胎头深陷剖宫产术娩胎方式与产科并发症的相关性研究  

Correlation between fetal head disengagement mode in cesarean section delivery and obstetric complications

作　　者：周隽[1] 毛胜艳 林春霞 Zhou Jun;Mao Shengyan;Lin Chunxia(Department of Obstetrics,First People’s Hospital of Longquanyi District,Chengdu(Longquan Hospital of West China Hospital of Sichuan University),Chengdu Sichuan 610100,P.R.China)

机构地区：[1]成都市龙泉驿区第一人民医院(四川大学华西医院龙泉医院)产科,四川成都610100

出　　处：《中国计划生育和妇产科》2022年第10期73-75,85,共4页Chinese Journal of Family Planning & Gynecotokology

基　　金：2022年成都市龙泉驿区卫健系统科研课题(项目编号:WJKY018)。

摘　　要：目的探讨头位难产剖宫产术中胎头深陷时采取不同的娩胎方式与产科并发症的相关性。方法回顾性分析2017年12月至2021年12月成都市龙泉驿区第一人民医院收治的180例头位难产胎头深陷行子宫下段剖宫产术患者的临床资料,根据胎儿取出方式分为臀牵引组40例,上推胎肩组50例,经阴道上推胎头组50例,使用单叶产钳组40例,比较各组娩胎时间、手术时间及产妇并发症和新生儿情况。结果上推胎肩组胎儿娩出时间[(6.2±1.55)min]较臀牵引组[(4.1±0.99)min]、经阴道上推胎头组[(4.3±1.25)min]更长,臀牵引组手术总时间[(43.1±4.68)min]低于其他各组[(75.9±8.60)min、(57.1±5.93)min、(68.8±7.94)min],差异均有统计学意义(P<0.05)。臀牵引组子宫切口裂伤发生率(5%)低于上推胎肩组(34%)和经阴道上推胎头组(26%),产后出血发生率(2.5%)低于上推胎肩组(24%),产褥感染率(2.5%)低于经阴道上推胎头组(22%),差异有统计学意义(P<0.05)。臀牵引组新生儿1 min Apgar评分(8.9±0.99)明显高于上推胎肩组(6.4±2.01),臀牵引组的产伤(0)明显少于上推胎肩组(20%)、经阴道上推胎头组(16%),差异有统计学意义(P<0.05)。结论胎头深陷剖宫产取头困难采用臀牵引术,可明显降低母婴并发症发生率。Objective To investigate the correlation between different delivery methods and obstetric complications during cesarean section with head position dystocia.Methods Retrospective analysis of the clinical data of 180 patients with cephalic dystocia who underwent cesarean section at the lower uterine segment who were admitted to the First People’s Hospital of Longquanyi District,Chengdu from December 2017 to December 2021.According to the method of fetal removal,they were divided into the gluteal traction group(40 cases),the fetal shoulder push-up group(50 cases),the transvaginal fetal head push-up group(50 cases),and the single-leaf forceps group(40 cases).The delivery time,operation time,maternal complications and neonatal conditions were compared in each group.Results The delivery time of the fetuses in the fetal shoulder push-up group[(6.2±1.55)min]was longer than that in the gluteal traction group[(4.1±0.99)min]and the transvaginal fetal head push-up group[(4.3±1.25)min],the total operation time in the gluteal traction group[(43.1±4.68)min]was lower than that in other groups[(75.9±8.60)min,(57.1±5.93)min,(68.8±7.94)min],and the differences were statistically significant(P<0.05).The incidence of uterine incision lacerationin the gluteal traction group(5%)was lower than that in the fetal shoulder push-up group(34%)and the transvaginal fetal head push-up group(26%),and the incidence of postpartum hemorrhage(2.5%)was lower than that in the transvaginal fetal head push-up group(24%),and the rate of puerperal infection in the gluteal traction group(2.5%)was lower than that in the transvaginal fetal head push-up group(22%),and the differences were statistically significant(P<0.05).The neonatal 1-minute Apgar score in the gluteal traction group(8.9±0.99)was significantly higher than that in the fetal shoulder push-up group(6.4±2.01),the birth injury in the gluteal traction group(0)was significantly less than that in the fetal shoulder push-up group(20%)and the transvaginal fetal head push-up group(16%),and t

关 键 词：胎头深陷 剖宫产 娩胎方式 

分 类 号：R714.4[医药卫生—妇产科学]