自由体位待产下两种破膜方式对分娩结局及新生儿的影响

Effect of two membrane rupture ways on delivery and neonatal outcomes under free position during laboring

摘要:

目的对比分析人工破膜与自然破膜结合自由体位待产产妇的母婴结局，探求更为安全有效的产程管理模式。方法以西藏民族大学附属医院产科2014 年6 月-2015 年7 月收治的170 例产妇为研究对象，根据破膜方法分为人工破膜组（85 例）与自然破膜组（85 例），人工破膜组采用活跃期人工破膜并结合自由体位待产，自然破膜组在自由体位待产模式下自然破膜待产，对比两组产妇分娩结局与新生儿结局的差异。结果人工破膜组因枕位异常、宫内胎儿窘迫行剖宫产比例（22.4%）高于自然破膜组（9.6%）。人工破膜组经阴道分娩产妇第1 产程时间为（537.8±50.3）min，第2 产程时间为（35.8±9.1）min，产后2 h 出血量（182.4±37.5）ml，均略少于自然破膜组（549.5±57.3）min、（38.5±10.5）min 和（190.7±40.4）ml；宫颈撕裂（4.5%）、宫颈水肿（4.5%）、产褥感染（1.5%）、尿潴留（6.1%）发生比例略高于自然破膜组（3.9%、2.6%、0.0%和3.9%），上述组间比较差异均无统计学意义（P >0.05）。人工破膜组经阴道分娩新生儿1 min Apgar 评分（7.92±0.97）、产瘤发生率（21.2%）略高于自然破膜组[（7.77±0.99）、14.3%]，新生儿窒息率（7.6%）略低于自然破膜组（10.4%），上述围产儿结局差异均无统计学意义（P >0.05）。结论自由体位待产模式下，活跃期予人工破膜较自然破膜并未明显减少产程时间，但却增加了因枕位异常、宫内窘迫等造成的剖宫产率；建议正常产程中活跃期不要行人工破膜干预。

Abstract:

Objective To compare delivery and neonatal outcomes of artificial membrane rupture and natural membrane rupture under free position for laboring, and seek for more effective labor management model. Methods A retrospective analysis was conducted on 170 parturient women in our hospital from June 2014 to July 2015. They were divided into artificial membrane rupture group (85 cases) and natural membrane rupture group (85 cases) according to membrane rupture ways. The artificial membrane rupture group was given artificial rupture in active period combined with free position for laboring, the natural membrane rupture group adopted free position for laboring and waited for natural rupture of membrane. The maternal birth outcomes and neonatal outcomes of the two groups were noted and compared. Results The cesarean section rate of the artificial membrane rupture group (22.4%) was significantly higher than that of the natural membrane rupture group (9.6%) due to abnormal occiput position and intrauterine fetal distress (P < 0.05). The first stage of labor [(537.8 ±50.3) min] and the second stage of labor [(35.8 ±9.1) min] were shorter, and 2-h postpartum hemorrhage volume [(182.4 ±37.5) ml] was smaller in the artificial rupture group compared to the natural rupture group [(549.5 ±57.3) min, (38.5 ±10.5) min, and (190.7 ±40.4) ml respectively]; and the rates of cervix laceration (4.5%), cervical edema (4.5%), puerperal infection (1.5%) and urinary retention (6.1%) were slightly higher than those of the natural rupture group (3.9%, 2.6%, 0.0% and 3.9% respectively), the differences had no statistical significance (P > 0.05). The 1-min Apgar score (7.92 ±0.97) and the occurrence rate of caput succedaneum (21.2%) in the artificial rupture group were slightly higher than those in the natural membrane rupture group [(7.77 ±0.99) and 14.3% respectively], and the neonatal asphyxia rate (7.6%) was slightly lower than that in the natural membrane rupture group (10.4%), the differences were not statistically significant (P > 0.05). Conclusions Under free position for labor, compared with natural rupture, artificial membrane rupture does not significantly reduce labor time, but increases cesarean section rate due to abnormal occiput position and intrauterine fetal distress. It is suggested that it is better not to use artificial membrane rupture during active period in order to avoid disturbing normal laboring process.