手转胎头适宜时机的临床观察

Clinical Observation of the Proper Time for Manually Rotating Fetal Head in the Process of Labor

目的:探讨头位难产时,选择适宜时机进行手转胎头,以加速产程进展,提高自然分娩率。方法:选择2009年1月至2010年12月共192例单胎头位,持续性枕横位、枕后位,无严重并发症及合并症的产妇,分为观察组96例,对产妇选择适宜时机(宫口开大6～10cm,胎先露在坐骨棘平或坐骨棘下1～2cm)进行手转胎头;对照A组53例,对产妇选择宫口开大<6cm,胎先露在坐骨棘上进行手转胎头;对照B组43例,选择宫口开全后,胎先露在坐骨棘下≥2cm进行手转胎头。结果:观察组手转胎头成功率明显高于对照组(P<0.01);观察组阴道分娩率显著高于对照组,剖宫产率显著低于对照组(P<0.01);产程进展时间、分娩方式、产后出血、新生儿1分钟阿普加评分等与对照组比较差异有高度统计学意义(P<0.01);新生儿窒息率明显降低。结论:手转胎头是处理头位难产的重要方法,选择适宜的时机进行手转胎头,使难产变为顺产,可缩短产程,提高自然分娩率,有效降低阴道助产及剖宫产率,减少母婴并发症。

Objective： To investigate the proper time for manually rotating fetal head to speed up the process of labor and increase the rate of vaginal delivery. Methods：192 cases of single fetal head position, persistent transverse occipital position, posterior occipital position, without serious maternal complications were recuited in this study from January 2009 to December 2010. 96 pregnant women were in the study group （ manually rotate fetal head when openning of cervix reached 6~10 cm, fetal presentation reached ischial spine or 1~2cm lower）, 53 women were in control group A（manually rotate fetal heak when openning of cervix was less than 6 cm, fetal presentation was above ischial spine）, 43 women were in control group B（ manually rotate fetal head when openning of cervix was almost 10 cm, fetal presentation reached to more than 2 cm lower of ischial spine）. Results：The success rate of manually rotating fetal head in study group was significantly higher than that in control group （P〈0.01） ; the rate of vaginal delivery in the study group was significantly higher than that of control group （ P 〈0.01 ） ; There were significant differences of labor time, delivery route, postpartum hemorrhage, one minute Apgar score in study group compared with control group （ P 〈0.01 ） ; The neonatal asphyxia was reduced markedly in study group. Conclusions. Manually rotating fetal head is an important method to deal with dystocia, so the selection of proper time to rotate fetal head can shorten labor time, increase the rate of vaginal delivery, and decrease the maternal and fetal complications.