切换至 "中华医学电子期刊资源库"

中华妇幼临床医学杂志(电子版) ›› 2021, Vol. 17 ›› Issue (03) : 355 -359. doi: 10.3877/cma.j.issn.1673-5250.2021.03.018

论著

旋后肩法处置肩难产对产妇分娩后盆底肌功能改善的临床研究
吴嘉涵(), 尤爱军, 宋燕   
  • 收稿日期:2020-11-08 修回日期:2021-03-17 出版日期:2021-06-01
  • 通信作者: 吴嘉涵

Effects of pelvic floor muscle function improvement of shoulder dystocia parturients by posterior shoulder rotation

Jiahan Wu(), Aijun You, Yan Song   

  • Received:2020-11-08 Revised:2021-03-17 Published:2021-06-01
  • Corresponding author: Jiahan Wu
  • Supported by:
    2019 Medical and Health Research Project of Zhejiang Province(2019ZH008)
引用本文:

吴嘉涵, 尤爱军, 宋燕. 旋后肩法处置肩难产对产妇分娩后盆底肌功能改善的临床研究[J]. 中华妇幼临床医学杂志(电子版), 2021, 17(03): 355-359.

Jiahan Wu, Aijun You, Yan Song. Effects of pelvic floor muscle function improvement of shoulder dystocia parturients by posterior shoulder rotation[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2021, 17(03): 355-359.

目的

探讨旋后肩法用于肩难产产妇,对其产后盆底肌功能的改善作用。

方法

选择2018年7月至2020年1月,在宁波市妇女儿童医院采用旋后肩法完成肩难产助产的28例产妇为研究对象,并纳入研究组。选取同期在本院分娩,采用耻骨联合上加压法完成肩难产助产的25例产妇纳入对照组。采用表面肌电图(sEMG),获取2组产妇分娩8周后盆底肌收缩运动肌电值。采用成组t检验,对2组产妇一般临床资料、盆底sEMG检测结果进行统计学分析。采用χ2检验,对2组产妇分娩巨大儿所占比例等进行统计学分析。本研究遵循的程序符合病例收集医院伦理委员会制定的伦理学标准,得到该委员会批准[审批文号:[2018]伦审字(28)号]。与所有受试者签署临床研究知情同意书。

结果

①2组产妇身高、体重,分娩时人体质量指数(BMI)、孕龄、年龄等一般临床资料比较,差异均无统计学意义(P>0.05)。②2组产妇分娩新生儿的出生体重和巨大儿所占比例分别比较,差异亦均无统计学意义(P>0.05)。③研究组产妇前基线值、快肌收缩最大值、混合肌收缩最大值、混合肌收缩平均值、耐力肌收缩平均值、后基线值分别为(1.4±0.3) μV、(23.8±5.5) μV、(19.9±3.4) μV、(17.2±2.9) μV、(13.7±3.0) μV、(1.3±0.3) μV,均超过对照组的(1.3± 0.3) μV、(20.6±4.4) μV、(17.7±3.3) μV、(14.2±4.1) μV、(11.8±3.4) μV、(1.1±0.3) μV,并且差异均有统计学意义(P<0.05)。而2组产妇耐力肌收缩最大值比较,差异无统计学意义(P>0.05)。

结论

旋后肩法用于肩难产产妇助产,较传统耻骨联合上加压法,可改善产妇产后短期内的盆底肌功能。

Objective

To evaluate effects of pelvic floor muscle function improvement of shoulder dystocia parturients after midwifery by posterior shoulder rotation.

Methods

A total of 28 parturients who were treated by posterior shoulder rotation maneuver during shoulder dystocia in Ningbo Women and Children Hospital were enrolled into study group from July 2018 to January 2020. Meanwhile, another 25 parturients who were treated by suprapubic pressure method during shoulder dystocia delivery in the same hospital were enrolled into control group. By surface electromyography (sEMG) technique, electromyographic parameters of pelvic floor muscle of parturients between two groups were recorded in 8 weeks after delivery. Independent-samples t test was used to compare general clinical data and electromyographic parameters between two groups. And chi-square test was used to analyze the difference between two groups in proportion of macrosomia, etc.. The study procedures obeyed the ethic rules established by the Ethics Committee of cases collection hospital and was approved by this Ethics Committee (Approval No.[2018] 28). All the patients enrolled submitted written informed consent.

