150例胎头吸引器助产体会

目的：探讨胎头吸引器在助产术中的护理技巧。方法：从150例使用胎头吸引术助产的产妇中总结施行胎头吸引器的体会。结果：150例施行胎头吸引术助产的产妇一次吸引助产成功者有144例,占96%,2次及以上吸引成功者有6例,均取得了较为满意的效果。结论：胎头吸引术在进行操作之前,应及时清理胎头露出位置和方位。正确的放置和使用吸引器,才能确保吸引成功、母子安全。     

阴道助产术应注意的问题

正确选用阴道助产方法,有益于降低剖宫产率,并保证母婴健康。在阴道助产指征明确和条件具备情况下,选用胎头吸引助产术或产钳助产术应结合各种情况考虑。低位或出口产钳以及胎吸助产是解决第二产程宫缩乏力、因疾病需缩短第二产程的良好手段,手术时间短,产后恢复好。     

低位产钳助产术

低位产钳助产术可以帮助难产患者快速结束分娩,是一种较好的阴道助产方法。低位产钳助产术前应仔细检查孕妇和胎儿的情况,严格把控手术指征和禁忌证,尽量减少母儿并发症。     

应用单叶产钳助产的临床初探

我院近年开始试用单叶产钳助产 ,发现其操作简单 ,助娩快捷 ,对母儿损伤小。1　资料与方法1 1　一般资料　自 1994年 1月至 1998年 12月 ,我院头位阴道分娩共 336 7例 ,阴道助产 316例 ,助产率 9 4%。其中产钳助产 (产钳 ) 175例占阴道助产术的 5 5 4% ,单叶产钳助产 (单叶 ) 82例占 2 5 9% ,胎头吸引器助产 (头吸 ) 5 9例占 18 7%。三组产妇年龄、胎产次、骨盆大小、新生儿体重等资料差异无显著性 (Ｐ >0 0 5 )。1 2　 5年三种助产术式变迁　产钳应用基本稳定 ,单叶呈递增趋势。 1994年胎头吸引在阴道助产术中占主导地位 ,1995年后单叶…     

产钳助产术与胎头吸引助产术的评估

在分娩过程中 ,采用适当的阴道助产方法 ,对于降低剖宫产率 ,保证母婴健康是安全而有效的手段。阴道助产的方法主要有两种 ,一种是产钳助产术 ,另一种是胎头吸引助产术。这两种助产方法所需条件基本相同 ,但又有各自的优缺点 ,怎样选择正确的助产方法 ,达到使产妇经阴道安全分娩 ,减少新生儿损伤的目的 ,是产科医生的必备技能。1　产钳助产术　　产钳是为牵引出胎儿而设计的 ,产钳助产术开始于 17世纪 ,在 2 0世纪初抗生素问世以前 ,剖宫产术的危险性较大 ,产钳助产术解决了部分难产 ,但高、中位的产钳也造成了较多的胎儿及母体的损伤。现在…     

887所医疗保健机构助产技术实施现况的分析

目的了解6种助产技术在全国各级医疗保健机构中的使用情况。方法采用信函问卷的方法调查了全国31个省、自治区、直辖市887所不同级别的医疗保健机构2002年助产技术的使用情况并进行分析。结果被调查的医疗保健机构平均剖宫产率为38．0％;会阴切开缝合术使用率为44．9％;胎头吸引术使用率为3．6％;产钳助产术使用率为1．9％;臀位牵引术使用率为1．4％,内倒转术使用率为0．2％。结论目前,剖宫产率偏高及会阴切开缝合术使用过于频繁,胎头吸引术、产钳助产术等阴道助产技术濒临荒废。卫生行政部门应该重视助产技术的培训,并加强对助产技术实施情况的监督管理。     

阴道助产的决策

<正>经阴道助产是处理第二产程的重要技术,产程中的情况随时可能发生变化,每次分娩都可能需要紧急或选择性助产。阴道助产术方式众多,正确的选择助产的时机、方式,可取得理想的效果,否则将会引起一系列近远期并发症,给母儿健康带来严重危害。头位分娩阴道助产的方法主要有两种,产钳助产术和胎头吸引助产术。这两种助产方法各有优缺点,怎样选择正确的助产方法,达到使产妇经阴道安全分娩,减少新生儿损伤的目的,是产科医生的必备技能。     

