36,OR=0.213,95%CI(0.128,0.447),P<0.05],两组的社会因素[β=0.614,OR=1.822,95%CI(0.613,4.643),P<0.05],胎儿窘迫[β=0.452,OR=1.608,95%CI(1.072,2.311),P<0.05],头先露异常[β=0.337,OR=1.341,95%CI(1.083,1.742),P<0.05],产程异常[β=0.329,OR=1.294,95%CI(0.724,2.541),P<0.05]均为中转剖宫产的独立危险因素;两组产妇产后出血率、胎儿宫内窘迫率以及新生儿5 min Apgar评分比较,差异均无统计学意义(P>0.05)。结论:新产程标准实施能有效降低阴道试产中转剖宫产率,减少缩宫素使用率及人工破膜率,对母婴分娩结局无影响,社会因素、胎儿窘迫及头先露异常均与产程中转剖宫产有关,应严密观察产程,对异常产程情况及早识别,实施新产程标准可为进一步降低剖宫产率提供临床指导。

Objective： To investigate the cause and outcome of cesarean section in the process of production under the new and old labor standards.Method： The new production process in our hospital from January 2015 to December 2015 after the implementation of the standards of syndrome and voluntary requirements of vaginal delivery in 2106 cases of maternal vaginal delivery （ the new standard group ） were selected.And old labor standards from January 2013 to December 2013 a sign and voluntary requirements of vaginal delivery in 2043 cases of maternal vaginal delivery （ the old standard group ） were selected.Maternal cesarean section rate, incidence rate of transfer of oxytocin, and the use of forceps delivery rate of artificial rupture of membrane of two groups were compared. And using Logistic regression analysis to analyze the reasons for the transfer of cesarean section in the process of the new and old production process.The complications and outcomes of two groups were observed and compared, the rate of postpartum hemorrhage, the rate of fetal distress and neonatal Apgar 5min score were compared. Result： In the new standard group, the transfer rate of cesarean section was 15.10% （ 318/2106 ） compared with 18.31% （374/2043）of the old standard group, and the difference was statistically significant （P〈0.05） .The use rate of oxytoein in the new standard group was 7.22% （ 152/2106 ） lower than 15.66% （ 320/2043 ） of the old standard group （ P〈0.05 ） .And the new standard group was 3.61% （ 76/2106 ） lower than 9.45% （ 193/2043 ） the old standard group （ P〈0.05 ） .But the forceps delivery rate showed no significant difference （ P〉0.05 ） .Logistic regression analysis of the new and old production process under the production process of the reasons for the transfer of cesarean section.The birth process standard was an independent protective factor for the transfer of the cesarean section [ β =-1.36, OR=0.213, 95%CI （ 0.128, 0.447 ）, P〈0.05].The social factors in two groups[ β=0.614, OR=1.822, 95%CI （0.613, 4.643 ）, P〈0.05], fetal distress[β =0.452, OR=1.608, 95%CI （ 1.072, 2.311 ）, P〈0.05], head of malpresentation[ β =0.337, OR=1.341, 95%CI （ 1.083, 1.742）, P〈0.05], Production process abnormalities[β =0.329, OR=1.294, 95%CI （0.724, 2.541 ）, P〈0.05] were independent risk factors of conversion of cesarean section.There was no significant difference in the rate of postpartum hemorrhage, fetal distress rate and neonatal Apgar 5 min score between two groups （ P〉0.05 ） .Conclusion： The new labor standards can effectively reduce the vaginal transit cesarean delivery rate, reduce the usage of oxytocin and artificial rupture rate has no effect on maternal birth outcomes.Social factors, fetal distress and the first exposure are all related to the birth process of the transfer of cesarean section, should be closely observed in the production process, the early identification of abnormal production process.The implementation of the new labor standards can provide clinical guidance to further reduce the rate of cesarean section.