Comparison of Sexual Function in Primiparous Women Pre-Pregnancy and Postpartum: Difference of the Sexual Function after the Normal Vaginal Delivery and the Cesarean Section

Introduction: Sexual function is undoubtedly an important dimension of adult life. Due to all the conflicting results with regard to sexual function after the normal vaginal delivery (NVD) or the Cesarean Section (CS), in the present study, we aimed to compare the sexual function in women pre-pregnancy and postpartum and also after the NVD and CS. Materials and Methods: In this cohort study, two groups of healthy women, with antenatal normal pregnancies, who underwent NVD (n = 90) and CS (n = 113), were prospectively studied. The sexual function of the participants was assessed through a Female Sexual Function Index (FSFI) questionnaire in two stages: once before pregnancy and then within 3 to 6 months after delivery, which lasted from June 2011 to September 2012. The data were analyzed by descriptive and inferential statistics. Data were analyzed using chi-square test, Mann-Whitney test, and T Test. Results: Based on the data gathered from 206 women who completed the FSFI questionnaire in two stages, the mean (±SD) self-reported timing of the resumption of sexual activity was 8.9 ± 1.3. There was no significant statistical difference found between the two groups by timing of the resumption of sexual activity in NVD and CS groups. There was also no statistically significant difference found in the overall sexual function scores between the two groups (NVD vs. CS). The average score for female sexual function in desire, arousal, orgasm, and satisfaction within 3 to 6 months after delivery was significantly lower than that of their pre-pregnancy period (p < 0.004). The mean coitus in postpartum period was 1.84 ± 1.20 per week. Conclusion: Based on the findings of this study, there was no significant relationship between the mode of delivery and changes in sexual function. Therefore, it can be claimed that CS is not preferred to NVD with regard to preserving normal sexual functioning.

Induction of Labor at 39 Weeks versus Expecting Labour till 41 Weeks: Randomized Controlled Trial on Class I Obese Egyptian Women, with Mode of Delivery Being a Study Endpoint

Background: Maternal obesity is reported to be associated with increased incidence of gestational diabetes mellitus and hypertension. These cause failure of labour induction, leading to higher incidence of cesarean section (CS). The aim of this study was to assess which reduces CS rate, labor induction at 39 weeks or leaving women for spontaneous labor onset till 41 weeks. Methodology: A randomized controlled trial was conducted in Ain Shams Maternity Hospital in Egypt from 2016 to 2018. Study population consisted of 200 term primigravida pregnant obese women delivered in Ain Shams Maternity Hospital. They were divided into two groups: Group A: induction of labor at 39 + 0 weeks (n = 100) by vaginal administration of 25 μg misoprostol (PGE1) every 6 hours for 5 doses;Group B: waiting spontaneous labor onset till 41 + 0 weeks (n = 100), and if no spontaneous labor occurred at 41 weeks, induction was performed in the same way. Results: Induction (Group A) vs. waiting spontaneous labor (Group B) showed the followings, which were significant: CS: 22% vs 39%, p = 0.009;maternal birth injury: 4% vs 12%, p = 0.037;non-assisted vaginal deliveries: 93.6% vs 78.7%, p = 0.034;APGAR scores at 1 & 5 min: 7.6 ± 0.8 vs 7.3 ± 1.1 p = 0.038, 8.4 ± 1.0 vs 8.1 ± 1.3 p = 0.040, respectively;birth weight;3.3 ± 0.1 vs 3.5 ± 0.2 kg, p < 0.001. The following did not show significance between Group A vs Group B but Group A showed lower incidence;postpartum hemorrhage: 3% vs 5%, blood transfusion: 1% vs 3%. Conclusion: CS rate was significantly lower in women with induction of labor at 39 weeks than those waiting for spontaneous labor onset till 41 weeks in obese Egyptian pregnant women.

