分娩镇痛下人工破膜的不同时期对产程影响的效果观察

Effects of artificial rupture of fetal membrane under epidural labor analgesia in different periods on birth process

目的探讨临产后行硬膜外分娩镇痛下人工破膜的不同时期对产程的影响效果。方法选择在产房待产均为硬膜外分娩镇痛下阴道试产已临产的初产妇行人工破膜的432例初产妇的资料,按照当时行人工破膜的不同时期分为4组,分别为:先露头仍在坐骨棘上、宫颈扩张减速期前破水组(A1组),先露头仍在坐骨棘上、宫颈扩张减速期或以后(宫口开大9 cm或宫口开全)破水组(A2组),先露头达坐骨棘下、宫颈扩张减速期前破水组(B1组),先露头达坐骨棘下、宫颈扩张减速期或以后(宫口开大9 cm或宫口开全)破水组(B2组)。比较4组产妇分娩方式、产程时间和新生儿体重、产妇和新生儿主要并发症、剖宫产原因等指标。结果 4组剖宫产率比较差异有统计学意义(P<0.05),A1组剖宫产率最高,A2、B1、B2、3组间比较剖宫产率差异无统计学意义(P>0.05)。窒息评分,产瘤形成、产后出血,4组比较差异有统计学意义(P<0.05),A1组发生率最高;其他3组间比较差异无统计学意义(P>0.05)。结论 A1组与其他3组比较,有更高的中转剖宫产率,原因多为活跃期停滞及增加胎儿宫内窘迫,且增加新生儿重度窒息可能,产瘤形成及产妇产后出血增加;如果先露较高,胎方位异常,胎儿偏大等宫口近开全或开全后行人工破膜,较少母儿发生并发症。

Objective To investigate the effects of artificial rupture of fetal membrane under epidural labor analgesia in different periods on birth process.Methods A total of 432 primipara who underwent artificial rupture of fetal membranes under epidural labor analgesia in our hospital from January 2016 to March 2017 were emrolled in the study.According to different periods artificial rupture of fetal membranes,the 432 primipara were divided into four groups:the primipara with fetal head appearing but above ischial spine and membrane rupture before cervical dilation deceleration period were divided into A1 group,the primipara with fetal head appearing but above ischial spine and membrane rupture after cervical dilation deceleration period(cervix open 9cm or full open)were divided into A2 group,the primipara with fetal head appearing under ischial spine and membrane rupture before cervical dilation deceleration period were divided into B1 group,and the primipara with fetal head appearing under ischial spine and membrane rupture after cervical dilation deceleration period(cervix open 9cm or full open)were divided into B2 group.The delivery mode,birth process duration,neonatal weigh,main complications of maternal and neonates,courses of caesarean section were obseved and compared among the four groups.Results There was significant difference in cesarean section rate among the four groups(P<0.05).The cesarean section rate in A1 group was the highest,however,there was no significant difference in cesarean section rate among A2,B1,B2 groups(P>0.05).There were significant differences in neonatal weight,asphyxia scores,caput succedaneum formation and postpartum hemorrhage among the four groups(P<0.05).The incidence rate of main complicatins in A1 group was the highest,but there was no significant difference in the incidence rate among A2,B1,B2 groups(P>0.05).Conclusion As compared with the other three groups,the puerpera in A1 group have higher transference cesarean section rate,and the main reasons are protracted active phase to increase fetal distress in uterus,and increase the possibility of severe neonatal asphysia,increase caput succedaneum formation and postpartum hemorrhage.The complications can be avoided if artificial rupture of fetal membrane is performed after cervical mouth is open completely.