单胎足月妊娠晚期宫颈不成熟因素分析

目的 分析单胎足月妊娠晚期宫颈不成熟的影响因素。方法 回顾性选取2018年1月至2019年12月于中山市中医院妇产科就诊的单胎足月妊娠晚期孕妇的病例资料,共548份,按照孕妇宫颈是否成熟分为宫颈成熟组(252例)与宫颈不成熟组(296例)。收集并记录两组孕妇的年龄、孕前体重指数(BMI)及孕期增重、日常运动量、孕晚期阴道炎、宫颈物理治疗史、不良妊娠史及产次等个人信息,对其进行单因素分析,并对其中有统计学意义的因素进行多因素logistic回归分析。结果 单因素分析结果显示,宫颈不成熟与年龄大、孕前BMI指数高、日常运动量少、孕晚期阴道炎、既往有宫颈物理治疗史、无阴道分娩史相关,差异有统计学意义(P<0.05)。logistic回归分析结果显示年龄≥35岁(β=0.713,OR=2.040,95%CI=1.229~3.452)、孕前BMI≥24kg/m2(β=0.907,OR=2.684,95%CI=1.481~4.864)、日常缺乏运动量(β=1.715,OR=5.595,95%CI=2.582~11.954)、孕晚期阴道炎(β=0.993,OR=2.743,95%CI=1.488~4.896)、宫颈物理治疗史(β=1.013,OR=2.653,95%CI=1.365~4.803)、无阴道分娩史(β=1.823,OR=6.190,95%CI=2.791~13.508)是宫颈不成熟的独立危险因素(P<0.05)。结论 年龄≥35岁、孕前BMI≥24 kg/m2,日常缺乏运动量、孕晚期有阴道炎、既往有宫颈物理治疗史、无阴道分娩史是影响妊娠晚期宫颈成熟度的高危因素,为预防宫颈不成熟所带来的分娩并发症提供了临床参考依据。

妊娠期孕妇学校课程参与频次对单胎足月妊娠孕妇自我护理能力及新生儿结局的影响

目的:探讨接受不同频次妊娠期孕妇学校课程对单胎足月妊娠孕妇自我护理能力及新生儿结局的影响。方法:选取医院2019年1月—2021年12月90例规律产检的单胎足月妊娠孕妇为研究对象,根据随机数字表法分为对照组与观察组各45例。两组孕妇均参加妊娠期孕妇学校课程,对照组参加课程频次≤3次,观察组参加课程频次>3次。比较两组新生儿状况、孕妇自我护理能力、并发症发生率。结果:观察组孕妇自我护理能力测定量表中的自我护理技能、自我护理责任感、自我概念和健康知识水平维度得分均明显高于对照组(P<0.05),观察组新生儿脐动脉血pH值高于对照组,脐动脉血乳酸水平低于对照组(P<0.05)。结论:单胎足月孕妇在妊娠期参与孕妇学校课程的频次越高,越有利于孕妇自我护理能力的提升,可改善新生儿结局。

臀位外倒转术对足月单胎臀位妊娠分娩结局的影响

分析对足月单胎臀位的产妇,实施臀位外倒转术对分娩结局所产生的临床效果。方法 选取自2021年1月~2023年1月期间,在我院产科进行阴道分娩的60例足月单胎臀位产妇,通过随机数字表法将60例足月单胎臀位妊娠产妇分成实验组30例和参比组30例,参比组产妇采取膝胸卧位纠正管理,实验组采取臀位外倒转术纠正管理,详细对比两组最终获得的临床效果。结果 实验组产妇的臀位矫正成功率高于参比组,(P<0.05);且实验组产妇分娩期间的焦虑情绪改善效果优于参比组,(P<0.05);就各产程时间和总产程时间对比结果来看,实验组产妇的时间要短于参比组,(P<0.05);实验组产妇顺产成功率高于参比组,(P<0.05);实验组发生的阴道裂伤、会阴侧切以及剖宫产均少于参比组,(P<0.05);实验组不良分娩结局发生率低于参比组,(P<0.05);最终实验组产妇的住院时间短于参比组,(P<0.05);实验组产妇及家属对此次分娩管理满意度高于参比组,组间指标结果对比有统计学意义(P<0.05)。结论 对足月单胎臀位妊娠产妇分娩期间开展臀位外倒转术,可有效提高分娩效率及安全性,减轻产妇分娩期间的过度紧张焦虑情绪和疼痛程度,减少不良分娩结局发生,提高产妇及胎儿的安全性。

