无保护会阴接生技术联合控制胎头娩出方案在阴道分娩中的效果分析

Effect of unprotected perineum delivery combined with fetal head delivery control on vaginal delivery

目的探究阴道分娩的产妇采用无保护会阴接生技术与控制胎头娩出方案对产妇及胎儿预后的影响。方法回顾性分析成都市妇女儿童中心医院产房2013年9月至2016年9月自然分娩的194例产妇的临床资料,根据分娩方式不同分为研究组(97例)和对照组(97例),研究组孕妇接受无保护会阴接生技术与控制胎头娩出方案,对照组孕妇接受常规会阴保护接生技术分娩,比较两组产妇会阴裂伤情况、第二产程时间、产后并发症发生情况和新生儿窒息情况等。结果研究组会阴无裂伤、Ⅰ度裂伤、Ⅱ度裂伤发生率分别为10.31%、64.95%、14.43%,对照组分别为3.09%、36.08%、25.77%,研究组会阴无裂伤、Ⅰ度裂伤发生率显著高于对照组(χ~2值分别为3.927、8.751,均P<0.05),会阴侧切率、Ⅱ度裂伤发生率均显著低于对照组(χ~2值分别为6.990、3.883,均P<0.05),两组均无Ⅲ度裂伤发生。研究组产后出血发生率显著低于对照组(χ~2=7.974,P<0.05),两组第二产程时间比较无显著性差异(t=0.772,P>0.05),粪便污染、产褥感染发生率比较均无显著性差异(χ~2=2.539,P>0.05)。两组新生儿Apgar评分、新生儿体重比较均无显著性差异(t值分别为1.923、0.675,均P>0.05),新生儿窒息情况比较无显著性差异(χ~2=3.08,P>0.05)。研究组产妇满意度为95.88%,对照组为81.44%,研究组显著高于对照组(χ~2=10.049,P<0.05)。结论自然分娩过程中采用无保护会阴接生技术联合控制胎头娩出方案对于降低会阴侧切率、减轻会阴裂伤效果较为显著,值得在临床上推广应用。

Objective To investigate the effect of unprotected perineum delivery combined with fetal head delivery control on maternal and neonatal outcomes in spontaneous labor. Methods Clinical data of 194 pregnant women undergoing spontaneous labor in delivery room of Chengdu Central Hospital of Women and Children from September 2013 to September 2016 were retrospectively analyzed. They were divided into research group（91 cases） and control group（97 cases） according to different delivery methods. Women in the research group were treated with unprotected perineum delivering technology and fetal head delivery control,while women in the control group were treated with conventional perineal protection delivering technology. Perineal laceration,second labor stage,postpartum complication,neonatal asphyxia in two groups were compared. Results Rates of non perineal laceration,I degree laceration and II degree laceration were10. 31%,64. 95% and 14. 43%,respectively in the research group and 3. 09%,36. 08% and 25. 77%,respectively in the control group. Rates of non perineal laceration and I degree laceration in the research group were significantly higher than those in the control group（χ~2value was 3. 927 and 8. 751,respectively,both P〈0. 05）. Perineotomy rate and incidence of II degree laceration in the research group were significantly lower than those in the control group（χ~2value was 6. 990 and 3. 883,respectively,both P〈0. 05）. There was noⅢ degree laceration in both groups. Incidence of postpartum hemorrhage in the research group was significantly lower than that in the control group（χ~2= 7. 974,P〈0. 05）. No significant difference existed in second labor stage time between two groups（t = 0. 772,P〈0. 05）. There was no significant difference in fecal contamination,puerperal infection,neonatal Apgar score and neonatal weight in two groups（χ~2= 2. 539,t value was 1. 923 and 0. 675,respectively,all P〈0. 05）. Neonatal asphyxia incidence in two groups had no significant difference（χ~2= 3. 08,P〈0. 05）. Satisfactory rate in the research group was 95. 88%,which was significantly higher than that（81. 44%） in the control group（χ~2= 10. 049,P〈0. 05）. Conclusion Unprotected perineum delivery technology combined with fetal head delivery control in spontaneous delivery has great effect on reducing perineotomy rate and relieving perineal laceration,and it is worthy of clinical application.