Mayerhofer Klaus, Bodner-Adler Barbara, Bodner Klaus, Rabl Michaela, Kaider Alexandra, Wagenbichler Peter, Joura Elmar Armin, Husslein Peter
Departments of Gynecology and Obstetrics and of Medical Computer Sciences, University of Vienna Medical School, and Semmelweis Frauenklinik, A-1090 Vienna, Währinger Gürtel 18-20, Austria.
J Reprod Med. 2002 Jun;47(6):477-82.
To investigate the influence of the traditional hands-on versus the innovative hands-poised method on the risk of perineal trauma during vaginal delivery and on neonatal outcomes.
In a prospective, randomized, multicenter study, 1,161 of 1,505 women giving birth at the Departments of Obstetrics and Gynecology of the University Hospital of Vienna and Semmelweis Women's Hospital, Vienna, between February and September 1999, were randomized into the trial. In the hands-on method, the left hand of the midwife puts pressure on the infant's head, and the right hand is placed against the perineum. In the hands-poised method, the midwife guides the parturient through the birth without touching the perineum, prepared to apply light pressure on the infant's head.
One hundred eighty-seven of 574 women (32.5%) in the hands-on group and 180 of 502 women (35.8%) in the hands-poised group experienced perineal tears (P = .5). Sixteen women (2.7%) treated with the hands-on method developed third-degree perineal tears as compared with five women (0.9%) treated with the hands-poised method (P < .05). In the hands-on group, 103 women (17.9%) underwent episiotomy as compared with 51 cases (10.1%) in the hands-poised group (P < .01). No significant differences in neonatal outcomes were observed between the two groups.
Our data suggest that a policy of hands-poised care is more suitable for preserving the perineum during birth and is a safe and effective birthing alternative for women.
探讨传统的手压法与创新的手悬法对阴道分娩时会阴创伤风险及新生儿结局的影响。
在一项前瞻性、随机、多中心研究中，1999年2月至9月间，维也纳大学医院妇产科和维也纳塞梅尔维斯妇女医院的1505名分娩妇女中有1161名被随机纳入试验。在手压法中，助产士左手按压婴儿头部，右手放在会阴处。在手悬法中，助产士在分娩过程中指导产妇，不接触会阴，准备好在婴儿头部施加轻压。
手压组574名妇女中有187名（32.5%）、手悬组502名妇女中有180名（35.8%）发生会阴撕裂（P = 0.5）。手压法治疗的16名妇女（2.7%）发生三度会阴撕裂，而手悬法治疗的妇女为5名（0.9%）（P < 0.05）。手压组103名妇女（17.9%）接受了会阴切开术，而手悬组为51例（10.1%）（P < 0.01）。两组新生儿结局无显著差异。
我们的数据表明，手悬护理策略更适合在分娩时保护会阴，对女性来说是一种安全有效的分娩替代方法。
