Timing of Elective Repeat Cesarean Delivery at 38 Weeks versus 39 Weeks: Rate of Spontaneous Onset of Labor before Planned Cesarean Section and Impact on Maternal Outcome: A Retrospective Cohort Study

Background: The timing of elective repeat cesarean delivery at 38 weeks versus 39 weeks is still a debatable subject, both regarding maternal and neonatal outcomes. In the Saudi context, there is lack of local data to aid decision-making regarding the timing of elective repeat cesarean delivery. Objectives: To estimate the rate of spontaneous onset of labor before the planned gestational age for repeat cesarean section in women who were booked at gestational age of (39 0/7 - 39 6/7) weeks (W39) versus (38 0/7 - 38 6/7) weeks (W38) and to compare the rate of maternal composite outcome between these groups. Design: Retrospective cohort. Setting: This study was conducted at King Abdulaziz Medical City, Jeddah, KSA. Method: Delivery registry books were reviewed to identify all deliveries from 1 January 2014 to 31 December 2016 (3 years). All low-risk pregnant women who had 2 or more cesarean deliveries and who met the inclusion criteria were included. Results: A total of 440 women were included of whom 318 (72.3%) were planned for elective cesarean section at W38 gestational age and 122 women at W39 gestational age. Mothers planned at W39 had higher rate of emergency cesarean deliveries versus those planned at W38 (18.0% versus 10.4%, p = 0.030;RR = 13.06), most frequently due to early onset of contractions (16.4% versus 8.2%, p = 0.012;RR = 12.17) or cervical dilatation (11.6% versus 5.4%, p = 0.024, RR = 16.15). No difference in the incidence of individual or composite maternal complications was noted between the two groups. Mother’s age (OR 0.93, p = 0.018) and schedule date at W39 (OR = 1.94, p = 0.028) were independently associated with spontaneous onset of labor before the scheduled gestational age, while no association was found with parity, previous number of spontaneous vaginal deliveries, number of previous cesarean deliveries or interval from last cesarean delivery. Conclusion: Elective cesarean section scheduled at 39 weeks of gestation or beyond carries a higher risk of emergency cesarean section, with no significant increase in maternal complications. The identification of factors associated with spontaneous onset of labor before the planned gestational age should be carefully identified to determine the optimal timing.

The Feto-Maternal Outcome in Instrumental Assisted Vaginal Delivery in Parapokar Maternity and Woman Hospital—A Retrospective Study

Aim: To determine maternal and neonatal morbidities associated with instrumental vaginal delivery. Methods: This retrospective study consisted of 233 women undergoing instrumental vaginal deliveries from April 2020 to March 2021 at Paropakar Maternity and Women Hospital, a tertiary care hospital in Kathmandu, Nepal. Neonatal and maternal complications were analyzed. Results: Of 233 women, 102 (43.7%) and 131 (56.2%) had vacuum and forceps deliveries, respectively. The use of instruments was more frequent in infants with higher birth weight and gestational age. There were no significant differences in Apgar scores between the two groups. Two main indications of instrumental deliveries were fetal distress and prolonged second stage labor. Forceps, compared with vacuum, more often caused 3rd/4th perineal tears, tear extending to fornices, and postpartum hemorrhage. Neonatal outcomes were similar in both types of instrumental deliveries. Conclusion: Instrumental vaginal delivery caused maternal morbidity and procedure/judgment training for it is essential.

