实施改良新产程对降低产时剖宫产率及母儿结局的影响

The Impact of Improved New Labor to Reduce the Rate of Cesarean Section and the Outcome of the Mother and Child

目的:探讨实施新产程对降低产时剖宫产率以及对母儿结局的影响。方法:利用苏州市围生保健登记的信息资料,回顾性分析2012年1—6月(A组)和2016年1—6月(B组)在南京医科大学附属苏州医院分娩的孕妇信息,比较开展新产程前后的产时剖宫产率和母儿结局。结果:A组总产程时间较B组长,但差异无统计学意义[(501.70±210.39)min vs.(496.42±254.21)min,P=0.941];A组第二产程超过2 h发生率较B组低,差异有统计学意义(1.38%vs.3.84%,P<0.001);A组缩宫素使用率、人工破膜率、会阴侧切率及阴道产钳助产率均高于B组(均P<0.001);A组产程中中转剖宫产率高于B组(6.56%vs.3.41%,P<0.001);剖宫产的原因中,A组因胎儿窘迫剖宫产率较B组高(2.37%vs.1.20%,P<0.001);A组的头盆不称剖宫产率较B组高(4.05%vs.1.98%,P<0.001);A组巨大儿发生率较B组高,差异有统计学意义(8.14%vs.6.76%,P=0.004);A组产后出血量、新生儿窒息发生率与B组比较差异无统计学意义(P>0.05);B组新生儿入住新生儿重症监护病房(NICU)率高于A组(9.13%vs.2.65%,P<0.001)。结论:实施新产程可以明显降低阴道试产时中转剖宫产率,第二产程时间可能延长,加强产时胎心监护并不增加母儿不良影响。

Objective:To explore the impact of the implementation of improved new labor to reduce the rate of cesarean section and the outcome of the mother and child. Methods:The information of pregnant women were analyzed from January to June in 2012(group A) and from January to June in 2016(group B) in Suzhou Hospital Affiliated to Nanjing Medical University.Compared the cesarean section rate and the outcome of the mother and child between the two groups. Results:The total labor time in group A was higher than that in group B, but the difference was not statistically significant [(501.70 ±210.39)min vs.(496.42±254.21)min, P=0.941]. The incidence of the second labor over 2 hours in group A was lower than that in group B, the difference was statistically significant(1.38% vs. 3.84%, P<0.001). The utilization rate of oxytocin, the rate of amniotomy, the rate of episiotomy and the rate of forceps delivery in group A were significantly higher than that in group B, the difference was statistically significant(P<0.001). The cesarean section rate in group A was higher than that in group B, and the difference was statistically significant(6.56% vs. 3.41%, P<0.001). The cesarean section rate of fetal distress in group A(2.37%) was higher than that in group B(1.20%), and the difference was statistically significant(P <0.001). The cesarean section rate of cephalopelvic disproportion in group A(4.05%) was higher than that in group B(1.98%) and the difference was statistically significant(P<0.001). The rate of macrosomia in group A(8.14%) was higher than that in group B(6.76%), and the difference was statistically significant(P =0.04). The difference was not statistically significant between the two groups on the amount of postpartum hemorrhage and the rate of neonatal asphyxia(P>0.05). The rate of being in NICU rate in group B was higher than that of group A, and the difference was statistically significant(9.13% vs. 2.65%, P<0.001). Conclusions:The implementation of new labor can significantly reduce cesarean section rate in the vaginal delivery process, and the second stage of labor may be extended, which does not increase the adverse outcome of mother and child as long as to strengthen the monitoring of fetal heart.