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[摘要] 目的:探讨临产前刺激乳头结合打坐体位促进宫颈成熟和胎头入盆,从而降低剖宫产率。方法:对产科门诊孕期检查的孕妇在孕37～38周时行阴道检查,筛查出宫颈成熟度极差、胎头未衔接,而具备阴道分娩条件的初孕妇280例,随机分为实验组和对照组,每组140例,对照组只常规检查和胎动计数,实验组另外在家自行刺激乳头结合打坐体位。结果:两组自然临产孕周、临产时产程时间、剖宫产率比较,差异有统计学意义(P0.05)。结论:在孕37、38周后,针对宫颈成熟极差和胎头未衔接者,采用刺激乳头结合打坐体位的方法,可降低剖宫产率。
[关键词] 刺激乳头;打坐体位;宫颈成熟;胎头衔接
[中图分类号] R714.3 [文献标识码]A [文章编号]1674-4721(2010)03(a)-034-02
A clinical study on reducing the cesarean rate effectively by stimulating the nipple in combination with meditation posture to promote cervical ripening and engagement onset of head
LIU Yanhua
(Department of Gynecology and Obstetrics,Maternal and Child Health Hospital of Zaozhuang, Zaozhuang 277100,China)
[Abstract] Objective: To study stimulating the nipple in combination with meditation posture to promote cervical ripening and engagement onset of head before onset of labor, in order to reducing the cesarean rate accordingly. Methods: 280 pregnant women with poor cervical ripening and no engagement onset of head were chosen by vaginal examination in obstetrics clinic during gestational 37-38 weeks. They were randomly divided into two groups,experimental group (140 cases) and control group(140 cases). In addition to routing examination and fetal movement for two groups,the experimental group had stimulated the nipple in combination with meditation posture by themselves at home. Gestational weeks of natural labor and labor time and the cesarean rate were observed. Results: two groups were significant in statistics(P0.05). Conclusion: For pregnancies with poor cervical ripening and no engagement onset of head after gestational 37-38 weeks, stimulating the nipple in combination with meditation posture can reduce the cesarean rate and be benefit to mother and infant.
[Key words] Stimulate the nipple;Meditation posture;Cervical ripening;Engagement onset of head
宫颈的成熟与分娩的发动有明显的时相关系[1]234,而胎头先露部的高低是宫颈成熟度(Bishop)评分中五项评分标准之一,本研究通过刺激乳头,结合打坐体位以促进宫颈成熟,能有效地降低延期妊娠和过期妊娠发生,缩短产程,利于自然分娩,从而降低剖宫产率,效果显著,现报道如下:
1 资料与方法
1.1 一般资料
2007年10月～2008年10月,在本院妇产科门诊孕期检查的初孕妇,在孕满37～38周时,行阴道检查,筛查出宫颈成熟度评分为零,胎头未衔接且具备阴道分娩条件的初孕妇280例,随机分为实验组和对照组,两组孕妇在年龄、孕周、体重、骨盆相比,差异无统计学意义(P>0.05),均无心、肺、肝、肾等脏器疾患及感染症状,经产科头盆相关检查可经阴道试产者。
1.2 方法
专人负责检查,常规消毒外阴行阴道检查,按Bishop宫颈成熟度评分法评分,检查宫颈管长度、子宫颈硬度、子宫颈口位置、宫口开大程度、胎先露高低,同时了解骨盆内径情况,以排除骨盆异常,进行Bishop评分。实验组除常规孕期检查和胎动计数外,还采用在家自行刺激乳头并结合打坐体位,刺激乳头即行乳头按摩,每个乳头按摩15 min,轮流按摩2次共用1 h[1]381,在乳头按摩的同时采取打坐体位,即在床上或沙发上采取和尚打坐的姿势,两大腿屈曲贴近腹壁,双足交叉与两坐骨共同作支点,孕妇身体稍前倾,使胎儿纵轴与产轴一致,对照组只行常规的孕期检查和胎动计数,跟踪观察两组孕妇,于孕39、40、41、42周分别进行宫劲成熟度评分检查,统计并排除自然临产的孕妇,再对未自然临产的孕妇分别进行宫颈评分,分娩时有专人统计产程时间及分娩结局,延期妊娠和过期妊娠时给予引产,并统计引产成功率及剖宫产率。
1.3 统计学处理
采用SPSS10.0软件进行t检验和χ2检验。
2 结果
2.1 孕39、40、41、42周分别对宫颈成熟度进行评估比较
见表1。观察组宫颈成熟度评分明显优于对照组,P0.05。见表3。
2.4 观察组与对照组引产成功率及剖宫产率比较
两组相比,差异均有统计学意义,P