Effect of prolonged second stage of labor on maternal and neonatal outcomes

Objective:To discuss the effect of prolonged second stage of labor on maternal and neonatal outcomes.Methods:A total of 101 primiparas with the length of second stage of labor longer than 2 h were selected and pregnant women with the length less than 2 h served as control.The maternal and neonatal outcomes of two groups were observed and compared.Results:A total of 62.1%(18/11) with the length of second stage of labor between 120 min and 180 min,46.7%(28/32) between 181 min and 240 min and 12 longer than 241 min underwent vaginal delivery.The longer the length of second stage of labor,the lower score of Apgar scale for infants in 1 min,and the higher the incidence of asphyxia.But there was no difference in scale in 5 min.As second stage of labor prolonged,the incidences of cesarean section and of postpartum hemorrhage increased. Conclusions:Almost half of puerperas with the length of second stage of labor longer than 2 h underwent vaginal delivery.The prolonged second stage of labor can decrease the score of Apgar scale in 1 min,increase the incidence of asphyxia,but has no effect on scale in 5 min.It still need more evidence from evidence medicine to definition of time and treatment of second stage of labor.

A Review of Caesarean Delivery at the Kogi State Specialist Hospital, Lokoja, Nigeria

Background: Caesarean delivery rate is increasing globally including in Nigeria. Caesarean delivery is a life-saving surgery for both mother and child. Objective: The aim of the study was to assess the caesarean delivery rate at the Kogi State Specialist Hospital, Lokoja, Nigeria over a one-year period. Methods: This was a prospective assessment of the demographic characteristics of patients, indications, types, rates and outcomes of Caesarean delivery in Kogi State Specialist Hospital, Lokoja, Nigeria from December 15, 2020 to December 14, 2021. Data collected were analyzed using SPSS version 20.0 statistical package (IBM Corp. Released 2011. IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp). The categorical data were displayed using tables and charts. Results: There was a total of 491 deliveries, out of which were 113 Caesarean deliveries and 378 spontaneous vaginal deliveries making the Caesarean delivery rate in Kogi State Specialist Hospital, Lokoja, Nigeria 23.0%. There were no instrumental deliveries during the study period. The commonest indication for Caesarean section was obstructed labour in 31% of cases. There was no maternal mortality. There were three early neonatal deaths due to severe birth asphyxia. Conclusion: The rate of Caesarean delivery in this study was 23.0% and obstructed labour was the leading indication in 31% of cases. The rate of Caesarean delivery in this study is high, albeit the overall outcome was good for both mother and child. Caesarean delivery, therefore, remains one of the means for reducing maternal and perinatal morbidity and mortality in Nigeria.

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。

椎管内分娩镇痛安全核查表的制订及其临床应用

目的制订椎管内分娩镇痛安全核查表,积极探索其临床应用的效果;建立椎管内分娩镇痛安全实施策略,保障母儿安全。方法选取东南大学附属中大医院2020年1月—2021年12月实施椎管内分娩镇痛的1072例产妇作为观察组,与2018年1月—2019年12月实施椎管内分娩镇痛的850例产妇作为对照组进行回顾性比较。对照组采取椎管内分娩镇痛常规操作流程,观察组在采取常规流程的基础上,应用东南大学附属中大医院制订的椎管内分娩镇痛安全核查表对椎管内分娩镇痛的各环节进行核查。对比2组产妇椎管内分娩镇痛常见并发症、产妇分娩结局等发生情况,对比2组新生儿不良结局的发生情况,对比2组医务人员在椎管内分娩镇痛各环节操作流程的执行力情况。结果2组产妇椎管内分娩镇痛常见麻醉并发症发生率比较,对照组产时发热发生率为11.18%,观察组为8.21%;对照组尿潴留发生率为10.94%,观察组为6.25%,差异有统计学意义(P<0.05)。2组产妇剖宫产及自然分娩情况比较,对照组剖宫产率为9.53%,观察组为6.06%;对照组自然分娩率为89.65%,观察组为93.47%,差异有统计学意义(P<0.05)。产妇对椎管内分娩镇痛满意度情况的比较,对照组总满意度为98.71%,观察组为99.81%;差异有统计学意义(P<0.05)。2组胎儿窘迫发生情况的比较,差异有统计学意义(P<0.05)。干预前后医务人员操作流程执行规范性的比较,差异有统计学意义(P<0.05)。结论椎管内分娩镇痛安全核查表可有效降低东南大学附属中大医院中转剖宫产率及母儿并发症的发生率,提高医务人员在椎管内分娩镇痛各环节执行的规范性,普及镇痛条件下的自然分娩,推进国内现代化产房的建设,提高孕产妇及家庭的幸福感及满意度。

