第二产程不同体位娩出胎儿的临床应用效果
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摘要
目的探讨第二产程中不同体位娩出胎儿在临床中的应用效果。方法选择广州医科大学附属第三医院2015年11月至2016年10月待产的200例足月产妇,全产程实施自由体位分娩,根据第二产程胎头拨露或着冠时产妇选择的分娩体位分为6组,即坐位、站位、跪趴位、蹲位、侧卧位和截石位,比较分析各组分娩结局。结果不同体位娩出胎儿对第二产程时间、产时出血和产后2 h出血量的影响比较,差异有统计学意义(χ~2=24. 063、18. 569、12. 700,P <0. 05),对会阴裂伤程度影响比较,差异无统计学意义(χ~2=11. 037,P>0. 05)。结论在不同分娩体位中,站位、跪趴位、蹲位分娩的第二产程时间较短,虽然直立体位,如站位、坐位、蹲位产时出血和产后2 h出血量稍多,但未达到产后出血的诊断标准。
Objective To explored the clinical application effect of delivering in different positions during second stage of labor.Methods Selected 200 full-term maternity women from November 2015 to October 2016 in the Third Affiliated Hospital of Guangzhou Medical University to perform free posture delivery,according to the chosen posture in second stage of labor,when the fetal head was exposed or crowned,divided them into 6 groups: sitting,standing,kneeling,squatting,lateral position and lithotomy position. Compared pregnancy outcomens of the 6 groups. Results There were significant differences in duration of second stage of labor,intrapartum hemorrhage and 2 hours after delivery hemorrhage among different delivery position groups( χ~2= 24. 063、18. 569、12. 700,P < 0. 05),but no statistically significant difference in the degree of perineal laceration( χ~2= 11. 037,P > 0. 05). Conclusion Among these different delivery groups,the duration of second stage of labor was shorter in standing,kneeing and squatting groups.The intrapartum hemorrhage and 2 hours after delivery was greater in upright position group,such as in standing,sitting and squatting groups,but the blood loss in each group did not meet the criteria of postpartum hemorrhage.
Objective To explored the clinical application effect of delivering in different positions during second stage of labor.Methods Selected 200 full-term maternity women from November 2015 to October 2016 in the Third Affiliated Hospital of Guangzhou Medical University to perform free posture delivery,according to the chosen posture in second stage of labor,when the fetal head was exposed or crowned,divided them into 6 groups: sitting,standing,kneeling,squatting,lateral position and lithotomy position. Compared pregnancy outcomens of the 6 groups. Results There were significant differences in duration of second stage of labor,intrapartum hemorrhage and 2 hours after delivery hemorrhage among different delivery position groups( χ~2= 24. 063、18. 569、12. 700,P < 0. 05),but no statistically significant difference in the degree of perineal laceration( χ~2= 11. 037,P > 0. 05). Conclusion Among these different delivery groups,the duration of second stage of labor was shorter in standing,kneeing and squatting groups.The intrapartum hemorrhage and 2 hours after delivery was greater in upright position group,such as in standing,sitting and squatting groups,but the blood loss in each group did not meet the criteria of postpartum hemorrhage.
引文
[1]潘敏,雪丽霜,零恒莉,等.产程早期体位干预配合分娩辅助设施对分娩的影响[J].中华护理杂志,2014,49(3):297-300.
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[12]齐月,赵彩云,张婷婷,等.产妇在第二产程中采取自由体位护理对分娩效果的影响[J].中国卫生标准管理,2015,6(8):179-180.
[13]涂伟妹,刘佩蓉,郭爱英,等.初产妇在第二产程中采取自由体位联合无保护会阴接生对分娩效果的影响[J].实用临床医学,2014,15(8):68-69,92.
[14]徐映,罗卫明,凌洁.第二产程产妇自由体位分娩效果的分析[J].中国医师杂志,2014,16(11):1563-1565.
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[16]Golara M,Plaat F,Shennan AH.Upright versus recumbent position in the second stage of labour in women with combined spinal-epidural analgesia[J].Int J Obstet Anesth,2002,11(1):19-22.
[17]梁小姝.自由体位分娩在产科的应用研究[J].中国实用护理杂志,2008,24(21):31-32.
[18]Gupta JK,Hofmeyr GJ,Shehmar M.Position in the second stage of labour for women without epidural anaesthesia[J].Cochrane Database Syst Rev,2012(5):CD 002006.
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[20]Ragnar I,Altman D,Tyden T,et al.Comparison of the maternal experience and duration of Labour in two upright delivery positions-a randomised controlled trial[J].BJOG,2006,113(2):165-170.
[21]厉跃红,吴娜,庄薇.分娩球配合自由体位助产对初产妇产痛、分娩控制感及妊娠结局的影响[J].中华护理杂志,2013,48(9):793-796.
[22]Lawrence A,Lewis L,Hofmeyr GJ,et al.Maternal positions and mobility during first stage Labour[J].Cochrane Database of Systematic Reviews,2009(2):D 3934.
[23]Reitter A,Daviss B,Bisits A,et al.Does pregnancy and/or shifting positions create more room in a woman's pelvis?[J].Am JObstet Gynecol,2014,211(6):661-662.
[24]孙小金,朱忍娣,周巧仪,等.分娩球联合自由体位助产对初产妇分娩的影响[J].国际护理学杂志,2014,33(7):1672-1674.
[25]王海荣.产妇第二产程应用自由体位88例效果观察[J].齐鲁护理杂志,2014,20(12):6-8.
[26]零恒莉,潘茹,杨晓娅.第二产程产妇自由体位分娩效果的研究[J].中国实用护理杂志,2007,23(6):20.
