Objectives A systematic review and network meta-analysis was conducted to evaluate the effectiveness of different childbirth positions in reducing the duration of the second stage of labor,providing evidence-based ins...Objectives A systematic review and network meta-analysis was conducted to evaluate the effectiveness of different childbirth positions in reducing the duration of the second stage of labor,providing evidence-based insights for obstetric institutions to guide interventions related to childbirth positions.Methods A comprehensive literature search was conducted in databases,including PubMed,Web of Science,the Cochrane Library,Embase,Wanfang Databases,China National Knowledge Infrastructure Databases(CNKI),China Science and Technology Journal Database(CSTJ),and China Biology Medicine disc(CBMdisc)to identify studies on the effectiveness of different childbirth positions in reducing the duration of the second stage of labor.The search included randomized controlled trials published from database inception to September 30,2024.The Cochrane risk-of-bias tool was used to assess the quality of the studies.Two independent reviewers screened the literature,extracted data,and evaluated study quality.Subsequently,a network meta-analysis was performed using STATA software.The study protocol has been registered in PROSPERO(CRD42023428217).Results This study analyzed data from 25 randomized controlled trials involving 9,844 women.The findings indicated that in comparison to lithotomy position,free position(MD=20.53,95%CI[11.38,29.68])and upright position(MD=−24.13,95%CI[−42.94,-5.32])were found to be superior in reducing the duration of the second stage of labor.Free position outperformed kneeling position(MD=21.48,95%CI[4.67,38.28])and squatting position(MD=23.43,95%CI[1.88,44.97]);upright position was superior to kneeling position(MD=−25.08,95%CI[−46.93,−3.22]);semirecumbent position surpassed squatting position(MD=19.71,95%CI[2.05,37.38]);and upright position was also superior to squatting position(MD=−27.03,95%CI[−51.48,−2.57]).According to the surface under the cumulative ranking curve(SUCRA),the upright position emerged as the most effective for reducing the duration of the second stage of labor(87.4%),followed by free position(81.1%),semirecumbent position(70.0%),and lateral position(62.3%).Conclusion These findings offer valuable insights for midwifery practice and help inform future research directions.Considering the limitations of this review,more larger-scale,multicenter randomized controlled trials are warranted to further evaluate the relative effectiveness of different childbirth positions in reducing the duration of the second stage of labor.展开更多
The second-stage of labor is the most stressful part of childbirth process and the proper maternal position during this period is paramount for women's safe vaginal birth.Midwives play a pivotal role in managing m...The second-stage of labor is the most stressful part of childbirth process and the proper maternal position during this period is paramount for women's safe vaginal birth.Midwives play a pivotal role in managing maternal positions during the second-stage of labor.However,there is limited evidence to support an ideal maternal position during the second-stage of labor.Further,the difference between different maternal positions might not be apparent.This paper aims to review and compare the benefits and risks of common maternal positions during the second-stage of labor,thereby to provide midwives evidence-based practical guidelines.展开更多
