Clinical Value Of Noninvasive Unprotected Perineum Midwifery Technique In Vaginal Delivery

Objective:To evaluate the effects of noninvasive unprotected perineum midwifery technique in natural childbirth on perinatal outcomes like perineal laceration,perineal edema,perineal pain degree,the duration of labor postpartum blood lose during childbirth,meconium-stained liquor,noenatal asphyxia and the admission of NICU. Methods:This prospective controlled trial included 633 primipara deliveried in Woman and Child Health Hospital of Jilin Province between November 2014 and April 2015, who were laboring with a head presentation fetus at 20~35 years old,37~41+6weeks’ gestation,without serious complication.A group of 317 women who choose the noninvasive unprotected perineum midwifery technique(perineal control with hands-off),and a control group of 316 women who choose traditional midwifery technique(perineal control with hand-on).Application of SPSS 17.00 statistical software,Maternal and neonatal outcomes were compared with the use of Student t tests,Chi-squared,and Fisher exact test,and a probability value of 0.05 indicated significance of statistics. Results:1.In primigravid women the use of noninvasive unprotected midwifery technique with traditional midwifery technique,there was a significant difference in the perineal laceration rate(2c =21.30, P<0.001).There is an increase in degree I perineal lacerations(85.49% vs 71.52%); a significant decrease in the degree II perineal lacerations(7.57% vs 13.29%); a significant reduction in the complex perineal laceration and Ⅲ or Ⅳdegree laceration(4.42% vs 12.97%).Meanwhile,there was a significant difference in the perineal edema rate(2c =7.13, P=0.03). fewer mild perineal edema(5.68% vs 10.44%);the moderate and the severe perineal edema rate was lower in the group of noninvasive unprotected midwifery technique(1.58% vs 4.11%),and no severe perineal edema case is found in this group. In primigravid women who received noninvasive unprotected midwifery technique with traditional midwifery technique,there was an statistically significant difference in perineal pain rate.There was an increase in zero degree perineal pain(17.98% vs 8.23%); I degree perineal pain rate in the noninvasive unprotected midwifery technique group is a bit higher(45.11% vs 38.29%); II degree and Ⅲ degree perineal pain rate is significantly lower(36.91% vs 53.48%); No severe perineal pain case is founded in the noninvasive unprotected midwifery technique group.2.The duration of the first and the second labor is a bit longer,but there was no significant difference(P>0.05), the suture materiall(VICRYL Rapide 2/0)dosage was fewer(0.52±0.05 vs 1.37±0.15, t=-90.06, P<0.01), And a less postpartum blood loss during labor in the noninvasive unprotected perineum midwifery technique group. there was a statistically significant differences(185.95±15.05 vs 201.32±16.92, t=-10.52, P<0.01)3.The rate of meconium-stained liquor was fewer(20.82% vs 33.23%,2c = 12.36, P<0.001) in the group of noninvasive unprotected perineum midwifery technique.an increasing rates of prolonged second stage of labor was no statistically significant differences(2c =0.12, P>0.05), and there were non-significant in operative vaginal delivery,using of oxytocin in the second stage of labor or neonatal asphyxia.(P>0.05). The retention of urine rate is significant lower,and there was significant difference(2.84% vs 9.81%, 2c =12.99, P<0.001).4.Though the neonatal asphyxia were 5 in the noninvasive unprotected perineum midwifery technique group and 6 in the traditional midwifery technique group,29 newborns were admitted in NICU in the noninvasive unprotected perineum midwifery technique group and 32 newborns were admitted in NICU in the traditional midwifery technique group.But there were no significant differences in the neonatal asphyxia and admission in NICU(2c =0.10, P>0.05;2c =0.17, P>0.05). Conclusion:The findings of this study suggest several possible benefits for noninvasive unprotected perineum midwifery technique which may reduce the episiotomies and perineal edema, decline perineal lacerations, relieve the perineal pain and meconium-stained liquor.Noninvasive unprotected perineum midwifery technique does not increased the risk of fetal distress,operative vaginal delivery or neonatal asphyxia and admitted newborns. Noninvasive unprotected perineum midwifery technique can reduce the blood lose during 1abor and the urinary retention. Noninvasive unprotected perineum midwifery technique(Perineal control with hand-off method) may reduce the severity of perineal tear and easy to operate compared with the traditional method,improve the comfort of delivery and promote natural delivery,which is worthy of further clinical application,has a positive effect to improve the quality of obstetrical service.