早期预警评分联合快速反应团队救护重度子痫前期患者的研究

目的 探讨早期预警评分联合快速反应团队对重度子痫前期患者的应用效果。方法 将2020年1-12月在急诊就诊的126例重度子痫前期患者为对照组,采用常规护理方法;2021年7月至2022年6月同类患者126作为干预组,采用早期预警评分表,客观对孕妇进行评估,早期预警评分触动快速反应系统,立即启动快速反应团队对患者进行紧急救护。比较两组患者母婴结局情况。结果 干预组孕妇就诊后收缩压和舒张压控制情况优于对照组,在急诊留观时间显著缩短(均P<0.05);干预组孕妇HELLP综合征、胎盘早剥、胎膜早破、宫缩乏力和产后出血发生率显著低于对照组(均P<0.05);干预组早产、胎儿窘迫和新生转ICU率显著低于对照组(均P<0.05)。结论 早期预警评分联合快速反应团队可有效降低重度子痫前期患者母婴不良结局,有助于保障母婴安全。

催眠技术联合镇痛仪应用于自然分娩产程对母婴结局的影响研究

目的:探究催眠技术与非药物镇痛仪联合应用于自然分娩产程中对母婴结局的影响。方法:回顾性分析郑州大学第一附属医院2021年3月—2022年3月收治的315例产妇的临床资料,且产妇入院时均有意愿自然分娩。根据产妇个人对镇痛方式选择的意愿分为对照组(n=156)和观察组(n=159)。对照组产妇采用常规镇痛,观察组产妇给予催眠技术与非药物镇痛仪相结合镇痛。对比两组产妇分娩的母婴结局。结果:干预后,观察组产妇各项分娩情况均显著优于对照组,差异有统计学意义(t=17.575、12.317、11.359、71.114,P<0.05);各产程阶段的产痛情况均轻于对照组,差异有统计学意义(t=7.646、11.396、13.621,P<0.05);观察组产妇顺产率高于对照组,差异有统计学意义(t=21.453,P<0.05);观察组产妇新生儿结局优于对照组,各项情绪评分低于对照组,各项血流动力学指标明显低于对照组,差异有统计学意义(t=34.330、20.998、43.589、20.335、19.225、17.060,P<0.05)。结论:在分娩过程中,给予产妇催眠技术联合非药物镇痛仪展开镇痛干预,可合理缩短产程,减轻各产程产痛程度,提高顺产率,改善新生儿结局,减少产妇分娩中焦虑等负面情绪,稳定生命体征,保障母婴结局。

新产程标准下不同时机实施分娩镇痛对初产妇产程、分娩方式及母婴结局的影响

目的:探讨新产程标准下初产妇分娩镇痛不同实施时机对产程、分娩方式及母婴结局的影响。方法:选取2022年1月—2023年2月于滕州市中心人民医院行自然分娩的129例初产妇,按照不同分娩镇痛时机分成Ⅰ组(n=43,宫口扩张≤2 cm)、Ⅱ组(n=43,2 cm<宫口扩张<3 cm)与Ⅲ组(n=43,宫口扩张≥3 cm)。所有初产妇均接受连续硬膜外阻滞分娩镇痛。对三组产程、镇痛效果、分娩方式及母婴结局进行比较。结果:三组自然分娩率、中转剖宫产率比较,差异均无统计学意义(P>0.05);与Ⅰ组、Ⅱ组比较,Ⅲ组第一产程、总产程均更短,第二产程更长(P<0.05);与Ⅰ组比较,Ⅱ组第一产程、总产程均更短,第二产程更长(P<0.05);Ⅲ组镇痛总有效率(95.35%)较Ⅰ组(73.81%)、Ⅱ组(78.57%)更高,差异均有统计学意义(P<0.05);Ⅲ组不良母婴结局发生率(11.63%)较Ⅰ组(34.88%)、Ⅱ组(30.23%)更低,差异均有统计学意义(P<0.05)。结论:宫口扩张≥3 cm时实施分娩镇痛虽然会延长第二产程,但能够缩短第一产程及总产程,提高镇痛效果,降低不良母婴结局发生率,临床可根据初产妇实际情况,合理选择分娩镇痛时机。

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.

