持续性枕后位产妇产程特征与胎儿体重、分娩结局的相关性研究

Relationship between the parturient characteristics of persistent occipitoposterior pregnant woman and fetal weight,birth outcomes

目的：研究持续性枕后位产妇产程中胎儿体重对产妇分娩结局的特征性影响。方法：回顾该院2009年5月～2013年5月以来分娩的持续性枕后位1140例产妇临床资料，依据新生儿的出生体重将其分为研究组（胎儿体重3500-4250g，580例）及对照组（胎儿体重2500-3500g，560例），对两组产妇的产程特征及母儿结局予以对比分析。结果：以侧俯卧位法将枕后位矫正为枕前位，两组产妇成功率相较差异有统计学意义（P〈0．05）；以手转胎头将枕后位矫正为枕前位，两组产妇成功率相较差异有统计学意义（P〈0．05）。研究组产妇剖宫产率与产后出血的发生率，研究组产褥病率与胎儿的窘迫率以及新生儿的窒息率和NICU的转入率，同对照组相较均增高，差异有统计学意义．（P〈0．05）。研究组225例经阴道分娩（占38．8％），对照组380例经阴道分娩（占67．9％），差异有统计学意义（P〈0．01）。研究组产妇第一产程及第二产程的时间同对照组相较，均明显延长，差异有统计学意义（P〈0．05），研究组产妇宫口的扩张延缓以及停滞发生率、产程中胎头下降的延缓以及停滞发生率同对照组相较差异均有统计学意义（P〈0．05）。结论：对持续性枕后位产妇进行产程处理时，需充分考虑到胎儿体重，如果胎儿体重估算在3500g以上，需积极进行临床干预，在干预失败情况下需放宽实施手术的指征，从而降低母儿出现并发症的概率。

Objective： To explore the characteristic effect of fetal weight on delivery outcome of persistent occipitoposterior. Methods： since May 2009 to May 2013, 1 140 cases of maternal persistent occiput after delivery were collected and divided according to neonatal birth weight into study group （fetal weight 3 500 - 4 250 g, 580 cases） and control group （fetal weight 2 500 ~ 3 500 g, 560 cases）, the production process characteristics of two groups of maternal and perinatal outcomes were compared. Results： The lateral posture could occipito posterior correction for occipitoanterior, there was significant difference between two groups in success rate （ P 〈 0. 05 ） ; The manual rotation of fetal head to occiput posterior position was corrected to occiput anterior position, there were significant differ- ence between two groups in success rate （ P 〈 0. 05） . There were significances in the incidence of maternal cesarean section, postpartum hemorrhage, distress rate, puerperal morbidity and the fetus, the rate of neonatal asphyxia and NICU transfer rate between the study and con- trol groups （P 〈0. 05） . There were 225 patients with vaginal delivery （38.8%） in study group and there were 380 patients with vaginal delivery （ 67.9% ） in the control group, there was significant difference （ P 〈 0. 01 ） . The first stage and the second stage of labor time of study group were prolonged significantly compared with those of control group （ P 〈 0. 05 ）. There were significant differences in maternal cervix expansion slow and stagnant rate, labor in delaying the descending of fetal head and stagnant rate between study and control groups （P 〈 0. 05） . Conclusion： To deal with the persistent occipitoposterior position of maternal birth process, the fetal weight estimation of fetal weight should be fully considered, if fetal weight above 3 500 g, active clinical intervention should be needed, when the intervention fail, the indication for operation then should be widen, thereby reducing the probability of occurrence of complications of mothers and infants.