欣普贝生、缩宫素在足月单胎妊娠引产促宫颈成熟临床效果观察

目的探讨欣普贝生、缩宫素分别在足月单胎妊娠引产促宫颈成熟的临床效果。方法将100例住院分娩的足月单胎妊娠分娩孕妇做为试验组;将100例同样条件的初产妇作为对照组,分别应用欣普贝生和缩宫素促宫颈成熟,观察两组临床效果。结果试验组用于足月单胎妊娠引产促宫颈成熟优效果于对照组。两组差异有统计学意义(P<0.05)。结论欣普贝生用于足月单胎妊娠引产促宫颈成熟的临床效果明显优于缩宫素组,且产程明显缩短,不仅提高自然分娩率,而且降低了剖宫产率。

优化分娩护理联合硫酸镁湿热敷在足月单胎妊娠初产妇自然分娩产后会阴水肿中的应用

目的:观察优化分娩护理联合硫酸镁湿热敷在足月单胎妊娠初产妇自然分娩产后会阴水肿中的应用价值。方法:选取2016年6月—2018年6月我院94例自然分娩后出现会阴水肿的足月单胎妊娠初产妇,根据入院顺序分组,各47例。对照组予以常规护理,实验组在对照组基础上予以优化分娩护理+硫酸镁湿热敷。观察对比两组产后72h会阴水肿消退情况、会阴伤口愈合情况、护理工作满意度。结果:产后72h实验组会阴水肿消退总有效率为91.49%,高于对照组的70.21%(P<0.05);实验组会阴伤口愈合情况优于对照组(P<0.05);实验组护理工作满意度为97.87%,高于对照组的76.60%(P<0.05)。结论:优化分娩护理联合硫酸镁湿热敷用于足月单胎妊娠初产妇自然分娩产后会阴水肿中,可加快会阴水肿消退,促进会阴伤口愈合,提高护理工作满意度。

足月单胎妊娠产程中异常胎心监护与新生儿结局相关性研究

目的研究足月单胎妊娠产程中异常胎心与新生儿结局的相关性。方法选取收治的第一产程中异常胎心监护产妇71例作为观察组,选取同期正常胎心监护产妇97例作为对照组,比较两组分娩情况及新生儿结局、异常胎心监护与新生儿结局关系。结果168例足月单胎妊娠产妇中,出现胎心监护异常占42.26%(71/168),其中轻度变异减速50.70%(36/71)、早期减速21.13%(15/71)、晚期减速9.86%(7/71)、心动过速5.63%(4/71)、心动过缓4.23%(3/71)、基线变异减弱4.23%(3/71)、延长减速2.82%(2/71)、重度变异减速1.41%(1/71);观察组剖宫产、缩宫素应用、羊水粪染、新生儿NICU、新生儿窒息均高于对照组,顺产发生率低于对照组(P<0.05);重度变异减速、基线变异减弱、晚期减速是造成新生儿不良结局重要危险因素(P<0.05)。结论产妇分娩过程中第一产程异常胎心监护发生率较高,其中重度变异减速、基线变异减弱、晚期减速是导致新生儿不良结局主要危险因素,需及时进行相关处理,而其他胎心情况可在严密监护下继续试产。

