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中华妇幼临床医学杂志(电子版)

Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition) ›› 2015, Vol. 11 ›› Issue (05): 640 -643. doi: 10.3877/cma.j.issn.1673-5250.2015.05.019

Special Issue: ；

Original Article

Effects of free position during delivery on maternal and perinatal outcomes

Hongyu Li1, Qing Chang1(), Dan Wang1   

  1. 1. Department of Obstetrics and Gynecology, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
  • Received:2015-05-06 Revised:2015-08-16 Published:2015-10-01
  • Corresponding author: Qing Chang
  • About author:
    Corresponding author: Chang Qing, Email:
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Objective

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

Methods

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.

Results

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).

Conclusions

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

Key words: Body position, Delivery process, Perinatal care
表1 两组一般情况比较(±s)
组别 例数 年龄(岁) 孕龄(孕周) 新生儿出生体质量(g)
研究组 480 26.6±3.3 38.3±1.4 3 041±398
对照组 480 27.7±3.5 38.1±2.0 3 078±389
t值   1.80 0.80 0.64
P值   >0.05 >0.05 >0.05
表2 两组产妇分娩方式比较[例数(%)]
组别 例数 阴道顺产 阴道助产 中转行剖宫产
研究组 480 422(87.9) 6(1.2) 52(10.8)
对照组 480 284(59.2) 36(7.5) 160(33.3)
χ2值   10.26 5.11 8.67
P值   <0.01 <0.05 <0.01
表3 两组阴道分娩产妇各产程持续时间比较(min，±s)
组别 例数 第一产程 第二产程 第三产程 总产程
研究组 428 488.3±147.8 30.5±16.6 7.4±3.1 536.7±159.4
对照组 320 643.6±133.6 58.6±13.2 7.1±3.4 662.6±161.5
t值   4.73 3.62 0.63 3.87
P值   <0.01 <0.01 >0.05 <0.01
表4 两组新生儿的分娩结局比较(±s)
组别 例数 新生儿生后1 min Apgar评分(分) 新生儿1 min窒息发生率[例数(%)]
正常 轻度窒息 重度窒息
研究组 428 9.7±0.4 422(98.6) 5(1.2) 1(0.2)
对照组 320 9.2±0.3 296(92.5) 21(6.6) 3(0.9)
t值/χ2值   0.48   6.43  
P值   >0.05   <0.05  
组别 新生儿生后5 min Apgar评分(分) 新生儿5 min窒息发生率[例数(%)]
正常 轻度窒息 重度窒息
研究组 9.8±0.3 428(100.0) 0(0.0) 0(0.0)
对照组 9.8±0.2 314 (98.1) 5(1.6) 1(0.3)
χ2值 0.64   5.07  
P值 >0.05   <0.05  
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