剖宫产术中取胎困难临床分析

The Clinical Analysis of Fetal Disengagement Difficulties in Caesarean Section

目的:探讨剖宫产术中胎儿娩出困难的原因及处理对策。方法:对2009年10月至2010年9月间1022例剖宫产术进行回顾性分析。结果:发生取胎困难51例,发生率为4.99%。主要原因有胎头高浮9例(17.65%)、腹壁或子宫切口过小8例(15.69%)、胎头深嵌骨盆底6例(11.76%)、横位4例(7.84%)、子宫下段形成不佳4例(7.84%)、麻醉效果不佳4例(7.84%)、以上多种因素合并存在26例(50.98%)。51例取胎困难中发生新生儿窒息5例(9.80%)、产后出血6例(11.76%)、子宫切口撕裂2例(3.92%)、新生儿产伤2例(3.92%)。发生胎儿娩出困难组造成新生儿窒息、产后出血、子宫切口撕裂、新生儿产伤发生率明显高于胎儿娩出顺利组,统计学有显著差异(P<0.005)。结论:剖宫产术中娩出胎儿是关键,发生胎儿娩出困难,增加新生儿窒息发生率、新生儿产伤发生率及产妇损伤发生率。术者术前对胎头高低、子宫下段情况、麻醉效果、胎儿大小及胎方位应有充分估计,困难的剖宫产术应由临床经验丰富的医生担任术者及助手,并备好相应助产器械,术中采取适当措施,避免发生取胎困难,以减少母婴并发症的发生。

Objective：To investigate the reasons and treatments of fetal disengagement difficulties in caesarean section.Methods： Make the retrospective analysis of 1022 cases,which had caesarean section between October 2009 and September 2010.Results：51 cases occurred fetal disengagement difficulties.The incidence rate was 4.99%.The major reasons included the high-floating fetal head（9 cases,17.65%）,too small incision of abdominal wall or uterus（8 cases,15.69%）,deeply impaction in the pelvic floor of fetal head（6 cases,11.76%）,transverse presentation（4 cases,7.84%）,poorly lower uterine segment forming（4 cases,7.84%） and poor anesthetic effect（4 cases,7.84%）.Most above factors were combined in 26 cases（50.98%）.In the 51 cases,5 cases occurred neonatal asphyxia（9.80%）,6 cases occurred postpartum hemorrhage（11.76%）,2 cases occurred uterine laceration（3.92%）,2 cases occurred birth injury（3.92%）.The incidence rates about neonatal asphyxia,postpartum hemorrhage,uterine laceration,birth injury in fetal disengagement difficulties group are higher than fetal disengagement successfully group significantly.These is significant difference in statistics（P0.005）.Conclusion：The criticality in caesarean section is fetal disengagement.The fetal disengagement difficulties will increase incidence rates of neonatal asphyxia,birth injury and parturient injury.The surgery should have sufficient estimation of fetal head position,lower uterine segment condition,anesthetic effect,fetus size and fetal position before the operation.The operator with full clinical experience should be a surgeon or assistant in the caesarean section of great difficulty,and provide midwifery equipment,take appropriate measures in surgery in order to avoid fetal disengagement difficulties and mother-infant complications.