关键词: 硬膜外镇痛, 分娩体位, 开放声门, 第二产程, 产科护理

Abstract:

Objective To investigate the efficacy of combining the arched back position with the open glottis technique during the second stage of labor in primiparous women receiving epidural analgesia for childbirth，aiming to provide references for optimizing midwifery practices in China. Methods Using convenience sampling，200 primiparous women undergoing epidural analgesia for labor at a tertiary-level A obstetrics and gynecology hospital in Nanjing from June to September 2024 were enrolled. They were randomly assigned to an experimental group and a control group using a random number table，with 100 women in each group. The experimental group employed the arched back position combined with glottis opening during the second stage of labor，while the control group used the flexed-leg semi-recumbent position combined with traditional glottis closure. Differences between groups were compared regarding duration of the second stage of labor，episiotomy，severity of perineal lacerations，blood loss at 2 and 24 hours postpartum，mode of delivery，perineal edema，perineal pain intensity，and fatigue levels. Results Ultimately，98 cases in the experimental group and 95 cases in the control group completed the study. The second stage of labor duration in the experimental group was（35.08±10.55） min，lower than（47.72±12.49） min in the control group. The episiotomy rate was 13.27%，and the rate of second-degree perineal lacerations was 11.76%，both lower than 25.26% and 26.76% in the control group，respectively. Postpartum bleeding volumes at 2 hours and 24 hours were（281.56±62.33） mL and（330.97±63.08） mL，respectively，lower than（318.61±88.47） mL and（365.72±89.08） mL in the control group. The spontaneous delivery rate was 96.94%，higher than the control group at 87.37%. Perineal edema and pain intensity were lower than those in the control group. The Li Fatigue Scale score was（4.89±0.62） points，lower than（6.12±0.77） points in the control group. Comparisons between the 2 groups showed statistically significant differences（P<0.05）. Conclusion The use of the arched back position combined with the open glottis technique under epidural analgesia for labor can increase the rate of spontaneous vaginal delivery in primiparas，shorten the duration of the second stage of labor，reduce the severity of perineal injury and the volume of postpartum hemorrhage，and alleviate maternal fatigue.

Key words: Epidural Analgesia, Labor Position, Open-Glottis Pushing, Second Stage of Labor, Obstetric Nursing