产程中自由饮食产妇的产程观察

Unrestrictive food intake on labor progress

目的探讨产程中产妇自由饮食与中转剖宫产及产程的关系。方法收集2019年1月至2019年12月期间在南方医科大学附属佛山市妇幼保健院产科进行阴道试产的产妇的临床资料,根据产程中有否进食半流质或固体食物,分为进食组和非进食组,比较进食与否对产程的影响,并采用多因素Logistic回归和线性多因素回归分析中转剖宫产发生的影响因素及产程的影响因素。结果345例研究对象中,进食组210例,占60.9%,非进食组135例,占39.1%。IVF-ET术后妊娠8例(2.3%),产程中呕吐12例(3.5%),中转剖宫产49例(14.2%);非进食组和进食组比较,非进食组的孕次大于进食组,差异有统计学意义[(2.18±1.24)vs(1.73±0.97),(P<0.001)],非进食组的产次大于进食组,差异有统计学意义[(0.72±1.03)vs(0.33±0.53),(P<0.001)];中转剖宫产发生影响因素的多因素Logistic回归分析显示:产次是产程中中转剖宫产发生的保护因素(OR=0.28),IVF-ET术后妊娠的产妇发生中转剖宫产的危险是自然受孕产妇的10倍(OR=10.03),产程中有进食的产妇发生中转剖宫产的危险是非进食组产妇的3倍(OR=3.10);所有进行阴道试产并顺利经阴道分娩的296例产妇中,进食与产程的单因素分析显示:非进食组的第一产程、第二产程和总产程时长均短于进食组,差异有统计学意义(均为P<0.001),两组间第三产程时长没有统计学差异(P=0.434);产程影响因素的线性多因素回归分析显示:产程中是否进食对产程的长短无影响。结论自由饮食的产妇临产后,孕产次更少的产妇或初产妇由于产程更长的原因大多有自主进食的需求,产程中进食产妇中转剖宫产的发生率更高。对于经阴道分娩的产妇而言,产程进食对产程长短没有影响。

Objective To investigate the relationship between unrestrictive food intake during labor and cesarean section and labor process.Methods Prospectively collected clinical data of women who underwent vaginal trial of labor in the Department of Obstetrics,Foshan Women and Children Hospital Affiliated to Southern Medical University from January 2019 to December 2019,the women were divided into eating and non-eating groups according to whether semi-liquid or solid food was consumed during labor,compared the effect of eating or non-eating on the course of labor,and analyzed transit using multifactorial logistic regression and linear multifactorial regression Factors influencing the occurrence of cesarean section and the course of labor.Results Among 345 subjects,210 cases(60.9%)were in the eating group and 135 cases(39.1%)in the non-eating group,8 cases(2.3%)were IVF-ET pregnancy,12 cases(3.5%)were vomiting during labor,and 49 cases(14.2%)were transit cesarean section;the number of pregnancies in the non-eating group was greater than that in the eating group,and the difference was statistically significant[(2.18±1.24)vs(1.73±0.97),(P<0.001)],and the difference was statistically greater in the non-eating group than in the eating group[(0.72±1.03)vs(0.33±0.53),(P<0.001)];multifactorial logistic regression analysis of the factors influencing the occurrence of cesarean section showed that the number of parity was greater in the non-eating group than in the eating group.Parity was a protective factor for the occurrence of cesarean section during labor(OR=0.28),the risk of cesarean section was 10 times higher in women with IVF-ET than in naturally conceived women(OR=10.03),and the risk of cesarean section was 3 times higher in women who were fed during labor than in the non-eating group(OR=3.10);Among the 296 women who gave birth naturally,the single factor analysis of food and labor duration showed that the length of the first stage of labor,the second stage of labor and the total length of labor were shorter in the non-eating group than in the eating group,and the difference was statistically significant(all P<0.001),and there was no statistical difference in the length of the third stage of labor between the two groups(P=0.434);the linear multifactor regression analysis showed that the influence of food intake on the duration of labor was not significantly affected by the presence or absence of food.Length of labor had no effect.Conclusions After free dieting,women with fewer pregnancies or primiparous women mostly have the need to eat on their own due to the longer duration of labor,and therefore the incidence of mid-labor feeding women relaying cesarean section is also higher,but for women who deliver vaginally,mid-labor feeding has no effect on the length of labor.