头方位异常对分娩结局的影响

Effect of fetal position on labor outcomes

目的:探讨第二产程中胎方位对分娩方式和母儿病率的影响。方法:采用回顾性分析方法,在2003年1月～2007年11月住院分娩的10 498例第二产程的分娩资料中,选择初产妇、单胎、足月妊娠、无明显头盆不称、无妊高征等妊娠并发症或合并症的持续性枕后位128例(枕后位组)、持续性枕横位104例(枕横位组)为研究对象,选择同期枕前位产妇130例做为对照组(枕前位组),选择条件同枕后位组。比较3组产程情况、分娩方式及母儿结局。结果:与枕前位组相比,枕后位组第一产程、第二产程及总产程时间均延长,差异有显著性意义(P<0.05);枕横位组与枕前位组比较第二产程差异有显著性意义(P<0.05)。与枕前位组比较,枕后(横)位组产钳助产、剖宫产、会阴裂伤、产后出血、缩宫素使用、胎儿窘迫等均明显高于枕前位组,差异均有显著性意义(P<0.05)。结论:胎方位异常可导致产程延长和母儿并发症增加,正确认识、及时处理枕后(横)位对改善分娩结局、减少母儿并发症具有重要意义。

Objective： To explore the effect of fetal position at second stage of labor on delivery modes and maternal and neonatal morbidities. Methods： The data of second stage of labor of 10 498 lying - in women from January 2003 to November 2007 were analysed retrospectively, 128 lying - in women with persistent occipitoposterior position （ occipitoposterior position group） and 104 lying - in women with persistent oeeipitotransverse position （oceipitotransverse position group） were selected, and all the women were single birth, primipara, full -term pregnancy, excluding pregnant complications such as eephalopelvic disproportion and hypertensive disorder complicating pregnancy, and 130 lying -in women with occipito -anterior position were selected as control group. The birth process, delivery modes and outcomes of mothers and infants were compared among 3 groups. Results ： The duration times of first, second and total stage of labor in oceipitoposterior position group were longer than those in control group （ P 〈 0. 05 ） ; there was significant difference in duration of second stage of labor between oeeipitotransverse position group and control group （ P 〈 0.05 ） . The rates of midwifery, cesarean section, perineal laceration, postpartum hemorrhage, oxytoein usage and fetal distress in occipitoposterior position group and oeeipitotransverse position group were higher than those in control group （ P 〈 0. 05 ） . Conclusion ： Fetal malposition may prolong labor and increase complications of mothers and infants, correct diagnosis and timely treatment are vital for improvement of labor outcomes and decreasing complications of mothers and infants.