中华围产医学杂志
中華圍產醫學雜誌
중화위산의학잡지
CHINESE JOURNAL OF PERINATAL MEDICINE
2013年
3期
148-152
,共5页
分娩过程%剖宫产术%接生,产科%妊娠结局
分娩過程%剖宮產術%接生,產科%妊娠結跼
분면과정%부궁산술%접생,산과%임신결국
Labor,obstetric%Cesarean section%Delivery,obstetric%Pregnancy outcome
目的 了解活跃期时限的处理对分娩方式以及妊娠结局的影响. 方法 2009年1月1日至12月31日,在北京大学第一医院分娩,进入产程的足月、单胎妊娠、头先露初产妇共1744例.回顾性分析其中417例活跃期时限出现异常(包括活跃期停滞和活跃期延长)者的病历资料,采用卡方检验分析活跃期停滞时间对阴道分娩和剖宫产分娩者妊娠结局的影响. 结果 417例活跃期停滞者中,剖宫产者205例,阴道分娩者212例.活跃期停滞发生率为23.9％(417/1744).其中50例伴活跃期延长,发生率为2.9％(50/1744).阴道分娩者中活跃期≥6h者新生儿转儿科率高于活跃期＜6 h组[20.6％(26/126)与8.1％(7/86),x2＝6.07,P＜0.05],剖宫产者中活跃期＜6h者宫内感染发生率高于活跃期≥6h者[22.7％(30/132)与6.8％(5/73),x2=8.37,P＜0.01].阴道分娩孕妇中,宫口开大6 cm之前停滞者产后出血发生率(4.8％,9/186)、产妇并发症率(3.8％,7/186)和新生儿转儿科率(15.6％,29/186)与官口开大≥6 cm停滞者[分别为6.2％(1/16)、0.0％(0/16)和12.5％(2/16)]比较,差异均无统计学意义(x2分别为0.12、0.01和0.00,P均＞0.05).剖官产孕妇中,宫口开大6 cm之后行剖宫产者新生儿转儿科率明显高于宫口开大6 cm之前停滞者,差异有统计学意义[60.0％(6/10)与(19.9％(34/171),x2=8.83,P＜0.05].剖宫产孕妇宫口开大3 cm时停滞时间≥4h和＜4 h相比,孕妇年龄、分娩孕周、分娩时体重指数、产后出血量、新生儿出生体重等差异均无统计学意义(P均＞0.05).单纯以活跃期停滞为指征的剖宫产者新生儿转儿科率较低(11.2％,9/80),而以活跃期停滞合并宫内感染为指征的剖宫产者新生儿转儿科率较高(42.1％,16/38).结论 宫口扩张6 cm以下出现活跃期异常者,母儿情况良好,可适当延长产程观察时限.阴道分娩者如活跃期时限≥6h,要注意新生儿情况.
目的 瞭解活躍期時限的處理對分娩方式以及妊娠結跼的影響. 方法 2009年1月1日至12月31日,在北京大學第一醫院分娩,進入產程的足月、單胎妊娠、頭先露初產婦共1744例.迴顧性分析其中417例活躍期時限齣現異常(包括活躍期停滯和活躍期延長)者的病歷資料,採用卡方檢驗分析活躍期停滯時間對陰道分娩和剖宮產分娩者妊娠結跼的影響. 結果 417例活躍期停滯者中,剖宮產者205例,陰道分娩者212例.活躍期停滯髮生率為23.9％(417/1744).其中50例伴活躍期延長,髮生率為2.9％(50/1744).陰道分娩者中活躍期≥6h者新生兒轉兒科率高于活躍期＜6 h組[20.6％(26/126)與8.1％(7/86),x2＝6.07,P＜0.05],剖宮產者中活躍期＜6h者宮內感染髮生率高于活躍期≥6h者[22.7％(30/132)與6.8％(5/73),x2=8.37,P＜0.01].陰道分娩孕婦中,宮口開大6 cm之前停滯者產後齣血髮生率(4.8％,9/186)、產婦併髮癥率(3.8％,7/186)和新生兒轉兒科率(15.6％,29/186)與官口開大≥6 cm停滯者[分彆為6.2％(1/16)、0.0％(0/16)和12.5％(2/16)]比較,差異均無統計學意義(x2分彆為0.12、0.01和0.00,P均＞0.05).剖官產孕婦中,宮口開大6 cm之後行剖宮產者新生兒轉兒科率明顯高于宮口開大6 cm之前停滯者,差異有統計學意義[60.0％(6/10)與(19.9％(34/171),x2=8.83,P＜0.05].剖宮產孕婦宮口開大3 cm時停滯時間≥4h和＜4 h相比,孕婦年齡、分娩孕週、分娩時體重指數、產後齣血量、新生兒齣生體重等差異均無統計學意義(P均＞0.05).單純以活躍期停滯為指徵的剖宮產者新生兒轉兒科率較低(11.2％,9/80),而以活躍期停滯閤併宮內感染為指徵的剖宮產者新生兒轉兒科率較高(42.1％,16/38).結論 宮口擴張6 cm以下齣現活躍期異常者,母兒情況良好,可適噹延長產程觀察時限.陰道分娩者如活躍期時限≥6h,要註意新生兒情況.
