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.
[1] 何镭, 刘兴会. 正常分娩指南(2020)要点解读: 产程的观察及处理[J]. 实用妇产科杂志, 2021, 37(2): 95-96.
[2] Anim-Somuah M, Smyth RM, Cyna AM, et al. Epidural versus non-epidural or no analgesia for pain management in labour[J]. Cochrane Database Syst Rev, 2018, 5(5): CD000331.
[3] 欧有良, 周春兰, 张军, 等. 孕产妇尿潴留时膀胱容积压力变化规律[J]. 实用医学杂志, 2020, 36(9): 1223-1227.
[4] 金珈汐, 孙静莉. 全面二孩政策实施前后的产妇特征及剖宫产指征分析[J]. 发育医学电子杂志, 2021, 9(5): 353-358.
[5] 张梦琴, 罗碧如. 自由分娩体位对分娩结局的影响研究进展[J]. 中国计划生育和妇产科, 2019, 11(3): 22-25.
[6] 李利娜. 自由体位待产对自然分娩的影响研究[J]. 中国实用医药, 2021, 16(32): 84-86.
[7] 张少云, 刘惠林, 徐中兰. 自由体位接产联合无痛分娩对初产妇分娩影响分析[J]. 现代医学, 2021, 49(9): 1045-1048.
[8] 谢幸, 孔北华, 段涛. 妇产科学[M]. 9版. 北京: 人民卫生出版, 2018.
[9] 刘志强. 椎管内分娩镇痛的技术进展和热点问题[J]. 同济大学学报(医学版), 2020, 41(6): 677-682.
[10] 宋佳, 王冬雪, 王冰冰, 等. 不同时机实施分娩镇痛对初产妇产程和分娩方式及新生儿结局的影响[J]. 中华妇产科杂志, 2020, 55(7): 476-479.
[11] 曹莉园, 周盛萍, 龚云辉, 等. 分娩镇痛对初产妇产程的影响[J]. 实用妇产科杂志, 2017, 33(4): 86-291.
[12] 荣彬, 冯怀, 张丽丽, 等. 自由体位在第一产程中纠正枕后位/枕横位的应用效果[J]. 中国当代医药, 2020, 27(6): 96-98, 102.
[13] 王孝贤, 李颖, 张莉, 等. 探讨无痛分娩中第二产程的体位管理对第二产程及分娩结局的影响[J]. 中国妇幼保健, 2018, 33(14): 3169-3171.
[14] 夏华安, 江紫妍, 胡静, 等. 第二产程不同体位娩出胎儿的临床应用效果[J]. 中国计划生育和妇产科, 2019, 11(1): 41-44.
[15] 侯静静, 付子毅, 孙志岭. 自由体位结合自主屏气用力对初产妇自我效能、分娩控制感的影响[J]. 中国妇产科临床杂志, 2019, 20(1): 70-71.
[16] 张晓丽, 张惠欣, 蒋睿, 等. 不同体位分娩对妊娠结局的临床观察[J]. 中国妇幼保健, 2016, 31(9): 1814-1816.
[17] 王鑫, 王秀梅, 王芳, 等. 产程中不同体位与运动对分娩结局的影响[J]. 蚌埠医学院学报, 2020, 45(1): 131-133.