Objective:To discuss the effect of prolonged second stage of labor on maternal and neonatal outcomes.Methods:A total of 101 primiparas with the length of second stage of labor longer than 2 h were selected and pregnan...Objective:To discuss the effect of prolonged second stage of labor on maternal and neonatal outcomes.Methods:A total of 101 primiparas with the length of second stage of labor longer than 2 h were selected and pregnant women with the length less than 2 h served as control.The maternal and neonatal outcomes of two groups were observed and compared.Results:A total of 62.1%(18/11) with the length of second stage of labor between 120 min and 180 min,46.7%(28/32) between 181 min and 240 min and 12 longer than 241 min underwent vaginal delivery.The longer the length of second stage of labor,the lower score of Apgar scale for infants in 1 min,and the higher the incidence of asphyxia.But there was no difference in scale in 5 min.As second stage of labor prolonged,the incidences of cesarean section and of postpartum hemorrhage increased. Conclusions:Almost half of puerperas with the length of second stage of labor longer than 2 h underwent vaginal delivery.The prolonged second stage of labor can decrease the score of Apgar scale in 1 min,increase the incidence of asphyxia,but has no effect on scale in 5 min.It still need more evidence from evidence medicine to definition of time and treatment of second stage of labor.展开更多
Objective: Evaluating the effect of perineal length on the duration of the second stage of labor, the mode of delivery, the need for episiotomy and the possibility of perineal and vaginal tears needing repair. Partici...Objective: Evaluating the effect of perineal length on the duration of the second stage of labor, the mode of delivery, the need for episiotomy and the possibility of perineal and vaginal tears needing repair. Participants and Methods: It is a prospective hospital-based observational study done on 483 parturient women in a university hospital. Personal, medical and obstetric data together with the measurement of perineal length were recorded in the first stage of labor. We followed up the progress of labor until delivery. Regression models were used to consider possible risk factors of episiotomy or tears needed repair. Results: The mean duration of the second stage of labor was significantly longer among women with a perineum of ≥4 cm length when compared with those with a perineal length of Conclusion: Longer perineum is associated with increase in the duration of the second stage of labor. Obstetricians should expect the need of episiotomy when confronted with circumcised primigravida with long perineum. However, if the perineum is short they should not be deceived, short perineum is more probably torn.展开更多
目的探讨BirthRite坐位分娩组件接产的安全性和有效性,为缩短初产妇第二产程时间,提升产妇生产体验提供参考。方法将住院分娩的低危初产妇236例,第二产程按照产妇意愿分为观察组(116例)和对照组(120例)。观察组采用BirthRite坐位分娩组...目的探讨BirthRite坐位分娩组件接产的安全性和有效性,为缩短初产妇第二产程时间,提升产妇生产体验提供参考。方法将住院分娩的低危初产妇236例,第二产程按照产妇意愿分为观察组(116例)和对照组(120例)。观察组采用BirthRite坐位分娩组件坐式分娩,对照组采用电动产床坐式分娩。观察两组产妇第二产程时间、非枕前位占比、阴道助产、产后出血、肩难产、会阴侧切、会阴裂伤、会阴水肿、会阴疼痛程度和产后满意度;比较两组新生儿出生体质量和1 min、5 min Apgar评分。结果对照组中途2例退出。两组均顺利分娩,观察组第二产程时间显著短于对照组,分娩非枕前位占比、肩难产发生率、会阴侧切率、会阴水肿及疼痛程度显著低于对照组,产妇满意度显著高于对照组(均P<0.05)。两组新生儿出生后1 min和5 min Apgar评分均为10分。结论使用BirthRite分娩椅能够缩短第二产程时间,提高产妇满意度,优化坐位分娩结局。展开更多
目的:探讨产时超声在改善第二产程异常产妇妊娠结局中的应用效果。方法:选取2023年1月—2024年9月江西省妇幼保健院产科收治的200例第二产程异常的产妇,根据信封编号后奇偶数法分为对照组、观察组,每组100例。对照组根据阴道指检情况决...目的:探讨产时超声在改善第二产程异常产妇妊娠结局中的应用效果。方法:选取2023年1月—2024年9月江西省妇幼保健院产科收治的200例第二产程异常的产妇,根据信封编号后奇偶数法分为对照组、观察组,每组100例。对照组根据阴道指检情况决定分娩方式,观察组根据阴道指检结合经腹及经会阴超声检查决定分娩方式。统计两组分娩方式、产时胎位不正情况,比较两组经阴道分娩产妇的产程、产程出血量、产后出血量、分娩相关并发症及新生儿情况。结果:观察组阴道分娩率高于对照组,产时胎位不正率低于对照组(P<0.05)。两组阴道分娩产妇第二产程、第三产程、总产程均短于对照组(P<0.05)。观察组阴道分娩产妇产程出血量、产后出血量少于对照组(P<0.05)。观察组分娩相关并发症发生率低于对照组(P<0.05);两组经阴道分娩新生儿体重、血气指标(pH值、氧分压、二氧化碳分压、乳酸)、出生后10 min Apgar评分比较,差异无统计学意义(P>0.05);观察组经阴道分娩新生儿出生后1、5 min Apgar评分高于对照组(P<0.05);观察组经阴道分娩新生儿不良结局发生率低于对照组(P<0.05)。结论:阴道指检联合产时超声可提高第二产程异常产妇阴道分娩成功率,辅助胎位判断,缩短产程,减少产后出血与分娩相关并发症风险,同时改善新生儿不良结局。展开更多