Results

①There were no significant differences between two groups in general clinical data, including maternal height, weight, body mass index (BMI), gestational age, and age(P>0.05). ②There were no significant differences between two groups in neonatal birth weight, and the proportion of macrosomia (P>0.05). ③The data of pre-baseline rest, maximum level of rapid contractions, maximum level of tonic contractions, mean level of tonic contractions, mean level of endurance contractions, and post-baseline rest in study group were (1.4±0.3) μV, (23.8±5.5) μV, (19.9±3.4) μV, (17.2±2.9) μV, (13.7±3.0) μV, and (1.3± 0.3) μV, respectively, much higher than those(1.3±0.3) μV, (20.6±4.4) μV, (17.7±3.3) μV, (14.2±4.1) μV, (11.8±3.4) μV, and (1.1±0.3) μV, respectively in control group (P<0.05). There was no significant difference between two groups at maximum level of endurance contractions (P>0.05).

Conclusions

Comparing with treatment by suprapubic pressure during shoulder dystocia delivery, treatment by posterior shoulder rotation maneuver could be good for improvement of pelvic floor muscle function of parturients in short-term postpartum.

图1 旋后肩法胎头和胎肩旋转方向示意图
表1 2组肩难产产妇一般临床资料比较(±s)
表2 2组肩难产产妇分娩新生儿结局比较
表3 2组肩难产产妇盆底表面肌电图检测结果比较(μV,±s)
[1]
Robinson R, Walker KF, White VA, et al. The test accuracy of antenatal ultrasound definitions of fetal macrosomia to predict birth injury: a systematic review[J]. European J Obstet Gynecol Reprod Biol, 2020, 246(1): 79-85. DOI: 10.1016/j.ejogrb.2020.01.019.
[2]
Santos P, Hefele JG, Ritter G, et al. Population-based risk factors for shoulder dystocia[J]. J Obstet Gynecol Neonatal Nurs, 2018, 47(1): 32-42. DOI: 10.1016/j.jogn.2017.11.011.
[3]
Pahlitzsch T, Hanne L, Henrich W, et al. Influence of foetal macrosomia on the neonatal and maternal birth outcome[J]. Geburtshilfe Frauenheilkd, 2019, 79(11): 1191-1198. DOI: 10.1055/a-0880-6182.
[4]
何玉甜,陈敦金. 肩难产的诊断与治疗[J]. 中华妇产科杂志2015, 50(1): 64-66. DOI: 10.3760/cma.j.issn.0529-567x.2015.01.016.
[5]
Lopez E, de Courtivron B, Saliba E. Neonatal complications related to shoulder dystocia[J]. J Gynecol Obstet Biol Reprod (Paris), 2015, 44(10): 1294-1302. DOI: 10.1016/j.jgyn.2015.09.049.
[6]
Dahlke JD, Bhalwal A, Chauhan SP. Obstetric emergencies: shoulder dystocia and postpartum hemorrhage[J]. Obstet Gynecol Clin North Am, 2017, 44(2): 231-243. DOI: 10.1016/j.ogc.2017.02.003.
[7]
