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不同待产方式对初产妇产后近期盆底功能的影响

Effect of different laboring methods on primipara pelvic floor function in early postpartum period

  • 摘要: 目的 比较不同待产方式对初产妇产后近期盆底功能的影响,寻求最有益的待产方式。方法 选取2015年6月-2016年2月于郑州大学第三附属医院分娩的初产妇,根据知情自愿的原则分为水中待产组69例(水中组)、传统待产组95例(传统组)、硬膜外麻醉待产组75例(药物组);分别收集每组阴道分娩产妇产程、会阴侧切及会阴裂伤情况、产后2 h出血量、1 min和5 min新生儿Apgar评分、孕期及产后42天压力性尿失禁情况、盆腔器官脱垂分度(POP-Q)和盆底电生理指标,并进行统计分析。结果 ①水中组与传统组相比:中转剖宫产率、会阴侧切率、产后42天压力性尿失禁发生率降低(P<0.017);POP-Q评分中,仅Aa指示点上移,差异有统计学意义(P<0.017)。②水中组与药物组相比:第一、二产程时间缩短,会阴侧切率降低,I类和II类肌力 ≥ Ⅲ级所占比率升高(P<0.017);POP-Q评分中,仅Aa指示点上移,差异有统计学意义(P<0.017)。药物组与传统组相比:第二产程时间延长(P<0.017)。结论 水中待产可降低初产妇剖宫产率、会阴侧切率及产后42天压力性尿失禁发生率;水中待产初产妇产后近期盆底电生理指标损伤程度、盆底器官脱垂程度均轻于传统及硬膜外麻醉待产者。水中待产可能对盆底功能有保护性作用。

     

    Abstract: Objective To compare the effect of different laboring methods on primipara pelvic floor function in early postpartum period, and to seek the most beneficial way of laboring.Methods From June 2015 to February 2016, primipara were selected who would deliver in the Third Affiliated Hospital of Zhengzhou University. According to the principle of informed consent and voluntary, the primipara were divided into laboring in water group 69 cases, traditional laboring group 95 cases and epidural anesthesia laboring group 75 cases, related information was collected and analyzed, such as the duration of labor undergoing vaginal delivery, episiotomy and perineal laceration, blood loss after delivery 2 hours, infant Apgar score with 1 minute and 5 minutes, stress urinary incontinence (SUI) during pregnancy and at 42 days after delivery, pelvic organ prolapse (POP-Q) and pelvic floor electrical physiological.Results (1) compared with traditional group, the water group can reduces the rate of cesarean delivery, episiotomy, SUI at 42 days after delivery (P < 0.017); Only Aa indicator point up in POP-Q score and the difference was statistically significant between the two groups (P < 0.017). (2) compared with drug group, the water group had shortened the first and second stage of laboring, reduced the rate of episiotomy, and increased the ratio of type I and type II muscle strength account for ≥ grade III (P < 0.017); Only Aa indicator point up in POP-Q score, and the difference was statistically significant (P < 0.017). (3) Compared with traditional group, drug group extended the time of the second stage of laboring, (P < 0.017).Conclusion Primipara laboring in water could reduce the rate of cesarean section, episiotomy and SUI 42 days after birth. Primipara who laboring in water had light level in postpartum pelvic floor electrophysiological index injury, pelvic organ prolapsed. Laboring in water may have a protective effect on the pelvic floor function.

     

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