Retrospective Cohort Study to Investigate Pregnancy Outcomes in a Population of Advanced Maternal Age Congolese Women of Kinshasa: A Study Protocol

Introduction: Pregnancies at advanced maternal age (AMA) are those occurring after the age of 35 years old. They carry a high risk of maternal-fetal morbidity and mortality, thus constituting a public health problem. Several African countries have reported an upward trend in both the age of childbirth and the frequency of women with AMA over the past 20 years. In the Democratic Republic of Congo (DRC), where maternal and neonatal morbidity and mortality remain very high, data on AMA pregnancies go back more than 20 years. Objective: We propose evaluating obstetrical outcomes among women in AMA in our setting and the associated factors. Methods: This retrospective cohort study will be conducted in two healthcare facilities (ESS) in Kinshasa. The study population will consist of all women who delivered a single fetus after 28 weeks of gestation between January 2012 and December 2022 (10 years) in the selected ESS. The data collected will be analyzed using R software version 4.2.0. Quantitative variables will be summarized as means with standard deviation or medians with interquartile range. Qualitative variables will be presented as proportions (%). Multivariate logistic regression will be used to determine the main maternal-fetal complications associated with AMA and predictors of obstetric outcomes. P Discussion: The high maternal and infant mortality rates in DRC are among the highest in the world. The context of maternal age has become a topic of growing interest due to its potential implications for the health of women and newborns, it is crucial to identify the risk factors associated with obstetric outcomes by identifying obstetrical outcomes associated with advanced maternal age in the DRC. Many Congolese women tend to start their maternity journey at a relatively young age. However, there is also an emerging trend towards delayed childbearing, particularly in urban areas and among women with access to education and family planning services. Conclusion: The results of this study will enable us to update the frequency of AMA pregnancies in our environment. The socio-demographic and clinical profile of these pregnancies will be determined. The main maternal-fetal complications associated with AMA in our setting and the associated factors will be identified.

Effects of Antiretroviral Therapy and HIV Exposure in Utero on Adverse Pregnancy and Infant Outcomes:A Prospective Cohort Study in Guangzhou, China

Objective This study aimed to evaluate the effects of in-utero exposure to HIV and ART on pregnancy outcome and early growth of children.Methods This cohort study enrolled 802 HIV-infected pregnant women between October 2009 and May 2018 in Guangzhou, China. The women were assigned to receive combination ART(c ART) or mono/dual ART or no treatment. The primary outcomes were the combined endpoints of any adverse pregnancy outcome [including ectopic pregnancy, spontaneous abortion, stillbirth, preterm birth, small for gestational age(SGA)] and adverse early growth outcome(including infant death, HIV infection of mother-to-child transmission, and underweight, wasting and stunting of infants at 4 weeks of age).Results Adverse pregnancy outcomes occurred in 202(35.1%) of all enrolled HIV-infected women, and121(31.3%) of all infants exhibited adverse effects on early growth at 4 weeks of age. The rates of adverse pregnancy outcomes, spontaneous abortion, ectopic pregnancy, stillbirth, infant death and perinatal HIV infection were higher among women not receiving ART, compared to those treated with c ART or mono/dual ART(P < 0.05). However, women treated with c ART had a higher rate of SGA,compared to untreated women(P < 0.05). No differences in early infant growth were observed among the different treatment regimens.Conclusion Our findings underscore the essentiality of prioritizing HIV-positive pregnant women for ART, as even mono/dual ART available in resource-limited countries could improve pregnancy outcomes and infant survival.

