自然娩肩法对产科肩部难产及产伤的预防作用

目的探讨自然娩肩法对预防产科肩部难产及新生儿产伤的价值,以指导选择分娩方案。方法选择深圳市福田区妇幼保健院2013~2014年经阴道分娩的5 466例产妇为观察组,等待宫缩后行自然娩肩法助产;将该院2011~2012年经阴道分娩的5 771例产妇作为对照组,未予特殊处理。比较两组肩难产及新生儿产伤发生率、肩难产产妇产程及出生体重、自胎头娩出到胎儿前肩娩出时间、新生儿Apgar评分、入住新生儿重症监护室(NICU)率、其他新生儿并发症发生率、产妇会阴Ⅲ度裂伤发生率。结果观察组出现肩难产5例,对照组肩难产22例;新生儿产伤:观察组3例,对照组18例;自胎头娩出到胎儿前肩娩出时间:观察组(77.3±10.5)s,对照组(90.5±11.5)s;产妇会阴Ⅲ度裂伤:观察组0例,对照组17例。上述各项比较,观察组均优于对照组(P0.05)。两组肩难产产妇产程及出生体重、其他新生儿并发症及入住NICU率比较差异无统计学意义(P0.05)。结论等待宫缩后自然娩肩法助产能够有效预防肩难产及新生儿产伤,且不会增加新生儿窒息及其他并发症发生率,值得临床推广。

Preventive effect of natural childbirth shoulder method on obstetric shoulder dystocia and birth injuries

Objective To discuss value of natural childbirth shoulder method in preventing natural childbirth shoulder dystocia and neonatal injury,in order to guide the choice of delivery plan.Methods 5 466 cases of maternal vaginal delivery hospitalized in Futian Women and Children Health Care Hospital of Shenzhen from 2013 to 2014 were selected as observation group,conducted midwifery by natural childbirth shoulder method after uterine contraction.5 771 cases of maternal vaginal delivery from 2011 to 2012 were selected as the control group,they were not given special handling.Occurring rate of shoulder dystocia and neonatal injury,stages of labor of shoulder dystocia,neonatal weight,delivery time of childbirth fetal head to the front of the fetal shoulder,neonatal Apgar score,admitted to the neonatal intensive care unit (NICU),other complications incidence rate,rate of perineal laceration of Ⅲ degree of two groups were compared.Results There were 5 cases of shoulder dystocia in observation group and 22 cases in control group;there were 3 cases of neonatal injury in observation group and 18 cases in control group;The delivery time of childbirth fetal head to the front of the fetal shoulder of the observation group was (77.3 ± 10.5) s,while that of the control group was (90.5 ± 11.5) s.NO one happened perineal laceration of Ⅲ degree in the observation group,but 17 cases happened in control group.The observation group had obvious advantages in the above indexes (P ＜ 0.05).Stages of labor of shoulder dystocia,neonatal weight,other complications incidence rate,admitted to the NICU of two groups had no significant differences (P ＞ 0.05).Conclusion Natural childbirth shoulder midwifery method after uterine contraction can can effectively preventing shoulder dystocia and neonatal injury,and will not increase neonatal asphyxia and other complication rate,which is worthy of promotion.