Effects of two different delivery positions on deliveryoutcomes and pelvic floor function of primiparas with full-term singleton fetus
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摘要:目的 探讨两种不同分娩体位对足月单胎初产妇分娩结局及产后盆底功能的影响。方法 将本院90例阴道分娩初产妇采用前瞻性随机对照试验方法分为对照组和观察组，每组均45例。所有初产妇均按照产程标准实施分娩护理管理，对照组采用传统平卧位分娩，观察组根据产妇个人喜好和舒适度自由选择分娩体位。比较2组初产妇分娩方式、产程时间、产后出血量、会阴无损伤率和新生儿Apgar评分等情况。产后6周进行盆底肌力检查，比较2组产后盆底功能。结果 2组产后出血量、第三产程时间和新生儿1 min Apgar评分比较，差异均无统计学意义(P>0.05); 观察组阴道分娩成功率100.00%, 无中转剖宫产者，对照组阴道分娩成功率86.67%，中转剖宫产率13.33%，2组分娩方式比较差异有统计学意义(P < 0.05); 观察组第一产程时间、第二产程时间短于对照组，会阴无损伤率高于对照组，差异有统计学意义(P < 0.05); 产后6周盆底肌力检测显示，观察组阴道静息压(VRP)、阴道收缩压(VSP)、收缩持续时间、Ⅰ、Ⅱ类纤维强度均高于对照组，差异均有统计学意义(P < 0.05)。结论 自由体位分娩能有效降低足月单胎初产妇中转剖宫产率、缩短产程时间和减少会阴损伤，对产妇盆底功能有较好保护作用。Abstract:Objective To explore the effects of two different delivery positions on the delivery outcomes and pelvic floor function of primiparas with full-term singleton fetus.Methods A total of 90 primiparas with vaginal delivery were divided into control group and observation group by prospective randomized controlled trial v method, with 45 cases in each group. All the primiparas were given birth nursing management according to the standard of labor process. The control group gave birth in the traditional lying position. The observation group freely chose the delivery positions according to the personal preference and comfort of the parturients. The mode of delivery, the time of labor, the amount of postpartum hemorrhage, the damage-free rate of perineum and Apgar scores of newborns were compared between the two groups.Results There were no significant differences between the two groups in the amount of postpartum hemorrhage, the time of the third stage of labor and the Apgar score at 1 min (P>0.05). The success rate of vaginal delivery was 100.00% in the observation group, and 86.67% in the control group. There were no cases with transit cesarean section in the observation group, and its rate was 13.33% in the control group. There were significant differences between the two groups in the delivery modes (P < 0.05). The time of the first stage of labor and the second stage of labor in the observation group were significantly shorter, and rate of no perineum injury was higher than that of the control group(P < 0.05). The detection of pelvic floor muscle strength at 6 weeks after delivery showed that the observation group had higher vaginal resting pressure(VRP), vaginal systolic pressure(VSP), duration of contraction, Ⅰ fiber strength and Ⅱ fiber strength than the control group (P < 0.05).Conclusion Free position delivery can effectively reduce the rate of transit cesarean section, shorten the time of delivery and reduce the perineum injury, which has a better protective effect on the pelvic floor function of parturients.
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Keywords:
- primiparas /
- free position /
- delivery mode /
- delivery outcomes /
- pelvic floor function
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表 1 2组初产妇分娩结局比较(x±s)[n(%)]
组别 分娩方式 产后出血量/mL 产程时间/min 会阴无损伤 新生儿Apgar
评分/分阴道分娩成功 中转剖宫产 第一产程 第二产程 第三产程 对照组(n=45) 39(86.67) 6(13.33) 192.37±50.03 426.58±105.37 56.24±10.38 9.43±2.14 6(13.33) 9.23±0.37 观察组(n=45) 45(100.00)* 0* 180.59±42.46 372.36±81.25* 39.72±5.94* 9.08±2.05 15(33.33)* 9.24±0.40 与对照组比较, *P < 0.05。 
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表 2 2组产后6周盆底功能检测比较(x±s)
组别 n VRP/kPa VSP/kPa 收缩持续时间/s Ⅰ类纤维强度/kPa Ⅱ类纤维强度/kPa 对照组 45 4.73±1.18 7.60±2.13 3.57±1.09 5.72±1.65 7.35±1.84 观察组 45 5.30±1.24* 8.59±2.20* 4.30±1.18* 6.68±1.70* 8.34±2.08* VRP: 阴道静息压; VSP: 阴道收缩压。与对照组比较, *P < 0.05。
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