产程中超声引导下系列性体位干预策略对异常胎方位分娩影响的研究

The effects of a series of posture intervention strategies guided by ultrasonography during labor process on the parturition with abnormal fetal head position

目的探讨系列性体位干预策略对纠正异常胎方位的临床效果,为临床开展体位管理、促进自然分娩提供依据。方法采用随机对照试验方法,便利抽样选择2022年3-10月在浙江大学医学院附属妇产科医院经B超明确为单胎头位异常胎方位的足月妊娠初产妇196例为研究对象,采用随机数字表法分为对照组106例和研究组90例。对照组进行常规护理,孕妇自愿选择舒适体位待产分娩;研究组在常规护理的基础上采用超声引导下系列性体位干预策略于第一、二产程指导孕妇进行体位管理。比较2组孕妇胎头下降角度、胎头旋转角度、宫口开全和胎儿娩出时胎方位情况及分娩结局。结果最终纳入分析190例,对照组105例,研究组85例。经阴道分娩研究组76例,对照组95例;研究组宫口开全时枕前位占比73.68%(56/76)、胎头旋转角度64.55(37.90,85.55)°,高于对照组的45.26%(43/95)、33.00(14.00,60.00)°,研究组宫口开全时大脑中线角为57.10(38.50,75.80)°,小于对照组的80.00(52.50,90.30)°,2组比较差异均有统计学意义(χ^(2)=14.14,Z=4.17、-3.74,均P<0.01)。研究组第一产程、总产程时长分别为522.50(413.00,695.00)、611.00(488.00,812.00)min,低于对照组的620.00(450.00,795.00)、700.00(539.00,904.00)min,差异均有统计学意义(Z=-2.34、-2.03,均P<0.05)。结论产程中运用超声引导下系列性体位干预策略可有效、安全改善异常胎方位、缩短第一产程时长,但未发现对改善分娩结局有明显效果。

Objective To explore the clinical effects of a series of posture intervention strategies on correcting abnormal fetal position,so as to provide a basis for Clinical position management and promotion of natural delivery.Methods This study was a randomized controlled trial.The convenience sampling method was used to select 196 full-term primiparas women with abnormal fetal orientation confirmed by ultrasound as single fetal head position in the Women′s Hospital,School of Medicine,Zhejiang University from March to October 2022 as the research objects.They were divided into control group 106 cases and research group 90 cases by random number table method.The control group received normal nursing and chose comfortable position by themselves during labor.The research group received a series of ultrasound-guided postural intervention strategies for postural management in the first and second stages of labor on the basis of normal nursing.The angle of progression and the midline angle,the fetal orientation,fetal orientation during complete uterine orifice and delivery outcome were compared between the two groups.Results Finally,190 cases were included,105 cases in the control group and 85 cases in the research group.There were 76 vaginal deliveries in the research group and 95 in the control group.The rate of anterior occipital position and the angle of fetal head rotation in the research group were 73.68%(56/76)and 64.55(37.90,85.55)°,which were higher than 45.26%(43/95)and 33.00(14.00,60.00)°in the control group;the midline angle of the research group was 57.10(38.50,75.80)°,which was lower than 80.00(52.50,90.30)°of the control group.There was significant difference between the two groups(χ^(2)=14.14,Z=4.17,-3.74,all P<0.01).The first stage of labor was 522.50(413.00,695.00)minutes and the total stage of labor was 611.00(488.00,812.00)minutes in the research group,which was lower than 620.00(450.00,795.00)and 700.00(539.00,904.00)minutes in the control group(Z=-2.34,-2.03,both P<0.05).Conclusions The application of the serial position intervention strategy under the ultrasound guidance during the labor process can improve the abnormal fetal position,shorten the first stage of labor time effectively and safely,while it does not have any significant effect on the improvement of the delivery outcome.