B超监视下宫腔镜治疗子宫剖产切口妊娠15例

子宫剖宫产切口妊娠（caesarean scar pregnancy，CSP）指孕卵着床于子宫剖宫产切口，目前多数学者认为是一种特殊的异位妊娠。CSP是剖宫产远期并发症之一，近年随着剖宫产率的不断上升，其发生率明显增加。以往临床治疗以药物杀胚治疗、子宫壁病灶切除术、子宫全切除术为主，近年来多采用子宫动脉介入治疗，然后行刮宫术或宫腔镜下妊娠物剔除或电切术，但介入治疗费用高，技术难度大，且介入治疗后手术仍有大出血可能。

护理干预对剖宫产术后产妇康复的疗效分析

目的：分析护理干预对宫剖产术后康复的临床效果。方法对比分析我院2014年6月～2015年8月实施宫剖产手术的178例产妇在不同护理模式下的恢复情况。结果观察组在肛门排气时间、自主排尿时间、下床活动时间、泌乳时间、住院时间等方面均优于对照组。结论观察组在肛门排气时间、自主排尿时间、下床活动时间、泌乳时间等方面均优于对照组，证明护理干预对剖宫产术后产妇的康复具有重要的作用。

两种剖宫产术后粘连的比较

目的探讨子宫下段剖宫产与新式宫剖产术中缝合腹壁腹膜引起腹壁、盆腔粘连的情况,以期改良现有术式,减少或减轻并发症的发生。方法对2004年1月至2008年7月间景德镇市第二人民医院妇产科再次宫剖产术212例病例进行回顾性分析,比较其腹壁、盆腔粘连情况。结果两组病例腹壁、盆腔均有不同程度粘连,两组比较差异无显著意义(P>0.05)。结论不缝合腹壁腹膜的新式宫剖产导致的粘连比缝合腹壁腹膜的改良新式宫剖产及子宫下段剖宫产严重。

剖宫产术后镇痛期间最佳尿管拔除时间探讨

目的探讨剖宫产术后使用PCA泵拔除尿管的时间。方法 198例行剖宫产的产妇分为三组对照,术后均给予PCA泵镇痛;手术之后留到尿管24h之后再拔除,我们将其定为A组;手术以后36h之后拔除尿管,我们将其定为B组;手术之后的48h停用PCA泵时候拔除尿管,我们将其定为C组,比较三组患者自行排尿和尿潴留情况。结果发生尿潴留较高的是A组,发生率相对低的是B组和C组,差异性显著的是A组和B组(P<0.05),无显著性差异的是B组和C组(P>0.50)。结论在剖宫产术后36h拔出导尿管较为适宜。

腹膜外剖宫产儿556例纯母乳喂养护理体会

我院１９９６．１～１９９６．１２月腹膜外剖宫产５５６例，平乳养率为９９．５％，我们体会到，术后早进饮食剖宫产产乳喂养的基础；护理制度改革，实行母婴同室，护理人员对产妇的精心护理，协助新生儿早吸吮，按需哺乳是剖宫产儿纯母乳喂养的关键；重视乳母的心理护理是剖宫产儿纯母乳喂养必不可少的护理措施。

联合应用氟派利多和地塞米松对降低剖宫产术中麻醉不良反应的效果观察

目的 :探讨分析联合应用氟派利多和地塞米松对降低剖宫产术中麻醉不良反应的临床效果。方法 :选取2013年8月至2014年8月间我院收治的接受剖宫产手术的孕产妇100例作为研究对象,采用随机数字表法将其分为对照组(50例)和实验组(50例),为对照组孕产妇进行腰硬联合麻醉,为实验组孕产妇在进行腰硬联合麻醉的同时使用氟派利多联合地塞米松进行辅助治疗,观察对比两组孕产妇的不良反应发生情况,并将对比的结果及两组孕产妇的临床资料进行回顾性的分析。结果 :在实验组50例产妇中,发生恶心呕吐的产妇有0例,发生低血压的产妇有20例(占产妇总数的%),发生寒颤的产妇有2例(占产妇总数的%);在对照组50例产妇中,发生恶心呕吐的产妇有10例(占产妇总数的%),发生低血压的产妇有21例(占产妇总数的%),发生寒颤的产妇有6例(占产妇总数的%)。实验组产妇的不良反应发生率明显低于对照组产妇,差异显著(P<0.05),具有统计学意义。两组新生儿在娩出1分钟后及5分钟后的apgar评分之间的差异不显著(P>0.05),不具有统计学意义。结论 :在急诊剖宫产手术中联合应用氟派利多和地塞米松对产妇进行辅助治疗,可明显降低其麻醉不良反应的发生率,值得在临床上推广应用。

