徒手旋转胎头在阴道分娩中应用.docVIP

徒手旋转胎头在阴道分娩中应用 　　[摘要] 目的 探讨徒手旋转胎头对头位难产产妇加速产程进展、提高自然分娩率、减少母婴并发症的作用。 方法 将212例单胎头位，持续性枕横位、枕后位，无严重并发症及合并症的产妇，随机分为观察组108例，采用手转胎头术；对照组104例，采用让孕产妇与大卤门方向一致的侧卧位。 结果 观察组产妇阴道分娩率显著高于对照组，剖宫产率显著低于对照组（P0.01）；产程进展时间、分娩方式、产后出血等方面与对照组比较差异有统计学意义（P0.01）。 结论 对持续性枕横位或枕后位的产妇适时采用徒手旋转胎头方法，转至枕前位，可使难产转为顺产，缩短产程，提高自然分娩率，降低剖宫产率，减少母婴并发症。 　　[关键词] 手转抬头；自然分娩；母婴并发症 　　[中图分类号] R714.3 [文献标识码] A [文章编号] 1674-4721（2013）11（b）-0010-03 　　Application of freehand rotation of fetal head in vaginal delivery 　　WANG Wen-xia 　　People′s Hospital of Feidong County in Anhui Province，Feidong 231600，China 　　[Abstract] Objective To investigate the effect of freehand rotation of fetal head on accelerating labour process，increasing natural delivery rate and reducing maternal and child complications in cephalic presentation. Methods 212 puerperae with continuous transverse position and occipitoposterior position and without severe complications and comorbidities were selected and randomly divided into the observation group with 108 patients received freehand rotation of fetal head and the control group with 104 patients adopted the lateral position consistent with the direction of fontanel. Results The observation group had significantly higher vaginal delivery rate and significantly lower cesarean section rate than the control group （P0.01）；The two groups were significantly different in the labour process time，delivery mode and postpartum hemorrhage （P0.01）. Conclusion The application of freehand rotation of fetal head in puerperae with continuous transverse position or occipitoposterior position can change difficult labour into natural labour，shorten labour process，increase natural delivery rate，decrease cesarean section rate and reduce maternal and child complications. 　　[Key words] Freehand rotation；Natural delivery；Maternal and child complications 　　随着围生期保健的日益完善，产前检查已逐渐正规化，胎位异常逐渐减少，仅占难产的10%，而头位异常约占难产的90%。在分娩过程中，胎头多以枕橫位或枕后位衔接，胎头下降过程中在强有力的宫缩作用下，绝大多数能向前转成枕前位自然分娩，5%～10%的胎头枕骨不能转成枕前位而成持续性枕橫位、枕后位造成难产，占头位难产的65%～70%。本研