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目的:比较腹部横切口剖宫产术中娩头困难时的两种处理方法。方法:对照组28例行两侧弧形延长子宫切口或子宫下段纵横互补式切开法,切断部分腹直肌,摇高手术床头20度,助手以适当力量向下推压宫底,使胎儿耳朵位于或接近切口,术者右手托住胎头,左手牵拉切口上缘助胎头娩出。观察组33例采用双叶小产钳助产,方法与阴道产钳相同,查清胎方位后,在子宫壁与胎头之间置入左叶产钳在胎头左侧,置右叶产钳于胎头右侧,放正扣合产钳,合拢钳柄。助手按压宫底,扣合后向母体下肢方向牵拉,当胎头移至子宫切口时,改为向上提取,继而娩出胎头。结果:观察组仅有2例新生儿轻度窒息,无重度窒息,1例子宫切口裂伤;对照组有8例新生儿窒息,其中2例重度窒息,有7例子宫切口裂伤。观察组33例中,22例枕横位、9例枕前位、2例枕后位,其中31例产钳一次性放置成功,2例放置2次,均一次牵引成功,无1例滑脱。有2例新生儿面部淤血,无新生儿头颅骨折及颅内血肿。结论:在剖宫产娩头困难时迅速果断应用双叶小产钳助产,可以明显减少母婴并发症。
OBJECTIVE: To compare the two methods of treatment when the head of the cesarean section in abdominal transverse incision is difficult. Methods: The control group of 28 patients underwent both sides of the elongated uterine incision or uterine segment of the vertical and horizontal complementary incision, cut off part of the rectus abdominis, shaking the bed head 20 degrees, the assistant with the appropriate force down the bottom of the palace Fetal ear at or near the incision, the surgeon right hand care of fetal head, left hand incision on the edge of the fetal head was delivered. The observation group of 33 cases with double-leaf forceps midwifery, vaginal forceps and the same method, check the fetus position, between the uterine wall and the fetal head into the left lobe forceps in the left fetal head, right lobe forceps in the fetal head On the right, put the buckle forceps, close the clamp handle. Assistant press the palace bottom, after the pull to the direction of maternal lower limbs, when the fetal head moved to the uterine incision, instead of upward extraction, and then delivered the fetal head. Results: In the observation group, there were only 2 neonates with mild asphyxia without severe asphyxia and 1 case with laceration of the uterine incision. In the control group, 8 neonates with asphyxia were asphyxiated, 2 of them were asphyxiated, and 7 had laceration of the uterine incision. Among the 33 cases in the observation group, 22 cases were occipital transverse, 9 cases were anterior occipital, and 2 cases were posterior occiput. Among them, 31 cases were placed in one-off forceps and 2 cases were placed in 2 cases. There are 2 cases of neonatal facial congestion, no newborn skull fracture and intracranial hematoma. Conclusions: The rapid and decisive application of double-leaf forceps in the delivery of cesarean delivery head decidua can significantly reduce maternal and infant complications.