无保护联合无痛分娩对初产妇产后盆底功能的影响

Effect of perineum-unprotected vaginal delivery combined with painless labor on pelvic floor function in early puerperium of primipara

目的探讨无保护联合无痛分娩对阴道分娩的初产妇产后盆底功能的影响。方法选取2020年7月至8月于温州市人民医院进行阴道分娩的240例初产妇为研究对象,7月入组者为对照组,8月入组者为观察组,每组120例。对照组采用无保护分娩,观察组采用无保护联合无痛分娩,比较两组的产程疼痛、会阴损伤、产后出血及产后早期盆底功能等。结果观察组在镇痛后30min、60min时的疼痛评分低于相同时间点的对照组,第二产程时间短于对照组,产后2h出血量少于对照组,住院时间短于对照组,差异均有统计学意义(t值分别为44.792、53.141、2.852、3.887、10.469,均P<0.05);观察组的会阴损伤程度轻于对照组,差异有统计学意义(χ^(2)=32.597,P<0.05);两组产后新生儿窒息评分、新生儿窒息率差异无统计学意义(均P>0.05);观察组产后42d的盆底肌力优于对照组,盆底动态压力异常少于对照组,差异有统计学意义(t/χ^(2)值分别为15.510、32.348,均P<0.05);观察组产后42d的压力性尿失禁、盆底器官脱垂发生率低于对照组,差异有统计学意义(χ^(2)值分别为4.630、4.364,均P<0.05)。结论无保护联合无痛分娩能够显著减轻阴道分娩初产妇产程疼痛,促进产程进展,减少会阴损伤,减轻产后早期盆底功能损害。

Objective To explore effect of perineum-unprotected vaginal delivery combined with painless labor on postpartum pelvic floor function of primiparae.Methods 240 primiparae who delivered vaginally in Wenzhou Municipal People’s Hospital from July to August 2020 were selected as research subjects.The primiparae who delivered in July were selected as control group, and those delivered in August were selected as observation group(120 cases in each group).The primiparae in the control group underwent perineum-unprotected delivery, and those primiparae in the observation group underwent peineum-unprotected delivery combined with painless labor.Labor pain, perineal injury, postpartum hemorrhage amount and early postpartum pelvic floor function of the primiparae were compared between the two groups.Results The pain scores of the primiparae in the observation group at 30 min and 60 min after analgesia were lower than those of the primiparae in the control group at the same time points, duration of second stage of labor was shorter than that in the control group, amount of postpartum hemorrhage within 2 hours was less than that in the control group, and length of hospital stay was shorter than that in the control group, the differences were all statistically significant(t=44.792,53.141,2.852,3.887 and 10.469 respectively, all P<0.05).And severity of perineal injury of the primiparae in the observation group was lighter than that in the control group, the difference was statistically significant(χ^(2)=32.597,P<0.05).There were no significant differences in scores in neonatal asphyxia and incidence rate of neonatal asphyxia between the two groups(both P>0.05).The strength of pelvic floor muscles of the primiparae in the observation group at the 42 nd day after delivery was stronger than that of the primiparae in the control group, and incidence of abnormal dynamic pressure of pelvic floor was lower than that in the control group, and the differences were statistically significant(t/χ^(2)=15.510 and 32.348 respectively, both P<0.05).The incidences of stress urinary incontinence(SUI) and pelvic floor organ prolapse(POP) of the primiparae in the observation group at the 42 nd day after delivery were significantly lower than those in the control group(χ^(2)=4.630 and 4.364 respectively, both P<0.05).Conclusion Perineum-unprotected vaginal delivery combined with painless labor can significantly reduce labor pain, promote progress of labor, decrease incidence of perineal injury, and lessen pelvic floor function damage in early puerperium.