| Objective:To study the effect of improved semi-supine position(hip and knee)on the outcome of childbirth,newborns and parturients,and to explore the significance of improved semi-supine position in improving the outcome indicators of obstetrics,so as to provide reference for clinical application.Methods:According to the admission criteria,primiparas who were normally waiting to give birth in our hospital from December 2018 to June 2019 were selected as the research objects.A total of 300 puerperas were included.According to the random number table method,they were divided into the improved semi-supine position group(observation group)and the supine position group(routine group),with 150 persons in each group.In the observation group,during the second labor process,the puerpera adopted the buttock lifting and kneeling position for delivery.The head of the bed should be raised 50°,and the buttocks should be raised 15°.The legs should be placed on the bracket,and the thighs should be as close to the abdomen as possible.In the conventional group,the second labor was performed in the lower half decubitus position of the upper body(Angle<15°),with the legs placed on the bracket and the hands holding the handle.Compared to two group of delivery position of maternal and child outcomes:the vagina ShunChanLv,vaginal midwifery(forceps or fetal)absorption rate,cesarean section rate,the labor time,rate of postpartum hemorrhage,and laceration of perineum incision rate rate variation and amniotic fluid dung to dye,cardiac,neonatal asphyxia and abnormal umbilical cord blood gas analysis values(PH)and BE concentration,maternal incidence of urinary retention,perineum swelling pain degree and comfort related effects.Results:Of the 300 women in the study,19 women dropped out of the study for different reasons,including 7 in the observation group and 12 in the routine group.Finally,281 patients were studied,143 in the observation group and 138 in the conventional group.1.There was no statistically significant difference in baseline data between the two groupsThere were no statistically significant differences in age,weight,gestational age and neonatal weight between the routine group and the observation group(P>0.05).Baseline data of delivery positions between the two groups were balanced and comparable.2.Comparison of vaginal delivery rate,vaginal delivery assisted rate and cesarean section rate between the two groupsThe results showed that the difference between the two groups was statistically significant(P<0.05),and the vaginal delivery rate in the observation group(93.7%)was higher than that in the conventional group(84.8%).In terms of vaginal delivery rate,the observation group(1.4%)was significantly lower than the conventional group(10.9%),and the cesarean section rate was similar between the two groups.3.Comparison of perineal incision rate and incidence of perineal laceration between the two groupsThe difference of perineal injury rate between the two groups was statistically significant(P<0.05).The perineal integrity rate in the observation group(15.4%)was higher than that in the conventional group(13.0%).The perineotomy rate in the observation group(10.5%)was significantly lower than that in the conventional group(36.3%).The rate of perineal I° laceration in the observation group(68.5%)was higher than that in the conventional group(38.4%),and the rate of perineal ?° laceration in the observation group(5.6%)was lower than that in the conventional group(12.3%).4.Comparison of the degree of perineal swelling and perineal pain score 24 hours after delivery between the two groupsThe degree of perineal swelling 24h after delivery was evaluated between the two groups,and the difference was not statistically significant(P>0.05).It indicated that the delivery position of the observation group would not increase the degree of perineal swelling.The perineal pain score 24 hours after delivery was observed,and the observation group was lower than the conventional group,with statistically significant difference(P<0.05).5.Comparison of the incidence of urinary retention and postpartum fatigue between the two groupsCompared the incidence of urinary retention between the two groups,the difference was statistically significant(P<0.05).The incidence of urinary retention in the observation group was lower than that in the conventional group.The fatigue 30min after delivery was compared between the two groups,and the difference was statistically significant(P<0.05).The fatigue 30min after delivery score of the observation group was lower than that of the conventional group.There was no statistically significant difference between the two groups in the fatigue score at the beginning of the second labor and 24h after delivery(P>0.05).6.Comparison of fetal heart changes between the two groups during laborThe normal rate of fetal heart was higher in the observation group than in the conventional group,and the difference was statistically significant(P<0.05).Compared the two groups,the observation group was significantly lower than the conventional group,the difference was statistically significant(P<0.05).There was no significant difference between the two groups in terms of cardiac variation deceleration,late deceleration and tachycardia(P>0.05).7.Relationship between delivery position and fecal contamination in amniotic fluid in the two groupsComparison of amniotic fluid fecal contamination between the two groups showed a statistically significant difference(P<0.05).The degree of amniotic fluid fecal contamination in the conventional group was higher than that in the observation group,that is,the degree of amniotic fluid fecal contamination in the conventional group was more serious than that in the observation group,indicating that the delivery position was related to the degree of amniotic fluid fecal contamination.8.Comparison of incidence of neonatal asphyxia and birth injuries between the two groupsNeonatal asphyxia was observed,including 2 cases in the observation group and 5 cases in the routine group.There were 0 cases of severe asphyxia in both groups,and the incidence of neonatal asphyxia between the two groups was not statistically significant(P>0.05).There was no significant difference in PH and SBH values between the two groups(P>0.05).There was no clavicular fracture or brachial plexus nerve injury in both groups.There were 2 cases of scalp hematoma in the observation group and 1 case in the routine group.Shoulder dystocia occurred in the two groups,including 2 cases in the observation group and 6 cases in the conventional group.There was no statistical significance in the comparison of neonatal injuries between the two groups(P>0.05).Conclusion:The modified semi-decubitus position in the second stage of labor can reduce the rate of vaginal delivery,reduce the rate of perineal incision,reduce the perineal pain,reduce the incidence of fetal heart deceleration and amniotic fluid fecal contamination,and improve the maternal and infant outcomes.At the same time,the modified half-supine delivery can shorten the time of the second labor,reduce the incidence of postpartum urinary retention,improve the comfort of the puerpera,and reduce postpartum fatigue.There was no significant difference in the incidence of postpartum hemorrhage,perineal swelling,neonatal birth injury and asphyxia,and neonatal blood gas analysis.Although there was no statistical difference in the number of shoulder dystocia between the two groups,the number of cases in the observation group was lower than that in the conventional group. |
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