【摘要】 目的探讨McRoberts法联合上推宫颈操作对活跃期产程停滞的作用。方法将2003年1月至2012年12月北京积水潭医院妇产科住院分娩的胎膜已破、因活跃期停滞而行阴道检查的足月单胎头位初产妇221例以随机数字法分为两组,采用McRoberts法行阴道检查及上推宫颈者为研究组(109例);采用膀胱截石位行相同操作者为对照组(112例)。观察两组孕妇阴道操作后1h宫颈扩张及胎先露下降情况及其分娩方式。结果研究组上推宫颈操作后宫颈扩张速度中位数为4cm/h,胎先露下降速度中位数为4cm/h,对照组分别为2cm/h和2cm/h,两组比较,差异均有统计学意义(P<0.001)。研究组自然分娩79例(72.5%),阴道助产6例(5.5%),对照组分别为60例(53.6%)和22例(19.6%),两组比较,差异均有统计学意义(P<0.05)。研究组剖宫产24例(22.0%),对照组30例(26.8%),两组比较,差异无统计学意义(P>0.05);但研究组手术分娩(剖宫产+产钳助产)30例(27.5%),对照组52例(46.4%),两组比较,差异有统计学意义(P<0.05)。研究组产后出血率(8.3%,9/109)明显低于对照组(20.5%,23/112;P<0.05)。结论 McRoberts法联合上推宫颈通过改变骨盆倾斜度,纠正胎头入盆姿势不良,达到缩短活跃期时间,降低手术分娩率和减少产后出血的作用。更多还原

【Abstract】 Objective To investigate the effects of McRoberts maneuver combined cervical push-up operation on active phase arrest. Methods 221 fetal membranes ruptured, cephalic, singleton, nulliparous women with active phase arrest who delivered during between January 2003 and December 2012 in Beijing Jishuitan Hospital were randomly allocated into two groups. 109 women underwent McRoberts maneuver combined cervical push-up operation were in the experimental group and 112 women received lithotomy position combined the same operation were in the control group. The cervical dilatation and presentation descent at an hour were observed and the mode of delivery were anylazed. Results The cervical dilatation rate (4 cm/h) and presentation descent rate (4 cm/h) in the experimental group were significantly faster than those in the control group (2 cm/h and 2 cm/h, P<0.001). Spontaneous vaginal delivery rate (72.5%) in the experimental group was higher than that in the control group (53.6%,P<0.05). Instrumental vaginal delivery rate (5.5%) and surgical delivery rate (27.5%) were markedly lower than those (19.6% and 46.4%, respectively) in the control group (P<0.05). Cesarean delivery rate was no difference between the two groups (P>0.05). Postpartum hemorrhage rate was lower in the experimental group than that in the control group (8.3% vs. 20.5%,P<0.05). Conclusion McRoberts maneuver combined cervical push-up operation can alter pelvic inclination, rectify adverse posture of fetal head entering pelvis, shorten abnormal labor course during active phase and reduce surgical delivery rate and postpartum hemorrhage rate.更多还原