无保护接生降低初产妇会阴损伤及新生儿肩难产发生率的效果

DECREASING INCIDENCE OF PERINIAL INJURY AND SHOULDER DYSTOCIA THROUGH UNPROTECTED DELIVERY

目的探讨无保护接生降低初产妇会阴损伤及新生儿肩难产发生率的效果。方法将300例经过筛选的初产妇随机分为观察组和对照组各150例。观察组于宫口开全、胎头着冠后,进行产道润滑及会阴体按摩,助产士指导产妇正确用力及哈气,利用左手控制胎头娩出速度,右手不再支托保护会阴体。对照组采用传统的会阴保护接生法进行接生。比较两组初产妇会阴损伤、新生儿肩难产发生率。结果观察组产妇会阴侧切32例(21.33%),会阴Ⅰ度裂伤57例(38.00%),会阴擦伤46例(30.67%),会阴完整15例(10.00%);对照组会阴侧切65例(43.33%),会阴Ⅰ度裂伤49例(32.67%),会阴擦伤31例(20.67%),会阴完整5例(3.33%)。观察组发生新生儿肩难产0例,对照组5例。观察组会阴侧切率和肩难产发生率明显低于对照组(χ2=3.92,P<0.05;P=0.024)。结论与传统接生手法相比较,无保护接生能降低初产妇会阴损伤和新生儿肩难产发生率。

Objective To assess the outcomes of reducing the incidence of perineal laceration and shoulder dystocia in pri- mipara using unprotected delivery. Methods This study consisted of 300 primiparae who were equally randomized to two groups as observation group and control group. The lying-in women in the observation group were given birth canal lubrication and perineal body massage when the cervix was fully dilated, and guided by a nurse to correctly exert herself and breathe. The midwife con- trolled the speed of fetal head expulsion with her left hand and no longer to protect the perineal body with her right hand. Those in the control group were offered a traditional method of perineum-protecting delivery. The incidence of perineal injury and neonate＇s shoulder dystocia in the two groups was observed and compared. Results In the observation group, episiotomy was done in 32 （21.33%） cases; 57 （38.00%） were noted of degree 1 perineal laceration perineal bruise was noted in 46 （30.67%） and 15 （10.00%） cases without injury of the perineum. In the control group, episiotomy was performed in 65 （43.33%） cases, degreeq perineal laceration was noted in 49 （32.67%）, 31 （21.67%） cases of perineum abrasion, intact perineum was seen in five （3.33%） eases. Shoulder dystocia was not recorded in the observation group, and that in the control group was recorded in five cases. The rates of episiotomy and shoulder dystocia in the observation group were dramatically lower than the control group （Z2 = 3.92,P〈0.05 P=0.024）. Conclusion Compared with the traditional method, unprotect delivery can reduce the incidence of perineal la- ceration and shoulder dystocia in primiparae.