自由体位配合无痛分娩对初产妇的影响

Effects of free position combined with painless labor on primiparae

目的探究自由体位与传统卧位分别配合无痛分娩对初产妇产痛、产后出血率、泌乳功能和母婴结局的影响。方法回顾性分析2017年1月至12月丽水市妇幼保健院经自由体位无痛分娩(观察组)和经传统卧位无痛分娩(对照组)的初产妇各104例临床资料。比较两组产妇产痛程度[第二产程末视觉模拟评分法(VAS)]、产后出血情况(产后2h出血量、产后出血发生率)、分娩方式(自然分娩、阴道助产、剖宫产)、经阴道分娩者第二产程时间及泌乳功能差异,并记录两组母婴结局[围生儿不良结局(宫内窘迫、新生儿窒息)、孕母不良结局(尿潴留、下肢疼痛麻木、软产道损伤)]差异。结果观察组第二产程末VAS评分、产后2h出血量均显著低于对照组(t值分别为3.764、2.800,均P<0.05),产后出血发生率显著低于对照组(χ~2=5.660,P<0.05),且孕母不良结局总发生率显著低于对照组(χ~2=4.396,P<0.05)。观察组自然分娩率明显高于对照组(χ~2=7.193,P=0.007),而剖宫产率低于对照组(χ~2=5.915,P=0.015),且观察组经阴道分娩者第二产程时间明显短于对照组(t=5.129,P=0.000)。观察组泌乳功能优于对照组(Z=2.079,P=0.038),有效泌乳率也明显高于对照组(χ~2=3.900,P=0.048)。两组围生儿不良结局及阴道助产率比较,差异无统计学意义(均P>0.05)。结论自由体位配合无痛分娩可有效降低初产妇产痛,并促进胎儿顺利经阴道娩出,且减少初产妇产后出血情况,改善初产妇产后泌乳功能,还可降低母婴不良结局发生风险,有利于保障母婴安全。

Objective To explore the effects of Liberal position or traditional lying position combined with painless labor on labor pain,postpartum hemorrhage rate,lactation function and maternal-infant outcomes of primiparae.Methods The clinical data of each of 104 primiparae who were treated with painless labor in the Liberal position(observation group)or in traditional lying position(control group)in Lishui Maternal and Child Health Care Hospital during the period from January 2017 to December 2017 were retrospectively analyzed.The degree of maternal labor pain[visual analogue scale(VAS)at the end of second stage of labor],postpartum hemorrhage(postpartum 2 h hemorrhage,incidence rate of postpartum hemorrhage),delivery modes(natural delivery,assisted vaginal labor,cesarean section),the period of second stage of labor of vaginal delivery and the lactation function were compared between the two groups.The neonatal outcomes Perinatal adverse outcomes(intrauterine distress,neonatal asphyxia)and maternal adverse outcomes(urinary retention,pain and numbness of lower limbs,soft birth canal injury)were recorded for the two groups.Results The VAS score at the end of second stage of labor and amount of postpartum 2 h hemorrhage in observation group were significantly lower than those in the control group(t=3.764,2.800,all P<0.05),and the incidence rate of postpartum hemorrhage was significantly lower than that in the control group(χ~2=5.660,P<0.05),and the total incidence rate of maternal-infant adverse outcomes was significantly lower than that in the control group(χ~2=4.396,P<0.05).The natural delivery rate in the observation group was significantly higher than that in the control group(χ~2=7.193,P=0.007)while the cesarean section rate was lower than that in the control group(χ~2=5.915,P=0.015).The period of second stage of labor of vaginal delivery in observation group was significantly lower than that in the control group(t=5.129,P=0.000).The lactation function in the observation group was better than that in the control group(Z=2.079,P=0.038),and the effective lactation rate was also significantly higher than that in the control group(χ~2=3.900,P=0.048).There was no significant difference in the perinatal adverse outcomes and rate of assisted vaginal delivery between the two groups(P>0.05).Conclusion Liberal position combined with painless labor can effectively reduce the labor pain of primiparae,and promote the smooth delivery of fetus through the vagina.And it can also reduce the postpartum hemorrhage,improve the postpartum lactation function,and reduce the risk of maternal-infant adverse outcomes,and it is beneficial to safeguard the maternal-infant safety.