新产程标准管理下的产程进展和干预研究

Study about progress of labor and intervention in the labor with the utilization of new partogram

目的探讨新产程标准管理对产程进展和干预措施的影响。方法回顾性分析2015年1月1日—2017年12月31日在成都市妇女儿童中心医院阴道分娩的初产妇。以旧产程标准管理者200例,设为对照组(A组);同期根据产程时长将以新产程标准管理者设为观察组:B组100例(临产到宫口开大3 cm时间≥16 h)、C1组100例(2 h≤第二产程<3 h)和C2组100例(第二产程≥3 h)。比较4组在产程中干预措施如缩宫素点滴、人工破膜、间苯三酚软化宫颈、导尿和手转胎头以及第一、二产程时限的差异;比较宫口开全时A组和C1、C2组胎先露、产瘤、胎方位以及胎先露下降进展的差异。结果在缩宫素和间苯三酚使用率、导尿和手转抬头率的组间两两比较上,主要是C2和其他各组之间的差异(P<0.008 5)。C1、C2和A组在第一产程时限,B组和A组在第二产程时限的比较上,差异有统计学意义(P<0.05)。宫口开全时胎先露所在位置,除+1处A组与C2组差异无统计学意义外(P≥0.017),A组和C1、C2组差异有统计学意义(P<0.017)。有无产瘤和是否枕前位的比较上,除枕前位上A和C1组差异无统计学意义(P>0.017)外,其余各组间差异均有统计学意义(P<0.017)。宫口开全后胎先露下降幅度在各组间的两两比较上,0~1 h:A组、C1组、C2组之间的差异均有统计学意义(P<0.05)。1~2 h:C1和C2组之间的差异有统计学意义(P<0.05);在组内横向比较上:C1组0~1 h和1~2 h的胎先露下降幅度差异有统计学意义(P<0.05)。C2组0~1 h、1~2 h和2~3 h胎先露下降幅度差异两两比较均无统计学意义(P>0.05)。结论新产程标准管理下不会增加产程干预,但当第二产程≥3 h,干预增加。应及时处理影响产程的异常因素,控制第二产程在3 h以内。

Objective To explore the effects of utilization of new partogram on the progress of labor and intervention in the labor. Methods We reviewed nulliparous women who had vaginal delivery at our hospital from January 1 st, 2015 to December 31 st, 2017. They were divided into control group（group A）（n=200; the old labor standard was used during this time） and observation group（the new labor standard was used at the same time）. The observation group was sub-divided into group B（n=100, the duration of dilatation of cervix from 0 to 3 centimeters greater than or equal to 16 hours after parturition）, group C1 [n=100; the second-stage duration（t） was greater than or equal to 2 hours,and less than 3 hours）, and group C2（n=100; t was greater than or equal to 3 hours）. We compared the differences in intervention at the stages of labor such as using oxytocin to strengthen the contractions, artificial rupture of membranes,using phloroglucinol to soften the cervix, urinary catheterization, and manual rotation of fetal head among the groups. We also compared the differences in fetal presentation position, head tumor, fetal position, cephalopelvic disproportion and progress of the drop when the dilatation of cervix get to 10 centimeters among the groups. Results In the comparison among group A, B, C1 and C2 in rates of using oxytocin to strengthen the contractions, using phloroglucinol to soften the cervix, urinary catheterization and manual rotation of fetal head, the differences were statistically significant between group C2 and the other groups（P〈0.008 5）. The differences among group C1, C2 and A were statistically significant in duration of the first stage of labor（P〈0.05）. The same result was found between group B and A in duration of the second stage of labor（P〈0.05）. In the comparison of the different ratios of fetal presentation position between group A and C1,and group A and C2, when the dilatation of cervix get to 10 centimeters, the differences were significant（P〈0.017）, except at ＋1 position. The differences in whether the fetal presentation was producing head tumor and occipital anterior position among group A, C1, and C2 were statistically significant（P〈0.017）, but there was no difference between group A and C1（P〈0.017） in occipital anterior position. In the comparison of the different progress of the drop when the dilatation of cervix had got to 10 centimeters, 0–1 hours： the differences were statistically significant among group A, C1, and C2（P〈0.05）; 1–2 hours： the difference was statistically significant between groups C1 and C2（P〈0.05）. In group C1, there was a statistically significant difference between 0–1 hour and 1–2 hours（P〈0.05）. In group C2, there was no statistically significant difference among 0–1 hour, 1–2 hours and 2–3 hours（P〈0.05）. Conclusions According to the new labor standard, the rates of intervention in the labor would not increase, but when the second-stage duration is greater than or equal to 3 hours, the frequency would increase. We should deal with the abnormal factors affecting labor in time, and try to control the duration in 3 hours.