摘要
目的 探讨胎膜早破患者的胎先露衔接情况对剖宫产指征的影响.方法 选择我院2008年4月至2009年4月足月妊娠（孕37～41＋6周）分娩的510例胎膜早破初产妇.根据先露衔接与否分为未衔接组（218例）和衔接组（292例）.对2组分娩方式、剖宫产指征、宫颈Bishop评分、新生儿结局进行分析.结果 不衔接组剖宫产率为64.7%（141/218）,衔接组剖宫产率为17.5%（51/292）,2组比较差异有统计学意义（P＜0.01）.不衔接组的胎儿窘迫、胎方位异常、活跃期停滞、引产失败率均高于衔接组（18.9%比8.9%,12.8%比3.4%,12.4%比1.0%,15.6%比2.4%,P＜0.05）.不衔接组顺产孕妇的宫颈Bishop评分高于剖宫产孕妇的宫颈Bishop评分[（4.2±1.3）分比（3.5±1.7）分,P＜0.01],顺产孕妇新生儿平均体重低于剖宫产孕妇的新生儿平均体重[（3.1±0.3）kg比（3.3±0.5）kg,P＜0.05].结论 胎膜早破胎先露不衔接者由于破膜后羊水流失难以控制、宫颈条件差,导致引产难度大、分娩并发症多、剖宫产率高,故足月后先露部尚未衔接者应尽可能避免胎膜早破,胎膜早破后应尽快促宫颈成熟、终止妊娠.
Objective To explore the cesarean section indications of fetal presentation unengagement in primipara with full-term premature rupture of membrane. Methods Five hundreds and ten primipara with premature rupture of membrane at term were divided into 2 groups： the fetal head was not engaged in the birthing process （ study group 218 cases） and engaged in the birthing process（ control group 292 cases）. The delivery course and the incidence of complication of the mother and infant were compared between 2 groups. The main outcome measure was the rate of caesarean section, indications of cesarean section, the cervical maturity（by Bishop scoring）, the rate of fetal distress and newborn asphyxia, et al. Results The rate of cesarean section was higher in study group （64.7%） than that in control group（ 17.5% ） （ P 〈0.01 ）, so were the rate of fetal distress, stagnant labor and of failure of induction（ P 〈0.05 ）. In the cases of study group, the cervical condition of easy delivery ones was better than that of caesarean section ones. Average neonatal weight of easy delivery ones is lighter than caesarean section ones. Conclusions When the fetal head is not engaged in the birthing process in primipara with premature rupture of membrane at term, the labor induction is difficult. The labor complications are common, and the rate of caesarean section is high because of the loss of amniotic fluid and the poor cervical condition. Primipara at term whose presentation is not engaged in the birthing process should try to avoid premature rupture of membrane. Cervical ripening and induction should be done as soon as possible after membrane rupture.
出处
《中国医药》
2011年第4期453-455,共3页
China Medicine
关键词
胎膜早破
衔接
剖宫产术
Premature rupture of membrane
Engagement
Cesarean section