目的:探讨自由体位结合“2+1”分娩陪伴对初产妇第二产程、分娩疼痛及母婴结局等分娩结局的影响。方法:回顾性分析2021年3月至2024年6月于我院分娩的150例初产妇一般资料,将采用自由体位完成分娩者纳入对照组(n=87),将自由体位结合“2+...目的:探讨自由体位结合“2+1”分娩陪伴对初产妇第二产程、分娩疼痛及母婴结局等分娩结局的影响。方法:回顾性分析2021年3月至2024年6月于我院分娩的150例初产妇一般资料,将采用自由体位完成分娩者纳入对照组(n=87),将自由体位结合“2+1”分娩陪伴完成分娩者纳入观察组(n=63),记录不同分娩方式对产妇第二产程、分娩疼痛及母婴结局的影响。结果:观察组第一、第二产程时间及产时出血量均低于对照组(P<0.05),两组第三产程比较,差异无统计学意义(P>0.05);观察组不同产程现时疼痛强度(PPI)、疼痛评级指数(PRI)、视觉模拟评分(VAS)较对照组更低(P<0.05);观察组软产道裂伤情况与对照组比较,差异无统计学意义(P>0.05);观察组1 min Apgar评分显著高于对照组,新生儿并发症发生率更低(P<0.05)。结论:自由体位结合“2+1”分娩陪伴显著缩短初产妇的产程时间,降低分娩疼痛,并有助于提高母婴结局的质量,显示出优于传统自由体位分娩的效果。展开更多
目的探讨双侧会阴神经阻滞麻醉联合气囊仿生助产术在第二产程胎头下降延缓初产妇中的应用效果。方法选择2023年7月至2024年12月在百色市人民医院住院分娩发生第二产程胎头下降延缓的90名初产妇作为研究对象,按照非随机同期对照的方法将...目的探讨双侧会阴神经阻滞麻醉联合气囊仿生助产术在第二产程胎头下降延缓初产妇中的应用效果。方法选择2023年7月至2024年12月在百色市人民医院住院分娩发生第二产程胎头下降延缓的90名初产妇作为研究对象,按照非随机同期对照的方法将其分为对照组(n=45,双侧会阴神经阻滞麻醉)和试验组(n=45,双侧会阴神经阻滞麻醉联合气囊仿生助产术)。比较两组的分娩情况、第二产程时间、软产道损伤情况及新生儿窒息情况。结果两组的阴道分娩率、产后2 h出血量比较,差异无统计学意义(P>0.05)。试验组的第二产程时间短于对照组(P<0.05)。试验组的会阴侧切发生率显著低于对照组(P<0.05);两组的宫颈裂伤、阴道裂伤及会阴Ⅰ度裂伤发生率比较,差异无统计学意义(P>0.05)。两组的新生儿1、5 min Apgar评分及新生儿窒息发生率比较,差异无统计学意义(P>0.05)。结论双侧会阴神经阻滞麻醉联合气囊仿生助产术可有效缩短第二产程胎头下降延缓的初产妇产程时间,且安全性良好,不仅有助于降低会阴侧切率,还不会增加产妇产后出血、软产道损伤及新生儿窒息的发生风险。展开更多
基金the Obstetrics and Gynecology Hospital of Fudan University for supporting this project。
文摘Objectives A systematic review and network meta-analysis was conducted to evaluate the effectiveness of different childbirth positions in reducing the duration of the second stage of labor,providing evidence-based insights for obstetric institutions to guide interventions related to childbirth positions.Methods A comprehensive literature search was conducted in databases,including PubMed,Web of Science,the Cochrane Library,Embase,Wanfang Databases,China National Knowledge Infrastructure Databases(CNKI),China Science and Technology Journal Database(CSTJ),and China Biology Medicine disc(CBMdisc)to identify studies on the effectiveness of different childbirth positions in reducing the duration of the second stage of labor.The search included randomized controlled trials published from database inception to September 30,2024.The Cochrane risk-of-bias tool was used to assess the quality of the studies.Two independent reviewers screened the literature,extracted data,and evaluated study quality.Subsequently,a network meta-analysis was performed using STATA software.The study protocol has been registered in PROSPERO(CRD42023428217).Results This study analyzed data from 25 randomized controlled trials involving 9,844 women.The findings indicated that in comparison to lithotomy position,free position(MD=20.53,95%CI[11.38,29.68])and upright position(MD=−24.13,95%CI[−42.94,-5.32])were found to be superior in reducing the duration of the second stage of labor.Free position outperformed kneeling position(MD=21.48,95%CI[4.67,38.28])and squatting position(MD=23.43,95%CI[1.88,44.97]);upright position was superior to kneeling position(MD=−25.08,95%CI[−46.93,−3.22]);semirecumbent position surpassed squatting position(MD=19.71,95%CI[2.05,37.38]);and upright position was also superior to squatting position(MD=−27.03,95%CI[−51.48,−2.57]).According to the surface under the cumulative ranking curve(SUCRA),the upright position emerged as the most effective for reducing the duration of the second stage of labor(87.4%),followed by free position(81.1%),semirecumbent position(70.0%),and lateral position(62.3%).Conclusion These findings offer valuable insights for midwifery practice and help inform future research directions.Considering the limitations of this review,more larger-scale,multicenter randomized controlled trials are warranted to further evaluate the relative effectiveness of different childbirth positions in reducing the duration of the second stage of labor.