Efficacy of Danshen Injection Combined with Phosphocreatine Disodium in Treating Frequent Premature Contractions during Pregnancy and Its Effects on Maternal and Infant Outcomes

[Objectives]To explore the efficacy of Danshen Injection combined with phosphocreatine disodium in treating frequent premature contractions during pregnancy and its effect on maternal and infant outcomes.[Methods]A total of 200 pregnant women with normal pregnancy and frequent premature contractions who were treated in the outpatient department of internal medicine in Women and Children's Hospital of Hubei Province and Xinzhou District People's Hospital of Wuhan Central Hospital during September 2015 and October 2018 were selected and randomly divided into the control group and observation group,100 cases for each group.The observation group was treated with Danshen Injection combined with phosphocreatine disodium,and the control group was treated with phosphocreatine disodium alone.The course of treatment in both groups was one week.During the treatment,the changes of heart rate,heart rhythm,electrocardiogram and 24-h dynamic electrocardiogram(DCG)of both groups were observed.[Results]After treatment,the clinical efficacy of the observation group was better than that of the control group,and the difference was statistically significant(P<0.01).There were no adverse drug reactions in both groups.However,in the control group,non-sustained ventricular tachycardia(NSVT)was found in 24-h dynamic electrocardiogram(DCG)of 2 pregnant women with premature ventricular contraction.The pregnancy process was smooth,with full-term natural delivery and no fetal malformation.There was no significant difference in gestational age and neonatal weight between the two groups(P>0.05).However,there was a statistically significant difference in Apgar score between the two groups(P<0.05).During the 6-month postpartum follow-up,the mother and child were unharmed,and examination of repeated electrocardiograms showed that the conditions were normal.[Conclusions]Danshen Injection combined with phosphocreatine disodium has better efficacy in the treatment of frequent premature contractions during pregnancy and the maternal and infant outcomes than the treatment with phosphocreatine disodium alone,and it has good safety and can prevent premature contractions from progressing to tachyarrhythmias.

Clinical Manifestations and Maternal and Infant Outcomes of Pregnancy Complicated with Thrombocytopenia

Objective:To explore the clinical manifestations as well as maternal and infant outcomes of pregnancy complicated with thrombocytopenia.Methods:A total of 478 pregnant women with thrombocytopenia,treated in Shaanxi Provincial People's Hospital from July 2019 to June 2021,were selected as the research group,while 200 nonnal pregnant women,treated during the same period,were selected as the control group to analyze gestational thrombocytopenia(GT),idiopathic thrombocytopenic purpura(ITP),pregnancy-induced hypertension(PIH),adverse maternal and infant outcomes,etc.Results:Among the 478 patients in the research group,the main causes of pregnancy complicated with thrombocytopenia were GT,ITP,and PIH,accounting for 75.51%,6.49%,and 8.79%,respectively,while other causes accounted for 9.21%.There was no significant difference between the research group and the control group in the amoxmt of intrapartum bleeding,premature delivery,stillbirth,thrombocytopenia,and neonatal asphyxia,but there was significant difference in the mode of delivery(P<0.05)・Conclusion:The traditional indexes of coagulation function are not abnormal with decreased platelets in pregnant women with thrombocytopenia,but the indexes of thromboelasticity are abnormal and can reflect the changes of coagulation function.The cesarean section rate of patients with thrombocytopenia in pregnancy increases with the decrease of platelet count,but the mode of delivery should be determined in consideration of specific conditions.

Influence of nutritional care during pregnancy on weight control and maternal and infant outcomes in patients with pregnancy-induced hypertension

Background Preeclampsia is a common disease in pregnant women,characterized by clinical manifestations such as hypertension and proteinuria,which not only seriously affect the safety of pregnant women,but also jeopardize the safety of the fetus,threatening maternal and infant safety.Currently,in addition to routine hypoglycemic and antihypertensive treatments,auxiliary treatment methods such as exercise and diet are gradually gaining clinical recognition.Therefore,this study aimed to observe the effects of comprehensive nutrition care during pregnancy on weight control during pregnancy and maternal and infant outcomes in patients with pregnancy-induced hypertension syndrome.Methods A total of 100 cases of preeclampsia patients in our hospital from August 2021 to May 2022 were selected and randomly divided into a nutrition group and a conventional group,with 50 cases in each group.The conventional group received routine care,while the nutrition group received additional comprehensive nutrition care during pregnancy based on routine care.The weight control and blood pressure control during pregnancy and maternal and infant outcomes of the two groups were observed.Results The weight control during pregnancy in the nutrition group was significantly better than that in the conventional group(P<0.05).There was no significant difference in systolic and diastolic blood pressure between the two groups before intervention(P>0.05),but both systolic and diastolic blood pressure in both groups were lower after intervention,with the nutrition group significantly lower than the conventional group(P<0.05).The incidence of neonatal asphyxia,placental abruption,postpartum hemorrhage,and cesarean section in the nutrition group was significantly lower than that in the conventional group(P<0.05).Conclusions Comprehensive nutrition care during pregnancy can effectively control weight and blood pressure levels in patients with preeclampsia,and improve maternal and infant outcomes.[S Chin J Cardiol 2024;25(3):156-161]