剖宫产术与脑性瘫痪的关系:Meta分析

目的分析剖宫产术与脑性瘫痪发生率的关系,以降低脑性瘫痪的发病率和致残率。方法以(脑性瘫痪/脑瘫)和(病因/高危因素/剖腹产/剖宫产)等关键词及主题词对数据库包括中国期刊全文数据库(CNKI)、万方数据库、中国维普数据库(VIP)、PubMed数据库、MEDLINE数据库、OVID数据库、Cochrane图书馆循证医学评价数据库进行检索,检索时间为1990年1月1日-2016年4月1日。对纳入文献采用Review Manager5.2软件对符合条件的数据进行Meta分析,检验水准为α=0.05。结果共检索出文献9篇,其中中文文献2篇,英文文献7篇。累计病历,观察组共纳入3 327名脑性瘫痪儿童,共852名进行了剖宫产,对照组纳入1 700 535名儿童,共126 323名进行了剖宫产。其分析结果如下:总的剖宫产与脑性瘫痪儿童关系(OR=1.61;95%CI:0.93~2.79;I2=95%);足月的剖宫产与脑性瘫痪儿童的关系(OR=2.04;95%CI:1.81~2.29;I2=23%);早产的剖宫产与脑性瘫痪儿童的关系(OR=0.84;95%CI:0.63~1.13;I2=94%);急诊的剖宫产与脑性瘫痪儿童的关系(OR=9.77;95%CI:7.37~12.96;I^2=95%)。结论总体而言,剖宫产并不能减低脑性瘫痪的发生率,但在急诊剖宫产中,需要一步研究证明到底在那些情况下更容易发生脑性瘫痪。

开展无痛分娩基层医院面临的问题与对策

近几年我国剖宫产比例渐渐升高,主要与孕妇害怕分娩疼痛而自主选择剖官产、医院顺产宣教不足和剖宫产把关不严等因素相关.然而,剖宫产率的升高带来了产后大出血、产褥感染以及子宫内膜异位等一系列近、远期的并发症,这些症状不容小视.无痛分娩技术的发展,极大改善了这些产后并发症的发展,具有重要的临床应用价值.本院作为基层医院自开展无痛分娩以来,对临床应用过程中遇到如医护人员专业知识不足、产妇及家属对无痛分娩缺乏认识、医师助产士配置不足等问题,进行了详细探讨及分析,并提出了相应有效的解决措施.

Effects of a theory of planned behavior-based intervention on breastfeeding behaviors after cesarean section:A randomized controlled trial

Objectives:To examine the efficacy of an intervention based on the theory of planned behavior(TPB)in improving breastfeeding behavior among women with cesarean sections(C-sections).Methods:This research was a randomized controlled trial.Women with planned elective C-sections were recruited to participate in a randomized controlled trial between June and September 2020.One hundred thirty-two women were divided randomly into the intervention(n=66)and control group(n=66)by systematic random sampling.In the intervention group,an intervention project was implemented after Keywords:Breastfeeding Cesarean section Intervention studies Theory of planned behavior the C-section to establish positive breastfeeding attitudes,cultivate supportive subjective norms,enhance perceived behavioral control,and strengthen breastfeeding intention to change behaviors.Those in the control group received routine pre-and post-delivery care.Exclusive breastfeeding rate and breast problem were collected at 5 days,2 weeks,and 1 month after C-section.The modified Breastfeeding Attrition Prediction Tool(BAPT)on the first day in the hospital,two weeks,and one month after C-section and Numerical Rating Scale(NRS)24 h postoperatively were used to compare the intervention effect between the two groups.Results:After the intervention,the intervention group had significantly higher exclusive breastfeeding rates than the control group at five days(86.4%vs.60.6%),two weeks(77.3%vs.57.6%),and one month(74.2%vs.50.0%)after the C-section.Besides,the intervention group was less likely to have sore nipples at five days(6.1%vs.18.2%in the control group,P<0.05)and two weeks(9.1%vs.12.1%in the control group,P<0.05).After two weeks of intervention,attitude scores(90.64±8.31 vs.87.20±8.15,P<0.05),subjective norm scores(88.07±24.65 vs.79.42±19.47,P<0.05)and behavior control scores in the intervention group were significantly higher than those in the control group.After one month of intervention,attitude scores(90.34±10.35 vs.84.22±10.51,P<0.05)and behavior control scores(43.13±5.02 vs.39.15±4.69,P<0.05)in the intervention group were significantly higher than those in the control group,which resulted in the higher breastfeeding intention in the intervention group.Conclusion:This study indicated that the TPB-based interventions effectively improved women's breastfeeding behaviors after C-sections.

