上推胎头、对侧卧位及徒手旋转在胎方位异常中的应用

Pushing Fetal Head Upward Direction,Contralateral Decubitus and Unarmed Rotation for Abnormal Fetal Position

目的探讨上推胎头、对侧卧位及徒手旋转在胎方位异常中的应用。方法将360例足月单胎、头位、进入活跃期后出现持续性枕横、枕后位孕妇按随机数字表法分为A组、B组和C组,每组120例。A组孕妇采取对侧卧位法进行转位,B组孕妇采取徒手旋转法进行转位,C组孕妇采取上推胎头、对侧卧位及徒手旋转法进行转位。观察3组孕妇转位成功与失败、分娩方式及新生儿出生后1min Apgar评分的新生儿结局等情况。结果 C组孕妇转位成功率、自然分娩率均明显高于A组、B组,差异均有统计学意义(均P<0.05);B组孕妇转位成功率、自然分娩率均明显高于A组,差异均有统计学意义(均P<0.05);C组孕妇产钳助产率、剖宫产率均明显低于A、B组,差异均有统计学意义(P<0.05或P<0.01)。C组新生儿出生后1min Apgar评分8～10分所占比例明显高于A组、B组,差异有统计学意义(P<0.05);C组新生儿出生后1min Apgar评分4～7分所占比例明显低于A组、B组,差异有统计学意义(P<0.01);C组新生儿出生后1min Apgar评分0～3分所占比例明显低于A组、B组,差异有统计学意义(P<0.05)。结论应用上推胎头、对侧卧位及徒手旋转的方法纠正持续性枕横、枕后位的胎方位异常可提高转位成功率,降低剖宫产率及新生儿窒息率。

Objective To explore the application of pushing fetal head upward direction,contralateral decubitus and unarmed rotation for abnormal fetal position.Methods Three hundred pregnant women with single full-term fetus（head position） in persistent occiput transverse and posterior position after entering active phase were divided into three groups.The transposition was performed by contralateral decubitus in group A,by unarmed rotation in group B,and by pushing fetal head upward direction combined with contralateral decubitus and unarmed rotation in group C.The success rate of transposition,delivery mode and 1-minute Apgar score were measured in the three groups.Results Compared with group B,translocation success rate and natural birth rate significantly increased in group C,but obviously decreased in group A（all P0.05）.Compared with group C,forceps delivery rate and cesarean section rate significantly increased in group A and group B（P0.05 or P0.01）.Furthermore,the proportion of infants with 1-minute Apgar score 4-7 or 0-3 in group C was obviously lower than that in group A and group B（P0.05 or P0.01）.Conclusion Pushing fetal head upward direction,contralateral decubitus and unarmed rotation for persistent occiput transverse and posterior position abnormality can improve translocation success rate and reduce cesarean section rate and neonatal asphyxia rate.