目的 分析初产妇在第二产程阶段采用手膝俯卧位、侧卧位等非常规体位实施分娩的临床效果.方法 选择2015年10月至2017年10月在本院产科分娩的初产妇600例,采用随机数字表法将其分为对照组和研究组,每组300例.对照组在第二产程阶段采用常规平卧位方式进行分娩,研究组在第二产程阶段采用手膝俯卧位、侧卧位等非常规体位进行分娩.比较两组产妇对分娩期临床干预模式的满意度,第二产程时间,第三产程时间,产后住院治疗时间,分娩期间接受会阴侧切、产钳、自然分娩和剖宫产手术的例数,母婴产后不良事件发生率,分娩后不同时间点疼痛程度视觉模拟评分(visual analogue scale,VAS)的改善幅度.结果 研究组产妇对分娩期临床干预模式的满意度达到96.0％,高于对照组的78.7％,差异有显著性(P＜0.05).研究组第二产程时间、产后住院治疗时间短于对照组,差异有显著性(P＜0.05);分娩期间仅有16例实施会阴侧切,8例实施产钳术,24例接受剖宫产手术,明显少于对照组的72例、32例和70例,而阴道分娩例数明显高于对照组,差异有显著性(P＜0.05);母婴产后不良事件发生率仅为2.0％,低于对照组的11.3％,差异有显著性(P＜0.05);分娩后不同时间点VAS评分均明显低于对照组,差异有显著性(P＜0.05).结论 初产妇在第二产程阶段采用手膝俯卧位、侧卧位等非常规体位实施分娩,能够缩短第二产程时间,提高自然分娩率,降低会阴侧切、产钳和剖宫产率,使母婴结局更加理想.%Objective To analyze the clinical effect of primipara in childbirth in the stage of second stage of labor using unconventional supine position such as prone hand position and lateral position.Method 600 primiparous women in our hospital were selected and divided into control group and study group using mathematical random number list,with an average of 300 cases in each group.Control group in the second stage of labor using routine supine position for delivery;the study group in the second stage of labor using hand prone position,lateral position and other unconventional supine position for childbirth.Comparing the two groups of maternal satisfaction with childbirth clinical intervention model,the second stage of labor time,the third stage of labor time,postpartum hospitalization time,during delivery to accept episiotomy,forceps,spontaneous delivery and cesarean section,maternal and child The incidence of postpartum adverse events,improvement in VAS score at different time points after delivery.Result The study group's satisfaction rate of clinical intervention model during childbirth reached 96.0％,which was significantly higher than that of control group (78.7％) (P＜0.05).The second stage of labor time and postpartum hospitalization time were shorter than those of control group and group There were significant differences between the two groups (P＜0.05).During delivery,only 16 cases underwent episiotomy,8 cases underwent forceps and 24 cases under cesarean section were significantly less than those in control group (72 cases,32 cases and 70 cases).While the number of vaginal delivery was significantly higher than that of the control group(P＜0.05).The incidence rate of maternal and child postpartum adverse events was only 2.0％,which was lower than that of the control group (11.3％) (P＜0.05).VAS scores at time point were better than those in control group (P＜0.05).Conclusion The first stage of labor in the second stage of labor using hand prone position,lateral position and other unconventional supine implementation of childbirth,can shorten the second stage of labor,improve the rate of natural delivery,reduce episiotomy,forceps and cesarean section rate,maternal and child fate makes the ideal.
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