英国皇家妇产科医师学会《阴道助产(2020)》指南要点解读

正阴道助产(assisted vaginal birth)是指在阴道分娩第二产程使用胎头吸引器或产钳直接牵引胎头,以实现或加快胎儿阴道分娩的重要手段,包括产钳助产术和胎头吸引术两种~([1])。近年来剖宫产率持续升高,已超过世界卫生组织(World Health Organization, WHO)制定的15%的标准,成为严重的公共卫生问题~([2])。阴道助产是降低剖宫产率、处理难产并提高阴道分娩率的一种有效操作技能,     

正确选择胎头吸引术

胎头吸引术是产科常用的一种助产技术，它常被用来缩短第二产程，帮助产妇顺利完成经阴道分娩，但处理不当可给母婴造成损害，甚至产生严重并发症。本文就如何正确选择胎头吸引术作简要叙述。１胎头吸引术的功能胎头吸引术是用胎头吸引器置于胎头上，形成一定负压区吸住胎...     

产时超声辅助产程管理

产程管理是产房工作的重要内容,胎方位和胎姿势异常是导致头位难产的首要原因,增加围产期并发症发生风险。目前,临床上主要通过阴道指诊和肛门指诊了解子宫颈口扩张、胎方位、胎先露位置及产道等情况,以指导产程管理。但其主观性强且操作者之间存在个体差异,胎方位和胎姿势评估不准确可能会增加阴道手术助产困难或失败的风险。产时超声检查可用于监测子宫颈口扩张程度、胎先露位置、胎方位等,更客观、准确且能避免阴道检查不适及感染风险,并具有良好的重复性,有助于辅助产程管理决策。     

Occipito-posterior fetal head position, maternal and neonatal outcome

The purpose of this review is to summarize the available evidence on occipito-posterior fetal head position and maternal and neonatal outcome. The occipito-posterior fetal head position is the most common malposition, but there are not so many data about it in literature. Its incidence is ranging from 1.8% by Fitzpatrick, to 4.6% and 5.5% by Yancey and Sizer, to 6% by Ponkey. Only two trials studied the occipito-posterior associated factors. There are lower incidence of premature rupture of membrane, arterial hypertension pregnancy-induced, induced labour, increased of episiotomy, instrumental delivery and a decreased of vaginal birth without a difference in neonatal Apgar, and with a neonatal bigger weight. The occipito-posterior fetal head position persistence compared to anterior position, has a statistically significant association with low maternal stature, previous cesarean section, longer first and second stage of labour, oxytocin augmentation, epidural analgesia, instrumental vaginal delivery, chorion-amniositis, vaginal perineal injures, loss of blood and post partum infections. A highest incidence of occipito-posterior fetal head position may depend by nulliparity, malnutrition with pelvic deformity, pelvic immaturity in the teenager and anterior placenta. Epidural analgesia is a risk factor for fetal head malposition. The majority of occipito-posterior fetal head positions is not due to a malrotation, but to a persistence in this position of the fetal head. In fact, this persistence leads to a failure of the fetal head rotation. The prolonged second stage is often the result of occipito-posterior fetal head position and instrumental delivery is required. The traditional vaginal examination is not useful for the determination of fetal head position, so and instrumental method is needed, such as ultrasound, for a correct evaluation of fetal head position, particularly if a vaginal instrumental delivery is necessary. This is recommended by the Canadian Society of Obstetrics and Gynecology. The evaluation of fetal head position is important in the prediction of labour induction.     

臀位阴道分娩

臀先露是最常见的胎位异常,阴道分娩风险高。产科医生和助产士应对臀先露的产妇进行充分评估及沟通,选择适宜的病例阴道分娩,同时加强产时监护,以确保臀位阴道分娩的母婴安全。本文围绕臀先露的病因、臀位阴道分娩的适应证、禁忌证、注意事项及可能的风险进行阐述。     

器械助产与新生儿产伤

器械助产包括产钳和胎头吸引器助产,对降低剖宫产率、处理难产并提高阴道分娩率起重要作用。充分的临床经验和对操作人员的适当培训对安全执行手术分娩至关重要。但应用不当可能会造成严重母儿损伤,严重者甚至导致新生儿永久性伤害和致残。助产人员应根据孕妇-胎儿-自身经验等进行决策,充分评估是否具备器械助产的成功条件,强调降低母体及新生儿并发症的发生至关重要。     

Study Protocol. IDUS -- Instrumental delivery & ultrasound. A multi-centre randomised controlled trial of ultrasound assessment of the fetal head position versus standard care as an approach to prevent morbidity at instrumental delivery

