新产程管理下第二产程时长对慢性HBV感染孕妇母婴阻断及母儿结局的影响

Effect of duration of second labor stage on maternal-infant transmission of HBV infected pregnant women and maternal-neonatal outcomes after application of new partogram

目的探讨新产程管理模式下第二产程时长对慢性HBV感染孕妇母婴阻断率及母儿结局的影响。方法回顾性分析2013年7月1日—2016年3月31日在解放军第三〇二医院妇产中心住院待产的401例初产单胎足月慢性HBV感染孕妇病例。将2014年6月31日前按旧产程标准(Friedman产程标准)管理的137例分为旧产程组,将2015年1月1日后按新产程标准管理的264例分为新产程组,分析新、旧产程组母婴阻断率、分娩方式及母儿合并症。进一步将新产程组按照第二产程时长分为2组:新二产程≥2 h组(58例)和新二产程<2 h组(206例),分析2组母婴阻断率、分娩方式及母儿合并症。结果新、旧产程组,新二产程≥2 h组及新二产程<2 h组新生儿出生后7个月和12个月HBs Ag均为阴性,母婴阻断成功率均为100%。新产程组自然分娩率(88.6%)显著高于旧产程组(78.8%),而产钳助产率(4.9%)和中转剖宫产率(6.4%)低于旧产程组(分别为10.2%、12.4%)(P均<0.05);新产程组与旧产程组比较,产后出血(13.6%vs.11.7%)、产后尿潴留(3.4%vs.2.2%)、产褥病率(12.9%vs.10.2%)和新生儿窒息(1.9%vs.1.5%)的发生率差异均无统计学意义。新二产程≥2 h组产钳助产率(10.3%)和中转剖宫产率(18.97%)均高于新二产程<2 h组(分别为3.4%、2.91%)(P均<0.05);新二产程≥2 h组产后出血(20.7%)、产后尿潴留(8.6%)和产褥病率(20.7%)发生率均高于新二产程<2 h组(分别为11.7%、1.9%、10.7%)(P均<0.05),而新生儿窒息发生率(5.2%vs.1.5%)2组之间差异无统计学意义。结论新产程管理下第二产程时限的延长显著降低了剖宫产率,不影响HBV母婴阻断率,从整体上未增加母儿并发症风险。

Objective To investigate the effect of duration of second labor stage on maternal-infant transmission of HBV infected pregnant women and maternal-neonatal outcomes under new partogram. Methods A retrospective analysis was performed on 401 nulliparous single full-term pregnant patients with HBV infection at the Center of Maternal Health of 302 Military Hospital of China from July 1st, 2013 to March 31st , 2016. Among them, 137 patients under the old labor standard （Friedman labor standard） before July 31st in 2016 served as the old-stage group, and 264 patients under the new labor standard after January 1st, 2015 served as the new-stage group. The new-stage group was further divided into 2 groups according to second-stage duration： new second-stage≥2 h group （n=58 cases） and new second-stage〈2 h group （n=206 cases）. The rates of mother-to-child transmission, delivery mode and complication in mother and infant between the new-stage group and the old-stage group, as well as between the new second-stage ≥ 2 h group and the new second-stage 〈 2 h group were analyzed. Results Whether the new-stage group and the old-stage group, or the new second-stage≥ 2 h group and the new second-stage〈 2 h group, the HBsAg was all negative for 7-month-old and 12-month-old infants, the success rate of mother-to-child transmission was 100%. The new-stage group had a significantly higher delivery rate （88.6%） than the old-stage group （78.8%）, but lower forceps delivery rate （4.9%） and cesarean rate （6.4%） than the old-stage group （10.2%, 12.4%） （P〈0.05）. There were no significant differences in the rate of postpartum hemorrhage （13.6% vs. 11.7%）, uroschesis （3.4% vs. 2.2%）, puerperal infection （12.9% vs. 10.2%） and neonates with asphyxia （1.9% vs. 1.5%）, between the new-stage group and the old-stage group. The new second-stage ≥ 2 h group had a higher forceps delivery rate （10.3% vs. 3.4%） and cesarean rate （18.97% vs. 2.91%） than the new second-stage 〈 2 h group （P 〈 0.05）. Compared with the new second-stage 〈 2 h group, the new second-stage ≥ 2 h group had higher rates of postpartum hemorrhage （20.7% vs. 11.7%）, uroschesis （8.6% vs. 1.9%） and puerperal infection （20.7% vs. 10.7%）. The neonatal asphyxia rate showed no significant difference between 2 groups （5.2% vs. 1.5%）. Conclusions Under new partogram, the prolonged duration of the second labor stage significantly decreases the rate of cesarean section. It does not increase the risk of maternal-infant transmission of HBV and maternal and child complication.