家属协同下导乐结合无痛分娩对初产妇分娩结局及满意度影响

目的:探讨家属协同下导乐结合无痛分娩对初产妇分娩结局及满意度影响。方法:纳入2022年1月-2023年10月本院收治的82例初产妇,随机数字表法分为对照组和观察组各组41例,两组均常规产科分娩干预,观察组同时实施家属协同下导乐结合无痛分娩,对比总产程、分娩恐惧问卷(FCQ)评分、分娩控制量表(LAS)评分、一般自我效能感量表(GSES)评分、产痛分级、分娩方式、产后焦虑(SAS)与抑郁(SDS)自评量表评分、产妇及新生儿不良结局、产妇分娩满意率。结果:观察组总产程短于对照组,FCQ评分、LAS评分、GSES评分均优于对照组,产痛分级优于对照组,自然分娩率(97.6%)高于对照组(73.2%),阴道助产率及顺转剖发生率低于对照组,产后SAS评分(41.28±5.29分)、SDS评分(42.93±4.95分)均低于对照组(49.36±6.23分、50.46±5.92分),产妇(2.4%)与新生儿(0)不良结局发生率均低于对照组(17.1%、12.2%),产妇分娩满意率(95.1%)高于对照组(80.5%)(均P<0.05)。结论:家属协同下导乐结合无痛分娩可较好缩短自然分娩总产程,降低产妇分娩恐惧感,改善产妇自我效能,缓解产妇分娩疼痛,提升自然分娩率,改善产妇产后心理状态及不良结局,产妇满意度较高。

新式产程管理指导下无痛分娩对产妇和新生儿结局的影响

目的:探讨新式产程管理指导下的无痛分娩对产妇和新生儿结局的影响。方法:选取在医院接受无痛分娩的100例初产妇作为研究对象,分为实验组和对照组,各50例。实验组产妇采用新式产程管理,对照组产妇则采用常规产程管理,比较两组产妇和新生儿的结局及第一和第二产程的持续时间、总产程、第一产程的医疗干预、完全宫颈扩张时的视觉模拟量表(VAS)评分、分娩方法和产妇满意率。结果:对照组产妇的第一、第二产程以及总产程都比实验组短(均P<0.001);对照组产妇的人工破膜率和静脉使用催产素的比率高于实验组(均P<0.05);对照组产妇完全宫颈扩张时的VAS评分明显高于实验组(P<0.05);对照组产妇的阴道分娩率和满意度明显低于实验组(均P<0.05)。结论:新式产程管理指导下的无痛分娩对产妇和新生儿结局无明显影响。相反,通过适当延长产程,减少了分娩时的过度干预,为孕妇提供更多分娩时间,减少分娩疼痛,最终提高自然分娩率及分娩满意度,值得临床推广。

