8025例阴道分娩人群新旧产程管理下分娩及妊娠结局比较

目的:探讨新旧产程管理对妊娠结局的影响。方法:选择本院阴道分娩的低危初产妇分为新产程组(2014年10月-2015年3月,新产程管理,n=4146)和旧产程组(2013年10月-2014年3月,旧产程管理,n=3879)。评价两组第一、二、总产程时限、分娩方式、产时发热、分娩镇痛、产后出血率、会阴侧切、阴道助产、新生儿体重、新生儿窒息及新生儿入住新生儿重症监护室情况。结果:新产程组第一、第二产程及总产程时间均长于旧产程组,分娩镇痛率(38.5%)、新生儿体重(3391.5±377.7g)及产后出血率(10.9%)高于旧产程(26.4%、3372.6±372.1g和6.3%),会阴侧切率(25.1%)低于旧产程组(36.8%)(均P0.05);产时发热(6.5%)、阴道助产率(8.9%)、新生儿窒息(0.9%)以及新生儿入住重症监护室的发生率(8.4%)与旧产程组(6.2%、8.7%、1.2%及7.3%)无差异(P0.05)。结论:新产程管理下新生儿结局与旧产程未见差异,但尚不能完全证实对产后出血安全性。

Clinical analysis of pregnancy outcomes of 8025 women with vaginal delivery managed by using new or old partogram

Objective:To explore the influence of applied new or old partogram for management women experinced vaginal delivery on their pregnancy outcomes.Methods:Primiparas who experienced vaginal birth in Beijing Obstetrics and Gynecology Hospital were divided into two groups,women in observation group were managed by new partogram (n=4146) and women in control group were managed by old partogram (n=3879).Duration time of first stage,second stage and total stage,delivery ways,intrapartum fever,labor analgesia,incidence of postpartum hemorrhage,episiotomy,assisted vaginal delivery,neonatorum birth weight,incidence of asphyxia neonatorum and neonatal intensive care unit(NICU)admission were compared between the two groups.Results:1.The duration time of first stage,second stage and total stage of women in new partogram group were significant longer than those of women in old partogram group(P＜0.05);2.The incidence of labor analgesia(38.5％),neonatorum birth weight(3391.5±377.7g) and incidence of postpartum hemorrhage(10.9 ％) of women in observation group were significant higher than those of women in control group(26.4％ 、3372.6±372.1g,and 6.3％,respectively),but the incidence of episiotomy of women in observation group (25.1 ％)was significant lower than that of women in control group(36.8 ％)(P＜0.05).There were no significant different in the incidence of intrapartum fever (6.5％ VS.6.2％),assisted vaginal delivery (8.9％ VS.8.7％),asphyxia neonatorum (0.9％ VS.1.2％) and NICU admission(8.4％ VS.7.3％)between the two groups(P＞0.05).Conclusions:The neonatal outcomes in the new partogram applied group are the same as those in the old partogram applied group,and the safety such as decreasing postpartum hemorrhage is not confirmed completely when new partogram used.