Adverse pregnancy outcomes in extremely maternal age

Objective: To study the adverse outcome in pregnant women ≤ 16 and ≥ 40 years. Study Design: A total of 1100 cases, 1061 cases of pregnant women ≤ 16 years, 20 - 29 and ≥ 40 years with completed charts between 1st January, 2006 to 31st December, 2010, were enrolled in this study. The patient data includeing demographic data, hospital course, maternal laboratory investigations, maternal complications, placental complications and neonatal outcomes were recorded. SPSS version 14, one-way Anowa, Chi-square and analysis of varience were used to compare the data among two and three groups. Results: Anemia, underlying medical diseases including heart, thyroid and pulmonary diseases, obstetric complications including severe pre-eclampsia and gestational diabetes mellitus, placenta previa and preterm labour;medical administrations including magnesium sulfate, dexamethasone and bricanyl, outcome of deliveries and neonatal outcomes, were different with statistical significance between the 3 groups of pregnant women. Conclusion: Adverse maternal and neonatal outcomes were mostly found in the pregnant women ≤ 16 and ≥ 40 years. Education of contraception, safe sex and effective care during pregnancy of both extremely maternal age groups should be implemented to reduce those poor outcomes.

Risk of adverse maternal outcome following macrosomic birth in Nigeria.

Objective: To determine the risk of adverse maternal outcome associated with obstetric intervention in labour.Methods:All cases of macrosomic births conducted at the University of Calabar Teaching Hospital,Calabar,between January 1st 1994 and December 31st 2000 were reviewed.Measure of treatment/intervention effect was calculated as relative risk for adverse maternal outcome,using spontaneous vaginal births as control.Results:Frequency of mode of delivery was as follow: vaginal births,139(60.7%);instrumental vaginal deliveries,16(7%);and abdominal deliveries,74(32.3%).Obstetric intervention occurred in 90(39.3%) cases.Sixty-four(28%) cases did not book for antenatal care,with 42 cases(18.3%) requiring obstetric intervention.About one in every two parturients(1: 2.1) in this study,requiring obstetric intervention at delivery had been interfered with at unorthodox health facilities.Relative risks for postpartum haemorrhage,wound sepsis and paralytic ileus were significantly high in parturients with abdominal delivery;while in parturients with instrumental vaginal delivery relative risks were significantly high for puerperal sepsis,paralytic ileus and obstetric palsy.There were no maternal deaths.Conclusion:Obstetric intervention in parturients with macrosomic births was high due to labour complications;and was associated with significant risk for adverse maternal outcome,especially in parturients with unskilled interference.

