Factors Influencing Mode of Delivery: A Case-Control Study

The primary objective of this investigation was to scrutinize the prepregnancy conditions and lifestyles of 2046 women residing in Liuzhou City, with the aim of delineating the determinants of delivery methods. Evidently, the study unearthed substantial correlations between prepregnancy body mass index, educational attainment, exposure to passive smoking, medical history, and other variables with the mode of delivery. Furthermore, a predictive nomogram model was formulated to accurately forecast the likelihood of cesarean section. These discernments equip pertinent authorities with the means to institute targeted screening and supportive measures for women contemplating pregnancy based on these identified factors. Moreover, provision of services such as prepregnancy counseling and clinical risk assessments could be instrumental in curbing the incidence of cesarean section.

Psychosocial Factors for Women Requesting Cesarean Section

Background: Rates of caesarean section are progressively increasing in many parts of the world. As a result of psychosocial factors, there has been an increasing tendency for pregnant women without justifiable medical indications for caesarean section to ask for this procedure in China. The psychosocial factors for requesting cesarean section were analyzed in our study. Methods: A self-made questionnaire and the State-Trait Anxiety Inventory (STAI) and Self-rating Depression Scale (SDS) were administered to evaluate lying-in women’s psychosocial state. Results: The proportion of lying-on women’s age and education degree was different significantly between the two groups (p % vs. 3.42%, p 0.05). By logistic regression, we found that for primipara, higher education degree, anxiety and lacking confidence were the dangerous factors for cesarean, while lower economic degree was a defendant factor. Conclusion: There were five main psychosocial factors such as education degree and economic state, parity, anxiety and confidence of lying-on women affecting the choice of the delivery way. The nulliparous women who feel anxious without confidence in nice economic state, with better education have higher risk to choose cesarean.

Outcome of cesarean delivery in women with excessive weight gain during pregnancy

The objective of this study was to assess the effects of excessive weight gain during pregnancy on the outcome of cesarean delivery. It was a cohort study comparing the outcome of cesarean delivery between 56 pregnant women with excessive weight gain during pregnancy and 75 pregnant women with no excessive weight gain during pregnancy, consecutively recruited at the Yaoundé Gyneco-Obstetric and Pediatric Hospital, Cameroon. In women delivered by cesarean section, excessive weight gain during pregnancy was found to predispose to: time interval from parietal incision to fetal extraction of more than five minutes, duration of cesarean section more than 60 minutes, blood loss more than 1000 ml during surgery, post-operative maternal complications, especially sepsis, fetal weight >3.5 kg and macrosomia. A systematic screening of excessive weight gain should be offered to all pregnant women, so as to prevent the adverse effects of excessive gestational weight gain on cesarean outcome.

Female urinary incontinence during pregnancy and after delivery: Clinical impact and contributing factors

Urinary incontinence(UI) is a common condition affecting adult women of all ages and it could have a negative infl uence on quality of life. The etiology of UI is multifactorial, but some of the most important risk factors are obesity and ageing, as well as adverse obstetric events. Pregnancy and delivery per se have been implicated in the etiology of UI. Although several studies have demonstrated a direct association between UI and vaginal delivery in short, medium and long-term, the role of childbirth on the risk of UI remains controversial. The mechanical strain during delivery may induce injuries to the muscle, connective and neural structures. Vaginal birth can be associated with relaxation or disruption of fascial and ligamentous supports of pelvic organs. Parity, instrumental delivery, prolonged labor and increased birth weights have always been considered risk factors for pelvic floor injury. Also genetic factors have been recently raised up but still there are not appropriate guidelines or measures to reduce signifi cantly the incidence of UI. The role of pelvic fl oor muscle training(PFMT) in the prevention and treatment of UI is still unclear. However, PFMT seems to be useful when supervised training is conducted and it could be incorporated as a routine part of women's exercise programmes during pregnancy and after childbirth.

Maternal choledochal cysts in pregnancy:A systematic review of case reports and case series

