徒手旋转胎头纠正持续性枕后位的临床观察(1)

http://www.100md.com 2011年12月15日 陈平 谢穗 许园园

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     [摘要] 目的：探讨经阴道徒手旋转胎头术在持续性枕后位产妇中的应用。方法：选择2008年12月～2010年12月持续性枕后位350例，分为A组182例、B组168例，A组经阴道徒手旋转胎头，B组严密观察产程，顺其自然。比较两组分娩结局。结果：A组148例徒手旋转胎头成功，成功率为81.32%，B组37例自然内旋转成功，成功率为22.02%；两组自然分娩率、剖宫产率、新生儿体质量差异有统计学意义(P<0.05)；两组新生儿窒息、产后出血及软产道裂伤差异无统计学意义(P>0.05)。结论：活跃期持续性枕后位行徒手旋转胎头术，可显著减低剖宫产率，促进阴道分娩，降低剖宫产率，保障母婴健康。

    [关键词] 头位难产；剖宫产；持续性枕后位

    [中图分类号] R71 [文献标识码] C [文章编号] 1674-4721(2011)12(b)-177-02

    Clinical observation of manual correction of persistent occipito-posterior position of fetus

    CHEN Ping, XIE Sui, XU Yuanyuan

    The Third People's Hospital of Hefei City, Anhui Province, Hefei 230022, China

    [Abstract] Objective: To observe the effects on manual correction of persistent occipito-posterior position of fetus. Methods: Three hundred and fifty cases of persistent occipital posterior position from December 2008 to December 2010 were randomly divided into manual correction group (group A, 182 cases) and spontaneous labor group (group B, 168 cases). Delivery outcome was compared between these two groups. Results: In group A, manual correction of 148 cases were successful, the success rate was 81.32%. In group B, spontaneous labor of 37 cases were successful, the success rate was 22.02%. There was remarkable difference of natural labor rate，cesarean section rate and body weight of the neonates between the two groups(P<0.05), but there was no remarkable difference of neonatal Apgar score, postpartum hemorrhage and genital tract lacerations between the two groups(P>0.05). Conclusion: It is worth recommending the use of manual correction of persistent occipito-posterior position of fetus because of its health and safety to mothers and infants.

    [Key words] Cephalic presentation difficult delivery; Cesarean Section persistent; Occipito-posterior position

    持续性枕后位是指正式临产后，经充分的试产，无论以任何方式结束分娩，无论胎头在骨盆的哪一平面上，只要胎儿枕骨在母体后方者。枕后位是头位难产的最常见的原因之一，在产程中适时行徒手旋转胎头术，可降低剖宫产率，减少产妇痛苦[1]。现将本院2008年12月1日～2010年12月30日182例持续性枕后位经阴道徒手旋转胎头病例，报道如下：

    1 资料与方法

    1.1 一般资料

    本院2008年12月1日～2010年12月30日住院分娩人数4 532例，其中，350例初产妇 (除外骨盆狭窄和骨盆畸形者)进入活跃期后，宫口开大6 cm，胎头仍阻滞在中骨盆平面，内诊为持续性枕后位，占分娩人数的7.72%。随机分为A组(182例)、B组(168例)。A组活跃期经阴道徒手旋转胎头术，B组严密观察产程，顺其自然试产 ......

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