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山东大学学报 (医学版) ›› 2021, Vol. 59 ›› Issue (6): 81-85.doi: 10.6040/j.issn.1671-7554.0.2020.1545

• 临床医学 • 上一篇    下一篇

新产程标准下合理选择入院时机对低危初产妇产程及分娩方式的影响

孙蓉蓉1,张文淼1,李冬2,肖碧如1,陈秋月1   

  1. 温州医科大学附属第一医院 1.产科;2.急诊科, 浙江 温州 325015
  • 发布日期:2021-06-10
  • 通讯作者: 张文淼. E-mail:zhwm63@126.com
  • 基金资助:
    温州市科技计划经费自筹项目(Y20180298)

Effects of admission time on labor duration and delivery mode among primiparas under new partogram

SUN Rongrong1, ZHANG Wenmiao1, LI Dong2, XIAO Biru1, CHEN Qiuyue1   

  1. 1. Department of Obstetrics;
    2. Department of Emergency, Wenzhou Medical University First Affiliated Hospital, Wenzhou 325015, Zhejiang, China
  • Published:2021-06-10

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摘要： 目的 探讨新产程标准管理下合理选择入院时机对低危初产妇产程及分娩方式的影响。 方法 收集2017年1月至2018年12月于温州医科大学附属第一医院产科住院分娩的低危初产妇的临床资料,总计1 057例,按孕妇入院时宫口扩张情况分为两组:宫口扩张<3 cm为A组(n=913),宫口扩张≥3 cm为B组(n=144)。采用病例-对照研究方法对两组临床资料进行单因素及多因素二元Logistic回归分析,分析入院时机对初产妇产程干预、产程及剖宫产率等妊娠结局的影响。 结果 A组孕妇体质量指数(BMI)(F=5.489, P=0.019)大于B组,分娩孕周(F=6.776, P=0.009)、胎儿出生体质量(F=9.721, P=0.002)均大于B组;A组孕妇有更高的无痛分娩比率(χ2=38.145, P<0.001),产程中催产素(χ2=10.416, P<0.001)、间苯三酚使用率(χ2=6.481, P<0.001)高于B组,第一产程时间(F=51.05, P<0.001)、总产程时间(F=49.76, P<0.001)、住院日(F=40.613, P<0.001)较B组孕妇长。A组宫产率(χ2=3.929, P=0.047)、产后出血量(F=6.724, P=0.01)、胎儿窘迫率(χ2=5.085, P=0.024)高于B组。多因素回归分析提示早入院(宫口扩张<3 cm)是第一产程(OR=3.347, 95%CI=2.062~5.431)、总产程(OR=3.792, 95%CI=2.292~6.271)时间延长的独立危险因素。 结论 宫口扩张≥3 cm入院可减少不必要的医疗干预,缩短产程时间,降低剖宫产率,改善母婴妊娠结局。

关键词: 宫口扩张, 阴道分娩, 产程, 剖宫产

Abstract: Objective To explore the effects of admission time on labor duration and delivery mode among primiparas under new partogram. Methods A retrospective analysis was conducted on the data of 1 057 primiparas during January 2017 and December 2018. The subjects were divided into group A(n=913, cervical dilatation <3 cm)and group B(n=144, cervical dilatation ≥3 cm). The effects of admission time on delivery mode and obstetric outcomes were explored using univariate and multivariate Logistic regression analyses. Results Compared with group B, group A had larger BMI(F=5.489, P=0.019), longer gestational weeks(F=6.776, P=0.009), heavier fetal weight(F=9.721, P=0.002); higher rate of painless delivery(χ2=38.145, P<0.001), higher usage rate of oxytocin(χ2=10.416, P<0.001)and phloroglucin(χ2=6.481, P<0.001); longer first labor duration(F=51.05, P<0.001), total labor duration(F=49.76, P<0.001)and hospitalization(F=40.613, P<0.001); higher rate of Cesarean section(χ2=3.929, P=0.047), higher incidence of fetal distress(χ2=5.085, P=0.024), and larger amount of postpartum bleeding(F=6.724, P=0.01). Multiple Logistic analysis revealed that early admission was independently associated with prolonged first stage of labor(OR=3.347, 95%CI=2.062-5.431)and total duration of labor(OR=3.792, 95%CI=2.292-6.271). Conclusion Admission when cervical dilatation ≥3 cm could avoid unnecessary interventions, shorten the stage of labor, reduce the high rate of Cesarean delivery and improve the pregnancy outcomes.

