新产程标准下孕妇产程中转剖宫产危险因素及临床结局分析

The clinical outcomes and risk factors of intrapartum cesarean section under the new labor standards

目的回顾性分析新产程标准下产程中转剖宫产的临床特点及分娩结局。方法采用回顾性病例对照研究,纳入经阴道试产的单胎足月孕妇3313例,根据分娩方式分为阴道分娩组(n=2867)和中转剖宫产组(n=446),对两组临床资料进行单因素分析及多因素logistic回归分析。结果3313例单胎足月孕妇中,中转剖宫产率为13.46%(446/3313)。单因素分析显示,身高、孕前体质指数(body mass index,BMI)、孕期增重、分娩孕周、初产妇、接受辅助生殖技术、分娩前2周内超声预测胎儿体重、分娩前1周内白细胞、合并妊娠期高血压疾病、接受引产与产程中转剖宫产相关(P均<0.05)。多因素logistic回归分析显示,孕前BMI、初产妇、需接受引产、2周内超声预测胎儿体重、分娩前一周内白细胞是产程中转剖宫产的独立危险因素。结论对于单胎足月孕妇,需要综合评估孕妇的产次、孕前BMI,是否需接受引产,孕前预测胎儿体重及分娩前白细胞等“亚剖宫产指征”,预测产程中转剖宫产。

Objective To retrospectively analyze the clinical characteristics and delivery outcomes of intrapartum cesarean section under the new labor standards.Methods A total of 3313 women who underwent vaginal trial delivery were enrolled in this study and assigned into the vaginal delivery group(n=2867)and intrapartum cesarean section group(n=446).Univariate analysis and multivariate logistic regression analysis were performed on the clinical data of the two groups.Results The rate of intrapartum cesarean section was 13.46%(446/3313).In the univariate analysis,intrapartum cesarean section was correlated with the patient’s height,gestational age,pre-pregnancy body mass index(BMI),weight gain during pregnancy,primipara,complicated with gestational hypertension,received assisted reproductive technology and received labor induction,estimation of fetal weight by ultrasound within 2 weeks before delivery and leukocytes within 1 week before delivery(All P<0.05).However,in multivariate logistic regression analysis,pre-pregnancy BMI,primipara,received labor induction,ultrasound estimation of fetal weight by ultrasound within 2 weeks,and leukocytes within 1 week before delivery were independent risk factors for intrapartum cesarean section.Conclusions For women with singleton cephalic full-term fetus,higher prepregnancy BMI,primipara,higher estimation of fetal weight by ultrasound within 2 weeks before delivery,higher leukocytes within 1 week before delivery and those who required induction of labor will influence the success rate of vaginal trial labor.Clinicians should pay more attention to the above sub-indications of cesarean section to predict the intrapartum cesarean section.