新产程标准中第二产程时长对单胎足月头先露初产妇母婴结局的影响

Effect of the second stage duration in the new standard of labor on the maternal and infant outcomes of single full-term primipara with first presentation

目的:研究新产程标准中第二产程时长对单胎足月头先露初产妇母婴结局的影响。方法:回顾性分析选接受妇产科试产的单胎足月头先露初产妇269例的临床资料,根据第二产程时长将其分为对照组(第二产程时长<2 h)113例和观察组(第二产程时长≥2 h)156例,其中观察组根据第二产程时长又分为甲组(2~<2.5 h)72例、乙组(2.5~<3 h)44例和丙组(3~h)40例,比较各组产妇分娩方式、妊娠结局和新生儿结局。结果:观察组和对照组产妇的会阴侧切率和产妇不良结局、新生儿不良结局各项指标差异均无统计学意义(P>0.05),观察组产妇产钳助产率和中转剖宫产率均明显高于对照组(P<0.01)。甲组产妇分娩方式、产妇不良结局、新生儿不良结局各项指标与对照组差异均无统计学意义(P>0.05);乙、丙组会阴侧切率、产钳助产率和产后发热、产后出血、产褥感染、尿潴留发生率均高于对照组和甲组(P<0.05),中转剖宫产率均高于对照组(P<0.05);丙组新生儿窒息、巨大儿、肩难产率和新生儿酸血症发生率均高于对照组和甲组(P<0.05);乙组肩难产发生率高于甲组(P<0.05),新生儿酸血症率低于丙组(P<0.05)。结论:与传统产程标准下第二产程时长比较,新产程标准管理下第二产程时长延长对母婴结局可造成不良影响,为减少剖宫产率和母婴不良结局发生,需密切监测产妇生命体征,以明确把握手术时机和降低母婴不良结局风险。

Objective:To study the effects of the labor duration of the second stage on maternal and infant outcomes of single full-term first-born primipara in the new standard of labor.Methods:The clinical data of 269 cases of single full-term primipara with first appearance were retrospectively analyzed.The cases were divided into the control group(n=113,duration of the second stage of labor<2 h)and observation group(n=156,duration of the second stage of labor>2 h)according to the length of the second stage of labor.The observation group subdivided into the group A(72 cases,duration of the second stage of labor for 2-2.5 h),group B(44 cases,duration of the second stage of labor for 2.5-3 h)and group C(40 cases,duration of the second stage of labor for 3 h)according to the duration of the second stage of labor,and the mode of delivery,pregnancy outcome and neonatal outcome were analyzed.Results:The differences of the perineal lateral resection rate,maternal adverse outcomes and neonatal adverse outcomes between the observation group and control group were not statistically significant(P>0.05),and the maternal forceps assisted delivery rate and cesarean section rate in observation group were significantly higher than those in control group(P<0.01).There was no statistical significances in the maternal delivery mode,maternal adverse outcomes and neonatal adverse outcomes between group A and control group(P>0.05).The episiotomy and forceps-assisted delivery rates,and incidence rates of postpartum fever,postpartum hemorrhage,puerperal infection and urinary retention in group B and group C were higher than those in control group and group A(P<0.05),and the cesarean section rates in group B and group C were higher than that in control group(P<0.05).The incidence rates of the neonatal asphyxia,macrosomia,shoulder dystocia and neonatal acidemia in group C were higher than those in control group and group A(P<0.05).The incidence rate of shoulder dystocia in group B was higher than that in group A(P<0.05),and the neonatal acidemia rate in group B was lower than that in group C(P<0.05).Conclusions:Compared with the duration of the second stage of labor under the traditional standard of labor,the prolongation of the second stage of labor under the new standard of labor has adverse effects on the maternal and infant outcomes.In order to reduce the rate of cesarean section and occurrence of adverse outcomes,it is necessary to closely monitor maternal vital signs.