第二产程中即刻用力与延迟用力对胎儿健康的影响：一项随机临床试验

Effects of immediate versus delayed pushing during second-stage labor on fetal well-being: a randomized clinical trial.

作者信息

Simpson Kathleen Rice, James Dotti C

机构信息

St. John's Mercy Medical Center, 7140 Pershing Avenue, St. Louis, MO 63130, USA.

出版信息

Nurs Res. 2005 May-Jun;54(3):149-57. doi: 10.1097/00006199-200505000-00002.

DOI:10.1097/00006199-200505000-00002

PMID:15897790

Abstract

BACKGROUND

Although there are two methods of caring for women with epidural anesthesia during second-stage labor (coached closed-glottis pushing immediately at 10-cm cervical dilation or delayed pushing until the woman feels the urge to push, passive fetal descent, and encouragement of open-glottis pushing when the woman has the urge to push), there are limited data concerning which method is most optimal for fetal well-being.

OBJECTIVE

To evaluate effects on fetal well-being, as measured by fetal oxygen saturation, of two different methods of second-stage labor nursing care for women with epidural anesthesia.

METHODS

Forty-five nulliparous women who had progressed to the second stage were randomized to 1 of 2 groups (immediate or delayed pushing). Fetal oxygen saturation was continuously monitored and values at 10 cm, initiation of pushing and immediately prior to birth, as well as the amount of time that fetal oxygen saturation values were abnormal (< or =30%) were compared between groups. Also evaluated were additional measures of fetal well-being such as fetal heart rate patterns, Apgar scores, and umbilical cord blood gases and maternal outcomes including length of labor, method of birth, and perineal status.

RESULTS

There was a significant difference between groups in fetal oxygen desaturation during the second stage (immediate: M = 12.5; delayed: M = 4.6) F(1, 43) = 12.24, p = .001, and in the number of > or =2-min epochs of fetal oxygen saturation <30% (immediate: M = 7.9; delayed: M = 2.7), F(1, 43) = 6.23, p = .02. There were more variable decelerations of the fetal heart rate in the immediate pushing group (immediate: M = 22.4; delayed: M = 15.6) F(1, 43) = 5.92, p = .02. There were no differences in length of labor, method of birth, Apgar scores, or umbilical cord blood gases. Women who pushed immediately had more perineal lacerations (immediate: n = 13; delayed: n = 5) chi(1, N = 45) = 6.54, p = .01.

DISCUSSION

Delayed pushing results in less fetal oxygen desaturation and less > or =2-min epochs of fetal oxygen saturation <30% during second-stage labor than the immediate pushing method; thus, delayed pushing is more favorable for fetal well-being as measured by fetal oxygen saturation.

摘要

背景

虽然在第二产程中，对于接受硬膜外麻醉的产妇有两种护理方法（在宫颈口扩张至10厘米时立即指导产妇屏气用力，或延迟用力直到产妇有便意、胎儿被动下降，当产妇有便意时鼓励其张口呼吸用力），但关于哪种方法对胎儿健康最为有利的数据有限。

目的

评估两种不同的第二产程护理方法对接受硬膜外麻醉产妇的胎儿健康（通过胎儿血氧饱和度来衡量）的影响。

方法

45名进入第二产程的初产妇被随机分为两组（立即用力组或延迟用力组）。持续监测胎儿血氧饱和度，并比较两组在宫颈口扩张至10厘米时、开始用力时以及即将分娩前的血氧饱和度值，以及胎儿血氧饱和度值异常（≤30%）的时长。还评估了胎儿健康的其他指标，如胎儿心率模式、阿氏评分、脐血气，以及产妇的结局，包括产程长度、分娩方式和会阴状况。

结果

两组在第二产程中的胎儿氧饱和度下降情况存在显著差异（立即用力组：M = 12.5；延迟用力组：M = 4.6），F(1, 43) = 12.24，p = .001；在胎儿血氧饱和度<30%且持续≥2分钟的时段数量上也存在显著差异（立即用力组：M = 7.9；延迟用力组：M = 2.7），F(1, 43) = 6.23，p = .02。立即用力组的胎儿心率变异减速更多（立即用力组：M = 22.4；延迟用力组：M = 15.6），F(1, 43) = 5.92，p = .02。在产程长度、分娩方式、阿氏评分或脐血气方面没有差异。立即用力的产妇会阴裂伤更多（立即用力组：n = 13；延迟用力组：n = 5），χ(1, N = 45) = 6.54，p = .01。