无痛结合无保护性会阴分娩的效果观察

An effect observation of painless labor combined with unprotected perineal delivery

目的探讨无痛结合无保护性会阴分娩对产妇的产程、产后出血量、新生儿Apgar评分和盆底肌力分级的影响。方法选取2017年2至12月于湖州市妇幼保健院分娩的200例产妇,根据不同分娩方式,分为A组(87例)采取无保护性会阴分娩;B组(113例)采取无痛结合无保护性会阴分娩。比较两组产妇产程、产后出血量、新生儿Apgar评分和盆底肌力分级等情况。结果B组产妇第二产程时间、产后2h出血量及住院天数均较A组明显减少(t值分别为4.01、4.22、13.83,均P<0.01)。B组产妇产后盆底肌力分级≤3级的比例较A组显著下降(χ^2=13.67,P<0.01),盆腔器官脱垂定量分类法(POP-Q)分度1度的比例较A组显著下降(χ^2=4.03,P=0.04)。与A组相比较,B组产妇会阴损伤程度明显减轻(χ^2=8.40,P=0.02)。两组新生儿Apgar评分的比较差异无统计学意义(t=1.74,P=0.08)。与A组相比较,B组产后并发症总发生率显著降低(χ^2=5.40,P=0.02)。结论无痛结合无保护性会阴分娩可有效缩短产程时间,减少产后出血量,改善分娩结局,减轻会阴损伤程度,减少盆底功能损伤,且产后并发症发生率较低,可作为有效且安全的接产方案,值得临床应用。

Objective To investigate effects of painless labor combined with unprotected perineal delivery on labor process,amount of postpartum hemorrhage,pelvic floor muscle strength grade of the parturient and neonatal Apgar score.Methods 200parturients delivered in our hospital from February 2017to December 2017were selected.According to delivery mode,87parturients who underwent unprotected perineal delivery were divided into group A and 113parturients who underwent painless labor and unprotected perineal delivery were divided into group B.The labor process,postpartum hemorrhage,pelvic floor muscle strength of the parturients and neonatal Apgar score were compared between the two groups.Results Time of the second stage of labor,postpartum hemorrhage at 2hours after delivery and hospitalization days of the parturients in group B were significantly shorter and less than those in group A(t=4.01,4.22and 13.83respectively,all P<0.01).The proportion of postpartum pelvic muscle strength grading≤3of the parturients in group B was significantly lower than that in group A(χ^2=13.67,P<0.01),and proportion of 1degree of pelvic organ prolapse quantification(POP-Q)was significantly lower than that in group A(χ^2=4.03,P=0.04).Compared with group A,the degree of perineal injury of the parturients in group B was significantly reduced(χ^2=8.40,P=0.02).There was no significant difference in neonatal Apgar score between the two groups(t=1.74,P=0.08).Compared with group A,the total incidence of postpartum complications of the parturients in group B was significantly reduced(χ^2=5.40,P=0.02).Conclusion Painless labor combined with unprotected perineal delivery can effectively shorten duration of the labor,reduce amount of postpartum hemorrhage,improve outcome of delivery,decrease degree of perineal injury,reduce pelvic floor function damage,with lower incidence of postpartum complications,so it can be used as an effective and safe delivery pattern.