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目的:探讨头位妊娠脐带绕颈经阴道分娩的评估标准及效果。方法:选择400例头位妊娠脐带绕颈的待产孕妇设为观察组,另选择同期无脐带绕颈的健康待产孕妇400例设为对照组。对照组根据经阴道分娩和剖宫产的适应症,并结合孕妇和家属意见选择分娩方式,观察组依据评估标准选择分娩方式。比较两组的分娩方式和围产儿情况。结果:观察组与对照组经阴道分娩率分别为57.25%、58.50%,剖宫产率分别为42.75%、41.50%,均无统计学差异(P>0.05)。观察组胎儿羊水污染、胎儿窘迫的发生率均高于对照组,差异具有统计学意义(P<0.05或P<0.01);而两组新生儿窒息、吸入性肺炎、缺血缺氧性脑病、围产儿死亡的发生率比较,差异均无统计学意义(P>0.05)。结论:在严密的监护措施下,严格掌握头位妊娠脐带绕颈经阴道分娩的评估标准,鼓励孕妇行阴道试产,配合娴熟的助产技术,可以顺利完成经阴道分娩,对保障母婴安全、降低医疗费用和剖宫产的比例均具有重要的意义。
Objective: To investigate the evaluation criteria and effect of transvaginal delivery of umbilical cord around the neck during head gestation. Methods: 400 cases of pregnant women with umbilical cord around neck were selected as the observation group and 400 healthy pregnant women without umbilical cord around the neck were selected as the control group. The control group according to vaginal delivery and cesarean indications, combined with the views of pregnant women and their families choose mode of delivery, the observation group based on the evaluation criteria to choose mode of delivery. The mode of delivery and perinatal conditions were compared between the two groups. Results: The vaginal delivery rates of the observation group and the control group were 57.25% and 58.50% respectively, and the rates of cesarean section were 42.75% and 41.50% respectively, with no significant difference (P> 0.05). The incidence of fetal amniotic fluid contamination and fetal distress in the observation group were higher than those in the control group (P <0.05 or P <0.01), while the incidence of asphyxia, aspiration pneumonia, hypoxic-ischemic encephalopathy, The incidence of perinatal death compared, the difference was not statistically significant (P> 0.05). CONCLUSION: Under strict guardianship measures, the strict evaluation criteria of transvaginal delivery of umbilical cord around the neck during pregnancy should be strictly followed to encourage pregnant women to carry out vaginal trial production. With skilled midwifery techniques, vaginal delivery can be successfully completed, , Reduce the cost of medical care and the proportion of cesarean section are of great significance.