中华妇产科杂志
中華婦產科雜誌
중화부산과잡지
CHINESE JOUNAL OF OBSTETRICS AND GYNECOLOGY
2008年
6期
401-404
,共4页
引产%妊娠末期%妊娠结局%产次
引產%妊娠末期%妊娠結跼%產次
인산%임신말기%임신결국%산차
Labor,induced%Pregnancy trimester,third%Pregnancy outcome%Parity
目的 探讨引产对孕41周、无妊娠合并症孕妇母儿结局的影响.方法 选择北京协和医院妇产科2002年9月至2007年4月收治的孕41-41周+0、无妊娠合并症的初产妇374例,按临产与否分为引产组225例,其中药物(包括应用缩宫素和地诺前列酮)引产173例,人工破膜引产5例,人工破膜+药物引产47例;自然临产组149例.分别对两组孕妇的一般情况、分娩方式、产后并发症、新生儿窒息发生情况、住院天数及费用等进行回顾性分析.结果 (1)引产组的剖宫产率(44.0%,99/225)明显高于自然临产组(18.1%,27/149),两组比较,差异有统计学意义(P<0.05).(2)引产组及自然临产组产后出血发生率分别为2.7%(6/225)和1.3%(2/149)、产褥病率分别为0.9%(2/225)和0.7%(1/149)、切口延期愈合发生率为0.9%(2/225)和0.7%(1/149)、尿潴留发生率分别为4.4%(10/225)和3.4%(5/149)、产时损伤发生率分别为0.4%(1/225)和0、羊水Ⅲ度污染发生率分别为11.6%(26/225)和13.4%(20/149)、新生儿窒息发生率分别为1.3%(3/225)和2.0%(3/149),两组孕妇以上各指标分别比较,差异均无统计学意义(P>0.05).(3)在阴道顺产中,第一产程时间引产组平均为413 min,自然临产组平均为461 min,两组比较,差异无统计学意义(P>0.05);第二产程时间引产组平均为40 min,自然临产组为48 min,两组比较,差异有统计学意义(P<0.05);引产组阴道顺产中第二产程超过60 min的发生率为17.1%(20/117),自然临产组为28.8%(34/118),两组比较,差异有统计学意义(P<0.05);引产组急产发生率为5.1%(6/117),自然l临产组为0,两组比较,差异有统计学意义(P<0.05).(4)住院天数自然临产组平均为(5.7±1.9)d,引产组为(6.9±2.7)d,两组比较,差异有统计学意义(P<O.05);引产组剖宫产产妇住院费用最高,平均为4480元,明显高于组内的阴道分娩及自然临产组的住院费用(P<0.05).结论 (1)对孕4l周的孕妇进行引产,会增加剖宫产率以及急产的发生率,在增加临床工作量的同时还增加孕妇的住院天数及经济支出.(2)临床上以引产方法预防过期妊娠的做法值得商榷;建议对孕41周的孕妇以等待自然临产为主,如42周仍未临产,根据临床实际情况再考虑引产.
目的 探討引產對孕41週、無妊娠閤併癥孕婦母兒結跼的影響.方法 選擇北京協和醫院婦產科2002年9月至2007年4月收治的孕41-41週+0、無妊娠閤併癥的初產婦374例,按臨產與否分為引產組225例,其中藥物(包括應用縮宮素和地諾前列酮)引產173例,人工破膜引產5例,人工破膜+藥物引產47例;自然臨產組149例.分彆對兩組孕婦的一般情況、分娩方式、產後併髮癥、新生兒窒息髮生情況、住院天數及費用等進行迴顧性分析.結果 (1)引產組的剖宮產率(44.0%,99/225)明顯高于自然臨產組(18.1%,27/149),兩組比較,差異有統計學意義(P<0.05).(2)引產組及自然臨產組產後齣血髮生率分彆為2.7%(6/225)和1.3%(2/149)、產褥病率分彆為0.9%(2/225)和0.7%(1/149)、切口延期愈閤髮生率為0.9%(2/225)和0.7%(1/149)、尿潴留髮生率分彆為4.4%(10/225)和3.4%(5/149)、產時損傷髮生率分彆為0.4%(1/225)和0、羊水Ⅲ度汙染髮生率分彆為11.6%(26/225)和13.4%(20/149)、新生兒窒息髮生率分彆為1.3%(3/225)和2.0%(3/149),兩組孕婦以上各指標分彆比較,差異均無統計學意義(P>0.05).(3)在陰道順產中,第一產程時間引產組平均為413 min,自然臨產組平均為461 min,兩組比較,差異無統計學意義(P>0.05);第二產程時間引產組平均為40 min,自然臨產組為48 min,兩組比較,差異有統計學意義(P<0.05);引產組陰道順產中第二產程超過60 min的髮生率為17.1%(20/117),自然臨產組為28.8%(34/118),兩組比較,差異有統計學意義(P<0.05);引產組急產髮生率為5.1%(6/117),自然l臨產組為0,兩組比較,差異有統計學意義(P<0.05).(4)住院天數自然臨產組平均為(5.7±1.9)d,引產組為(6.9±2.7)d,兩組比較,差異有統計學意義(P<O.05);引產組剖宮產產婦住院費用最高,平均為4480元,明顯高于組內的陰道分娩及自然臨產組的住院費用(P<0.05).結論 (1)對孕4l週的孕婦進行引產,會增加剖宮產率以及急產的髮生率,在增加臨床工作量的同時還增加孕婦的住院天數及經濟支齣.(2)臨床上以引產方法預防過期妊娠的做法值得商榷;建議對孕41週的孕婦以等待自然臨產為主,如42週仍未臨產,根據臨床實際情況再攷慮引產.
