Trial of Labour after Caesarean Section: A 5-Year Review

Background: Trial of labour after Caesarean section (TOLAC) refers to an attempt at vaginal delivery after a previous caesarean section. Outcome is influenced by a number of factors which are important in patient’s selection. Objectives: The aim of this study was to find out the incidence and feto-maternal outcome of the practice of Trial of labour after Caesarean section. Methodology: This is a retrospective study of cases of vaginal birth after Caesarean section Data were retrieved from the case notes of patients who attempted vaginal birth after Caesarean section from January 1, 2013 to December 31, 2017, a period of five years. Result: There were 10,669 deliveries, 3179 of which were through Caesarean section. This gave a Caesarean section rate of 29.8%. A total of 217 patients attempted vaginal birth after Caesarean section and 83 ended up as repeat Caesarean section (38.2%) while 138 (61.8%) had successful vaginal birth after Caesarean section. Patients with previous vaginal delivery, age range 25 - 29 years and interdelivery interval of greater than or equal to 2 years were more successful at achieving vaginal birth after Caesarean section. The leading indications for the repeat Caesarean section include cephalopelvic disproportion (45.8%), poor progress of labour (19.3%) and hypertensive disorders of pregnancy (8.4%). Conclusion: Vaginal birth after Caesarean section was successful in most of the parturients that attempted it in this study especially in patients within the age range of 25 - 29 years, those that have had previous vaginal delivery and with interdelivery interval of greater than or equal to 2 years.

Effect of Gum-Chewing after Cesarean Section on Gastrointestinal Function Recovery: A Systematic Review and Meta-Analysis of Randomized Trials

Objective: To evaluate the effect of chewing sugar-free gum on gastrointestinal function recovery after cesarean section. Methods: Randomized controlled trials comparing the use of chewing gum in postoperative recovery with a control group were retrieved from the databases including Pubmed, Cochrane Library, Science Direct, Web of Science, CBM, CNKI, Wanfang and VIP, et al. After screening literatures, evaluating the quality of studies, extracting data, the RevMan5.3 software was used for data analysis. Results: A total of 13 RCTs including 2233 patients were analyzed in the study. The results showed that chewing gum after cesarean delivery can effectively shorten the recovery time of bowel sounds, passage of flatus and first defecation (all P Conclusion: Chewing sugar-free gum after cesarean section can promote the early recovery of gastrointestinal function, but the side effects of chewing gum are still unclear, which needs more clinical, large sample and high-quality studies to further verify.

Vaginal Birth after a Cesarean Section at Good Shepherd Mission Hospital at Tshikaji in Democratic Republic of the Congo (DRC)

Background: The success rate of vaginal birth after cesarean section with a single cesarean scar is greater than 50%, the lack of the information about the safety of vaginal birth after cesarean delivery pushes most of obstetricians to increase the num ber of cesarean sections following a previous cesarean section. Guidelines for Vaginal birth after cesarean (VBAC) indicate that TOLAC offers women with no contraindications and one previous transverse low-segment cesarean. The objective of the current study was to study the outcome of trial of labour after caesarean section (TOLAC), the indications for emergency repeat cesarean section and to determine the maternal and fetal prognosis in vaginal birth after caesarian section (VBAC) at Tshikaji Mission Hospital. Patients, Material and Methods: This is a retrospective study of the records of 126 women were selected to undergo the TOLAC in the department of gynecology and obstetrics at the Tshikaji Mission Hospital over the period from January 1st to December 31st, 2021. The data on demography, antenatal care, labour and delivery and outcomes were collected from the maternity unit of this hospital. The data were analyzed using SPSS version 2.0. Results: The TOLAC in 126 studied women. The course of work allowed vaginal delivery 107 parturient women, a success rate of successful VBAC of 85% after the TOLAC. The repeat emergency cesarean section was necessary for delivery in 15% of cases for failed TOLAC. There was no maternal mortality, but we recorded one fetal death or 0.8% of perinatal mortality, 2 cases of cicatricial dehiscence, the incidence of 1.6%. Maternal morbidity after delivery on cicatricial uterus was dominated by postpartum hemorrhages, with 19 cases or 15.1% of cases. Cervical dilatation of more than 3 cm at the time of admission, the parity more than 3 and were the significant factors in favor of a successful VBAC. Birth weight of more than 3500 g, fetal distress and malpresentation were associated with a lower success rate of VBAC. The TOLAC in selected cases has great importance in the present era of the rising rate of primary CS especially in rural areas. Conclusion: Pregnancy on a cicatricial uterus represents a high-risk pregnancy. Trial of VBAC in selected cases has great importance in the present era of the rising rate of primary CS especially in rural areas. There is a significantly high vaginal birth after caesarian section (VBAC) success rate among selected women undergoing trial of scar in Tshikaji Hospital. TOLAC remains the option for childbirth in low resource settings as Kasai region in DRC. Adequate patient education and counselling in addition to appropriate patient selection for TOLAC remain the cornerstone to achieving high VBAC success rate.