목적 료해활약기시한적처리대분면방식이급임신결국적영향. 방법 2009년1월1일지12월31일,재북경대학제일의원분면,진입산정적족월、단태임신、두선로초산부공1744례.회고성분석기중417례활약기시한출현이상(포괄활약기정체화활약기연장)자적병력자료,채용잡방검험분석활약기정체시간대음도분면화부궁산분면자임신결국적영향. 결과 417례활약기정체자중,부궁산자205례,음도분면자212례.활약기정체발생솔위23.9％(417/1744).기중50례반활약기연장,발생솔위2.9％(50/1744).음도분면자중활약기≥6h자신생인전인과솔고우활약기＜6 h조[20.6％(26/126)여8.1％(7/86),x2＝6.07,P＜0.05],부궁산자중활약기＜6h자궁내감염발생솔고우활약기≥6h자[22.7％(30/132)여6.8％(5/73),x2=8.37,P＜0.01].음도분면잉부중,궁구개대6 cm지전정체자산후출혈발생솔(4.8％,9/186)、산부병발증솔(3.8％,7/186)화신생인전인과솔(15.6％,29/186)여관구개대≥6 cm정체자[분별위6.2％(1/16)、0.0％(0/16)화12.5％(2/16)]비교,차이균무통계학의의(x2분별위0.12、0.01화0.00,P균＞0.05).부관산잉부중,궁구개대6 cm지후행부궁산자신생인전인과솔명현고우궁구개대6 cm지전정체자,차이유통계학의의[60.0％(6/10)여(19.9％(34/171),x2=8.83,P＜0.05].부궁산잉부궁구개대3 cm시정체시간≥4h화＜4 h상비,잉부년령、분면잉주、분면시체중지수、산후출혈량、신생인출생체중등차이균무통계학의의(P균＞0.05).단순이활약기정체위지정적부궁산자신생인전인과솔교저(11.2％,9/80),이이활약기정체합병궁내감염위지정적부궁산자신생인전인과솔교고(42.1％,16/38).결론 궁구확장6 cm이하출현활약기이상자,모인정황량호,가괄당연장산정관찰시한.음도분면자여활약기시한≥6h,요주의신생인정황.
Objective To investigate the effects of duration of active phase on delivery mode and pregnancy outcome.Methods Data of 417 women with abnormal active phase identified from 1744 term-birth,singleton,cephalic presentation primiparas who had tried vaginal delivery in Peking University First Hospital from January 1,2009 to December 31,2009 were retrospectively studied.Effects of different durations of protracted active phase on pregnancy outcomes were compared between women with vaginal delivery or cesarean section by Chi square test.Results The incidence of protracted active phase was 23.9％ (417/1744); and the incidence of prolonged active phase was 2.9％ (50/1744).There were 205 cases of cesarean section and 212 cases of vaginal deliveries.The incidence of neonates hospitalization in Department of Pediatrics in vaginal delivery group with active phase ≥6 h was higher than that of those with active phase ＜6 h [20.6％ (26/126) vs 8.1％ (7/86),x2 =6.07,P＜0.05].The incidence of intrauterine infection in cesarean section group with active phase ＜6 h were higher than that of those with active phase ≥6 h [22.7％ (30/132) vs 6.8％(5/73),x2 =8.37,P＜0.01].In vaginal group with protracted active phase before 6 cm of cervical dilation,the incidences of postpartum hemorrhage (4.8％,9/186),maternal complications (3.8％,7/186) and neonates hospitalization (15.6％,29/186) were similar with those after 6 cm of cervical dilation [6.2％ (1/16),x2=0.12; 0.0％ (0/16),x2=0.01 and 12.5％ (2/16),x2=0.00; all P＞0.05] respectively.In cesarean delivery group with cervical dilation ≥6 cm,the incidence of neonates hospitalization was higher than that of those with cervical dilation ＜6 cm [60.0％ (6/10) vs 19.9％ (34/171),x2 =8.83,P＜0.05].There were no difference in maternal age,gestational age,body mass index at delivery,volume of postpartum hemorrhage and neonatal birth weight between women with cesarean section whose protracted active phase ≥4 h or ＜4 h when cervical dilation at 3 cm (P＞ 0.05 respectively).The incidence of neonates hospitalization was low in women whose indication of cesarean section was protracted active phase (11.2％,9/80),while it was high when protracted active phase complicated with intrauterine infection (42.1％,16/38).Conclusions Protracted active phase with cervical dilation less than 6 cm might not need active management if neither the mother nor the fetus is compromised.The infants born vaginally should be closely monitored if the active phase is over 6 h.