ABSTRACT: BACKGROUND: Instrumental deliveries are commonly performed in the United Kingdom and Ireland, with rates of 12 -- 17% in most centres. Knowing the exact position of the fetal head is a pre-requisite for safe instrumental delivery. Traditionally, diagnosis of the fetal head position is made on transvaginal digital examination by delineating the suture lines of the fetal skull and the fontanelles. However, the accuracy of transvaginal digital examination can be unreliable and varies between 20% and 75%. Failure to identify the correct fetal head position increases the likelihood of failed instrumental delivery with the additional morbidity of sequential use of instruments or second stage caesarean section. The use of ultrasound in determining the position of the fetal head has been explored but is not part of routine clinical practice. METHODS: A multi-centre randomised controlled trial is proposed. The study will take place in two large maternity units in Ireland with a combined annual birth rate of 13,500 deliveries. It will involve 450 nulliparous women undergoing instrumental delivery after 37 weeks gestation. The main outcome measure will be incorrect diagnosis of the fetal head position. A study involving 450 women will have 80% power to detect a 10% difference in the incidence of inaccurate diagnosis of the fetal head position with two-sided 5% alpha. DISCUSSION: It is both important and timely to evaluate the use of ultrasound to diagnose the fetal head position prior to instrumental delivery before routine use can be advocated. The overall aim is to reduce the incidence of incorrect diagnosis of the fetal head position prior to instrumental delivery and improve the safety of instrumental deliveries.Trial registrationCurrent Controlled Trials ISRCTN72230496.     

Strategies to enhance assessment of the fetal head position before instrumental delivery: a survey of obstetric practice in the United Kingdom and Ireland

Objective

To establish the current practice of obstetricians with regard to assessment of women in labour before instrumental delivery.

Study design

A national postal survey of obstetricians in consultant-led obstetric units in the United Kingdom and Ireland. Clinical assessment before instrumental delivery, factors associated with difficulty in determining the fetal head position, approaches used to enhance determination of the fetal head position, perceived accuracy rates in assessment of the fetal head position and willingness to participate in a clinical trial of ultrasound assessment of the fetal head position before instrumental delivery were explored.

Results

The response rate was 75%. The majority of obstetricians assess women clinically before instrumental delivery as recommended by guidelines. Both consultants and trainees reported the following factors as being associated with difficulty in diagnosing the fetal head position: inadequate maternal pain relief, fetal caput and clinical inexperience. Strategies used when experiencing difficulty in determining the fetal head position varied, with trainees more likely than consultants to seek a second opinion (40% vs. 5%, p < 0.0001), reassess in an operating theatre (80% vs. 68%, p = 0.048) or abandon the procedure in favour of caesarean section (14% vs. 6%, p = 0.035). One in five obstetricians reported using abdominal ultrasound to aid diagnosis, with some consultants reporting the use of ultrasound as ‘a great idea’ and others being ‘appalled’. One in eight consultants perceived that they made an incorrect diagnosis of the fetal head position at instrumental delivery in more than 10% of deliveries compared to one in four trainees.

Conclusion

The contrasting views on the role of ultrasound to enhance the assessment of the fetal head position before instrumental delivery suggest that it should be evaluated in a randomised clinical trial.     

Failed individual and sequential instrumental vaginal delivery: contributing risk factors and maternal-neonatal complications

BACKGROUND: To identify the risk factors for failed instrumental vaginal delivery, and to compare maternal and neonatal morbidity associated with failed individual and sequential instruments used. DESIGN: A retrospective case-control study. METHODS: From January 1995 to June 2001, there were 39 508 live births at >37 weeks' gestation of which 2628 (6.7%) instrumental vaginal deliveries were performed, 1723 (4.4%) were vacuum extractions and 905 (2.3%) were forceps. A total of 155/2628 (5.9%) patients who had failed instrumental delivery were matched with 204 patients who had successful instrumental delivery. The patients were divided into five groups. Group I (n = 129) had failed vacuum extraction, group II (n = 13) failed forceps, group III (n = 13) failed both (i.e. failed attempt at both instruments sequentially), group IV (n = 138) had successful vacuum extraction and group V (n = 66) successful forceps. RESULTS: The failure rate for vacuum extractions 129/1723 (7.5%) was significantly higher than that for forceps 13/905 (1.4%) [odds ratio (OR) = 5.6, 95% CI 3-10.3]. There were no significant differences in all maternal complications (25.5% vs. 26.6%) between vacuum (groups I and IV) and forceps (groups II and V) assisted deliveries. There were more maternal complications in group III (46.2%) than in groups I (35.7%), II (23.1%) and V (27.3%) that did not reach statistical significance but were significantly higher than in group IV (15.9%, OR = 4.5, 95% CI 1.2-16.9). There was a significantly higher rate of all fetal complications in group III [11/13 (84.6%)] than in groups I [69/129 (53.5%)], II [7/13 (53.8%)], IV [35/138 (25.4%)] and V [22/66 (33.3%)] (OR = 4.8, 95% CI 0.9-19.9). CONCLUSIONS: Applying the instrument at < or =0 fetal station, nulliparous women, history of previous cesarean section and fetal head other than occipitoanterior position were risk factors for failed instrumental delivery. Sequential use of instrumental delivery carries a significantly higher neonatal morbidity than when a single instrument is used.     

