The Study Of The Effect Of Pudendal Nerve Block Anesthesia Combined With Noninvasive Delivery On Maternal Vaginal Delivery Quality

ObjectiveAccording to analyze the data of puerperas with noninvasive delivery,instrument analgesia combined with noninvasive delivery and pudendal nerve block anesthesia combined with noninvasive delivery,to explore the effect of pudendal nerve block anesthesia combined with noninvasive delivery on maternal vaginal delivery quality.MethodsAccording to the inclusion criteria and exclusion criteria,300 puerperas who were received vaginal in gynaecology and obstetrics of our hospital from July 2014 to July 2015 were collected.Iclusion criteria:(1)unipara;(2)the puerperas were healthy;(3)according to the BPD,FL,AC,the weight of the fetus was 2500g to 4000g and the fetus has no congenital disease;(4)the pelvis and fetus position were normal;(5)the informed consents of the puerperae or their family members were received.Exclusion criteria:(1)CPD;(2)the age of the puerpera was over 3 5years;(3)complications of pregnancy;(4)the puerpera with a abnormal history of pregnancy;(5)the puerpera or her family members did not agree this study.The general information of all the puerperas had no significant difference.The 300 puerperas were devided into A group(noninvasive delivery group),B group(instrument analgesia + noninvasive delivery group)and C group(pudendal nerve block anesthesia + noninvasive delivery group),according to the order.The puerperas of A group(noninvasive delivery group)received noninvasive delivery,B group(instrument analgesia + noninvasive delivery group)puerperas received Doula instrument analgesia to ease pain based on noninvasive delivery.The puerperas of C group(pudendal nerve block anesthesia +noninvasive delivery group)received 10 ml Lidocaine to get bilateral pudendal nerve block anesthesia,and then undergo noninvasive delivery.1.To count the number of puerperas with perineum laceration after delivery,and counted the incidence of perineum laceration and the degree of perineum laceration.2.To evaluate the delivery pain of three groups of puerperas used VAS.The number 0 to 3 were defined as mild pain,the number 4 to 6 were defined as moderate pain,and the 7 to 10 were defined as severe pain.To count the numbers of three groups' puerperas feel mild pain,moderate pain and severe pain.3.To record the time of second stage of labor of the puerperas of A group(noninvasive delivery group),B group(instrument analgesia + noninvasive delivery group)and C group(pudendal nerve block anesthesia + noninvasive delivery group).4.According to the Apgar mark sheet,the apneas of newborn were marked:0 to 3 were defined as severe apnea,4 to 7 were defined as mild apnea,8 to 10 were defined as normality.To count the numbers of three groups puerperas feel mild apnea and severe apnea.5.Contrast to the time of in hospital,the time of leaving bed,and the incidence of complication(Perineal infection,postpartum hemorrhage and uroschesis)of the puerperas of A group(noninvasive delivery group),B group(instrument analgesia +noninvasive delivery group)and C group(pudendal nerve block anesthesia +noninvasive delivery group).All data was processed with statistics software SPSS 17.0,there exist significant difference when P<0.05.Result1.The number of perineum laceration of A group(noninvasive delivery group),B group(instrument analgesia + noninvasi-ve delivery group)and C group(pudendal nerve block anesthesia + noninvasive delivery group)were 31(31%),19(19%)and 9(9%).The incidence of perineum laceration in C group(pudendal nerve block anesthesia + noninvasive delivery group)was significantly lower than that of other two groups,and the difference was statistically significant.The number of degree I laceration,degree ? laceration,and degree III laceration in A group(noninvasive delivery group)were 19(19%),10(10%)and 2(2%).The number of degree I laceration,degree ? laceration,and degree III laceration inB group(instrument analgesia + noninvasive delivery group)were 12(12%),6(6%)and 1(1%).The number of degree I laceration,degree II laceration,and degree ? laceration in C group(pudendal nerve block anesthesia + noninvasive delivery group)were 6(6%),3(3%)and 0(0%).The degree of perineum laceration in C group(pudendal nerve block anesthesia + noninvasive delivery group)was significantly lower than that of other two groups,and there exist significant difference.2.There were 2(2%)puerperas felt mild pain,27(27%)puerperas felt moderate pain and 71(71%)puerperas felt severe pain in second stage of labor in A group(noninvasive delivery group).There were 43(43%)puerperas felt mild pain,53(53%)puerperas felt moderate pain and 4(4%)puerperas felt severe pain in second stage of labor in B group(instrument analgesia + noninvasive delivery group).There were 68(68%)puerperas felt mild pain,32(32%)puerperas felt moderate pain and 0(0%)puerperas felt severe pain in second stage of labor in C group.3.The time of second stage of labor of A group(noninvasive delivery group),B group(instrument analgesia + noninvasive delivery group)and C group(pudendal nerve block anesthesia + noninvasive delivery group)were(55.68 + 7.41)min,(44.31+ 7.59)min,(35.02 + 6.26)min.The time of second stage of labor of C group(pudendal nerve block anesthesia + noninvasive delivery group)was significantly lower than that of other two groups(P<0.05).4.There were 2(2%)newborns existed apnea and all the two baby were mild apnea in A group(noninvasive delivery group).In B group(instrument analgesia +noninvasive delivery group)and C group(pudendal nerve block anesthesia +noninvasive delivery group),there were only one newborn existed mild apnea.All the three groups have no severe apnea.The weight of newborn of A group(noninvasive delivery group)was(3.13±0.11)kg;The weight of newborn of B group(instrument analgesia + noninvasive delivery group)was(3.01±0.27)kg;The weight of newborn of C group(pudendal nerve block anesthesia + noninvasive delivery group)was(3.21±0.11)kg.There was no significant difference in weight of newborn between the three groups.5.The time of leaving bed of A group(noninvasive delivery group)puerperas was(2.51 ±0.22)days,and that of B group(instrument analgesia + noninvasive delivery group)was(2.78±0,26)days,C group(pudendal nerve block anesthesia+noninvasive delivery group)was(2.64±0.13)days.The time of the puerperas of A group(noninvasive delivery group),B group(instrument analgesia + noninvasive delivery group)and C group(pudendal nerve block anesthesia + noninvasive delivery group)was(2.23±0.57)days,(2.79±0.41)days and(2.31±0.38)days.There were 20(20%),18(18%),15(15%)puerperas existed complication(perineum infection,postpartum hemorrhage,urochesis)in the three groups.There was no significant difference.ConclusionThe pudendal nerve block anesthesia combined with noninvasive delivery could significantly decreased the incidence and the degree of perineum laceration,the pain of second stage of labor,the time of second stage of labor,but has no significant effect on the recover of puerperas.The pudendal nerve block anesthesia combined with noninvasive delivery significantly increased the maternal vaginal delivery quality.The technology is simple and easy to promote.