研究表明,随着第二产程延长,母婴不良结局的风险增加。第二产程产力是影响第二产程时间的重要因素。第二产程产力根据力的来源可分为子宫收缩力、核心肌群产生的腹压以及肛提肌收缩力。腹压在第二产程产力中发挥着重要的作用,同时由于其相对较易于控制的特点,故而在临床实践中常作为一种加速分娩和提高自然分娩率的方式。随着研究的深入以及技术的进步,第二产程中增强腹压的方法得到了不断发展和应用,不同方法之间各有优缺点。本文总结了目前第二产程中增强腹压的方法及其效果,为寻找避免第二产程延长或适当缩短第二产程的最佳方法和进一步创新提供参考。According to reports from studies, the risk of maternal and neonatal adverse outcomes would rise along with prolonged second stage of labor. Labor of force, playing a significant role in the second stage of labor, is divided into three parts (including the force of uterine contraction, abdominal pressure by core muscle group and levator ani contraction) according to the source of force. Abdominal pressure is an important part of labor force in the second stage of labor and has the characteristic that could be controlled more easily, so it is often considered as a way to accelerate delivery and increase the rate of spontaneous delivery. With further researches and technological advance, approaches during the second stage of labor have been developed and applied gradually while every approach has its advantages and disadvantages. This review summerizes various approaches enhancing abdominal pressure in the second stage of labor and their function in practice, for further creation and finding the best method of avoiding prolonged second stage or shortening it appropriately.
目的探讨BirthRite坐位分娩组件接产的安全性和有效性,为缩短初产妇第二产程时间,提升产妇生产体验提供参考。方法将住院分娩的低危初产妇236例,第二产程按照产妇意愿分为观察组(116例)和对照组(120例)。观察组采用BirthRite坐位分娩组件坐式分娩,对照组采用电动产床坐式分娩。观察两组产妇第二产程时间、非枕前位占比、阴道助产、产后出血、肩难产、会阴侧切、会阴裂伤、会阴水肿、会阴疼痛程度和产后满意度;比较两组新生儿出生体质量和1 min、5 min Apgar评分。结果对照组中途2例退出。两组均顺利分娩,观察组第二产程时间显著短于对照组,分娩非枕前位占比、肩难产发生率、会阴侧切率、会阴水肿及疼痛程度显著低于对照组,产妇满意度显著高于对照组(均P<0.05)。两组新生儿出生后1 min和5 min Apgar评分均为10分。结论使用BirthRite分娩椅能够缩短第二产程时间,提高产妇满意度,优化坐位分娩结局。
