自由体位分娩完整版本.ppt

自由体位分娩;; 是指在分娩过程中会指产妇采用自感舒适的体位，而不是传统的仰卧截石位分娩。; 随着现代产科的发展，促进自然分娩已成为产科工作者的共识，而在分娩的人文关怀我们助产人员在服务中主要的内容。 传统的床上卧位待产和接产，由于产程时间长，增大的子宫压迫下腔静脉极易造成体位性低血压，引起产妇出汗，眩晕等不适。 自由体位待产与分娩正是顺应了时代的发展所提出，它一方面可以消除产妇的紧张与恐惧，提高其顺产的信心与依从性，另一方方面可以减少医患纠纷，提高了对助产服务工作的满意度。 ;自由体位应用的依据;;;产程中的自由体位 在产程过程中采取如卧，走，立，坐，跪、蹲等各种姿势，选择自己感到舒适的体位，而不是之躺在床上。第一产程中产妇采取各种舒适的自由体位，如自由走动，站立，趴着，坐或蹲这些体位相对孕产妇来讲都是纵体位，与胎儿纵轴相一致，可以有效增加胎头对宫颈的压迫，加速宫口扩张和胎先露下降，从而缩短产程，促进自然分娩，提高顺产率，降低剖宫产率。 ; 跪式体位 跪式体位站立姿势产妇用双手抱住丈夫的脖子或腰部，并靠在他身上或步行车，站立行走，可以分散产妇注意力增加舒适感减轻产痛。 ;;;;;侧卧位;;;蹲位; 优点： 　　1、可以将力量集中，提高分娩的速度。 　　2、可以借助重力的作用。 　　3、可以加速胎头的旋转。 　　4、可以自由地变换重心，准妈妈会感觉舒服。 　　5、不用向下使太大的力气。 　　6、待产妈咪以蹲式骨产道宽度最大，当待产妈咪从平卧位改为蹲式时，骨产道横断面的面积可增加30%，蹲位时出口前后径可增大0.5～2.0cm。有利于顺产。 　　缺点： 　　1、待产妈咪久蹲容易疲劳。 　　2、有时很难听到胎心。;站立位;;文献摘录;;自由体位的注意事项;水中分娩也是自由体位的另一种形式;;水中分娩的原理;水中分娩的要求;水中分娩的好处;水中分娩的注意事项;;水中分娩不适合的孕妇群;文献学习;;;; Methods: This case-control study was carried out atthe Department of Obstetrics and Gynaecology of theUniversity Hospital Vienna between 1997 and 2002. Atotal of 307 women who delivered in an upright positionwere enrolled in the study. Upright position was definedas free squatting and was also described as an alterna-tive birth position. 307 controls, delivering in a supineposition, were selected from the delivery database as thenext parity-matched normal spontaneous vaginal delivery.Our analysis was restricted to a sample of women with agestational age 37 weeks, a normal sized fetus and apregnancy with cephalic presentation. Women with med-ical or obstetric risk factors were excluded.; During the study period the data of 614 women (307women with upright position and 307 women with supineposition) were available for analysis. The median maternalage of women who delivered in an upright position was 29years (25–75% quartile: 25–32 years) and those deliveringsupine 27 years (25–75% quartile: 24–31 years). Themedian gestation