孕晚期骨盆运动对初产妇分娩要素和结局的影响

Effects of pelvic motion in third trimester on the elements and outcomes of childbirth in primipara

目的探讨孕晚期骨盆运动对初产妇分娩结局的影响。方法选取南京市妇幼保健院助产门诊2019年11月1日至2020年3月10日收治的127例单胎头位初产妇为研究对象,按随机数字表法分为散步组及骨盆运动组,最终散步组纳入62例,骨盆运动组纳入65例。散步组孕晚期的运动方式是快步走;骨盆运动组孕晚期的运动方式是包含脊柱直立位和脊柱水平位2个平面,多个骨盆周围关节的综合骨盆运动。观察2组孕妇运动前后产力、产道、胎儿各方面数值变化,并比较2组孕妇的分娩结局。结果生产前1 d骨盆运动组"空中自行车"坚持时间为(27.12±7.73)s,散步组为(20.56±6.60)s,差异有统计学意义(t值为5.12,P<0.01);生产前骨盆运动组运动后出现宫缩的时间为(269.38±123.70)s,散步组为(591.29±201.82)s,差异有统计学意义(t值为10.89,P<0.01)。骨盆运动组坐位体前屈水平为(33.64±5.91)cm,散步组为(29.50±5.28)cm,差异有统计学意义(t值为4.15,P<0.01);规律宫缩时宫颈评分,骨盆运动组(8.01±1.69)分,散步组(7.30±1.40)分,差异有统计学意义(t值为2.56,P<0.05)。规律宫缩开始时胎儿"枕前位"比例:骨盆运动组为93.85%(61/65),散步组为72.58%(45/62),差异有统计学意义(χ2值为10.41,P<0.01)。生产前1 d运动后无疼痛:骨盆运动组为72.31%(47/65),散步组为29.03%(18/62),差异有统计学意义(χ2值为25.30,P<0.01)。第一产程时间:骨盆运动组(395.84±165.24)min,散步组(574.35±152.23)min,差异有统计学意义(t值为6.32,P<0.01);第二产程时间:骨盆运动组(25.98±9.88)min,散步组(33.62±13.94)min,差异有统计学意义(t值为3.57,P<0.01)。结论孕晚期骨盆运动,更能影响产力、产道、胎儿等分娩要素,减少运动疼痛,缩短产程时间。

Objective To investigate the effect of pelvic motion in late pregnancy on the outcome of first trimester delivery.Methods A total of 127 first-borns admitted to the midwifical clinic of Nanjing Maternal and Child Health Hospital from November 1,2019 to March 10,2020 were selected as the research objects,and they were divided into the walking group and the pelvic motion group according to the random number table method.In the end,62 cases were included in the walking group and 65 cases in the pelvic motion group.The walking group did brisk walking in the third trimester.In the pelvic motion group,the motion in the third trimester consisted of the combined pelvic motion involving the two planes of the upright spine and the horizontal spine,and multiple peripelvic joints.The changes of fertility,birth canal and fetus before and after exercise were observed,and the outcomes of childbirth were compared between the two groups.Results Indicators reflecting productivity:persistence time of"air bike"on the day before delivery was(27.12±7.73)seconds in the pelvic motion group and(20.56±6.60)seconds in the walking group,the difference was statistically significant(t value was 5.12,P<0.01).The time of contractions after exercise before delivery was(269.38±123.70)seconds in the pelvic motion group and(591.29±201.82)seconds in the walking group,the difference was statistically significant(t value was 10.89,P<0.01).The indicators reflecting the situation of the maternal birth canal were as follows:"sitting forward flexion level",pelvic motion group was(33.64±5.91)cm,walking group was(29.50±5.28)cm,the difference was statistically significant(t value was 4.15,P<0.01).The cervical score during regular contractions was 8.01±1.69 in the pelvic motion group and 7.30±1.40 in the walking group,the difference was statistically significant(t value was 2.56,P<0.05).At the beginning of regular contractions,the proportion of fetal"occipital position"was 93.85%(61/65)in the pelvic motion group and 72.58%(45/62)in the walking group,the difference was statistically significant(χ2 value was 10.41,P<0.01).The"no pain rate after exercise the day before delivery"was 72.31%(47/65)in the pelvic motion group and 29.03%(18/62)in the walking group,the difference was statistically significant(χ2 value was 25.30,P<0.01).Time of the first labor was(395.84±165.24)min in the pelvic motion group and(574.35±152.23)min in the walking group,the difference was statistically significant(t value was 6.32,P<0.01).The second stage of labor was(25.98±9.88)min in the pelvic motion group and(33.62±13.94)min in the walking group,the difference was statistically significant(t value was 3.57,P<0.01).Conclusions Pelvic motion in middle and late pregnancy can affect labor force,birth canal,fetus and other delivery factors,reduce movement pain and shorten the time of labor.