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目的探析在实施分娩镇痛后仍需剖宫产结束妊娠的原因。方法在试产失败改行剖宫产(指征单一)的产妇中选择施行分娩镇痛的产妇290例为观察组(A组),另选未施行分娩镇痛的产妇250例为对照组(B组)。记录两组患者的剖宫产指征、缩宫素的使用情况、术中出血量、产后24 h出血量及新生儿阿普加评分。结果两组试产失败的主要原因均为胎方位异常、胎儿窘迫、活跃期停滞,其中A组胎儿窘迫发生率低于对照组(P<0.05),胎方位异常的发生率和使用缩宫素产妇所占比例高于B组(P<0.05)。术中及术后24 h出血量A组均多于B组(P<0.05),新生儿阿普加评分比较差异无统计学意义(P>0.05)。结论胎方位异常、活跃期停滞、胎儿窘迫是分娩镇痛后试产失败的主要原因。分娩镇痛可降低胎儿窘迫的风险,但对产妇子宫收缩有影响,可增加产后出血量。
Objective To investigate the reasons for cesarean section termination of pregnancy after the implementation of labor analgesia. Methods 290 maternal women who chose to perform labor analgesia as the observation group (Group A) from the failed cesarean section (group A) and 250 pregnant women who did not undergo labor analgesia as the control group (B) group). Record cesarean section indications, oxytocin use, intraoperative blood loss, 24 h postpartum hemorrhage and neonatal Apgar scores were recorded. Results The main causes of trial failure in both groups were fetal position abnormality, fetal distress and active phase arrest. The incidence of fetal distress in group A was lower than that in control group (P <0.05), and the incidence of abnormal fetal orientation and the use of oxytocin The proportion of mothers was higher than that of group B (P <0.05). The blood loss in group A was higher than that in group B at 24 h after operation (P <0.05). There was no significant difference in the Apgar scores between the two groups (P> 0.05). Conclusion Abnormal fetal position, active stagnation and fetal distress are the main reasons for failure of trial production after labor analgesia. Labor analgesia can reduce the risk of fetal distress, but it affects maternal uterine contractions and increases the amount of postpartum hemorrhage.