实施新产程标准后首次剖宫产率、指征的变化及母儿预后分析

Analysis of Primary Cesarean Delivery Rates and Cesarean Delivery Indications after Strict Control of Cesarean Delivery and the Implement of New Labor Standards

目的:研究新产程标准(New Labor Standards)实施,严格控制剖宫产后,首次剖宫产率primary cesarean delivery(CD)rates、剖宫产指征cesarean delivery indications及母儿预后maternal and neonatal outcomes的变化。方法:选取2015年1月至2016年7月到本院首次剖宫产分娩的孕妇800例作为研究组,2014年1月至12月新产程标准实施前于本院首次剖宫产分娩的孕妇798例作为对照组。分析实施新产程标准,严格控制剖宫产前、后的剖宫产率、剖宫产前6位指征变化,以及剖宫产孕妇产后7 d内的母儿结局。结果:新产程标准的实施,严格控制剖宫产后,研究组首次剖宫产率13.5%,明显低于对照组17.9%,(P<0.05);非医学指征、头位异常、时限异常剖宫产率大幅度减少,两组比较,差异有统计学意义(P<0.01);胎儿窘迫成为研究组剖宫产的首位指征,显著高于对照组(P<0.01);两组胎位异常、巨大胎所致的剖宫产率分别比较,差异均无统计学意义(P>0.05);研究组产后出血发生率、手术切口愈合不良明显高于对照组(P<0.01),产褥病率无明显增加(P<0.05),均无严重并发症如羊水栓塞、子宫切除等发生。两组新生儿产时并发症:巨大儿、新生儿窒息两组无差异(P>0.05),新生儿转科发生率明显高于对照组(P<0.01),但均无新生儿死亡。结论:实施新产程标准是安全的,加上严格控制剖宫产,可以明显降低产妇的首次剖宫产率,但产妇产后出血率增加,新生儿转科率增加。

Objective ：To investigate the change of primary cesarean delivery（CD） rates, CD indications and maternal and neonatal outcomes after strict control of CD and the implement of New Labor Standards. Methods： 800 cases of primary CD from January 2015 to July 2016 were chosen as the research group and 798 cases of primary CD from January 2014 to December 2014 when the New Labor Standards was not carried out were chosen as the control group. Compare and analyze the CD rates,6 indications before CD and outcomes of mothers and new-born babies 7days after CD before and after the strict implement of New Labor Standards.Results ： After strict control of CD and the implement of New Labor Standards,the primary CD rate of the research group was 13.5%, obviously lower than that of the control group （ P〈 0.05 ）. The rate of CD that has non-medical indications, abnormal head position and abnormal delivery duration significantly decreased compared with that of the control group. The difference was of significance in statistics science （P〈0.01）. Fetal distress has become the first CD indication of the research group, obviously higher than that of the control group （P〈 0.01 ）. The rates of CD that was caused by abnormal fetal position and giant fetus of the two groups didn＇ t have statistics significanee（ P〉0.05） .Compared to the control group, the research group had higher postpartum hemorrhage rate and poorer incision healing（P〈0.01 ）. There was no significant increase of puerperalism of the research group（P〈0.05）. There were no severe complications such as amniotic fluid embolism and hysterectomy in both groups. Intrapartum complications of new-born babies such as giant fetus and neonatal asphyxia were of no difference in both groups （P〉0.05）. There are obviously more new-born babies going to a different medical division in the research group （P〈0.01）. None new-born babies died in both groups. Conclusions： The implement of New Labor Standards is safe, which can significantly decrease the primary CD rates with strict control of CD,but postpartum hemorrhage rate increases and more new-born babies go to a different medical division.