剖宫产术后瘢痕子宫再次妊娠行阴道试产的临床可行性分析

目的 研究剖宫产术后瘢痕子宫再次妊娠行阴道试产的临床可行性。方法 选择剖宫产术后再次妊娠行阴道试产的66例产妇作为瘢痕组,另选择同期非瘢痕子宫妊娠行阴道试产的66例产妇作为非瘢痕组。比较两组阴道试产结果,阴道试产成功产妇产程,产后出血量、住院时间及产后胎盘残留发生情况,不良妊娠结局发生情况,新生儿Apgar评分。结果 瘢痕组与非瘢痕组的阴道试产成功率(78.79%VS 84.85%)、转剖宫产率(21.21%VS 15.15%)比较,差异无统计学意义(P>0.05)。瘢痕组阴道试产成功产妇第一、二、三产程及总产程时间与非瘢痕组比较,差异无统计学意义(P>0.05)。瘢痕组产后出血量(210.28±56.36)ml、住院时间(3.69±1.62)d和产后胎盘残留发生率12.12%与非瘢痕组的(205.17±49.69)ml、(3.71±1.59)d、7.58%(5/66)比较,差异无统计学意义(P>0.05)。瘢痕组不良妊娠结局发生率(13.64%)与非瘢痕组(10.61%)比较,差异无统计学意义(P>0.05)。瘢痕组出生后1、5、10 min的新生儿Apgar评分比较,差异无统计学意义(P>0.05)。两组新生儿预后良好,无转入新生儿科记录。结论 剖宫产术后瘢痕子宫再次妊娠产妇的阴道试产成功率与非瘢痕子宫妊娠产妇基本一致,且未增加产程时间及产后出血量,不良妊娠结局发生率无明显升高,临床应用安全性可靠,证实该类产妇经阴道分娩的可行性较强,对提升阴道分娩率及降低剖宫产率具有重要应用价值。

多元共享决策模式对瘢痕子宫再次妊娠分娩方式的影响

目的探究决策辅助手册联合在线分娩决策支持的多元共享决策模式对瘢痕子宫再次妊娠女性分娩方式的影响。方法选取2019年9月至2022年10月在某三甲医院产检的94例瘢痕子宫再次妊娠女性为研究对象,采用随机数字表法分为观察组与对照组。对照组接受常规孕期宣教,观察组在常规孕期宣教的基础上接受多元共享决策干预。分别对两组分娩决策冲突程度、分娩方式偏好、分娩后决策后悔程度和最终分娩方式进行比较。结果观察组在接受多元共享决策干预后,决策冲突量表得分降低(P<0.001),在分娩方式偏好调查中表示“不确定”的人数减少,选择经阴道生产的人数增加;最终观察组孕妇行剖宫产者30人(68.2%),阴道分娩者14人(31.8%);观察组孕妇对本次分娩决策后悔程度低于对照组(P<0.001)。结论对瘢痕子宫再次妊娠女性开展多元共享决策可降低其决策冲突程度、增强阴道试产意愿并帮助其做出理性科学的分娩决策。

