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她凌晨生出8斤的孩子，会阴却裂伤严重，产科医生：3招预防裂伤

发布日期：2024-09-02 23:57:24编辑：胖虎爱撩妹

凌晨六点，产房外的太阳已悄悄爬起，散落在窗户上星星点点，街道上也开始有了生活气息，汽车的鸣笛声、菜摊上的吆喝声、路过的笑声……仿佛新的一天，都充满了生机盎然。可产房内的我们还在“战斗”，灯火通明，这个黑夜还没过去，她依然在使劲用力，我们在给她加油鼓劲。
 
她是凌晨三点半住院的准妈妈，当时我刚上手术室准备做剖宫产术，给她检查的是产房助产师，电话汇报情况是：一胎，41周，胎心正常，宫口扩张1公分，让我安心做完手术再来看她。
 
 
 
等手术结束已四点四十分，去待产室看她，已经痛得“哇哇哇”大喊了，赶紧给她进行了检查，宫口扩张6公分，看肚型及摸胎头，估算这胎儿较大，至少有8斤重，而且她下面看起来及感觉明显是生过孩子，并不是“传说中”的一胎。经过严查，原来在她20岁那时，她为前男友生过一个孩子，出生体重5.8斤，但因为感情不合分手了，孩子由男方抚养。现除了她丈夫知道这个情况外，其他家属不知道，她希望我们为她保密。
 
了解情况后，我们紧急将她推进产房，但考虑胎儿过大，建议她做手术结束妊娠，因为巨大儿阴道试产，可能会因为生不出来而剖，也可能会发生严重的阴道裂伤，或者胎儿出生后因为窒息需要抢救等风险。最后，她和家属都表示愿意承担这些风险，坚决拒绝手术，要求顺产。
 
我们留她老公在产房陪产，让其他家属在产房外等待。五点那时宫口开全，但胎头比较高，只能让她反复用力：蹬脚、提水动作、头部微抬、吸气憋气呼气。可由于胎儿过大，用力的时间比普通的经产妇要长，会阴也渐渐水肿。尽管我们做好了会阴侧剪及保护会阴的准备，终于在六点十二分顺利娩出一活男婴，重约8斤，但会阴裂伤严重，已达三度！
 
 
 
综上所述，造成她会阴严重裂伤的因素有两个：胎儿过大、会阴水肿导致阴道组织弹性差。
 
其实，在顺产过程中，会阴裂伤是比较常见的情况，但多数是轻度裂伤，很少会像她一样裂伤严重，直接裂到肛门括约肌。若缝合不好，很容易导致排便失禁、或影响她以后的夫妻生活。这也是为什么准妈妈们都惧怕生孩子的原因之一啊，除了宫缩痛还有这裂伤痛、缝合痛！
 
为什么顺产时会 “会阴裂伤”呢？
 
小小的通道，大大的能力，但它有时也会很脆弱。还没生过孩子的人很难想象，这阴道出口就如筷子般大小，胎宝宝的头却比饭碗还大，到底是怎么通过呢？这功劳可要归于准妈妈的体内激素，随着孕周增长，准妈妈的生产通道，如宫颈、阴道、外阴受到激素的刺激，会逐渐变得柔软而富有弹性。在分娩时，这些通道便可扩张到原来数十倍的宽度，让胎宝宝顺利通过出生。
 
正常情况下，如果准妈妈的产道、会阴弹性好的话，顺产时往往不会裂伤。但如果准妈妈的产道弹性差、胎头很大、或者胎儿出来的速度过急过快，产道还来不及充分扩张时胎儿就出来，那很有可能就会导致阴道、会阴和肛门括约肌的撕裂。
 
 
 
会阴裂伤有轻重之分
 
在临床上，我们会根据裂伤程度，分为四个等级：
 
I度会阴裂伤：会阴部皮肤及阴道入口黏膜裂伤，少量出血。
 
Ⅱ度会阴裂伤：会阴部皮肤、阴道黏膜及肌肉层裂伤，虽解剖结构难于辨认，但肛门括约肌是完整的，出血量较多。
 
Ⅲ度会阴裂伤：会阴部皮肤、阴道黏膜及肌肉层裂伤、肛门括约肌完全裂伤，但直肠黏膜尚完整，出血量多。
 
Ⅳ度会阴裂伤：指肛门、直肠和阴道完全贯通，直肠肠腔外露，组织损伤严重，但出血量可不多。
 
对于一般的I度、Ⅱ度轻度裂伤，经过缝合后及产后注意卫生，会完全恢复；而如果是Ⅲ度、Ⅳ度重度裂伤，缝合的难度比较大，需要重新构建解剖结构，恢复的时间相对来说就比较长，缝合后也有可能会出现阴道直肠瘘的并发症需要进行第二次手术缝合。
 
 
 
但准妈妈们放心，为了避免你在生产时出现严重裂伤，我们医护人员会尽力保护好你的会阴，也会采取措施，如提前进行侧剪，预防撕裂严重。
 
准妈妈该如何预防会阴裂伤的发生呢？
 
1、孕期控制胎儿体重
 
在我们传统的观念中，胎宝宝出生时体重越重越健康，就如前面案例中的她，为了让宝宝长体重，她每天逼自己吃下两个鸡蛋，一杯牛奶，三餐供应肉类，少量进食蔬菜水果。没想到，生的时候却受累了，使劲全力把宝宝生出来，自己却裂伤严重！所以，准妈妈孕期一定要均衡饮食，在医生的指导下合理控制胎儿体重增长。
 
2、增加会阴肌肉弹性
 
会阴肌肉有弹性，可塑性就强，生产时发生撕裂的情况也会减少。准妈妈可在孕期多进行憋尿动作，即在无尿欲感时进行憋尿，锻炼盆底肌肉，提高弹性。到了孕晚期，也可用精油或茶油按摩会阴部，注意动作宜轻柔。
 
3、分娩时配合医护人员的指导用力
 
分娩时都会有医生或助产士陪护，教你何时用力，该怎么用力。如果用力不当，只会是浪费体力，还会造成宫颈或会阴水肿，往往会增加会阴裂伤、会阴侧剪和剖宫产的风险。所以，准妈妈们在分娩时一定要配合医护人员的指导用力。
 
生一个健康的孩子本就不容易，让准妈妈受尽了孕期的早孕反应、腰酸背痛、腿抽筋、失眠等煎熬，终于等来了瓜熟蒂落的一天，还要被宫缩痛、撕裂痛、缝合痛折磨。所以，为了分娩时可以少受点痛苦，准妈妈们可要记住曾医生说的三个预防会阴裂伤的秘笈哦，愿你顺利生出宝宝后会阴仍完美无缺！
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