Evaluation on the Influence of the Timing of Twin Pregnancy Termi­nation on the Outcome of Mother and Infants

Objective:Objective:To observe the maternal and infant outcomes of pregnant women with twins terminating their pregnancy at different timings.Methods:Among the twin pregnant women admitted to our hospital from August 2019 to August 2020,50 primiparous women who opted to terminate their pregnancies at 5 different timings of“34--34^(+6) weeks”,“35--35^(+6) weeks”,“36--36^(+6) weeks”,“37--37^(+6) weeks”,“38--38^(+6) weeks”were selected as the research subjects.According to the timing of pregnancy termination,they were divided into 5 groups,each with 10 cases of pregnant women,and the impact of the timing of pregnancy termination on the outcome of the mothers and infants were compared.Results:The“37--37^(+6) weeks”group had the largest amount of postpartum hemorrhage,and the difference in Hb level before and after delivery was the largest.With the increase in gestational week,the weight of both large and small fetuses increased.In terms of neonatal diseases,the comparison between“34--34^(+6) weeks”,“35--35^(+6) weeks”,“36--36^(+6) weeks”and“37--37^(+6) weeks”,“38--38^(+6) weeks”,P<0.05,the comparison between“37--37^(+6) weeks”and“38--38^(+6) weeks”,P>0.05.Conclusions:The extension of the gestational week of twin pregnancies has no effect on postpartum hemorrhage,but it can improve the outcome of infants.

产时超声联合Kielland’s产钳的临床应用

目的观察产时超声联合Kielland’s产钳在第二产程中的应用效果。方法选取2020年8月至2022年8月在湖州市妇幼保健院进行足月分娩的产妇350例进行回顾性分析,根据应用超声辅助Kielland’s产钳助产情况,分为观察组(n=242)和对照组(n=108)。观察组在第二产程中应用超声辅助Kielland’s产钳进行助产分娩,对照组进行二程剖宫产。比较两组产妇和新生儿的并发症情况,包括产妇产后出血、绒毛膜羊膜炎、产后尿潴留、产后发热等,以及新生儿窒息和新生儿重症监护病房(neonatal intensive care unit,NICU)入住情况。结果观察组的产后出血、绒毛膜羊膜炎及住院天数均低于对照组,产后尿潴留发生率高于对照组,差异均有统计学意义(P<0.05);两组的新生儿NICU入住率及窒息率比较,差异均无统计学意义(P>0.05)。结论产时超声联合辅助Kielland’s产钳分娩,不仅不增加产妇或新生儿不良妊娠结局的发生,反而可以实现阴道助产,改善分娩结局,降低剖宫产率。

Clinical implication of platelet to lymphocyte ratio in early onset preeclampsia:A single-center experience

BACKGROUND Preeclampsia(PE)is a pregnancy syndrome of undetermined etiology;inflammation was one of the proposed theories for its development.AIM To examine the platelet to lymphocyte ratio(PLR),an inflammatory biomarker,as a marker to predict poor maternal-neonatal outcomes in early-onset PE(EoPE).METHODS A cross-sectional study enrolled 60 pregnant women with EoPE(at 32-30 wk of gestation)at a university hospital.Demographic criteria and hematological indices were collected,including platelet counts and indices(mean platelet volume and platelet distribution width),PLR,and the Doppler study,which calculated estimated fetal weight(EFW),amniotic fluid index(AFI),resistance index(RI),and pulsatility index(PI).Participants were followed until delivery,where maternal outcomes were recorded,including;delivery mode and reason for cesarean section,and neonatal outcomes,including fetal growth restriction(FGR),meconium-stained liquid,the 5-min Apgar score,and admission to the intensive care unit.RESULTS There was a trend of insignificant increases in cesarean sections.Sixty-one-point two percent(37/60)fetuses were admitted to the neonatal care unit;70.0%of admitted fetuses were meconium-stained liquor,and 56.7%of them had FGR.PLR was positively correlated with AFI and EFW as r=0.98,0.97,P<0.001;PLR showed negative correlations with PI and RI as r=-0.99,-0.98,P<0.001.The Apgar score and the number of days admitted to the intensive care unit had a positive and negative correlation(0.69,-0.98),P<0.0001,respectively.Receiver operating characteristic calculated a PLR cutoff value(7.49)that distinguished FGR at 100%sensitivity and 80%specificity.CONCLUSION Strong,meaningful relationships between PLR and FGR parameters and a poor neonatal outcome with a significant P value make it a recommendable biomarker for screening EoPE-related complications.Further studies are suggested to see the impact on maternal-neonatal health.

