第二产程站立位用力与接产的临床应用效果

The effect of clinical application of standing position pushing and delivery in the second stage of labor

目的探讨第二产程站立位用力与接产的临床应用效果。方法选择2019年1月—2020年3月在广州医科大学附属第三医院分娩的78例低危产妇为研究对象,采用数字抽签法分为观察组和对照组,各39例。观察组产妇在第二产程中采用站立位用力及接产,对照组产妇在第二产程中采用仰卧截石位用力和接产。比较两组产妇会阴损伤程度、会阴侧切率、产时出血量、产后2 h出血量、产后24 h出血量、第二产程时间及新生儿窒息发生率。结果观察组产妇会阴裂伤程度、会阴侧切率低于对照组,差异有统计学意义(P<0.05);观察组产时出血量为(207.89±42.31)ml,对照组为(235.00±53.86)ml,观察组产后2 h出血量为(256.44±45.63)ml,对照组为(362.31±211.88)ml,观察组产后24 h出血量为(254.89±45.54)ml,对照组为(422.38±237.44)ml,3个出血量指标的两组差异均有统计学意义(均P<0.05);观察组第二产程时间为(46.46±36.56)min,对照组为(69.10±51.16)min,差异有统计学意义(P<0.05);两组新生儿均未发生窒息。结论第二产程采用站立位用力和接产可降低产时和产后出血量,降低会阴损伤和会阴侧切率,减少第二产程时间,不增加新生儿窒息发生率,提高产科助产质量,促进自然分娩,可以在临床推广及应用。

Objective To investigate the clinical application effect of standing position push and delivery in the second stage of labor.Methods Seventy-eight cases of low-risk mothers delivered in the Third Affiliated Hospital of Guangzhou Medical University from January 2019 to March 2020 were selected for the study,and were divided into observation and control groups of 39 cases each using the digital lottery method.In the observation group,women in the second stage of labor were delivered in the standing position,while in the control group,women in the second stage of labor were delivered in the supine lithotomy position.The degree of perineal injury,the rate of lateral episiotomy,the amount of bleeding during labor,the amount of bleeding 2 h after delivery,the amount of bleeding 24 h after delivery,the time of the second stage of labor and the incidence of neonatal asphyxia were compared between the two groups.Results The degree of perineal laceration and the rate of lateral episiotomy in the observation group were lower than those in the control group,and the difference was statistically significant(P<0.05);the amount of bleeding at delivery was(207.89±42.31)ml in the observation group,compared with(235.00±53.86)ml in the control group;the amount of bleeding at 2 h after delivery was(256.44±45.63)ml in the observation group,compared with(362.31±211.88)ml in the control group;the amount of bleeding at 24 h after delivery was(254.89±45.54)ml in the observation group,compared with(422.38±237.44)ml in the control group.The difference between the two groups was statistically significant(P<0.05)for all three bleeding indicators.The time of the second stage of labor was(46.46±36.56)min,in the observation group and(69.10±51.16)min in the control group,and the differences were statistically significant(P<0.05).No asphyxia occurred in both groups.Conclusion The use of standing position and delivery during the second stage of labor can reduce the amount of bleeding during and after delivery,decrease the rate of perineal injury and lateral episiotomy,reduce the duration of the second stage of labor,not increase the incidence of neonatal asphyxia,improve the quality of obstetric assistance and promote natural delivery,and can be promoted and applied in clinical practice.