探讨自由体位分娩对母婴围生期结局的影响。

回顾性分析2013年5月至2014年5月于第三军医大学第一附属医院产科住院分娩的960例低危、足月初产妇的临床病历资料为研究对象。按照随机数字表法，将其分为研究组(n＝480)和对照组(n＝480)。研究组产妇于第一产程取自由体位待产，第二产程取胱截石位加床头抬高(30°～45°)分娩。对照组产妇第一产程取仰卧位或侧卧位待产，第二产程取膀胱截石位分娩。比较两组产妇的分娩方式、会阴侧切率、各产程持续时间、经阴道分娩新生儿生后1，5 min Apgar评分和经阴道分娩新生儿生后1，5 min窒息发生率。本研究遵循的程序符合第三军医大学第一附属医院人体试验委员会所制定的伦理学标准，得到该委员会批准，征得受试对象本人及其家属的同意，并与之签署临床研究知情同意书。

①研究组产妇的阴道顺产率高于对照组(87.9% vs 59.2%)，但其阴道助产率和剖宫产率均低于对照组(1.2% vs 7.5%，10.8% vs 33.3%)，两组比较，差异均有统计学意义(χ²＝10.26，5.11，8.67；P<0.05)。②研究组产妇会阴侧切率为15.0%(64/428)，对照组为41.6%(133/320)，两组比较，差异有统计学意义(χ²＝893，P<0.01)。③研究组阴道分娩产妇的第一产程时间、第二产程时间及总产程时间均短于对照组[(488.3±147.8) min vs (643.6±133.6) min, (30.5±16.6) min vs (58.6±13.2) min, (536.7±159.4) min vs (662.6±161.5) min]，并且差异均有统计学意义(t＝4.73，3.62，3.87；P<0.05)。④研究组新生儿生后1 min和5 min窒息发生率均低于对照组，并且差异有统计学意义(χ²＝6.43，5.07；P<0.05)。研究组新生儿生后1 min和5 min Apgar评分均高于对照组，并且差异均无统计学意义(t＝0.48, 0.64；P>0.05)。

自由体位分娩可促进阴道分娩，减少医疗干预，利于母婴健康。

To investigate the effects of free position during delivery on maternal and perinatal outcomes.

Clinical data of 960 cases of low risk primiparas delivering in our labor room from May 2013 to May 2014 were retrospectively analyzed. All primiparas were randomly divided into study group (n=480) and control group (n=480). Primiparas in the study group were in free position during the first stage of labor and in bladder lithotomy position with semireclining position during the second stage of labor. Primiparas in the control group were in supine position or lateral position during the first stage of labor and in bladder lithotomy position during the second stage of labor. Delivery mode, episiotomy rate, time of birth process, Apgar score of newborns and incidence of neonatal asphyxia at 1, 5 min after birth were compared. This study followed the ethical standards set out by the human trial committee of the First Affiliated Hospital of Third Military Medical University. It was approved by the committee, with the consent of the subjects themselves and their families. Meanwhile, a clinical research informed consent was signed between us.

① Rate of vaginal delivery was higher in study group than that in control group (87.9% vs 59.2%), and episiotomy rate and cesarean section rate were lower in study group than those in control group (1.2% vs 7.5%, 10.8% vs 33.3%). There were statistically significant difference in these indexes between two groups (χ²=10.26, 5.11, 8.67; P<0.05). ② Episiotomy rate was 15.0% (64/428) in study group and 41.6% (133/320) in control group with statistically significant difference (χ²=893, P<0.01). ③ Duration of the first stage of labor, second stage of labor and total stage of labor were shorter in study group than those in control group with statistically significant difference [(488.3±147.8) min vs (643.6±133.6) min, (30.5±16.6) min vs (58.6±13.2) min, (536.7±159.4) min vs (662.6±161.5) min, t=4.73, 3.62, 3.87; P<0.05]. ④ Incidence of neonatal asphyxia at 1, 5 min after birth were lower in study group than those in control group with statistically significant difference (χ²=6.43, 5.07; P<0.05). Apgar score of newborns at 1, 5 min after birth were higher in study group than those in control group without statistically significant difference (t=0.48, 0.64; P>0.05).

Free position could promote natural delivery, reduce medical intervention and be good for maternal and fetal health.