新产程标准下阴道试产失败中转剖宫产的影响因素分析及风险预测模型构建

目的分析新产程标准下阴道试产失败中转剖宫产的影响因素,构建风险预测的列线图模型。方法选取2021年1月1日至12月31日在南京医科大学附属泰州人民医院产科阴道试产的1888例产妇作为研究对象,依据是否发生阴道试产失败中转剖宫产将产妇分为中转剖宫产组(352例)与阴道分娩组(1536例),收集并比较两组产妇的临床资料。采用多因素Logistic回归模型分析阴道试产失败中转剖宫产的影响因素,建立列线图模型,并绘制受试者工作特征曲线及校准曲线对该模型进行验证。结果阴道分娩组与中转剖宫产组产次、身高、孕前体质量指数(BMI)、住院时间、胎儿腹围、孕妇焦虑评分、妊娠压力评分、人工破膜、无痛分娩、导乐分娩、妊娠期高血压疾病、接受辅助生殖技术、巨大儿、羊水过多、胎膜早破、缩宫素引产、水囊引产、胎心监护分类为Ⅱ类方面比较,差异均有统计学意义(P<0.05)。产次≥1次、身高高、人工破膜、无痛分娩、导乐分娩是阴道试产失败中转剖宫产的独立保护因素(P<0.05);妊娠期高血压疾病、巨大儿、羊水过多、孕前BMI升高、住院时间延长、胎膜早破、缩宫素引产、水囊引产、胎心监护分类为Ⅱ类、胎儿腹围增加、孕妇焦虑评分升高和妊娠压力评分升高是阴道试产失败中转剖宫产的独立危险因素(P<0.05)。阴道试产失败中转剖宫产预测模型的曲线下面积为0.90。当列线图总分≥275.60分时,预测阴道试产失败中转剖宫产的灵敏度为84.4%,特异度为79.0%。结论新产程标准下阴道试产失败中转剖宫产风险预测模型有较高的准确率,可以应用并降低阴道试产失败中转剖宫产的风险,提高产妇和新生儿的安全性。

43例子宫破裂的临床分析

目的:探讨子宫破裂产妇的临床特点和妊娠结局。方法:回顾性分析2016年12月-2022年12月在南京医科大学附属妇产医院分娩的43例子宫破裂产妇的临床资料,按照是否有子宫手术史,分为瘢痕子宫组和非瘢痕子宫组,比较其临床特点和妊娠结局,并对20例经阴道试产发生子宫破裂产妇的产时情况进行分析。结果:43例子宫破裂产妇中瘢痕子宫33例,非瘢痕子宫10例;与瘢痕子宫组相比,非瘢痕子宫组术中出血量≥1000 mL的比例(P<0.001)、累积出血量≥1000 mL的比例(P=0.003)更高,输血率更高(P=0.012)。43例子宫破裂中预期剖宫产23例,余20例阴道试产者中产后发现子宫破裂组(13例)与产时发现子宫破裂组(7例)相比,产后发现子宫破裂组中完全性子宫破裂占比明显增加(P=0.044),输血率显著增加(P<0.001),两组相比差异有统计学意义。此外,与产后发现子宫破裂组相比,产时发现子宫破裂组中羊水异常比例和胎心改变比例增高,虽差异无统计学意义(P>0.05),但仍需引起临床高度重视。结论:非瘢痕子宫发生子宫破裂时出血量更多,阴道试产者于产后发现子宫破裂的并发症更严重,分娩前后应密切注意羊水、胎心、生命体征等情况,及时发现子宫破裂,降低母儿不良妊娠结局的发生率。

硒营养水平与血脂异常相关的人群研究进展

硒是人体必需的一种微量元素,在维持细胞氧化还原平衡、代谢等方面发挥作用;近年来,我国人群血脂异常的患病率明显增加,而硒蛋白能催化并清除脂质过氧化物,因此,硒被认为在脂代谢中起着重要作用。本文拟从横断面、队列及随机对照三类人群研究入手,来探讨硒营养水平与血脂异常的关系,为进一步研究提供参考。

不同剂量缩宫素对剖宫产术后再次妊娠经阴道试产孕妇母婴结局的影响

目的探究不同剂量缩宫素(oxytocin,OT)对剖宫产术后再次妊娠经阴道试产(trial of labor after cesareansection,TOLAC)孕妇产程进展、凝血功能和母婴结局的影响。方法回顾性分析138例TOLAC孕妇临床病历资料,根据产程中OT总用量分为低剂量组61例、中剂量组45例和高剂量组32例,比较三组的产程进展、凝血功能、分娩方式、妊娠结局及围产儿结局。结果三组第一产程、第二产程、第三产程及总产程比较,差异均无统计学意义(P>0.05);与用药前比,三组用药后凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)均降低,纤维蛋白原(FIB)水平均升高,差异有统计学意义(P<0.05),三组间用药后PT、APTT、FIB比较差异无统计学意义(P>0.05)。低剂量组及中剂量组孕产妇的胎盘早剥、新生儿高胆红素血症发生率均低于高剂量组,差异有统计学意义(P<0.05)。结论OT可增强TOLAC孕妇子宫收缩力,改善凝血功能,但大剂量OT可能增加胎盘早剥及新生儿高胆红素血症发生风险。

