第二产程支撑式前倾跪位对全程分娩镇痛孕妇分娩的影响

Effect of prone kneeling position in the second stage of labor on labor analgesia in pregnant women

目的:探讨第二产程初期运用支撑式前倾跪位对全程实施分娩镇痛的初产妇分娩结局的影响。方法:按纳入排除方法将实施分娩镇痛的初产妇按完全随机方法分成观察组和对照组各95例。两组孕妇第一产程均采取自由体位。观察组第二产程初期采用支撑式前倾跪位,至胎先露为(S+4)时,改为膀胱截石位;对照组第二产程全程为膀胱截石位。两组产妇均使用常规手法接生,分析比较两组孕产妇间产程和分娩结局的差异。结果:观察组第二产程时间较对照组短(67.54±37.28 min vs.79.17±35.76 min,P<0.05),新生儿1 min Apgar评分高于对照组(9.97±0.67 vs.9.77±0.23,P<0.05)。二分类Logistic回归分析显示观察组阴道分娩率明显高于对照组(OR=8.644,95%CI=1.059-70.530),第二产程中胎心减速的发生率明显低于对照组(OR=0.253,95%CI=0.079-0.809)。结论:对于全程实施分娩镇痛的初产妇,在第二产程初期运用支撑式前倾跪位可以缩短第二产程,降低中转剖宫产率,提高阴道分娩成功率,改善新生儿评分。

Objective:To investigate the effect of prone kneeling position in the second stage of labor on the delivery outcome of primipara who underwent labor analgesia.Methods:Base on the inclusion and exclusion methods,the primiparas who underwent labor analgesia were randomly divided into the observation group and the control group with 95 cases in each group.In the observation group,the prone kneeling position was adopted at the beginning of the second stage of labor until the fetus was exposed(S+4),and then the bladder lithotomy position was instead.The bladder lithotomy position was adopted in the control group for the whole of delivery.The women in both groups were delivered under conventional ways.The differences of labor and delivery outcomes between the two groups were analyzed and compared.Results:The second stage of labor in the observation group was shorter than that in the control group,and the one-minute Apgar score of newborns in one minute was higher than that in the control group.Binary logistic regression analysis showed that the vaginal delivery rate in the observation group was significantly higher than that in the control group(OR=8.644,95%CI 1.059-70.530),and the incidence of fetal deceleration during the second stage of labor was significantly lower than that in the control group(OR=0.253,95%CI 0.079-0.809).Conclusion:For primiparas who under going labor analgesia throughout the whole process of delivering,the application of prone kneeling position in the second stage of labor can shorten the second stage of labor,reduce the rate of conversion to cesarean section,increase the success rate of vaginal delivery,and improve Apgar score of newborns.