| ObjectiveTo explore the safety and feasibility of new lying positions(semi-reclining position with legs bent and lateral position with legs bent)for delivery by comparing the influence of new lying positions with supine position at the second stage of labor on pregnancy outcome.Methods450 cases of term primiparas without vaginal delivery contraindications who were hospitalized in the Obstetrics Department of the Obsterics and Gynecology Hospital Affiliated to Nanjing medical university from April to September,2017 were selected according to the inclusion and exclusion criteria.Randomized controlled trial was used as the research method,and the study objects were randomly divided into three groups,i.e.lateral position group,semi-reclining position group and supine position group,with 150 cases in each group.During the study process,8 cases suffered from infant loss due to precipitate delivery,and 22 cases underwent cesarean delivery because of fetal heart late deceleration,puerperae intrapartum fever,continuous occipitoposterior position and other special situation and suffered from infant loss.At last,140 cases from lateral position group,142 cases from semi-reclining position group and 138 cases from supine position group were included in the study.The puerperae from these three groups were taken care of by normal delivery procedure at the first and third stage of labor,while at the second stage of labor,puerperae from the lateral position group adopted lateral position with legs bent for the delivery,puerperae from the semi-reclining position group adopted semi-reclining position with legs bent for the delivery,and puerperae from the supine position group adopted traditional supine position for the delivery.The following indexes were analyzed among the three groups:(1)Pregnancy outcome:natural delivery rate,vaginal delivery rate,cesarean section rate,duration of the second stage of labor,bleeding amount of 24 hours after delivery,perineal injury condition;(2)Perineal swelling and pain condition of 24 hours after delivery,the occurrence rate of urine retention after delivery and the exhaustion level of puerperae;(3)Pelvic floor muscle strength after delivery of the puerperae from three groups;(4)Fetal heart rate,neonatal asphyxia rate,result of umbilical cord arterial blood gas analysis[pH value,HC03 level,standard base excess(sBE)],occurrence rate of newborn birth injury[scalp hematoma,intracranial hemorrhage(above grade II),clavicular fracture,branchial plexus injury].Results1.Comparison of the pregnancy outcome of the puerperae among three groups1.1 The difference of the natural delivery rate and cesarean section rate among the three groups was statistically significant(P<0.05).The natural delivery rate of the lateral position group and semi-reclining position group was higher than that in the supine position group(P<0.05);the cesarean section rate of the lateral position group and semi-reclining position group was lower than that in the supine position group(P<0.05);The difference of natural delivery rate and cesarean section rate between the lateral position group and semi-reclining position group was not statistically significant(P>0.05).The difference of vaginal delivery rate among the three groups was not statistically(P>0.05).1.2 The difference of the duration of the second stage of labor among three groups was statistically significant(P<0.05).The duration of the lateral position group and the semi-reclining position group was shorter than that of the supine position group(P<0.05);the difference of the duration of the second stage of labor of the semi-reclining position group and the lateral position group was not statistically significant(P>0.05).The difference of bleeding amount of 24 hours after delivery among three groups was not statistically significant(P>0.05).1.3 The difference of episiotomy rate and perineal laceration rate among the three groups was statistically significant(P<0.05).Comparison of episiotomy rate between any two groups,the episiotomy rate of the lateral position group and the semi-reclining position group was lower than the supine position group(P<0.05),the difference between the lateral position group and the semi-reclining position group was not statistically significant(P>0.05);the perineal laceration rate of the lateral position group and the semi-reclining position group was higher than the supine position group(P<0.05);compared with the semi-reclining position group,grade I perineal laceration rate of the lateral position group was higher,the difference of the constituent ratio of perineal laceration degree between the two groups was statistically significant(P<0.05).Among the three groups,there were 7 cases with perinaeum integrity in the lateral position group,5 cases with perinaeum integrity in the semi-reclining position group and 4 cases with perinaeum integrity in the supine position group,and the perinaeum integrity rate of the lateral position group was higher than other two groups,but the difference of the perinaeum integrity rate among the three groups was not statistically