摘要
目的探讨新产程标准管理下第二产程时长对母儿结局的影响。方法回顾新产程标准在我院试行4个月来(2014年10月1日至2015年1月31日)第二产程持续时间≥2 h的单胎足月头先露初产妇病例,去除死胎引产、胎儿畸形、前置胎盘病例,满足条件病例共202份,根据第二产程持续时间(t)长短将其分为3组:2h≤t<2.5 h,共106例设为A1组;2.5 h≤t<3 h,共63例,为A2组;t≥3 h共33例,为A3组。随机抽取同期产房试产到达第二产程且t<2h的单胎足月头先露初产妇病例(排除死胎引产、胎儿畸形、前置胎盘病例)共234例作为对照组(B组)。回顾并收集四组产妇的病历资料,将A1组、A2组、A3组的母儿结局与B组的母儿结局分别进行比较。结果 A1组剖宫产率为3.8%,高于B组的0%(P<0.05),产钳助产率、产妇病率及新生儿病率两组间差异无统计学意义(P>0.05)。A2组产钳助产率(42.8%)、剖宫产率(3.2%)、产后出血率(41.3%)及伤口愈合不良率(7.9%)均显著高于B组(分别为9.0%、0%、14.2%及1.3%),(P<0.05),新生儿病率两组间差异无统计学意义(P>0.05)。A3组产钳助产(51.5%)、剖宫产(9.1%)、产后出血(33.3%)、伤口愈合不良(12.1%)、产后发热(30.3%)及新生儿儿科住院率(30.3%)均显著高于B组(P<0.05)。结论第二产程>3h致产妇病率和新生儿病率显著升高,第二产程>2.5 h致产妇病率显著升高。
Objective To study the association of the duration of second labor stage and outcomes of maternal and neonatal when the new labor standard was used. Methods We reviewed all nulliparous women whose duration of second stage greater or equal to 2 hours at our hospital from 2014 Oct to 2015 Jan（The new labor standard was used during this time）. Women with preterm labor, multiple gestation, noncephalic presentations, fetal malformations, placenta previa, or induction of labor after fetal death were excluded. 202 women met inclusion criteria, they were divided into 3 groups based on second-stage duration （t）, 106 women with 2 hours≥t 〈 2.5 hours composed of group A1, 63 women with 2.5 hours≥t 〈 3 hours composed of group A2, 33 women with 2.5 t≥3 hours composed of group A3. We drew nulliparous women with t 〈 2 hours randomly, women with preterm labor, multiple gestation, noncephalic presentations, fetal malfor- mations, placenta previa, or induction of labor after fetal death were excluded. 234 women met inclusion criteria were se- lected, they composed of the control group named group B. Medical records of these four groups were assembled. Mater- nal and neonatal outcomes of group A1, A2, A3 were compared with Maternal and neonatal outcomes of group B respec- tively. Results （1）Group A1 had higher cesarean section rate than group B（P 〈 0.05）. As to rates of forceps delivery, ma- ternal morbidity and neonatal morbidity, there were no significant differences between group B and group A1 （P 〉 0.05）. （2）Group A2 had higher rates of cesarean section, forceps delivery, postpartum hemorrhage and bad wound healing than group B （P 〈 0.05）. As to neonatal morbidity rate, there was no significant difference between group B and group A2（P 〉 0.05）. （3）Group A3 had higher rates of cesarean section, forceps delivery, postpartum hemorrhage, bad wound healing, pu- erperal fever and neonatal morbidity than group B （P 〈 0.05）. Conclusion Matemal and neonatal morbidities are signifi cantly increased with second stages beyond 3 hours. Maternal morbidity is significantly increased with second stage be- yond 2.5 hours.
出处
《北京医学》
CAS
2015年第7期633-636,共4页
Beijing Medical Journal
关键词
第二产程
母儿预后
Second stage of labor Matemal and neonatal outcome