文摘The second-stage of labor is the most stressful part of childbirth process and the proper maternal position during this period is paramount for women's safe vaginal birth.Midwives play a pivotal role in managing maternal positions during the second-stage of labor.However,there is limited evidence to support an ideal maternal position during the second-stage of labor.Further,the difference between different maternal positions might not be apparent.This paper aims to review and compare the benefits and risks of common maternal positions during the second-stage of labor,thereby to provide midwives evidence-based practical guidelines.
文摘Objective:To discuss the effect of prolonged second stage of labor on maternal and neonatal outcomes.Methods:A total of 101 primiparas with the length of second stage of labor longer than 2 h were selected and pregnant women with the length less than 2 h served as control.The maternal and neonatal outcomes of two groups were observed and compared.Results:A total of 62.1%(18/11) with the length of second stage of labor between 120 min and 180 min,46.7%(28/32) between 181 min and 240 min and 12 longer than 241 min underwent vaginal delivery.The longer the length of second stage of labor,the lower score of Apgar scale for infants in 1 min,and the higher the incidence of asphyxia.But there was no difference in scale in 5 min.As second stage of labor prolonged,the incidences of cesarean section and of postpartum hemorrhage increased. Conclusions:Almost half of puerperas with the length of second stage of labor longer than 2 h underwent vaginal delivery.The prolonged second stage of labor can decrease the score of Apgar scale in 1 min,increase the incidence of asphyxia,but has no effect on scale in 5 min.It still need more evidence from evidence medicine to definition of time and treatment of second stage of labor.
文摘Objective: Evaluating the effect of perineal length on the duration of the second stage of labor, the mode of delivery, the need for episiotomy and the possibility of perineal and vaginal tears needing repair. Participants and Methods: It is a prospective hospital-based observational study done on 483 parturient women in a university hospital. Personal, medical and obstetric data together with the measurement of perineal length were recorded in the first stage of labor. We followed up the progress of labor until delivery. Regression models were used to consider possible risk factors of episiotomy or tears needed repair. Results: The mean duration of the second stage of labor was significantly longer among women with a perineum of ≥4 cm length when compared with those with a perineal length of Conclusion: Longer perineum is associated with increase in the duration of the second stage of labor. Obstetricians should expect the need of episiotomy when confronted with circumcised primigravida with long perineum. However, if the perineum is short they should not be deceived, short perineum is more probably torn.
