手膝俯卧位分娩与等待至少一次宫缩原则的效果分析

目的：分析比较手膝俯卧位分娩与平卧位分娩在采用等待娩肩的措施时对母婴结局的影响。方法共有621例产妇进入临床研究，其中手膝卧位组364例，平卧位组257例，两组均采用等待至少1次宫缩娩肩助产方式。比较两组的肩难产发生率、产程时间、产后出血、新生儿评分、头-肩时间等指标。结果产妇分娩的头-肩时间为5～480 s，平均（53.6±40.1）s；头-肩时间≤60 s 与＞60s 比较，新生儿窒息率差异无统计学差异，头-肩时间≤120 s 与＞120 s 比较，新生儿窒息率增高，差异有统计学意义。手膝俯卧位组与平卧位组的头-肩时间分别为（60.1±46.8）s 和（44.5±25.6）s，差异有统计学意义。手膝俯卧位与平卧位的肩难产发生率分别为0，1.6％，差异有统计学意义。新生儿窒息的发生率分别为1.4％，1.9％，两组差异无统计学意义。结论采用手膝俯卧位分娩和等待至少一次宫缩自然娩肩，减少肩难产发生率，不增加新生儿窒息率，是安全可行的助产方法。

Waiting for a contraction and on your hands and knees position delivery in the prevention of shoulder dystocia and baby injury

Objective To examine the adaptation of waiting for a contraction principle and on your hands and knees positions delivery on maternal and neonatal outcomes. Methods A total of 621 of women with vaginal delivery were enrolled.Women willing to delivery on your hands and knees position were assigned to the experimental group （364cases）,and the controlled group included women on supine position delivery （257 cases）.Both groups were adapted to waiting for one contraction after head delivered.The rate of shoulder dystocia,labor process,postpartum hemorrhage, Apgar score and time of head to shoulder interval were recorded. Results The head to shoulder interval was from 5 s to 480 s,with an average of （53.6 ±40.1）s.The rate of asphyxia between the head to shoulder intervals of （60 s and ＇60 s was not statistically different,but the rate was higher in those of head to shoulder interval 〉120s as compared with interval （120s.The head to shoulder interval was longer in hands and knees position （60.1 ±46.8）s than in supine position （44.5±25.6）s.The rate of shoulder dystocia in hands and knees position was lower than that in supine position delivery （1.6%,4 /257）.The rates of asphyxia in hands and knees position （1.4%,5 /364）and in supine position （1.9%, 5 /257）were not statistically different. Conclusion Hands and knees position delivery and awaiting for a contraction method had lower rate of shoulder dystocia,with no increase in asphyxia.