阴道试产失败中转剖宫产手术指征及分娩结局的临床分析

发布时间：2018-12-26 15:41

【摘要】：目的:在对延安大学附属医院5年以来经阴道试产失败中转剖宫产手术指征和分娩结局的临床资料统计整理的基础上,分析阴道试产失败中转剖宫产手术指征构成比变化,比较不同产程中转剖宫产对分娩结局的影响,为提出有效的干预措施以及选择中转剖宫产的最佳时机提供理论依据,以期达到降低阴道试产失败中转剖宫产率和改善不良分娩结局的目的。方法:选取延安大学附属医院2012年1月1日至2016年12月31日5年期间的34777例住院分娩产妇,将其中843例阴道试产失败中转剖宫产的产妇作为临床研究对象,针对其中转剖宫产率、中转剖宫产手术指征、不同产程中转剖宫产对分娩结局的影响进行回顾性分析。结果:1.2012年至2016年分娩总数逐年增加,2013年剖宫产率最高为53.13%,2015年最低为40.89%,平均剖宫产率为45.88%;2012年和2016年的中转剖宫产率分别为5.24%和3.56%,两者相比呈下降变化,差异有统计学意义(P=0.000)。2.5年期间以胎儿窘迫为中转剖宫产手术指征一直居于第一位或第二位;以产程异常为中转剖宫产手术指征由第一位下降为第三位;以社会因素为中转剖宫产手术指征一直居于第三位或第四位;以相对头盆不称为中转剖宫产手术指征由第四位上升至第二位。其他中转剖宫产手术指征顺位无变化。3.第二产程中转剖宫产的产妇其胎头娩出困难率、子宫切口延伸率、子宫收缩乏力率、产后出血率、术后发热率、腹部切口感染率均明显高于第一产程,差异有统计学意义(P0.05)。4.第二产程中转剖宫产新生儿的窒息率明显高于第一产程,差异有统计学意义(P0.05)。结论:1.总剖宫产率、阴道试产失败中转剖宫产率均呈下降变化,但仍然处于较高水平。2.胎儿窘迫是中转剖宫产重要手术指征之一,以相对头盆不称为中转剖宫产手术指征呈上升变化。降低阴道试产失败中转剖宫产率,需关注胎儿窘迫和相对头盆不称手术指征。3.第二产程中转剖宫产母婴并发症发生率均高于第一产程。因此,尽量避免在第二产程中转剖宫产,若需第二产程中转剖宫产应加强预防产后母婴并发症发生的措施。4.加强对孕期、分娩时的管理;严格把握中转剖宫产手术指征;早发现、早诊断、早处理产程中出现的异常情况,尽最大努力降低中转剖宫产率和改善不良分娩结局的发生。
[Abstract]:Objective: on the basis of statistical analysis of clinical data of indications and outcome of cesarean section during the failure of vaginal trial delivery in the hospital affiliated to Yanan University in the past 5 years, the change of the index ratio of indications for cesarean section during the failure of vaginal trial delivery was analyzed. To compare the effects of cesarean section in different stages of labor on the outcome of labor, to provide theoretical basis for effective intervention and the choice of optimal time for cesarean section. The aim is to reduce the rate of cesarean section and improve the bad delivery outcome. Methods: 34777 hospitalized parturients were selected from the affiliated Hospital of Yan'an University from January 1, 2012 to December 31, 2016. Among them, 843 women who failed in vaginal trial delivery were selected as the clinical study objects. According to the rate of cesarean section, the indication of cesarean section and the influence of different stages of cesarean section on the outcome of labor, this paper analyzed retrospectively the effect of cesarean section on the outcome of labor. Results: 1. The total number of births increased year by year from 2012 to 2016, the highest rate of cesarean section was 53.13 in 2013, the lowest was 40.89 in 2015, and the average cesarean section rate was 45.88; The rates of caesarean section in 2012 and 2016 were 5.24% and 3.56%, respectively. The difference was statistically significant (P0. 000). During 2.5 years, fetal distress was always the first or second indication of cesarean section. The indication of cesarean section with abnormal labor process decreased from the first to the third, and the social factor was always the third or the fourth. The relative cephalopelvic is not called transitional cesarean section from the fourth to the second. The indications of other transmissible cesarean section were not changed. 3. The rate of fetal head delivery difficulty, uterine incision elongation, uterine contraction fatigue, postpartum hemorrhage rate, postoperative fever rate, abdominal incision infection rate were significantly higher in the second stage of labor than in the first stage of labor. The difference was statistically significant (P0.05). 4. The asphyxia rate of newborns transferred to cesarean section in the second stage of labor was significantly higher than that in the first stage of labor (P0.05). Conclusion: 1. The total rate of cesarean section and the rate of conversion to cesarean section during the failure of vaginal trial delivery were all decreased, but were still at a high level of 2.2%. Fetal distress is one of the important indications of cesarean section. To reduce the rate of caesarean section during vaginal trial labor failure, we should pay attention to fetal distress and the indication of relative cephalopelvic disproportion. The incidence of complications in the second stage of labor converted to cesarean section was higher than that in the first stage of labor. Therefore, to avoid the second stage of labor transfer cesarean section, if the second stage of cesarean section should be strengthened to prevent the occurrence of postpartum complications. 4. Strengthen the management of pregnancy and delivery; strictly grasp the indications of the transition to cesarean section; early detection, early diagnosis, early treatment of abnormal conditions in the labor process, do their utmost to reduce the rate of transition cesarean section and improve the occurrence of bad delivery outcome.
【学位授予单位】：延安大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R719.8

【参考文献】