持续性枕后位的临床特点及分娩方式选择

目的探讨持续性枕后位的临床特点及分娩方式。方法采用回顾性分析方法，对1998年1月至2004年12月在重庆医科大学两所附属医院住院分娩的112例持续性枕后位（枕后位组）和112例枕前位（枕前位组）的临床资料进行分析，比较两组产程情况、分娩方式及母儿结局。结果两组头位分娩评分、第一产程、第二产程及总产程时间比较，差异有显著性意义（P〈0．05）。枕后位组产钳助产、剖宫产、会阴裂伤、产后出血、胎儿窘迫、新生儿窒息率等均明显高于枕前位组，差异均有显著性意义（P〈0．05）。枕后位组宫口扩张及胎头下降延缓和第二产程延长的发生率均高于枕前位组，差异均有显著性意义（P〈0．05）。剖宫产组富口扩张延缓、胎头下降停滞和第二产程延长的发生率明显高于阴道分娩组（P〈0．05）。而剖宫产组和阴道分娩组骨盆临界狭窄、潜伏期及活跃期延长的发生率比较，差异无显著性意义（P〉0．05）。结论持续性枕后位导致母儿并发症增加，及时处理并选择最佳分娩方式可减少母儿并发症的发生。

The clinical characteristics and mode of delivery of occiput posterior position

Objective To investigate the clinical characteristics and modes of delivery in patients with persistent occiput posterior position. Methods A total of 112 primipara with fetus in a persistent occiput posterior position and 112 primipara with fetus in a occiput anterior position from Jan.1998 to Dec.2004 were analyzed retrospectively in the two affiliated hospitals of Chongqing Medical University. The labor course , mode of delivery and maternal-neonatal complications were compared between the two groups. Results Significant differences were found in the delivery score of apholic position, first, second stage and total labor duration between the two groups (P<0.05). The occurrences of forceps delivery, cesarean section, perineal tear, postpartum haemorrhage, fetal distress and birth asphyxia were significantly higher in persistent occiput posterior position as compared with those in occiput anterior position(P<0.05). Compared with the occiput anterior position, there were significant differences in the incidences of protracted active phase dilatation, protracted descent and prolonged second-stage in persistent occiput posterior position (P<0.05). Compared with the cesarean section, there were significant differences in the incidences of protracted active phase dilatation, arrest of descent and prolonged second-stage in the vaginal delivery (P<0.05). There were no significant differences in the rates of critical contracted pelvis, prolonged latent phase and active phase between cesarean section and vaginal delivery in the occiput posterior position(P>0.05).Conclusion Persistent occiput posterior position can lead to higher incidence of complications in both mother and fetus. Better prognosis may be achieved by early treatment and selecting the best mode of delivery.