枕后位活跃期停滞同侧俯卧位提高阴道顺产率的前瞻性研究

A study to lift the rate of viginal delivery with occiput posterior position by changing gravida's posture when active-phase arrested

目的:探讨枕后位产程活跃期停滞时孕妇改变体位对纠正胎方位、提高阴道顺产率的效果。方法:以胎方位为枕后位,在发现产程活跃期停滞开始孕妇采取与胎儿脊柱同方向的同侧俯卧位的的正常初产妇共150例作为观察对象,以孕妇与胎儿脊柱相反方向的对侧俯卧位150例及随意卧位150例分别作为对照组。结果:产程加速阶段及最速阶段停滞始孕妇采取同侧俯卧位时,胎方位的纠正率分别为78%及80%,产程减速阶段停滞时,同侧俯卧位纠正胎方位的机会为52%,总的胎方位纠正率为70%,总顺产率为69.3%;相应地,对侧俯卧位的胎方位的纠正率分别是58%、62%和34%,胎方位的总纠正率为51.3%,总顺产率为45.3%;随意卧位胎方位纠正率分别是30%、32%和18%,总纠正率为26.7%,总顺产率为26.7%。不论产程停滞在加速阶段、最速阶段还是减速阶段,孕妇采用同侧俯卧位组的胎方位纠正率、阴道顺产率均比采取对侧俯卧位的相应的对照组高,也比随意卧位的相应的对照组高(所有P值均<0.05);持续性枕后位及剖宫产的发生率均比对侧俯卧位相应的对照组及随意卧位相应的对照组低(所有P值均<0.05)。结论:枕后位在活跃期出现了产程停滞,孕妇需采取与胎儿脊柱同方向的侧俯卧位可有效地纠正胎方位,提高阴道顺产率,方法简单、孕妇依从性好,易于在任何医院推广使用,有助于提高产科质量。

Objective： To investigate the effect on correction of occiput posterior （OP） position and lift the rate of viginal delivery by changing maternal posture when active -phase was arrested. Methods： With occiput posterior position, 150 normal nulliparous gravida were instructed to lay on the same lateral posture with fetal spine in order to correct the fetal position from OP position to occipito anterior （OA） position once active - phase arrested were diagnosed as observed group, in which , 50 cases with acceleration phase arrested, 50 cases with phase of maximum slope arrested and 50 cases with deceleration phase arrested.. Similarly , 150 normal nulliparous gravida with head OP position and active - phase arrested were instructed to lay on the opposite side to the fetal spine as the first control group , another 150 cases normal nulliparus gravida with head OP position and active - phase arrested were instructed to lay randomly when the same as above ab- normal course of labor were diagnosed as the second control groups. Results： In observed group which gravidas were instructed to lay on the same lateral posture with fetal spine, the rate of the fetal position from OP to OA was 78%, 80% and 52% respectively when courses of labor arrested in acceleration phase, phase of maximum slope and deceleration phase, the total correcting rate of the fetal position was 70% , the total rate of viginal delivery was 69. 3% . In the first control group which gravida were instructed to lay on the opposite side to the fetal spine the rate of the fetal position from OP to OA was 58%, 62% and 34% respectively when the same courses of labor arrested as observed group , the total correcting rate of the fetal position was 51. 3% , the total rate of viginal delivery was 45. 3% . In the second control group which gravida were instructed to lay randomly , the rate of the fetal position from OP to OA was 30%, 32% and 18% respectively when the same courses of labor arrested as observed group the total correcting rate of the fetal position was 26. 7% , the total rate of viginal delivery was 26. 7% . For all abnormal courses of labor regardless of arrest in acceleration phase, phase of maximum slope or deceleration phase , the rates of viginal delivery and the fetal position from OP to OA were significantly higher in observed group than the first control group and the second control group （ P 〈 0. 05, or P 〈 0. 005 ） ; the rates of cesarean section and persistent oeciput posterior position were significantly lower in observed group than the first control group and the second control group （ P 〈 0. 05, or P 〈 0. 005 ） . Conclusion： When active - phase of labor course arrest , instructing pregnancy to lay on the same lateral posture with fetal spine can correct the fetal position from OP to OA , lift the rate of viginal deliver and low the rate of cesarean section effectively, it is helpful to improve obstetric quality and can be adopted in most obstetric units.