应用第二产程时限新产程标准对母儿结局的影响

目的 探讨新产程标准临床应用对母儿结局的影响.方法 回顾性分析保定市第四中心医院2015年1-6月和2018年1-6月分别使用旧产程和新产程分娩产妇各500例的分娩资料,分别作为对照组和观察组.观察组产妇依据第二产程时限长短将第二产程时限为2～2.5 h、2.5～3 h以及3 h以上产妇分为观察T1亚组(n=263),观察T2亚组(n=159)和观察T3亚组(n=78).比较四组产妇分娩方式,产后并发症发生率,新生儿结局以及观察组和对照组产妇中转剖宫产原因.结果 观察T1亚组中转剖宫产率(2.66％比6.00％)、发热(1.90％比5.60％)和会阴伤口感染发生率(0.76％比5.20％)显著低于对照组(P<0.05),会阴侧切率显著高于对照组(36.50％比4.00％,P<0.05);观察T2亚组和T3亚组自然分娩率显著低于对照组和观察T1亚组(P<0.05),产钳助产率、中转剖宫产率、会阴侧切率显著高于对照组和观察T1亚组(P<0.05);观察T2和T3亚组产后出血、产后发热、尿潴留、会阴伤口感染发生率显著高于对照组和观察T1亚组(P<0.05);四组新生儿窒息、NICU入住发生率差异无统计学意义(P>0.05),观察T3亚组巨大儿和新生儿酸中毒发生率显著高于对照组(P<0.05);观察组和对照组产妇胎儿宫内窘迫、脐带脱垂和头盆不对称而致中转剖宫产比例差异无统计学意义(P>0.05),而因为心理因素导致中转剖宫产比例显著高于对照组(P<0.05).结论 第二产程时限低于2.5 h时可以在不改变母儿结局基础上有效降低剖宫产率,而高于2.5 h不仅影响产妇分娩方式,增加产后并发症发生,还会增加新生儿不良结局.

Effect of new stage application of second stage time limit on maternal and child outcome

Objective To explore the effect of clinical application of new stage of labor on maternal and neonatal outcomes.Meth? ods A retrospective analysis was performed on the delivery data from 500 puerperae who were treated with old stage of labor from January to June 2015 and 500 puerperae who were treated with new stage of labor from January to June 2018 in the Fourth Central Hospital of Baoding. And they were assigned into the control group and observation group, respectively. According to the duration of the second stage of labor, puerperae with the duration within 2 to 2.5 h, 2.5 to 3 h and above 3 h in the observation group were assigned intoT1 observation subgroup (n=263), T2 observation subgroup (n=159) and T3 observation subgroup (n=78). The delivery methods, the incidence of postpartum complications and neonatal outcomes were compared among the 4 groups. The reasons for transferring to cesarean section in the observation group and the control group were compared.Results The incidence of cesarean section (2.66% vs. 6.00%), rates of fever (1.90% vs. 5.60%) and perineal wound infection (0.76% vs. 5.20%) in T1 observation subgroup were significantly lower than those in the control group (P<0.05), while the perineal side-cutting rate was significantly higher than that in the control group (36.50% vs. 4.00%, P<0.05). The natural delivery rate of T2 observation subgroup and T3 observation subgroup was significantlylower than that of the control group and T1 observation subgroup (P<0.05), while forceps delivery rate, the rate transferring to cesarean section and perineal side-cutting rate were significantly higher than those of the control group and T1 observation subgroup (P<0.05).The incidence of postpartum hemorrhage, postpartum fever, urinary retention and perineal wound infection in the T2 observation subgroup and T3 observation subgroup was significantly higher than that in the control group and T1 observation subgroup (P<0.05). Therewas no significant difference in the incidence of neonatal asphyxia or occurrence rate of NICU occupancy among the 4 groups (P>0.05).The incidence of macrosomia and neonatal acidemia in T3 observation subgroup was significantly higher than that in the control group(P<0.05). There was no significant difference in the proportion of puerperae with intrauterine fetal distress, omphaloproptosis or transferring to cesarean section due to head and pelvis asymmetry between the observation group and the control group (P>0.05). The proportion of transferring to cesarean section caused by psychological factors was significantly higher than that of the control group (P<0.05). Conclusion When the duration of second stage of labor is less than 2.5 h, the cesarean section rate can effectively reduce without changing the maternal and neonatal outcomes. When the duration is higher than 2.5 h, not only the delivery mode will be effected, andthe occurrence of postpartum complications will increase, but also the neonatal adverse outcomes will increase.