Head-to-head dystocia means dystocia with head first, which is more than 2/3 of the total dystocia. Timely detection and correct treatment of dystocia in the first position are the key to reducing the incidence of perinatal mothers and infants. Proper yang clinical nursing treatment can effectively reduce maternal and infant injuries. From January to December 2010, our hospital timely intervened and nursed pregnant women who may cause dystocia in the head, which effectively prevented the occurrence of dystocia in the head and reduced cesarean section. The birth rate and the occurrence of maternal and child complications have improved the quality of obstetrics. The martyrdom is as follows.
Objects and methods
1.1 General Information
From January to December 2010, there were 1,563 women who delivered in our hospital, and 282 cases of dystocia in the head position occurred, accounting for 15.7% of the total number of births in the head. From gestational week 38-41 to week, there were 257 primiparous women and 25 perinatal women.
The mothers who have a threat of dystocia in the first place analyze and compare the various factors such as the inducement of dystocia in the first place, intervention methods, delivery methods and newborn scores. The maternal delivery score can be used to evaluate the fetal position, pelvis, contractions, and fetal size of the mother during the delivery. ζ 8 points, cesarean delivery I ;; .. 9 points, according to the specific circumstances of the mother given artificial rupture of the membrane, intravenous diazepam, intravenous infusion of low-dose oxytocin and other treatments. For lateral occipital or posterior occipital fetal spine lying on the same side or correct fetal position, cervical closure, etc. by hand when appropriate
Intervene in a timely manner. Trial production is 2-4 hours. Finally, the delivery method is selected according to the labor curve, head position score, and fetal heart rate. At the same time, personalized care is performed according to the patient's situation. Create a good delivery environment for the parturient mothers, instruct the mothers on the correct delivery position and hold their breath after using the uterine opening. Use abdominal pressure to encourage the mothers to eat and pay attention to rest to maintain adequate physical strength and energy. Give play to the role of the head nurse in the communication between doctors and patients. The head nurse should take the initiative to introduce the midwifery staff, the environment and equipment of the delivery room and the delivery room to the mother and her family members, and explain the natural birth process and benefits, so that the mother has a preliminary rationality. Recognizing and building confidence in natural childbirth also reassures family members of patients.
1.3 Determination method of fetal position
A vaginal examination is performed every 4h during the incubation period, and a vaginal examination is performed every 2h during the active parturition period. An artificial rupture of the fetal membrane is not performed, and a B-mode ultrasound examination is performed with an unclear fetal position, and timely intervention and observation of abnormal fetal position are performed. .
1.4 Observation indicators
A special person observes the progress of the birth process, records the correction of the abnormal fetal position, records the birth process time, the delivery mode and vaginal bleeding, the cervix enlargement and the presence or absence of edema, fetal heart monitoring, amniotic fluid, postpartum hemorrhage, cervical laceration and newborn Child situation. Newborns were assigned Apgar scores. The calculation method of 24h postpartum hemorrhage is the special dressing and blood volume used within 24h after giving birth, and the maternal vital signs are observed at the same time.
1.5 Statistical methods
The SPSSI 3.0 statistical software package was used, t-test was used for measurement data, and i-test was used for count data. P <0.05 was considered statistically significant.
2.1 Birth patterns and causes of dystocia in the head
2.2 The relationship between delivery mode and fetal position during delivery
Among the 282 cases of dystocia in the head position, the abnormal fetal head position was 213. Among the 68 cases of cesarean delivery, 20 (29.4%) had a continuous lateral occipital position, and 38 (55.9%) had a continuous posterior occipital position. 5 cases (7.4%) showed a high upright position, 4 cases (5.9%) showed an uneven frontal position, 1 case (1.5%) showed a face position, and 102 cases of fetal head attraction showed that 74 cases (72.5%) were persistent. In the horizontal occipital position, 28 cases (27.5%) showed a persistent posterior occipital position. Among 43 cases of natural delivery, 27 (62.8) showed a continuous lateral occipital position, and 16 cases (37.2%) showed a continuous posterior occipital position. 203 cases of abnormal occipital lateral and posterior occipital abnormalities accounted for 72.0% of total dystocia in the head position, which is the main cause of dystocia in the head position. Among them, 144 cases of vaginal delivery, accounting for 70.9%, can be seen The posterior occipital position is not an indication for cesarean section. Ten cases of severe fetal head position abnormalities, such as high upright position, forward uneven position, and face position, accounted for 3.5%, which was significantly lower than domestic reports, which was related to our lack of understanding and led to missed diagnosis.
3.1 Reasons for head position dystocia
There are many unknown risk factors for head delivery, such as pelvic abnormalities, abnormal fertility, and abnormal fetal position. The formation of dystocia in the head position is intricate and complicated. In clinical practice, there are several factors that coexist and interact with each other, rarely caused by a single factor. Abnormal fetal position and abnormal soft birth canal are often accompanied by uterine weakness. The birth canal is an invariant factor in childbirth. Fertility, fetus, and psycho-psychological factors are variable and can affect each other. Pregnant women are over-stressed, causing cerebral cortical dysfunction, reduced sleep, insufficient bladder filling, inadequate eating after childbirth, excessive physical exertion, and water and electrolyte disturbances, which can lead to contraction weakness, and also promote maternal neuroendocrine changes and sympathy. Nerve excitement, release of catechin, increase in blood pressure, cause fetal ischemia and hypoxia, and intrauterine distress. 4]. The main reason for dystocia in the head position is the increased resistance of the birth canal. The resistance comes from the cephalopelvic disparity caused by abnormal fetal head and birth canal, and the increase in resistance can lead to abnormal productivity and dystocia. In addition, there are umbilical cord factors, such as the umbilical cord around the neck, the umbilical cord is too short, which affects the decline of the fetal head, causing fetal distress.
3.2 Timely intervention countermeasures for dystocia in head position
Caesarean section, forceps, and fetal head suction are common delivery methods. Head dystocia should be carefully selected, neither early intervention nor loss of time. Necessary trial production and corresponding treatment should be performed. Comprehensive analysis can determine the best choice. Way to end childbirth. The main experience is as follows: ① Maintain effective regular contractions during the incubation period after giving birth, and give intravenous injection of diazepam to observe the dilatation of the uterine orifice and the decline of the fetal head. If the trial production fails, consider cesarean section. If the double apical diameter is located in the flat ischial spine Even if the uterine opening is full, it is not easy to decide to assist the delivery through perineal surgery to avoid greater damage to the newborn. ② The abnormality in the active period plays an important role in the entire labor process. If there is stagnation or prolongation, immediately check the position of the fetal head, estimate the relationship between the fetus and the pelvis, and timely find the pelvic disproportion. Conditions, to create conditions for vaginal delivery, if there is no progress in the labor process, cesarean delivery should be performed. ③ The choice of vaginal midwifery surgery methods. After trial delivery, the uterine opening is full, and the fetal skull quality has fallen below the spine. Fetal forceps or fetal head suction can be used. ④ Correcting the position of the fetal head should be the most important measure to prevent dystocia in the head position. In addition, pregnant women should be given reasonable nutritional guidance to avoid excessive nutrition and appropriate activities to reduce the incidence of gigantic children.
Therefore, through early estimation, early diagnosis, and careful observation during the delivery process, timely treatment measures can clearly reduce the incidence of perinatal dystocia in the perinatal period, and timely nursing intervention can effectively improve the clinical efficacy and reduce the number of mothers. Infant damage. It is of great significance to reduce maternal and infant injuries and improve perinatal outcomes.