An exploration of the breastfeeding behaviors of women aftercesarean section: A qualitative study

Objectives:To explore the factors affecting breastfeeding behaviors in women after cesarean section.Methods:This is a qualitative study that used a phenomenological approach.This study used individual face-to-face interviews with 19 women who underwent a cesarean section in a Women and Children’s Hospital in China between July to September 2019.Information saturationwas used to determine sample size.Data were analyzed using a thematic content analysis method.Themes were developed based on the theory of planned behavior.Results:Thirteen(68.42%)had a planned cesarean section,and six(31.58%)cesarean sections were unplanned or emergent.Three major themes emerged:ambivalent attitude about breastfeeding,motivation to comply with the traditional cultural norms,and barriers and challenges.The motivating factors for breastfeeding after cesarean sections included perceived benefits of human milk,support from healthcare professionals,and responsibility for breastfeeding.The challenges for breastfeeding after cesarean sections included physical discomfort,knowledge and skills deficit of breastfeeding,lactation deficiency,and lack of knowledge and coping skills in managing their depressive mood after cesarean sections.There were a couple of neutral factors,such as the influences of family and peers.These factors could influence women either positively as facilitators or negatively as barriers.Conclusions:The findings can offer valuable information for healthcare professionals to help women breastfeed after cesarean sections.To promote women’s breastfeeding behaviors after cesarean sections,it is necessary to change women’s attitudes,belief systems,and the external environments and help them become more confident.

DIAGNOSIS AND TREATMENT OF CESAREAN SCAR PREGNANCY

Objective To investigate the early diagnosis and treatment of cesarean scar pregnancy （CSP）. Methods Clinical data of 28 patients with CSP in Peking Union Medical College Hospital from January 1994 to April 2007, including age, interval from the last cesarean delivery to diagnosis, clinical presentation, location of the lesion, process of diagnosis and treatment, outcome, and follow-up, were retrospectively analyzed. Re, salts CSP constituted 1.05 % of all ectopic pregnancies, and the ratio of CSP to pregnancy was 1 ： 1 221. The mean age of the group was 31.4 years. Twenty-six women had only one prior cesarean delivery. The interval from the last cesarean delivery to diagnosis ranged from 4 months to 15 years. The most common presenting symptoms of CSP were amenorrhoea and vaginal bleeding. Seventeen cases were misdiagnosed as early intrauterine pregnancies and 2 were misdiagnosed as gestational trophoblastic tumor. The other 9 were diagnosed definitely before treatment. The diagnosis was made based on cesarean delivery history, gynecologic examination, ultrasound, and magnetic resonance imaging （MRI）. The treatment of CSP included systemic or local methotrexate administration, conservative surgery, and hysterectomy. The conservative treatment was successful in 24 cases. All of the 28 women were cured through individual therapies. Conclusions CSP is rare and usually misdiagnosed as other diseases. Ultrasound is valuable for diagnosing CSP, and MRI can be used as an adjunct to ultrasound scan. Early diagnosis offers the options of conservative treatment and greatly improves the outcome of patients. Individual therapy is strongly recommended.