引产前使用30ml和80ml Foley尿管球囊促宫颈成熟效果的比较:一项随机试验

Objectives The purpose of this study was to compare the efficacy of cervical ripening with 2 Foley catheter balloon volumes. Study design Pregnant women admitted for induction of labor with a term singleton gestation were randomly assigned for cervical ripening by a balloon inflated with 30 mL or 80 mL of sterile saline. Results Two hundred and three women were included in the analysis. Ripening of the cervix with the larger balloon volume was associated with a significantly higher rate of postripening dilatation of 3 cm or more (76.0%vs 52.4%, P <.001). In primiparous women, the larger balloon volume resulted in a significantly higher rate of deliveries by 24 hours (71.4%vs 49%, P <.05), and a significantly less requirement of augmentation with oxytocin (69.3%vs 90.4%, P <.05). Conclusion Ripening of the unfavorable cervix in primiparous women with a Foley catheter balloon inflated with 80 mL provided effective more dilatation, faster labor, and decreased need for oxytocin than with a balloon inflated with 30 mL of sterile saline.

关于出生体重和成年后体重指数预测女性发生冠心病和脑卒中风险的纵向研究

To determine whether birth weight and adult body size interact to predict coronary heart disease in women, as has been observed for men. To determine whether birth weight and adult body size interact to predict risk of stroke. Design: Longitudinal cohort study. Setting and participants: 66 111 female nurses followed since 1976 who were born of singleton, term pregnancies and reported their birth weight in 1992. Main outcome measures: 1504 events of coronary- heart disease(myocardial infarction or sudden cardiac death) and 1164 strokes. Results: For each kilogram of higher birth weight, age adjusted hazard ratios from prospective analysis were 0.77(95% confidence interval 0.69 to 0.87) for coronary heart disease and 0.89(0.78 to 1.01) for total stroke. In combined prospective and retrospective analysis, hazard ratios were 0.84(0.76 to 0.93) for total stroke, 0.83(0.71 to 0.96) for ischaemic stroke, and 0.86(0.66 to 1.11) for haemorrhagic stroke. Exclusion of macrosomic infants( > 4536 g)yielded stronger estimates. Risk of coronary heart disease was especially high for women who crossed from a low centile of weight at birth to a high centile of body mass index in adulthood. The association of lower birth weight with increased risk of stroke was apparent across categories of body mass index in adults and was not especially strong among heavier women. Conclusions: Higher body mass index in adulthood is an especially strong risk factor for coronary heart disease among women who were small at birth. In this large cohort of women, size at birth and adiposity in adulthood interacted to predict events of coronary-heart disease but not stroke events.

剖宫产时舌下含服米索前列醇与输注催产素减少出血的比较

To compare the effectiveness of sublingual misoprostol administered immediately after delivery of the neonate at cesarean section, with intravenous oxytocin infusion in prevention of uterine atony and thereby reducing blood loss at cesarean section. Methods: One hundred women with singleton term pregnancy undergoing elective or emergency lower segment cesarean section under spinal anesthesia were included in this study. They were randomly allocated to receive either misoprostol 400 μ g sublingually or intravenous infusion of 20 units of oxytocin soon after delivery of the neonate. The main outcome measures were blood loss at cesarean section, change in hemoglobin levels, need for additional oxytocics and drug related side effects. Results: The mean blood loss estimatedc was significantly lower in misoprostol group compared to oxytocin group (819 ml versus 974 ml; p = 0.004). The number of women who had blood loss exceeding 500 ml and the change in hemoglobin, however,was comparable between the two groups. There was a need for additional oxytocic therapy in 16% and 18% after use of misoprostol and oxytocin respectively (p = 0.673). The incidence of side effects such as pyrexia, shivering and metallic taste was significantly higher in misoprostol group compared to oxytocin group. Conclusion: Sublingual misoprostol appears to be as effective as intravenous infusion of oxytocin in reducing blood loss at cesarean section. However, occurrence of transient side effects such as shivering and pyrexia were noted more frequently with the use of misorostol.