左甲状腺素钠治疗对妊娠合并甲状腺功能减退患者甲状腺功能指标及母婴结局的影响

目的探讨左甲状腺素钠治疗妊娠合并甲状腺功能减退患者的效果。方法378例妊娠合并甲状腺功能减退患者随机分为两组,对照组采用甲状腺片治疗,观察组采用左甲状腺素钠治疗,对比两组的临床疗效。结果治疗后,观察组的FT_(4)、FT_(3)水平均高于对照组,TSH水平、不良母婴结局发生率均低于对照组(P<0.05)。两组的不良反应发生率对比,差异无统计学意义(P>0.05)。结论左甲状腺素钠治疗妊娠合并甲状腺功能减退患者可有效改善其甲状腺功能与母婴结局。

产房家庭协同护理对初产妇心理状况、分娩自我效能及母婴结局的影响

目的:探讨产房家庭协同护理对初产妇心理状况、分娩自我效能及母婴结局影响.方法:选取2020年5月-2021年12月在本院产检并分娩的初产妇为研究对象,按随机数字表法分为观察组和对照组各60例.对照组临产进入产房后常规护理与指导,观察组在对照组的基础上实施家庭成员协同护理.对比分析两组产妇干预前后SAS、SDS评分,分娩自我效能评分,分娩方式,产时VAS评分、产程时间及母婴结局之间的差异.结果:干预后观察组对象SAS评分、SDS评分下降显著,且低于对照组(P<0.05);结果效能、期望效能、自我效能总分提高,且高于对照组(均P<0.05);阴道分娩率显著高于对照组(91.7%比73.3%),中转剖宫产率低于对照组(8.3%比26.7%),差异有统计学意义(P<0.05).观察组经阴道分娩对象产时VAS评分、第一、二产程时间、产后2h出血量及新生儿Apgar评分均明显好于对照组(P<0.05).结论:产房家庭成员协同护理干预可有效改善初产妇心理状况,提高分娩自我效能,降低产时疼痛水平,缩短产程时间,促进阴道分娩,改善母婴结局.

基于FTS理念的多模式护理在妊娠期糖尿病产妇剖宫产围术期的应用

目的探讨基于快速康复外科(FTS)理念的多模式护理在妊娠期糖尿病产妇剖宫产围术期的应用效果。方法将2019年12月至2021年12月于我院接受剖宫产手术分娩的60例妊娠期糖尿病产妇随机分为两组30例。对照组接受常规围术期护理,观察组采用基于FTS理念的多模式护理。比较两组的血糖水平、分娩指标及不良母婴结局发生率。结果预产期前1 d,观察组空腹血糖及餐后2 h血糖水平低于对照组(P<0.05)。观察组术后住院时间短于对照组,产中及产后24 h出血量少于对照组(P<0.05)。观察组不良母婴结局发生率低于对照组(P<0.05)。结论基于FTS理念的多模式护理可提高妊娠期糖尿病产妇血糖水平控制效果,减少出血量,缩短住院时间,降低不良母婴结局发生率。

