自由体位待产下两种破膜方式对分娩结局及新生儿的影响

发布时间：2018-04-19 18:56

本文选题：人工破膜 + 自然破膜　；参考：《中国现代医学杂志》2017年22期

【摘要】：目的对比分析人工破膜与自然破膜结合自由体位待产产妇的母婴结局,探求更为安全有效的产程管理模式。方法以西藏民族大学附属医院产科2014年6月-2015年7月收治的170例产妇为研究对象,根据破膜方法分为人工破膜组(85例)与自然破膜组(85例),人工破膜组采用活跃期人工破膜并结合自由体位待产,自然破膜组在自由体位待产模式下自然破膜待产,对比两组产妇分娩结局与新生儿结局的差异。结果人工破膜组因枕位异常、宫内胎儿窘迫行剖宫产比例(22.4%)高于自然破膜组(9.6%)。人工破膜组经阴道分娩产妇第1产程时间为(537.8±50.3)min,第2产程时间为(35.8±9.1)min,产后2 h出血量(182.4±37.5)ml,均略少于自然破膜组(549.5±57.3)min、(38.5±10.5)min和(190.7±40.4)ml;宫颈撕裂(4.5%)、宫颈水肿(4.5%)、产褥感染(1.5%)、尿潴留(6.1%)发生比例略高于自然破膜组(3.9%、2.6%、0.0%和3.9%),上述组间比较差异均无统计学意义(P0.05)。人工破膜组经阴道分娩新生儿1 min Apgar评分(7.92±0.97)、产瘤发生率(21.2%)略高于自然破膜组[(7.77±0.99)、14.3%],新生儿窒息率(7.6%)略低于自然破膜组(10.4%),上述围产儿结局差异均无统计学意义(P0.05)。结论自由体位待产模式下,活跃期予人工破膜较自然破膜并未明显减少产程时间,但却增加了因枕位异常、宫内窘迫等造成的剖宫产率;建议正常产程中活跃期不要行人工破膜干预。
[Abstract]:Objective to compare and analyze the maternal and infant outcome of artificial membrane breaking and natural membrane breaking combined with free position, and to explore a more safe and effective mode of labor process management. Methods 170 pregnant women admitted from June 2014 to July 2015 in the affiliated Hospital of Tibet University for nationalities were studied. According to the method of membrane breaking, 85 cases were divided into artificial rupture group (85 cases) and natural membrane breaking group (85 cases). The difference between delivery outcome and neonatal outcome was compared between the two groups. Results the proportion of cesarean section in the artificial rupture group was 22. 4% higher than that in the natural rupture group because of the abnormal occipital position. The time of the first stage of labor was 537.8 卤50.3 min, the time of the second stage of labor was 35.8 卤9.1 min, the volume of blood loss was 182.4 卤37.5 ml at 2 h postpartum, which was slightly less than that of the group of natural rupture of membrane (549.5 卤57.3 min 38.5 卤10.5)min and 190.7 卤40.4 ml); the cervical tear was 4.5 卤4.5ml; the puerperal infection was 1.5m; the urine retention was 6.1ml). The cases were slightly higher than those in the natural membrane breaking group (P < 0.01), and the difference between the two groups was not statistically significant (P 0.05). The rate of neonatal asphyxia and neonatal asphyxia in artificial rupture group was slightly lower than that in natural rupture group (7.92 卤0.97 Apgar score 7.92 卤0.97 卤7.92 卤0.97 and 21.2g / kg), respectively, and the neonatal asphyxia rate was slightly lower than that of natural rupture group (10.4%). There was no significant difference in the perinatal outcome between the two groups (P 0.05). Conclusion in the mode of waiting for labor in free posture, artificial rupture of membrane in active period does not significantly reduce the time of labor process, but it increases the rate of cesarean section caused by occipital abnormality and intrauterine distress. It is suggested that artificial membrane breaking intervention should not be performed during the active stage of normal labor.
【作者单位】：西藏民族大学附属医院产科;
【分类号】：R714

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