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目的探讨自然分娩初产妇第一产程活跃期起点、活跃期时限及活跃期宫口平均扩张速率的分布情况。方法回顾性分析2013年1月-2014年12月该院东院产科经阴道分娩的单胎、头位、自然临产初产妇的产程图及产程观察记录表,将宫颈扩张曲线由平缓转向斜度最大的转折点时所对应的宫颈扩张情况定为活跃期起点,记录每例产妇的活跃期起点、活跃期时限及活跃期宫口平均扩张速率。按照活跃期起点不同进行分组,采用中位数(第5百分位数或第95百分位数)描述活跃期时限及活跃期宫口平均扩张速度的分布情况。结果 1 017例初产妇中活跃期起点位于宫口扩张2 cm、3 cm、4 cm、5 cm、6cm、7 cm和8 cm分别有44例(4.3%)、249例(24.5%)、373例(36.7%)、209例(20.6%)、88例(8.7%)、34例(3.3%)和19例(1.9%);各组活跃期时限的中位数为2.0 h、3.0 h、2.5 h、1.8 h、1.4 h、1.2 h、0.8 h;第95百分位数分别为5.9 h、8.6 h、8.0 h、5.5 h、6.2 h、4.5 h、2.0 h;各组活跃期宫口平均扩张速率的中位数分别为4.0 cm/h、2.3 cm/h、2.4 cm/h、2.9 cm/h、2.9 cm/h、2.5 cm/h、2.7/h;第5百分位数分别为1.4 cm/h、0.8 cm/h、0.8 cm/h、0.9 cm/h、0.7 cm/h、0.7 cm/h、0.4 cm/h。结论活跃期起点存在个体差异,大部分位于宫口扩张3~5 cm,一旦进入活跃期,产程进展明显加速,临床中应准确判断活跃期起点,避免不必要的干预。
Objective To investigate the distribution of the first stage of spontaneous labor primipara during the active stage, the active stage and the average rate of uterine cervix expansion. Methods Retrospective analysis from January 2013 to December 2014, the hospital East Hospital obstetrics by vaginal delivery of single-fetus, head position, spontaneous labor primipara labor charts and labor observation record form, the cervical dilatation curve from the gently turning slope The largest turning point corresponding to the expansion of the cervix as a starting point for the active period, record each mothers active period, the active period and the average rate of active cervical Palace expansion. According to the different starting points of the active stage, the median (5th percentile or 95th percentile) is used to describe the distribution of the average duration of the uterine cervix during the active stage and the active stage. Results The onset period of 1 017 primipara was 2 cm in 3, 4 cm, 5 cm, 6 cm, 7 cm and 8 cm respectively. There were 44 cases (4.3%), 249 cases (24.5%) and 373 (36.7%), 209 cases (20.6%), 88 cases (8.7%), 34 cases (3.3%) and 19 cases (1.9%). The median duration of active phase in each group was 2.0 h, 3.0 h, 2.5 h, 1.8 h, 1.4 h, 1.2 h, 0.8 h; the 95th percentile was 5.9 h, 8.6 h, 8.0 h, 5.5 h, 6.2 h, 4.5 h, The average median expansion rate was 4.0 cm / h, 2.3 cm / h, 2.4 cm / h, 2.9 cm / h, 2.9 cm / h, 2.5 cm / h and 2.7 h respectively. The 5th percentile H, 0.8 cm / h, 0.8 cm / h, 0.9 cm / h, 0.7 cm / h, 0.7 cm / h, 0.4 cm / h. Conclusion There are individual differences at the beginning of the active stage, most of which are located in the cervix with an expansion of 3 ~ 5 cm. Once entering the active stage, the progress of labor process is obviously accelerated. The starting point of the active stage should be accurately judged in clinical practice to avoid unnecessary intervention.