阴道试产中转剖宫产术前Ⅲ型安尔碘阴道灌洗预防产褥感染效果

目的:分析阴道试产中转剖宫产术前Ⅲ型安尔碘阴道灌洗预防产褥感染效果。方法:回顾性分析2022年1月-2023年12月本院产科阴道试产失败中转剖宫产产妇400例临床资料,其中2022年1-12月术前作外阴备皮、冲洗的200例纳入对照组,2023年1-12月术前作外阴备皮、Ⅲ型安尔碘阴道灌洗、冲洗的200例产妇纳入观察组,对比两组术后体温、24h出血量、产褥感染率、切口感染率及白细胞计数(WBC)、C反应蛋白(CRP)和降钙素原(PCT)水平变化情况。结果:观察组术后24h(36.90±0.17℃)、48h(36.70±0.15℃)、72h体温(36.50±0.12℃)均低于对照组(37.00±0.21℃、36.80±0.16℃、36.60±0.13℃),术后24h出血量(287.3±21.5ml)少于对照组(296.2±23.7ml),产褥感染率(0.5%)低于对照组(3.5%)(均P<0.05),两组切口感染率(0.5%、1.0%)无差异(P>0.05)。观察组术后72h WBC(10.07±2.28×10^(9)/L)、CRP(2.23±0.39mg/L)、PCT(4.05±0.62ng/ml)水平均低于对照组[(12.77±3.59)×10^(9)/L、5.06±1.28mg/L、7.33±1.51ng/ml](均P<0.05)。结论:阴道试产中转剖宫产术前Ⅲ型安尔碘阴道灌洗可有效控制术后产妇体温和WBC、CRP、PCT水平,减少产褥感染发生。

产程进展角、胎头下降距离及其变化率在剖宫产术后瘢痕子宫经阴道试产结局预测中的价值

目的探讨产程进展角(AOP)、胎头下降距离(HPD)及其变化率在剖宫产术后瘢痕子宫经阴道试产结局预测中的价值。方法选取剖宫产术后瘢痕子宫再次妊娠经阴道试产的170例孕妇为研究对象,依据试产结局将其分为成功组和失败组。分别采用超声测量第一产程活跃期宫口扩张至4 cm时以及1 h时(宫口开至4 cm后1 h)AOP、HPD,并计算1 h时AOP变化率、HPD变化率。采用受试者工作特征(ROC)曲线分析AOP、HPD及其变化率对剖宫产术后瘢痕子宫再次妊娠经阴道试产结局的预测效能,采用Delong检验比较不同曲线下面积(AUC)的差异。结果170例剖宫产术后瘢痕子宫再次妊娠孕妇中,经阴道试产成功分娩为139例(成功组),试产失败转剖宫产为31例(失败组)。成功组在宫口开至4 cm时的AOP大于失败组,HPD短于失败组,差异均有统计学意义(P<0.05);成功组宫口开至4 cm、1 h时的AOP变化率、HPD变化率均大于失败组,差异有统计学意义(P<0.05)。AOP与HPD预测剖宫产术后瘢痕子宫再次妊娠经阴道试产结局的AUC分别为0.846、0.812,AOP与HPD联合预测的AUC与单独预测的AUC比较,差异无统计学意义(P>0.05)。AOP与HPD的变化率预测剖宫产术后瘢痕子宫再次妊娠经阴道试产结局的AUC分别为0.899、0.852;AOP变化率与HPD变化率联合预测的AUC大于单独预测的AUC,且大于AOP与HPD联合预测的AUC,差异均有统计学意义(P<0.05)。结论第一产程活跃期宫口扩张至4 cm时的AOP、HPD及其变化率对剖宫产术后瘢痕子宫再次妊娠经阴道试产结局具有预测价值。

