初产妇分娩镇痛中第二产程腹压时机对产妇分娩结局的影响

Effect of timing of abdominal pressure during the second stage of labor on delivery outcome in primipara

目的探讨分娩镇痛的初产妇第二产程中不同时机的腹压对产妇分娩结局的影响。方法选取2019年6月至2020年5月苏州市立医院北区产科收治的120例经阴道分娩的初产妇,按随机数字表分为两组,对照组(60例)初产妇待宫口完全打开后立即使用腹压,观察组(60例)初产妇待胎头下降至+3 cm时再采用腹压。观察两组产妇分娩方式、第二产程及腹压用时、产妇分娩结局、新生儿状况等。结果两组产妇第二产程用时相较均差异无统计学意义(P>0.05);观察组产妇自然分娩率高于对照组,腹压用时短于对照组(P<0.05);观察组产妇会阴裂伤程度,侧切率以及产后出血少对照组(P<0.05);两组产程中胎心减速情况相较差异无统计学意义(P>0.05);观察组新生儿窒息率为1.66%,低于对照组的13.33%(P<0.05)。结论分娩镇痛的初产妇第二产程中当胎头下降至+3 cm时再采用腹压,可有效提升产妇自然分娩率,缩短腹压用时,改善产妇分娩结局,并可有效降低新生儿窒息率,值得推广。

Objective To explore the effect of abdominal pressure on the delivery outcome of primipara during the second stage of labor.Methods From June 2019 to May 2020,120 cases of primipara who had vaginal delivery were divided into two groups according to the table of random numbers.The control group(60 cases)were given abdominal pressure immediately after the opening of the uterus,in the observation group(60 cases),abdominal pressure was applied again when the fetal head descended to 3 cm.The mode of delivery,the second stage of Labor,the duration of abdominal pressure,the outcome of delivery and the condition of newborn were observed.Results After the intervention,there was no significant difference in the second stage of labor between the two groups(P>0.05),the duration of abdominal pressure in the two groups was significantly shorter than that in the control group(P<0.05),there were statistical significance(P<0.05),and there was no significant difference between the two groups in the reduction of fetal heart rate(P>0.05).The neonatal asphyxia rate in the observation group was 1.66%,which was significantly better than that in the control group(13.33%,P<0.05).Conclusions Using abdominal pressure during the second stage of labor when the head of the fetus drops to 3 cm can effectively increase the natural delivery rate of the parturient,shorten the time of abdominal pressure,improve the delivery outcome of the parturient and effectively reduce the rate of asphyxia neonatorum,which is worth clinical promotion.