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  • 李励△,刘胜楠△,和儒林,汤春涛,胡越,刘玉环*.新产程标准指导下剖宫产率及阴道试产成功率分析[J].第二军医大学学报,2018,39(6):610-614    [点击复制]
  • LI Li△,LIU Sheng-nan△,HE Ru-lin,TANG Chun-tao,HU Yue,LIU Yu-huan*.Analysis of caesarean section rate and vaginal labor success rate guided by new criteria of labor[J].Acad J Sec Mil Med Univ,2018,39(6):610-614   [点击复制]
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新产程标准指导下剖宫产率及阴道试产成功率分析
李励△,刘胜楠△,和儒林,汤春涛,胡越,刘玉环*
0
(海军军医大学(第二军医大学)长海医院妇产科, 上海 200433
共同第一作者
*通信作者)
摘要:
目的 探讨实施新产程标准后剖宫产率、经阴道试产成功率和产程中剖宫产指征的变化情况。方法 收集2013年1月至2016年12月在海军军医大学(第二军医大学)长海医院分娩产妇的临床资料,共5 769例。将2015年1月至2016年12月分娩的2 829例产妇归为研究组,对其中经阴道试产的1 824例采用2014年中华医学会妇产科学分会产科学组提出的新产程标准处理产程;将2013年1月至2014年12月分娩的2 940例产妇作为对照组,对其中经阴道试产的1 779例采用原产程标准进行干预和管理。对两组的剖宫产率、手术指征构成比、阴道试产成功率、阴道试产中转剖宫产的指征等进行统计分析。结果 研究组产妇剖宫产率为52.7%(1 490/2 829),低于对照组(57.7%,1 696/2 940),两组差异有统计学意义(P<0.05)。在经阴道试产的产妇中,研究组阴道分娩成功率为73.4%(1 339/1 824),高于对照组(69.9%,1 244/1 779),差异有统计学意义(P<0.05)。瘢痕子宫(23.4%,348/1 490)、胎儿宫内窘迫(19.0%,283/1 490)、社会因素(11.3%,168/1 490)是研究组主要的剖宫产指征,胎儿宫内窘迫(21.0%,356/1 696)、社会因素(16.2%,275/1 696)、瘢痕子宫(14.5%,246/1 696)是对照组产妇剖宫产的主要指征,研究组剖宫产手术指征中瘢痕子宫的构成比高于对照组,社会因素和妊娠期糖尿病[5.8%(86/1 490)vs 7.5%(127/1 696)]的构成比低于对照组,差异均有统计学意义(P<0.05)。胎儿宫内窘迫及社会因素是产妇经阴道试产失败中转剖宫产的主要手术指征,研究组和对照组中胎儿宫内窘迫的构成比差异无统计学意义[36.3%(176/485)vs 37.2%(199/535),P>0.05];但研究组社会因素[26.6%(129/485)vs20.9%(112/535)]及头位胎方位异常[17.3%(84/485)vs 12.5%(67/535)]构成比高于对照组,而产程时限异常构成比低于对照组[8.9%(43/485)vs 14.8%(79/535)],差异均有统计学意义(P<0.05)。两组产妇产后出血、产道深度裂伤、新生儿窒息及产褥感染发生率差异均无统计学意义(P>0.05)。结论 新产程标准对于降低剖宫产率、提高经阴道试产成功率具有重要意义,贯彻实施新产程标准时需强调规范产程管理,遵循个体化原则标准。
关键词:  剖宫产术  自然分娩  产程标准  胎儿窘迫  妊娠糖尿病
DOI:10.16781/j.0258-879x.2018.06.0610
投稿时间:2017-12-05修订日期:2018-03-14
基金项目:国家自然科学基金(81641059),上海市加强公共卫生体系建设三年行动计划(SCREENING STUDY GWIV-26).
Analysis of caesarean section rate and vaginal labor success rate guided by new criteria of labor
LI Li△,LIU Sheng-nan△,HE Ru-lin,TANG Chun-tao,HU Yue,LIU Yu-huan*
(Department of Obstetrics and Gynecology, Changhai Hospital, Navy Medical University(Second Military Medical University), Shanghai 200433, China
Co-first authors.
* Corresponding author)
Abstract:
Objective To investigate the changes of caesarean section rate, success rate of vaginal labor and intrapartum cesarean indications after applying the new criteria of labor. Methods The clinical data of 5 769 pregnant women who delivered in Changhai Hospital of Navy Medical University (Second Military Medical University) during Jan. 2013 to Dec. 2016 were collected. Among them, 2 829 pregnant women who delivered during Jan. 2015 to Dec. 2016 were enrolled into study group, of which 1 824 women undergoing vaginal trial production were treated with the new criteria of labor by Obstetrics Group of the Society of Obstetrics and Gynecology of the Chinese Medical Association to manage the labor process; 2 940 pregnant women who delivered during Jan. 2013 to Dec. 2014 were enrolled into control group, of which 1 779 women undergoing vaginal trial production were treated according to the original criteria of labor to manage the labor process. The caesarean section rate, the composition ratio of surgical indications, the success rate of vaginal labor and the indications of vaginal trial production for conversion to cesarean section between the two groups were statistically analyzed. Results The caesarean section rate in the study group was 52.7% (1 490/2 829), being significantly lower than that in the control group (57.7%, 1 696/2 940; P<0.05). Among the pregnant women undergoing vaginal trial production, the success rate of vaginal labor in the study group was significantly higher than that in the control group (73.4%[1 339/1 824] vs 69.9%[1 244/1 779], P<0.05). Scarred uterus (23.4%, 348/1 490), fetal distress (19.0%, 283/1 490), and social factors (11.3%, 168/1 490) were the primary cesarean indications in the study group, while fetal distress (21.0%, 356/1 696), social factors (16.2%, 275/1 696), and scarred uterus (14.5%, 246/1 696) were the primary cesarean indications in the control group. The composition ratio of scarred uterus in the study group was significantly higher than that in the control group, and the ratios of social factors and gestational diabetes mellitus (5.8%[86/1 490] vs 7.5%[127/1 696]) were significantly lower than those in the control group (P<0.05). The main indications of vaginal trial production for conversion to cesarean section were fetal distress and social factors. There was no significant difference in fetal distress between the study and control groups (36.3%[176/485] vs 37.2%[199/535]), P>0.05]. However, the ratio of social factors and abnormal fetal position in the study group were significantly higher than those in the control group (26.6%[129/485] vs 20.9%[112/535], 17.3%[84/485] vs 12.5%[67/535]; P<0.05), and the date of abnormal labor progresses at a rate (including labor protraction and labor arrest) was significantly lower (8.9%[43/485] vs 14.8%[79/535], P<0.05). There were no significant differences in the incidences of postpartum hemorrhage, deep perineal laceration, neonatal asphyxia, or puerperal infection between the two groups (P>0.05). Conclusion The new criteria of labor has great clinical value in reducing the cesarean section rate and improving the success rate of vaginal trial production. When implementing the new criteria of labor, we should emphasize the standardized management of birth process and follow the principle of individualization.
Key words:  caesarean section  natural childbirth  criteria of labor  fetal distress  gestational diabetes