新产程标准管理下无痛分娩对妊娠结局的影响

Effect of painless delivery on pregnancy outcomes under management of new labor standards

目的探究新产程标准管理下无痛分娩对妊娠结局的影响。方法回顾性筛选2018年1月至2019年12月来本院经阴道试产的单胎足月产妇386例,按照随机数字法将其分为对照组200例和观察组186例。对照组新产程标准管理下未经分娩镇痛处理,而观察组主要采用新产程标准管理下无痛分娩方法。统计两组产程、催产素利用率、剖宫产情况及产后孕妇出血量和妊娠结局。结果观察组总产程(161.28±20.34)min,短于对照组的(182.09±35.31)min;观察组宫口全开时间(118.32±13.27)min,短于对照组的(220.47±40.18)min;观察组剖宫产前试产时间(797.43±29.57)min,长于对照组的(720.60±48.29)min;两组差异有统计学意义(t=5.735、11.935、7.716,均P<0.05)。观察组催产素使用率42.47%(79/186),高于对照组的33.50%(67/200),差异有统计学意义(χ^(2)=4.427,P<0.05)。观察组中转剖宫产、产钳或胎头吸引助产率分别为6.45%(12/186)、4.83%(9/186),低于对照组的34.00%(68/200)、10.00%(20/200),差异有统计学意义(χ^(2)=7.196、3.028,均P<0.05)。观察组自然分娩率为84.95%(158/186),高于对照组的62.50%(123/200),差异有统计学意义(χ^(2)=5.367,P<0.05)。观察组产后尿潴留、产后出血及会阴侧切率分别为3.23%(6/186)、2.15%(4/186)、6.45%(12/186),均低于对照组的9.50%(19/200)、8.50%(17/200)、17.50%(35/200),差异有统计学意义(χ^(2)=3.172、3.103、5.608,均P<0.05)。两组新生儿PCO2、PO2及pH差异均有统计学意义(均P<0.05)。结论新产程标准管理下无痛分娩可有效提高催产素利用率,降低剖宫产率,改善分娩产程情况和新生儿脐动脉血气指标,而对母婴结局无影响。

Objective To explore the effect of painless delivery on pregnancy outcomes under the management of new labor standards.Methods From January,2018 to December,2019,386 single full-term birth women were selected and randomly divided into a control group(n=200)and an observation group(n=186).The control group took no labor analgesia under the new labor process standard management,while the observation group mainly used the painless labor method under the management.The labor courses,oxytocin utilization rates,cesarean section,postpartum maternal bleeding,and pregnancy outcomes of the two groups were recorded.Results The total labor course and time for full cervical dilation were shorter and the trial delivery time before cesarean section was longer in the observation group than in the control group[(161.28±20.34)min vs.(182.09±35.31)min,(118.32±13.27)min vs.(220.47±40.18)min,and(797.43±29.57)min vs.(720.6±48.29)min;t=5.735,11.935,and 7.716,all P<0.05)].The oxytocin use rate was higher in the observation group than in the control group[42.47%(79/186)vs.33.50%(67/200);χ^(2)=4.427,P<0.05].The rates of cesarean section and accoucheur with forceps were lower in the observation group than in the control group[6.45%(12/186)vs.34.00%(68/200)and 4.83%(9/186)vs.10.00%(20/200);χ^(2)=7.196 and 3.028,both P<0.05].The natural delivery rate was higher in the observation group than in the control group[84.95%(158/186)vs.62.50%(123/200);χ^(2)=5.367,P<0.05)].The rates of postpartum urinary retention,postpartum hemorrhage,and perineal lateral cut were lower in the observation group than in the control group[3.23%(6/186)vs.9.50%(19/200),2.15%(4/186)vs.8.50%(17/200),and 6.45%(12/186)vs.17.50%(35/200);χ^(2)=3.172,3.103,and 5.608,all P<0.05].There were statistical differences in neonatal PCO2,PO2,and pH between the two groups(all P<0.05).Conclusion Painless delivery under the management of the new labor standards can effectively improve the utilization of oxytocin,the delivery process,and the newborns'umbilical artery blood gas indicators and reduce the rate of cesarean section,and have no effect on maternal and child outcomes.