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目的分析剖宫产不同断脐时机及位置对母儿的影响。方法选取2015年5月至2016年5月于深圳市福田区妇幼保健院行剖宫产分娩的1 200例产妇,用随机抽样法分为A、B、C、D 4组,每组各300例。A组胎儿娩出后先钳夹子宫切缘后断脐,位置尽可能靠近胎盘,脐带长度>30 cm;B组胎儿娩出后先钳夹子宫切缘后断脐,断脐位置距脐轮<10 cm;C组清理呼吸道后即刻断脐,位置尽可能靠近胎盘,脐带长度>30 cm,后钳夹子宫切口;D组清理呼吸道后即刻断脐,断脐位置距脐轮<10 cm,再钳夹子宫切口,对比4组母儿结局。结果 4组新生儿Apgar评分、胆红素峰值比较差异无统计学意义(P>0.05),产后出血量、胎盘残血量、产后24 h血红蛋白、红细胞压积比较差异有统计学意义(P<0.05)。其中C组与D组产后出血量、胎盘残血量显著高于A组、B组,A组与C组产后24 h血红蛋白水平、红细胞压积显著高于B组、D组,差异均有统计学意义(P<0.05)。结论剖宫产时先钳夹子宫切口,可减少母体产后出血量,延迟断脐并尽可能接近胎盘断脐可提高新生儿血红蛋白,改善预后。
Objective To analyze the effects of cesarean section on the timing and location of maternal umbilicus. Methods From May 2015 to May 2016, 1,200 pregnant women delivered by cesarean section at Futian District Maternity and Child Care Hospital of Shenzhen City were randomly divided into groups A, B, C and D 4, each with 300 example. A group of fetus after the first delivery of uterine incisors cut off the edge of the uterus, the location as close as possible to the placenta, the umbilical cord length> 30 cm; B group after the first delivery of uterine incision the uterus cut off the edge of the uterus, broken umbilical cord position <10 cm; group C immediately after the removal of the respiratory tract umbilical cord, the location as close to the placenta, umbilical cord length> 30 cm, after the clamp uterine incision; D group immediately after the removal of the respiratory tract umbilical cord, umbilical cord off umbilical distance <10 cm, Incision uterine incision, compared with 4 sets of maternal and child outcomes. Results There was no significant difference in Apgar score and bilirubin peak between the 4 groups (P> 0.05). The postpartum hemorrhage volume, placental residual volume, hemoglobin and hematocrit at 24 h postpartum were significantly different (P < 0.05). The postpartum hemorrhage volume and placental residual blood volume in group C and group D were significantly higher than those in group A. The levels of hemoglobin in group B, group A and group C at 24 h postpartum were significantly higher than those in group B and group D Significance (P <0.05). Conclusion Cesarean section when the first clamp uterine incision, can reduce the amount of maternal postpartum hemorrhage, delayed off the umbilical cord and as close to the placenta as the umbilical cord can improve neonatal hemoglobin, improve prognosis.