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目的:探讨产程体位改变对矫正产妇后位胎位不正的临床效果。方法:回顾性分析1 800例自然分娩产妇的临床资料,其中经内诊检查及B超诊断证实为枕后位胎位不正的初产妇128例,随机将患者分为观察组及对照组,每组各64例。观察组孕妇在分娩过程中取侧卧位,并利用羊水浮力、胎儿重力、子宫间隙收缩力等合力的相关作用改变胎头娩出的位置,使得胎头下降时从枕后位转为枕前位,而对照组孕妇不进行体位指导,任意让孕妇卧床或行动,对比分析两组孕妇阴道试产成功率、自然分娩产程、妊娠并发症、新生儿阿氏评分、新生儿死亡率、产中出血量、产后出血量等方面的差异。结果:观察组自然分娩成功率显著高于对照组,而剖宫产率、产钳助产率、宫缩乏力、软产道裂伤率高、发生率显著低于对照组,差异有统计学意义(P<0.05)。观察组潜伏期产程、活跃期加速阶段产程、第二产程以及总产程显著低于对照组,差异有统计学意义(P<0.05)。观察组枕位胎头先露下降速度在潜伏期、加速期、急速下降期显著快于对照组,差异有统计学意义(P<0.05)。对照组新生儿阿氏评分较低、产伤率较高、宫内窒息率高、产中、产后出血量较大,差异有统计学意义(P<0.05)。结论:枕后位胎位不正是引起产妇胎位不正的重要因素,分娩过程中通过改变产妇体位对提高母婴分娩安全具有重要的作用。
Objective: To investigate the clinical effect of postoperative birth position change on correction of posterior fetal position malocclusion. Methods: A retrospective analysis of 1 800 cases of spontaneous childbirth clinical data, which confirmed by internal examination and B ultrasound diagnosis of post-occipital position of primiparous malformations in 128 cases, the patients were randomly divided into observation group and control group, each group Each 64 cases. Observation group of pregnant women in the delivery process to take the lateral position, and the use of amniotic fluid buoyancy, fetal gravity, uterine space contraction force and other synergies related changes in the role of fetal head position, making the fetal head down from the occiput to the anterior occiput , While the pregnant women in the control group did not have body position guidance, and any pregnant women were allowed to stay in bed or move freely. The success rate of vaginal trial production, spontaneous labor, pregnancy complications, neonatal Asperger’s score, neonatal mortality, Volume, amount of postpartum hemorrhage and so on. Results: The success rate of natural childbirth in the observation group was significantly higher than that of the control group. The incidences of cesarean section, forceps delivery, uterine inertia, and soft birth canal laceration were significantly lower than those in the control group P <0.05). Latent labor process in the observation group, labor process in the accelerated phase of the active phase, the second stage of labor and the total production process were significantly lower than the control group, the difference was statistically significant (P <0.05). In the observation group, the rate of decline of the fetal head of the pillow was significantly faster than that of the control group in the incubation period, acceleration period and rapid decline period (P <0.05). The neonates in the control group had lower scores, higher birth injury rate, higher intrauterine asphyxia rate, larger amount of postpartum hemorrhage, the difference was statistically significant (P <0.05). Conclusion: The abnormal position of the occiput posterior position is an important factor that causes the malposition of the fetus. It plays an important role in improving the safety of mother and child delivery by changing the position of the mother during childbirth.