The Clinical Observation Of The New Labor Process Standard In Term Pregnancy

Objective:To explore the applicability and advantage of production process of the new obstetrics labor standards, and compare the difference of delivery women in labor modes, progress intervention, vaginal delivery rate, cesarean section rate, maternal and infant prognosis between the new and the old labor standards under the premise of maternal and infant safety. Materials and methods:Retrospective collected pregnant women in term pregnancy and trial of labor from April 1, 2013 to Mar 31, 2014(12 months) and August 1, 2015 to January 31, 2016(6 months) in the First Affiliated Hospital of Jinan University(Guangzhou Overseas Chinese Hos) were chose as object, and their clinical data were collected. The objects before and after the implementation of new production process standards were divided into control group(old labor group) and observation group(new labor group),there are 1977 cases in control group and 1116 cases in observation group. There are 53 cases of repeated pregnancy after cesarean section in observation group, that means pregnant n times but production one. No trial of labor in last pregnancy as the indications for cesarean section, but be will to trail of labor and no contraindication of it, they will be divided into scar group and non scar group. The observation group were divided into analgesia group and non analgesia group for the reason of labor analgesia or not. Delivery women with analgesia of control group and observation group were named old analgesia group and new analgesia group.The control group were observed and treated by Friedman production process standards(old production process standards), and new production process standards were used in observation group. Data analysis uses SPSS16.0 statistical software to carry out normal testing. Measurement data is showed as`c±s and uses t testing for comparison. Comparison of enumeration data uses χ2 testing. P < 0.05 means the difference is statistically significant. Results:1. Comparison of general informatio n, prenatal pregnancy comorbidity and complication between the observation group and control groupThere is no statistic difference of educational background, age, actual gestational weeks and neonatal birth weight(NBW) in pregnant women between observation group and control group(P>0.05),either of accident rate in gestational diabetes mellitus(GDM), Hypertensive disorder complicating pregnancy(HDCP), pregnancy associated with hysteromyoma, premature rupture of membranes, hydramnios and hypamnion(P>0.05).2. Comparison of maternal delivery modes between the ne w and the old labor standardsThe vaginal delivery rate and vaginal spontaneous labor rate in observation group are all higher than that in control group, so as assisted vaginal delivery rate,but lower of cesarean section rate. There is significant difference of delivery modes between the two groups(P<0.05).No incidence of uterine rupture, the rate of vaginal delivery is lower slightly than that in non scar group,but cesarean section rate is higher slightly in scar group.The rate of vaginal delivery in new analgesia group is higher than old analgesia group, while the cesarean section rate is lower than old analgesia group, the differences is significant(P<0.05), but no statistic difference in the comparison of delivery rate between those two during the second stage of labor which is over 2 hours(P>0.05). But delivery rate in new analgesia group which is over 2 hours is higher.The incident rate of vaginal delivery rate and the second stage of delivery over 2 hours in analgesia delivery group is higher than that in non analgesia delivery group, but there is no statistic difference between those two rate(P>0.05).3. Comparison of the obstetric intervention methods in the first stage of labor between the observation group and control groupThe intervention rate of artificial rupture and intravenous oxytocin in observation group is lower obviously than that in control group, the differences is significant(P<0.05),but higher rate in use of sedation and labor analgesia(P<0.05).4. Comparison of delivery outcome between the observation group and control groupThere is no statistic difference of incident rate in postpartum hemorrhage, puerperal infection, postpartum retention of urine, serious perineal laceration and episiotomy infection(P>0.05) between observation group and control group,so as the incident rate of episiotomy/direct resection and mild perineal laceration(P<0.05).5. Comparison of perinatal outcomes between the observation group and control groupThere is no statistic difference of incident rate in perinatal fetal distress, Neonatal Apgar score,asphyxia neonatorum, meconium aspiration syndrome, Neonatal transfer and giant baby between observation group and control group(P>0.05).6. Comparison of the main reasons for the transit cesarean section between the observation group and control groupThe transit cesarean section rate for the reason of production process time limit in observation group is lower obviously than that in control group(P<0.05), so as the reasons of relative cephalopelvic disproportion, fetal distress, malposition in observation group(P<0.05), but no statistic difference of transit cesarean section rate for the reasons of social factors in observation group(P>0.05). Conclusions:(1) Trial of labor completely according to the new labor standards and the emphasis of supporting therapy such as using sedation and labor analgesia can reduce interventions of artificial rupture of non medical indications and intravenous oxytocin.(2) Promoting vaginal delivery according to the new labor standards can increase the rate of vaginal delivery and eutocia, reduce cesarean section rate and no obvious increasing of adverse maternal and infant outcomes. To a certain extent, assisted vaginal delivery was increased.(3) With any reasonable indication, the new labor standards are also suitable for the woman previously received cesarean section, which greatly reduces cesarean section rate.