硬膜外镇痛孕妇产程中中转剖宫产的临床研究

Clinical study on referral to cesarean section in vaginal labor under epidural analgesia

目的分析硬膜外镇痛孕妇产程中中转剖宫产的临床特点,评估其中转剖宫产对母儿近期结局的影响。方法选取2019年7月1日至2020年6月30日,在广州市妇女儿童医疗中心足月单胎头位经阴道试产分娩的11493例孕妇内于产程中中转剖宫产的729例为研究对象,将产程中使用硬膜外镇痛中转剖宫产的409例定为研究组,产程中未使用硬膜外镇痛中转剖宫产的320例定为对照组,比较两组孕妇的临床特点及母儿近期结局。结果在11493例孕妇中,产程中使用硬膜外镇痛孕妇中转剖宫产率为4.35%(409/9399),未使用硬膜外镇痛孕妇中转剖宫产率为15.28%(320/2094),经比较差异有统计学意义(χ^2=344.389,P<0.05)。研究组孕妇产程中出现Ⅱ类或Ⅲ类电子胎儿监护率、产时体温≥38℃发生率、第一产程活跃期剖宫产率、第二产程剖宫产率均显著高于对照组(χ^2值分别为49.202、120.343、42.590、16.635,均P<0.05)。两组孕妇的产后出血率、产后24h出血量、脏器损伤率、腹部伤口愈合不良发生率、输血率、术后住院天数比较差异均无统计学意义(均P>0.05);两组新生儿羊水污染率、窒息率差异均无统计学意义(均P>0.05)。结论孕妇产程中使用硬膜外镇痛可以降低剖宫产率,中转剖宫产不会增加母儿近期不良结局。

Objectives To investigate clinical characteristics of pregnant women who received epidural analgesia(EA)in trail vaginal labor and evaluate influence of referral to cesarean section on maternal-fetal short-term outcomes.Methods Among 11493 pregnant women of singleton pregnancy,term delivery with cephalic presentation,729 pregnant women who were referral to cesarean section in trail vaginal labor in Guangzhou Municipal Women and Children’s Medical Center from July 1 st,2019 to June 30 th,2020 were selected in the study.409 pregnant women who received EA in ceserean section were allocated to the EA group while 320 pregnant women who did not receive EA in ceserean section were allocated to the non-EA group.The clinical characteristics of the pregnant women and maternal-fetal short-term outcomes were compared between the two groups.Results Among 11493 pregnant women,the rate of referral to ceserean section in pregnant women who received EA in thier labor process was 4.35%(409/9399),while the rate of referral to cesarean section in the pregnant women who did not receive EA in their labor process was 15.28%(320/2094),and there was a significane difference in the rate of referral to ceserean section in labor between the two groups(χ^2=344.389,P<0.05).Incidence rates of category II or category III of fetal heart monitoring in labor,temperature≥38℃during labor,cesarean section performed in active phase of the first stage of labor,cesarean section performed in the second stage of labor in the EA group were much higher than those in the non-EA group(χ^2=49.202,120.343,42.590 and 16.635 respectively,all P<0.05).There were no significant differences in the incidence rates of postpartum hemorrhage,amount of bleeding within 24 h after partuition,organ injury,poor abdominal wound healing,blood transfusion and hospitalization days after cesarean section between the two groups(all P>0.05).As well,in incidence rates of meconium-stained amniotic fluid and neonatal asphyxia there were no significant differences between the two groups(both P>0.05).Conclusion Application of EA during labor can reduce rate of cesarean section,even referral to cesarean section in labor can’t increase the risk of adverse maternal-fetal outcomes.