羊水胎粪污染的产科处理方法探讨

Investigation of obstetric treatments on meconium - stained amniotk fluid

目的 探讨羊水胎粪污染的产科处理时机与方法。方法 对1998年1月至1998年12月在我院分娩的、产程中羊水为Ⅱ～Ⅲ度污染的220例初产妇的母婴结局进行回顾性分析,其中破膜时羊水粪染(Ⅰ组)有120例,产程中羊水由清亮变为污染(Ⅱ组)有100例;另随机选择同期产程中羊水清亮的210例产妇为对照组。结果 1254例产妇中,羊水胎粪污染的发生率为17.5％;粪染组在母体合并症、胎心监护异常发生率、剖宫产率及新生儿窒息率上均高于对照组(P<0.01);Ⅱ组在胎心监护异常及新生儿窒息的发生率上高于羊水粪染Ⅰ组(P<0.01)。结论 重视羊水粪染的临床处理。在伴发母体合并症、胎心监护异常及产程中羊水由清亮变为粪染时处理需积极,以及早剖宫产及缩短第二产程为宜。在无上述情况下,可在严密监护下阴道分娩。

Objective To investigate the obstetric management opportunity and methods on meconium- stained amniotic fluid.Methods 220 pregnant women with meconium- stained amniotic fluid were divided into two groups, Meconium -stained amniotic fluid at rupture of membrane as group I , and clear amniotic fluid gradually becoming meconium - stained during labor as group Ⅱ , and were compared with 210 cases of normal amniotic fluid as control group. Results The incidence of meconium- stained amniotic fluid was 17.5% in 1 254 deliveries. Maternal complication, abnormal fetal monitoring, cesarean section rate and neonatal asphyxia were higher than those of the control group respectively. Compared with group Ⅱ , abnormal fetal monitoring and neonatal asphyxia were significatedly lower in group I (P < 0.01) .Conclusions More attention should be paid to the pregnant women with meconium- stained amniotic fluid, especially with maternal complication, abnormal fetal monitoring and amniotic fluid from clear turned to meconium - stained during labor. Cesarean section and shortened second stage of labor should be taken in time. Vaginal delivery could be adopted on the basis of closely monitoring without abnormal situations.