[27]Meyvis I,Van Rompaey B,Goormans K,et al.Maternal position and other variables:effects on perineal outcomes in 557 births[J].Birth-Issues in Perinatal Care,2012,39(2):115-120.
[28]Elvander C,Ahlberg M,Thies-Lagergren LA,et al.Birth position and obstetric anal sphincter injury:a population-based study of 113 000 spontaneous births[J].BMC Pregnancy Childbirth,2015,15(1):252.
[29]祁志宇,韩萍.自由体位分娩对促进自然分娩的临床研究[J].河北医药,2015,37(7):1000-1003.
[2]涂伟妹,刘佩蓉,郭爱英,等.初产妇在第二产程中采取自由体位联合无保护会阴接生对分娩效果的影响[J].实用临床医学,2014,15(8):68-69,92.
[3]曹红旭,李伟伟,李燕.第二产程改良式体位与自由直立位分娩效果比较[J].齐鲁护理杂志,2014,20(18):122-123.
[4]黄丽华,郑月媚,朱建英,等.136例第二产程自由式接产分娩效果观察[J].中国生育健康杂志,2014,25(2):154-156.
[5]李仁兰,王承玲,刘梅,等.自然娩肩法对产伤和新生儿窒息的影响[J].护士进修杂志,2016,31(10):909-911.
[6]ZHANG Hong-yu,GUO Ren-fei,WU Yan,et al.Normal range of head-to-body delivery interval by two-step delivery[J].Chin Med J(Engl),2016,129(9):1066-1071.
[7]杨学颖.肩难产的诊断与治疗进展[J].医学理论与实践,2011,24(8):891-892,900.
[8]张依妮,郭洪花.不同分娩体位在第二产程应用的研究进展[J].中华护理杂志,2013,48(3):281-283.
[9]李晶,纪艳洁.立式体位对分娩的影响[J].中国医药指南,2011,9(20):324-325.
[10]江秀敏,高丽素,金丽珠,等.分娩第一产程自由体位的临床研究[J].中华护理杂志,2002,37(3):165-167.
[11]徐晓俊,胡诚.坐式体位对活跃期及二产程和分娩结局的影响[J].护士进修杂志,2007,22(15):1380-1381.
[12]齐月,赵彩云,张婷婷,等.产妇在第二产程中采取自由体位护理对分娩效果的影响[J].中国卫生标准管理,2015,6(8):179-180.
[13]涂伟妹,刘佩蓉,郭爱英,等.初产妇在第二产程中采取自由体位联合无保护会阴接生对分娩效果的影响[J].实用临床医学,2014,15(8):68-69,92.
[14]徐映,罗卫明,凌洁.第二产程产妇自由体位分娩效果的分析[J].中国医师杂志,2014,16(11):1563-1565.
[15]Gizzo S,Di Gangi S,Noventa M,et al.Women's choice of positions during labour:return to the past or a modern way to give birth?a cohort study in Italy[J].Biomed Res Int,2014(5):1-7.
[16]Golara M,Plaat F,Shennan AH.Upright versus recumbent position in the second stage of labour in women with combined spinal-epidural analgesia[J].Int J Obstet Anesth,2002,11(1):19-22.
[17]梁小姝.自由体位分娩在产科的应用研究[J].中国实用护理杂志,2008,24(21):31-32.
[18]Gupta JK,Hofmeyr GJ,Shehmar M.Position in the second stage of labour for women without epidural anaesthesia[J].Cochrane Database Syst Rev,2012(5):CD 002006.
[19]Bodner-Adler B,Bodner K,Kimberger O,et al.Women's position during labour:influence on maternal and neonatal outcome[J].Wien Klin Wochenschr,2003,115(19/20):720-723.
[20]Ragnar I,Altman D,Tyden T,et al.Comparison of the maternal experience and duration of Labour in two upright delivery positions-a randomised controlled trial[J].BJOG,2006,113(2):165-170.
[21]厉跃红,吴娜,庄薇.分娩球配合自由体位助产对初产妇产痛、分娩控制感及妊娠结局的影响[J].中华护理杂志,2013,48(9):793-796.
[22]Lawrence A,Lewis L,Hofmeyr GJ,et al.Maternal positions and mobility during first stage Labour[J].Cochrane Database of Systematic Reviews,2009(2):D 3934.
[23]Reitter A,Daviss B,Bisits A,et al.Does pregnancy and/or shifting positions create more room in a woman's pelvis?[J].Am JObstet Gynecol,2014,211(6):661-662.
[24]孙小金,朱忍娣,周巧仪,等.分娩球联合自由体位助产对初产妇分娩的影响[J].国际护理学杂志,2014,33(7):1672-1674.
[25]王海荣.产妇第二产程应用自由体位88例效果观察[J].齐鲁护理杂志,2014,20(12):6-8.
[26]零恒莉,潘茹,杨晓娅.第二产程产妇自由体位分娩效果的研究[J].中国实用护理杂志,2007,23(6):20.
[27]Meyvis I,Van Rompaey B,Goormans K,et al.Maternal position and other variables:effects on perineal outcomes in 557 births[J].Birth-Issues in Perinatal Care,2012,39(2):115-120.
[28]Elvander C,Ahlberg M,Thies-Lagergren LA,et al.Birth position and obstetric anal sphincter injury:a population-based study of 113 000 spontaneous births[J].BMC Pregnancy Childbirth,2015,15(1):252.
[29]祁志宇,韩萍.自由体位分娩对促进自然分娩的临床研究[J].河北医药,2015,37(7):1000-1003.