改良式侧卧位分娩在第2产程中的应用
摘要
目的探讨第2产程改良式侧卧位分娩对分娩结局的影响。方法选择2016年1月至2017年6月厦门市妇幼保健院分娩的产妇252例为研究对象,按分娩方式分观察组88例(改良式侧卧位分娩)、对照组164例(传统仰卧位分娩)。比较两组产妇的软产道裂伤、第2产程时间、产后2h出血量、阴道助产及新生儿结局。结果观察组产妇无宫颈裂伤、无会阴水肿和会阴切开,会阴Ⅱ度裂伤发生率(3.4%)低于对照组(18.3%),第2产程时间(24.5±21.0min)短于对照组(41.0±57.1min),产后2h出血量(198.4±32.7mL)少于对照组(217.4±152.3mL)。两组产妇的阴道助产、胎儿窘迫及新生儿窒息发生率差异无统计学意义。结论改良式侧卧位分娩可减轻软产道损伤、缩短第2产程时间、减少产后2h出血量,降低助产率,改善新生儿结局,值得临床推广。
引文
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[13]CAROLINA W.Alternative model of birth to reduce the risk of assisted vaginal delivery and perineal trauma[J].Int Urogynecol J,2012,23(9):1249-1256.
[14]ROBERTS J,HANSON L.Best Practices in Second Stage Labor Care:Maternal Bearing Down and Positioning[J].J Midwifery,Womens Health,2007,52(3):238-245.
[15]郭仁妃,吴燕,王爱宝,等.侧卧位接产在阴道分娩中的可行性与安全性分析[J].中国妇幼保健,2015,30(33):5901-5903.
[2]BERGHELLA V,BAXTER JK,CHAUHAN SP.Evidencebased labor and delivery management[J].Am J Obstet Gynecol,2008,199(5):445-54.
[3]SIMPSON KR.When and how to push:providing the most current information about second-stage labor to women during childbirth education[J].J Perinat Educ,2006,15(4):6-9.
[4]CAROLINA W,RODRíGUEZ T,HERRANZ A,et al.Alternative model of birth to reduce the risk of assisted vaginal delivery and perineal trauma[J].Int Urogynecol J,2012,23:1249-1256.
[5]GUPTA JK,SOOD A,HOFMEYR GJ,et al.Position in the second stage of labour for women without epidural anaesthesia[J].Cochrane Database Syst Rev,2017,5:CD002006.
[6]PATERNOTTE J,POTIN J,DIGUISTO C,et al.Delivery in lateral position.Comparative study in low risk pregnancy between lateral and dorsal position for the delivery in eutocic vaginal[J].Gynecol Obstet Fertil,2012,40(5):279-283.
[7]张文秀.改良式低位产钳术联合无保护会阴助产的临床观察[J].实用妇产科杂志,2014,30(8):625-628.
[8]谢幸,苟文丽.妇产科学[M].8版.北京:人民卫生出版社,2013:213.
[9]LEMOS A,AMORIM MMR,DORNELAS DE ANDRADE A,et al.Pushing bearing down methods for the second stage of labour[J].Cochrane Database Syst Rev,2015,10:CD009124.
[10]JOYCE R.HANSON L.Best practices in second stage labor care:Maternal bearing down and positioning[J].J Midwifery Womens Health,2007,52(3):238-245.
[11]王金凤,王忠民,张蕊,等.会阴切开术对产后的影响[J].中国妇产科临床志,2014(3):199-201.
[12]GUPTA JK,HOFMEYR GJ,SHEHMAR M.Position in the second stage of labour for women without anaesthesia[J].Cochrane Database Syst Rev,2012(5):CD002006.
[13]CAROLINA W.Alternative model of birth to reduce the risk of assisted vaginal delivery and perineal trauma[J].Int Urogynecol J,2012,23(9):1249-1256.
[14]ROBERTS J,HANSON L.Best Practices in Second Stage Labor Care:Maternal Bearing Down and Positioning[J].J Midwifery,Womens Health,2007,52(3):238-245.
[15]郭仁妃,吴燕,王爱宝,等.侧卧位接产在阴道分娩中的可行性与安全性分析[J].中国妇幼保健,2015,30(33):5901-5903.