持续性枕横位和枕后位479例临床分析

目的探讨持续性枕横位和枕后位分娩方式及产程进展及围产儿预后。方法对2005年1月至2007年12月在我院分娩479例持续性枕横位和枕后位（研究组）和随机抽取同期分娩479例枕前位（对照组）的临床资料进行分析，比较两组产程进展情况、分娩情况及围产儿预后。结果①研究两组第一产程、第二产程及总产程时间明显长于对照组，差异有显著性意义（P〈0．05）。（参研究组产钳助产、剖宫产、静滴催产素，软产道损伤率较对照组高，差异有显著性意义（P〈0．05）。③研究组胎儿窘迫，新生儿窒息率均高于对照组，差异有显著性（P〈0．05）。④研究组宫口扩张延缓、胎头下降延缓、胎头下降停滞、第二产程延长发生率均明显高于对照组，差异有显著性（P〈0．05）。结论持续性枕横位和枕后位是常见的头位异常，产程中及早发现，积极处理，部分枕横位及枕后位可机转为枕前位分娩，如处理不当，导致难产、母婴危险性增高，围产儿预后欠佳。

Clinical analysis of 479 cases with persistent occipitotransverse position or occipitoposterior position

Objective To investigate the way of delivery, progress of labor and prognosis of perinatal period infant in cases with persistent occipitotransverse position or occipitoposterior position. Methods Four hundred seventy - nine cases with persistent occipitotransverse position or occipitoposterior position who gave birth in our hospital from Jan. 2005 to Dec. 2007 were treated as observation group, while 479 cases randomly selected in normal delivery cases in our hospital in the same period were treated as control group. Clinical data of the two groups were analyzed. Progress of labor, state of delivering and prognosis of perJnatal period infants were compared. Results ①The differences between two groups in the first stage of labor, second stage of labor and total stage of labor were significant （ P 〈 0.05 ）. ②The ratios of forceps operation, uterine - incision delivery, intravenous drip of pitocin and injury of soft birth canal in observation groups were higher than those in control groups （ P 〈 0.05 ）.③The ratios of fetal distress and asphyxia neonatorum in observation group were higher than those in control group （ P 〈 0.05）. ④The ratios of tardy cervical dilatation, slow descending of fetal head, stagnation of descending of fetal head and prolongation of second stage of labor in observation group were higher than those in control group （ P 〈 0.05 ）. Conclusion Persistent occipitotransverse position and occipitoposterior position are common abnormal position of fetus. If they are detected in time and treated properly, some occipitotransverse and occipitoposterior may be put right. If they are treated improperly, difficult delivery, higher risks of lying - in woman and infant and real - prognosis of perinatal period infant may result.