• 中国科技论文统计源期刊
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Volume 44 Issue 4
Apr.  2019
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Clinical effect of the mobile delivery vehicle combined with special position in correcting the transverseposition during the active period of the first stage of labor

  • Received Date: 2018-11-01
    Accepted Date: 2019-01-15
  • ObjectiveTo investigate the clinical effects of the mobile delivery vehicle combined with special position in correcting the transverseposition during the active period of the first stage of labor.MethodsOne hundred and thirty patients with transverseposition diagnosed by B ultrasound and without premature rupture of membrane under trial condition were randomly divided into the experimental group and control group.The experimental group without rupture of membrane during active period could free walk on mobile delivery vehicle, and when the contraction was strong, the patients stayed in bed under the lateral position of the fetal back.The control group was given the routine care, and the patients were free to choose the lying position.The fetal head positive rate, delivery mode, first stage of labor, neonatal Apgar score and complications of maternal delivery were analyzed in two groups.ResultsDuring the labor process, 60 cases in experimental group were transferred from the transverse occipital fetal head to the anterior occipital position, and 41 cases in control group were transferred from the transverse occipital fetal head to the anterior occipital position, and the positive rate of which in experimental group was higher than that in control group(P < 0.01).The rate of natural delivery in experimental group was higher than that in control group, and the rate of cesarean section in experimental group was lower than that in control group(P < 0.01).The incubation period and active period of the first stage of natural delivery in experimental group were shorter than those in control group, the neonatal Apgar score in experimental group was higher than that in control group, and the postpartum blood loss, soft birth canal injury rate and puerperal infection rate in experimental group were lower than those in control group(P < 0.01).ConclusionsDuring the active period of the first stage of labor, the mobile delivery vehicle combined with special position can improve the maternal fetal head rate, natural delivery rate and Apgar score of the newborn, significantly shorten the time of the first stage of labor, and reduce the incidence rate of postpartum complications.
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  • [1] 倪配娣.体位干预枕横位矫正胎方位的临床观察[J].中国保健营养, 2017, 27(9):152.
    [2] 童美和, 于海微.产程中枕横位和枕后位的胎头机转临床研究[J].中国医师杂志, 2015, 17(11):1682. doi: 10.3760/cma.j.issn.1008-1372.2015.11.024
    [3] 杨玲.持续性枕横位与枕后位122例临床分析[J].蚌埠医学院学报, 2011, 36(7):712. doi: 10.3969/j.issn.1000-2200.2011.07.015
    [4] 王桂梅, 杨小红, 胡娅萍.单绒毛膜单羊膜囊双胎之一畸形1例[J].实用医学杂志, 2015, 31(20):3426. doi: 10.3969/j.issn.1006-5725.2015.20.046
    [5] 徐赛英.综合护理干预对枕横位及枕后位产妇产程和分娩结局的影响[J].中国计划生育学杂志, 2016, 24(3):183.
    [6] 魏丽娜.探究徒手旋转胎头术对枕横位和枕后位难产的治疗效果[J].中国继续医学教育, 2016, 8(19):112. doi: 10.3969/j.issn.1674-9308.2016.19.071
    [7] 兰景尤.评价影响初产妇头位难产的因素、临床表现及其临床处理对策[J].世界最新医学信息文摘, 2016, 16(A5):32.
    [8] 赵舜枝王少娜, 林晓冰.自由体位纠正枕后(横)位的效果观察[J].中国医学创新, 2016, 13(1):50. doi: 10.3969/j.issn.1674-4985.2016.01.014
    [9] XING XZ, WANG HJ, QU SN, et al.The value of esophagectomy surgical apgar score (eSAS) in predicting the risk of major morbidity after open esophagectomy[J]. J Thorac Dis, 2016, 8(7):1780. doi: 10.21037/jtd
    [10] 贺利平, 李晋琼, 张瑛, 等.不同分娩方式高危产妇产褥期感染相关因素及对新生儿的影响[J].中华医院感染学杂志, 2018, 28(12):1884.
    [11] 何玉平.阴道分娩产后出血预见性护理效果研究[J].实用临床医药杂志, 2017, 21(20):197.
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Clinical effect of the mobile delivery vehicle combined with special position in correcting the transverseposition during the active period of the first stage of labor

  • Department of Obstetrics, Lu'an Hospital Affiliated to Anhui Medical University, Lu'an People's Hospital, Lu'an Anhui 237005, China

