产钳助产在阴道分娩中的应用价值与并发症预防

目的探讨产钳助产在阴道分娩中的应用价值,重新认识产钳助产的利与弊,提高阴道助产能力,降低剖宫产率。方法使用黄维新等人根据胎头双顶径及先露部(骨质最低部)的位置的新分类法,按照李巨主编的产科学有关产钳助产的手法进行操作。结果产钳助产的主要原因依次为胎头位置异常、胎儿宫内窘迫、宫缩乏力、并发症与合并症、疤痕子宫和羊水栓塞;母体并发症依次为阴道裂伤、宫颈裂伤、产后出血、阴道壁血肿、会阴伤口裂开、会阴Ⅲ度裂伤;新生儿并发症依次为头皮血肿、头面部皮肤擦伤和新生儿窒息;低位产钳和出口产钳的新生儿窒息率与同期比较差异无显著性,P>0.05,中位产钳的新生儿窒息率与同期比较差异有显著性,P<0.05。结论低位和出口产钳助产不能被其他产科手术完全取代,在阴道分娩中仍有较好的应用价值。

THE APPLICATION VALUE AND COMPLICATIONS PREVENTION OF FORCEPS DELIVERY IN VAGINAL DELIVERY

Objective To explore the application value and complications prevention of forceps delivery in vaginal delivery, to recognize the advantages and disadvantages of forceps delivery again and to enhance the ability of forceps delivery and decrease the cesarean section rate. Methods Used the new classification of Huang Weixin and so on, according to the opposition relation between fetal cephalometry and presentation (the lowest bone) and operated on the basis of maneuver of forceps delivery in the obstetric edited by Li Ju. Results The main causes of forceps delivery were the abnormal lie of fetus, intrauterine fetal anoxia, uterine inertia, complications, cicatricial uterine and amniotic fluid embolism. The complications of mother included vaginal laceration, laceration of cervix, postpartum, hematoma of vagina, laceration of perineum and Ⅲo perineal laceration. The newborn's complications included hematoma of scalp, scalp injury and asphyxia neonatorum. Low forceps delivery and outlet forceps delivery showed on significant difference in the rate of asphyxia neonatorum compared with that in the same time (P>0.05). There was significant difference in the rate of asphyxia neonatorum between middle forceps delivery and spontaneous delivery in the same time (P<0.05). Conclusion Low delivery operation and outlet delivery operation cannot be completely replaced by obstetrics operations else. They still have better application value in vaginal delivery.