significant(P>0.05);no median episiotomy,grade III or grade IV perineal laceration were observed.2.Comparison of the postpartum comfort messures of the puerperae among three groups2.1 The difference of perineal swelling and pain scores of 24 hours after delivery among the three groups was statistically significant(P<0.05).Comparison of the perineal swelling condition of 24 hours after delivery between any two groups,the lateral position group and the semi-reclining position group was lower than the supine position group(P<0.05);the difference between the lateral position group and the semi-reclining position group was not statistically significant(P>0.05).Regarding to the perineal pain scores of 24 hours after delivery,the lateral position group and the semi-reclining position group was lower than the supine position group(P<0.05);the difference between the lateral position group and the semi-reclining position group was not statistically significant(P>0.05).2.2 The difference in the occurrence rate of urine retention after delivery among the three groups was statistically significant(P<0.05).Comparison between any two groups,the lateral position group and the semi-reclining position group was higher than the supine position group(P<0.05);the difference between the lateral position group and the semi-reclining position group was not statistically significant(P>0.05).2.3 The difference of the exhaustion level of puerperae 30 minutes after delivery was statistically significant(P<0.05);the lateral position group and the semi-reclining position group were lower than the supine position group(P<0.05);the difference between the lateral position group and the semi-reclining position group was not statistically significant(P>0.05).The difference of the exhaustion level of puerperae at the beginning of the second stage of labor and 24 hours after delivery among the three groups were not statistically significant(P>0.05).3.The three groups of fetal heart rate,rate of neonatal asphyxia,umbilical cord blood,blood gas analysis and comparing the status of the maternal injuries3.Comparison of the early postpartum pelvic floor muscle strength of the puerperae among three groupsThe difference in the abnormal rate of type I and type II muscle fiber strength at pelvic floor among the three groups was statistically significant(P<0.05).Regarding to the abnormal rate of type I and type II muscle fiber strength,the lateral position group and the semi-reclining position group were lower than the supine position group(P<0.05);the difference between the lateral position group and the semi-reclining position group was not statistically significant(P>0.05).4.Comparison of neonatal outcomes among three groups.4.1 The difference of normal fetal heart occurrence rate and early deceleration occurrence rate of infants among the three groups was statistically significant(P<0.05).Comparison between any two groups,regarding to normal fetal heart occurrence rate,the lateral position group and the semi-reclining position group was higher than the supine position group(P<0.05);compared with the semi-reclining position group,the normal fetal heart occurrence rate of the lateral position group was higher,but the difference was not statistically significant(P>0.05);regarding to early deceleration occurrence rate,the lateral position group and the semi-reclining position group was lower than the supine position group(P<0.05);compared with the semi-reclining position group,the early deceleration occurrence rate of the lateral position group was lower,but the difference was not statistically significant(P>0.05).The difference of the occurrence rate of fetal tachycardia,fetal variable deceleration and fetal late-deceleration among the three groups was not statistically significant(P>0.05).4.2 Neonatal asphyxia rate in three groups:2 cases of mild asphyxia in the lateral position group,2 cases of mild asphyxia in the semi-reclining position group,and 4 cases in the supine group,no severe asphyxia cases observed in three groups,and the difference of neonatal asphyxia rate among the three groups was not statistically significant(P>0.05).4.3 The difference of result of umbilical cord arterial blood gas analysis[pH value,HCO3-level,standard base excess(sBE)]among the three groups was not statistically significant(P>0.05).4.4 Occurrence rate of newborn birth injury:no newborn birth injury observed in the lateral position group,1 case of scalp hematoma observed in the semi-reclining position group,3 cases of scalp hematoma observed in the supine position group,and the difference of occurrence rate of newborn birth injury among the three groups was not statistically significant(P>0.05).ConclusionsDuring the second stage of labor,the application of lateral position with legs bent and semi-reclining position with legs bent for delivery could significantly improve the pregnancy outcome.Therefore,new type lying position for delivery is an effective way to promote natural delivery,which is worth wide-spread application in clinical practice. |
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