分娩球联合改良式跪膝俯卧位对产程、分娩结局及产后盆底肌肌力的影响

Effects of delivery ball combined with improved kneeling prone position on labor course,delivery outcome and postpartum pelvic floor muscle strength

目的 研究初产妇第二产程采用分娩球联合改良式跪膝俯卧位的临床效果。方法 回顾性分析2019年6月至2021年6月在西北妇女儿童医院产科分娩的377例初产妇临床资料。根据第二产程采用的分娩方式不同分为观察组和对照组,其中观察组154例采用分娩球联合改良式跪膝俯卧位,对照组223例采用传统屈膝半卧位分娩。比较两组产妇产程情况及分娩结局,包括第二产程时间、产后2 h出血量、分娩方式、新生儿Apgar评分、新生儿体重及新生儿头围;比较两组产妇分娩疼痛及分娩控制感;比较两组经阴道分娩产妇会阴情况,包括会阴完整率、会阴侧切率、会阴Ⅰ度裂伤率及会阴Ⅱ度裂伤率;比较两组产妇产前初诊时及产后42 d的盆底肌肌力。结果 观察组产妇第二产程时间[(58.2±17.4)min]、产后2 h出血量[(192.3±43.2)mL]均明显少于对照组[(76.7±19.6)min,(214.7±54.1)mL],自然分娩率高于对照组,差异均有统计学意义(P<0.05);两组新生儿体重、新生儿头围及Apgar评分比较,差异无统计学意义(P>0.05)。观察组产妇分娩疼痛明显低于对照组,分娩控制感明显高于对照组,差异均有统计学意义(P<0.05)。观察组产妇会阴完整率(12.8%)明显高于对照组(4.7%),会阴侧切率(0%)明显低于对照组(27.0%),差异有统计学意义(P<0.05)。观察组会阴Ⅰ度裂伤率(84.0%)高于对照组(58.8%),Ⅱ度裂伤率(4.0%)低于对照组(9.5%),差异有统计学意义(P<0.05)。产前两组产妇深Ⅰ、浅Ⅰ、深Ⅱ、浅Ⅱ类纤维收缩力分值差异无统计学意义(P>0.05);产后42 d两组产妇深Ⅰ、浅Ⅰ、深Ⅱ、浅Ⅱ类纤维收缩力分值均较产前明显降低,差异有统计学意义(P<0.05);观察组产妇产后42 d深Ⅰ、浅Ⅰ、深Ⅱ、浅Ⅱ类纤维收缩力分值均高于对照组,组间差异有统计学意义(P<0.05)。结论 分娩球结合改良式跪膝俯卧位可缩短初产妇第二产程时间,改善分娩结局,降低会阴侧切率,缓解分娩疼痛感,提高分娩控制感,降低阴道分娩对产妇产后早期盆底肌肌力的影响。

Objective To study the clinical effect of the delivery ball combined with the improved kneeling prone position in the second stage of labor in primipara.Methods The clinical data of 377 primiparas who delivered in the Obstetrics Department of Northwest Women’s and Children’s Hospital from June 2019 to June 2021 were retrospectively analyzed.According to delivery methods adopted in the second stage of labor, they were divided into observation group and control group.In the observation group, 154 cases were delivered in improved kneel prone position combined with delivery ball, and 223 cases in control group were delivered in traditional half-decubitus position with knees bent.The labor process and delivery outcomes of the two groups were compared, including the time of the second stage of labor, 2-hour postpartum hemorrhage, mode of delivery, neonatal Apgar score, neonatal weight and neonatal head circumference;the labor pain and sense of control of labor were compared between the two groups;the perineal conditions of the vaginal delivery women, including the perineal integrity rate, the rate of lateral episiotomy, the rate of first-degree perineal laceration, and the rate of second-degree perineal laceration;the pelvic floor muscle strength of the two groups of puerperae at the first visit before delivery and 42 days after delivery were compared.Results The time of the second stage of labor and the amount of 2 h postpartum hemorrhage in the observation group [(58.2±17.4)min, [(192.3±43.2)mL] were significantly less than those in the control group [(76.7±19.6)min, [(214.7±54.1)mL],and the natural delivery rate was higher than that in the control group, with statistically significant differences(P<0.05).There was no significant difference in neonatal weight, neonatal head circumference and Apgar score between the two groups(P>0.05).The labor pain in the observation group was significantly lower than that in the control group, and the sense of labor control was significantly higher than that in the control group, with statistical significance(P<0.05).The perineal integrity rate in the observation group(12.8%) was higher than that in the control group(4.7%),while the perineal lateral resection rate(0%) was lower than that in the control group(27.0%),with statistical significance(P<0.05).The rate of degree Ⅰ laceration of perineum in the observation group(84.0%) was higher than that in the control group(58.8%),and the rate of degree Ⅱ laceration(4.0%) was lower than that in the control group(9.5%),and the difference was statistically significant(P<0.05).There was no significant difference in the contractile force scores of deep Ⅰ,shallow Ⅰ,deep Ⅱ and shallow Ⅱ between the two groups before delivery(P>0.05).Three months after delivery, the contractile force scores of deep Ⅰ,shallow Ⅰ,deep Ⅱ and shallow Ⅱ fibers in both groups were significantly lower than those in the prenatal period, with statistical significance(P<0.05).The contractile force scores of deep Ⅰ,shallow Ⅰ,deep Ⅱ and shallow Ⅱ fibers in the observation group were higher than those in the control group at 42 days postpartum, and the difference was statistically significant(P<0.05).Conclusion Delivery ball combined with improved kneeling prone position can shorten the time of the second stage of labor, reduce the rate of lateral episiotomy, relieve the pain of delivery, improve the sense of control of delivery, and reduce the influence of vaginal delivery on the early postpartum pelvic floor muscle strength.