分娩镇痛下第二产程剖宫产及产钳术145例分析

Analysis of 145 cases of cesarean section and forceps midwifery during the second stage of labor under labor analgesia

目的:观察分娩镇痛下第二产程实施剖宫产及产钳术的指征及母儿结局。方法:回顾性分析2016年1月至2018年10月湘雅医院第二产程剖宫产88例、产钳术57例产妇的临床资料,比较两组的干预指征、产道或子宫切口裂伤、产后出血、新生儿体重、窒息、转科率及第二产程和决策至分娩时间。结果:产钳助产组指征主要是胎儿窘迫,剖宫产组是胎头下降停滞。产钳助产组裂伤、产后出血、血色素下降及新生儿转科率高于剖宫产组,决策至胎儿娩出时间和住院时间短于剖宫产组,差异有统计学意义(P<0.05);两组产妇填塞、输血、第二产程时间、新生儿出生体重、窒息及新生儿损伤情况差异无统计学意义(P>0.05)。结论:产钳术能较快结束分娩,但应注意裂伤及产后出血,剖宫产组应避免子宫切口延裂。

Objective:To observe the indications and outcomes of cesarean section and forceps midwifery during the second stage of labor under labor analgesia.Methods:The clinical data of 88 cases of cesarean section and 57 cases of forceps midwifery during the second stage of labor at Xiangya Hospital from January 2016 to October 2018 were retrospectively analyzed.The intervention indications,birth canal or uterine incision laceration,postpartum hemorrhage,neonatal weight,asphyxia,rate of admission to neonatal ICU(NICU)as well as the second stage of labor and decision-making to delivery time were compared between the two groups.Results:The main midwifery indication in the obstetric forceps group was fetal distress,and the main indication of delivery in the cesarean section group was fetal head arrest.The rates of laceration,postpartum hemorrhage,decrease of hemoglobin and NICU in the forceps group were higher than those in the cesarean section group,while the decision-making to delivery time and hospitalization days were shorter than those in the cesarean section group with statistically significant difference(P<0.05).There were no statistically significant differences in maternal tamponade,blood transfusion,time of the second stage of labor,birth weight,asphyxia and neonatal injury between the two groups(P>0.05).The time and length of stay in the cesarean section group were shorter than those in the cesarean section group(P<0.05).Conclusion:Obstetric forceps can make the delivery faster,while attention should be paid to avoid laceration and postpartum hemorrhage.Cesarean section should avoid uterine laceration.