实施全程分娩管理模式对高危孕产妇妊娠结局的影响

Effect of continuous delivery management model on pregnancy outcome in high-risk pregnant women

摘要

目的 探讨实施全程分娩管理模式对高危孕产妇妊娠结局的影响。方法 选择2018年1月1日至2022年12月31日南京大学医学院附属鼓楼医院住院分娩的4068例孕产妇为研究对象.根据是否接受全程分娩管理服务,分为全程分娩管理组(n=1029)和对照组(n=3039),比较两组孕产妇临床资料和妊娠结局。结果 接受全程分娩管理的孕产妇在临产后对硬膜外麻醉镇痛和盐酸哌替啶的需求、剖宫产分娩率、阴道分娩产后尿潴留率和总住院天数均显著低于对照组,差异均有统计学意义(χ²/Z值介于-7.178~27.899之间,P<0.001).两组孕产妇产后24h出血量≥1000mL、宫腔水囊压迫、输注异体红细胞悬液和产后42天再入院的发生率比较,差异无统计学意义(χ²值介于0.515~2.293之间,P>0.05).Logistic回归分析结果显示发现,全程分娩管理是硬膜外分娩镇痛、盐酸哌替啶、使用二线宫缩剂、剖宫产分娩、产后住院天数>4d和阴道分娩产后尿潴留的独立保护因素,其aOR及95%CI分别为0.791(0.675~0.926)、0.744(0.578~0.957)、0.409(0.308~0.542)、0.576(0.423~0.784)、0.712(0.568~0.894)、0.684(0.538~0.869)。结论 在制定明确的孕妇收治标准及人力资源充足的前提下,为高危孕产妇提供全程分娩管理服务是安全可行的,以保障妊娠结局更安全.

Abstract

Objective To explore the effect of continuous delivery management model on pregnancy outcome of high-risk pregnant women. Methods A total of 4068 pregnant women who were hospitalized for delivery at Nanjing Drum Tower Hospital, Affiliated to Nanjing University Medical School, from January 1, 2018, to December 31, 2022, were included in this study. According to whether they received continuous delivery management, they were divided into the continuous delivery management group (n=1029) and the control group (n=3039). Clinical data and pregnancy outcomes were compared between the two groups. Results Pregnant women who received continuous delivery management had significantly lower demand for epidural labor analgesia, and pethidine hydrochloride, lower cesarean section rates, lower incidence of postpartum urinary retention after vaginal delivery, and shorter total hospitalization days compared to the control group, with statistically significant differences (χ²/Z values ranging from -7.178 to 27.899, P<0.001). However, there were no statistically significant differences between the two groups in terms of the incidence of postpartum hemorrhage ≥1000mL within 24 hours, intrauterine balloon tamponade, allogeneic red blood cell transfusion, and incidence of hospital readmission within 42 days postpartum (χ² values ranging from 0.515 to 2.293, P>0.05). Logistic regression analysis showed that continuous delivery management was an independent protective factor for epidural labor analgesia, pethidine hydrochloride use, second-line uterotonic use, cesarean delivery, postpartum hospitalization duration >4 days, and postpartum urinary retention after vaginal delivery. The aOR and 95% CI were 0.791 (0.675-0.926), 0.744 (0.578-0.957), 0.409 (0.308-0.542), 0.576 (0.423-0.784), 0.712 (0.568-0.894), and 0.684 (0.538-0.869). Conclusion Under the premise of establishing clear admission criteria for pregnant women and ensuring sufficient human resources, providing continuous delivery management services for high-risk pregnant women is a safe and feasible approach to improving pregnancy outcomes.

关键词

全程分娩管理 / 剖宫产术 / 硬膜外分娩镇痛 / 妊娠结局 / 高危孕产妇

Key words

continuous delivery management / cesarean section / epidural analgesia / pregnancy outcome / high-risk pregnant women

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基金资助

国家重点研发计划资助(2021YFC2701500)

国家重点研发计划资助(2021YFC2701501)