产程中改变产妇体位矫正胎方位的探讨

目的：探讨产程中改变产妇体位以矫正胎方位的临床效果。方法：选择先兆临产至潜伏期经Ｂ超检查判断为枕后位的初产妇２４０例，随机分为两组，各１２０例。研究组在产程中指导产妇取侧俯卧位，利用胎儿重力、羊水浮力、子宫间歇收缩的合力作用，使胎头在下降时逐渐从枕后位转至枕前位娩出，并与对照组比较。结果：研究组１０６例（８８．３％）胎儿从枕后位转到枕前位经阴道娩出。剖宫产１４例（１１．７％）。对照组经阴道娩出仅２０例（１６．７％），剖宫产１００例（８３．３％）。两组比较，差异有非常显著性（Ｐ＜０．００１）。研究组第一产程平均时间３０２．６分钟，第二产程平均５９．８分钟。对照组第一产程平均４８３．７分钟，第二产程平均１５６．７分钟。两组比较，差异有极显著性（Ｐ＜０．０１）。结论：在产程中指导产妇取侧俯卧位矫正胎头枕后位是降低难产发生率的有效方法。

Correction of Occipito Posterior Position by Maternal Posture during the Process of Labor

Objective: To investigate the effect on correction of occipito posterior (OP) presentation by changing maternal posture during labor. Method: A prospective study was conducted in 120 pregnant women from March 1994 to December 1995. Women in labor were instructed to take the lateral posture so that the resultant force of the gravity of the fetus, the buoyancy of amniotic fluid, and the intermittent uterine contraction may change the fetal position from occipito posterior into occipito anterior (OA) presentation. Another 120 women were selected as controls. Results: (1) In the study group, 106 women (88.3%) delivered vaginally with fetal presentation changed from OP into OA, and 14 (11.7%) received cesarean section. In the control group, only 20 women (16.7%) delivered vaginally, and 100 (83.3%) had cesarean sections ( P <0.001). (2) The average time interval in the study group was 302.6 min for the first stage and 59.8 min for the second stage, whereas 483.7 min and 156.1 min respectively in the controls. A significant difference was noted( P <0.01). Conclusion: It is an effective method for the mother to take the lateral posture on the same side of the fetal spine for correcting the OP position. The incidence of dystocia may be reduced as well as the cesarean section rate. The method is simple and effective, and can be used in most of hospitals.