목적 탐토인산대잉41주、무임신합병증잉부모인결국적영향.방법 선택북경협화의원부산과2002년9월지2007년4월수치적잉41-41주+0、무임신합병증적초산부374례,안임산여부분위인산조225례,기중약물(포괄응용축궁소화지낙전렬동)인산173례,인공파막인산5례,인공파막+약물인산47례;자연임산조149례.분별대량조잉부적일반정황、분면방식、산후병발증、신생인질식발생정황、주원천수급비용등진행회고성분석.결과 (1)인산조적부궁산솔(44.0%,99/225)명현고우자연임산조(18.1%,27/149),량조비교,차이유통계학의의(P<0.05).(2)인산조급자연임산조산후출혈발생솔분별위2.7%(6/225)화1.3%(2/149)、산욕병솔분별위0.9%(2/225)화0.7%(1/149)、절구연기유합발생솔위0.9%(2/225)화0.7%(1/149)、뇨저류발생솔분별위4.4%(10/225)화3.4%(5/149)、산시손상발생솔분별위0.4%(1/225)화0、양수Ⅲ도오염발생솔분별위11.6%(26/225)화13.4%(20/149)、신생인질식발생솔분별위1.3%(3/225)화2.0%(3/149),량조잉부이상각지표분별비교,차이균무통계학의의(P>0.05).(3)재음도순산중,제일산정시간인산조평균위413 min,자연임산조평균위461 min,량조비교,차이무통계학의의(P>0.05);제이산정시간인산조평균위40 min,자연임산조위48 min,량조비교,차이유통계학의의(P<0.05);인산조음도순산중제이산정초과60 min적발생솔위17.1%(20/117),자연임산조위28.8%(34/118),량조비교,차이유통계학의의(P<0.05);인산조급산발생솔위5.1%(6/117),자연l임산조위0,량조비교,차이유통계학의의(P<0.05).(4)주원천수자연임산조평균위(5.7±1.9)d,인산조위(6.9±2.7)d,량조비교,차이유통계학의의(P<O.05);인산조부궁산산부주원비용최고,평균위4480원,명현고우조내적음도분면급자연임산조적주원비용(P<0.05).결론 (1)대잉4l주적잉부진행인산,회증가부궁산솔이급급산적발생솔,재증가림상공작량적동시환증가잉부적주원천수급경제지출.(2)림상상이인산방법예방과기임신적주법치득상각;건의대잉41주적잉부이등대자연임산위주,여42주잉미임산,근거림상실제정황재고필인산.
Objective To estimate the maternal.neonatal morbidity associated with induction deliveries compared with spontaneous deliveries in 41 gestational weeks uncomplicated primiparae.Methods Three hundred and seventy.four uncomplicated primiparous deliveries at 41 gestational weeks at Peking Union Medical College Hospital from Sept 2002 to Apr 2007 were reviewed.including 225 women undergoing induced labor and 149 women undergoing spontaneous labor.The induction methods included drug induction (173),rupture of membrane induction(5)and combined drug with rupture of membrane induction(47).The maternal morbidity,delivery method,matemal cost on hospital stay and neonatal asphyxia associated with induction deliveries or spantaneous deliveries were retrospectively analyzed.Results (1)There was no maternal death.The caesarean section rate in the induction group(44.0%,99/225)was significantly higher than that of spontaneous group(18.1%,27/149;P<0.05).(2)No statistically significantdifference(P>0.05)was observed between induction group and spontaneous group in the following puerperal complications:postpartum hemorrhage(2.7%,6/225 and 1. 3%,2/149 respectively),puerperal morbidity(0.9%,2/225 and 0.7%,1/149 respectively),severe amniotie fluid contamination (11.6%,26/225 and 13.4%,20/149 respectively),wound infection(0.9%,2/225 and 0.7%.1/149 respectively),urinary retention(4.4%,10/225 and 3.4%,5/149 respectively),traumata(0.4%,1/225and 0 respectively)and neonatal asphyxia(1.3%,3/225 and 2.0%,3/149 respectively).(3)The average duration of first stage of labor in the induction group(413 min)Was not significantly different from tllat of spontaneous group(461 min;P>0.05).In the induction group,more women had precipitate lahore(P<O.05)and the average duration of the second stage of labor Was shorter than that of spontaneous group (40 min and 48 min,P<0.05).(4)Spontaneous group had shorter maternal hospital stay[(5.7±1.9)days VS(6.9±2.7)days,P<0.05]and caesarean section after induction had the highest hospital expense (P<0.05).Conclusions Induction delivery at 41 weeks of gestation increases the rates of caesarean section,precipitate labor,clinical workload and hospital costs.Induction delivery as a prevention method of over due labor needs to be further discussed.Uncomplicated pregnancies of 41 weeks should be intentionally monitored if continued surveillance iS possible.They should wait for spontanous delivery.and decision of induction should be made based on ita benefit to the case.