Spontaneous versus Induced Labor Delivery, a Retrospective Analysis

Background: Induction of labor is the stimulation of the uterus to initiate the labor process whether by administering oxytocin, prostaglandin or reputing the membrane [1]. It was realized that the number of induction of labor patients was thought to be increasing in comparison with the spontaneous labor patients. Therefore, the complications of induced labor were higher. A detailed analysis was needed to confirm that. Objective: The aim of the study is to analyze the outcomes between spontaneous versus induced labor. Materials and Methods: A retrospective analysis was conducted at our tertiary care university hospital, in the period from December 2015 to December 2016 when 311 women were divided into two groups: group 1, women who had spontaneous labor (n = 106) compared with group 2, women who were labor induced (n = 205). Complications of pregnancy, delivery type, tear, episiotomy, blood transfusion and instruments used were analyzed retrospectively. Results: The mean ± SD of baseline characteristics, like age, height, weight, BMI and hemoglobin level for all study samples was 28.59 ± 5.95 years, 1.58 ± 0.06 m, 71.77 ± 13.42 kg, 28.59 ± 5.89 kg/m2 and 11.08 ± 1.45 g/dl respectively. A statistically significant difference was noticed in the duration of labor between spontaneous and induced labor (95% CI: 9.194 - 152.130;p-value 0.004 and OR: 0.239). There was no significant difference in complications, delivery type (Spontaneous Vaginal Delivery (SVD) or other), blood transfusion, and instrument used between women who had spontaneous labor versus induced labor. However, significant differences in tear (95% CI: 4.354 - 0.996;p-value 0.035) and episiotomy (95% CI: 0.928 - 0.224;p-value 0.028) were found between the two groups. In conclusion, the induced labor was found to be associated with high incidence of duration of labor, tear and episiotomy. Patients should always be counseled when there it is an option between the two delivery types.

Non-medical factors on choice of delivery (CS/NVD) in hospitals of Tehran University of Medical Sciences

Background: Kind of delivery affect many aspects of individuals, families and health systems situations. The aim of this study was to identify the Role of non-medical factors on choice of delivery (CS/NVD) in hospitals affiliated to Tehran University of Medical Sciences. Materials and Method: This cross-sectional study was performed to identify the factors involved in the choice of delivery (CS/NVD) among women attending hospitals affiliated to Tehran University of Medical Sciences. Data was derived from the medical records of women who gave birth in the hospitals. Results: A significant statistical relationship was found between factors such as age of mother, level of education, occupational status, type of previous delivery, person supervising the pregnancy and dissatisfaction about delivery were more frequent in women who underwent CS than those who gave birth by NVD. Conclusion: The highly increasing rise in the rate of unnecessary CS during throughout the world, and its adverse effect on maternal and child health, the financial burden imposed on families and health systems, has highlighted the importance of studies to identify the non-medical factors that affect decision-making concerning type of delivery as well as to determine the appropriate medical indications of CS.

Disparities in caesarean section prevalence and determinants across sub-Saharan Africa countries

Background:Access to safe Cesarean section(C-section)in resource-constrained settings such as sub-Sahara Africa(SSA)region is a foremost approach to reduce maternal mortality.C-section is an obstetric operative procedure used appropriately to improve delivery outcomes.However,errors in the procedure have enormous potential harm that may outweigh the benefits.This study assessed the prevalence and determinants of C-section in several SSA countries.This study examined the prevalence and determinants associated with cesarean delivery in SSA countries.Methods:Secondary data of women of reproductive age(15-49 years)from the current Demographic and Health Survey(DHS)in 34 SSA countries was utilized in this study.The mode of delivery among women was the primary outcome variable.Percentage and descriptive statistics were used to conduct univariate analyses.Furthermore,multivariable multilevel logistic regression was used to investigate correlates of C-section among SSA women.Results:Results showed disparities in the percentage of C-section among women from 34 SSA countries.C-section at public healthcare settings ranged from 3%in Burkina Faso to 15.6%in Ghana.However,in private healthcare settings,C-section ranged from 0%in Sao Tome and Principe to 64.2%in Rwanda.Overall,C-section was 7.9%from public healthcare and 12.3%from private healthcare facilities respectively.In the adjusted regression model;women aged 35-49 had increase in the odds of C-section,while a unit increase in the number of children ever born had 17 and 20%significant reduction in the odds of C-section in public and private healthcare respectively.Assessing public healthcare settings;women from richer/richest households,male and large size children at birth had increase in the odds of C-section,while those from rich neighbourhood had reduction in the odds of C-section.In private healthcare settings,women with high decision making power and multiple births had increase in the odds of C-section,while those who attended ANC visits had significant reduction in the odds of C-section.Conclusion:The findings from this study would help formulate health policies and implement actions that would improve the outcome of C-section care.Monitoring of emergency obstetric care services is necessary to address issues connected to poor C-section outcomes in resource-constrained settings.Also training of medical personnel including midwives and nurses in emergency obstetric care,ensuring accessibility to life-saving drugs and supplies should be encouraged in health care system.

