摘要
目的 探讨坐式分娩联合产时超声评估对初产妇胎头下降及母婴分娩结局的影响。方法 采用前瞻性随机对照研究,选取2024年3—9月首都医科大学附属北京妇产医院足月妊娠进入第二产程的初产妇264例,随机分为分娩椅组(n=130)和对照组(n=134),分娩椅组采用分娩椅坐式分娩,对照组采用常规仰卧位分娩。两组产妇均在第二产程初期和第二产程指导分娩30 min后,采用彩色多普勒超声诊断仪行超声检查。比较两组胎头进展角(angle of pro‐gression,AOP)、胎头-会阴距离(head perineum distance,HPD)及胎方位、分娩结局和新生儿结局。结果 与对照组相比,分娩椅组在第二产程指导分娩30 min后产妇AOP角度增大[(154.8±16.0)°比(141.4±12.6)°]、HPD距离缩短[(2.1±0.8)cm比(2.9±0.7)cm]、胎方位非枕前位占比降低(15.4%比41.8%),且ΔAOP角度变化更大[15.0(0.0,27.8)°比0.0(0.0,8.0)°]、ΔHPD距离缩短更多[-0.6(-1.4,0.2)cm比0.0(-0.1,0.5)cm],第二产程时长缩短[34.0(23.0,49.8)min比44.0(32.0,64.0)min],中转剖宫产率、产钳助产率、会阴侧切率、会阴水肿发生率和缩宫素使用率均较低,差异均有统计学意义(P<0.05)。两组新生儿体质量、Apgar评分(1 min)的比较,差异均无统计学意义(P>0.05)。结论 分娩椅坐式分娩联合产时超声可以增大产妇AOP角度,缩短HPD距离,加速第二产程时长,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 To explore the impact of upright sitting position delivery combined with intrapartum ultrasound assessment on fetal head descent and maternal-neonatal delivery outcomes in primiparas.Methods A total of 264 primiparas who entered the second stage of labor with a full-term pregnancy at Beijing Obstetrics and Gynecology Hospital,Capital Medical University,from March 2024 to September 2024 were selected by prospective randomized controlled study,and were randomly devided into the delivery chair group(n=130)and the control group(n=134).The delivery chair group underwent upright sitting position delivery using a birth chair,while the control group delivered in the conventional supine position.All participants in both groups underwent ultrasound examinations using a color Doppler ultrasound diagnostic instrument at the beginning of the second stage of labor and after 30 minutes of guidance during the second stage of labor.The angle of progression(AOP),head perineum distance(HPD),fetal position,maternal delivery outcomes,and neonatal outcomes were compared between the two groups.Results Compared with the control group,the delivery chair group utilizing an upright sitting position demonstrated significantly greater improvements at 30 minutes after guidance:a larger AOP[(154.8±16.0)°vs.(141.4±12.6)°],a shorter HPD[(2.1±0.8)cm vs.(2.9±0.7)cm],a lower proportion of non-occiput anterior fetal positions(15.4%vs.41.8%),a greater increase inΔAOP[15.0(0.0,27.8)°vs.0.0(0.0,8.0)°],and a greater reduction inΔHPD[-0.6(-1.4,0.2)cm vs.0.0(-0.1,0.5)cm].Furthermore,the delivery chair group experienced a significantly shorter duration of the second stage of labor[34.0(23.0,49.8)min vs.44.0(32.0,64.0)min],along with significantly lower rates of intrapartum cesarean delivery,forceps-assisted vaginal delivery,episiotomy,perineal edema,and oxytocin augmentation,and the differences were statistically significant(P<0.05).There was no significant difference in neonatal weight and Apgar score(1 min)between the two groups(P>0.05).Conclusions The upright sitting position delivery combined with intrapartum ultrasound assessment can increase the maternal AOP,reduce the HPD,shorten the duration of the second stage of labor,enhance the rate of spontaneous vaginal delivery,reduce the need for obstetric interventions,and decrease the incidence of maternal and neonatal complications during delivery.
作者
闫思思
姜海利
李悦
Yan Sisi;Jiang Haili;Li Yue(Department of Obstetrics,Beijing Obstetrics and Gynecology Hospital,Capital Medical University,Beijing Maternal and Child Health Care Hospital,Beijing 100026,China)
出处
《北京医学》
2025年第6期477-482,491,共7页
Beijing Medical Journal
基金
首都卫生发展科研专项(首发2024-2-2116)
首都医科大学附属北京妇产医院科技创新及转化专项(FCYYHL202406)。
关键词
分娩椅
坐式分娩
胎头进展角
胎头-会阴距离
分娩结局
产时超声
第二产程
delivery chair
upright sitting position delivery
angle of progression(AOP)
head perineum distance(HPD)
delivery outcome
intrapartum ultrasound
second stage of labor
