足月头位已衔接的胎膜早破孕妇采用不同体位对阴道分娩结局的影响

Effects of different postures adopted by full- term and cephalic engagement pregnant women with premature rupture of fetal membrane on vaginal delivery outcome

目的：探讨足月头位已衔接的胎膜早破孕妇采用不同体位对阴道分娩结局的影响。方法：选取2013年1～12月待产的足月头位已衔接的胎膜早破孕妇150例,采用抽签法随机分为观察组和对照组,每组75例。观察组采用自由体位待产,对照组采用高臀卧位待产。比较两组孕妇待产舒适度,第一、二、三产程时间,羊水流出量,失血量,新生儿情况以及相关并发症情况。结果：观察组孕妇失眠及相关自觉症状的发生率均低于对照组,差异均有统计学意义（P〈0.05）;观察组孕妇第一、二产程时间及羊水流出量均小于对照组,差异均有统计学意义（P〈0.05）;两组新生儿窒息、吸入综合征及颅内出血发生率比较,差异均无统计学意义（P〉0.05）;观察组会阴侧切和尿潴留发生率均低于对照组,差异均有统计学意义（P〈0.05）。结论：对于足月头位已衔接的胎膜早破孕妇,应在常规胎心及产程的监测下,嘱其选择自觉舒适的体位,并鼓励其多采取坐、站、蹲、走等姿势,同时协助其经常改变体位,以增加孕妇舒适度,减少羊水流出量,缩短产程,降低会阴侧切、尿潴留等并发症的发生率。

Objective： To explore the effects of different postures adopted by full-term and cephalic engagement pregnant women with premature rupture of fetal membrane（ PROM） on vaginal delivery outcome. Methods： A total of 150 full- term and cephalic engagement pregnant women with PROM who were awaiting delivery from January to December in 2013 were selected and randomly divided into observation group and control group by sortition randomization method,75 pregnant women in each group. The pregnant women in observation group adopted free posture,while the pregnant women in control group adopted lateral and supine posture with hip- up. The comfortable degrees,the first,the second and the third stages of labor,amniotic fluid volumes,the amounts of blood loss,neonatal situations and related complications in the two groups were compared. Results： The incidence rates of insomnia and self- conscious symptoms in observation group were statistically significantly lower than those in control group（ P〈0. 05）. The first and the second stages of labor,amniotic fluid volume in observation group were statistically significantly lower than those in control group（ P〈0. 05）. There was no statistically significant difference in the incidence rates of neonatal asphyxia,aspiration syndrome and intracranial hemorrhage between the two groups（ P〈0. 05）; the incidence rates of episiotomy and urinary retention in observation group were statistically significantly lower than those in control group（ P〈0. 05）. Conclusion： For the full- term and cephalic engagement pregnant women with PROM,it is recommended to adopt comfortable postures under the monitoring of conventional fetal heart and labor process,they are encouraged to take more sitting,standing,hunkering and walking postures,clinicians should help them change posture frequently to increase comfortable degree,reduce amniotic fluid volume,shorten the stages of labor,reduce related complications such as episiotomy and urinary retention.