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。

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。

自由体位联合无痛暗示对足月无痛分娩产妇的效果及睡眠质量的影响

目的:探究足月无痛分娩产妇于护理期间联合应用自由体位、无痛暗示护理的干预价值。方法:选取2022年6月至2023年1月福建省立医院南院收治的足月无痛分娩产妇86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43例。对照组实施常规护理,观察组予以自由体位联合无痛暗示护理,对比2组护理效果,评估指标包含产程时间、顺转剖宫产率及睡眠质量。结果:测定2组产妇产程,所得结果均显示为观察组第一、二、三产程以及总产程时间偏短,与对照组比较,差异均有统计学意义(均P<0.05);相较于对照组,观察组顺转剖宫产等风险事件发生率较低,差异有统计学意义(P<0.05);术后,评估2组产妇睡眠质量,观察组各项指标数值均偏低于对照组,差异均有统计学意义(均P<0.05)。结论:足月无痛分娩的产妇予以其自由体位、无痛暗示护理在缩短产程的同时可以提高产妇睡眠质量,降低了顺转剖宫产率以及风险事件发生率。

产时Ⅱ度及以上会阴裂伤风险预测模型的构建和验证

目的 构建产时Ⅱ度及以上会阴裂伤风险预测随机森林算法模型,并初步评价模型的预测性能。方法 采用方便抽样法,选取经阴道分娩的1 366例产妇为研究对象,将其按照7∶3的比例随机分为训练集和验证集。采用LASSO回归分析筛选产时Ⅱ度及以上会阴裂伤的风险因素,采用随机森林算法构建预测模型,计算ROC曲线下面积、预测准确率、灵敏度和特异度等评价模型的性能。结果 共计8个预测因子被纳入随机森林模型中,分别为孕前BMI、孕期体质量增加、初产妇、剖宫产史、硬膜外麻醉、催产、引产和胎儿估计体质量,其中胎儿估计体质量对产时Ⅱ度及以上会阴裂伤的影响最大,其次是初产妇和催产。随机森林模型在验证集中的ROC曲线下面积为0.698(95%CI:0.645~0.751),预测准确率为80.0%(95%CI:75.8%~83.8%),灵敏度和特异度分别为50.5%和89.1%。结论 基于随机森林算法构建的产时Ⅱ度及以上会阴裂伤风险预测模型具有一定的预测价值,但预测性能仍有待提高。

剪切波弹性成像联合盆底超声用于评估不同分娩方式对产后盆底功能影响的价值

目的探讨剪切波弹性成像技术联合盆底超声评估不同分娩方式对产后不同时期盆底功能影响的价值。方法选取医院2022年12月至2023年6月分别于产后42 d及产后5个月行盆底检查的产妇82例,按分娩方式的不同分为阴道分娩组(58例)和剖宫产组(24例),应用剪切波弹性成像技术测量产妇静息及缩肛状态下双侧耻骨直肠肌的杨氏模量值,应用盆底超声测量产妇膀胱颈移动度、尿道旋转角及最大ValsalVa状态肛提肌裂孔面积及盆底各器官的位置。结果剖宫产组产后42 d双侧耻骨直肠肌在静息及缩肛状态下的杨氏模量值均显著大于阴道分娩组(P<0.05),膀胱颈移动度、尿道旋转角及最大ValsalVa状态下肛提肌裂孔面积均显著小于阴道分娩组(P<0.05),膀胱膨出发生率显著低于阴道分娩组(P<0.05)。剖宫产组产后5个月膀胱颈移动度显著小于阴道分娩组(P<0.05)。结论剪切波弹性成像联合盆底超声对不同分娩方式产妇产后盆底功能具有较好的评估价值。剖宫产对产后早期的盆底功能具有保护作用,但从远期来看,二者对盆底功能的影响相当。

分娩方式对“二孩”产妇产后盆底肌电的影响

目的探讨分娩“二孩”的产妇盆底肌电情况,为促进产妇盆底康复提供相关临床依据。方法选取2019年12月至2022年1月在福建省妇幼保健院产后盆底筛查的7629例分娩两次的产妇作为研究对象,采用Glazer盆底表面肌电评估方案采集盆底肌电值,按照分娩方式分为顺产-剖宫产组(631例,编号为“1组”)、剖宫产-顺产组(158例,编号为“2组”)、剖宫产-剖宫产组(2202例,编号为“3组”)与顺产-顺产组(4638例,编号为“4组”),比较四组产后盆底肌电值的特征。结果1组的前静息阶段平均值、快速收缩最大值、紧张收缩阶段平均值、耐力收缩阶段平均值、后静息阶段平均值高于2组、4组,低于3组,差异有统计学意义(P<0.05)。3组的前静息阶段平均值、快速收缩最大值、紧张收缩阶段平均值、耐力收缩阶段平均值、后静息阶段平均值高于2组、4组,差异有统计学意义(P<0.05)。结论“二孩”产后盆底肌电特征主要与二孩分娩方式有关。阴道分娩对盆底肌的损害大于剖宫产,剖宫产对盆底肌有保护作用,但容易导致静息电位升高。