腰-硬联合麻醉在无痛分娩中的应用效果

目的研究腰-硬联合麻醉在无痛分娩中的应用效果。方法选取2021年1月至2022年12月景德镇市第二人民医院收治的100例无痛分娩的产妇作为研究对象。依据麻醉方案不同将其分成观察组(n=52)和对照组(n=48)。对照组接受硬膜外麻醉,观察组接受腰-硬联合麻醉。比较两组患者的麻醉起效时间、产程、疼痛程度、麻醉不良反应、妊娠结局及新生儿Apgar评分。结果观察组产妇的麻醉起效时间短于对照组,差异有统计学意义(P<0.05);观察组产妇的第一、第二产程短于对照组,差异有统计学意义(P<0.05);两组第三产程比较,差异无统计学意义(P>0.05);观察组产妇麻醉后5、30和60 min的疼痛评分低于对照组,差异有统计学意义(P<0.05);观察组产妇的麻醉相关不良反应发生率低于对照组,差异有统计学意义(P<0.05);观察组新生儿的出生后1 min Apgar评分高于对照组,差异有统计学意义(P<0.05)。结论无痛分娩中选择硬膜外麻醉与腰-硬联合麻醉均可实现镇痛效果,但腰-硬联合麻醉方案优势更为明显,主要体现在麻醉起效迅速,术中可获得良好镇痛效果,缩短产程,可提高麻醉安全性避免相关并发症的出现,具备临床推广价值。

导乐陪伴联合自由体位在无痛分娩产妇中的应用

目的 探究导乐陪伴联合自由体位在无痛分娩产妇中的应用效果。方法 选取2021年6月—2022年6月于医院行无痛分娩的产妇85例为研究对象,按照组间基线资料均衡可比的原则分为对照组(n=42)和观察组(n=43)。两组产妇均行无痛分娩,对照组采取常规分娩方式,观察组在常规分娩基础上采取导乐陪伴联合自由体位分娩。比较两组产妇产程、疼痛分级、心理状态、分娩自我效能、母婴结局、产妇满意率。结果 与对照组相比,观察组产妇第一、第二、第三及总产程均缩短,疼痛程度减轻,经比较差异有统计学意义(P<0.05)。护理前两组产妇心理状态、分娩自我效能评分比较差异无统计学意义(P>0.05);相比于对照组,观察组产妇抑郁自评量表(SDS)评分、焦虑自评量表(SAS)评分均降低,自我效能期望(EE-16)评分、结果期望(OE-16)评分、简化中文版分娩自我效能量表(CBSEI-C32)评分均升高,经比较差异有统计学意义(P<0.05)。观察组母婴不良结局发生率低于对照组,差异有统计学意义(P<0.05)。观察组产妇满意率高于对照组,差异有统计学意义(P<0.05)。结论 导乐陪伴联合自由体位能够有效缩短无痛分娩产妇产程,减轻疼痛、不良情绪,增强分娩自我效能感,降低不良母婴结局发生率,提高产妇满意率。

无痛分娩对初产妇产程及新生儿脐血血气指标的影响

目的研究无痛分娩对初产妇产程及新生儿脐血血气指标的影响。方法以60例初产妇为研究对象,根据生育意愿将产妇分为无痛分娩组(n=27)和常规分娩组(n=33),无痛分娩组使用罗哌卡因+舒芬太尼镇痛,常规分娩组不使用镇痛。比较两组一般情况、疼痛情况、新生儿脐血血气指标、母婴结局。结果无痛分娩组产妇首次下床活动时间短于常规分娩组,第二产程、总产程长于常规分娩组,差异有统计学意义(P<0.05),两组第一产程、第三产程、住院时间比较差异无统计学意义(P>0.05);两组产妇分娩前后视觉模拟评分法(VAS)得分差异有统计学意义(P<0.05),无痛分娩组得分更低;两组新生儿动脉氧分压(PaO2)、碱剩余(BE)、酸碱度(pH)、乳酸比较差异无统计学意义(P>0.05);两组母婴结局比较差异无统计学意义(P>0.05)。结论无痛分娩有助于减缓初产妇分娩疼痛,促进尽早下床活动,对新生儿脐血血气指标影响较小,未明显导致母婴不良结局,但可延长产程。

