摘要
Abstract
Objective To explore the application of restrictive episiotomy (RE) in vaginal delivery of macrosomia and to compare the maternal and neonatal results before and after RE.Methods A retrospective analysis was carried out on the clinical data of 533 cases of single macrosomia fetal through vaginal delivery from January 2013 to June 2015.The patients (n=295) with RE in vaginal delivery were taken into observation group, and the patients ( n =238 ) who did not take RE were in control group.Two groups were compared in maternal and neonatal outcomes.Results There were no significant differences in second stage of labor, intraoperative bleeding volume, and bleeding volume 2h after delivery between two groups (t value was 1.458, 0.457 and 0.512, respectively, all P>0.05).The rate of episiotomy in the observation group was 62.04%(183/295), which was lower than that in the control group (76.89%, 183/238) (χ2 =24.236, P<0.01).There was no significant difference in the incidence of perineal laceration and perineum complete rate (χ2 value was 4.379 and 2.901, respectively, both P>0.05).In the observation group maternal pelvic floor muscle strength was slightly poorer than that in the control group, but two groups were not significantly different in type I muscle fibers strength and type II muscle fiber strength (χ2 value was 2.568 and 1.296, respectively, both P>0.05).No severe asphyxia was found in either group, and there were 6 mild cases (2.03%) and 5 mild cases (2.10%) of asphyxia in the observation group and the control group, respectively.Two cases (0.07%) of birth trauma (brachial plexus injury and fracture of clavicle) were found in the observation group and 2 cases (0.08%) in the control group.Comparing the incidence of mild asphyxia and birth trauma in two groups, the complications in the observation were slightly fewer than the control group, but the difference was not significant (χ2 value was 4.560 and 5.112, respectively, both P>0.05).Conclusion RE will not increase the incidence of severe perineal laceration and neonatal asphyxia among macrosomia delivery, and the stage of labor will not extend.In the process of macrosomia delivery through vaginal delivery, dynamic, continuous and accurate assessments should be made both for mothers and neonates.Under the condition of ensuring safety of mother and neonates, experienced midwives should try to reduce the rate of perineal incision.关键词
限制会阴切开/巨大儿/自然分娩/会阴切开率Key words
limited episiotomy/macrosomia/natural childbirth/episiotomy rate分类
医药卫生