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。

阴道试产中转剖宫产术前Ⅲ型安尔碘阴道灌洗预防产褥感染效果

目的:分析阴道试产中转剖宫产术前Ⅲ型安尔碘阴道灌洗预防产褥感染效果。方法:回顾性分析2022年1月-2023年12月本院产科阴道试产失败中转剖宫产产妇400例临床资料,其中2022年1-12月术前作外阴备皮、冲洗的200例纳入对照组,2023年1-12月术前作外阴备皮、Ⅲ型安尔碘阴道灌洗、冲洗的200例产妇纳入观察组,对比两组术后体温、24h出血量、产褥感染率、切口感染率及白细胞计数(WBC)、C反应蛋白(CRP)和降钙素原(PCT)水平变化情况。结果:观察组术后24h(36.90±0.17℃)、48h(36.70±0.15℃)、72h体温(36.50±0.12℃)均低于对照组(37.00±0.21℃、36.80±0.16℃、36.60±0.13℃),术后24h出血量(287.3±21.5ml)少于对照组(296.2±23.7ml),产褥感染率(0.5%)低于对照组(3.5%)(均P<0.05),两组切口感染率(0.5%、1.0%)无差异(P>0.05)。观察组术后72h WBC(10.07±2.28×10^(9)/L)、CRP(2.23±0.39mg/L)、PCT(4.05±0.62ng/ml)水平均低于对照组[(12.77±3.59)×10^(9)/L、5.06±1.28mg/L、7.33±1.51ng/ml](均P<0.05)。结论:阴道试产中转剖宫产术前Ⅲ型安尔碘阴道灌洗可有效控制术后产妇体温和WBC、CRP、PCT水平,减少产褥感染发生。

经会阴四维盆底超声评估不同分娩方式对产妇盆底结构及功能的影响

目的观察经会阴四维盆底超声评估不同分娩方式对产妇盆底结构及功能的影响。方法选择2021年1月至2022年12月于本院分娩的120例产妇,依据分娩方式将其分为顺产组(60例,经阴道分娩)和手术组(60例,经剖宫产术分娩),同期纳入于我院体检的60例健康女性为对照组。所有研究对象均给予经会阴四维彩色多普勒超声成像仪检测。比较研究对象的三维超声指标、盆底功能异常发生情况、肛提肌裂孔超声指标及膀胱超声指标。结果顺产组的尿道膀胱连接部移动度(UVJ-M)、膀胱尿道后角角度(As、Ar)、膀胱颈距离耻骨联合下缘距离(Ds、Dr)大于手术组,肛直肠连接部距耻骨联合下缘距离(ARJ-VD)小于手术组(P<0.05)。顺产组的膀胱膨出、子宫脱垂、阴道前壁脱垂发生率显著高于手术组(P<0.05)。静息状态及最大Valsava状态下,顺产组的肛提肌裂孔前后径、肛提肌裂孔左右径、肛提肌裂孔面积均大于手术组及对照组,手术组的肛提肌裂孔前后径、肛提肌裂孔左右径、肛提肌裂孔面积均大于对照组(P<0.05)。静息状态及最大Valsava状态下,顺产组的膀胱旋转角度、膀胱颈位移距离均大于手术组与对照组,手术组的膀胱颈角度、膀胱旋转角度以及膀胱颈位移距离大于对照组(P<0.05);最大Valsava状态下,顺产组的膀胱颈角度大于手术组与对照组(P<0.05)。结论经会阴四维盆底超声针对不同分娩方式产妇可准确评估其盆底结构与功能,可用于早期诊断盆底功能障碍情况,且经阴道顺产产妇的盆底功能障碍发生风险高于剖宫产产妇。

