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前臂主动娩出与二度会阴裂伤发生率：一项临床实践评估

Active delivery of the anterior arm and incidence of second-degree perineal tears: a clinical practice evaluation.

作者信息

Mottet Nicolas, Bonneaud Marine, Eckman-Lacroix Astrid, Ramanah Rajeev, Riethmuller Didier

机构信息

Department of Obstetrics and Gynecology- Besancon University Medical Center, CHRU Jean Minjoz, Alexander Fleming Boulevard, 25000, Besancon, France.

出版信息

BMC Pregnancy Childbirth. 2017 May 12;17(1):141. doi: 10.1186/s12884-017-1322-8.

DOI:10.1186/s12884-017-1322-8
PMID:28499362
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5429558/
Abstract

BACKGROUND

Evaluate the feasibility of active delivery of the anterior arm during spontaneous delivery. This maneuver could decrease incidence of second-degree perineal tears because it reduces fetal biacromial diameter.

METHODS

An observational comparative prospective study was conducted at our teaching maternity from July 2012 to March 2013. The study included 199 nulliparous women ≥18 years, who met the following criteria: singleton pregnancy, vaginal delivery with occiput anterior presentation, on epidural analgesia, from 37 weeks of gestation onward. The distribution of rate and type of perineal tears were compared between two groups: a non-exposed group and a group exposed to the maneuver.

RESULTS

A total of 101 patients were exposed to Couder's maneuver (CM) and 98 patients were not exposed. In the intervention group, 3 failures of the maneuver were reported. The maneuver was considered easy in 80% of cases, moderately easy in 12% and difficult in 8% of cases. There was a significant difference (p = 0.03) in the distribution of perineal tears between the two groups. There was a significant reduction (p < 0.001) in the number of second-degree perineal tears in the patients exposed to CM. There was no significant difference in the rate of anterior perineal trauma between the exposed and non-exposed arms.

CONCLUSIONS

CM in primiparous women at term is feasible with a low failure rate and influences the distribution of perineal tears by lowering second-degree perineal tears in a highly significant manner (p <0.01).

摘要

背景

评估自然分娩时主动娩出前肩的可行性。此操作可减小胎儿双肩径，从而降低二度会阴撕裂的发生率。

方法

2012年7月至2013年3月在我院教学产科进行了一项观察性比较前瞻性研究。该研究纳入了199名年龄≥18岁的初产妇，她们符合以下标准：单胎妊娠、枕前位阴道分娩、采用硬膜外镇痛、孕周≥37周。比较了两组会阴撕裂的发生率和类型分布：未暴露组和接受该操作的暴露组。

结果

共有101例患者接受了库德手法（CM），98例未接受。在干预组中，报告了3例该手法操作失败。80%的病例认为该手法操作容易，12%为中等容易，8%为困难。两组会阴撕裂的分布存在显著差异（p = 0.03）。接受CM的患者二度会阴撕裂的数量显著减少（p < 0.001）。暴露侧和未暴露侧的会阴前部创伤发生率无显著差异。

结论

足月初产妇采用CM是可行的，失败率低，且能显著降低二度会阴撕裂的发生率（p < 0.01），从而影响会阴撕裂的分布。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/001d/5429558/510b9e135aeb/12884_2017_1322_Fig6_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/001d/5429558/4000a931387a/12884_2017_1322_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/001d/5429558/51c9a0e2b5cd/12884_2017_1322_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/001d/5429558/1bbacbe3c887/12884_2017_1322_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/001d/5429558/6dc80304c611/12884_2017_1322_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/001d/5429558/073c9cac680c/12884_2017_1322_Fig5_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/001d/5429558/510b9e135aeb/12884_2017_1322_Fig6_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/001d/5429558/4000a931387a/12884_2017_1322_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/001d/5429558/51c9a0e2b5cd/12884_2017_1322_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/001d/5429558/1bbacbe3c887/12884_2017_1322_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/001d/5429558/6dc80304c611/12884_2017_1322_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/001d/5429558/073c9cac680c/12884_2017_1322_Fig5_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/001d/5429558/510b9e135aeb/12884_2017_1322_Fig6_HTML.jpg

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