不同待产方式对初产妇分娩结局及产后阴道微环境、 盆底功能的影响

目的探讨不同待产方式对初产妇分娩结局及产后阴道微环境、盆底功能的影响。方法选取2018年1月至2019年3月于西安市第五医院进行阴道试产的152例健康初产妇作为研究对象。根据其待产意愿分为水中组(水中待产,n=64)与药物组(硬膜外麻醉待产,n=88)。比较两组各产程持续时间及分娩结局;产后6~8周采用神经肌肉刺激治疗仪测定两组的盆底肌力,并使用盆腔器官脱垂定量分期法(POP-Q)评价两组盆腔器官脱垂程度,同时检测两组阴道酸碱度(pH值)与清洁度;统计两组产后阴道炎发生情况。结果水中组第一、二产程持续时间均显著短于药物组(P<0.05),但两组第三产程持续时间比较差异无统计学意义(P>0.05)。水中组会阴侧切率(4.69%)显著低于药物组(15.91%),两组剖宫产率、产后2h出血量、新生儿体重、新生儿窒息率比较,差异均无统计学意义(P>0.05)。水中组产后盆底肌Ⅰ、Ⅱ类肌纤维中肌力>Ⅲ级者占比均显著高于药物组(P<0.05)。水中组产后盆腔器官脱垂率低于药物组,但差异无统计学意义(P>0.05)。两组产后阴道pH值和清洁度、细菌性及滴虫性阴道炎、外阴阴道假丝酵母菌病(VVC)发生率比较,差异均无统计学意义(P>0.05)。结论水中待产相对于硬膜外麻醉待产能有效加快初产妇产程进展,降低初产妇会阴侧切率,减轻对初产妇盆底功能的损害,且两种待产方式对初产妇产后阴道微环境的影响程度相当。

Effects of different modes of delivery on delivery outcome,postpartum vaginal microenvironment and pelvic floor function of primipara

Objective To explore effects of different modes of delivery on delivery outcome,postpartum vaginal microenvironment and pelvic floor function of primipara.Methods A total of 152 healthy primiparas who underwent vaginal trial delivery in Xi′an Fifth Hospital from January 2018 to March 2019 were selected as the research subjects,and divided into water group(delivery in water,n=64)and drug group(epidural anesthesia,n=88)according to their wishes.The duration and outcome of labor were compared between the two groups.After 6-8 weeks postpartum,the pelvic floor muscle strength of the two groups was measured by neuromuscular stimulation therapy,and the degree of pelvic organ prolapse was evaluated by POP-Q.Meanwhile,the pH and cleanliness were measured.The occurrence of postpartum vaginitis was counted.Results Water group′s durations of first and second stage were significant shorter than those in drug group(P<0.05),but there was no statistically significant difference in the duration of the third stage between the two groups(P>0.05).The lateral perineal cut rate in the water group(4.69%)was significantly lower than that in the drug group(15.91%).There were no statistically significant differences between the two groups in cesarean section rate,2h postpartum blood loss,neonatal weight and neonatal asphyxia rate(P>0.05).The percentage of postpartum pelvic floor muscleⅠ,Ⅱtype of muscle fiber strength>Ⅲlevel person in water group than were significantly higher than that of drug group(P<0.05).The rate of postpartum pelvic organ prolapse in the water group was lower than that in the drug group,but the difference was not statistically significant(P>0.05).There were no statistically significant differences in postpartum vaginal pH and cleanliness,bacterial and trichomoniasis vaginitis,and vulvovaginal candidiasis(VVC)between the two groups(P>0.05).Conclusions Compared with epidural anesthesia,delivery in water can effectively accelerate the labor process of primipara,reduce perineal lateral cut rate,and reduce the damage to the pelvic floor function of primipara.And the two methods of delivery have a similar effect on the postpartum vaginal microenvironment of primipara.