The Characteristics Of Birth Duration And Maternal-neonatal Outcomes In The New Obstetric Service Model

Objective: To explore the characteristics of birth duration and maternal-neonatal outcomes in the new obstetric service model, and further improve the natural delivery rate and maternal-neonatal outcomes.Methods: This study was a clinical case observation study. The subjects were the primipara who intended vaginal delivery in the Fourth Hospital of Hebei Medical University between may 2014 and October 2015. All the primipara were managed according to the new obstetric service model: during the first stage of labor using the free position, the second stage of labor choose comfortable delivery position, such as lateral position and prone position according to the voluntary principle, waiting for shoulder delivery method was adopted in the midwifery process, after the delivery of the fetus umbilical cord pulsation disappeared to cut the umbilical cord. To explore the characteristics of birth duration and maternal-neonatal outcomes. Application of SPSS13.0 statistical software, the measurement normal distribution data compared with the use of Student t test and F test; do not meet the normal distribution, use the median and Mann Whitney U test or Kruskal Wallis H test, The comparison of the rates using the X~2 test,Logistic regression was used to analysis the risk factors. P<0.05 indicated that the difference was statistically significant.Result:1 A total of 679 primipara were intended vaginal delivery, of those, 538 primipara give birth through vaginal delivery, 141 primipara with cesarean delivery. Before the cervix dilatation 3cm who transferred to cesarean section, abnormal fetal heart was the main indications; 3cm-6cm transferred to cesarean section, cephalopelvic disproportion was main indications; after 6cm transferred to cesarean section, the main indication is cephalopelvic disproportion.2 The pregnant women with vaginal delivery, their starting point of active stage of labor respectively at 2cm, 3cm, 4cm, 5cm, 6cm, 7cm, 8cm were in 27 cases(5.0%), 151 cases(28.1%), 138 cases(25.7%), 122 cases(22.7%), 64 cases(11.8%), 24 cases(4.5%) and 12 cases(2.2%); the median active duration were2.3h, 3.3h, 2.6h, 2.0h, 1.5h, 1.7h, 0.8h;the 95 th percentile were 6.7h, 8.5h, 7.3h, 5.4h, 6.9h, 6.6h, 4.1h.3 The pregnant women with vaginal delivery, cervix dilatation 1cm from 2cm to 10 cm need the median time respectively were 2.2h, 1.5h, 1.3h, 1.0h, 1.1h, 0.8h, 0.8h, 0.3h, the 5th percentiles were 0.8h, 0.5h, 0.4h, 0.3h, 0.3h, 0.1h, 0.3h, 0.2h, the 95 th percentile were 9.8h, 4.6h, 3.7h, 4.4h, 4.5h, 2.1h, 2.0h, 1.0h.4 According to the duration of the second stage of labor, the primipara were divided into <1h group, 1-2h group, >2h group, in which the second stage of labor >2h group umbilical artery blood PH compared with <1h group and 1-2h group, the differences had statistical significance(P<0.05); The umbilical artery blood PH abnormality rate had no statistical significance in each group(P>0.05); the second stage >2h group 1 minute Apgar score compares with < 1h group and 1-2h group, the differences were statistically significant(P< 0.05); the abnormal rate of 1 minute Apgar score, <1h group compared with >2h group, the difference was statistically significant(P<0.05); the 5 minutes Agpar score and abnormal rate in each group had no statistical significance(P >0.05).5 The pregnant women with vaginal delivery, the incidence of neonatal asphyxia were 2.9%(16/538). The umbilical artery blood PH in asphyxia group compared with the control group decreased significantly, the difference is statistically significant(P<0.05),The umbilical artery blood PH abnormal rate in asphyxia group was significantly higher than the control group, the difference is statistically significant(P<0.05).6 Logistic regression analysis showed that the duration of the second stage of labor,supine position, fetal heart abnormalities are risk factors on umbilical artery blood PH.Conclusion:1 In the new obstetric service mode,the main indications for cesarean section were fetal heart abnormalities and abnormal fetal position.2 The starting point of active stage of labor have individual differences, mainly concentrated in the 3-5cm, which accounted for 28.1% of the 4cm, 3cm accounted for 25.7%, 5cm accounted for 22.7%.3 The ninety-fifth percentile of the active period is generally not more than nine hours, the fifth percentage of expansion rate is lower than 1.0cm/h.4 With the prolongation of the second stage of labor, umbilical artery blood Ph showed a downward trend, but the abnormal rate did not increase, neonatal Apgar score at 1 min and abnormal rate were increase,but after a late cut of the umbilical cord and neonatal nursing, the 5 min Apgar score,abnormal rate were not increase.5 Fetal heart rate, Apgar score and umbilical artery blood pH play a complementary role in predicting and evaluating neonatal asphyxia, providing scientific basis for neonatal intensive care and treatment.