早产初产妇活跃期起点与产程特点及影响分娩成功的因素分析

Analysis of the starting point of the active phase and the characteristics of the labor process and the factors that affect the success of delivery in preterm primipara

目的探究早产初产妇活跃期起点与产程特点及影响分娩成功的相关因素。方法选择2020年10月至2022年2月于华中科技大学协和江北医院和湖北省黄冈市黄州区人民医院住院分娩的单胎妊娠早产初产妇(489例)为研究对象,按照2∶1的比例分为训练集(326例)和验证集(163例)。训练集中,根据分娩方式,分为自然分娩组(196例)和非自然分娩组(130例)。另选足月初产妇(326例)为对照组。通过与足月组对比,分析早产组孕妇的一般情况、活跃期相关指标及产程时限、活跃期起点分布情况。多因素Logistic回归分析影响早产初产妇自然分娩成功的独立保护因素,依据β值对各保护因素进行赋分,构建预测评分模型,并进行模型评价。结果与足月组相比,早产组初产妇的孕次、人工流产次数均更多(P<0.05),新生儿出生后1和5 min Apgar评分均更低(P<0.05)。与足月组相比,早产组初产妇的活跃期以及第一、二、三产程时限均更短(P<0.05),活跃期平均宫口扩张速度更快(P<0.05)。早产组:活跃期起点多位于2cm;足月组:活跃期起点多位于4cm,两组差异显著(P<0.05)。多因素分析结果显示,年龄<35岁、情绪无异常、开展产前运动、产检结果无异常、无巨大儿、无胎儿窘迫,均为自然分娩成功的独立保护因素(P<0.05)。训练集和验证集的最佳界值均为5.97分。模型评价结果显示,该预测评分模型具有较高的精准度,且有效性较好、安全可靠、实用性强。结论年龄<35岁、情绪无异常、开展产前运动、产检结果无异常、无巨大儿、无胎儿窘迫,均为自然分娩成功的独立保护因素。本研究依据保护因素建立了一种具有较精准度及有效性且简单易行的预测评分模型,具有为优化早产初产妇分娩评估及管理提供参考的潜能。

Objective To explore the starting point of the active phase of preterm primipara,the characteristics of the labor process and the related factors that affect the success of delivery.Methods Selected the singleton pregnancy preterm primiparous women(489 cases)who were hospitalized and delivered at Union Jiangbei Hospital of Huazhong University of Science and Technology and Huangzhou District People’s Hospital of Huanggang City from October 2020 to February 2022 as the research subjects,and divided into training set(326 cases)and validation set(163 cases)according to the ratio of 2∶1.In the training set,according to the mode of delivery,they were divided into a natural birth group(196 cases)and a non-natural birth group(130 cases).Another 326 cases of pregnant women at the beginning of the term were selected as the control group.By comparing with the full-term group,the general condition of the pregnant women in the preterm group,the indicators related to the active period,the duration of the labor process,and the distribution of the starting point of the active period were analyzed.Multivariate Logistic regression analysis was conducted to analyze the independent protective factors affecting the success of natural delivery in primipara.Scores were assigned to each protective factor according to theβvalue,and a predictive scoring model was constructed and evaluated.Results Compared with the term group,primiparous women in the preterm group had more pregnancies and induced abortions(P<0.05),and lower Apgar scores at 1 and 5 minutes after birth(P<0.05).Compared with the full-term group,primiparous women in the preterm group had shorter active phase and duration of the first,second and third stages of labor(P<0.05),and the average cervix dilation rate was faster in the active phase(P<0.05).Preterm birth group:the starting point of the active phase is mostly located at 2 cm.Term group:The starting point of the active phase was mostly located at 4 cm,and the difference between the two groups was significant(P<0.05).The results of multivariate analysis showed that age<35 years old,no abnormal mood,prenatal exercise,no abnormal obstetric examination results,no macrosomia,and no fetal distress were independent protective factors for successful natural delivery(P<0.05).The best bounds for both training and validation sets are 5.97 points.The model evaluation results show that the predictive scoring model has high accuracy,good effectiveness,safety and reliability,and strong practicability.Conclusion Age<35 years old,no abnormal mood,prenatal exercise,no abnormal results of obstetric examination,no macrosomia,and no fetal distress were all independent protective factors for successful natural delivery.Based on protective factors,this study established a simple and easy predictive scoring model with high accuracy and validity,which has the potential to provide a reference for optimizing the evaluation and management of preterm primipara.