肩难产产妇不同体位分娩方式对分娩结局的影响

Effects of delivery modes of different postures of puerperae with shoulder dystocia on their delivery outcomes

目的:探讨肩难产产妇不同体位分娩方式的分娩结局。方法:回顾性收集2015年8月-2019年6月本院肩难产孕妇分娩资料,根据其娩体位不同分为对照组(半卧位屈大腿抱膝法)和观察组(手膝支持俯卧位法),采用倾向性匹配评分法排除年龄、孕周、孕次等混杂因素影响,最终纳入46对肩难产孕妇,对比两组分娩方式、产程时间和产后2 h出血量、新生儿并发症情况,评估两组阴道分娩产妇6个月后会阴伤口愈合及盆腔肌综合收缩力情况。结果:观察组顺产率(82.6%)高于对照组(58.7%),剖宫产率(15.2%)低于对照组(34.8%),产程时间短于对照组,产后2h出血量(148.2±43.5ml)少于对照组(188.3±52.2ml)(均P<0.05);新生儿出生体重观察组(3872.23±215.25g)与对照组(3889.58±195.68g)无差异(P>0.05);观察组新生儿窒息发生率(12.8%)和并发症总发生率(15.4%)均低于对照组(35.9%、53.9%)(P<0.05);阴道分娩产妇会阴伤口愈合分级和盆腔肌综合收缩力等级观察组均优于对照组(P<0.05)。结论:肩难产产妇选择手膝支持俯卧位法进行胎方位矫正,能明显提高顺产率,降低剖宫产率,缩短产程时间并减少产后出血量,有效降低新生儿窒息等并发症风险,利于阴道分娩产妇产后会阴伤口愈合和盆腔功能恢复。

Objective:To explore the delivery outcomes of puerperae with shoulder dystocia by delivery modes of different postures.Methods:The delivery data of puerperae with shoulder dystocia from August 2015to June 2019were analyzed retrospectively.These puerperae were divided into control group(46puerperae with semi-recumbent position of thigh flexion and knee-holding)and observation group(46puerperae with hand-knee support prone position)according to the different delivery positions.After propensity score march was used to exclude the influences of the confounding factors,such as age,gestational weeks,and gravidity,the puerperae with shoulder dystocia in the two groups were included in this study finally.The delivery mode,the duration of delivery,and the hemorrhage volume in postpartum 2h of the puerperae,and the rate of neonatal complications were compared between the two groups.The situations of perineal wound healing and comprehensive contractility of pelvic muscles of the puerperae were assessed in the 6th month after vaginal delivery.Results:The rate of vaginal delivery(82.6%)of the puerperae in the observation group was significantly higher than that(58.7%)of the puerperae in the control group.The rate of cesarean section(15.2%)of the puerperae in the observation group was significantly lower than that(34.8%)of the puerperae in the control group.The duration of labor of the puerperae in the observation group was significantly shorter than that of the puerperae in the control group,and the volume of 2hpostpartum blood loss(148.2±43.5mL)of the puerperae in the observation group was significantly lower than that(188.3±52.2ml)of the puerperae in the control group(all P<0.05).There was no significant difference in the birth weight(3872.23±215.25g vs.3889.58±195.68g)between the two groups(P>0.05).The incidence of neonatal asphyxia(12.8%)and the total incidence of neonatal complications(15.4%)in the observation group were significantly lower than those(35.9%and 53.9%)in the control group(P<0.05).The grade of perineal wound healing and the grade of pelvic muscle contractility of the puerperae in the observation group were significantly better than those of the puerperae in the control group(P<0.05).Conclusion:Hand-knee support prone position for correcting the fetal position of the puerperae with shoulder dystocia during delivery can significantly improve the natural delivery rate,reduce the cesarean section rate,shorten the delivery duration,reduce the postpartum hemorrhage volume,and also can effectively reduce the risk of neonatal asphyxia and other complications.It is beneficial to the healing of the perineal wound and the recovery of the pelvic function after delivery.