摘要：
目的 探讨《新产程标准及处理的专家共识(2014)》(本研究称为新产程标准)的实施对低危产妇母婴围生期结局的影响.方法 选取2015年7月1日至2016年6月30日,在陆军军医大学第一附属医院产科住院分娩,并且采用新产程标准进行产程管理的2 066例低危产妇为研究对象,将其纳入研究组.选取2014年7月1日至2015年6月30日,在本院采用旧产程标准进行产程管理的2 108例低危产妇纳入对照组.采用回顾性分析方法,收集2组产妇的年龄、身高、体重、孕龄等一般临床资料,以及分娩方式(经阴道试产失败转剖宫产术分娩、产钳助产和经阴道分娩),经阴道试产失败转剖宫产术分娩指征构成比,产后出血量及其发生率;新生儿Apgar评分、出生体重及窒息发生率.采用成组t检验,对2组产妇的一般临床资料(年龄、身高、体重、孕龄),新生儿Apgar评分、出生体重等计量资料进行统计学分析.采用Mann-Whitney U秩和检验,对产后出血量进行统计学分析.采用x2检验对于经阴道试产失败转剖宫产术分娩率、产钳助产率、经阴道分娩率、产后出血发生率等计数资料进行统计学分析.本研究遵循的程序符合陆军军医大学第一附属医院人体试验委员会制定的伦理学标准,并得到该伦理委员会审查[批准文号:2014年科研第(102)号],与产妇本人及其家属均签署临床研究知情同意书.结果 ①2组产妇的年龄、身高、体重、孕龄及新生儿出生体重比较,差异均无统计学意义(P＞0.05).②研究组的经阴道试产失败转剖宫产术分娩率及产钳助产率,分别为27.4％(566/2 066)与2.4％(50/2 066),均显著高于对照组的36.7％(774/2 108)与8.1％(171/2 108),研究组的经阴道分娩率为70.2％(1 450/2 066),显著低于对照组的55.2％(1 163/2 108),2组分别比较,差异均有统计学意义(x2=41.592、67.412、100.451,P＜0.001).③经阴道试产失败转剖宫产术分娩的指征构成比中,研究组产妇的产程时限异常(潜伏期延长、活跃期停滞及第二产程延长)发生率,均显著低于对照组,差异均有统计学意义(x2=73.925、69.443、35.734,P＜0.001);研究组产妇的胎儿宫内窘迫发生率为46.6％ (264/566),显著高于对照组的20.7％(160/774),并且差异有统计学意义(x2=101.950,P＜0.001).④2组产妇的产后出血量和产后出血发生率比较,差异均无统计学意义(P＞0.05).⑤2组产妇分娩新生儿的生后1、5 min Apgar评分、窒息发生率比较,差异均无统计学意义(P＞0.05).结论 新产程标准的实施可降低低危产妇的经阴道试产失败转剖宫产率和产钳助产率,促进自然分娩,并且不会增加母婴围生期不良妊娠结局,值得在临床上推广应用.%Objective To investigate the effects of the implementation of Expert Consensus on the New Standard and Treatment of Labor Stage new standard of labor stage on perinatal outcomes in low-risk puerperae.Methods A total of 2 066 low-risk puerperae who were hospitalized in the Department of Obstetrics of First Affiliated Hospital of Army Military Medical University from July 1,2015 to June 30,2016 and were managed by new standard of labor stage,were selected and included into study group.Meanwhile,another 2 108 low-risk puerperae who were managed by old standard of labor stage in the same hospital from July 1,2014 to June 30,2015 were selected and included into control group.The following items were retrospectively analyzed and compared,general clinical data (age,height,weight,gestational age),modes of delivery (intrapartum cesarean section,forceps delivery,vaginal delivery),composition ratio of indications for intrapartum cesarean section,incidence of postpartum hemorrhage of parturient,Apgar score and birth weight and incidence of neonatal asphyxia of newborns.The general clinical data (age,height,weight,gestational age),newborn birth weight and Apgar score of newborns between two groups were statistically analyzed by independent-samples t test.The amount of postpartum hemorrhage were statistically analyzed by Mann-Whitney U rank sum test.The incidence of intrapartum cesarean section,forceps delivery and vaginal delivery were statistically analyzed by chi-square test.The procedures followed in this study were in accordance with the ethical standards established by the Human Subjects Trial Committee of First Affiliated Hospital of Army Medical University,and this study was approved by this committee [Approval No.2014(102)].Informed consent was obtained from each individual participant included in the study.Results ①There were no significant differences between two groups in the general clinical data and birth weight of newborns (P ＞ 0.05).②The intrapartum cesarean section rate and forceps delivery rate in study group were 27.4％ (566/2 066) and 2.4％ (50/2 066) respectively,which were significantly higher than those of control group 36.7％ (774/2 108) and 8.1％ (171/2 108),while the vaginal delivery rate of study group was 70.2％ (1 450/2 066),which was significantly lower than that of control group 55.2％ (1 163/2 108),and the differences were statistically significant (x2 =41.592,67.412,100.451;all P＜0.001).③ For the indications of intrapartum cesarean section,the incidences of abnormal labor duration (extended labor incubation period,stagnation of active period,extended second stage of labor) of study group were significantly lower than these of control group (x2 =73.925,69.443,35.734;all P＜0.001).While the incidence of fetal distress in study group was 46.6％ (264/566),which was higher than that of 20.7％ (160/774) in control group,and the difference was statistically significant (x2=101.950,P＜ 0.001).④Moreover,there were no significant differences between two groups in the amount of postpartum hemorrhage and the incidence of postpartum hemorrhage (P ＞ 0.05).⑤ There were no significant differences between two groups in Apgar score of 1 min and 5 min after birth and incidence of neonatal asphyxia (P ＞ 0.05).Conclusions New standard of laber stage can reduce the incidence of intrapartum cesarean section and forceps delivery,promote vaginal delivery in low-risk puerperae,and it will not increase the risk of adverse perinatal outcomes.New standard of labor stage is worthy of clinical application.
