产时超声监测胎心及胎方位结合新产程图产程管理对产妇分娩方式及妊娠结局影响

Impacts of the intrapartum ultrasound monitoring of fetal heart and the fetal position combined with the new partogram management for primiparas on the delivery modes and the pregnancy outcomes of the primiparas

目的:探究产时超声监测结合新产程图产程管理对初产妇分娩方式和妊娠结局的影响。方法:选取2022年10月-2023年10月本院分娩且行阴道试产的单胎、足月妊娠初产妇,依据产时监测方式不同分为常规组(电子监护仪联合新产程图产程管理)和超声组(彩色多普勒超声监测结合新产程图产程管理),经倾向性匹配评分法排除基线资料混杂因素后,两组各获得134例产妇,对比两组分娩方式、阴道分娩产妇各产程时间、产后盆底肌功能(活力值、功值、峰值)、不良分娩结局。结果:超声组剖宫产率(22.4%)低于常规组(34.3%),超声组阴道分娩产妇第一产程(10.5±0.8h)、第二产程(79.5±11.5min)均短于常规组阴道分娩产妇(10.8±1.0h、93.4±13.2min),两组阴道分娩产妇盆底肌活力值、功值、峰值均低于同组剖宫产产妇(P<0.05);超声组不良分娩结局发生率与常规组无差异(P>0.05)。结论:超声监测胎心及胎方位结合新产程图产程管理用于初产妇,可缩短产程时间,降低剖宫产率,改善母婴结局。

Objective:To explore the impacts of the intrapartum ultrasound monitoring of fetal heart combined with the new partogram management for primiparas on the delivery modes and the pregnancy outcomes of the primiparas.Methods:The primiparas with singleton and full-term pregnancy who wanted vaginal trial delivery in hospital were selected and were divided into two groups according to the different intrapartum monitoring methods from October 2022 to October 2023.The primiparas in group A were given intrapartum electronic monitor combined with new partogram management.And the primiparas in group B were given intrapartum color Doppler ultrasound monitoring combined with new partogram management.After excluding the confounding factors of the baseline data of the primiparas by propensity score matching method,134primiparas in each group were obtained for analysis.The delivery modes,the duration of different stage of labor,the postpartum pelvic floor muscle function(activity value,work value and peak value),and the adverse delivery outcomes of the primiparas were compared between the two groups.Results:The rate of cesarean section(22.4%)of the primiparas in group B was significantly lower than that(34.3%)of the primiparas in group A.The durations of the first stage of labor(10.5±0.8h)and the second stage of labor(79.5±11.5min)of the primiparas in group B were significantly shorter than those(10.8±1.0hand 93.4±13.2min)of the primiparas in group A.The activity value,work value and peak value of the pelvic floor muscle of the primiparas with vaginal delivery in the two groups were significantly lower than those of the primiparas with cesarean section(P<0.05).There was no significant difference in the incidence of adverse delivery outcomes of the primiparas between the two groups(P>0.05).Conclusion:The application of the intrapartum ultrasound monitoring of fetal heart and the fetal position combined with the new partogram management for the primiparas can shorten their delivery stage duration,reduce their cesarean section rate and improve the maternal-infant outcomes.