坐式分娩在矫正持续性枕横位、枕后位中的应用
2022-06-09
【论文摘要】目的 探讨坐式分娩在矫正持续性枕横位、枕后位孕妇中的应用效果。 方法 选取2014年1～12月在本科住院并要求阴道试产且活跃晚期经阴道检查确诊为持续性枕横位、枕后位的120例足月妊娠孕妇作为研究对象，随机分成观察组 和对照组，各60例。观察组在第二产程采用坐式分娩，对照组采用传统仰卧位分娩，比较两组的临床效果。 结果 观察组的经阴道分娩率显著高于对照组，差异有统计学意义（P<0.05）。观察组的第二产程时间显著短于对照组，产后2 h阴道出血量显著少于对照组，1 min新生儿Apgar评分显著高于对照组，差异有统计学意义（P<0.05）。 结论 在持续性枕横位、枕后位孕妇第二产程中采用坐式分娩有利于纠正胎方位，能够减少母婴并发症，提高阴道分娩率。
【论文关键词】坐式分娩；第二产程；持续性枕横位、枕后位
Application of sitting delivery position on correcting persistent occipitotransverse，occipitoposterior position
LIU Hong-juan ZHENG Li-juan ZHENG Ying YU Hui-wen
Department of Obstetrics，Maternal and Child Health Care Hospital of Guangdong Province，Guangzhou 510045，China
[Abstract] Objective To explore the application effect of sitting delivery position on correcting persistent occipitotransverse，occipitoposterior position. Methods 120 full-term pregnant women definitely diagnosed as persistent occipitotransverse，occipitoposterior position by vaginal examination who were asked for vaginal trial labor in active advanced stage from January 2014 to December 2014 in our department were selected and randomly divided into the observation group and the control group，60 cases in each group.The observation group was given the sitting delivery position in the second stage of labor，the control group was given traditional supine position for delivery.The clinical effect in the two groups was compared. Results The rate of vaginal delivery in the observation group was higher than that in the control group，with significant difference （P<0.05）.The second stage of labor time in the observation group was shorter than that in the control group，with significant difference （P<0.05）.Postpartum 2 h vaginal bleeding volume in the observation group was less than that in the control group，the Apgar score of newborns at 1 min in the observation group was higher than that of the control group，with significant difference （P<0.05）. Conclusion Adoption of sitting delivery position is beneficial to correct position of foetus，which can reduce infant & mom complication，increase vaginal delivery rate for persistent occipitotransverse，occipitoposterior position pregnant women in the second stage of labor.
[Key words] Sitting delivery position；The second stage of labor；Persistent occipitotransverse，occipitoposterior position
持续性枕横位、枕后位是造成头位难产的主要原因，因临产后胎头衔接较晚及俯屈不良，胎先露不易贴紧子宫下段及宫颈内口，常导致继发性宫缩乏 力、宫口扩张缓慢[1]。另外，合并枕后位时，因枕骨位于骨盆后方持续压迫直肠，导致孕妇有肛门坠胀及排便感，在宫口未开全的情况下使用腹压，易导致宫颈 水肿及产妇疲劳，影响产程进展，常需要剖宫产或阴道助产[2]。对产妇而言，以上情况容易发生软产道损伤，增加产后出血及感染机会，若胎头长时间压迫软产 道，还可发生缺血、坏死、脱落，形成生殖道瘘；对于胎儿而言，因第二产程延长和手术助产常出现胎儿宫内窘迫和新生儿窒息，使围生儿死亡率增高[3-4]， 因此，在产程中纠正枕横位、枕后位受到产科工作者的特别重视。为争取阴道分娩，尽量减少母婴损伤，本研究选取在本科分娩的枕横位、枕后位孕妇作为研究对 象，在第二产程采用坐式分娩，取得了较满意的效果。
1 资料与方法
1.1 一般资料
选取2014年1～12月在本科住院并要求阴道试产的120例足月妊娠孕妇作为研究对象，均于活跃晚期经阴道检查确诊为持续性枕横位、枕后 位。持续性枕横位、枕后位诊断标准：在分娩过程中，胎头以枕后位或枕横位衔接，在下降过程中，胎头枕骨持续不能转向前方，直至分娩后期仍位于母体骨盆后方 或侧方，致使分娩发生困难者，称为持续性枕横位或持续性枕后位[5]。所有纳入研究的孕妇均为初产妇，并排除头盆不对称、妊娠合并严重并发症、胎儿窘迫等 情况，胎儿体重均<3500 g。将研究对象随机分为观察组和对照组，各60例。观察组中，平均年龄（29.6±1.9）岁，平均孕周为（39.5±2.4）周。对照组中，平均年龄 （27.9±2.5）岁，平均孕周为（38.9±2.6）周。两组的一般资料比较，差异无统计学意义（P>0.05），具有可比性。