Galbiatti JA, Cardoso FL, Galbiatti M. Obstetric paralysis: who is to blame? A systematic literature review[J]. Rev Bras Ortop (Sao Paulo), 2020, 55(2): 139-146. DOI: 10.1055/s-0039-1698800.
[8]
Doty MS, Chauhan SP, Chang KW, et al. Persistence and extent of neonatal brachial plexus palsy: association with number of maneuvers and duration of shoulder dystocia[J]. AJP Rep, 2020, 10(1): e42-42e48. DOI: 10.1055/s-0040-1705140.
[9]
Poujade O, Azria E, Ceccaldi PF, et al. Prevention of shoulder dystocia: a randomized controlled trial to evaluate an obstetric maneuver[J]. Eur J Obstet Gynecol Reprod Biol, 2018, 227: 52-59. DOI: 10.1016/j.ejogrb.2018.06.002.
[10]
漆洪波,余昕烊. 重视肩难产的防治[J]. 中华妇产科杂志2015, 50(1):9-11. DOI: 10.3760/cma.j.issn.0529-567x.2015.01.003.
[11]
FG Cunningham, KJ Leveno, S Bloom, et al. Williams obstetrics [M]. 23th ed. US: McGraw-Hill Companies, Inc, 2010: 484.
[12]
尤爱军. 旋后肩法在肩难产处理中的应用[J]. 中华护理杂志201550(11): 1318-1321. DOI:10.3761/j.issn.0254-1769.2015.11.007.
[13]
Savas M. Shoulder dystocia: incidence, mechanisms, and management strategies[J]. Int J Womens Health, 2018, 10: 723-732. DOI: 10.2147/IJWH.S175088.
[14]
Scharschmidt R, Derlien S, Siebert T, et al. Intraday and interday reliability of pelvic floor muscles electromyography in continent woman[J]. Neurourol Urodyn, 2020, 39(1): 271-278. DOI: 10.1002/nau.24187.
[15]
Gei AF, Mastache JS, Pacheco LD, et al. The carit maneuver: a novel approach for the relief of shoulder dystocia-a case series[J]. AJP Rep, 2020, 10(2): e133-133e138. DOI: 10.1055/s-0040-1708498.
[16]
Sentilhes L, Sénat MV, Boulogne AI, et al. Shoulder dystocia: guidelines for clinical practice from the French College of Gynecologists and Obstetricians (CNGOF)[J]. Eur J Obstet Gynecol Reprod Biol, 2016, 203: 156-161. DOI: 10.1016/j.ejogrb.2016.05.047.
[17]
Meghan G Hill, Wayne R Cohen. Shoulder dystocia: prediction and management[J]. Womens Health (Lond), 2016, 12(2): 251-261. DOI: 10.2217/whe.15.103.
[18]
American College of Obstetricians and Gynecologists. Practice bulletin No 178: shoulder dystocia[J]. Obstet Gynecol, 2017, 129(5): 123-133. DOI: 10.1097/AOG.0000000000002043.
[19]
Pimentel-Soares I, Sartorato Beleza AC, da Silva Corrêa M, et al. Long-term effect of first childbirth on pelvic floor muscle function: cross-sectional study[J]. Clin Exp Obstet Gynecol, 2019, 46(4): 630-634. DOI: 10.1111/ajo.12948.
[20]
Hannan-Leith MN, Dayan M, Hatfield G, et al. Is pelvic floor sEMG a measure of women′s sexual response?[J]. J Sex Med, 2019, 16(1): 70-82. DOI: 10.1016/j.jsxm.2018.10.013.