Key words: Cervical dilatation, Vaginal delivery, Stages of labor, Caesarean delivery

中图分类号: 

  • R714.7
[1] Antila-L(。overa)ngsjö RM, Mäenpää JU, Huhtala HS, et al. Cesarean scar defect: a prospective study on risk factors [J]. Am J Obstet Gynecol, 2018, 219(5): 458.e1-458.e8.
[2] Hesselman S, Högberg U, R(。overa)ssjö EB, et al. Abdominal adhesions in gynaecologic surgery after caesarean section: a longitudinal population-based register study[J]. BJOG, 2018, 125(5): 597-603.
[3] Abenhaim HA, Tulandi T, Wilchesky M, et al. Effect of cesarean delivery on long-term risk of small bowel obstruction [J]. Obstet Gynecol, 2018, 131(2): 354-359.
[4] Keag OE, Norman JE, Stock SJ. Long-term risks and benefits associated with cesarean delivery for mother, baby, and subsequent pregnancies: Systematic review and meta-analysis [J]. PLoS Med, 2018, 15(1): e1002494. doi: 10.1371/journal. pmed.1002494.
[5] Mitselou N, Hallberg J, Stephansson O, et al. Cesarean delivery, preterm birth, and risk of food allergy: Nationwide Swedish cohort study of more than 1 million children [J]. J Allergy Clin Immunol, 2018, 142(5): 1510-1514.e2.
[6] Lumbiganon P, Laopaiboon M, Gülmezoglu AM, et al. Method of delivery and pregnancy outcomes in Asia: the WHO global survey on maternal and perinatal health 2007-08 [J]. Lancet, 2010, 375(9713): 490-499.
[7] Li HT, Hellerstein S, Zhou YB, et al. Trends in cesarean delivery rates in China, 2008-2018 [J]. JAMA, 2020, 323(1): 89-91.
[8] Wang E. Requests for cesarean deliveries: The politics of labor pain and pain relief in Shanghai, China [J]. Soc Sci Med, 2017, 173(1): 1-8.
[9] Breckenkamp J, Läcke EM, Henrich W, et al. Advanced cervical dilatation as a predictor for low emergency cesarean delivery: a comparison between migrant and non-migrant Primiparae-secondary analysis in Berlin, Germany [J]. BMC Pregnancy Childbirth, 2019, 19(1): 1. doi: 10.1186/s12884-018-2145-y.
[10] Jeremy L NEAL, Jane M LAMP, Jacalyn S BUCK, et al. Outcomes of nulliparous women with spontaneous labor onset admitted to hospitals in preactive versus active labor [J]. J Midwifery Womens Health, 2014, 59(1): 28-34.
[11] Chuma C, Kihunrwa A, Matovelo D, et al. Labour management and obstetric outcomes among pregnant women admitted in latent phase compared to active phase of labour at Bugando Medical Centre in Tanzania [J]. BMC Pregnancy Childbirth, 2014, 14: 68. doi: 10.1186/1471-2393-14-68.
[12] Mikolajczyk RT, Zhang J, Grewal J, et al. Early versus late admission to labor affects labor progression and risk of cesarean section in nulliparous women [J]. Front Med(Lausanne), 2016, 3: 26. doi: 10.3389/fmed. 2016. 00026.
[13] Neal JL, Lamp JM, Buck JS, et al. Outcomes of nulliparous women with spontaneous labor onset admitted to hospitals in preactive versus active labor [J]. J Midwifery Womens Health, 2014, 59(1): 28-34.
[14] Ashwal E, Livne MY, Benichou JIC, et al. Contemporary patterns of labor in nulliparous and multiparous women [J]. Am J Obstet Gynecol, 2020, 222(3): 267.e1-267.e9.
[15] 中华医学会妇产科学分会产科学组, 中华医学会围产医学分会. 对“新产程标准及处理的专家共识(2014)”的理解和说明[J]. 中华妇产科杂志, 2018, 53(2): 143-144.
[16] 中华医学会妇产科学分会产科学组, 中华医学会围产医学分会. 正常分娩指南[J]. 中华妇产科杂志, 2020, 55(6): 361-370.
[17] Kobayashi S, Hanada N, Matsuzaki M, et al. Assessment and support during early labour for improving birth outcomes [J]. Cochrane Database Syst Rev, 2017, 4(4): CD011516. doi: 10. 1002/14651858. CD011516. pub2.
[18] Bedwell C, Levin K, Pett C, et al. A realist review of the partograph: when and how does it work for labour monitoring? [J]. BMC Pregnancy Childbirth, 2017, 17(1): 31. doi: 10. 1186/s12884-016-1213-4.
[19] 段然, 漆洪波. “WHO-产时管理改进分娩体验(2018)”第一产程相关推荐的解读[J]. 中国实用妇科与产科杂志, 2019, 35(4): 431-434. DUAN Ran, QI Hongbo. Interpretation of the recommendations related to the first stage of labor of WHO-Intrapartum Management to Improve Labor Experience(2018)[J]. Chinese Journal of Practical Gynecology and Obstetrics, 2019, 35(4): 431-434.
[20] Cappelletti G, Nespoli A, Fumagalli S, et al. First-time mothers’ experiences of early labour in Italian maternity care services [J]. Midwifery, 2016, 3(34): 198-204.
[21] Devane D, Lalor JG, Daly S, et al. Cardiotocography versus intermittent auscultation of fetal heart on admission to labour ward for assessment of fetal wellbeing [J]. Cochrane Database Syst Rev, 2017, 15(2): CD005122. doi: 10.1002/14651858. CD005122. pub4.
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