妊娠期糖尿病患者体重增长情况及与母婴不良结局的相关性研究

目的根据我国妊娠期体重增长(GWG)标准,分析妊娠期糖尿病(GDM)孕妇妊娠期体重增长情况及其和母婴不良结局的相关性。方法选取北京市朝阳区2019年2月至2022年8月建档分娩的单胎妊娠GDM孕妇10539例为研究对象,采用Logistic回归分析GDM孕妇GWG与妊娠期高血压、妊娠合并贫血、子痫前期/子痫、胎膜早破、剖宫产、低出生体重、巨大儿、小于胎龄儿(SGA)、大于胎龄儿(LGA)的相关性。结果10539例GDM孕妇中,35.53%GWG过多,20.56%GWG不足,43.90%GWG适宜;42.49%的超重人群和45.61%的肥胖人群GWG过多。在调整年龄、民族、文化程度、职业、孕次、孕前体质量指数、孕龄后,多因素Logistic回归分析结果显示,GWG过多是妊娠期高血压、子痫前期/子痫、剖宫产、巨大儿和LGA的危险因素(aOR值介于1.39~2.37之间,P<0.05),是低出生体重、SGA的保护性因素(aOR值分别为0.60、0.61,P<0.01);而GWG不足是低出生体重、SGA的危险因素(aOR值分别为1.81、1.38,P<0.01),是胎膜早破、剖宫产、LGA的保护性因素(aOR值分别为0.65、0.89、0.81,P<0.05);未观察到GWG与妊娠合并贫血的相关性(P>0.05)。结论在我国妊娠期体重增长标准下,GDM孕妇中约20%增重不足,约40%的肥胖和超重人群增重过多。GDM孕妇妊娠期体重增长过多和不足均会增加母婴不良结局的风险,为GDM人群制定针对性妊娠期增重标准,指导和监测GDM孕妇妊娠期增重具有一定的意义。

腰硬联合麻醉分娩镇痛后发热对母婴分娩结局的影响

目的探讨腰硬联合麻醉分娩镇痛后发热对分娩结局的影响,以期改善母婴结局。方法选取2020年1月至2022年6月进行腰硬联合麻醉分娩镇痛的300例产妇作为研究对象,根据镇痛后是否出现发热将产妇分为两组。对照组为未出现发热的产妇,共150例;观察组为出现发热的产妇,共150例。比较两组产妇的阴道操作次数、破膜时间、总产程时间、缩宫素使用比例、分娩方式、产妇不良结局发生率以及新生儿不良结局发生率。结果观察组阴道操作次数(7.56±1.12)次,破膜时间为(11.86±2.03)h,总产程时间为(17.08±2.34)h,使用缩宫素加强宫缩为51例(34.00%),对照组阴道操作次数(5.41±1.04)次,破膜时间为(8.69±1.75)h,总产程时间为(15.04±1.84)h,使用缩宫素加强宫缩为20例(13.33%),两组产妇的阴道操作次数、破膜时间、总产程时间、缩宫素使用比例等指标比较差异均有统计学意义(P<0.001)。观察组产妇自然分娩82例(54.67%),剖宫产45例(30.00%),器械助产23例(15.33%),对照组产妇自然分娩121例(80.67%),剖宫产19例(12.67%),器械助产10例(6.67%),两组产妇的分娩方式比较差异有统计学意义(P<0.05或0.001)。观察组产妇出现低血压、头痛、产后出血、产褥感染等总不良结局发生率为60.67%(91/150),对照组产妇出现低血压、头痛、产后出血、产褥感染等总不良结局发生率为31.33%(47/150),两组产妇总不良结局发生率差异有统计学意义(P<0.001)。观察组出现胎儿窘迫、新生儿窒息、新生儿败血症、新生儿高胆红素血症等总不良结局发生率为40.67%(61/150),对照组出现胎儿窘迫、新生儿窒息、新生儿败血症、新生儿高胆红素血症等总不良结局发生率为22.67%(34/150),两组新生儿总不良结局发生率差异有统计学意义(P<0.001)。结论产时发热是一种临床表现,早发现早预防非常重要。对于产科医生而言,应加强产程管理,掌握阴道操作指征,严格遵循无菌操作,以预防感染性产时发热。同时,要避免产时发热相关因素的叠加,防止非感染性发热的发生。此外,还需综合分析产时发热的原因,动态监测各项指标,仔细鉴别,并采取适宜的产程处理措施。