[21]
Bocardi D, Pereira-Baldon VS, Ferreira C, et al. Pelvic floor muscle function and EMG in nulliparous women of different ages: a cross-sectional study[J]. Climacteric, 2018, 21(5): 462-466. DOI: 10.1080/13697137.2018.1453493.
[22]
Navarro Brazález B, Sánchez Sánchez B, Prieto Gómez V, et al. Pelvic floor and abdominal muscle responses during hypopressive exercises in women with pelvic floor dysfunction[J]. Neurourol Urodyn, 2020, 39(2): 793-803. DOI: 10.1002/nau.24284.
[23]
Oleksy , Wojciechowska M, Mika A, et al. Normative values for Glazer Protocol in the evaluation of pelvic floor muscle bioelectrical activity[J]. Medicine (Baltimore), 2020, 99(5): e19060. DOI: 10.1097/MD.0000000000019060.
[24]
谢幸,孔北华,段涛. 妇产科学[M]. 9版. 北京:人民卫生出版社,2018.
[25]
Desseauve D, Fradet L, Gherman RB, et al. Does the McRoberts′ manoeuvre need to start with thigh abduction? An innovative biomechanical study[J]. BMC Pregnancy Childbirth, 2020, 20(1): 264. DOI: 10.1186/s12884-020-02952-6.
[1] 高艳多, 朱霞, 范建华, 戢秀勤, 赵胜, 谢磊. 产钳助产术后女性盆底机能的三维超声评估[J]. 中华医学超声杂志(电子版), 2022, 19(12): 1361-1365.
[2] 危玲, 李会, 陈奕. 孕产妇产超广谱β-内酰胺酶的肠杆菌定植/感染与母婴传播研究现状[J]. 中华妇幼临床医学杂志(电子版), 2023, 19(05): 517-521.
[3] 陈莉, 雷雪芹, 段炼, 曾悦, 何国琳. 影响2次剖宫产术后阴道试产产妇试产成功因素及妊娠结局分析[J]. 中华妇幼临床医学杂志(电子版), 2023, 19(03): 287-294.
[4] 吴晶晶, 胡倩, 李华凤. 围产期焦虑/抑郁与分娩疼痛相关性的研究现状[J]. 中华妇幼临床医学杂志(电子版), 2023, 19(02): 156-161.
[5] 赵春桃, 梁峰雪, 杨瑞敏, 陈云璇, 陈曦, 焦桂清. 三维盆底超声预测产妇发生盆腔脏器脱垂的价值及影响因素[J]. 中华妇幼临床医学杂志(电子版), 2022, 18(05): 606-614.
[6] 雍瑞欣, 柴红霞, 妥薇薇, 陈丹丹, 赵东荣. COVID-19疫情背景下围生期孕产妇抑郁情绪相关影响因素分析[J]. 中华妇幼临床医学杂志(电子版), 2022, 18(05): 591-598.
[7] 刘百岁, 倪霞, 王琴. 硬膜外分娩镇痛相关产时发热对母婴结局的影响[J]. 中华妇幼临床医学杂志(电子版), 2022, 18(05): 577-584.
[8] 朱丽丽, 李冰, 薛静, 于慧, 李淑红. 椎管内分娩镇痛对经阴道分娩初产妇产后早期盆底功能的影响[J]. 中华妇幼临床医学杂志(电子版), 2022, 18(04): 484-491.
[9] 魏佳文, 徐爱群. 肥胖症对孕产妇分娩镇痛及麻醉的影响[J]. 中华妇幼临床医学杂志(电子版), 2022, 18(03): 249-254.
[10] 李振华, 解宝江, 易为, 李丽, 卫雅娴, 周明书, 伊诺. 82例孕产妇对新型冠状病毒肺炎疫情防控认知的心理干预及常态化疫情防控应对要点[J]. 中华实验和临床感染病杂志(电子版), 2023, 17(03): 173-179.
[11] 吴玥琳, 欧泳琳, 肖海燕, 段业英, 陆翠薇, 李德阳, 王懿春, 唐灏珂. 危重症孕产妇的心理状况及其影响因素的调查[J]. 中华重症医学电子杂志, 2023, 09(02): 198-204.
[12] 肖海燕, 段业英, 吴玥琳, 伍丽婵, 唐灏珂. 神经学音乐治疗心搏骤停后缺血缺氧性脑病产妇一例[J]. 中华重症医学电子杂志, 2023, 09(02): 217-224.
[13] 杨晓光, 王玉妹, 王晓岩, 高婉丽, 王岩, 何璇, 刘海洋, 周建新. 5G+物联网冬奥会医疗保障指挥调度平台在危重孕产妇抢救中的应用展望[J]. 中华重症医学电子杂志, 2022, 08(03): 253-256.
[14] 汤宝鹏, 董震宇. 心肌收缩力调节器的最佳适应证人群选择[J]. 中华心脏与心律电子杂志, 2022, 10(03): 129-132.
[15] 麦憬霆, 周淑娴, 王景峰, 郑韶欣, 陈样新. 难治性心力衰竭患者植入心肌收缩力调节器一例[J]. 中华心脏与心律电子杂志, 2022, 10(03): 183-184.
阅读次数
全文


摘要