第二产程分娩体位对母婴结局的影响

发布时间：2018-05-28 03:23

  本文选题：手膝俯卧位 + 侧卧位　； 参考：《河北医科大学》2014年硕士论文

【摘要】：目的：探讨非平卧位分娩（手膝俯卧位、侧卧位）与平卧位分娩对会阴侧切/裂伤/水肿情况、第二产程时间、产后2h出血量、羊水粪染、胎心情况及新生儿窒息率等的影响。 方法：本研究为前瞻性队列研究，对2013年1月至2014年3月期间于河北医科大学第四医院产科经阴道分娩的初产单胎头位、20-36岁、37-41+6周、非药物镇痛、估计胎儿体重在2500-4500g、无阴道分娩禁忌的633例低危产妇进行临床观察分析，将第二产程自愿选择手膝俯卧位、侧卧位中任意一种体位的317例产妇作为非平卧位组，选择平卧位分娩的316例产妇作为平卧位组，探讨分娩体位对母婴结局的影响。应用SPSS13.0统计软件进行数据分析，计量资料的比较，符合正态分布，采用均数及t检验；不符合正态分布，则采用中位数及Mann-Whitney U秩和检验。计数资料率的比较采用χ2检验、Fisher确切概率法。P0.05表示差异有统计学意义。 结果： 1非平卧位组会阴侧切率(5.36%)低于平卧位组(23.42%)，差异有统计学意义(χ2=41.91， P=0.000,OR=0.19,95%CI0.11-0.32)；会阴Ⅰ度裂伤率(85.18%)多于平卧位(65.19%)，差异有统计学意义(χ2=33.88，P=0.000,OR=3.07,95%CI2.08-4.52)；会阴Ⅱ度裂伤率(7.57%)低于平卧位组(8.23%)，会阴正中切开率(1.89%)低于平卧位组(3.16%)，但差异均无统计学意义（P0.05）；两组均无会阴完整及会阴Ⅲ度、Ⅳ度裂伤。非平卧位组会阴水肿发生率(13.56%)较平卧位组(21.20%)低，差异有统计学意义(χ2=6.43,P=0.011,OR=0.58,95%CI0.38-0.89)。2非平卧位羊水粪染发生率(20.82%)低于平卧位(33.23%)，差异有统计学意义(χ2=12.36，P=0.000, OR=0.53,95%CI0.37-0.76)。非平卧位组第二产程时间长于平卧位组，第二产程延长发生率高于平卧位组，差异均有统计学意义（P0.05）。非平卧位组产后2h出血量多于平卧位组，差异有统计学意义（P0.05）。非平卧位组无产钳或胎吸助娩者，，无肩难产者，平卧位组产钳助娩2例、胎吸助娩1例、肩难产1例，两组比较差异无统计学意义（P0.05）。两组第二产程应用缩宫素、产后应用前列腺素类药物等比较差异无统计学意义（P0.05）。 3非平卧位组胎心正常发生率(82.34%)高于平卧位组(65.82%)，差异有统计学意义(χ2=22.48，P=0.000, OR=2.42,95%CI1.67-3.51)；胎心早期减速发生率(10.09%)低于平卧位组(17.09%)，差异有统计学意义(χ2=6.59，P=0.010, OR=0.55,95%CI0.34-0.87)；胎心变异减速发生率(2.84%)低于平卧位组(6.65%)，差异有统计学意义(χ2=5.08，P=0.024, OR=0.41，95%CI0.19-0.91)；胎心晚期减速发生率(3.15%)低于平卧位组(7.59%)，差异有统计学意义(χ2=6.14，P=0.013, OR=0.39,95%CI0.19-0.84)；两组胎心过速差异无统计学意义（P0.05）。非平卧位组新生儿轻度窒息5例，平卧位组新生儿轻度窒息5例，重度窒息1例，两组新生儿窒息率比较差异无统计学意义（P0.05）。 结论：第二产程采用非平卧位分娩（手膝俯卧位、侧卧位），可以降低会阴侧切率、减轻会阴裂伤程度、减少会阴水肿、降低羊水粪染及胎心减速的发生率，改善母婴结局。非平卧位第二产程时间较长，但并未增加胎儿窘迫、阴道助娩率及新生儿窒息的发生率。对不增加母婴并发症情况下的第二产程时限，以及分娩过程对产妇盆底的影响，仍需要大样本的研究进一步探讨。非平卧位分娩过程中，产后2h内阴道出血量的中位数较平卧位分娩多，但分娩体位对产后平均出血量的影响，仍需扩大样本量进一步研究。
[Abstract]:Objective: To investigate the effects of parturition (prone position of hand and knee, lateral position) and lying position on perineum lateral cut / laceration / edema, second birth process time, postpartum 2H bleeding, amniotic fluid infection, fetal heart condition and neonatal asphyxia rate.
Methods: This study was a prospective cohort study. The clinical observation and analysis of 633 cases of low risk parturients in fourth hospital, Hebei Medical University, from January 2013 to March 2014, were 20-36 years old, 20-36 years old, 37-41+6 weeks, non drug analgesia, 633 cases of low risk maternal fetal weight in 2500-4500g and no taboo of vaginal delivery. 317 parturients in the lateral position and any kind of position in the lateral position were chosen as the non flat position group, and 316 parturients in the supine position were selected as the supine position. The effect of the birth position on the maternal and infant outcome was investigated. The data were analyzed with the SPSS13.0 software, and the data were compared with the normal distribution and the average number was used. And t test; the median and Mann-Whitney U rank sum test were not conformed to the normal distribution. The comparison of the count data rate was compared with the x 2 test, and the Fisher exact probability method.P0.05 indicated that the difference was statistically significant.
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