摘要目的 对比分析早产与足月初产妇的活跃期起点及产程时限差异,为临床正确处理提供依据. 方法 回顾性纳入2013年1月至2016年12月于天津市中心妇产科医院住院分娩的单胎妊娠早产初产妇(分娩孕周28～36周 +6)925例,以及同期分娩的单胎妊娠足月初产妇(分娩孕周37～41周 +6)925例.将宫口扩张曲线由平缓转向斜度最大的转折点时所对应的宫口扩张大小定为活跃期起点.比较早产与足月初产妇的活跃期起点及产程时限差异,采用两独立样本t检验、方差分析及秩和检验进行统计学分析. 结果 早产初产妇与足月初产妇相比,第一产程时限 [(5.7±2.5)与(6.8±5.2)h,t= － 5.835]、第二产程时限 [(29.9±16.8)与(34.2± 17.2)min,t=－12.637]和活跃期时限[M(P95)为1.0(3.2)与1.0(4.5)h,Z=2.017] 明显缩短,活跃期平均宫口扩张速度[M(P5)为6.7(1.8)与5.1(1.6)cm/h,Z=－2.676]明显加快,差异均有统计学意义(P值均＜0.05).早产初产妇活跃期起点分布:1 cm 25例(2.7%)、2 cm 275例(29.7%)、3 cm 258 例(27.9%)、4 cm 203 例(21.9%)、5 cm 109 例(11.8%)、≥ 6 cm 55 例(5.9%).足月初产妇活跃期起点分布:2 cm 74 例(8.0%)、3 cm 208例(22.5%)、4 cm 287 例(31.0%)、5 cm 168 例(18.2%)、6 cm 127 例(13.7%)、＞6 cm 61例(6.6%).早产初产妇活跃期起点在宫口扩张≤3 cm、≤4 cm和≤5 cm者分别占60.3%(558/925)、82.3% (761/925)和94.1%(870/925);足月初产妇活跃期起点在宫口扩张≤4 cm、≤5 cm和≤6 cm者分别占61.5%(569/925)、79.7%(737/925)和93.4%(864/925). 结论 早产初产妇与足月初产妇相比,产程时限更短,且进入活跃期更早,产程监护中不应将足月初产妇的产程标准套用于早产初产妇.

abstractsObjective To compare the starting points of the active phase of labor and labor duration between preterm and full-term primiparae and to provide evidence for appropriate labor management. Methods From January 2013 to December 2016, 925 preterm primiparae (preterm group, 28 to 36+6 weeks) and equal number of full-term primiparae (full-term group, 37 to 41+6 weeks) who delivered in Tianjin Central Hospital of Gynecology Obstetrics were recruited. The starting point of the active labor was defined as the cervical dilatation at the turning point on the cervical dilatation curve where changing from almost flat to the biggest slope. Differences in the starting points and labor duration between the two groups were compared. Statistical analysis was performed using two independent sample t-test, one way analysis of variance and rank-sum test. Results The duration of the first and second stages [(5.7±2.5) vs (6.8±5.2) h, t=－5.835; (29.9±16.8) vs (34.2± 17.2) min, t=－12.637; both P<0.001] and the active phase [M (P95): 1.0 (3.2) vs 1.0 (4.5) h, Z=2.017, P=0.047] of the preterm primiparae were all significantly shorter than those of the full-term primiparae, and the average cervical dilatation rate was significantly accelerated during the active period [M (P5): 6.7 (1.8) vs 5.1 (1.6) cm/h, Z=－2.676, P<0.001]. In the preterm group, women whose starting points of the active phase were at 1 cm, 2 cm, 3 cm, 4 cm, 5 cm and ≥ 6 cm of cervical dilatation were 25 (2.7%), 275 (29.7%), 258 (27.9%), 203 (21.9%), 109 (11.8%) and 55 (5.9%), respectively. While in the full-term group, women whose starting points of the active phase were at 2 cm, 3 cm, 4 cm, 5 cm, 6 cm and >6 cm of cervical dilatation were 74 (8.0%), 208 (22.5%), 287 (31.0%), 168 (18.2%), 127 (13.7%) and 61(6.6%), respectively. In the preterm group, the starting points of the active phase at cervical dilatation≤3 cm, ≤4 cm and ≤5 cm accounted for 60.3% (558/925), 82.3% (761/925) and 94.1% (870/925), respectively. In the full-term group, the percentages of the active phase starting at cervical dilatation≤4 cm, ≤5 cm and ≤6 cm were 61.5% (569/925), 79.7% (737/925) and 93.4% (864/925), respectively. Conclusions Preterm primiparae may experience shorter labor duration and an earlier start of the active phase than full-term primiparae. The routine labor progression model for full-term primiparae should not be applied to preterm primiparae.