新旧产程标准管理对分娩和新生儿结局影响的分析

目的 探讨不同产程标准管理对分娩方式、产程、新生儿分娩结局的影响.方法 选取2014年1月至2014年12月在北京和美妇儿医院妇产科进行试产的1 000例单胎妊娠、足月、头位孕妇进行研究,其中500例采用新产程标准进行助产管理(新产程组)、500例采用旧产程标准进行助产管理(旧产程组),对比两组的分娩方式、产程、新生儿分娩结局等指标.结果 新产程组产妇的产时潜伏期、第一产程时间均显著长于旧产程组,差异均具有统计学意义(t值分别为29.788、14.569,均P＜0.05);新产程组产妇和旧产程组的第二、第三产程时间比较差异均不具有统计学意义(t值分别为0.881、1.679,均P＞0.05);新产程组产妇的产钳助产率、剖宫产率、催产素使用率、产后出血率、产时发热率均显著低于旧产程组,差异均具有统计学意义(x2值分别为4.871、4.624、11.390、4.948、4.466,均P＜0.05);新产程组产妇和旧产程组的切口感染、会阴裂伤发生率比较差异均不具有统计学意义(x2值分别为1.616、2.016,均P＞0.05);新产程组新生儿的1min Apgar评分低于旧产程组,差异均具有统计学意义(t=3.318,P＜0.05);新产程组和旧产程组的胎儿窘迫发生率、新生儿窒息发生率、5min Apgar评分比较差异均不具有统计学意义(x2/t值分别为1.162、1.809、1.657,均P＞0.05).结论 采用新产程标准进行助产管理有助于减少剖宫产率、催产素使用率及产后并发症的发生率.

Influence of new and old labor process standard management on delivery and neonatal outcomes

Objective To explore the influence of different birth process standard management on delivery mode,labor process,delivery and neonatal outcomes.Methods Altogether 1 000 cases of singleton,full term,head position pregnancy attempting delivery in obstetrics and gynecology department of Beijing Hemei Women and Children' s Hospital from January to December in 2014 were selected for study,among whom 500 cases used new process standard for obstetrical management (new labor process group) and 500 cases used old labor process standard for obstetrical management (old labor process group).Mode of delivery,birth process and neonatal outcomes in two groups were compared.Results Intrapartum latency and first stage of labor in new labor process group were significantly longer than those in old labor process group,and the differences were statistically significant (t value was 29.788 and 14.569 respectively,both P ＜ 0.05).There was no significant difference in second and third stage of labor between two groups (t value was 0.881 and 1.679 respectively,both P ＞ 0.05).Forceps delivery rate,cesarean section rate,oxytocin utilization rate,postpartum hemorrhage rate,intrapartum fever rate in new labor process group were lower than those in old labor process group,and the differences were statistically significant (x2 value was 4.871,4.624,11.390,4.948 and 4.466 respectively,all P ＜ 0.05).There was no significant difference in incidence of incision infection and perineal laceration between two groups (x2 value was 1.616 and 2.016 respectively,both P ＞ 0.05).Apgar score of neonate at 1 min after birth in new labor process group was lower than that in old labor process group,and difference was statistically significant (t =3.318,P ＜0.05).There was no significant difference in incidence of fetal distress and neonatal asphyxia and Apgar score at 5min after birth between two groups (x2/t value was 1.162,1.809 and 1.657,respectively,all P ＞ 0.05).Conclusion Obstetrical management under new labor process standard can help to reduce cesarean section rate,oxytocin utilization and incidence of postpartum complications.