摘要
目的探讨产时干预对初产妇分娩结局及产后盆底功能的影响。方法选取2018年6月至2018年9月济南市中西医结合医院收治的393例健康初产妇为研究对象,根据产时干预措施的不同分为观察组196例(减少产时医疗干预措施)和对照组197例(传统产时医疗干预)。比较2组的分娩结局和并发症情况;经会阴盆底超声测量在静息及最大Valsalva动作状态下尿道倾斜角(UTA)、膀胱尿道后角(PUVA)、膀胱颈位置(BNP)及肛提肌裂孔面积,并计算尿道旋转角(URA)和膀胱颈移动度(BND),进一步通过经盆底肌电生理检查评估产妇产后的盆底肌纤维肌力情况。结果 2组产妇总产程差异无统计学意义(P> 0. 05);观察组自然分娩率更高,会阴侧切率、会阴裂伤率、产后出血发生率、新生儿并发症发生率、PUVA、URA及BND均低于对照组,2组比较差异有统计学意义(P <0. 05);观察组盆底肌力明显高于对照组,并且异常肌力发生率低于对照组,差异均有统计学意义(P <0. 05)。结论减少产时医疗干预对低危初产妇分娩具有重要临床意义,有助于促进自然分娩,改善母婴结局,减轻盆底功能损害。
Objective To explore the effect of intrapartum intervention on outcome and pelvic floor function of primiparous women. Methods From June 2018 to September 2018,a total of 393 healthy primiparous women who underwent natural childbirth in our Hospital were included,and they were divided into the observation group ( limited intrapartum medical intervention,196 cases) and the control group ( conventional intrapartum medical interventions,197 cases). The delivery outcomes and postpartum complications in the two groups were compared. Furthermore,the urethral tilt angel ( UTA),posterior urethrovesical angel ( PUVA),bladder neck position ( BNP) and area of levator hiatus were measured at rest and maximum Valsalva operation by perineal pelvic ultrasonography,respectively. The urethral rotation angel ( URA) and bladder neck descent ( BND) were calculated. In addition,the pelvic floor muscle fibers strength of postpartum period was detected with the instrument of pelvic floor muscle electrophysiological examination. Results There was no statistically significant difference in total labor duration between the two groups ( P >0. 05). However,spontaneous delivery rate in the observation group were significantly higher than that in the control group ( P <0. 05). In addition,the occurrences of episiotomy,perineal laceration,postpartum hemorrhage,neonatal complications,PUVA,URA and BND in the observation group were significantly lower than those in the control group ( P <0. 05). The pelvic floor muscle fibers strength grading in the observation group were significantly higher than those in the control group ( P <0. 05),and the incidence of abnormal muscle fibers strength in the observation group was significantly lower ( P <0. 05). Conclusion Less intrapartum intervention has important clinical significances in management of low-risk primiparous women,which can effectively pro- mote spontaneous labor,improve maternal and neonatal outcomes,and reduce pelvic floor dysfunction.
作者
武春鸿
杨辰晨
李燕
陈凯
李慧
吴茂勤
WU Chun-hong;YANG Chen-chen;LI Yan;CHEN Kai;LI Hui;WU Mao-qin(Department of Obsterics and Gynecology,Jinan Hospital of Integrated Chinese and Western Medicine,Jinan Shandong 271100,China;Department of Obsterics and Gy- necology,People's Hospital of Jinan,Jinan Shandong 271100,China)
出处
《局解手术学杂志》
2019年第10期794-798,共5页
Journal of Regional Anatomy and Operative Surgery
基金
山东省科技发展计划政策引导类项目(2013YD18047)
关键词
产时干预
初产妇
分娩结局
盆底功能
剖宫产
intrapartum intervention
primiparous women
delivery outcomes
pelvic floor function
cesarean delivery