阴道试产失败转剖宫产产后出血的危险因素分析

目的探讨阴道试产失败转剖宫产产后出血(PPH)的相关危险因素。方法收集2022年1月至2023年3月杭州市妇产科医院362例阴道试产失败转剖宫产分娩产妇临床资料,根据是否发生PPH,分为PPH组(n=40)和非PPH组(n=322),通过单因素及多因素Logistic回归模型筛查PPH发生的危险因素。结果PPH组产妇年龄、术前宫口、试产时间、软产道水肿、胎盘黏连、子宫切口撕裂、巨大儿高于非PPH组(P<0.05),术前血红蛋白水平、纤维蛋白原水平、分娩镇痛低于非PPH组(P<0.05)。Logistic回归分析显示:产前纤维蛋白原(FIB)≤3 g/L、试产时间长≥18 h、软产道水肿、子宫切口撕裂、分娩巨大儿是发生PPH的危险因素(P<0.05),分娩镇痛是产妇PPH的保护因素(P<0.05)。结论阴道试产失败中转剖宫产PPH主要与试产时间过长、软产道水肿、子宫切口撕裂、分娩巨大儿、FIB减少等因素有关,科学应用分娩镇痛可改善产妇分娩体验,降低产后出血风险。

低频脉冲磁场慢性暴露对健康成年股四头肌收缩力及形态的影响

背景:目前已有关于低频脉冲磁场对骨骼肌结构形态影响研究发现了骨骼肌质量变化,但对接受慢性暴露后的形态变化未见相关研究。目的:观察低频脉冲磁场慢性暴露对腿部股四头肌最大自主收缩力与形态指标的影响,为使用该技术作为肌肉功能改善策略提供组织形态变化的参考依据。方法:招募普通健康受试者70名,随机分为接受磁场刺激的试验组与进行假治疗的对照组,每组35名,试验时长共计4周,试验组受试者每隔48 h进行1次15 min的低频脉冲磁刺激干预,对照组进行假治疗,干预间隔与时长与试验组一致,干预4周后观察不同组别受试者股四头肌最大自主收缩力值变化,利用B型超声影像作为评估手段,观察肌肉厚度、肌肉横截面积及羽状角指标的变化。结果与结论:①经过4周的低频脉冲磁场慢性暴露,68名受试者完成试验,试验组受试者股四头肌最大自主收缩力测试值显著增长(P=0.000),提升幅度显著高于对照组(P=0.008);②试验组受试者的肌肉形态3项指标均显著高于试验前测(P=0.000),而对照组肌肉厚度指标呈显著性下降(P=0.020),羽状角无显著性变化,横截面积显著性提升(P=0.000);③组间对比发现,试验组关于肌肉形态的肌肉厚度(P=0.012)、羽状角(P=0.003)及横截面积(P=0.049)3项指标均显著高于对照组;④上述数据证实,健康成年受试者经过4周的低频脉冲磁场慢性暴露,股四头肌的最大自主收缩力显著提升,同时观察到试验组的肌肉厚度、横截面积及羽状角3项肌肉形态指标的显著增长,对使用该技术作为肌肉改善的运动替代与医疗策略提供了肌组织形态改善的支持依据。

剖宫产术后瘢痕子宫再次妊娠阴道试产结局分析

目的 分析剖宫产术后瘢痕子宫再次妊娠孕产妇进行阴道试产的结局及其安全性。方法 160例剖宫产术后瘢痕子宫再次妊娠产妇,将80例进行剖宫产术后再次妊娠阴道试产(TOLAC)的瘢痕子宫产妇纳入观察组, 80例行选择性再次剖宫产(ERCS)的瘢痕子宫产妇纳入对照组。分析观察组产妇TOLAC失败情况及其原因,比较两组产妇住院时间、产时及产后24 h总出血量、妊娠结局、围生儿结局。结果 观察组产妇TOLAC成功率为85.00%(68/80),失败率为15.00%(12/80),失败原因包括产程异常、产妇惧怕宫缩疼痛、胎儿宫内窘迫以及产妇子宫不全破裂。与对照组的住院时间(5.36±1.36)d、产时及产后24 h总出血量(417.53±21.18)ml相比,观察组的住院时间(3.12±1.01)d更短、产时及产后24 h总出血量(245.36±19.95)ml更少(P<0.05)。两组产妇羊水污染、产后出血、输血、子宫破裂、子宫切除、膀胱受损发生率比较,差异较小(P>0.05)。与对照组新生儿出生体质量(3526.95±155.96)g对比,观察组新生儿的出生体质量(3335.29±163.25)g较低(P<0.05);两组新生儿的Apgar评分、窒息发生率、缺血缺氧性脑病发生率比较,差异均较小(P>0.05)。结论 对于具有阴道试产指征的剖宫产术后瘢痕子宫再次妊娠产妇,对其进行产前的综合评估以及产程中的严密监测,选择TOLAC是安全且可行的。

