分娩期间水浸浴与传统分娩方式的母婴结局比较。
A comparison of maternal and neonatal outcomes between water immersion during labor and conventional labor and delivery.
作者信息
Liu Yinglin, Liu Yukun, Huang Xiuzhi, Du Chuying, Peng Jing, Huang Peixian, Zhang Jianping
机构信息
Department of Obstetrics and Gynecology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, No 107, Yanjiang West Road, Guangzhou, Guangdong 510120, China.
出版信息
BMC Pregnancy Childbirth. 2014 May 6;14:160. doi: 10.1186/1471-2393-14-160.
BACKGROUND
Water immersion during the first stage of labor can reduce the length of the first stage and epidural/spinal analgesia use; however, there is limited information regarding other outcomes. Our purpose was to compare maternal and neonatal outcomes of women who underwent water immersion during the first stage of labor with those who underwent conventional labor and delivery.
METHODS
Healthy primipara with singleton pregnancies and cephalic presentation were included in the study. Patients were allowed to choose water immersion during labor or conventional labor and delivery. For water immersion, the water temperature was maintained at 35-38°C and subjects left the tub on complete cervical dilatation. A visual analogue scale (VAS) was used to assess pain during labor. Other outcome measures included duration of labor, type of delivery, blood loss, pelvic floor dysfunction and symptoms of stress urinary incontinence (SUI) at 42 days after delivery, infant Apgar scores, and need for transfer of the infant to the neonatal intensive care unit.
RESULTS
Thirty eight subjects (mean age, 28.66 ± 3.08 y) received water immersion and 70 (mean age, 27.89 ± 2.99 y) underwent conventional labor and delivery. There were no differences in maternal height, weight, age, gestational age, gravidity, and newborn weight between the groups (all, p>0.05). VAS pain scores were significantly greater in the conventional labor group at 30 min and 60 min after a cervical dilatation of 3 cm (30 min: 10 [9, 10] vs. 6 [5, 8]; 60 min: 10 [10, 10] vs. 7 [6, 8], respectively, both, p<0.001). The duration of labor and postpartum bleeding were similar between the groups (all, p>0.05). The cesarean section rate was higher in the conventional labor group (32.9% vs. 13.2%, p=0.026). The 1-minute and 5-minute Apgar scores were similar between the groups. Maternal and neonatal culture results were similar between the groups. SUI symptoms at 42 days after delivery was significantly higher in the conventional labor group (25.5% vs. 6.1%, respectively, p=0.035).
CONCLUSIONS
Water immersion can reduce labor pain, and is associated with a lower rate of cesarean delivery and SUI symptoms at 42 days.
背景
分娩第一产程中进行水浸浴可缩短第一产程时间并减少硬膜外/脊髓镇痛的使用；然而，关于其他结局的信息有限。我们的目的是比较在分娩第一产程中进行水浸浴的女性与进行传统分娩的女性的母婴结局。
方法
纳入单胎妊娠、头先露的健康初产妇。患者可选择分娩时水浸浴或传统分娩方式。对于水浸浴，水温维持在35 - 38°C，产妇在宫颈完全扩张时离开浴盆。采用视觉模拟评分法（VAS）评估分娩时的疼痛。其他结局指标包括产程时长、分娩方式、失血量、产后42天盆底功能障碍及压力性尿失禁（SUI）症状、婴儿阿氏评分以及婴儿转入新生儿重症监护病房的需求。
结果
38名受试者（平均年龄28.66 ± 3.08岁）接受水浸浴，70名（平均年龄27.89 ± 2.99岁）进行传统分娩。两组产妇的身高、体重、年龄、孕周、产次及新生儿体重均无差异（均p>0.05）。宫颈扩张3 cm后30分钟和60分钟时，传统分娩组的VAS疼痛评分显著更高（30分钟：10[9, 10] 对6[5, 8]；60分钟：10[10, 10] 对7[6, 8]，均p<0.001）。两组的产程时长和产后出血量相似（均p>0.05）。传统分娩组的剖宫产率更高（32.9%对13.2%，p = 0.026）。两组的1分钟和5分钟阿氏评分相似。两组的母婴培养结果相似。产后42天传统分娩组的SUI症状显著更高（分别为25.5%对6.1%，p = 0.035）。
结论
水浸浴可减轻分娩疼痛，并与较低的剖宫产率及产后42天的SUI症状相关。
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