BACKGROUND Choledochal cysts(CC)are cystic dilatations of the biliary tract,usually diagnosed during childhood,with an estimated incidence in the general population of 1:100000.Complications related to CC include rupture,biliary obstruction,and cholangitis.Maternal CC in pregnancy are rarely reported,and there are no guidelines on optimal management.AIM To systematically review maternal CC diagnosed during pregnancy or postpartum with regard to the clinical presentation of CC,the mode of treatment and delivery,and maternal outcomes.METHODS A literature search of cases and case series of maternal CC in pregnancy and postpartum was conducted using MEDLINE/PubMed,Web of Science,Google Scholar,and Embase.There were no restrictions on language or publication year.Databases were lastly accessed on September 1,2022.RESULTS Overall,71 publications met the inclusion criteria,reporting 97 cases.Eighty-eight cases were diagnosed during pregnancy and nine in the puerperium.The most common symptoms were abdominal pain(81.2%)and jaundice(60.4%).Interventions for CC complications were required in 52.5%of the cases,and 34%of pregnancies were induced.Urgent cesarean section(CS)was done in 24.7%.The maternal mortality was 7.2%,while fetal mortality was inconsistently reported.Cholangitis,CC>15 cm,and bilirubin levels>80 mmol/L were associated with a higher likelihood of urgent CS and surgical intervention for CC.Bilirubin levels positively correlated with CC size.There was no correlation between age and cyst dimension,gestational age at cyst discovery,and CC size.CONCLUSION Although rare,maternal CC in pregnancy should be included in the evaluation of jaundice with upper abdominal pain.Symptomatology and clinical course are variable,and treatment may range from an expectative approach to emergent surgical CC treatment and urgent CS.While most cases were managed by conservative measures or drainage procedures,CC>15 cm and progressive cholangitis carry the risk of CC rupture and septic complications,which may increase the rates of unfavorable maternal and fetal outcomes.Therefore,such cases require specific surgical and obstetric interventions.

Maternal and Perinatal Outcomes of Pregnant Women with Heart Disease in Three YaoundéReferral Hospitals

Heart disease in pregnancy is the cause of significant maternal and perinatal morbidity. We wanted to evaluate the maternal and perinatal outcomes of pregnant women with heart disease in Yaoundé, Cameroon. This was a cross sectional study with retrospective data collection of 45 pregnancies in 42 women with heart disease followed at three Yaoundé referral hospitals in Yaoundé, Cameroon from January 1st 2015 to December 31st 2020. We collected data on maternal obstetrical and perinatal outcomes. The frequency of pregnancies with heart diseases was 0.1%. The mean maternal age was 29.05 ± 6.5 years. At first antenatal visit, all patients were in class I (84.4%) and II (15.6%) of the New-York Heart Association (NYHA) functional class. Valvular heart disease (51.1%) was the most common type followed by cardiomyopathy (37.7%). Over half of the deliveries were vaginal (51.1%). A cesarean section was generally indicated for the usual obstetrical reasons (54.5%) and for heart disease (31.8%). Complications included 17 (37.7%) cases of heart failure, 6 (13.3%) cases of pulmonary edema, 2 (04.4%) cases of pulmonary embolism, 3 (06.6%) maternal deaths and 3 (06.3%) perinatal deaths, 14 (29.7%) premature births and 3 cases of (6.3%) intrauterine growth retardation. The maternal deaths were cases complicated by pulmonary edema and all had dilated cardiomyopathy. The maternal and perinatal outcomes of pregnant women with heart disease are marked in our environment by increased morbidity and mortality. Therefore, it is necessary to improve the prenatal, per partum and postpartum management of this high-risk group.

基于多模态超声建构胎儿先天性心脏病决策树模型及其应用价值

目的:分析基于多模态超声建构胎儿先天性心脏病决策树模型及其应用价值。方法:随机选取2021年4月-2023年7月在本院产前超声检查孕中期孕妇300例,常规产科超声检查确定胎儿生长程度,核实孕周,采用超声多断面模式方法对胎儿心脏进行多断面检测,包括四腔心断面、三血管断面、主动脉弓断面、左室流出道断面、右室流出道断面。对正常分娩的新生儿进行心脏多断面超声检测。对300例胎儿进行多断面模式超声检测,分析胎儿是否伴有先天性心脏畸形,对比超声检查与随访结果符合情况。结果:超声检出21例先天性心脏畸形胎儿,8例选择引产,余13例正常分娩。超声诊断与随访结果对比,卵圆孔直径增大、法洛四联症、完全型心内膜垫缺损、二尖瓣闭锁、右室发育不良综合征、左室发育不良综合征、大动脉转位、永存动脉干、单心室、三尖瓣下移符合率均为100%,超声诊断室间隔缺损7例,随访发现室间隔诊断5例,诊断符合率71.4%。279例超声诊断无先天性心脏畸形胎儿出生后经超声诊断发现有1例卵圆孔未闭、3例室间隔缺损,共4例漏诊患儿,漏诊率0.54%。四腔心断面、三血管断面、主动脉弓断面、左室流出道断面、右室流出道断面诊断胎儿畸形率分别为3.95%、0.63%、2.76%、3.27%、3.25%。由决策树模型可得,产前超声检查发现胎儿心脏可疑异常、高龄孕妇、孕妇接受药物治疗或射线暴露、孕妇有先天性心脏病家族史是胎儿存在先天性心脏病的独立危险因素,其中产前超声检查发现胎儿心脏可疑异常的影响最为显著。结论:孕中期胎儿产前超声多断面模式筛查胎儿先天性心脏病,能够对多数胎儿先天性心脏病进行诊断。