足月妊娠初产妇阴道试产失败中转剖宫产的影响因素

目的:分析足月妊娠初产妇阴道试产失败中转剖宫产的影响因素。方法:回顾性分析2019年3月至2022年3月在该院进行阴道试产的158例初产妇的临床资料。统计158例初产妇中转剖宫产发生情况,根据分娩结局不同将初产妇分为中转剖宫产组和阴道分娩组,对初产妇阴道试产失败中转剖宫产的相关因素进行单因素和多因素Logistic回归分析。结果:158例初产妇中阴道分娩135例(85.44%),中转剖宫产23例(14.56%)。两组胎膜早破、分娩镇痛占比及羊水污染程度比较,差异均无统计学意义(P>0.05);两组年龄、身高、孕前体质量指数(BMI)、孕期增重、新生儿体质量、妊娠时长、引产情况比较,差异均有统计学意义(P<0.05)。Logistic回归分析结果显示,年龄、孕前BMI、孕期增重、妊娠时长、引产均为足月妊娠初产妇阴道试产失败中转剖宫产的危险因素(OR>1,P<0.05),而身高则是足月妊娠初产妇阴道试产失败中转剖宫产的保护因素(OR<1,P<0.05)。结论:年龄、孕前BMI、孕期增重、妊娠时长、引产均为足月妊娠初产妇阴道试产失败中转剖宫产的危险因素,身高是足月妊娠初产妇阴道试产失败中转剖宫产的保护因素,临床可针对上述影响因素制订预防措施,或提前调整分娩方式。

子痫前期孕妇产时中转剖宫产的临床特征和危险因素

目的探讨子痫前期(PE)患者阴道试产中转剖宫产的相关危险因素。方法选取300例实施阴道试产的PE患者为研究对象,按照阴道试产结局分为阴道试产成功组(n=177)、中转剖宫产组(n=123),回顾性分析两组临床资料并对所得数据进行统计学分析。结果阴道试产成功组体质量指数(BMI)为(26.25±0.99)kg/m^(2),低于中转剖宫产组的(29.13±1.12)kg/m^(2),瘢痕子宫、胎位为枕横位、未接受分娩镇痛占比均低于中转剖宫产组,子宫下段肌壁厚度大于中转剖宫产组,差异有统计学意义(P<0.05)。结论PE患者阴道试产中转剖宫产的主要危险因素包括胎位、瘢痕子宫、分娩镇痛、子宫下段肌壁厚度、BMI等,医师应准确掌握该类患者的临床特征,针对存在中转剖宫产危险因素者进行积极干预,以确保母婴安全。

剖宫产术后再次妊娠经阴道分娩状况及影响因素分析

目的:探讨剖宫产术后再次妊娠经阴道分娩状况及影响因素。方法:回顾性收集2021年1月至2024年1月期间在本院分娩的剖宫产术后再次妊娠产妇的临床资料。所有产妇均进行阴道试产,并根据最终产妇分娩方式的不同,将产妇分为经阴道分娩组(阴道试产成功,n=36)和剖宫产组(阴道试产失败转剖宫产,n=14)。收集比较两组的基线资料,分析比较导致产妇试产失败的独立危险因素。结果:本研究50例剖宫产术后再次妊娠产妇,经阴道试产成功率为72.00%(36/50),中转剖宫产率28.00%(14/50)。Logistic回归分析显示,孕期增重不合理、宫颈成熟评分<6分、妊娠间隔时间不足4y、胎儿双顶径过大、产妇情绪焦虑都是导致剖宫产再次妊娠产妇经阴道试产失败的独立危险因素。结论:剖宫产术后再次妊娠产妇经阴道分娩试产成功率为72.00%,孕期增重不合理、宫颈成熟评分<6分、妊娠间隔时间不足4y、胎儿双顶径过大、产妇情绪焦虑都是导致剖宫产再次妊娠产妇经阴道试产失败的独立危险因素。

