胎头吸引器和产钳助产在阴道分娩中的应用

Application of Vacuum Extractors and Forceps in Assisted Vaginal Delivery

【目的】比较胎头吸引器和产钳阴道助产的分娩结局。【方法】收集我院规律产检并分娩的孕妇164例,其中使用胎头吸引器的82例作为吸引器组,使用低位和出口产钳的82例作为产钳组,使用阴道助产前胎位为枕横位或枕后位者为胎位异常组。比较分析吸引器组和产钳组的母婴并发症。【结果】产钳组阴道裂伤率明显高于吸引器组(56.1%vs 24.2%,P<0.01),但新生儿头皮血肿和新生儿高胆红素血症(NHB)的发生率低于吸引器组(P<0.05);产钳胎位异常组的阴道裂伤率也高于吸引器胎位异常组(76.5%vs.22.2%,P<0.05),但新生儿高胆红素血症的发生率低于吸引器胎位异常组(P<0.05)。决策到分娩的时间间隔、产后24 h出血量、产后24 h白细胞和中性粒值、新生儿窒息率、颅内出血、帽状腱膜下出血、新生儿转科率及新生儿缺血缺氧性脑病(HIE),吸引器组和产钳组两组间比较差异均无统计学意义(P>0.05)。【结论】胎头吸引器阴道助产会降低阴道的裂伤率,尤其是胎位异常时的阴道裂伤率,但增加新生儿头皮血肿和NHB的发生。

[ Objective ] Compare the outcomes of vacuum extractors and forceps in assisted vaginal delivery. [Methods ] One hundred and sixty-four pregnant women with operative vaginal delivery who received prenatal examination and delivered in our hospital were enrolled. Eighty-two women with vacuum extractors were assigned into vacuum extractors group, another eighty-two women with low or outlet forceps were assigned into forceps group. Occiput transverse or posterior position women before operative vaginal delivery were assigned into abnormal fetal position group. Compare the maternal and neonatal outcomes of vacuum extractors and forceps in assisted vaginal delivery. [Results ] The vaginal laceration rate of forceps group was significant higher than vacuum extractors group （56.1% vs 24.2%, P 〈 0.01 ）, but neonatal subscalp hematoma and hyperbilirubinemia rate were lower than vacuum extractors group （P 〈 0.05 ）. The vaginal laceration rate of abnormal fetal position forceps group was also higher than abnormal fetal position vacuum extractors group （76.5% vs 22.2%, P 〈 0.05） , but neonatal hyperbilirubinemia rate was lower than abnormal fetal position vacuum extractors group （P 〈 0.05）. The Interval time from decision to delivery, postpartum hemorrhage volume with 24 hours, leukocyte and neutrophil count after 24 hours, asphyxia of newborn rate, intracranial hemorrahge, subgaleal hemorrahge, referral rate and hypoxic-ischemic encephalopathy did not significantly differ between vacuum extractors group and forceps group （all P 〉 0.05）. [ Conclusions ] Vacuum extractors can reduce the incidence of vaginal laceration rate, especial for abnormal fetal position, but increase the incidence of neonatal subscalp hematoma and hyperbilirubinemia rate.