新旧产程标准对母儿结局的影响

The influence of new labor standard on maternal and neonatal outcome

目的探讨新旧产程标准对母儿结局的影响。方法采用回顾性分析的方法,将按照旧产程标准管理的孕妇5 385例设为对照组,按照新产程标准管理的孕妇6 836例设为研究组,排除经产妇、瘢痕子宫、双胎妊娠、前置胎盘、骨盆狭窄、胎儿畸形及合并严重妊娠合并症等具有绝对剖宫产指征的病例。比较两组孕妇一般资料、剖宫产原因、孕妇分娩结局及新生儿结局。结果研究组和对照组剖宫产率分别为25.19%(1 722/6 836)和28.79%(1 550/5 385),两组比较,差异有统计学意义(P<0.05),其中研究组因活跃期停滞行剖宫产742例(43.09%),对照组757例(48.83%);研究组因第二产程延长行剖宫产64例(3.72%),对照组93例(6.00%),两组比较差异均有统计学意义(P<0.05)。母儿预后方面:研究组和对照组产钳助产例数分别为113例(1.65%)和110例(2.04%);产后出血分别为534例(7.81%)和407例(7.56%);绒毛膜羊膜炎例数分别为96例(1.40%)和58例(1.08%);新生儿窒息例数分别为69例(1.01%)和42例(0.78%);新生儿感染性肺炎分别为9例(0.13%)和6例(0.11%),两组以上母儿预后指标比较,差异均无统计学意义(P>0.05)。结论新产程应用后剖宫产率降低,主要是活跃期停滞、第二产程延长为指征的剖宫产率降低,孕妇产后并发症及新生儿结局无显著影响。

Objective To investigate the effect of the new labor standard on maternal and fetal outcomes. Methods A retrospective study was performed in Peking University the Third Hospital. 6 836 cases managed with new labor standard as the study group, and 5 385 cases with the old labor management as control group. All patients in the study had excluded absolute indications of cesarean section such as multipara, cesarean section history, twin pregnancy, placenta previa and other severe pregnancy complications. The general condition, cesarean section indications, maternal and neonatal outcomes of the two groups were compared. Results Cesarean section rate of study group （25.19%, 1 722/6 836） was significantly lower than that of control group （28.79%, 1 550/5 385,P〈0.05）. There were 757 cases of cesarean section due to stagnation of active period in control group （48.83%）, while 742 cases in the study group （43.09%）. 93 cases of cesarean section due to prolonged second stage in control group （6.00%） and 64 cases in study group （3.72%）. There were 113 cases of forceps assisted delivery in study group （1.65%）, 110 in control group （2.04%）, with no statistically difference （P〉0.05）. 534 cases of postpartum hemorrhage in the study group （7.81%）, 407 cases in the control group （7.56%）, with no statistically difference （P 〉 0.05）. 96 cases of chorion amnion inflammatory in study group （1.40%）, 58 cases in the control group （1.08%）,P〉0.05.42 cases of neonatal asphyxia in control group （0.78%）, 69 cases in study group （1.01%）, P 〉 0.05.9 cases of neonatal pneumonia in the study group （0.13%）, and 6 in the control group （0.11%）, with no statistical difference （P〉0.05）. Conclusion Using the new labor management, the total cesarean section rate, cesarean due to active period stagnation and prolonged second stage were all reduced. There was no significant difference on maternal and neonatal outcomes using the new labor management.