无痛分娩过程中的转剖宫产指征分析

Analysis of clinical indications of cesarean in the process of painless delivery

无痛分娩技术能有效缓解生产疼痛,降低剖宫产率,在临床得到广泛推广,然而目前并不完全清楚无痛分娩对母婴是否足够安全,也没有研究调查无痛分娩过程中转剖宫产指征的情况.本文通过分析无痛分娩过程中转剖宫产的常见临床指征,探讨无痛分娩对母婴的可能影响.采用麦迪斯顿麻醉系统收集宁波大学医学院附属医院2018年1月至2019年3月入院进行阴道分娩的产妇的临床资料.将进行无痛分娩产妇作为观察组,自然分娩产妇作为对照组,比较两组分娩过程中转剖宫产率及转剖宫产临床指征比率的异同.在分娩过程中,观察组(1844例)的转剖宫产率(6.29%)远远低于(P<0.0001,χ^(2)=288.75)对照组(2514例)的转剖宫产率(32.10%).进一步分析发现,观察组的头位难产指征比率(73.28%,n=85)、宫内感染指征比率(42.24%,n=49)以及胎儿宫内窘迫指征比率(37.07%,n=43)均显著高于(P<0.01,χ^(2)=6.68;P<0.0001,χ^(2)=36.64;P<0.0001,χ^(2)=188.92)对照组的相应指征比率(60.84%,n=491;3.84%,n=31;14.37%,n=116).与先前的报道一致,使用无痛分娩技术的确可以显著降低产妇在分娩过程中转剖宫产的比率,然而,无痛分娩过程中转剖宫产的头位难产、宫内感染或胎儿宫内窘迫指征的可能性风险也显著提高.

Painless delivery effectively alleviates pain of delivery and reduces cesarean section rate,which makes it a commonly used approach in practice.However,it remains unknown whether painless delivery was safe enough for both mothers and infants.By analyzing several clinical indicators of cesarean section during painless delivery,the possible effect of painless delivery on mothers and infants was investigated.The clinical data of women admitted to the Affiliated Hospital of Medical School,Ningbo University for vaginal delivery from January 2018 to March 2019 were collected by using the Megaston anesthesia system.The observation group(painless delivery)and the control group(natural birth)were used to compare the cesarean section rate and the clinical indications of cesarean section.The cesarean section rate in the observation group(6.29%,n=1844)was significantly lower(P<0.0001,χ^(2)=288.75)than that(32.10%,n=2514)in the control group.Further analysis showed that the cephalic dystocia rate(73.28%,n=85),the intrauterine infection rate(42.24%,n=49),and the fetal distress rate(37.07%,n=43)in the observation group were significantly greater(P<0.01,χ^(2)=6.68;P<0.0001,χ^(2)=36.64 and P<0.0001,χ^(2)=188.92)than those in the control group(60.84%,n=491;3.84%,n=31 and 14.37%,n=116).Consistent with previous reports,painless delivery significantly decreased the rate of women transferring to cesarean sections during delivery processing.However,the possibility of head dystocia,intrauterine infection,or fetal distress during painless delivery also significantly increased.