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
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
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
目的:探究间羟胺联合腰硬联合麻醉对剖宫产产妇的影响。方法:选取2021年1月—2022年10月泉州市第一医院收治的100例待剖宫产产妇。根据随机数表法将其分为腰硬联合麻醉组和联合治疗组,各50例。腰硬联合麻醉组给予腰硬联合麻醉,联合治疗...目的:探究间羟胺联合腰硬联合麻醉对剖宫产产妇的影响。方法:选取2021年1月—2022年10月泉州市第一医院收治的100例待剖宫产产妇。根据随机数表法将其分为腰硬联合麻醉组和联合治疗组,各50例。腰硬联合麻醉组给予腰硬联合麻醉,联合治疗组给予间羟胺联合腰硬联合麻醉。比较两组麻醉前、术后收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)、心输出量(CO)、心率(HR)、心脏指数(CI),手术指标,新生儿缺氧情况及不良反应。结果:术后,两组DBP、SBP、MAP下降,但联合治疗组DBP、SBP、MAP均高于腰硬联合麻醉组,差异有统计学意义(P<0.05)。术后,两组HR、CO、CI均降低,但联合治疗组HR、CO、CI均高于腰硬联合麻醉组,差异有统计学意义(P<0.05)。两组手术时间、术中失血量、术中液体输注量比较,差异无统计学意义(P>0.05)。两组新生儿1 min和5 min Apgar评分比较,差异无统计学意义(P>0.05)。联合治疗组不良反应发生率低于腰硬联合麻醉组,差异有统计学意义(P<0.05)。结论:间羟胺联合腰硬联合麻醉对剖宫产产妇进行干预,能较好地维护产妇血压、心率水平,调节产妇血流动力学,对新生儿Apgar评分有较小的影响,效果显著。展开更多
目的:探讨水囊引产与米索前列醇引产对足月妊娠孕妇的影响。方法:选取2022年1月—2023年6月厦门莲花医院收治的100例足月妊娠孕妇。根据随机数表法将其分为对照组和观察组,各50例。对照组采用米索前列醇引产,观察组采用水囊引产。比较...目的:探讨水囊引产与米索前列醇引产对足月妊娠孕妇的影响。方法:选取2022年1月—2023年6月厦门莲花医院收治的100例足月妊娠孕妇。根据随机数表法将其分为对照组和观察组,各50例。对照组采用米索前列醇引产,观察组采用水囊引产。比较两组促宫颈成熟效果、相关指标、分娩产程、分娩方式、并发症及满意度。结果:观察组促宫颈成熟总有效率高于对照组,差异有统计学意义(P<0.05)。观察组临产时间早于对照组,产后24 h出血量少于对照组,新生儿5 min Apgar评分高于对照组,差异有统计学意义(P<0.05)。观察组阴道分娩率高于对照组,第一产程、第二产程、第三产程均短于对照组,差异有统计学意义(P<0.05)。两组并发症发生率比较,差异无统计学意义(P>0.05)。观察组总满意度高于对照组,差异有统计学意义(P<0.05)。结论:水囊引产较米索前列醇引产更利于宫颈成熟,可缩短产程,降低剖宫产率,提高孕妇满意度。展开更多
目的:分析水中待产分娩与传统待产分娩对产后盆底功能障碍性疾病(PFD)预防效果。方法:回顾性分析2022年4月—2023年4月驻马店市中医院进行阴道试产的60例产妇临床资料,依据产妇意愿分为两组,32例采用传统待产分娩的为传统组,28例采用水...目的:分析水中待产分娩与传统待产分娩对产后盆底功能障碍性疾病(PFD)预防效果。方法:回顾性分析2022年4月—2023年4月驻马店市中医院进行阴道试产的60例产妇临床资料,依据产妇意愿分为两组,32例采用传统待产分娩的为传统组,28例采用水中待产分娩的为水中组。比较两组产妇盆腔器官脱垂(POP)、压力性尿失禁(SUI)发生率、盆底电生理指标、产程时间、产后2 h出血量、新生儿1 min Apgar评分、新生儿体重和剖宫产率。结果:水中组POP及SUI发生率低于传统组,差异均有统计学意义(χ^(2)=4.115、4.391,P<0.05);水中组盆底肌肉Ⅰ类、Ⅱ类肌纤维肌力分级高于传统组,差异均有统计学意义(Z=2.781、2.401,P<0.05);水中组第一产程时间短于传统组,差异有统计学意义(t=2.227,P<0.05);两组产妇第二、第三产程时间、产后2 h出血量、新生儿1 min Apgar评分、新生儿体重比较,差异均无统计学意义(t=0.501、0.339、0.980、0.478、0.255,P>0.05);水中组剖宫产率低于传统组,差异有统计学意义(χ^(2)=4.391,P<0.05)。结论:水中待产分娩对产后PFD预防效果优于传统待产分娩,能够缩短第一产程时间,促进产妇自然分娩,降低POP及SUI发生率,减轻对盆底肌纤维的损伤,且对母婴结局无明显影响。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.
