第二产程自由体位接产促进自然分娩的效果观察

Effect of free posture in the second stage of labor on promoting spontaneous delivery

目的探讨第二产程自由体位用力与自由体位接产的应用效果。方法选择320例在杭州市第一人民医院分娩的低危初产妇,随机分为观察组和对照组各160例,观察组产妇在第二产程采取自由体位用力和接产,对照组采用仰卧截石位用力和接产,比较2组第二产程时间、分娩方式、新生儿窒息、产后出血、会阴裂伤、会阴侧切、疼痛指数。结果观察组自然分娩率85.0%(136/160),明显高于对照组70.6%(113/160,χ2=9.575,P<0.05)。观察组会阴完整率15.4%(21/136),明显高于对照组5.3%(6/113,χ2=6.553,P<0.05)。观察组会阴侧切率3.6%(5/136),明显低于对照组20.3%(23/113,χ2=17.2,P<0.05)。观察组无重度疼痛病例发生,而对照组出现重度疼痛38例(24.0%,χ2=38.03,P<0.05)。观察组第二产程时间[(38.9±18.6)min]较对照组[(58.6±23.7)min]明显缩短(t=6.54,P<0.05)。2组产后出血率差异无统计学意义(χ2=0.11,P>0.05)。2组新生儿窒息发生率差异无统计学意义(χ2=0.389,P>0.05)。结论第二产程采用自由体位用力和接产可降低剖宫产率,降低会阴损伤和会阴侧切率,明显减轻产妇疼痛,缩短第二产程时间,不增加产后出血和新生儿窒息率,值得临床应用。

Objective To explore the effect of free posture to exert and deliver in the second stage of labor. Methods A total of 320 low risk primiparas were randomly divided into observation group and control group with 160 primiparas in each group. The observation group took free posture in the second stage of labor,while control group took supine lithotomy position. The effect was measured by comparing the time of the second stage, delivery mode, neonatal asphyxia, postpartum hemorrhage,perineal lacerations,lateral episiotomy and pain index. Results The spontaneous delivery rate of the obser- vation group was 85% （ 136/160 ）, significantly higher than 70.6% （ 113/160 ） of the control group, （ χ2 = 3.22, P 〈 0.05 ）. In the observation group, the integrity rate of perineum was 15.0% （ 24/160 ）, significantly higher than 4.3 % （ 7/ 160 ） in the control group （χ2= 10.56, P 〈 0.05 ）. The lateral episiotomy rate in the observation group 3.1% （5/160）was significantly lower than 20.0% （33/160） in the control group （ χ2 = 17.14, P 〈 0.05 ）. There was no severe pain in the observation group, while in control group there were 38 （24%）severe pain cases（ χ2 = 38.03 ,P 〈 0.05 ）. The time of the second stage in the observation group （38.9 ± 18.6） min was significantly shorter than （58.6 ±23.7） min in the control group（ t = 6.54, P 〈 0.05 ）. The percentage of postpartum hemorrhage was not significantly different （ χ2 = 0. 11, P 〉 0.05 ） between the two groups. The percentage of neonatal asphyxia was not significantly different（ χ2 = 0.389 ,P 〉 0.05 ） between two groups. Conclusion The free posture in the second stage of labor could increase rate of vaginal delivery, reduce rate of perineal lacerations and lateral episiotomy, relieve maternal pain and reduce time of the second stage. Besides, free posture in the second stage of labor did not increase neonatal asphyxia and postpartum hemorrhage. Therefore, it is worth recommending in clinical applications.