剖宫产时不同断脐时机及位置对母儿的影响

目的分析剖宫产不同断脐时机及位置对母儿的影响。方法选取2015年5月至2016年5月于深圳市福田区妇幼保健院行剖宫产分娩的1 200例产妇,用随机抽样法分为A、B、C、D 4组,每组各300例。A组胎儿娩出后先钳夹子宫切缘后断脐,位置尽可能靠近胎盘,脐带长度30 cm;B组胎儿娩出后先钳夹子宫切缘后断脐,断脐位置距脐轮10 cm;C组清理呼吸道后即刻断脐,位置尽可能靠近胎盘,脐带长度30 cm,后钳夹子宫切口;D组清理呼吸道后即刻断脐,断脐位置距脐轮10 cm,再钳夹子宫切口,对比4组母儿结局。结果 4组新生儿Apgar评分、胆红素峰值比较差异无统计学意义(P0.05),产后出血量、胎盘残血量、产后24 h血红蛋白、红细胞压积比较差异有统计学意义(P0.05)。其中C组与D组产后出血量、胎盘残血量显著高于A组、B组,A组与C组产后24 h血红蛋白水平、红细胞压积显著高于B组、D组,差异均有统计学意义(P0.05)。结论剖宫产时先钳夹子宫切口,可减少母体产后出血量,延迟断脐并尽可能接近胎盘断脐可提高新生儿血红蛋白,改善预后。

Effects of different time and location of omphalotomy on maternal and child in cesarean section

Objective To analyze the effects of different time and location of omphalotomy on mother and infant in cesarean section.Methods The data of 1 200 maternal underwent cesarean section delivery in Futian Women and Children Health Care Hospital from May 2015 to May 2016 were retrospectively analyzed.Randomized sampling method was used to divide them into four groups:A, B, C, D, with 300 cases in each group.A group of fetuses after delivery first clamp the uterus cut edge then cut off the umbilicus, the location as close as possible to the placenta, with umbilical cord length>30cm;B group of fetus after delivery first clamp the uterus cut edge then cut off the umbilicus, cut position from the umbilical wheel <10 cm;C group of fetus after cleaning the respiratory tract immediately cut the umbilical cord, the position as close as possible to the placenta, with umbilical cord length>30cm,and then clamp the uterine incision.Compared outcomes of the four groups of mother and child.Results There were no significant differences in Apgar score and bilirubin peak between the four groups (P>0.05).Postpartum hemorrhage, placental blood residue, postpartum 24h hemoglobin, hematocrit differences were statistically significant(P<0.05).The amount of postpartum hemorrhage and the placental blood residue of group C and group D were significantly higher than those of group A and group B.The 24h hemoglobin and hematocrit were significantly higher in group A and group C than those in group B and group D (P<0.05).Conclusion Cesarean section when at first clamp the uterine incision, can reduce the amount of maternal postpartum hemorrhage, delay omphalotomy and as close as possible to the placenta umbilical can improve neonatal hemoglobin and improve the prognosis.