新产程标准将活跃期拐点定位对初产妇及经产妇分娩结局的影响

Influence of the inflection point of active period of new labor standard on delivery outcomes of primiparas and parturients

目的研究采用新产程标准进行活跃期拐点的定位对初产妇及经产妇分娩结局的影响。方法 380例初产妇为初产组,273例经产妇为经产组。两组均采用新产程标准。比较两组宫口扩张3 cm后每扩张1 cm、第一产程、第二产程的时间,观察上述指标第95百分位时间,比较两组分娩结局。结果初产组宫口扩张3 cm后每扩张1 cm所用时间长于经产组,差异有统计学意义(P<0.05)。初产组第一产程所用时间(663.96±51.63)min、第二产程所用时间(44.24±4.50)min长于经产组的(385.82±50.20)、(12.32±4.39)min,差异有统计学意义(P<0.05)。初产组第一产程第95百分位时间为1340.00 min、第二产程第95百分位时间为110.00 min,经产组分别为824.00、40.00 min。两组均未发生新生儿窒息、严重产后出血等不良结局,且两组产后出血量、新生儿Apgar评分比较,差异无统计学意义(P>0.05)。结论新产程标准将活跃期拐点定为宫口扩张6 cm适用性较强,母婴结局不受影响,临床可在依照产程管理原则基础上,根据产妇实际情况进行合理化调整。

Objective To study the effect of inflection point of active period of new labor standard on delivery outcomes of primiparas and parturients. Methods There were 380 primiparas as primiparous group, and 273 parturients as production group, and both group adopted new labor standard. The average time of 1 cm of dilatation, first stage of labor, and second stage of labor and 95 th percentile time were compared between the two groups after 3 cm of dilatation of the uterus. The delivery outcome of the two groups was compared. Results Primiparous group had longer time of 1 cm of dilatation after 3 cm of dilatation of the uterus than production group, and the difference was statistically significant（P〈0.05）. Primiparous group had longer duration of first stage of labor as（663.96±51.63） min, and second stage of labor as（44.24±4.50） min than（385.82±50.20） and（12.32±4.39） min in production group. Their difference was statistically significant（P〈0.05）. Primiparous group had 95 th percentile time of first stage of labor as 1340.00 min and 110.00 min of second stage of labor, which were 824.00 and 40.00 min respectively in production group. There were no adverse outcomes of neonatal asphyxia and severe postpartum hemorrhage in the two groups, and there was no significant difference in the amount of postpartum hemorrhage and neonatal Apgar score between the two groups（P〈0.05）. Conclusion The new labor standard set the active period of the inflection point as the 6 cm of dilatation of the uterus, and the outcome of the mother and the baby is not affected. The clinical practice can be adjusted according to the actual situation of the maternity based on the principle of labor management.