对促宫颈成熟与引产孕产妇的全程分娩管理模式

Feasibility analysis of cervical ripening and labor induction under the whole process management during delivery

目的探讨在全程分娩管理模式下,为孕产妇提供促宫颈成熟与引产服务的可行性。方法选择2018年1月1日至2020年12月31日,在南京大学医学院附属鼓楼医院接受待产、分娩到产后康复(LDRP)一体化全程分娩管理模式(以下简称为LDRP管理)的848例孕产妇为研究对象。根据孕产妇进入产房时是否进入自然产程,将其分为自然临产组(n=441)和引产组(n=407)。采用回顾性分析法,对2组孕产妇的一般临床资料,如分娩年龄、孕次、孕龄、妊娠并发症,以及母儿结局进行比较。本研究遵循的程序符合2013年修订的《世界医学协会赫尔辛基宣言》的要求,并经过南京大学医学院附属鼓楼医院伦理委员会审核批准(审批文号:201702001)。结果①2组孕产妇分娩年龄、孕次和高龄孕产妇所占比例比较,差异无统计学意义(P>0.05)。2组孕产妇分娩孕龄、经产妇占比、早产率、缩宫素使用率、分娩时长比较,差异有统计学意义(P<0.05)。②引产组孕产妇均使用前列腺素类药物促宫颈成熟或缩宫素进行引产,其中使用地诺前列酮栓、米索前列醇、缩宫素、地诺前列酮栓+米索前列醇分别为26.5%(108/407)、10.3%(42/407)、60.0%(244/407)、3.2%(13/407)。③2组接受LDRP管理孕产妇总剖宫产术分娩率(2.9%vs 7.1%)、会阴侧切率(20.1%vs 28.6%)、新生儿出生体重[3410 g(3180~3650 g)vs 3340 g(3040~3640 g)]、总住院时间[4 d(3~4 d)vs 4 d(4~5 d)]比较,差异均有统计学意义(χ^(2)=7.846、χ^(2)=7.894、Z=-2.730、Z=-5.112,P<0.05)。④2组LDRP管理孕产妇临产后剖宫术分娩产率、产后24 h出血率、产后24 h出血量≥1000 mL、异体红细胞悬液输注率和宫腔水囊压迫率和产后住院天数比较,差异均无统计学意义(P>0.05)。结论为符合纳入、排除标准孕产妇LDRP管理具有一定可行性,孕产妇及其分娩新生儿均可获得良好妊娠结局。

Objective To explore the feasibility of cervical ripening and labor induction under the whole management during delivery.Methods From January 1,2018 to December 31,2020,a total of 848 puerperae who received whole process delivery management in labor-delivery-recovery-postpartum(LDRP)integrated ward in the Department of Obstetrics and Gynecology of Nanjing Drum Tower Hospital,Affiliated Hospital of Nanjing University Medical School were selected as research subjects.According to whether in labor or not,848 puerperae were divided into natural labor group(n=441)and induced labor group(n=407).The general clinical data,such as age,gravidity,gestational age,pregnancy complications and delivery outcomes were compared between two groups by restrospective study mehod.The procedure followed in the study met the requirements of the Helsinki Declaration of the World Medical Association revised in 2013,and had been reviewed and approved by the Ethics Committee of Nanjing Drum Tower Hospital,Affiliated Hospital of Nanjing University Medical School(Approval No.201702001).Results①There were no significant differences between two group in the age,the proportion of elder pregnant women and gravidity(P>0.05).There were significantly differences in gestational age,the proportion of multiparous,the rate of premature birth,the rate of oxytocin for contraction,and the duration of entry to delivery between two groups(P<0.05).②In induced labor group,all puerperae received prostaglandins or oxytocin in promoting cervical ripening and labor induction,and the ratios of dinoprostone,misoprostol,oxytocin,dinoprostone+misoprostol were 26.5%(108/407),10.3%(42/407),60.0%(244/407),3.2%(13/407).③The total cesarean section rate(2.9%vs 7.1%),episiotomy rate(20.1%vs 28.6%),neonatal birth weight[3410 g(3180-3650 g)vs 3340 g(3040-3640 g)]and hospital time[4 d(3-4)d vs 4 d(4-5 d)],the differences were statistically significant between two groups(χ^(2)=7.846,χ^(2)=7.894,Z=-0.730,Z=-5.112;P<0.05).④There was no significant difference in the cesarean section rate after labor,the rate of postpartum hemorrhage,bleeding volume≥1000 mL in 24 hours after delivery,red blood cell infusion,placing intrauterine balloon tamponade and postoperative hospital stay between two groups(P>0.05).Conclusions It is feasible to provide puerperae with cervical ripening and labor induction under the whole management during delivery for the appropriate nursing resource and standard labor induction procedure,which can obtain the improving perinatal outcomes.