胎儿体质量估计对初产妇巨大儿分娩方式及围产结局的临床观察

目的观察胎儿体质量估计对初产妇巨大儿的分娩方式和围产结局的影响。方法选取2022年1月至2023年12月北京市海淀区妇幼保健院分娩的足月单胎初产妇206例,根据估计体质量分为甲组(估计胎儿体质量<4000 g,118例)和乙组(估计胎儿体质量≥4000 g,88例)。比较两组产妇及新生儿的分娩方式和分娩结局等。结果206例初产妇年龄21~39岁,平均(30.6±3.4)岁。与乙组相比,甲组阴道分娩比例较高(61.9%比40.9%)、剖宫产比例较低(32.2%比56.8%),两组分娩方式的差异有统计学意义(P<0.05)。甲组试产率明显高于乙组(90.7%比59.1%),差异有统计学意义(P<0.05)。甲组产后出血量(容积法)和校正产后出血量均高于乙组[350(300,500)ml比300(300,380)ml,440(230,720)ml比360(160,560)ml],差异有统计学意义(P<0.05)。两组胎儿窘迫、肩难产、新生儿窒息比例的差异无统计学意义(P>0.05)。结论低估胎儿体质量可增加初产妇巨大儿试产率及阴道分娩率,也增加了产后出血量,但并未增加胎儿窘迫、肩难产、新生儿窒息等分娩并发症。建议胎儿估计体质量<4500 g且有阴道分娩意愿的产妇,应该在充分告知的情况下,增加试产机会。

经鼻肠梗阻导管置入术治疗妊娠期肠梗阻的效果分析

目的探讨经鼻肠梗阻导管置入术治疗妊娠期肠梗阻的效果。方法通过随机数字表法将2021年1月至2022年1月本院接收的92例妊娠期肠梗阻患者分为观察组(46例,采用经鼻肠梗阻导管置入术治疗)和对照组(46例,采用普通鼻胃管进行胃肠减压)。观察2组患者疗效、胃肠功能以及免疫功能情况,并记录母婴结局。结果观察组患者总有效率高于对照组(P<0.05)。2组患者治疗后的CD_(4)^(+)T淋巴细胞水平上升,IgG、IgA、IgM、CD_(8)^(+)T淋巴细胞水平降低,且观察组均优于对照组,差异有统计学意义(P<0.05)。观察组患者治疗后肠鸣音恢复时间、肛门排气时间、首次排便时间均早于对照组(P<0.05)。观察组中有42例(91.30%)患者经保守治疗后足月分娩,母婴结局良好,对照组中有35例(76.09%)经保守治疗后康复出院,2组患者康复出院率比较差异具有统计学意义(P<0.05)。结论经鼻肠梗阻导管置入术能有效改善妊娠期肠梗阻患者胃肠功能,提高免疫功能及康复率。

探讨小剂量罗哌卡因联合舒芬太尼连续硬膜外麻醉对无痛分娩产妇镇痛效应及母婴结局的影响

目的 探析应用小剂量罗哌卡因联合舒芬太尼连续硬膜外麻醉对无痛分娩产妇镇痛效应及母婴结局的影响。方法 纳入产科产检并拟用无痛分娩的100例产妇为分析对象,对产妇编序后采用随机数字表格方法分组,分设为对照组(罗哌卡因连续硬膜外麻醉)、观察组(小剂量罗哌卡因联合舒芬太尼连续硬膜外麻醉),各50例。比较两组产妇的麻醉镇痛效果(镇痛起效时间、完全阻滞时间、镇痛持续时间),产程(第一产程、第二产程、第三产程及总产程),不同时间段(镇痛前、镇痛后15 min、镇痛后30 min、宫口开全时)疼痛评分,母婴结局。结果 观察组产妇的镇痛起效时间(4.56±1.68)min、完全阻滞时间(12.35±2.42)min显著短于对照组的(15.14±1.87)、(23.41±2.13)min,镇痛持续时间(5.38±0.57)h长于对照组的(2.66±0.33)h,有统计学意义(P<0.05)。观察组产妇的第一产程(376.22±61.23)min及总产程(427.71±82.21)min显著短于对照组的(432.42±88.21)、(484.77±112.42)min,有统计学意义(P<0.05),两组第二产程及第三产程比较无统计学意义(P>0.05)。观察组产妇镇痛后15 min、镇痛后30 min、宫口开全时疼痛评分分别为(1.78±0.34)、(1.23±0.24)、(1.54±0.28)分,显著低于对照组的(2.12±0.41)、(1.87±0.27)、(3.23±1.16)分,有统计学意义(P<0.05)。两组新生儿出生后10 min的Apgar评分及产妇恶心呕吐、头痛、尿潴留发生率比较无统计学意义(P>0.05)。结论 产妇无痛分娩时应用小剂量罗哌卡因联合舒芬太尼连续硬膜外麻醉方式的镇痛效果显著,不会增加母婴结局不良风险。

