臀位牵引术在剖宫产胎头娩出困难的应用

The use of breech extraction for difficulty of labor fetus head in cesarean section

目的探讨头位子宫下段剖宫产术，胎头娩出困难应用臀位牵引术助娩胎儿的疗效。方法分析105例足月妊娠单胎头位剖宫产，胎头娩出困难的孕妇行臀位牵引术助娩胎儿，其中极度胎头高浮86例（19．91％），胎头深嵌骨盆底19例（4．40％）的临床资料。结果105例臀位牵引术助娩均成功，切开子宫肌层至胎儿身体全部娩出的间隔时间≤150秒，平均90秒；无新生儿产伤；3例子宫切口撕廷，发病率（3／105）2．86％；手术出血（280-860ml）。结论剖宫产极度胎头高浮，胎头深嵌骨盆底娩出困难行臀位牵引助娩胎儿，可减少新生儿窒息的发生率，降低母婴并发症，提高产科质量，手术方式可行、安全、效果良好，值得进一步总结经验和推广。

Objective To observe the effect of used breech extraction for difficulty of labor fetus head in low cervical cesarean section. Methods 105 cases of term pregnancy with fetus head presentation were analyzed. Among that 86 cases were sincipital presentation （19.91%）. 19 cases were deep in pelvic floor of fetal head（4.40%）. Results All cases were succeed. It took less than 150 seconds （average 90 seconds） from incised uterine muscle till the baby born, hemorrhage about 280- 860ml. There were no newborn injuries. 3 cases uterine incision were tore（3/105）2.86%. Conclusion It was effective to use breech extraction for difficulty of labor fetus head in low cervical cesarean section. It can reduced neonatal asphyxia and maternal and infant complications.