换流站交流滤波器电容器组不平衡保护故障分析

交流滤波器的运行工况直接影响直流输电系统的稳定运行。针对某换流站交流滤波器发生不平衡保护动作导致开关跳闸事故,结合交流滤波器实际运行经验及故障录波数据,对交流滤波器异常情况进行了分析,基于现场解体试验,查明具体故障位置存在于电容器单体的单一串联段内,故障由电容器元件击穿引起。针对电容器故障的具体原因,提出了有效的解决措施。

Factors affecting failed trial of labor and countermeasures:A retrospective analysis

BACKGROUND Vaginal delivery is the ideal mode of delivery for the termination of a pregnancy.However,the cesarean section rate in China is much higher than the published by the World Health Organization in the Lancet in 2010.AIM To retrospectively analyze the factors related to failed trial of labor and the clinical indications for cesarean section conversion,explore how to promote the trial of labor success rate,and determine the feasibility of reducing the rate of conversion to cesarean section.METHODS A retrospective analysis was performed on 9240 maternal women who met vaginal delivery conditions and required a trial of labor from January 2016 to December 2018 at our hospital.Among them,8164 pregnant women who had a successful trial of labor were used as a control group,and 1076 pregnant women who had a failed trial of labor and converted to an emergency cesarean section were used as an observation group.The patients’clinical data during hospitalization were collected for comparative analysis,the related factors of the failed trial of labor were discussed,and reasonable prevention and resolution strategies were proposed to increase the success rate of trial of labor.RESULTS The analysis revealed that advanced age(≥35 years old),macrosomia(≥4000 g),delayed pregnancy(≥41 wk),use of uterine contraction drugs,primipara,and fever during labor were associated with conversion to an emergency cesarean section in the failed trial of labor.Multivariate regression analysis showed that age,gestational age,primipara,use of uterine contraction drugs,fever duringbirth,and newborn weight led to a higher probability of conversion to an emergency cesarean section in the failed trial of labor.The analysis indicated that the following clinical indications were associated with the conversion to cesarean section in the failed trial of labor:Fetal distress(44.3%),social factors(12.8%),malpresentation(face presentation,persistent occipitoposterior position,and persistent occipitotransverse position)(9.4%),and cephalopelvic disproportion(8.9%).CONCLUSION The conversion to emergency cesarean section in failed trial of labor is affected by many factors.Medical staff should take appropriate preventive measures for the main factors,increase the trial of labor success rate,improve the quality of delivery,ensure the safety of mother and child during the perinatal period,and improve the relationship between doctors and patients.

腰方肌阻滞与切口局部浸润对剖宫产术后镇痛效果的影响

目的比较腰方肌阻滞与切口局部浸润用于剖宫产术后镇痛的效果。方法选取行剖宫产术的产妇共计120例,产妇随机逐个纳入腰方肌阻滞组(Quadratus lumborum block group,Q组)、切口局部浸润组(Wound infiltration group,W组)和经静脉自控镇痛组(patient-controlled intravenous analgesia,P组),每组各40例。剖宫产结束后,Q组行双侧腰方肌阻滞,W组实施切口局部浸润,P组行静脉自控镇痛。分别在返回病房即刻,术后2 h、4 h、12 h、24 h多个时间点使用NRS评分评估产妇疼痛情况。使用BCS评分评估活动状态下疼痛情况,改良Bromage评分评估产妇术后运动功能。分别记录各组产妇首次下床时间、行走时间,其它不良反应发生情况。结果在静止状态下,3组患者NRS评分不同时间点及组间差异具有统计学意义(P<0.05),存在时间和组间的交互效应(P<0.05)。3组患者NRS评分均于术后逐渐升高,且W组患者术后12 h的NRS评分均高于Q、P组(P<0.05)。在活动状态下,3组患者BCS舒适评分不同时间点及组间差异无统计学意义(P>0.05),亦不存在交互效应(P>0.05)。在运动功能方面,3组患者Bromage评分在不同时间点组内及组间差异具有统计学意义(P<0.05),存在时间和组间的交互效应(P<0.05),Q组患者术后4 h、术后12 h的Bromage评分均高于W、P组(P>0.05)。Q组产妇首次下床时间、首次行走时间均明显高于W和P组产妇,差异有统计学意义(P<0.05)。在安全性方面,3组产妇均未见局麻药中毒、局部血肿等严重并发症。结论腰方肌阻滞与切口局部浸润均能为剖宫产产妇提供良好的术后镇痛效果,腰方肌阻滞镇痛持续时间更长,但对产妇术后下肢活动功能有一定影响。