BMI变化对妊娠期糖尿病母婴结局的影响

目的探讨妊娠期糖尿病(GDM)孕妇孕期不同体重指数(BMI)变化与母婴结局的相关性。方法选取百色市人民医院2019至2021年进行产检、分娩并确诊为GDM的孕妇200例作为研究对象,根据体重(BMI)增长幅度(ΔBMI)变化量将其分成ΔBMI<4 kg/m^(2)组(BMI增长不足组,n=51)、4 kg/m^(2)≤ΔBMI≤6 kg/m^(2)组(BMI增长正常组;n=87)和ΔBMI>6 kg/m^(2)组(BMI增长过多组,n=62)。利用调查问卷发放的方式获取所有受试者的基线资料与实验数据,利用Logistic回归模型分析评估不同BMI变化与母婴结局的相关性。结果BMI增长过多组妊高症、先兆子痫、产后出血各占29.03%、18.03%、41.94%,BMI增长正常组各占19.54%、14.94%、12.64%,BMI增长不足组各占25.49%、7.84%、13.73%。②BMI增长过多组胎儿窘迫、巨大儿各占29.03%、40.32%,BMI增长正常组各占13.79%、14.94%,BMI增长不足组各占9.80%、7.84%。BMI增长过多组产后并发症发生率、新生儿结局不良率较BMI增长正常组、BMI增长不足组更高(P<0.05)。将BMI增长正常作为参照进行Logistic回归分析发现,BMI增长不足会增加妊高症、先兆子痫、产后出血、胎儿窘迫、巨大儿的发生风险(OR=3.376、2.658、1.354、1.713、2.165,P<0.05);BMI增长过多会增加妊高症、先兆子痫、产后出血、胎儿窘迫、巨大儿、低体重儿和GDM的发生风险(OR=2.647、1.659、3.675、4.132、2.876、3.151、3.325)。结论GDM产妇的BMI增长不足、BMI增长过多均会增加母婴结局的不良发生率,故在孕期内控制可监测孕妇的体重增长,不仅有利于母婴的健康,对降低GDM及相关并发症发生率也有积极的影响。

院前院内无缝隙一体化急救模式对急诊危重症孕产妇救治效果及母婴结局的影响

目的:探讨院前院内无缝隙一体化急救模式对急诊危重症孕产妇救治效果及母婴结局的影响。方法:回顾性收集2022年5月-2023年2月本院实施传统急救模式时救治的急诊危重孕产妇83例作为传统组,2023年3月-2024年1月本院实施院前院内无缝隙一体化急救模式时救治的急诊危重孕产妇85例作为观察组。比较两组急救时间、急救效果、母婴不良结局。结果:观察组院前急救反应时间(6.4±1.6 min)、院内转运时间(10.3±3.1 min)、急救物品准备时间(15.4±5.1 min)、急诊科救治时间(21.5±6.8 min)均短于传统组(8.1±1.8 min、13.8±4.2 min、24.5±6.4 min),急救总有效率(95.3%)高于传统组(85.5%),孕产妇不良结局发生率(3.5%)、新生儿窒息率(5.9%)及死亡率(1.2%)均低于传统组(16.9%、9.6%)(均P<0.05)。结论:在危重症孕产妇急救中采取院前院内无缝隙一体化急救模式可明显提高急救效率,改善母婴结局。