Koyucu Refika Genç, Demirci Nurdan
University of Beykent, Institute of Health Science, Department of Maternity and Gynecology Nursing, Istanbul, Turkey.
University of Marmara, Institute of Health Science, Department of Maternity and Gynecology Nursing, Istanbul, Turkey.
Taiwan J Obstet Gynecol. 2017 Oct;56(5):606-612. doi: 10.1016/j.tjog.2017.02.005.
Spontaneous pushing is a method that is used in the management of the second stage of labor and suggested to be more physiological for the mother and infant. The present study aims to evaluate the effects of pushing techniques on the mother and newborn.
This randomized prospective study was performed between June 2013-March 2014 in a tertiary maternity clinic in Istanbul. 80 low risk, nulliparous cases were randomized to pushing groups. Valsalva pushing group was told to hold their breath while pushing. No visual-verbal instructions were given to spontaneous pushing group and they were encouraged to push without preventing respiration. Demographic data, second stage period, perineal laceration rates, fetal heart rate patterns, presence of meconium stained amniotic liquid, newborn APGAR scores, POP-Q examination and Q-tip test results were evaluated in these cases.
The second stage of labor was significantly longer with spontaneous pushing. Decrease in Hb levels in valsalva pushing group was determined to be higher than spontaneous pushing group. An increased urethral mobility was observed in valsalva pushing group.
Although the duration of the second stage of labor was longer compared to valsalva pushing technique, women were able to give birth without requiring any verbal or visual instruction, without exceeding the limit value of two hours and without affecting fetal wellness and neonatal results.
自然屏气用力是一种用于分娩第二产程管理的方法,被认为对母婴更为生理。本研究旨在评估屏气用力技术对母亲和新生儿的影响。
本随机前瞻性研究于2013年6月至2014年3月在伊斯坦布尔的一家三级妇产诊所进行。80例低风险初产妇被随机分为屏气用力组。瓦萨尔瓦屏气用力组被告知在用力时屏住呼吸。自然屏气用力组未给予视觉-语言指导,鼓励他们在不阻碍呼吸的情况下用力。对这些病例的人口统计学数据、第二产程时间、会阴裂伤率、胎儿心率模式、羊水胎粪污染情况、新生儿阿氏评分、盆腔器官脱垂定量(POP-Q)检查和棉签试验结果进行了评估。
自然屏气用力时第二产程明显更长。确定瓦萨尔瓦屏气用力组血红蛋白水平的下降高于自然屏气用力组。在瓦萨尔瓦屏气用力组观察到尿道活动度增加。
尽管与瓦萨尔瓦屏气用力技术相比,第二产程时间更长,但女性能够在无需任何语言或视觉指导的情况下分娩,不超过两小时的限值,且不影响胎儿健康和新生儿结局。