Study On The Influence To The Mother And Neborn For Two Types Rupture Of Membranes Combined With Free Position For Delivery

Background:In1996World Health Organization (World Health Organization, WHO) in "normal childbirth care:Technical Work Report" proposed, the normal progress of labor, we should try to maintain the integrity of membranes, rather than the conventional give artificial rupture of membranes. Artificial rupture of membranes where there is sufficient evidence to prove its benefits when prudent measures taken. In our work in obstetrics, early conventional artificial rupture is widely used in the normal progress of labor, the emphasis on active labor intervention that artificial rupture of membranes can accelerate the progress of labor, reduce the rate of cesarean section.In order to prevent the rupture of the umbilical cord prolapse, placental abruption occurs, too much emphasis on the bed to be produced; while for a normal term fetal maternal and fetal head position has been convergence, artificial rupture of membranes, in under the normal birth process observation, fetal heart rate monitoring conditions to encourage women to take the comfort of their position in accordance with their wishes to be produced, advocating legislation, sitting, walking, squatting, lying, etc. upright position, either shorten the production process and improve the birth rate, and reducing the outflow of amniotic fluid, reduce maternal difficulty urinating, enhance comfort women. Purpose:In this study, single fetus, full-term pregnancy, cephalic select normal vaginal delivery Primipara Liberal position in the labor process, respectively, using artificial rupture of membranes, waiting for the two different membranes rupture ruptured natural ways to compare birth outcomes and their causes each labor time,2hours postpartum hemorrhage, meconium, neonatal and maternal conditions, etc., to investigate a safe, reliable and effective labor management.Methods:Collected in November2012in August2013in Jinan City, the maternity ward of a hospital to be produced, I want a low-risk vaginal delivery Primipara327cases for the study, excluding the use of oxytocin during childbirth drugs in7cases. Before enrollment were doing routine prenatal care, including routine obstetric examination, pelvic measurements, fetal heart rate monitoring, B-ultrasound, umbilical artery blood flow detection. Strict inclusion criteria, exclusion criteria, using a random number table will be included in the study were divided into two groups: artificial rupture of membranes group (152cases, excluding four cases) free-position expectant mothers, into the active phase of labor, when the cervix3cm experienced midwives give artificial rupture of membranes, pre-fetal interface to be produced after the rupture of the lateral position, the maternal fetal interface encourages the use of the comfort of their position, the free position to be produced; natural rupture group (168cases, excluding three cases) maternal Liberal position to be produced, the labor process as much as possible to keep intact membranes, waiting for natural membranes rupture. Birth outcomes and maternal reasons recorded were compared, each labor time,2h post-partum bleeding, meconium, neonatal and maternal and soData are expressed as mean±standard deviation form, two groups were compared using approximate Z test was used to compare the rate of chi-square test, amniotic degree level data using two frequency data sample Wilcoxon rank sum test to compare. With P<0.05was considered statistically significant.Results:1. Maternal, neonatal clinical data comparison Two women are at low risk primipara, maternal age, gestational age, birth weight showed no significant difference (P>0.05), good comparability between groups. Compare different ways rupture maternity outcomes2. Two types of rupture in way puerpera childbirth result comparison Artificial rupture in cesarean delivery rate was23.03%, the natural rupture in group of cesarean delivery rate was8.93%, artificial rupture in group cesarean section rate, higher birth outcomes similar between the two groups was statistically significant (P<0.05).3. Two types of rupture mode maternal vaginal delivery time for each stage of labor and postpartum hemorrhage compare2hTwo maternal vaginal delivery are natural childbirth, no forceps dystocia. Between the two groups, the first group, the average labor artificial rupture of membranes rupture naturally shorter than the group12.65min, the second stage of labor reduced by an average2.89min, an average reduction of only the third stage0.4min, the difference was not statistically significant (P>0.05),2h postpartum hemorrhage artificial rupture group, the average is less than the natural rupture group4.11ml, the difference was not statistically significant (P>0.05).4. Two types of rupture in reason to compare maternal cesarean delivery Artificial rupture in group with abnormal pillow bits, fetal distress, surgery after birth accounted for8.55%,8.55%respectively, and the proportion of natural rupture in group with abnormal pillow bits, fetal distress, surgery after birth accounted for2.38%,2.38%respectively, and the proportion of artificial rupture in group with abnormal pillow bits, fetal distress, surgery after birth ratio is higher, the difference was statistically significant (P<0.05). 5. Two types of maternal amniotic fluid pollution situation is rupture in wayMaternal amniotic fluid Ⅰ, Ⅱ, Ⅲ degrees of pollution, proportion of artificial rupture in group are2.63%,5.92%and2.63%respectively; Proportion of natural broken membrane group was3.57%,6.56%,2.38%, two groups of mothers with amniotic fluid Ⅱ degree of pollution, the largest proportion of both amniotic fluid Ⅲ degree pollution happens, but each index to compare the amniotic fluid pollution, there was no statistically significant difference (P>0.05).6. Two types of neonatal asphyxia by, rupture in comparison Artificial rupture and natural broken membrane group, two groups have neonatal asphyxia happens, respectively2.63%,7.74%, the difference was statistically significant (P<0.05). But two groups of asphyxia newborn are mild asphyxia, low Apgar score is6points,2cases with artificial rupture in group, natural broken3cases of membrane group, two groups had no cases of neonatal severe asphyxia and death.7. Two types of rupture in neonatal tumor production by comparison Artificial rupture and natural broken membrane group, two groups have the occurrence of neonatal tumor production, respectively,30.92%,10.71%, the difference was statistically significant (P<0.05). No cases of neonatal intracranial hemorrhage occurred in both groups.8. Two types of rupture in way puerpera childbirth complications Two groups of puerpera childbirth complications ratio are smaller, artificial rupture in groups and natural rupture in urinary retention cases occurred3cases,2cases espectively; The cervix edema happened cases respectively,3cases,2cases; Puerperal infection cases occurred in1case, respectively0cases; Postpartum hemorrhage in cases of0cases,1case respectively.Conclusion:1. The normal progress of labor during the birth process into an active period, when cervical dilation3cm artificial rupture of membranes, giving active intervention, the impact of the three labor was not statistically significant. 2. Into the active phase of labor, when the cervix3cm artificial rupture increases due to abnormal posterior position, fetal distress and the incidence of cesarean section.3. Into the active phase of labor, give artificial rupture of membranes significantly reduced the incidence of neonatal asphyxia when the cervix3cm, but all neonatal asphyxia lowest score of6points, easy recovery after ten minutes were rating10points. This difference was statistically significant, the clinical value if there is need for further research.4. Into the active phase of labor, the cervix give artificial rupture of membranes increases the incidence of neonatal tumors produced when opening3cm.