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。

剖宫产术后再次妊娠经阴道分娩的相关影响因素

目的探讨剖宫产术后再次妊娠时经阴道分娩的影响因素。方法选取本院80例剖宫产后再次妊娠孕妇为研究对象,根据分娩方式不同划分为经阴道分娩组与剖宫产组,各40例。回顾性分析两组的基础资料,包含年龄、产次、孕前体质量指数、上次剖宫产间隔时间等,总结分析剖宫产术后再次妊娠经阴道分娩的影响因素。结果多因素分析结果显示,年龄≤30岁、孕前体质量指数≤25kg/m²、上次剖宫产间隔时间>2年、子宫下段厚度>2mm、分娩前子宫颈Bishop评分>5分、有不良妊娠结局史是剖宫产术后再次妊娠经阴道分娩的影响因素(P<0.05)。结论年龄、孕前体质量指数、上次剖宫产间隔时间、子宫下段厚度、分娩前子宫颈Bishop评分、不良妊娠结局史是剖宫产术后再次妊娠经阴道分娩的影响因素,临床需要在分娩前高度重视,提前做好相关准备,以尽可能提高经阴道分娩成功率,改善母婴结局,提升分娩质量。

共享决策在剖宫产术后再次妊娠分娩方式中的应用进展

就再次妊娠妇女面临的分娩方式决策挑战以及共享决策在再次妊娠分娩方式中的实施过程、应用效果、阻碍因素和发展策略进行综述,以期为剖宫产术后再次妊娠妇女的分娩管理提供依据。

硬膜外分娩镇痛在剖宫产后阴道分娩产妇中的应用效果分析

目的:探讨硬膜外分娩镇痛在剖宫产后阴道分娩(VBAC)产妇中的应用效果。方法:选取2019年4月—2023年4月于昆明医科大学第一附属医院产科住院分娩的145例VBAC产妇作为研究对象,随机分为观察组(n=68)和对照组(n=77)。对照组实施常规自然分娩,观察组实施硬膜外分娩镇痛。比较两组疼痛程度、并发症发生情况、新生儿情况。结果:宫口开4~5 cm、宫口开6~7 cm、宫口开全,对照组疼痛评分逐渐升高,且观察组疼痛评分低于对照组(P<0.05)。观察组产时发热率高于对照组(P<0.05)。观察组脐静脉碱剩余量高于对照组,脐静脉乳酸水平低于对照组(P<0.05)。结论:硬膜外分娩镇痛在VBAC产妇中的应用效果显著,可减轻产妇疼痛,预防无氧酵解导致的代谢性酸中毒,虽然产时发热率较高但对妊娠结局无不良影响。

剖宫产后再次妊娠孕妇分娩决策冲突的质性研究

目的:分析剖宫产后再次妊娠孕妇的分娩决策行为冲突,为制定决策支持策略提供依据。方法:通过目的抽样法选取13名剖宫产术后再次妊娠孕妇为研究对象,采用描述性质性研究方法对其进行半结构式访谈,应用内容分析法进行分析。结果:剖宫产后妊娠孕妇的分娩决策行为冲突包括决策认知受限是行为冲突前因(分娩决策复杂、信息限制)、知情决策不足是行为过程冲突诱因(价值观冲突、多元决策主体冲突)、决策冲突行为及体验(决策行为表现、决策情感体验)。结论:剖宫产后妊娠孕妇在分娩决策过程中受多重因素影响,护士应制定适宜的决策支持策略,以期尽可能降低其决策冲突,提升决策质量,以降低盲目再次剖宫产率。

