初产妇巨大儿分娩方式合理性探讨

目的：观察初产妇阴道分娩巨大儿时的产程特点以及对母婴的影响，从而合理安排巨大儿分娩方式，保障母婴安全。方法：对2008年1月—2010年12月在兰州大学第一医院妇产科住院行阴道试产的88例分娩巨大儿的初产妇、60例分娩正常体质量儿的初产妇以及60例择期剖宫产分娩巨大儿的初产妇的临床资料进行回顾性分析。结果：88例初产妇中有43例阴道分娩成功，其余45例阴道分娩失败的初产妇主要表现为活跃期停滞，宫颈口开大3～5 cm。阴道分娩失败改行剖宫产不增加产后出血、产褥感染及新生儿窒息的发生率。结论：对于临床上预测为巨大儿的初产妇，若无明显头盆不称，可进行试产。在产程中若出现活跃期停滞等产程异常，需及时改行剖宫产，从而降低巨大儿分娩对母婴的损伤。

Analysis of Labor Mode in Primipares with Fetal Macrosomia

Objective：To observe the birth process characteristics of primiparas via vaginal delivery macrosomia and the influence on maternal and infant，so as to make reasonable arrangements to the delivery mode of macrosomia，ensure the safety of maternal and infant. Methods：From January 2008 to December 2010 in our hospital，the data of 88 cases of fetal macrosonia with trial of labor and 60 normal newborns with trial of labor，60 cases of fetal macrosonia with selective cesarean section were subjected to retrospective analysis. Results：Of 88 deliveries of primiparas，43 cases succeeded in vaginal delivery compared with the normal controls，the study group showed shortened latent phase of labor（P＜0.05），prolonged active phase and second stage of labor（P＜0.05），while the total duration of labor were not significantly different between the two groups（P＞0.05）. 45 cases of failed vaginal delivery primiparas were mainly in the protracted active phase，when cervical dilatation was usually 3- 5 cm. Vaginal delivery failure did not increase the rate of postpartum hemorrhage，puerperal infection，and neonatal asphyxia. Conclusions：If there is no obvious cephalopelvic disproportion，normal delivery could be tried. If there is abnormal stages of labor，such as protracted active phase，it needs to divert cesarean section in time，which can reduce the damage of the macrosomia on maternal and infant.