Abstract: ObjectiveTo investigate the clinical effects of the mobile delivery vehicle combined with special position in correcting the transverseposition during the active period of the first stage of labor.MethodsOne hundred and thirty patients with transverseposition diagnosed by B ultrasound and without premature rupture of membrane under trial condition were randomly divided into the experimental group and control group.The experimental group without rupture of membrane during active period could free walk on mobile delivery vehicle, and when the contraction was strong, the patients stayed in bed under the lateral position of the fetal back.The control group was given the routine care, and the patients were free to choose the lying position.The fetal head positive rate, delivery mode, first stage of labor, neonatal Apgar score and complications of maternal delivery were analyzed in two groups.ResultsDuring the labor process, 60 cases in experimental group were transferred from the transverse occipital fetal head to the anterior occipital position, and 41 cases in control group were transferred from the transverse occipital fetal head to the anterior occipital position, and the positive rate of which in experimental group was higher than that in control group(P < 0.01).The rate of natural delivery in experimental group was higher than that in control group, and the rate of cesarean section in experimental group was lower than that in control group(P < 0.01).The incubation period and active period of the first stage of natural delivery in experimental group were shorter than those in control group, the neonatal Apgar score in experimental group was higher than that in control group, and the postpartum blood loss, soft birth canal injury rate and puerperal infection rate in experimental group were lower than those in control group(P < 0.01).ConclusionsDuring the active period of the first stage of labor, the mobile delivery vehicle combined with special position can improve the maternal fetal head rate, natural delivery rate and Apgar score of the newborn, significantly shorten the time of the first stage of labor, and reduce the incidence rate of postpartum complications.

  • 枕横位是头先露中一种常见的胎方位,通常情况下约50%的孕妇以枕横位入盆[1]。其临床表现为:临产后胎头衔接较晚,易导致宫缩乏力、宫口扩张缓慢及胎头下降停滞[2];胎儿宫内窘迫[3];宫颈水肿,产程进展缓慢[4]。枕横位包括枕横左位以及枕横右位,大部分枕横位能自行向前转90°至枕前位自然分娩,也有小部分发展为持续性枕横位,虽然持续性枕横位是最轻微的胎头位置异常,其难产程度也是胎头位置异常中的最轻者,但其手术率高达80%~90%,仅次于持续性枕后位[5]。对母儿的危害与持续性枕后位相仿。但常常由于认识上的错误,认为持续性枕横位是一种轻微的胎头位置异常,胎头位置低,阴道分娩的机会比持续性枕后位多,因此容易放松警惕,反而对胎儿造成严重后果[6]。持续性枕横位因胎头俯屈不良无法经阴道分娩,是导致头位难产的原因之一[7]。如何在产程中给予积极有效的干预措施,促使枕横位转为枕前位,从而提高自然分娩率,降低剖宫产率已经成为当前产科研究的热门课题。本文通过指导孕妇在第一产程活跃期使用产程活动车及采取特殊体位,缩短了第一产程并降低了剖宫产率。现作报道。

1.   资料与方法
  • 选取我院2017年6月至2017年12月住院的130例孕妇为研究对象。纳入第一产程进入活跃期并且经B超确诊为枕横位而无明显头盆不称的初产妇,单胎头位,孕周37~41周,骨盆外测量正常,估计胎儿体质量小于4 000 g,无妊娠合并症的产妇,随机分为对照组和试验组,2组临产妇的孕周、年龄、经B超预测的胎儿体质量、胎头双顶径和羊水指数差异均无统计学意义(P>0.05)(见表 1),具有可比性。

    类别 n 孕周/周 年龄/岁 胎儿体质量/g 胎头双顶径/cm 羊水指数/mm
    对照组 65 38.50±3.25 25.45±5.36 2 625.42±56.36 9.26±0.65 169.22±12.68
    试验组 65 39.10±2.98 26.41±4.89 2 612.87±45.69 9.41±0.48 172.69±9.89
    t 1.10 1.07 1.40 1.50 1.74
    P >0.05 >0.05 >0.05 >0.05 >0.05
  • 常规护理:2组孕妇均给予有效的心理支持,缓解其焦虑与恐惧,随时告知其产程进展情况,以取得配合。督促其及时排空大小便,以免影响胎头下降。鼓励孕妇适当饮水及进流食,以保持充足的体力。根据宫缩强度适时给予催产素静滴,维持良好宫缩。

    护理干预:对照组在胎膜未破前采取自由体位及卧位,不作特殊要求。试验组在胎膜未破前予产程活动车自由行走,在胎膜破裂宫缩较强时采取胎背对侧体位,床头抬高30°~40°,旨在以重力的作用促使胎头转至枕前位。2组产妇均经过充分试产且按常规观察产程并详细记录第一产程时间及分娩方式,以及非自然分娩新生儿出生后的Apgar评分和产妇并发症的发生率。

  • 采用t(或t′)检验和χ2检验。

2.   结果
  • 在产程中,试验组由枕横位胎头转到枕前位的有60例,对照组由枕横位胎头转枕前位有41例,试验组胎头转正率高于对照组(χ2=16.02,P < 0.01)。

  • 试验组65例产妇中胎头转正的60例中56例分娩方式为自然分娩,4例由于慢性胎儿窘迫行产钳助产,5例胎头未转正的产妇因持续性枕横位行剖宫产。对照组65例产妇中胎头转正的41例中35例分娩方式为自然分娩,6例由于慢性胎儿窘迫行产钳助产,24例胎头未转正的产妇因持续性枕横位行剖宫产。试验组自然分娩率高于对照组,剖宫产率低于对照组(χ2=17.70,P < 0.01)(见表 2)。

