改变产妇体位矫正胎方位异常的临床观察

Clinical observation of changing body position of lying-in women with abnormal fetal position

目的探讨在产程中通过改变产妇体位以矫正胎方位异常的临床效果。方法选择在潜伏期经B超确诊为枕后位的初产妇170例,随机分为2组,每组85例。研究组在产程中指导产妇取同侧侧俯卧位,利用胎儿的重力,羊水的浮力,子宫间歇收缩时的合力作用,使胎头在下降时逐渐从枕后位转至枕前位娩出,并与对照组比较。结果研究组有72例(84.71%)胎儿从枕后位转至枕前位经阴道娩出,剖宫产13例(15.29%)。对照组经阴道娩出仅28例(22.94%),剖宫产57例(67.06%)。2组比较有显著的差异性(P<0.01)。研究组第一产程平均时间为308.2 min,第二产程平均时间为57.9 min。对照组第一产程平均时间为492.6 min,第二产程平均时间为105.8 min。2组比较有显著的差异性(P<0.01)。结论在产程中指导产妇取同侧侧俯卧位来矫正胎头枕后位是将难产转变为顺产的有效方法,也是降低剖宫产率及难产发生率的有效方法。

Objective To explore the effect of changing body position of lying--in women during labor process in order to rectify abnormal fetal position. Methods 170 pregnant women with occiput posterior（OP） and diagnosed by type B ultrasound were sampled and divide into two groups. During delivery, 85 pregnant women in study group were instructed to take the lateral posture so that the resultant force of the grarity of fetus, the buoyancy of amniotie fluid and the inter mitten uterine contraction may change the fetal position from occipito--posterior into oceipito--anterior presentation. They were corn pared with 85 pregnant women in control group. Results 72 women （84.71%） in study group delivered vaginally with fetal presentation changed from OP to OA and 13 women （15.29%） received cesarean sec tion. In control group, only 28 women （22.94%）, delivered vaginally and 57（67.06%） had received ce sarean section （P 〈 0.01）. The average time of the women in the study group was 308.2 minutes at first stage and 57.9 minutes at second stage, where as 492.6 minutes and 105.8 minutes respectively in con trol group, and the difference was significant （P 〈0.01）. Conclusions It is an effective method for the mother to take the lateral posture on the same side of the fetal spine for correcting the op position . The incidence of dystocia and cesarean section may be reduced.