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目的探讨第二产程胎心延长减速(prolonged deceleration,PD)对新生儿结局的影响。方法回顾性分析2014年1~10月成都市锦江区妇幼保健院3 977例足月单胎头位分娩产妇的临床资料,第二产程中胎心监护出现PD的874例作为观察组;胎心监护无PD的3 103例作为对照组,比较两组新生儿结局。结果观察组胎盘早剥、胎儿生长受限、脐带缠绕和羊水过少的发生率(分别为2.06%、2.75%、27.0%、5.26%)高于对照组(分别为0.48%、1.06%、13.99%、1.22%)(P<0.05);观察组应用缩宫素比例、第二产程时限、阴道手术产率、剖宫产率、Ⅱ度或Ⅲ度羊水粪染率[(分别为53.55%、(46.6±25.5)min、16.93%、21.97%、10.53%]高于对照组[分别为23.40%、(64.5±38.7)min、11.99%、13.02%、2.42%](P<0.05);两组新生儿窒息和新生儿转入新生儿重症监护室(neonatal intensive care unit,NICU)发生率比较差异无统计学意义(P>0.05)。观察组产妇出现PD至分娩时间超过1 h,新生儿轻、重度窒息发生率未见明显上升(P>0.05),而新生儿转入NICU率明显上升(P<0.05)。结论第二产程中胎心监护出现PD的发生率较高。在发生PD 1 h内结束分娩,可明显改善新生儿结局。
Objective To investigate the effect of prolonged deceleration (PD) on neonatal outcome in the second stage of labor. Methods The clinical data of 3 977 pregnant women with full-term single-head delivery in Maternity and Child Health Hospital of Jinjiang District, Chengdu from January to October 2014 were retrospectively analyzed. 874 PD patients with fetal heart rate monitoring in the second stage of labor were used as the observation group. 3 103 cases of non-PD as the control group, compared two groups of neonatal outcomes. Results The incidence of placental abruption, fetal growth restriction, umbilical cord entanglement and oligohydramnios in observation group were significantly higher than those in control group (2.06%, 2.75%, 27.0%, 5.26% respectively) (0.48%, 1.06%, 13.99 %, 1.22% respectively) (P <0.05). The proportion of oxytocin, the second stage of labor, the rate of vaginal surgery, the rate of cesarean section, the degree of meconium-stained amniotic fluid Ⅱ (Ⅲ.5.5% (46.6 ± 25.5) min, 16.93%, 21.97% and 10.53%, respectively, compared with those in the control group (23.40% and 64.5 ± 38.7 min, 11.99% and 13.02%, 2.42% Neonatal asphyxia and neonatal intensive care unit (neonatal intensive care unit, NICU) the incidence was no significant difference (P> 0.05) .The observation group maternal PD until delivery time more than 1 h, neonatal light (P0.05), but the NICU rate of newborn infants was significantly increased (P0.05) .Conclusion The incidence of PD in the second stage of labor was higher in patients with PD h end of delivery, can significantly improve the outcome of newborns.