不同体位娩出胎儿对产后早期盆底功能的影响  

The Influence of Early Postpartum Pelvic Floor Function for Those Delivered Fetus in Different Maternal Positions During Second Stage of Labor

作　　者：夏华安[1] 江紫妍[1] 张苏玉 黄美凌[1] 胡静[1] XlA Huaan;JIANG Ziyan;ZHANG Suyu(The Third Affiliated Hospital of Guangzhou Medical University,Guangzhou Guangdong 510150,China)

机构地区：[1]广州医科大学附属第三医院,广东广州510150

出　　处：《实用妇产科杂志》2018年第7期546-550,共5页Journal of Practical Obstetrics and Gynecology

基　　金：2015年广东省医学科学技术研究基金项目(编号:A2015174)

摘　　要：目的:探讨第二产程中实施自由体位娩胎是否会加重分娩对盆底功能的影响。方法:纳入对象为成功全产程实施自由体位分娩的产妇,根据第二产程胎头拨露或着冠时产妇选择的娩胎体位按是否应用重力作用分为直立位组(包括:坐位组、站位组、跪趴位组、蹲位组)和非直立位组(侧卧位组和截石位组),产后6~8周对成功实施自由体位娩胎的产妇进行盆底肌力、疲劳度和阴道压力的检测及诊断。结果:成功随访176例产妇,6组不同体位娩胎的阴道压力、Ⅰ类肌疲劳度、Ⅰ类肌肌力、Ⅱ类肌疲劳度、Ⅱ类肌肌力异常率比较,差异均无统计学意义(P>0.05),6组间两两比较,差异也无统计学意义(P>0.05);直立位组产妇的盆底Ⅰ类肌肌力异常率高于非直立位(75.86%vs58.33%,P<0.05),直立位组的阴道压力的异常率低于非直立位组(20.69%vs 35.00%,P<0.05)。结论:未得到足够的证据证明不同体位娩出胎儿会增加阴道分娩对产后早期盆底功能的损害,但直立位的分娩产妇对盆底Ⅰ类肌的影响可能更大,尚需要今后的进一步验证。Objective：The study aimed to explore whether the early postpartum pelvic floor function could be aggravated by the implementation that women delivered fetus in different maternal positions during second stage of labor. Methods： Included subjects that successfully utilized liberal delivery positions during whole labor process. And they were grouped into upright position group （including： sitting, standing, kneeing and squatting） and recumbent position group（including.lateral position and supine position） according to whether the delivery position the puerperae used associated with gravity in crowning of fetal head. The follow-up of 6 to 8 weeks postpartum was performed on mothers who participated in the study. Their early postpartum pelvic floor muscle strength,fatigue and vaginal pressure would be measured. Results：One hundred and seventy-six subjects were successfully followed up. There were no statistically significant differences of early postpartum vaginal pressure, Class Ⅰ muscle fatigue,Class Ⅰ muscle strength,Class Ⅱ muscle fatigue and Class Ⅱ muscle strength among differ- ent delivery groups（ P 〉 0.05）. And there were no statistically significant differences of early postpartum pelvic floor function between the six groups either（ P 〉 0.05）. However,the abnormal ratio of pelvic floor Class Ⅰ muscle in upright position group was higher than it in recumbent position group（75.86% vs 58.33%, P 〈0.05）. The abnormal ratio of vaginal pressure in upright position group was lower than it in recumbent position group（20.69% vs 35.00%, P 〈0.05）. Conclusions.The study failed to provide sufficient evidence that delivery in different position during second stage of labor would increase the injury of early postpartum pelvic floor function. However, women delivered in upright position were considered more vulnerable to weaker postpartum pelvic floor Class I muscle function. But further verification is needed.

关 键 词：不同体位娩胎 产后 盆底功能 直立位 

分 类 号：R691.5[医药卫生—泌尿科学]