1.2 方法
【论文关键词】坐式分娩；第二产程；持续性枕横位、枕后位
Application of sitting delivery position on correcting persistent occipitotransverse，occipitoposterior position
LIU Hong-juan ZHENG Li-juan ZHENG Ying YU Hui-wen
Department of Obstetrics，Maternal and Child Health Care Hospital of Guangdong Province，Guangzhou 510045，China
[Abstract] Objective To explore the application effect of sitting delivery position on correcting persistent occipitotransverse，occipitoposterior position. Methods 120 full-term pregnant women definitely diagnosed as persistent occipitotransverse，occipitoposterior position by vaginal examination who were asked for vaginal trial labor in active advanced stage from January 2014 to December 2014 in our department were selected and randomly divided into the observation group and the control group，60 cases in each group.The observation group was given the sitting delivery position in the second stage of labor，the control group was given traditional supine position for delivery.The clinical effect in the two groups was compared. Results The rate of vaginal delivery in the observation group was higher than that in the control group，with significant difference （P<0.05）.The second stage of labor time in the observation group was shorter than that in the control group，with significant difference （P<0.05）.Postpartum 2 h vaginal bleeding volume in the observation group was less than that in the control group，the Apgar score of newborns at 1 min in the observation group was higher than that of the control group，with significant difference （P<0.05）. Conclusion Adoption of sitting delivery position is beneficial to correct position of foetus，which can reduce infant & mom complication，increase vaginal delivery rate for persistent occipitotransverse，occipitoposterior position pregnant women in the second stage of labor.
[Key words] Sitting delivery position；The second stage of labor；Persistent occipitotransverse，occipitoposterior position
持续性枕横位、枕后位是造成头位难产的主要原因，因临产后胎头衔接较晚及俯屈不良，胎先露不易贴紧子宫下段及宫颈内口，常导致继发性宫缩乏 力、宫口扩张缓慢[1]。另外，合并枕后位时，因枕骨位于骨盆后方持续压迫直肠，导致孕妇有肛门坠胀及排便感，在宫口未开全的情况下使用腹压，易导致宫颈 水肿及产妇疲劳，影响产程进展，常需要剖宫产或阴道助产[2]。对产妇而言，以上情况容易发生软产道损伤，增加产后出血及感染机会，若胎头长时间压迫软产 道，还可发生缺血、坏死、脱落，形成生殖道瘘；对于胎儿而言，因第二产程延长和手术助产常出现胎儿宫内窘迫和新生儿窒息，使围生儿死亡率增高[3-4]， 因此，在产程中纠正枕横位、枕后位受到产科工作者的特别重视。为争取阴道分娩，尽量减少母婴损伤，本研究选取在本科分娩的枕横位、枕后位孕妇作为研究对 象，在第二产程采用坐式分娩，取得了较满意的效果。
1 资料与方法
1.1 一般资料
选取2014年1～12月在本科住院并要求阴道试产的120例足月妊娠孕妇作为研究对象，均于活跃晚期经阴道检查确诊为持续性枕横位、枕后 位。持续性枕横位、枕后位诊断标准：在分娩过程中，胎头以枕后位或枕横位衔接，在下降过程中，胎头枕骨持续不能转向前方，直至分娩后期仍位于母体骨盆后方 或侧方，致使分娩发生困难者，称为持续性枕横位或持续性枕后位[5]。所有纳入研究的孕妇均为初产妇，并排除头盆不对称、妊娠合并严重并发症、胎儿窘迫等 情况，胎儿体重均<3500 g。将研究对象随机分为观察组和对照组，各60例。观察组中，平均年龄（29.6±1.9）岁，平均孕周为（39.5±2.4）周。对照组中，平均年龄 （27.9±2.5）岁，平均孕周为（38.9±2.6）周。两组的一般资料比较，差异无统计学意义（P>0.05），具有可比性。
1.2 方法