阴道分娩时使用子宫底压力手法与严重会阴裂伤的风险。

Use of uterine fundal pressure maneuver at vaginal delivery and risk of severe perineal laceration.

机构信息

Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Maryland School of Medicine, 22 South Greene Street, PO Box 290, Baltimore, MD 21201, USA.

出版信息

Arch Gynecol Obstet. 2009 Nov;280(5):781-6. doi: 10.1007/s00404-009-1015-2. Epub 2009 Mar 5.

DOI:10.1007/s00404-009-1015-2

PMID:19263062

Abstract

OBJECTIVE

Owing to the lack of evidence supporting the use of uterine fundal pressure maneuver in vaginal delivery, the role of the maneuver is undetermined and remains controversial. The aim of this study was to identify the prone factor of the use of uterine fundal pressure maneuver and to evaluate its obstetrical outcomes.

METHODS

All vaginal delivery records between 1 January 2005 and 30 April 2006 were evaluated. Maternal and neonatal variables and obstetrical complications were analyzed for subjects underwent uterine fundal pressure maneuver.

RESULTS

Six hundred sixty-one vaginal deliveries were evaluated. Fundal pressure maneuver was performed in 39 cases (5.9%, 95% CI 4.4-7.1). Primiparity (76.9 vs. 53.3%; odds ratio 2.92, 95% CI 1.36-6.25, P = 0.004), larger maternal body weight gain during pregnancy (11.16 +/- 0.4 kg vs. 10.05 +/- 0.16 kg, P = 0.013), and longer duration of labor (922.3 +/- 111.7 vs. 566.6 +/- 18.3 min, P = 0.003) were prone risk factors for the use of uterine fundal pressure maneuver at vaginal delivery. One case of shoulder dystocia following uterine fundal pressure maneuver was reported (2.5 vs. 0%). Episiotomy (76.9 vs. 44.9%, P < 0.001) and vacuum extraction (41.0 vs. 3.8%, P < 0.001) were frequently performed with uterine fundal pressure maneuver. Uterine fundal pressure maneuver increased the risk of severe perineal laceration (28.1 vs. 4.8%; odds ratio 2.71, 95% CI 1.03-7.15, P = 0.045). The risk of severe perineal laceration was synergistically increased with the concurrent use of uterine fundal pressure maneuver with vacuum extraction and episiotomy.

CONCLUSION

Uterine fundal pressure maneuver during the second stage of labor increased the risk of severe perineal laceration. The use of the maneuver must be cautioned and careful attention must be paid to its application.

摘要

目的

由于缺乏支持在阴道分娩中使用子宫底压力手法的证据，该手法的作用尚未确定，仍存在争议。本研究的目的是确定使用子宫底压力手法的倾向因素，并评估其产科结局。

方法

评估 2005 年 1 月 1 日至 2006 年 4 月 30 日期间所有阴道分娩记录。对接受子宫底压力手法的产妇和新生儿变量以及产科并发症进行分析。

结果

共评估了 661 例阴道分娩。39 例（5.9%，95%CI 4.4-7.1）行子宫底压力手法。初产妇（76.9%比 53.3%；优势比 2.92，95%CI 1.36-6.25，P=0.004）、孕期体重增加较多（11.16±0.4kg 比 10.05±0.16kg，P=0.013）、产程较长（922.3±111.7min 比 566.6±18.3min，P=0.003）是阴道分娩时使用子宫底压力手法的倾向风险因素。子宫底压力手法后发生 1 例肩难产（2.5%比 0%）。子宫底压力手法常与会阴切开术（76.9%比 44.9%，P<0.001）和真空吸引术（41.0%比 3.8%，P<0.001）联合应用。子宫底压力手法增加了严重会阴裂伤的风险（28.1%比 4.8%；优势比 2.71，95%CI 1.03-7.15，P=0.045）。子宫底压力手法与真空吸引术和会阴切开术同时应用时，严重会阴裂伤的风险呈协同增加。