产妇自主选择非平卧位分娩与传统平卧位分娩的比较

Comparison of lying-in woman autonomous selection labor with non-horizontal position or horizontal position

目的比较由产妇自主的选择非平卧位分娩体位与传统的平卧位分娩对产程和新生儿的影响。方法前瞻性队列研究,研究对象为足月、头位、初产妇,无妊娠合并症与并发症,经阴道分娩者。试验组让产妇自主选择非平卧位分娩体位,胎头拔露后转为平卧或侧卧接产,也可在其他体位接产;对照组按目前国内常规,宫口开全后平卧产床,平卧位接产。比较两组产程时间、产后出血、新生儿情况、产后会阴损伤等。结果两组在一般情况如产妇年龄、孕周、新生儿体重等方面无差异,试验组比对照组第一产程时间及产后出血量、新生儿窒息发生率无差异,第二产程时间短于对照组(t=3.635,P=0),会阴侧切率低(χ2=10.416,P=0.015),有更多的会阴完整者(χ2=12.577,P=0),Ⅰ度裂伤多于对照组(χ2=5.365,P=0.020),Ⅱ度裂伤者两组间差异无统计学意义(χ2=1.652,P=0.121),两组均未出现Ⅲ度裂伤者。结论足月头位初产妇正常分娩中,产妇自主的选择分娩体位,取非平卧位分娩,缩短第二产程,降低会阴侧切率,减少会阴损伤。

Objective To compare the influence of stages of labor and new arrival for lying-in woman autonomous selection labor with non-horizontal position or conventional horizontal position.Methods A prospectie cohort study,the subjects investigated were lying-in women with mature,head birth,primipara,vaginal delivery and who had no complication of pregnancy.On experimental group,lying-in women autonomous selected labor with non-horizontal position,after head visible on vulval gapping,chose horizontal or lateral position,or another position;On control group,lying-in women accouched with horizontal position when cervix orifice fully opening as conventional methods.Time of labor stage,postpartum hemorrhage,new arrival and injury of perineum after labor were compared between two groups.Results There was no statistically significant difference between two groups such as age of lying-in woman,gestational weeks,neonatal weight etc.,the time,postpartum hemorrhage and the rates of asphyxia neonatorum in first stage of labor had no statistically significant difference between two groups,the time of second stage of labor in experimental group was significantly shorter than that of control group（t = 3.635,P = 0）,the rate of episiotomy was low（χ2 = 10.416,P = 0.015）,there were more episiotomy integrated patients in experimental group（χ2 = 12.577,P = 0）,laceration Ⅰof cervix were more than control group（χ2 = 5.365,P = 0.020）,the laceration Ⅱof cervix between two groups had no statistically significant difference（χ2 = 1.652,P = 0.121）,there were no one had laceration Ⅲ of cervix.Conclusion Lying-in women with mature cephalic presentation primipara autonomous select labor with non-horizontal position can shorten the second stage of labor,reduce the rate of episiotomy,decrease the injury of perineum.