无痛分娩对妊娠期糖尿病患者分娩的效果分析

目的 观察妊娠期糖尿病(Gestational Diabetes Mellitus, GDM)患者选择无痛分娩的效果。方法 选取2021年1月—2022年12月厦门大学附属妇女儿童医院收治的80例GDM患者为研究对象,按不同分娩方式分为对照组和观察组,观察组选择无痛分娩,对照组选择传统分娩,各40例。比较两组的血糖变化、母婴结局及分娩疼痛情况。结果 分娩后,相较对照组,观察组空腹血糖[(4.45±0.72)mmol/L]、餐后2 h血糖[(5.29±1.14)mmol/L]更优,差异有统计学意义(t=2.946、3.242,P均<0.05)。观察组的剖宫产率(7.50%)、新生儿窒息率(2.50%)、胎儿窘迫率(0),新生儿低血糖发生率(2.50%)均低于对照组,差异有统计学意义(χ^(2)=4.588、5.000、5.333、5.000,P均<0.05)。观察组的分娩疼痛缓解情况及新生儿Apgar评分均优于对照组,差异有统计学意义(P均<0.05)。结论 无痛分娩可降低GDM患者的血糖水平,降低不良妊娠结局发生率及分娩疼痛评分,促进新生儿质量的改善。

孕期群组化健康教育模式对初产妇孕期健康行为、分娩方式及母婴结局的影响

目的探讨孕期群组化健康教育模式在初产妇中的应用效果。方法选取2020年2月—2022年2月拟于郑州市妇幼保健院分娩的98例初产妇,采用随机数字表法分为对照组与观察组,每组49例。对照组产妇采用常规健康教育进行干预,观察组产妇接受孕期群组化健康教育模式进行干预,2组均干预至分娩结束。比较2组产妇自我管理能力、孕期健康行为、心理状态、分娩方式、母婴结局及满意度。结果干预后,观察组产妇自我管理量表中的遵医行为、日常生活行为、自我防护行为及胎儿监护行为评分均高于对照组,差异均有统计学意义(P<0.05)。干预后,观察组产妇孕期健康行为调查表中睡觉姿势、合理饮食、适当运动及体质量监测评分均高于对照组,差异均有统计学意义(P<0.05)。干预后,观察组产妇焦虑自评量表(SAS)及抑郁自评量表(SDS)评分均低于对照组,差异均有统计学意义(P<0.05)。观察组产妇阴道助产及剖宫产率均低于对照组,自然分娩率高于对照组,差异均有统计学意义(P<0.05)。观察组不良母婴结局发生率为4.08%(2/49),低于对照组的18.37%(9/49),差异有统计学意义(χ^(2)=5.018,P=0.025)。观察组产妇护理满意度调查表中宣教方式、沟通态度、健康指导及宣教效果评分均高于对照组,差异均有统计学意义(P<0.05)。结论孕期群组化健康教育模式能够提高初产妇自我管理能力,促进产妇孕期健康行为改善,减轻不良情绪,有助于提高自然分娩率,降低不良母婴结局发生风险,产妇满意度较高。

以会阴中心腱紧张度为标准控制胎头娩出速度在自然分娩初产妇中的应用

目的:探讨自然分娩初产妇以会阴中心腱紧张度为标准控制胎头娩出速度的应用效果。方法:选取2022年5月—2023年4月在北京怀柔医院进行自然分娩的产妇共计106例,以随机数字表法分成研究组(53例)与对照组(53例),两组均控制胎头娩出速度,对照组以每次用力时胎头露出阴道外口直径<1 cm为标准,研究组以会阴中心腱紧张度为标准,比较两组分娩时间、会阴裂伤情况、疼痛程度、分娩出血量、母婴结局。结果:研究组胎头拨露至娩出时间、第二产程均短于对照组,差异均有统计学意义(P<0.05),两组第三产程比较差异无统计学意义(P>0.05);研究组会阴裂伤程度较对照组更轻,差异有统计学意义(P<0.05);研究组胎儿娩出时、产后2 h时的疼痛程度数字评分法(NRS)评分均较对照组更低,差异均有统计学意义(P<0.05);研究组产时、产后2 h出血量均较对照组更少,差异均有统计学意义(P<0.05);研究组不良母婴结局发生率(3.77%)较对照组(16.98%)更低,差异有统计学意义(P<0.05)。结论:在自然分娩初产妇中以会阴中心腱紧张度为标准控制胎头娩出速度,能够缩短分娩时间,减轻会阴裂伤及分娩疼痛,降低分娩出血量,改善母婴结局。

