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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)
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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。

关键词: 自然分娩, 产后期, 旋后肩法, 肩难产, 肌收缩, 骨盆底肌, 肌电描记术, 产妇
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.

Key words: Natural childbirth, Postpartum period, Posterior shoulder rotation method, Shoulder dystocia, Muscle contraction, Pelvic floor muscle, Electromyography, Parturient
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)
组别 例数 身高(m) 体重(kg) 分娩孕龄(周) 分娩年龄(岁) BMI(kg/m2)
研究组 28 1.61±0.06 65.2±6.5 39.9±1.3 28.2±4.0 25.3±2.2
对照组 25 1.59±0.06 63.6±5.3 39.7±0.9 27.3±3.9 25.0±1.2
t值   0.611 0.940 0.319 0.613 0.261
P值   0.438 0.337 0.574 0.437 0.612
表2 2组肩难产产妇分娩新生儿结局比较
组别 例数 出生体重(g，±s) 巨大儿[例数(%)]
研究组 28 3 940±160 11(39.3)
对照组 25 4 000±140 12(48.0)
检验值   t＝1.896 χ2＝0.408
P值   0.175 0.523
表3 2组肩难产产妇盆底表面肌电图检测结果比较(μV，±s)
组别 例数 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 耐力肌收缩最大值 耐力肌收缩平均值 后基线值
研究组 28 1.4±0.3 23.8±5.5 19.9±3.4 17.2±2.9 17.5±3.1 13.7±3.0 1.3±0.3
对照组 25 1.3±0.3 20.6±4.4 17.7±3.3 14.2±4.1 16.3±3.6 11.8±3.4 1.1±0.3
t值   4.815 5.371 5.738 9.253 1.803 5.095 4.701
P值   0.033 0.025 0.020 0.004 0.185 0.028 0.035
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