Increasing rates of cesarean section, as high as 50% in some countries in Latin America, compared with the US and the rest of the world, demand a closer analysis of its causes and implications. The significant morbidi...Increasing rates of cesarean section, as high as 50% in some countries in Latin America, compared with the US and the rest of the world, demand a closer analysis of its causes and implications. The significant morbidity for both mother and baby associated with cesarean section requires immediate action from national and international societies to confront the situation with specific solutions, including patient education. We recommend a consensus meeting of Latin American ACOG (American College of Obstetricians and Gynecologists) section members to address the issue and to consider adopting guidelines based on evidence and reflecting the realities of the countries involved.展开更多
Background： The cesarean section rate （CSR） bas been a main concern worldwide. The present study aimed to investigate the CSR in Beijing, China, and to analyze the related lactors of CS delivery. Methods： An obser...Background： The cesarean section rate （CSR） bas been a main concern worldwide. The present study aimed to investigate the CSR in Beijing, China, and to analyze the related lactors of CS delivery. Methods： An observational study was conducted in 15 medical centers in Beijing using a systemic cluster sampling naethod. In total, 15, 194 pregnancies were enrolled in the study between ,lune 20, 2013 and November 30, 2013. Independent t-tests and Pearson＇s Chi-square test were nsed to examine differences between two groups, and related factors of the CSR were examined by multivariable logistic regression. Results： The CSR was 41.9% （4471/10,671） in singleton primiparae. Women who were more than 35 years old had a 7.4-fold increased risk of CS delivery compared with women 〈25 years old （odd ratio [OR] 7.388, 95% confidence interval [Cl] = 5.561-9.816, P 〈 0.001 ）. Prepregnancy obese women had a 2-1bid increased risk of CS delivery compared with prepregnancy normal weight women （OR = 2.058. 95% CI = 1.640-2.584, P〈 0.001 ）. The excessive weight gain group had a 1.4-fold increased risk of CS delivery compared with the adequate weight gain group （OR 1.422, 95% CI = 1.289 1.568, P〈 0.001 ）. Gestational diabetes mellitus （GDM） women and DM women had an increased risk of CS delivery （ 1.2- and 1.7-fold, respectively） compared with normal blood glucose women. Women who were born in rural areas had a lower risk of CS delivery than did those who were born in urban areas （OR 0.696, 95% CI = 0.625-0.775, P 〈 0.001 ）. The risk of CS delivery gradually increased with a decreasing education level. Neonates weighing 3000-3499 g had the lowest CSR （36.2%）. Neonates weighing 〈2500 g had a 2-fold increased risk of CS delivery compared with neonates weighing 3000 3499 g （OR - 2.020, 95% CI=1.537 2.656, P 〈 0.001 ）. Neonates weighing ≥4500 g had an 8.3-fold increased risk of CS delivery compared with neonates weighing 3000-3499 g （OR = 8.313.95% CI= 4.436-15.579, P 〈 0.001）. Conclusions： Maternal age, prepregnancy body mass index, geslational weight gain, blood glncose levels, residence, education level, and singleton fetal birth weight arc all factors that might significantly affect the CSR.展开更多
背景自“全面二孩”政策实施后,经产妇为主要分娩人群,高龄、慢性合并症、产科并发症、剖宫产术后再次妊娠等问题日渐突出,给产科工作者带来新的挑战。目的基于修正版Robson分类系统对新生育政策下经产妇的剖宫产现状进行分析,为合理控...背景自“全面二孩”政策实施后,经产妇为主要分娩人群,高龄、慢性合并症、产科并发症、剖宫产术后再次妊娠等问题日渐突出,给产科工作者带来新的挑战。目的基于修正版Robson分类系统对新生育政策下经产妇的剖宫产现状进行分析,为合理控制剖宫产率、提高产科医疗质量提供数据支持。方法纳入2017—2020年在南方医科大学第十附属医院剖宫产分娩的产妇共19170例,分为初产妇组(n=5630)和经产妇组(n=13540)。通过电子病历系统收集产妇信息,包括年龄、孕产次、既往分娩情况、胎方位、妊娠合并症及并发症、产妇结局及新生儿结局等,并对两组产妇的一般资料、产妇结局及新生儿结局进行比较。采用修正版Robson分类系统,根据产科特征(产次、胎位、胎儿数量、分娩孕周)对产妇进行分类,对比两组在修正版Robson分类系统中的分布及各组占比随年度变化情况。结果经产妇中剖宫产后再次妊娠的比例高达81.4%(11026/13540);经产妇组的年龄、孕次、产次及年龄≥35岁、妊娠合并糖尿病比例均高于初产妇组(P<0.05)。修正版Robson分类在所有剖宫产产妇中,以R3类(妊娠≥37周单胎头位,至少有1次剖宫产史)为主(50.4%,9668/19170),其次为R1类(妊娠≥37周单胎头位初产,自然临产、诱导临产或临产前剖宫产)(20.8%,3993/19170);经产妇中,R3类的占比最高达71.4%(9668/13540)。分析经产妇人群特征发现,2017—2020年,占比最高的R3类产妇从73.5%下降至67.1%,而R2类[妊娠≥37周单胎头位经产(无剖宫产史),自然临产、诱导临产或临产前剖宫产]、R8类[所有妊娠<37周单胎头位(包括有剖宫产史)]的占比均有所升高。经产妇组产后24 h出血量、输血比例高于初产妇组,而术后住院天数低于初产妇组(P<0.05)。19170例产妇共分娩新生儿20026名例,其中初产妇分娩6077例,经产妇分娩13949例;经产妇组新生儿出生体质量、1 min Apgar评分高于初产妇组新生儿,而1 min Apgar评分≤7分、转新生儿科比例低于初产妇组新生儿(P<0.05);两组产妇剖宫产新生儿5 min Apgar评分比较,差异无统计学意义(P>0.05)。结论高龄和剖宫产术后再次妊娠是经产妇的突出特征。R3类的占比虽然逐年下降,但仍是剖宫产经产妇的主要人群,为降低剖宫产率,需有效控制初次分娩剖宫产,并在安全的前提下积极推广R3类产妇经阴道试产。同时,经产妇中R2类和R8类的占比有所升高,对产科临床实践提出了新的要求。展开更多
