摘要
目的:利用产时超声监测,观察并分析上身直立坐位分娩对第二产程中胎头下降及母儿结局的影响。方法:采用前瞻性随机对照研究,选取2023年2~9月在首都医科大学附属北京妇产医院足月宫口开全可经阴道分娩的产妇110例,采用简单随机法分为对照组(56例)和直立位组(54例),对照组采用常规仰卧位或半卧位分娩,直立位组采用上身直立坐位分娩。两组产妇均在第二产程初期即宫口开全指导分娩时和第二产程指导分娩30分钟后,对产妇行彩色多普勒超声检查。经腹部和会阴二维超声检查检测胎头进展角(AOP)、胎头-会阴距离(HPD)及胎方位,同时记录产妇第二产程时间及分娩结局,分析两组产妇AOP、HPD角度和位置变化,分娩时长及母儿结局的差异。结果:第二产程初期两组产妇AOP、HPD及胎方位非枕前位比率比较,差异无统计学意义(P>0.05)。指导分娩30分钟后,与对照组比较,直立位组产妇AOP角度增大,HPD距离缩短,胎方位非枕前位比率降低,差异有统计学意义(P<0.05)。同时与对照组比较,直立位组自然分娩率提高,第二产程时间显著缩短,产钳助产率、会阴侧切率、会阴水肿率和缩宫素使用率均降低,差异有统计学意义(P<0.05)。所有新生儿均活产,1分钟Apgar评分两组均全为10分。两组新生儿出生体质量差异无统计学意义(P>0.05)。结论:产妇在第二产程采取上身直立坐位分娩时,AOP增大,HPD缩短,加速第二产程时间,从而提高自然分娩率,降低医学干预,减少分娩时母儿并发症的发生。
Objective:Using intrapartum ultrasound monitoring to observe and analyse the impact of upright sit-ting delivery on fetal head descent and maternal and infant outcomes during the second stage of labor.Methods:This study used a prospective randomized controlled study,including 110 pregnant women with full-term and com-plete opening of the cervix who were able to undergo vaginal delivery at Beijing Obstetrics and Gynecology Hospi-tal,Capital Medical University from February to September 2023.They were randomly divided into a control group(n=56)and an upright group(n=54)by simple randomization.The control group was delivered in routine supine or semi-supine positions,and the upright group was delivered in upright positions.The parturients in both groups were examined by color Doppler ultrasound at the beginning of the second stage of labor when the cervix was full-y opened to guide delivery and 30 minutes after guidance of the second stage of labor.Abdominal and perineal two-dimensional ultrasound was used to detect fetal head angle of progression(AOP),fetal head perineal dis-tance(HPD),and fetal orientation.At the same time,the time of the second stage of labor and delivery outcome were recorded.The changes in AOP,angle and position of HPD,delivery duration,and maternal and fetal out-comes between the two groups were analyzed.Results:At the beginning of the second stage of labor,there was no significant difference in AOP,HPD,and the rate of non-occipital anterior position of fetal position between the two groups(P>0.05).After 30 minutes of guiding delivery,compared with the control group,the AOP angle in-creased,the HPD distance shortened,and the proportion of non-occipital anterior fetal position was reduced in the upright position group,and all the differences were statistically significant(P<0.05).At the same time,compared with the control group,the spontaneous delivery rate,the duration of the second stage of labor,forceps delivery rate,lateral perineal incision rate,perineal edema rate,and oxytocin use rate were significantly decreased in the upright position group,and all the differences were statistically significant(P<0.05).All newborns were born a-live,and the 1-minute Apgar score was 10 for all newborns in both groups.There was no significant difference in birth weight between the two groups(P>0.05).Conclusions:When the parturient delivers in an upright sitting position in the second stage of labor,the AOP increases,the HPD shortens,and the time of the second stage of labor is accelerated to increase the natural delivery rate,reduce medical intervention,and reduce maternal and in-fant complications during delivery.
作者
闫思思
吴英
付玉惠
YAN Sisi;WU Ying;FU Yuhui(Department of Delivery Room,Beijing Obstetrics and Gynecology Hospital,Capital Medical University,Beijing 100026,China)
出处
《实用妇产科杂志》
CAS
CSCD
北大核心
2024年第6期474-478,共5页
Journal of Practical Obstetrics and Gynecology
基金
北京市医院管理中心2024年度“培育计划”(编号:PX2024050)。
关键词
产时超声
第二产程
直立坐位分娩
分娩结局
Prenatal ultrasound
Second stage
Upright sitting delivery
Delivery outcome
作者简介
通讯作者:吴英,E-mail:wuyingwin@ccmu.edu.cn。