剖宫产术后瘢痕子宫再次妊娠阴道分娩的临床研究

目的研究剖宫产术后瘢痕子宫再次妊娠阴道分娩的可行性。方法选取88例剖宫产术后瘢痕子宫再次妊娠经剖宫产分娩的产妇作为观察组,另外选择34例剖宫术后瘢痕子宫再次妊娠经阴道分娩的产妇作为对照组。比较两组决定分娩方式的条件(前次子宫下段横切、单胎妊娠、头先露情况、宫颈长度、子宫下段厚度)、妊娠结局[平均出血量、新生儿阿氏评分(Apgar评分)、产后泌乳时间、住院时间]、妊娠合并症(产后出血、产后感染、脏器拉伤、宫缩乏力、尿潴留、腹膜粘连)发生情况。结果观察组前次子宫下段横切、单胎妊娠、头先露占比分别为69.32%、73.86%、51.14%,均低于对照组的100.00%、91.18%、85.29%,宫颈长度(19.41±3.63)mm、子宫下段厚度(2.76±0.52)mm小于对照组的(26.82±4.98)、(4.59±0.85)mm,差异有统计学意义(P<0.05)。观察组平均出血量(212.36±39.67)ml、新生儿Apgar评分(9.59±1.79)分、产后泌乳时间(1.17±0.22)d、住院时间(3.57±0.67)d与对照组的(205.80±38.18)ml、(9.32±1.73)分、(1.16±0.22)d、(3.52±0.65)d比较无明显差异(P>0.05)。观察组妊娠合并症发生率29.55%与对照组的32.35%比较无明显差异(P>0.05)。结论剖宫产术后瘢痕子宫产妇再次妊娠可以实施阴道分娩和剖宫产分娩两种方式,但限制剖宫产分娩的原因是多方面的,及时筛查阴道试产的适应证和剖宫产指征可避免产妇出现严重的妊娠风险,考虑产妇的实际情况灵活的选择分娩途径。

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。

高频超声对剖宫产术后再妊娠分娩方式的评估效果

目的:探讨高频超声在剖宫产术后再妊娠阴道分娩产前评估中的应用价值.方法:选取2019年2月-2022年11月于本院产科分娩的有剖宫产史产妇80例,产前均实施高频超声检测并根据检测结果将80例产妇分为Ⅰ级瘢痕、Ⅱ级瘢痕、Ⅲ级瘢痕,对比不同分级产妇分娩情况及超声检测子宫下段肌层厚度及形态、滋养层动脉阻力指数、产程相关指标、新生儿Apgar评分等.结果:Ⅰ级瘢痕产妇剖宫产率最低,阴道分娩率最高,Ⅲ级瘢痕产妇剖宫产率最高且无阴道分娩;Ⅰ级瘢痕产妇子宫下段肌层厚度最厚,Ⅲ级瘢痕产妇下段肌层厚度最薄(均P<0.05).不同瘢痕分级产妇滋养层动脉阻力指数未见差异,不同瘢痕分级产妇分娩新生儿体重及Apgar评分无差异(均P>0.05).Ⅰ级瘢痕产妇手术产程用时最短、出血量与缩宫素用量最少,Ⅲ级瘢痕产妇产程用时最长、产时出血量与缩宫素用量最多(均P<0.05).80例中有61例经阴道分娩成功(76.3%),其中1例子宫破裂(1.6%),19例行剖宫产术(23.8%),均无产妇及围生儿死亡.结论:高频超声通过监测产妇子宫下段肌层厚度及形态可准确了解瘢痕愈合情况,对剖宫产瘢痕子宫再妊娠产妇分娩方式的选择有较高指导价值,使分娩方式合理化、安全化,提升瘢痕子宫再次妊娠阴道分娩率.

瘢痕子宫再妊娠经剖宫产分娩产后出血的影响因素分析

目的 探讨瘢痕子宫再妊娠经剖宫产分娩产后出血(PPH)的影响因素。方法 回顾性分析2021年8月至2022年12月263例瘢痕子宫再次剖宫产分娩产妇临床资料,以是否发生PPH,分为PPH组(n=25)和非PPH组(n=238),采用单因素与多因素Logistic回归模型分析产妇二次剖宫产并发PPH的影响因素。结果 263例产妇PPH发生率为9.51%,PPH组流产次数、硫酸镁保胎史、产前出血、合并凶险性前置胎盘、切口撕裂、宫缩乏力等高于非PPH组(P<0.05),产前血红蛋白、产前纤维蛋白原水平低于非PPH组(P<0.05)。Logistic回归分析,既往人流次数≥3次(OR=3.122)、产前纤维蛋白原≤3 g/L(OR=2.510)、妊娠合并凶险性前置胎盘(OR=7.903)、宫缩乏力(OR=4.096)、子宫切口撕裂(OR=5.831)是产妇二次剖宫产并发PPH的危险因素。结论 避免意外妊娠减少流产次数,加强产前纤维蛋白原指标监测,重视凶险性前置胎盘及宫缩乏力的处理,警惕术中切口撕裂,能有效预防PPH的发生。