Objective:To analyze the effect of midwife psychological nursing intervention in the clinical care of elderly women in labor.Methods:According to the order of admission,74 elderly women were divided into the control g...Objective:To analyze the effect of midwife psychological nursing intervention in the clinical care of elderly women in labor.Methods:According to the order of admission,74 elderly women were divided into the control group and the observation group.In addition to the routine perinatal nursing interventions,the observation group strengthened the implementation of midwives’psychological nursing interventions.The duration of labor,mode of delivery,psychological state,and stress response indexes of the two groups were analyzed and compared.Results:The observation group had a shorter duration of all labor stages and total duration of labor than the control group,a lower cesarean section rate than the control group,and a higher degree of improvement in anxiety,depression,and stress response indexes in the 3-day postpartum period as compared to the control group(P<0.05).Conclusion:The implementation of midwife psychological care intervention in perinatal care of elderly women can further shorten the duration of labor,reduce the cesarean section rate,and improve the psychological state and stress indicators,which is worth promoting.展开更多
文摘Increasing rates of cesarean section, as high as 50% in some countries in Latin America, compared with the US and the rest of the world, demand a closer analysis of its causes and implications. The significant morbidity for both mother and baby associated with cesarean section requires immediate action from national and international societies to confront the situation with specific solutions, including patient education. We recommend a consensus meeting of Latin American ACOG (American College of Obstetricians and Gynecologists) section members to address the issue and to consider adopting guidelines based on evidence and reflecting the realities of the countries involved.
文摘Background： The cesarean section rate （CSR） bas been a main concern worldwide. The present study aimed to investigate the CSR in Beijing, China, and to analyze the related lactors of CS delivery. Methods： An observational study was conducted in 15 medical centers in Beijing using a systemic cluster sampling naethod. In total, 15, 194 pregnancies were enrolled in the study between ,lune 20, 2013 and November 30, 2013. Independent t-tests and Pearson＇s Chi-square test were nsed to examine differences between two groups, and related factors of the CSR were examined by multivariable logistic regression. Results： The CSR was 41.9% （4471/10,671） in singleton primiparae. Women who were more than 35 years old had a 7.4-fold increased risk of CS delivery compared with women 〈25 years old （odd ratio [OR] 7.388, 95% confidence interval [Cl] = 5.561-9.816, P 〈 0.001 ）. Prepregnancy obese women had a 2-1bid increased risk of CS delivery compared with prepregnancy normal weight women （OR = 2.058. 95% CI = 1.640-2.584, P〈 0.001 ）. The excessive weight gain group had a 1.4-fold increased risk of CS delivery compared with the adequate weight gain group （OR 1.422, 95% CI = 1.289 1.568, P〈 0.001 ）. Gestational diabetes mellitus （GDM） women and DM women had an increased risk of CS delivery （ 1.2- and 1.7-fold, respectively） compared with normal blood glucose women. Women who were born in rural areas had a lower risk of CS delivery than did those who were born in urban areas （OR 0.696, 95% CI = 0.625-0.775, P 〈 0.001 ）. The risk of CS delivery gradually increased with a decreasing education level. Neonates weighing 3000-3499 g had the lowest CSR （36.2%）. Neonates weighing 〈2500 g had a 2-fold increased risk of CS delivery compared with neonates weighing 3000 3499 g （OR - 2.020, 95% CI=1.537 2.656, P 〈 0.001 ）. Neonates weighing ≥4500 g had an 8.3-fold increased risk of CS delivery compared with neonates weighing 3000-3499 g （OR = 8.313.95% CI= 4.436-15.579, P 〈 0.001）. Conclusions： Maternal age, prepregnancy body mass index, geslational weight gain, blood glncose levels, residence, education level, and singleton fetal birth weight arc all factors that might significantly affect the CSR.
