手膝俯卧位与平卧位分娩对母儿结局的影响

Effects of delivery in the prone position and supine position on the maternal and infant outcomes

目的探讨第二产程采取手膝俯卧位与平卧位分娩对母儿结局的影响。方法选取2017年8月至2018年4月期间在本院住院自然分娩的初产妇200例,根据娩出胎儿时的体位分组,娩出胎儿时是手膝俯卧位组为观察组,平卧位组为对照组,每组100例。观察组产妇第二产程助产士指导其根据自我感觉舒适的意愿用力,每15~20 min自由交替选择调整分娩体位,当胎头拨露后采取手膝俯卧位娩出胎儿;对照组产妇第二产程助产士指导其全程取平卧位娩出胎儿;两组产妇待产过程中均采取自由体位待产,接产时均采用无保会阴接产。比较两组产程时间、会阴侧切率、会阴裂伤程度、产后2 h出血量、新生儿窒息率。结果观察组第二产程时间较对照组短[(38.98±9.02)min比(59.14±8.82)min],差异有统计学意义(P<0.05);观察组会阴侧切率(0.0%比18.0%)和会阴II度裂伤率(16.0%比57.0%)均优于对照组,差异均有统计学意义(均P<0.05)。两组第一产程时间、第三产程时间、产后2 h出血量、新生儿窒息率比较差异均无统计学意义(均P>0.05)。结论手膝俯卧位分娩可缩短第二产程,不增加新生儿窒息发生率,减轻会阴损伤,提高产妇分娩舒适度,且对母婴结局无不良影响,值得推荐临床应用。

Objective To investigate the effect of prone position and supine position on the outcomes of the second stage of labor.Methods From August 2017 to April 2018,200 cases of primipara of natural childbirth hospitalized in our hospital were divided into two groups according to the position of delivery,the prone position as the observation group,supine position as the control group,100 cases in each group.The midwife instructed the puerpera to exert their strength according to comfortable sensation during the second stage of labor in the observation group,the puerpera adjusted the delivery position alternately each 15 to 20 minutes,and chose to deliver the fetus in the prone position after head visible on vulval gapping.The midwife instructed the puerpera to deliver the fetus in the supine position during the second stage of labor in the control group.The puerpera in the two groups were in free position in the process of predelivery,and took no protection perineal delivery.The stage of labor,the rate of lateral episiotomy,the degree of perineal laceration,2 h postpartum blood loss,the rate of neonatal asphyxia were compared between the two groups.Results The second stage of labor in the observation group was shorter than that in the control group[(38.98±9.02)min vs.(59.14±8.82)min],with statistically significant difference(P<0.05).The rate of lateral episiotomy and the rate of grade II perineal laceration in the observation group were better than those in the control group(0.0%vs.18.0%,16.0%vs.57.0%),with statistically significant differences(P<0.05).There were no statistically significant differences in the first labor stage,the third labor stage,2 h postpartum blood loss,and the rate of neonatal asphyxia between the two groups(P>0.05).Conclusion Delivery in the prone position can shorten the second stage of labor,reduce perineal injury,improve the comfort of parturient delivery,does not increase the incidence of neonatal asphyxia,and has no adverse effects on maternal and infant outcomes.