低位产钳术与剖宫产术在第二产程延长或停滞产妇中的应用效果比较

目的:比较低位产钳术与剖宫产术在第二产程延长或停滞产妇中的应用效果。方法:回顾性分析2019年10月至2023年10月于该院行阴道试产且第二产程延长或停滞的116例产妇的临床资料,根据分娩方式的不同将其分为剖宫产组(n=62)和低位产钳组(n=54),比较两组围产期指标(第二产程时间、产时出血量、产后出血量)水平和住院时间,新生儿体质量和脐带血pH,并发症发生率及新生儿结局。结果:低位产钳组第二产程时间、住院时间均短于剖宫产组,产时出血量、产后出血量均少于剖宫产组,差异有统计意义(P<0.05);两组新生儿体质量、脐带血pH比较,差异均无统计学意义(P>0.05);两组并发症发生率比较,差异均无统计学意义(P>0.05);低位产钳组新生儿酸中毒和头皮血肿发生率均低于剖宫产组,差异有统计学意义(P<0.05);两组新生儿窒息、皮肤损伤发生率比较,差异均无统计学意义(P>0.05)。结论:低位产钳术应用于第二产程延长或停滞产妇可缩短第二产程时间和住院时间,减少产时和产后出血量,以及降低新生儿酸中毒、头皮血肿发生率的效果优于剖宫产术。

剖宫产术后再妊娠产妇分娩方式相关KAP现况调查及影响因素分析

目的分析剖宫产术后再妊娠产妇分娩方式相关知识、态度、行为(KAP)的影响因素。方法选取2020年3月至2021年6月我院收治的96例剖宫产术后再妊娠产妇作为调查对象,采用一般资料调查问卷调查一般资料;采用分娩方式相关KAP调查问卷统计分娩方式相关KAP评分;采用多元线性回归分析影响分娩方式相关KAP的因素。结果分娩方式相关知识评分(12.53±3.09)分,分娩方式相关态度评分(16.01±2.94)分,分娩方式相关行为评分(12.83±2.01)分。多元线性回归分析显示,受教育程度、孕周、医生建议分娩方式、医保状况、分娩意向为影响分娩方式相关知识的独立因素(P<0.05);受教育程度、平均月收入、医生建议分娩方式、分娩意向为影响分娩相关态度的独立因素(P<0.05);受教育程度、孕周、医生建议分娩方式、分娩意向为影响分娩相关行为的独立因素(P<0.05)。结论剖宫产术后再妊娠产妇分娩方式相关KAP水平有待提升,均受受教育程度、医生建议分娩方式等因素的影响,临床中可以此制定针对性干预措施。

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。

超声估测胎儿体质量的准确性、一致性及其对胎儿分娩方式的影响

目的探讨超声估测胎儿体质量的准确性、一致性及其对胎儿分娩方式选择的影响。方法选取妊娠满28周且在本院住院分娩的单活胎妊娠初产妇1258例,记录胎儿实际体质量,采用三维容积超声测量部分肢体体积上臂中段50%的体积(AVol)和大腿中段50%的体积(TVol)评估胎儿体质量,比较不同年份胎儿实际体质量、超声AVol评估胎儿体质量、超声TVol评估胎儿体质量、分娩方式,以及不同分娩方式胎儿实际体质量、超声AVol评估胎儿体质量、超声TVol评估胎儿体质量,并分析胎儿实际体质量与超声AVol评估胎儿体质量、超声TVol评估胎儿体质量的相关性,以及超声AVol与超声TVol评估胎儿体质量的准确性、Kappa一致性。结果常规二维评估胎儿体重量与实际胎儿体质量、超声AVol评估胎儿体质量、超声TVol评估胎儿体质量比较,差异有统计学意义(P<0.05)。不同年份胎儿实际体质量、常规二维评估胎儿体质量、超声AVol评估胎儿体质量、超声TVol评估胎儿体质量比较,差异均无统计学意义(P>0.05)。不同年份胎儿剖宫产率比较,差异均无统计学意义(P>0.05)。剖宫产胎儿实际体质量、常规二维评估胎儿体质量、超声AVol评估胎儿体质量、超声TVol评估胎儿体质量高于顺产胎儿,差异有统计学意义(P<0.05)。经Pearson分析,实际体质量与超声AVol评估胎儿体质量、超声TVol评估胎儿体质量呈正相关(r=0.979、0.974,P<0.05)。超声AVol评估胎儿体质量的准确率为85.85%,超声TVol评估胎儿体质量的准确率为85.61%;超声AVol与超声TVol评估胎儿体质量的Kappa一致性为0.834。结论超声AVol、TVol评估胎儿体质量具有较高的准确性和一致性,控制胎儿体质量,有利于降低剖宫产率。