胎头深定取头困难剖宫产的母儿结局分析  

The maternal and neonatal outcomes in difficultly delivering the deeply impacted fetal head during cesarean section

作　　者：赵芳[1] 王雪卿[1] 张岩[1] 郑秀丽[1] 孙丽芳[1] ZHAO Fang;WANG Xueqing;ZHANG Yan(Department of Obstetrics and Gynecology,Jishuitan Hospital of Beijing University,Beijing 100035,China)

机构地区：[1]北京积水潭医院妇产科,100035

出　　处：《河北医药》2022年第5期764-766,共3页Hebei Medical Journal

摘　　要：目的了解胎头深定骨盆上推胎头剖宫产的母儿结局及预防措施。方法回顾性分析2014年1月至2020年1月经过阴道试产,进入活跃期(宫口开大>3 cm)后改剖宫产的初产患者临床资料,胎头深陷骨盆并经阴道上推胎头娩出胎儿的79例为研究组,未上推胎头的114例为对照组。分析2组子宫切口撕裂(包括泌尿系损伤)、产后出血、术后感染及新生儿窒息发生率及新生儿体重、胎儿娩出时间、住院时间、手术时宫口开大情况、肛门排气、住院费用等。结果2组子宫切口撕裂(包括泌尿系损伤)、产后出血、术后感染及新生儿窒息发生率及胎儿娩出时间、住院时间、手术时宫口开大情况、肛门排气时间差异有统计学意义(P<0.05);2组新生儿体重、住院费用比较差异无统计学意义(P>0.05)。结论胎头深定取头困难剖宫产母儿并发症多,严重影响母儿健康。应积极处理产程异常,有预见性的评估、避免试产过度;合理选择切口、时机、掌握手法和技巧,熟练配合,减少母婴并发症发生。Objective To investigate the maternal and neonatal outcomes in difficultly delivering the deeply impacted fetal head during cesarean section,and to explore related prevention measures.Methods The clinical data about the primipara who underwent vaginal trial labor in our hospital from January 2014 to January 2020,who had entered the active stage(cervical dilatation>3cm)and then underwent cesarean section were retrospectively analyzed.The 79 primipara with deeply impacted fetal head in the pelvis and delivering the fetus by head pushing via vaginal dislodge were enrolled as observation group,and the other 114 primipara without deeply impacted fetal head in the pelvis and delivering the fetus were enrolled as control group.The incidence of uterine incision laceration including urinary tract injury,postpartum hemorrhage,postoperative infection and neonatal asphyxia,neonatal weight,and the delivery time of fetus,hospitalization time,dilatation of cervix were observed and compared between the two groups.Results There were significant differences in the incidence of uterine incision laceration including urinary system injury,postpartum hemorrhage,postoperative infection and neonatal asphyxia,and the time of fetal delivery,hospitalization duration as well as dilatation of cervix between the two groups(P<0.05).However there was no significant difference in neonatal weight between the two groups(P>0.05).Conclusion The primipara with deeply impacted fetal head in the pelvis have many complications,which seriously affect the health of mother and infant.Therefor it is necessary to strengthen the management of production process,deal with the abnormal labor process actively,avoid excessive trying to vaginal labor.select the incision reasonablely to reduce the incidence of complications.

关 键 词：胎头深定 上推胎头 剖宫产 母儿预后 

分 类 号：R719.8[医药卫生—妇产科学]