论 著

    作者单位: 1. 重庆医科大学附属第一医院妇产科,重庆

    400016; 2.重庆医科大学附属第二医院妇产科 ,重庆 400010

    E2 mail : qihongbo@sina . com

    文章编号: 1005 - 2216 (2006) 02 - 0102 - 04

    持续性枕后位的临床特点及分娩方式选择

    漆洪波1

    , 孙江川2

    , 李 莉1

    , 张建华1

    【摘 要 】 目的 探讨持续性枕后位的临床特点及分娩方式。方法 采用回顾性分析方法 ,对 1998年 1月至

    2004年 12月在重庆医科大学两所附属医院住院分娩的 112例持续性枕后位 (枕后位组 )和 112例枕前位 (枕前

    位组 )的临床资料进行分析 ,比较两组产程情况、 分娩方式及母儿结局。结果 两组头位分娩评分、 第一产程、 第

    二产程及总产程时间比较 ,差异有显著性意义 ( P < 0105)。枕后位组产钳助产、 剖宫产、 会阴裂伤、 产后出血、 胎

    儿窘迫、 新生儿窒息率等均明显高于枕前位组 ,差异均有显著性意义 (P < 0105)。枕后位组宫口扩张及胎头下降

    延缓和第二产程延长的发生率均高于枕前位组 ,差异均有显著性意义 ( P < 0105)。剖宫产组宫口扩张延缓、 胎头

    下降停滞和第二产程延长的发生率明显高于阴道分娩组 ( P < 0105)。而剖宫产组和阴道分娩组骨盆临界狭窄、潜伏期及活跃期延长的发生率比较 ,差异无显著性意义 (P > 0105)。结论 持续性枕后位导致母儿并发症增加 ,及时处理并选择最佳分娩方式可减少母儿并发症的发生。

    【关键词 】 难产;枕后位 ,持续性; 分娩

    中图分类号: R71 文献标识码:A

    The cl i n i ca l character isti cs andmode of del i very of occ iput poster i or positi on. Q i Hongbo3 , Sun J iangchuan,L i L i , et al . Depart m ent of Obstetrics and Gynecology, the First Aff iliated Hospital of Chongqing Univer sity ofM edical

    Sciences, Chongqing 400016, China

    Abstract Objecti ve To investigate the clinical characteristics and modes of delivery in patientswith persistent occi put

    posteri or positi on . Methods A t otal of 112 p ri mi para with fetus in a persistent occi put posteri or positi on and 112 p ri mi p2

    ara with fetus in a occi put anteri or positi on from Jan . 1998 t o Dec . 2004 were analyzed retr os pectively in the t wo affiliated

    hos p itals of ChongqingMedicalUniversity . The labor course , mode of delivery and maternal2 neonatal comp licati onswere

    compared bet ween the t wo gr oup s . Results Significant differenceswere found in the delivery score of apholic positi on,first, second stage and t otal labor durati on bet ween the t wo group s ( P < 0105) . The occurrences of forcep s delivery, ce2

    sarean secti on, perineal tear, post partum haemorrhage, fetal distress and birth as phyxia were significantly higher in per2

    sistent occi put posteri or positi on as compared with those in occi put anteri or positi on ( P < 0105) . Compared with the oc2

    ci put anteri or positi on, there were significant differences in the incidences of p rotracted active phase dilatati on, p r otracted

    descent and p rol onged second2stage in persistent occi put posteri or positi on ( P < 0105) . Compared with the cesarean sec2

    ti on, there were significant differences in the incidences of p r otracted active phase dilatati on, arrest of descent and p ro2

    l onged second2stage in the vaginal delivery ( P < 0105) . There were no significant differences in the rates of critical con2

    tracted pelvis, p r ol onged latent phase and active phase bet ween cesarean secti on and vaginal delivery in the occi put poste2

    ri or positi on ( P > 0105) . Conclusi on Persistent occi put posteri or positi on can lead t o higher incidence of comp licati ons

    in both mother and fetus . Better p r ognosismay be achieved by early treat ment and selecting the bestmode of delivery .

    Keywords Dyst ocia;Occi put posteri or positi on, Persistent ;Delivery

    枕后位是常见的头位异常 ,其发生率为 6%～41% ,其

    中 60%转为枕前位[ 1 ]。第二产程枕后位的发生率为 4%～

    10% ,正确处理第二产程枕后位有助于改善母婴预后[ 2 ]。

    本文对 112例持续性枕后位的临床资料进行回顾性分析 ,探讨持续性枕后位不同分娩方式及对母儿的影响。

    1 资料与方法

    111 研究对象 1998年 1月至 2004年 12月在重庆医科

    大学两所附属医院分娩孕妇 13476例 ,选择持续性枕后位

    112例作为研究对象 (枕后位组 ) ,年龄平均 ( 2816 ±417)

    · 201 · 中国实用妇科与产科杂志 2006年 2月 第 22卷 第 2期

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