Abstract:

Objective　To explore the effects of family delivery room combined with epidural analgesia on the delivery mode, duration of labor, and maternal and infant outcomes of primiparae. Methods　From October 2019 to February 2022, 805 primiparae with single term cephalic presentation who met the conditions for trial delivery in Binzhou Medical University Hospital were collected as the research objects. According to their wishes, they were divided into a home-based delivery room combined with epidural delivery analgesia group (group A, 226 cases), a home-based delivery room group (group B, 177 cases), an epidural delivery analgesia group (group C, 198 cases), and a conventional delivery group (group D, 204 cases). Group A were 21-34 (27.77±2.87) years old, group B 17-33 (27.77±3.05), group C 20-36 (27.21±3.15), and group D 19-35 (27.16±3.01). By comparing the general clinical data, labor process times, rates of conversion from natural labor to cesarean section, delivery bleeding, HGB differences before and after delivery, lateral episiotomy rates, incidence rates of postpartum urinary retention, fever rates during delivery, and various indicators of the newborn, the influence of family delivery room combined with epidural analgesia on the delivery mode, delivery process, and maternal and infant outcomes was studied. One-way analysis of variance and χ² test were applied. Results　The rates of conversion from natural labor to cesarean section in group A [9.73% (22/226)] and group C [10.61% (21/198)] were lower than those in group B [33.33% (59/177)] and group D [33.33% (68/204)]; the rate of conversion from natural labor to cesarean section was the lowest in group A. The total labor processes of group A [(8.83±3.44) h] and group C [(9.56±3.98)] h were longer than those of group B [(6.78±2.72) h] and group D [(7.24±3.12) h], with a statistical difference between the 4 groups (F=21.88, P<0.05). The total labor process, the first labor process, and the second labor process of group B were the shorter than those of the other three groups. The rate of lateral resection in group C 61.58% (109/177) was significantly higher than those in group A [45.10% (92/204)] and group B [44.07% (52/118)], with a statistical difference between the four groups (χ²=13.12, P<0.05). The urinary retention rate in group C [28.28% (56/198)] was significantly higher than those in group A [11.95% (27/226)], group B [7.91% (14/177)], and group D [5.88% (12/204)], with a statistical difference between the four groups (χ²=52.26, P<0.05). Stratified analysis of labor process intervention also showed that the total labor process, the first labor process, and the second labor process of the family delivery room group were relatively shorter than those of the other three groups; the application of epidural labor analgesia could prolong the total labor process, the first labor process, and the second labor process, but had different effects on the third labor process. Conclusions　The rate of conversion from natural labor to cesarean section and the rate of lateral episiotomy of primiparae taking home delivery room and epidural labor analgesia are lower. Epidural labor analgesia relatively prolongs the total labor process, the first labor process, and the second labor process, but they are within the normal range. There is no significant difference between the third labor process and the neonatal outcomes. It has no effect on the amount of labor bleeding and the rate of fever during labor. Therefore, this mode is worthy of promotion.

Key words:

Family delivery room, Epidural analgesia, Primiparae, Delivery mode

摘要：

目的　探讨家庭化产房联合硬膜外分娩镇痛对初产妇分娩方式、产程时长及母婴结局的影响。方法　收集于2019年10月至2022年2月期间，在滨州医学院附属医院具备试产条件且为单胎足月头位初产妇805例为研究对象。根据初产妇的意愿，将其分成四组：家庭化产房联合硬膜外分娩镇痛组（A组），226例，年龄21～34（27.77±2.87）岁；家庭化产房组（B组），177例，年龄17～33（27.77±3.05）岁；硬膜外分娩镇痛组（C组），198例，年龄20～36（27.21±3.15）岁；常规分娩组（D组），204例，年龄19～35（27.16±3.01）岁。通过比较各组间产妇的一般临床资料、产程时间、顺转剖宫产率、分娩出血量、分娩前后血红蛋白（Hb）差值、侧切率、产后尿潴留发生率、分娩时发热率、新生儿的各项指标情况等来研究家庭化产房联合硬膜外分娩镇痛对初产妇分娩方式、产程及母婴结局的影响。统计学方法采用单因素方差分析、χ²检验。结果　A组［9.73%（22/226）］、C组［10.61%（21/198）］顺转剖宫产率均小于B组［33.33%（59/177）］、D组［33.33%（68/204）］，四组中A组顺转剖宫产率最低。四组经自然分娩的产妇产程比较：A组［（8.83±3.44）h］、C组［（9.56±3.98）h］总产程较B组［（6.78±2.72）h］、D组［（7.24±3.12）h］延长，四组比较，差异有统计学意义（F=21.88，P<0.05），B组较其他三组总产程、第一产程、第二产程短。C组侧切率［61.58%（109/177）］大于A组［45.10%（92/204）］、B组44.07%（52/118），四组比较，差异有统计学意义（χ²=13.12，P<0.05）；C组尿潴留率［28.28%（56/198）］大于A组［11.95%（27/226）］、B组［7.91%（14/177）］、D组［5.88%（12/204）］，差异有统计学意义（χ²=52.26，P<0.05）。产程干预分层分析同样显示，家庭化产房组较其他三组的总产程、第一产程和第二产程相对缩短；硬膜外分娩镇痛的应用使其总产程、第一产程、第二产程相对延长，但对第三产程的影响并不相同。结论　家庭化产房联合硬膜外分娩镇痛初产妇顺转剖宫产率及侧切率更低，硬膜外分娩镇痛相对延长了总产程、第一产程、第二产程时长，但其均在正常范围内，第三产程和新生儿结局无明显差异，对分娩出血量及分娩时发热率无影响，该模式是值得推广的。

关键词:

家庭化产房, 硬膜外分娩镇痛, 初产妇, 分娩方式