文摘背景自“全面二孩”政策实施后,经产妇为主要分娩人群,高龄、慢性合并症、产科并发症、剖宫产术后再次妊娠等问题日渐突出,给产科工作者带来新的挑战。目的基于修正版Robson分类系统对新生育政策下经产妇的剖宫产现状进行分析,为合理控制剖宫产率、提高产科医疗质量提供数据支持。方法纳入2017—2020年在南方医科大学第十附属医院剖宫产分娩的产妇共19170例,分为初产妇组(n=5630)和经产妇组(n=13540)。通过电子病历系统收集产妇信息,包括年龄、孕产次、既往分娩情况、胎方位、妊娠合并症及并发症、产妇结局及新生儿结局等,并对两组产妇的一般资料、产妇结局及新生儿结局进行比较。采用修正版Robson分类系统,根据产科特征(产次、胎位、胎儿数量、分娩孕周)对产妇进行分类,对比两组在修正版Robson分类系统中的分布及各组占比随年度变化情况。结果经产妇中剖宫产后再次妊娠的比例高达81.4%(11026/13540);经产妇组的年龄、孕次、产次及年龄≥35岁、妊娠合并糖尿病比例均高于初产妇组(P<0.05)。修正版Robson分类在所有剖宫产产妇中,以R3类(妊娠≥37周单胎头位,至少有1次剖宫产史)为主(50.4%,9668/19170),其次为R1类(妊娠≥37周单胎头位初产,自然临产、诱导临产或临产前剖宫产)(20.8%,3993/19170);经产妇中,R3类的占比最高达71.4%(9668/13540)。分析经产妇人群特征发现,2017—2020年,占比最高的R3类产妇从73.5%下降至67.1%,而R2类[妊娠≥37周单胎头位经产(无剖宫产史),自然临产、诱导临产或临产前剖宫产]、R8类[所有妊娠<37周单胎头位(包括有剖宫产史)]的占比均有所升高。经产妇组产后24 h出血量、输血比例高于初产妇组,而术后住院天数低于初产妇组(P<0.05)。19170例产妇共分娩新生儿20026名例,其中初产妇分娩6077例,经产妇分娩13949例;经产妇组新生儿出生体质量、1 min Apgar评分高于初产妇组新生儿,而1 min Apgar评分≤7分、转新生儿科比例低于初产妇组新生儿(P<0.05);两组产妇剖宫产新生儿5 min Apgar评分比较,差异无统计学意义(P>0.05)。结论高龄和剖宫产术后再次妊娠是经产妇的突出特征。R3类的占比虽然逐年下降,但仍是剖宫产经产妇的主要人群,为降低剖宫产率,需有效控制初次分娩剖宫产,并在安全的前提下积极推广R3类产妇经阴道试产。同时,经产妇中R2类和R8类的占比有所升高,对产科临床实践提出了新的要求。
文摘Objective:To analyze the effect of midwife psychological nursing intervention in the clinical care of elderly women in labor.Methods:According to the order of admission,74 elderly women were divided into the control group and the observation group.In addition to the routine perinatal nursing interventions,the observation group strengthened the implementation of midwives’psychological nursing interventions.The duration of labor,mode of delivery,psychological state,and stress response indexes of the two groups were analyzed and compared.Results:The observation group had a shorter duration of all labor stages and total duration of labor than the control group,a lower cesarean section rate than the control group,and a higher degree of improvement in anxiety,depression,and stress response indexes in the 3-day postpartum period as compared to the control group(P<0.05).Conclusion:The implementation of midwife psychological care intervention in perinatal care of elderly women can further shorten the duration of labor,reduce the cesarean section rate,and improve the psychological state and stress indicators,which is worth promoting.
