乳房按摩促进足月孕妇宫颈成熟与分娩的临床观察

Clinical observation of breast massage to promote cervical ripening and labor in full-term pregnancy

目的 探讨足月孕妇乳房按摩对促进宫颈成熟及分娩的有效性和安全性.方法 采用前瞻、对照研究的方法,将300例初产、单活胎、头位、无妊娠合并症及并发症、无明显阴道分娩禁忌的孕妇采用随机表格方法分为两组,两组孕38＋5周确定胎儿成熟后首次记录宫颈评分,观察组150例孕妇在专人指导下进行双侧乳房按摩（手持温湿布交替按摩双侧乳房,每天3次,每次lh）;对照组150例常规产前检查.观察两组至临产后宫颈成熟情况、临产的孕周,分娩方式、产程时间和新生儿情况.结果 研究前两组孕妇的Bishop评分差异无统计学意义（t=0.73,P＞0.05）;干预第3、6天及临产时观察组Bishop评分均显著高于对照组（t =3.28、5.38、11.27,均P＜0.05）.观察组150例孕妇宫颈Bishop评分提高,总有效率为100.0％;对照组宫颈Bishop评分提高,总有效率66.7％;两组差异有统计学意义（x2 =60.00,P＜0.05）.观察组40周内分娩率为86.0％,无1例过期妊娠.对照组40周内分娩率为56.0％,过期妊娠9例.两组40周内分娩率差异有统计学意义（x2=32.78,P＜0.05）.观察组阴道分娩率为131例（87.3％）,显著高于对照组的92例（61.3％）（x2=26.57,P＜0.05）.观察组阴道分娩总产程（7.92 ＆#177;4.15）h,显著短与对照组的（12.28＆#177;4.18）h（t =4.20,P＜0.05）.观察组分娩并发症的发生率为5例（3.3％）,显著低于对照组的16例（10.7％）（x2=6.20,P＜0.05）.结论 孕足月乳房按摩对促进宫颈自然成熟,促进阴道分娩,方法简便、安全、有效,能有效降低因延期妊娠、过期妊娠造成的剖宫产率,对适时分娩有一定的临床实用价值.

Objective To evaluate the effectiveness and safety of the breast stimulation expediting on the cervical ripening and labour.Methods By using the method of prospective,controlled study,according to the digital table,300 primiparas with single viable fetus in longitudinal lie with head,without complicating disease and contraindication of vaginal delivery scored in 38 ＋5 weeks were randomly separated into the study group with breast stimulation and control group with regular tests except for the breast stimulation.150 cases in the study group were bilateralbreast massaged under the guidance of the hand （handheld temperature wetalternating bilateral breast massage,3 times every day,each time 1 H） ; 150 cases in the control group was routine examination group.The labor,labor cervical maturity gestational age,mode of delivery,birth process and newborn situation in the two groupswere observed.Results There was no significant difference between the two groups of patients about the Bishop score （t =0.73,P 〉 0.05） before the study;3 and 6 days after the intervention and parturient,Bishop scores in the observation group were higher than those in the control group （t =3.28,5.38,11.27,all P 〈 0.05）.The cervical bishop score increase total efficiency was 100.0% in the 150 cases of pregnant women of the study group;in the control group,the cervical bishop score increase total efficiency was 66.7 % ; there was significant difference between the two groups （x2 =60.00,P 〈 0.05）.The 40 weeks delivery rate of the observation group was 86.0%,there was no case of prolonged pregnancy.The 40 weeks delivery rate of the control group was 56.0%,9 cases of prolonged pregnancy.The 40 weeks delivery rate of the two groups had significant difference （x2 =32.78,P 〈0.05）.The observation group vaginal delivery rate was 131 cases （87.3%）,which was significantly higher than 92 cases （61.3%） of the control group,there was significant difference （x2 =26.57,P 〈 0.05）.The vaginal delivery total labor of the study group wass （7.92 ＆#177; 4.15） h,which was significantly shorter than （12.28 ＆#177; 4.18） h of the control group,there was significant difference （t =4.20,P 〈0.05）.The study group delivery complications occurred in 5 cases （3.3%）,which was significantly lower than 16 cases （10.7 %） of the control group,there was significant difference （x2 =6.20,P 〈 0.05）.Conclusion The advance of the labour process by breast stimulation was safe and effective.And this method could remarkably decrease the chance of uterine-incision delivery caused by the prolonged or delayed pregnancy,which should be utilized in routine clinical work.