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。
文摘目的:探究间羟胺联合腰硬联合麻醉对剖宫产产妇的影响。方法:选取2021年1月—2022年10月泉州市第一医院收治的100例待剖宫产产妇。根据随机数表法将其分为腰硬联合麻醉组和联合治疗组,各50例。腰硬联合麻醉组给予腰硬联合麻醉,联合治疗组给予间羟胺联合腰硬联合麻醉。比较两组麻醉前、术后收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)、心输出量(CO)、心率(HR)、心脏指数(CI),手术指标,新生儿缺氧情况及不良反应。结果:术后,两组DBP、SBP、MAP下降,但联合治疗组DBP、SBP、MAP均高于腰硬联合麻醉组,差异有统计学意义(P<0.05)。术后,两组HR、CO、CI均降低,但联合治疗组HR、CO、CI均高于腰硬联合麻醉组,差异有统计学意义(P<0.05)。两组手术时间、术中失血量、术中液体输注量比较,差异无统计学意义(P>0.05)。两组新生儿1 min和5 min Apgar评分比较,差异无统计学意义(P>0.05)。联合治疗组不良反应发生率低于腰硬联合麻醉组,差异有统计学意义(P<0.05)。结论:间羟胺联合腰硬联合麻醉对剖宫产产妇进行干预,能较好地维护产妇血压、心率水平,调节产妇血流动力学,对新生儿Apgar评分有较小的影响,效果显著。
文摘目的:探讨水囊引产与米索前列醇引产对足月妊娠孕妇的影响。方法:选取2022年1月—2023年6月厦门莲花医院收治的100例足月妊娠孕妇。根据随机数表法将其分为对照组和观察组,各50例。对照组采用米索前列醇引产,观察组采用水囊引产。比较两组促宫颈成熟效果、相关指标、分娩产程、分娩方式、并发症及满意度。结果:观察组促宫颈成熟总有效率高于对照组,差异有统计学意义(P<0.05)。观察组临产时间早于对照组,产后24 h出血量少于对照组,新生儿5 min Apgar评分高于对照组,差异有统计学意义(P<0.05)。观察组阴道分娩率高于对照组,第一产程、第二产程、第三产程均短于对照组,差异有统计学意义(P<0.05)。两组并发症发生率比较,差异无统计学意义(P>0.05)。观察组总满意度高于对照组,差异有统计学意义(P<0.05)。结论:水囊引产较米索前列醇引产更利于宫颈成熟,可缩短产程,降低剖宫产率,提高孕妇满意度。
文摘目的:分析水中待产分娩与传统待产分娩对产后盆底功能障碍性疾病(PFD)预防效果。方法:回顾性分析2022年4月—2023年4月驻马店市中医院进行阴道试产的60例产妇临床资料,依据产妇意愿分为两组,32例采用传统待产分娩的为传统组,28例采用水中待产分娩的为水中组。比较两组产妇盆腔器官脱垂(POP)、压力性尿失禁(SUI)发生率、盆底电生理指标、产程时间、产后2 h出血量、新生儿1 min Apgar评分、新生儿体重和剖宫产率。结果:水中组POP及SUI发生率低于传统组,差异均有统计学意义(χ^(2)=4.115、4.391,P<0.05);水中组盆底肌肉Ⅰ类、Ⅱ类肌纤维肌力分级高于传统组,差异均有统计学意义(Z=2.781、2.401,P<0.05);水中组第一产程时间短于传统组,差异有统计学意义(t=2.227,P<0.05);两组产妇第二、第三产程时间、产后2 h出血量、新生儿1 min Apgar评分、新生儿体重比较,差异均无统计学意义(t=0.501、0.339、0.980、0.478、0.255,P>0.05);水中组剖宫产率低于传统组,差异有统计学意义(χ^(2)=4.391,P<0.05)。结论:水中待产分娩对产后PFD预防效果优于传统待产分娩,能够缩短第一产程时间,促进产妇自然分娩,降低POP及SUI发生率,减轻对盆底肌纤维的损伤,且对母婴结局无明显影响。
