第二产程侧卧位分娩对初产妇分娩结局及盆底功能的影响

doi:10.3760/cma.j.issn.1007-1245.2024.20.021

摘要/Abstract

摘要：

目的　探讨第二产程侧卧位分娩对初产妇分娩结局及盆底功能的影响。方法　本研究为随机对照试验。选取2020年11月至2021年3月在温州医科大学附属第二医院住院分娩的360例初产妇作为研究对象。采用随机数字表法，将患者分为侧卧组（180例）、仰卧组（180例）。侧卧组采用侧卧位分娩，仰卧组采用仰卧位分娩。因胎儿窘迫需产钳助产、产后失访等，两组均最终收集150例。比较两组一般资料（年龄、体重、体重指数、孕周）、产时指标［新生儿体重、第二产程时间、1 min Apgar评分、第二产程视觉模拟评分法（VAS）评分、产后2 h出血量、阴道分娩转剖宫产率］、会阴情况（会阴完整率、会阴侧切率）、产后42 d和3个月盆底肌力变化、产后3个月并发症（阴道松弛、子宫脱垂、尿失禁、腰骶部疼痛）、产后3个月生活质量（疾病影响程度量表）。采用独立样本t检验和χ²检验。结果　侧卧组年龄（27.82±2.01）岁，孕周（38.62±1.12）周；仰卧组年龄（28.23±2.31）岁，孕周（39.24±0.95）周。侧卧组阴道分娩转剖宫产率［8.67%（13/150）］、第二产程时间［（48.65±9.41）min］、第二产程VAS评分［（3.22±1.18）分］均优于仰卧组［18.67%（28/150）、（62.11±10.21）min、（5.51±1.36）分］（均P<0.05）。侧卧组会阴完整率高于仰卧组［10.67%（16/150）比3.33%（5/150）］，会阴侧切率低于仰卧组［6.67%（10/150）比13.33%（20/150）］（均P<0.05）。产后42 d及3个月，侧卧组盆底肌力≥3级人数占比［58.00%（87/150）、80.67%（121/150）］均高于仰卧组［30.00%（45/150）、64.00%（96/150）］（均P<0.05）。产后3个月，侧卧组阴道动态压力，阴道松弛、子宫脱垂、尿失禁、腰骶部疼痛发生率、生活质量评分（3个维度及总分）均优于仰卧组（均P<0.05）。结论　第二产程侧卧位分娩可有效降低阴道分娩转剖宫产率，缩短第二产程时间，减轻会阴裂伤程度和产后盆底肌损伤，提高生活质量。

关键词:

第二产程, 侧卧位, 分娩结局, 疼痛, 盆底功能

Abstract:

Objective　To explore the effects of side-lying position delivery in the second stage of labor on the birth outcomes and pelvic floor function. Methods　This study was a randomized controlled trial. A total of 360 primiparas undergoing delivery in the Second Affiliated Hospital of Wenzhou Medical University from November 2020 to March 2021 were selected as the research objects, and were divided into a side-lying group (180 cases) and a supine group (180 cases) by the random number table method. The side-lying group was delivered in the side-lying position during the second stage of labor, and the supine group was delivered in the supine position during the second stage of labor. Due to fetal distress requiring forceps assistance and postpartum loss of follow-up, 150 cases were collected in both groups. The general data (age, body weight, body mass index, and gestational week), intrapartum indexes [neonatal body weight, second stage of labor, 1 min Apgar score, Visual Analogue Scale (VAS) score in the second stage of labor, bleeding at postpartum 2 h, and rate of vaginal delivery transferring to cesarean section], perineal condition (perineal integrity rate and perineal lateral resection rate), pelvic floor muscle strength changes at postpartum 42 d and 3 months, complications at postpartum 3 months (vaginal relaxation, uterine prolapse, urinary incontinence, and lumbosacral pain), and quality of life [Sickness Impact Profile (SIP)] at postpartum 3 months were compared between the two groups. Independent sample t test and χ² test were used. Results　The age of the side-lying group was (27.82±2.01) years old, and the gestational age was (38.62±1.12) weeks. The age of the supine group was (28.23±2.31) years old, and the gestational age was (39.24±0.95) weeks. The rate of vaginal delivery transferring to cesarean section [8.67% (13/150)], second stage of labor [(48.65±9.41) min], and VAS score in the second stage of labor [(3.22±1.18) points] in the side-lying group were better than those in the supine group [18.67% (28/150), (62.11±10.21) min, and (5.51±1.36) points] (all P<0.05). The perineal integrity rate in the side-lying group was higher than that in the supine group [10.67% (16/150) vs. 3.33% (5/150)], and the perineal lateral resection rate was lower than that in the supine group [6.67% (10/150) vs. 13.33% (20/150)] (both P<0.05). At postpartum 42 d and 3 months, the proportions of pelvic floor muscle strength ≥ grade 3 in the side-lying group [58.00% (87/150) and 80.67% (121/150)] were higher than those in the supine group [30.00% (45/150) and 64.00% (96/150)] (both P<0.05). At postpartum 3 months, the vaginal dynamic pressure, incidences of vaginal relaxation, uterine prolapse, urinary incontinence, and lumbosacral pain, and quality of life score (scores of 3 dimensions and total score) in the side-lying group were better than those in the supine group (all P<0.05). Conclusion　Side-lying position delivery in the second stage of labor can effectively reduce the rate of vaginal delivery transferring to cesarean section, shorten the second stage of labor, reduce the degree of perineal laceration and postpartum pelvic floor muscle injury, and improve the quality of life.

Key words:

Second stage of labor, , Side-lying position, , Delivery outcomes, Pain, Pelvic floor muscle function

戴丽芳董小琼厉晨洁王小梅.

第二产程侧卧位分娩对初产妇分娩结局及盆底功能的影响 [J]. 国际医药卫生导报, 2024, 30(20): 3453-3457.

Dai Lifang, Dong Xiaoqiong, Li Chenjie, Wang Xiaomei.

Effects of side-lying position delivery in the second stage of labor on the birth outcomes and pelvic floor function [J]. International Medicine and Health Guidance News, 2024, 30(20): 3453-3457.

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