前倾跪位与侧俯卧位在进入活跃期后纠正枕后位的效果观察(1)
摘要：目的：分析产程中产妇进入活跃期后应用前倾跪位(身体前倾屈位)及侧俯卧位(夸张Sims体位)纠正枕后位的可行性及安全性。方法：将我院 2017年6月—2018年12月进入活跃期后，经阴道检查确诊为枕后位的单胎、低危初产妇150例作为研究对象，其中75例采用前倾跪位及侧俯卧位纠正枕后位作为试验组，75例未做体位指导作为对照组，比较两组产妇的第一、第二产程时间、顺产率、新生儿窒息等效果观察。结果：试验组顺产率明显高于对照组，第一、第二产程时间、新生儿窒息率明显低于对照组，组间差异有统计学意义(P < 0.05)。结论：产程中产妇进入活跃期后应用前倾跪位及侧俯卧位纠正枕后位缩短了产程时间，能够提高顺产率，降低因头盆不称引起的剖宫产率，还能够降低新生儿窒息的发生，这些特殊体位技巧的运用值得临床推广。
关键词：活跃期;枕后位;前倾跪位;侧俯卧位;顺产率;效果观察
[Abstract] Objective： To analyze the feasibility and safety of correcting occipitoposterior position with anteversion kneeling position (body forward bending position) and lateral prone position (exaggerated Sims position) after active stage of labor. Methods： 150 cases of single fetus and low-risk primipara diagnosed as occipitoposterior unit by vaginal examination in our hospital from June 2017 to December 2018 were studied. 75 cases of them were treated with anteversion kneeling position and lateral prone position to correct occipitoposterior position as the experimental group， 75 cases without body position guidance as the control group. The first and second stages of labor， spontaneous birth rate and neonatal asphyxia were compared between the two groups. Equivalent effect observation. Result： The rate of spontaneous delivery in the experimental group was significantly higher than that in the control group. The time of the first and second stages of labor and the rate of neonatal asphyxia in the experimental group were significantly lower than those in the control group， and there was a significant difference between the two groups (P < 0.05). CONCLUSION： The application of anteversion kneeling position and lateral prone position to correct occipitoposterior position after active stage of labor can shorten the duration of labor， improve the rate of spontaneous delivery， reduce the rate of cesarean section caused by cephalopelvic asymmetry， and reduce the incidence of neonatal asphyxia. The application of these special postural techniques is worthy of clinical promotion.
[Key words] Observation on active period， occipitoposterior position， anteversion kneeling position， lateral prone position， spontaneous birth rate and effect
胎位异常是造成难产的常见因素之一。分娩时枕前位约占90%，而胎位异常约占10%，其中胎头位置異常居多，包括持续性枕横(后)位，面先露，还有胎头高直位、前不均倾位等[1]。在试产过程中发生的头位难产中有60%-70%是属于枕后位。胎头在持续性枕后位的作用下难以转为枕前位俯屈的形式通过产道，进而导致分娩停滞或胎位下降非常慢，最终使得产程时间不正常延长，对产妇以及胎儿的预后结局造成严重的威胁[2]。难产重在预防，为了促进自然分娩，减少难产的发生，保障母儿健康，在观察产程中及早发现胎方位异常，通过采取特殊体位，帮助胎头旋转，最终完成自然分娩。本研究旨在分析产程中产妇进入活跃期后应用前倾跪位及侧俯卧位纠正枕后位的可行性及安全性。现报道如下。, 百拇医药(施荣 钱波)
关键词：活跃期;枕后位;前倾跪位;侧俯卧位;顺产率;效果观察
[Abstract] Objective： To analyze the feasibility and safety of correcting occipitoposterior position with anteversion kneeling position (body forward bending position) and lateral prone position (exaggerated Sims position) after active stage of labor. Methods： 150 cases of single fetus and low-risk primipara diagnosed as occipitoposterior unit by vaginal examination in our hospital from June 2017 to December 2018 were studied. 75 cases of them were treated with anteversion kneeling position and lateral prone position to correct occipitoposterior position as the experimental group， 75 cases without body position guidance as the control group. The first and second stages of labor， spontaneous birth rate and neonatal asphyxia were compared between the two groups. Equivalent effect observation. Result： The rate of spontaneous delivery in the experimental group was significantly higher than that in the control group. The time of the first and second stages of labor and the rate of neonatal asphyxia in the experimental group were significantly lower than those in the control group， and there was a significant difference between the two groups (P < 0.05). CONCLUSION： The application of anteversion kneeling position and lateral prone position to correct occipitoposterior position after active stage of labor can shorten the duration of labor， improve the rate of spontaneous delivery， reduce the rate of cesarean section caused by cephalopelvic asymmetry， and reduce the incidence of neonatal asphyxia. The application of these special postural techniques is worthy of clinical promotion.
[Key words] Observation on active period， occipitoposterior position， anteversion kneeling position， lateral prone position， spontaneous birth rate and effect
胎位异常是造成难产的常见因素之一。分娩时枕前位约占90%，而胎位异常约占10%，其中胎头位置異常居多，包括持续性枕横(后)位，面先露，还有胎头高直位、前不均倾位等[1]。在试产过程中发生的头位难产中有60%-70%是属于枕后位。胎头在持续性枕后位的作用下难以转为枕前位俯屈的形式通过产道，进而导致分娩停滞或胎位下降非常慢，最终使得产程时间不正常延长，对产妇以及胎儿的预后结局造成严重的威胁[2]。难产重在预防，为了促进自然分娩，减少难产的发生，保障母儿健康，在观察产程中及早发现胎方位异常，通过采取特殊体位，帮助胎头旋转，最终完成自然分娩。本研究旨在分析产程中产妇进入活跃期后应用前倾跪位及侧俯卧位纠正枕后位的可行性及安全性。现报道如下。, 百拇医药(施荣 钱波)