无干预接生法在阴道分娩产妇中的应用效果

Application effects of “hands-off” delivery method in puerpera with vaginal delivery

目的：探讨无干预接生法在阴道分娩产妇中的临床应用效果。方法采用回顾性研究设计，采用方便抽样法选取2013年7—11月在北京市某妇幼专科医院应用无干预接生法顺产的产妇1040例作为观察组，选取2010年7—11月该院应用会阴保护接生技术的产妇1005例作为对照组，比较两组产妇分娩情况和会阴损伤情况，并分析观察组产妇发生会阴侧切和会阴裂伤的影响因素。结果两组产妇均没有发生Ⅲ度、Ⅳ度会阴裂伤和产科肛门括约肌损伤。观察组产妇的会阴侧切率为25.38%，对照组为13.93%，差异有统计学意义（P 〈0.01）。观察组产妇Ⅱ度裂伤发生率（48.85%）低于对照组（82.09%），差异有统计学意义（P〈0.01）。两组产妇会阴损伤情况比较，观察组产妇中度损伤（Ⅱ度裂伤及侧切）发生率（74.23%）低于对照组产妇（96.02%），差异有统计学意义（P〈0.01）。观察组阴道壁血肿发生率（0.77%）低于对照组（4.68%），差异有统计学意义（P〈0.01）。观察组第二产程时间、会阴伤口缝合时间均少于对照组，差异有统计学意义（P〈0.05），两组产后2 h出血量差异无统计学意义（P〉0.05）。回归分析结果显示，产妇年龄、分娩镇痛、新生儿出生体质量是无干预接生法产妇发生会阴侧切的影响因素（P〈0.05）；产妇年龄、孕周、分娩镇痛、新生儿出生体质量是其发生会阴裂伤的影响因素（P〈0.05）。结论无干预接生法可减轻阴道分娩产妇的会阴裂伤程度，减少第二产程时间，缩短会阴伤口缝合时间。

Objective To explore clinical application effects of hands-off method among puerperas delivered through vagina. Methods To utilize retrospective study design, a total of 1 040 puerperas, who could not received natural labour from July to November 2013, were selected as observation group by convenient sampling method and underwent hands-off method to deliver children, while 1 005 prerperas were taken deliver technical protection of perineum from July to November 2010 as control group. We compared puerperas′delivery conditions and injury of perineum, and observed and analyzed the influencing factors of puerpera′s episiotomy and perineal laceration. Results No incidences of Ⅲ and Ⅳ degree perineal laceration and obstetric anal sphincter injury happened. The rate of puerpera′s episiotomy in the observation group was 25. 38% compared with 13.93% in the control group （P 〈0.01）. The Ⅱ degree of perineal laceration was 48. 85% in the observation group lower than 82. 09% in the control group （P〈0. 01）. Comparing injury of perineum between two groups, the medium injury of observation group （Ⅱdegree of perineal laceration and episiotomy, 74. 23%） was lower than 96. 02% puerperas of control group （P 〈0. 01）. The rate of vaginal wall hematoma in the observation group was 0. 77% lower than 4. 68% in the control group （P〈0. 01）. The length of second stage of labor and length of perineum wound suture were shorter than those of the control group （P〈0. 05）;the amount of bleeding 2 h after labor in two groups had no statistical significance （P〉0. 05）. Regression analysis showed that, maternal age, analgesia, newborn weight were the influence factors of lateral episiotomy （P 〈0. 05）;maternal age, weeks of gestation, analgesia, newborn weight were the influence factors of perineal laceration （P〈0. 05）. Conclusions The hands-off method to deliver child can elevate the perineal laceration degree of perineum, reduce the length of the second stage labor, and shorten the length of perineal wound suture.