助产士导乐陪伴分娩结合拉玛泽减痛分娩法对初产妇分娩恐惧感及睡眠质量的影响

目的:分析助产士导乐陪伴分娩结合拉玛泽减痛分娩法对初产妇分娩恐惧感及睡眠质量的影响。方法:选取2020年3月至2023年3月山东省菏泽市中医医院产科收治的分娩产妇60例作为研究对象,按照随机数字表法分为对照组和观察组,每组30例。对照组给予助产士导乐陪伴分娩,观察组给予助产士导乐陪伴分娩结合拉玛泽减痛分娩法。采用手术恐惧问卷(SFQ)对术中恢复、术后疼痛、手术失败、麻醉等方面进行评估,采用状态-特质焦虑量表(STAI)比较2组患者干预前后焦虑状态的改善效果;采用医学应对问卷(MCMQ)比较2组患者的应对方式的区别;采用视觉模拟评分法(VAS)比较2组患者干预前后的疼痛感受;采用匹兹堡睡眠质量指数(PSQI)比较2组患者干预前后睡眠质量的变化,并比较2组患者的分娩结局。结果:护理干预后,观察组分娩恐惧感SFQ评分各指标、STAI评分显著低于对照组,观察组VAS评分显著低于对照组,观察组产妇产后第1天、第2天、第4天的PSQI评分显著低于对照组,观察组医学应对问卷(MCMQ)评分显著高于对照组,差异均有统计学意义(均P<0.05)。结论:对产妇施以助产士导乐陪伴分娩结合拉玛泽减痛分娩法效果突出,可使产妇的恐惧感降低,减轻疼痛感受,有效提升产妇的睡眠质量,改善其分娩结局,建议推广应用。

Caesarian Section for Placenta Praevia: Does Booking Status Affect Maternofetal Outcome?

Background: Placenta praevia accounts for significant maternal morbidity and perinatal morbidity and mortality. Despite advances in blood transfusion technique and surgical procedure, abnormal placentation still remains a difficult challenge for obstetricians. Objective: To determine the influence of booking status on the fetal and maternal outcome among parturients with placenta praevia that underwent caesarian delivery. Methodology: This was a comparative and retrospective study between booked and unbooked subjects with significant placenta praevia that were delivered by caesarian section between January 1st 2004 and December 31st 2008 with respect to maternal and fetal outcome. Result: Out of 14,344 deliveries during study period, 123 cases of placenta praevia that underwent caesarian delivery were identified giving a prevalence rate of 0.86%. 49 subjects were booked while 74 were unbooked. There was no statistically significant difference between booked and unbooked cases with respect to risk factors (30.6% of booked and 23% of unbooked), X2(4) = 7.203, P = 0.126 and the mean blood loss at surgery (870.4 ± 486.9 ml in booked versus 779.7 ± 380.96 ml in unbooked), X2(1) = 0.202, P = 0.653. However, antepartum transfusion (12.2% booked versus 34.7% unbooked) and postpartum transfusion (51% booked versus 72% unbooked) showed statistically significant difference, X2(1) = 9.744, P = 0.002. One maternal death occurred amongst the unbooked cases and none among the booked cases. Statistically significant differences were also noted in the apgar score at 1 minute X2(3) = 15.528, P = 0.001 and 5 minutes X2(3) = 12.912, P = 0.005 respectively. More babies died in the unbooked group (19) compared to two (2) in the booked mothers. Conclusion: Unbooked status in placenta previa significantly increases the risk for antepartum and postpartum transfusion, is associated with higher mortality, increased preterm delivery, poorer apgar scores and higher perinatal mortality rate.