文摘目的探讨BirthRite坐位分娩组件接产的安全性和有效性,为缩短初产妇第二产程时间,提升产妇生产体验提供参考。方法将住院分娩的低危初产妇236例,第二产程按照产妇意愿分为观察组(116例)和对照组(120例)。观察组采用BirthRite坐位分娩组件坐式分娩,对照组采用电动产床坐式分娩。观察两组产妇第二产程时间、非枕前位占比、阴道助产、产后出血、肩难产、会阴侧切、会阴裂伤、会阴水肿、会阴疼痛程度和产后满意度;比较两组新生儿出生体质量和1 min、5 min Apgar评分。结果对照组中途2例退出。两组均顺利分娩,观察组第二产程时间显著短于对照组,分娩非枕前位占比、肩难产发生率、会阴侧切率、会阴水肿及疼痛程度显著低于对照组,产妇满意度显著高于对照组(均P<0.05)。两组新生儿出生后1 min和5 min Apgar评分均为10分。结论使用BirthRite分娩椅能够缩短第二产程时间,提高产妇满意度,优化坐位分娩结局。
文摘目的:探讨产时超声在改善第二产程异常产妇妊娠结局中的应用效果。方法:选取2023年1月—2024年9月江西省妇幼保健院产科收治的200例第二产程异常的产妇,根据信封编号后奇偶数法分为对照组、观察组,每组100例。对照组根据阴道指检情况决定分娩方式,观察组根据阴道指检结合经腹及经会阴超声检查决定分娩方式。统计两组分娩方式、产时胎位不正情况,比较两组经阴道分娩产妇的产程、产程出血量、产后出血量、分娩相关并发症及新生儿情况。结果:观察组阴道分娩率高于对照组,产时胎位不正率低于对照组(P<0.05)。两组阴道分娩产妇第二产程、第三产程、总产程均短于对照组(P<0.05)。观察组阴道分娩产妇产程出血量、产后出血量少于对照组(P<0.05)。观察组分娩相关并发症发生率低于对照组(P<0.05);两组经阴道分娩新生儿体重、血气指标(pH值、氧分压、二氧化碳分压、乳酸)、出生后10 min Apgar评分比较,差异无统计学意义(P>0.05);观察组经阴道分娩新生儿出生后1、5 min Apgar评分高于对照组(P<0.05);观察组经阴道分娩新生儿不良结局发生率低于对照组(P<0.05)。结论:阴道指检联合产时超声可提高第二产程异常产妇阴道分娩成功率,辅助胎位判断,缩短产程,减少产后出血与分娩相关并发症风险,同时改善新生儿不良结局。
文摘目的:探讨自由体位结合“2+1”分娩陪伴对初产妇第二产程、分娩疼痛及母婴结局等分娩结局的影响。方法:回顾性分析2021年3月至2024年6月于我院分娩的150例初产妇一般资料,将采用自由体位完成分娩者纳入对照组(n=87),将自由体位结合“2+1”分娩陪伴完成分娩者纳入观察组(n=63),记录不同分娩方式对产妇第二产程、分娩疼痛及母婴结局的影响。结果:观察组第一、第二产程时间及产时出血量均低于对照组(P<0.05),两组第三产程比较,差异无统计学意义(P>0.05);观察组不同产程现时疼痛强度(PPI)、疼痛评级指数(PRI)、视觉模拟评分(VAS)较对照组更低(P<0.05);观察组软产道裂伤情况与对照组比较,差异无统计学意义(P>0.05);观察组1 min Apgar评分显著高于对照组,新生儿并发症发生率更低(P<0.05)。结论:自由体位结合“2+1”分娩陪伴显著缩短初产妇的产程时间,降低分娩疼痛,并有助于提高母婴结局的质量,显示出优于传统自由体位分娩的效果。
文摘目的探讨双侧会阴神经阻滞麻醉联合气囊仿生助产术在第二产程胎头下降延缓初产妇中的应用效果。方法选择2023年7月至2024年12月在百色市人民医院住院分娩发生第二产程胎头下降延缓的90名初产妇作为研究对象,按照非随机同期对照的方法将其分为对照组(n=45,双侧会阴神经阻滞麻醉)和试验组(n=45,双侧会阴神经阻滞麻醉联合气囊仿生助产术)。比较两组的分娩情况、第二产程时间、软产道损伤情况及新生儿窒息情况。结果两组的阴道分娩率、产后2 h出血量比较,差异无统计学意义(P>0.05)。试验组的第二产程时间短于对照组(P<0.05)。试验组的会阴侧切发生率显著低于对照组(P<0.05);两组的宫颈裂伤、阴道裂伤及会阴Ⅰ度裂伤发生率比较,差异无统计学意义(P>0.05)。两组的新生儿1、5 min Apgar评分及新生儿窒息发生率比较,差异无统计学意义(P>0.05)。结论双侧会阴神经阻滞麻醉联合气囊仿生助产术可有效缩短第二产程胎头下降延缓的初产妇产程时间,且安全性良好,不仅有助于降低会阴侧切率,还不会增加产妇产后出血、软产道损伤及新生儿窒息的发生风险。
