足月初产妇急产的围产结局及影响因素分析：381 例病例分析。
Perinatal outcome and risk factors of precipitate labor in term primipara: an analysis of 381 cases.
机构信息
1. Department of Obstetrics, Women's Hospital, Zhejiang University School of Medicine, Hangzhou 310006, China.
2. Department of Obstetrics, Shengzhou People's Hospital, Shengzhou 312400, Zhejiang Province, China.
出版信息
Zhejiang Da Xue Xue Bao Yi Xue Ban. 2022 Dec 25;51(6):724-730. doi: 10.3724/zdxbyxb-2022-0448.
OBJECTIVE
To investigate the perinatal outcome and risk factors of precipitate labor in term primipara.
METHODS
A total of 6951 full-term singleton primiparas with cephalic vaginal delivery in Women's Hospital, Zhejiang University School of Medicine from January 2020 to December 2020 were enrolled, among whom 381 cases of precipitate labor were classified as the precipitate labor group and 762 cases of normal labor were randomly selected as the control group. The perinatal outcomes of the two groups were compared, and the risk factors of precipitate labor were analyzed by multivariate logistic regression.
RESULTS
The incidence of precipitate labor in full-term, singleton pregnancy and cephalic primiparas was 5.48% (381/6951). The durations of the first and second stages of labor in the precipitate labor group were significantly shorter than that in the control group ( <0.01); while there was no significant difference in the duration of the third stage of labor between the two groups ( >0.05). Compared with the control group, the incidence of soft birth canal laceration in the precipitate labor group was increased ( <0.01). However, there was no significant difference in postpartum hemorrhage and neonatal related perinatal outcomes between the two groups (all >0.05). Multivariate logistic regression analysis showed that maternal height ( =1.038, 95% : 1.010-1.067, <0.01), gestational age at delivery ( =0.716, 95% : 0.618-0.829, <0.01), late miscarriage ( =1.986, 95% : 1.065-3.702, <0.05), membrane rupture before labor ( =1.802, 95% : 1.350-2.406, <0.01), labor induction by transcervical balloon ( =3.230, 95% : 2.027-5.147, <0.01), labor induction by propess ( =2.332, 95% 1.632-3.334, <0.01) and labor induction by oxytocin ( =0.291, 95% : 0.219-0.386, <0.01) were independently associated with precipitate labor.
CONCLUSIONS
The incidence of precipitate labor in full-term, singleton pregnancy was not low. Precipitate labor could lead to a significant increase in perineal laceration. Maternal height, history of late miscarriage, membrane rupture before labor and labor induction by transcervical balloon, labor induction by propess are risk factors, while labor induction by oxytocin and late gestational time of delivery are protective factors for precipitate labor in term primipara.
目的
探讨足月初产妇急产的围产结局及危险因素。
方法
选取 2020 年 1 月至 2020 年 12 月浙江大学医学院附属妇产科医院足月、单胎、头位初产妇 6951 例，其中急产 381 例为急产组，随机选取同期正常分娩 762 例为对照组，比较两组围产结局，采用多因素 logistic 回归分析急产的危险因素。
结果
足月、单胎、头位初产妇急产发生率为 5.48%（381/6951）。急产组产妇第一、二产程明显短于对照组（ <0.01），第三产程差异无统计学意义（ >0.05）。急产组软产道裂伤发生率高于对照组（ <0.01），但两组产后出血及新生儿相关围产结局比较差异无统计学意义（均 >0.05）。多因素 logistic 回归分析显示，产妇身高（ =1.038，95%CI：1.0101.067， <0.01）、分娩孕周（ =0.716，95%CI：0.6180.829， <0.01）、晚期流产史（ =1.986，95%CI：1.0653.702， <0.05）、胎膜早破（ =1.802，95%CI：1.3502.406， <0.01）、经宫颈球囊促宫颈成熟（ =3.230，95%CI：2.0275.147， <0.01）、普贝生促宫颈成熟（ =2.332，95%CI：1.6323.334， <0.01）、缩宫素促宫颈成熟（ =0.291，95%CI：0.219~0.386， <0.01）与急产独立相关。
结论
足月初产妇急产发生率不低，急产可显著增加软产道裂伤的发生，产妇身高、晚期流产史、胎膜早破、经宫颈球囊促宫颈成熟、普贝生促宫颈成熟是急产的危险因素，而缩宫素促宫颈成熟及分娩孕周晚是足月初产妇急产的保护因素。
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