分娩第二阶段使用的手动会阴保护和推挤技术对会阴结局的影响：策略组合的随机对照试验
Effects of manual perineal protection and pushing techniques used in the second stage of labor on perineal outcomes: a randomized controlled trial of combinations of strategies.
作者信息
Genç Koyucu Refika, Ketenci Gencer Fatma, Bilici Sema Rumeysa
机构信息
Department of Midwifery, Istinye University, Istanbul, Türkiye.
, Topkapı Campus, Maltepe Mah., Edirne Çırpıcı Yolu, No. 9, Istanbul, Türkiye.
出版信息
BMC Pregnancy Childbirth. 2025 Jun 19;25(1):671. doi: 10.1186/s12884-025-07564-6.
BACKGROUND
Manual perineal protection and pushing techniques can impact the incidence of perineal trauma. Limited data exist on the impact of combinations of management strategies employed during the second stage of labor on perineal outcomes. The objective of this study was to evaluate the combined impact of interventional and relatively more spontaneous techniques employed during the second stage of labor on perineal outcomes.
MATERIALS AND METHODS
This randomized controlled study was carried out in the maternity clinic of a state hospital. Low-risk, term nulliparous women with vertex presentation upon admission to the delivery unit were included in the study. The participants in the study were randomly assigned to either the hands-on perineal protection and directed pushing group or the hands-poised perineal protection and coached pushing group at the onset of the second stage of labor. The frequencies of episiotomy and perineal injury were the primary outcomes of the study. The secondary outcomes included maternal satisfaction, breastfeeding, Apgar scores, perineal muscle function and perineal pain scores, and the amount of postpartum hemorrhage.
RESULTS
The frequency of episiotomy was significantly lower in the hands-poised-undirected pushing group than in the hands-on-coached pushing group (RR: 0.65, 95% CI: 0.44-0.98, P = 0.04). The frequency of first-degree perineal injury was significantly greater in the hands-poised - undirected pushing group than in the hands-on-directed pushing group (RR: 2.04, 95% CI: 1.06-3.90, P = 0.02). The frequencies of second-degree and higher perineal injuries were similar between the groups. No significant differences were observed between the groups in terms of secondary outcomes.
CONCLUSIONS
Second-stage management strategies with fewer interventions can be used to reduce the frequency of episiotomy. Both hands-on directed pushing and hands-poised undirected pushing combinations for second-stage management exhibit similar frequencies of intact perineum.
TRIAL AND PROTOCOL REGISTRATION
Clinical Trials; ID: NCT04823598; Date: 25.03.2021; URL: https://clinicaltrials.gov/study/NCT04823598 .
背景
手动会阴保护和推挤技术会影响会阴创伤的发生率。关于分娩第二阶段采用的管理策略组合对会阴结局的影响，现有数据有限。本研究的目的是评估分娩第二阶段采用的干预性和相对更自然的技术对会阴结局的综合影响。
材料与方法
本随机对照研究在一家州立医院的产科诊所进行。纳入分娩单元入院时为低风险、足月、初产且头先露的女性。研究参与者在分娩第二阶段开始时被随机分配到手动会阴保护并指导推挤组或双手准备会阴保护并指导推挤组。会阴切开术和会阴损伤的发生率是本研究的主要结局。次要结局包括产妇满意度、母乳喂养、阿氏评分、会阴肌肉功能和会阴疼痛评分以及产后出血量。
结果
双手准备无指导推挤组的会阴切开术发生率显著低于手动指导推挤组（RR：0.65，95%CI：0.44 - 0.98，P = 0.04）。双手准备无指导推挤组的一度会阴损伤发生率显著高于手动指导推挤组（RR：2.04，95%CI：1.06 - 3.90，P = 0.02）。两组间二度及以上会阴损伤的发生率相似。两组在次要结局方面未观察到显著差异。
结论
采用较少干预的第二阶段管理策略可用于降低会阴切开术的发生率。第二阶段管理中手动指导推挤和双手准备无指导推挤组合的会阴完整率相似。
试验与方案注册
临床试验；ID：NCT04823598；日期：2021年3月25日；网址：https://clinicaltrials.gov/study/NCT04823598 。
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