Pervin Jesmin, Aktar Shaki, Nu U Tin, Rahman Monjur, Rahman Anisur
International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b); Mohakhali, Dhaka 1212, Bangladesh.
International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b); Mohakhali, Dhaka 1212, Bangladesh.
Midwifery. 2018 Nov;66:30-35. doi: 10.1016/j.midw.2018.07.010. Epub 2018 Jul 29.
To evaluate the efficacy of care in the second stage of labour with a package of interventions that included (1) maintaining the birthing position according to the woman's choice, (2) adopting a spontaneous pushing technique and (3) using a support person, to reduce maternal and neonatal complications.
Used the data collected from two cohorts- before and after an initiative to improve care during the second stage of labour.
A rural hospital in Bangladesh where 90-100 deliveries are conducted monthly and cesarean section provision is not available.
One thousand and fifty-one singleton pregnancies who attended the hospital for giving birth in the first stage of labour before full dilatation of the cervix and with cephalic presentation.
Data were collected through a structured checklist and questionnaire completed by research assistants; and also retrieved from hospital case record files, and the ongoing demographic surveillance system database. Coverage of adopting the upright or lateral position in the post-intervention period increased to 76% from about 1% in the pre-intervention period, and the spontaneous pushing technique increased to 97% from 77% in the same period. The odds of combined maternal and neonatal complications decreased by 46% between pre- and post-intervention periods (odds ratio: 0.54, 95% confidence interval: 0.43-0.70). Frequency of episiotomy (from 43% to 29%, P < 0.001), cervical tear (3.8% to 1.5%, P = 0.02), and median blood loss (200 ml to 150 ml; P < 0.001) were reduced significantly in the same period. No significant associations were observed in perineal tear or birth asphyxia occurrences.
The study suggests that there is a beneficial effect of care during the second stage of labour with a package of interventions in reducing maternal and neonatal complications, particularly in reducing the frequency of episiotomy, cervical tear, and blood loss during delivery. The preferred choice of posture during giving birth, adopting a spontaneous pushing technique and continuous presence of support person during the second stage of labour may be encouraged for better health outcomes.
评估一套包括以下内容的干预措施在第二产程护理中的效果：（1）根据产妇选择保持分娩体位；（2）采用自然推娩技术；（3）使用陪产人员，以减少母婴并发症。
利用从两个队列收集的数据——一项旨在改善第二产程护理的举措实施前后的数据。
孟加拉国的一家乡村医院，该医院每月进行90 - 100例分娩，不提供剖宫产服务。
1051名单胎妊娠产妇，她们在宫颈未完全扩张且为头位时进入医院进入第一产程待产。
数据通过研究助理填写的结构化检查表和问卷收集；也从医院病例记录文件以及正在使用的人口监测系统数据库中获取。干预后采用直立或侧卧位的比例从干预前的约1%增至76%，同期自然推娩技术的比例从77%增至97%。干预前后母婴并发症合并发生率降低了46%（优势比：0.54，95%置信区间：0.43 - 0.70）。同期，会阴切开术发生率（从43%降至29%，P<0.001）、宫颈撕裂发生率（从3.8%降至1.5%，P = 0.02）和平均失血量（从200ml降至150ml；P<0.001）均显著降低。会阴撕裂或出生窒息发生率未观察到显著关联。
该研究表明，一套干预措施在第二产程护理中对减少母婴并发症有有益效果，特别是在降低会阴切开术、宫颈撕裂和分娩时失血的发生率方面。为获得更好的健康结局，可鼓励在分娩时优先选择姿势、采用自然推娩技术并在第二产程期间持续有陪产人员在场。
