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目的:比较传统的用手扶持会阴体的保护会阴接产方法与不用手扶持会阴的新法接产方法,对分娩结局的影响。方法:前后历史对照临床研究。研究对象为低危初产妇头位单胎,正常阴道分娩者。对照组实行传统的接产手法,在宫缩时用右手扶持托住会阴体,左手控制胎头速度接产,试验组实行只用一手扶持胎头控制娩出速度,右手不扶持会阴体。对比两组会阴损伤情况与新生儿情况。结果:全部产妇均为阴道正常分娩,无新生儿死亡病例,无Ⅲ度裂伤者。两组孕妇年龄、孕周、新生儿体重比较无统计学差异。试验组会阴侧切率低于对照组(u=8.671,P<0.05),会阴Ⅱ度裂伤率低于对照组(u=19.105,P<0.05),会阴Ⅰ度裂伤及完整率高于对照组(u=30.026,P<0.05),有统计学差异。两组在新生儿窒息(u=1.765,P>0.05)与新生儿骨折发生率u=0.488,P>0.0)比较,无统计学差异。结论:改良后的接生方法,即只用一只手控制胎头娩出速度,而不用手扶持会阴体的接产方法,降低会阴侧切与会阴Ⅱ度裂伤率,增加会阴Ⅰ度裂伤和会阴完整率,未出现3度裂伤,不增加新生儿窒息与新生儿产伤。该方法操作简单、安全、有效,有益于保护孕产妇安全,防止会阴体损伤,值得临床推广使用。
OBJECTIVE: To compare the effects of traditional methods of hand-supporting the perineal body to protect the perineal delivery method and the new method of supporting the perineum without hand support on delivery outcomes. Methods: A historical and controlled clinical study. Study of low-risk first-born mothers first single-child, normal vaginal delivery. Control group, the practice of the traditional method of interception, contractions with the right hand to support the perineal support, the left hand control fetal head rate, the experimental group only with one hand to support fetal head delivery speed, the right hand does not support the perineal body. Comparison of two groups of perineal injury and neonatal conditions. Results: All the mothers were normal vaginal delivery, no neonatal deaths, no grade III laceration. Two groups of pregnant women age, gestational age, weight of newborns no significant difference. The rate of perineum lateral cleavage in the experimental group was lower than that in the control group (u = 8.671, P <0.05), the rate of laceration of the perineal second degree was lower than that of the control group (u = 19.105, P <0.05) Group (u = 30.026, P <0.05), there is statistical difference. There was no significant difference between the two groups in neonatal asphyxia (u = 1.765, P> 0.05) and neonatal fracture rate u = 0.488, P> 0.0). Conclusions: The improved method of delivery is to use only one hand to control the delivery rate of the fetal head without supporting the production of the perineal body, reduce the rate of laceration of perineal circumflex circumcision and laceration of the perineal second degree, increase the severity of perineal first degree laceration and perineum Complete rate, there is no 3 degree laceration, does not increase neonatal asphyxia and newborn birth injury. The method is simple, safe and effective, is beneficial to protect the safety of pregnant women and prevent perineal body injury, and is worthy of clinical promotion.