Clinical Analysis of Placenta Previa Complicated with Previous Caesarean Section

Objective To investigate the clinical features and treatment of placenta previa complicated with previous caesarean section. Methods The clinical data of 29 patients with placenta previa complicated with a previous caesarean section (RCS group) admitted in Peking Union Medical College Hospital during a period from 2003 to 2011 were retrospectively reviewed and compared with those of 243 patients with placenta previa without a previous caesarean section (FCS group) during the same period. Results There was no difference in the mean age (28.9±3.6 vs. 28.1±4.5 years) and the average gravidity (2.35±1.48 vs. 2.21±1.53) between RCS group and FCS group (all P>0.05). The RCS group had more preterm births (24.1% vs. 13.2%), complete placenta previa (55.2% vs. 4.9%), placenta accreta (34.5% vs. 2.5%), more blood loss during caesarean section (1412±602 vs. 648±265 mL), blood transfusion (51.7% vs. 4.9%), disseminated intravascular coagulation (13.8% vs. 2.1%), and obstetric hysterectomy (13.8% vs. 0.8%) than the FCS group (all P<0.05). The preterm infant rate (30.0% vs. 13.0%), neonatal asphyxia rate (10.0% vs. 4.9%), and perinatal mortality rate (6.7% vs. 0.4%) of the RCS group were higher than those of the FCS group (all P<0.05). Conclusions More patients had complete placenta previa and placenta accreta, postpartum hemorrhage, transfusion, uterine packing, obstetric hysterectomy, and perinatal morbidity in the placenta previa patients with previous caesarean section. The patient should be informed of the risk and unnecessary first cesarean sections should be avoided.

Management of Pregnancy with Ankylosing Spondylitis

Objective To discuss the interaction between pregnancy and ankylosing spondylitis, and the management of pregnancy with ankylosing spondylitis. Methods Twelve cases of pregnancy with ankylosing spondylitis in Peking Union Medical College Hospital from September 2004 to July 2011 were analyzed retrospectively, focusing on the arteritis condition, pregnancy complications, and outcomes. Results All the 12 patients had full-term pregnancy. Five cases gave birth naturally, and 7 cases received cesarean section for maternity factors. No adverse pregnancy outcomes were encountered. Waist pain appeared in 2 cases in the second trimester, for both of which medication failed. One of the 2 cases had natural childbirth, while the other maintained pregnancy smoothly to cesarean section. Conclusions Pregnancy monitoring can help obtain favorable pregnancy outcomes. Attention should be paid to postpartum change of the illness.

Clinical analysis of 322 cases of placenta previa

In recent years, the incidence of placenta previa has been increasing. According to the literature, it is mainly related to induced labor, artificial abortion, cesarean section, high aging pregnancy, multipara or smoking. The placenta previa is the chief cause of bleeding in late pregnancy and threatens the lives of mother and infant, resulting in a high risk problem in obstetrics. This article studies 322 cases of placenta previa from my hospital and Dalian Obstetrics and Gynecological Hospital from January, 2002 to July, 2009, on the basis of clinicretrospective analysis, in order to deepen our understanding and art of treating placenta previa. The study revealed that: 1. With 322 cases of placenta previa, the incidence was 0.73%. It was higher than the incidence 0.3% reported abroad and lower than the incidence 0.94% reported in our country. The data were from sampling survey and did not prove relations between placenta previa and ages, different from the result obtained abroad in which placenta previa had relation with pregnancy ages. The outcome needs further study. But artificial abortion, induced labor, cesarean section and multipara clearly influence the incidence. The study did not analyze the relation between smoking and placenta previa, but there was external data proving that smoking was related to placenta previa; 2. Ultrasound-B is a better method for examination at present; 3. In cases of vaginal childbirth there was a higher incidence of lateral placenta previa and partial placenta previa. The conservative temporization and timely cesarean section can greatly decrease the mortality of mother and infant.