    分组 n 自然分娩 产钳助产 剖宫产 χ2 P
    试验组 65 56(86.15) 4 (6.15) 5(7.69)
    对照组 65 35(53.85) 6 (9.23) 24(36.92) 17.70 < 0.01
    合计 130 91(70.00) 10(7.69) 29(22.31)
  • 试验组自然分娩第一产程的潜伏期和活跃期的时间均短于对照组(P < 0.01)(见表 3)。

    分组 n 潜伏期 活跃期
    试验组 65 5.74±2.02 2.99±1.96
    对照组 65 8.68±1.69 6.36±1.24
    t 9.00 7.88
    P < 0.01 < 0.01
  • 对比对照组和试验组由于慢性胎儿窘迫行产钳助产以及胎头未转正的产妇因持续性枕横位行剖宫产出生的新生儿Apgar评分,结果显示,试验组新生儿Apgar评分高于对照组(P < 0.01)(见表 4)。

    分组 n 胎儿窘迫 剖宫产
    试验组 65 2.25±0.96 8.62±1.64
    对照组 65 1.00±0.89 6.41±2.24
    t 7.70 6.12*
    P < 0.01 < 0.01
    *示t′值
  • 试验组产妇产后出血量、软产道损伤率、产褥感染率均低于对照组(P < 0.01)(见表 5)。

    分组 n 产后出血量/mL 软产道损伤 产褥感染
    试验组 65 159.47±45.61 8(12.31) 6 (9.23)
    对照组 65 235.15±80.45 24(36.92) 19(29.23)
    χ2 6.60* 10.61 8.37
    P < 0.01 < 0.01 < 0.01
    *示t′值
3.   讨论
  • 枕横位可因胎头俯屈不良,增大胎头经过产道的径线,妨碍胎头旋转下降, 如不及时纠正,就会引起持续性枕横位,致使宫口扩张及胎先露下降缓慢,在头位难产中发病率最高[8]。因此, 早期护理干预纠正胎头位置异常是预防头位难产的重要措施。本研究试验组由枕横位胎头转到枕前位的有60例,对照组由枕横位胎头转枕前位有41例,可以看出产程活动车联合特殊体位可以大大增加使枕横位的胎儿胎头转正的概率。

    在活跃期早期,宫缩尚不是特别剧烈,使用产程活动车督促孕妇行走,可以通过重力的作用促使胎头下降及在骨盆内的内旋转。当宫缩较强或者胎膜破裂时,孕妇无法耐受行走及不宜行走时,督促其选择胎背对侧卧位。胎背对侧卧位可以使胎儿背部的重心在胎儿重力与羊水浮力作用下向前移动,在良好的宫缩协同作用下,促使胎儿背部向腹部前方移动,同时带动胎头向骨盆前方旋转。本研究中,试验组65例产妇中, 胎头转正的60例中56例分娩方式为自然分娩,4例由于慢性胎儿窘迫行产钳助产,5例胎头未转正的产妇因持续性枕横位行剖宫产。对照组65例产妇中, 胎头转正的41例中35例分娩方式为自然分娩,6例由于慢性胎儿窘迫行产钳助产,24例胎头未转正的产妇因持续性枕横位行剖宫产。结果表明,产程活动车的使用联合特殊体位提高了自然分娩率的同时降低了产妇分娩的风险。且试验组孕妇的第一产程中潜伏期和活跃期的时间明显缩短,进一步证实了产程活动车联合特殊体位降低了产妇分娩的风险。

    Apgar评分是评价新生儿出生时一般状态的量化评估表,与新生儿的死亡率以及当前状况和预后密切相关,是当前临床所使用评估新生儿身体状况的常用方法[9]。本研究中,试验组非自然分娩新生儿Apgar评分明显高于对照组,表明产程活动车联合特殊体位的方法可以改善新生儿窒息情况。产褥感染是由于分娩期间和产褥期间病原体通过侵害生殖道从而引起局部或者全身的炎症性变化,是产妇死亡的重要原因之一[10]。软产道损伤是指阴道、外阴等撕裂或者子宫破裂,是产后出血的主要原因之一[11]。本研究试验组的产后出血量少于对照组,且软产道损伤和产褥感染的发生率大大降低。这可能与产程活动车联合特殊体位明显缩短了第一产程的时间,进一步降低了产妇受到感染的可能性。

    但是,在实施产程活动车联合特殊体位护理干预中也需要注意以下问题:首先,维持良好的产力是纠正枕横位的关键,也是维护分娩情况良好的基础。对于枕横位的孕妇,若想促使其转为枕前位,必须要有良好的产力,因此根据2组产妇的情况,在宫缩乏力时适时给予催产素静滴,以维持良好的宫缩。同时,使用产程活动车时也需要根据产妇的具体情况,以产妇能够耐受为主。综上所述,产程活动车联合特殊体位护理干预简便易行,值得临床应用推广。

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