基于新产程管理模式研究初产妇第二产程延长对盆底功能损伤的影响分析

Study on the Effect of The Second Stage of Labor Extension on Pelvic Floor Function Injury Based on The Management Model of New Stage of Labor

目的针对初产妇在新产程管理模式下延长第二产程盆底功能情况进行分析与研究。方法选择浙江省温州医科大学附属第二医院2019年1月—2019年10月在本院分娩的200例初产妇为研究对象,根据入选对象第二产程时长进行分组,时长≥3 h为研究组(88例),时长≤2 h为对照组(112例),分别对两组初产妇产后6~10周进行盆底综合肌力测定,并进行压力性尿失禁、盆腔器官脱垂评价,比较分析第二产程延长初产妇的盆底功能。结果研究组Ⅰ类与Ⅱ类肌力分级低于3级占比分别为60.22%、63.63%,发生压力性尿失禁占比为20.45%;对照组产妇Ⅰ类与Ⅱ类肌力分级低于3级占比分别为40.17%、36.60%,压力性尿失禁占比为5.36%,以上结果比较差异有统计学意义(P<0.05);两组初产妇均存在不同程度的盆腔器官脱垂情况,涉及阴道前壁脱垂、阴道后壁脱垂、子宫脱垂,研究组初产妇盆腔器官脱垂显著高于对照组(P<0.05)。结论基于新产程管理模式,初产妇第二产程延长可增加导致盆底功能损伤几率,此产程中需采取观察胎心率、警惕头盆不称等措施,对产妇进行差异化产程时间管理。

Objective To analyze and study the extension of pelvic floor function of primipara in the second stage of labor under the new mode of labor management.Methods 200 primiparas who delivered in Second Affiliated Hospital of Wenzhou Medical University from January 2019 to October 2019 were selected as the research objects.According to the second labor process length of the selected objects,they were divided into two groups:the study group(88 cases)whose labor time was≥3 hours,and the control group(112 cases)whose labor time was≤2 hours.The pelvic floor muscle strength of the primiparas in the two groups was measured at 6—10 weeks delivery respectively,and stress urinary incontinence was performed.The pelvic organ prolapse was evaluated and the pelvic floor function of primipara in the second stage of labor was analyzed.Results In the study group,60.22%and 63.63%of classⅠand classⅡmuscle strength grades were lower than Class 3,respectively,and 20.45%of them had stress urinary incontinence;in the control group,40.17%and 36.60%of classⅠand classⅡmuscle strength grades were lower than Class 3,respectively,and 5.36%of them had stress urinary incontinence,the above results were compared,P<0.05;in the two groups,there were different degrees of pelvic organ prolapse,involving Prolapse of anterior vaginal wall,posterior vaginal wall and uterus were significantly higher in the study group than in the control group(P<0.05).Conclusion Based on the new labor process management mode,prolongation of the second labor process of primipara can increase the risk of pelvic floor function injury.In this labor process,measures such as observing fetal heart rate and alerting the imbalance of head and pelvis should be taken to manage the different labor process of primipara.