Sonographische Beurteilung der Einstellung und des Höhenstandes vor vaginal-operativer Entbindung

Ultrasound scanning is routinely performed intrapartum in many delivery rooms. Investigations have shown that transperineal ultrasound using the angle of progression to quantify fetal head descent before operative vaginal delivery has the potential to reduce the rate of cesarean sections without increasing maternal and neonatal morbidity. However, recently Ramphul et al. could not confirm the influence of the use of ultrasound for assessing the position of the fetal head on morbidity. Currently, no study has yet been carried out to systematically assess the acceptability of ultrasound for women in labor. It is generally agreed that sonography is highly operator-dependent and the skill and experience required to obtain and interpret sonographic images should not be underestimated. In the hand of an experienced operator, ultrasound is a very useful tool; however, only one study has systematically looked at the level of expertise required to obtain reliable information by transperineal ultrasound. Further research is required to demonstrate that routine use of ultrasound prior to performing an operative vaginal delivery is a valid, reproducible, acceptable and safe intervention, which can enhance decision-making about the ongoing management of a prolonged second stage of labor.     

Parto operatorio fallido

Globally, the rate of instrumental vaginal delivery is declining in all developed countries at the expense of a general increase in the rate of cesarean sections. Failed operative vaginal delivery is an undesirable situation for all obstetricians and can sometimes lead to increased maternal and fetal morbidity and, in extreme cases, to fetal mortality. These risks can be minimized or avoided through individualized assessment of each patient, fetus, and clinical situation by using the protocols recommended by scientific societies to perform instrumental delivery and abandoning the vaginal route at the appropriate moment without extending the number of attempts or increasing the intensity of the traction performed. Experience of vaginal surgery is essential, and the procedure should be abandoned whenever the obstetrician feels uncertain.     

Shock management in acute fetomaternal hemorrhage

Abstract

The determination of fetal head position can be useful in labor to predict the success of labor management, especially in case of malpositions. Malpositions are abnormal positions of the vertex of the fetal head and account for the large part of indication for cesarean sections for dystocic labor. The occiput posterior position occurs in 15–25% of patients before labor at term and, however, most occiput posterior presentations rotate during labor, so that the incidence of occiput posterior at vaginal birth is approximately 5–7%. Persistence of the occiput posterior position is associated with higher rate of interventions and with maternal and neonatal complications and the knowledge of the exact position of the fetal head is of paramount importance prior to any operative vaginal delivery, for both the safe positioning of the instrument that may be used (i.e. forceps versus vacuum) and for its successful outcome. Ultrasound (US) diagnosed occiput posterior position during labor can predict occiput posterior position at birth. By these evidences, the time requested for fetal head descent and the position in the birth canal, had an impact on the diagnosis of labor progression or arrested labor. To try to reduce this pitfalls, authors developed a new algorithm, applied to intrapartum US and based on suitable US pictures, that sets out, in detail, the quantitative evaluation, in degrees, of the occiput posterior position of the fetal head in the pelvis and the birth canal, respectively, in the first and second stage of labor. Authors tested this computer system in a settle of patients in labor.     

双胎妊娠阴道分娩

双胎妊娠孕妇的合并症和新生儿发病率均较高,其分娩方式的选择虽然目前仍有争议,但在临床处理上仍需结合双胎类型、胎方位、胎儿体重、母体情况和接生者经验等进行综合考虑。阴道分娩过程中应加强监护,尤其注意第二产程的管理,以降低双胎第二胎儿发生宫内窘迫和新生儿窒息的风险。