新产程对产妇产后近期盆底肌力的影响

Effect of new labor process on early postpartum pelvic floor muscle strength

目的研究应用新产程后产妇近期盆底肌力的变化。方法本研究为回顾性队列研究,选择2011年2月至2016年3月在北京大学第一医院分娩并进行产后6~8周盆底复查的1834例单胎足月初产妇,其中2014年8月前应用旧产程者738例为旧产程组,之后应用新产程者1096例为新产程组。比较2组产妇的基本资料、产时情况及产后盆底肌力情况。采用t检验、χ^(2)检验、Mann-Whitney U检验和Wilcoxon秩和检验对数据进行统计学分析,并采用有序多分类logistic回归分析新旧产程及其他因素对盆底肌力的影响因素。结果新产程组产妇的总产程、第一产程、第二产程时间均长于旧产程组[分别为549.0 min(360.0~768.0 min)与482.5 min(328.0~635.0 min)、465.0 min(297.5~672.5 min)与420.0 min(285.0~555.0 min)、42.0 min(24.0~74.0 min)与27.0 min(18.0~45.0 min),Z值分别为-5.72、-3.95及-9.28,P值均<0.05],阴道分娩及分娩镇痛比例大于旧产程组[分别为72.1%(790/1096)与67.2%(496/738)、67.4%(739/1096)与53.4%(394/738),χ^(2)值分别为7.41和36.82,P值均<0.05]。2组产妇的Ⅰ类及Ⅱ类肌纤维的盆底肌力分级比较,差异均无统计学意义(P值均>0.05)。结论应用新产程标准后,产妇近期盆底肌力无显著性下降。

Objective To explore the changes in early postpartum pelvic floor muscle strength following the implementation of the new labor process.Methods This retrospective cohort study selected 1834 primiparous women with singleton,full-term pregnancies who delivered at Peking University First Hospital from February 2011 to March 2016 and had a pelvic floor re-examination 6-8 weeks postpartum.Out of these,738 cases who followed the old labor process before 2014 were categorized as the old process group,and 1096 cases who followed the new labor process after 2014 were categorized as the new process group.Basic data,childbirth information,and postpartum pelvic floor muscle strength of the two groups were compared.Data were statistically analyzed using t-test,Chi-square test,Mann-Whitney U test,Wilcoxon rank-sum test,and ordered multicategory logistic regression to assess the impact of the new and old labor process and other factors on pelvic floor muscle strength.Results The total duration of labor,as well as the duration of the first,second,and third stages of labor,were longer in the new process group than in the old process group[549.0 min(360.0-768.0 min)vs.482.5 min(328.0-635.0 min),465.0 min(297.5-672.5 min)vs.420.0 min(285.0-555.0 min),42.0 min(24.0-74.0 min)vs.27.0 min(18.0-45.0 min),with Z-value of-5.72,-3.95,and-9.28,all P<0.05].The rates of vaginal delivery and labor analgesia were higher in the new process group[72.1%(790/1096)vs.67.2%(496/738),χ^(2)=7.41;67.4%(739/1096)vs.53.4%(394/738),χ^(2)=36.82;both P<0.05].There were no statistically significant differences in the comparison of ClassⅠand ClassⅡmuscle strength grades between the two groups(all P>0.05).Conclusion There was no significant decline in early postpartum pelvic floor muscle strength following the implementation of the new labor process standards.