Individualized misoprostol dosing for labor induction or augmentation: A review

Cesarean birth rates are greater than 20% in many developed countries. The main diagnoses contributing to the high rate of cesarean births in nulliparous women are dystocia and prolonged labor. Traditionally, a policy of vaginal dinoprostone for the treatment of unripe cervix or early amniotomy with oxytocin administration for a ripened cervix has been associated with a modest reduction in the rate of cesarean births due to arrest disorders. However, the course of vaginal dinoprostone is tedious and oxytocin should be administered through an infusion pump, which may be inconvenient in certain settings. Because misoprostol has powerful uterotropic and uterotonic effects, and has become a common agent used in the practice of obstetrics and gynecology, the United States Food and Drug Administration removed the absolute contraindication of the drug during pregnancy from its label in April 2002. However, excessive uterine contractility resulting in tachysystole or fetal distress is always a concern with the oral or vaginal use of fixeddosage misoprostol. Therefore, misoprostol should be administered with caution to ensure that fetal hypoxia does not occur. A pilot trial examining the use of very small, frequent, titrated oral misoprostol dosages administered every 2 h was fi rst conducted by Hofmeyr et al in 2001. Given women's different metabolisms and responses tomisoprostol, another method of titrating individualized oral misoprostol with dosing administered every hour relative to uterine response was then developed by Cheng in 2006. Based on previous studies, this titration method is potentially an ideal alternative to traditional dinoprostone, oxytocin or the previously established misoprostol dosing method for labor induction or augmentation.

Emergency Cesarean Delivery in a Parturient with Fontan Circulation and Reduced Platelets: A Case Report

NOWADAYS,Fontan circulation always refers to the hemodynamic status after total cavo-pul-monary connection, which was first created in the 1990s. There are two modern surgeryforms, one creating a channel within the right atrium and another making an extra-cardiac channel to connect infe-rior venous cava directly to the right pulmonary artery. Parturients with Fontan circulation are at increased risk of cardiac morbidity and thrombotic complications. We pre-sented a parturient with reduced platelet status of un-known reason undergoing an emergent cesarean delivery.

Pregnancy Outcomes of Repeat Cesarean Section in Peking Union Medical College Hospital

Objective To evaluate the effect of elective repeat cesarean section on the maternal and neonatal outcomes. Methods A retrospective clinic- and hospital-based survey was designed for comparing the maternal and neonatal outcomes of elective repeat cesarean section [RCS group （one previous cesarean section） and MRCS group （two or more previous cesarean sections）] and primary cesarean section （FCS group） at Peking Union Medical College Hospital from January 1998 to December 2007. Results The incidence of repeat cesarean section increased from 1.26% to 7.32%. The mean gestational age at delivery in RCS group （38.1±1.8 weeks） and MRCS group （37.3±2.5 weeks） were significantly shorter than that in FCS group （38.9±2.1 weeks, all P〈0.01）. The incidence of complication was 33.8% and 33.3% in RCS group and MRCS group respectively, and was significantly higher than that in FCS group （7.9%, P〈0.05）. Dense adhesion （13.5% vs. 0.4%, OR=7.156, 95% CI： 1.7-30.7, P〈0.01） and uterine rupture （1.0% vs. O,P〈0.05） were commoner in RCS group compared with FCS group. Neonatal morbidity was similar among three groups （P〉0.05）. Conclusions Repeat cesarean section is associated with more complicated surgery technique and increased frequency of maternal morbidity. However, the incidence of neonatal morbidity is similar to primary cesarean section.

Anesthetic Management during Cesarean Section in English Bulldogs

The authors describe their experience with the management of the perioperative period, general anesthesia and the postoperative period in English bulldogs undergoing elective cesarean section and its effect on the neonates. The anesthetist for animals undergoing cesarean operation must be aware of any special needs, not only of the patient undergoing surgery, but also of the neonates. Anesthetic drugs administered to the pregnant patient will readily cross the placenta and affect them, with the exception of local anesthetics. Pregnant female patients are at increased anesthetic risk due to pregnancy-associated physiological alterations, such as altered pulmonary function. The anesthetist is often called to perform anesthesia on brachycephalic dogs for an elective cesarean section. Due to their conformation, these animals may have one or more anatomical abnormalities of the upper airways, which compromise the ability to ventilate adequately. The induction and recovery phases of anesthesia can be extremely dangerous in these patients, but the maintenance phase is generally fairly straightforward because the airways are controlled during maintenance In addition, vagal tone is frequently high and this can contribute towards significant bradycardia and further airway narrowing. All these reasons make general anesthesia in brachycepbalic dogs undergoing cesarean section rather complicated.