初产妇无痛分娩第二产程中自由体位与传统体位对妊娠结局的影响

Effect of Free and Traditional Postures of Primipara during the Second Stage of Painless Labor on Pregnancy Outcomes

【目的】探讨初产妇无痛分娩第二产程中自由体位与传统体位对妊娠结局的影响。【方法】120例初产妇随机分为自由组和传统组各60例。两组均采用无痛分娩椎管内麻醉.待进入第二产程后,传统组采用传统卧位待产,自由组采用自由体位待产。比较两组产程、妊娠结局、并发症发生情况及产后主观分娩疼痛程度、分娩控制感。【结果】自由组初产妇第二产程时间、胎心异常好转时间明显短于传统组(P<0.05),且第二产程中胎心率异常发生率明显低于传统组;自由组初产妇自然分娩率明显高于传统组,中转剖宫产率明显低于传统组(P<0.05);与传统组相比,自由组初产妇会阴侧切率显著降低M产后不适、张力性尿失禁发生率及新生儿窒息发生率明显减少(P<0.05);且自由组初产妇主观分娩视觉模拟疼痛(VAS)评分明显低于传统组,分娩控制量表(LAS)评分明显高于传统组(P<0.05)。【结论】与传统体位相比,初产妇无痛分娩第二产程中采用自由体位待产可明显缩短产程时间,提高自然分娩率,减少母婴并发症,并可进一步减轻分娩疼痛和提高分娩控制感,值得临床推广应用。

【Objective】To investigate the effect of free posture and traditional position of primipara during the second stage of painless labor on pregnancy outcomes.【Methods】A total of 120 pri mi paras were randomly divided into the free group and the traditional group,with 60 cases in each group.The prenatal intervention of the two groups was the same,and they were given spinal anesthesia of painless labor.When entering the second stage of labor,the traditional group adopted the traditional supine before delivery while the free group adopted free position.Comparisons were made between the two groups in terms of labor process,pregnancy outcome,complications,postpartum subjective pain and sense of delivery control.【Results】The second stage of labor in the free group was significantly shorter than that in the traditional group(P<0.05),and the incidence of abnormal fetal heart rate in the second stage of labor was significantly lower than that in the traditional group.The improvement time of abnormal fetal heart rate was significantly shorter than that in the traditional group(P<0.05).The natural delivery rate of primipara in the free group was significantly higher than that in the traditional group,and the transit cesarean section rate was significantly lower than that in the traditional group(P<0.05).Compared to the traditional group,the in cidences of lateral perineal excision,postpartum discomfort,ten sion urin ary inc on tinence and neonatal asphyxia were significantly lower in the free group(P<0.05).The pain visual analogue scale(VAS)score of subjective delivery in the free group was significantly lower than that in the traditional group,and the parturition control(LAS)score was significantly higher than that in the traditional group(P<0.05).【Conclusion】Compared to the traditional position,the free posture during the second stage of primipara painless labor can shorten the labor time,improve the rate of natural delivery and reduce maternal and neonatal complications.Thus,it can further reduce labor pain and improve parturition control.