子痫前期产妇阴道试产失败的影响因素及其风险预测列线图模型构建

目的筛查子痫前期阴道试产失败的影响因素,构建子痫前期阴道试产失败的预测模型。方法回顾性分析2020年1月至2023年10月在汉中市人民医院分娩的137例子痫前期产妇病历资料,年龄(32.29±3.16)岁,依据80/20定律随机分为训练集(107例)和验证集(30例)。训练集107例患者根据分娩方式分为阴道分娩组(85例)和中转剖宫产组(22例)。筛查子痫前期阴道试产失败的影响因素,构建并验证子痫前期阴道试产失败的预测模型。统计学方法采用t检验、χ^(2)检验。结果中转剖宫产组年龄、乳酸脱氢酶、24 h尿蛋白、T淋巴辅助细胞-22(Th-22)及初产妇占比均高于阴道分娩组[(33.35±2.71)岁比(31.29±3.05)岁、(302.91±50.24)U/L比(259.78±32.61)U/L、(2.41±0.75)g比(1.79±0.34)g、(1.27±0.34)%比(1.06±0.31)%、95.45%(21/22)比76.47%(65/85)],浆细胞样树突细胞(pDC)低于阴道分娩组[(0.13±0.04)%比(0.18±0.06)%],差异均有统计学意义(均P<0.05)。logistic回归分析结果显示,年龄(OR=3.601,95%CI 1.063~12.194)、产次(OR=3.725,95%CI 1.099~12.615)、乳酸脱氢酶(OR=4.088,95%CI 1.207~13.846)、24 h蛋白尿(OR=3.740,95%CI 1.104~12.667)、Th-22(OR=4.088,95%CI 1.207~13.846)、pDC(OR=0.223,95%CI 0.066~0.754)是子痫前期阴道试产失败的影响因素(均P<0.05)。训练集107例患者列线图模型预测子痫前期阴道试产失败的灵敏度为0.804(95%CI 0.715~0.862),特异度为0.749(95%CI 0.675~0.816),曲线下面积为0.832(95%CI 0.731~0.899)。另将验证集30例子痫前期患者带入验证,列线图模型预测子痫前期阴道试产失败的灵敏度为0.756(95%CI 0.682~0.825),特异度为0.773(95%CI 0.701~0.851),曲线下面积为0.804(95%CI 0.707~0.881)。结论年龄、产次、乳酸脱氢酶、24 h尿蛋白、Th-22、pDC与子痫前期阴道试产失败有关,构建列线图预测模型有助于早期评估子痫前期阴道试产失败的风险。

产时超声监测对分娩结局的影响研究

目的探究阴道触诊与产时超声监测对分娩结局的影响。方法选取2021年12月至2022年11月在南浔区人民医院住院分娩的200例单胎足月孕妇作为研究对象。采用随机数字表法将其分为A组和B组,各100例。B组进行阴道触诊,A组进行经腹部联合经会阴超声。比较两组的检查次数、破膜总时间、平均产程时间、钳产率、顺产率、剖宫产率、宫腔操作率、宫颈前后唇距离、胎方位符合率,比较两组的数字疼痛评分法(NRS)评分,比较两组不良事件发生情况。结果A组检查次数、剖宫产率显著低于B组,A组胎方位符合率显著高于B组,A组NRS评分显著低于B组,A组不良事件总发生率显著低于B组,差异均具有统计学意义(P<0.05)。结论孕妇采取经腹部联合经会阴超声进行检测,能够有效提高检测质量,减少孕妇检查次数及疼痛评分,降低不良事件的发生风险。

不同分娩方式产妇产后盆腔器官脱垂与肛提肌裂孔面积变化的关系及影响因素

目的探讨经阴道与剖宫产产后肛提肌裂孔面积差异及与产后盆腔器官脱垂(POP)发生的关系。方法选取2021年1月至2022年1月在上海市宝山区吴淞中心医院就诊的产后POP患者的临床资料,共78例。其中经阴道分娩患者49例,设为POP阴道分娩组;剖宫产分娩患者29例,设为POP剖宫产分娩组。选取同期来我院体检的健康产妇的临床资料,共120例。其中经阴道分娩产妇75例,设为健康阴道分娩组;剖宫产分娩产妇45例设为健康剖宫产分娩组。对各组研究对象的临床资料进行回顾性分析。分别比较阴道分娩产妇、剖宫产产妇不同状态下肛提肌裂孔面积。对阴道分娩产妇发生POP及剖宫产产妇发生POP的因素进行单因素分析和logistic回归分析。分析POP产妇肛提肌裂孔面积与POP-Q分度相关性。结果POP阴道分娩组产妇静息状态、Valsalva状态及缩肛状态下肛提肌裂孔面积明显高于健康阴道分娩组产妇(P<0.05)。POP剖宫产分娩组产妇静息状态、Valsalva状态及缩肛状态下肛提肌裂孔面积明显高于健康剖宫产分娩组产妇(P<0.05)。POP阴道分娩组中分娩周期≥37周、胎儿体重>4 kg的产妇所占比例显著高于健康阴道分娩组(P<0.05)。POP剖宫产分娩组阴道试产产妇所占比例显著高于健康剖宫产分娩组产妇(P<0.05)。胎儿体重和分娩周期是阴道分娩产妇发生POP的影响因素(P<0.05)。阴道试产是剖宫产产妇发生POP的影响因素(P<0.05)。POP产妇POP-Q分度:Ⅰ度32例,Ⅱ度29例,Ⅲ度17例。静息状态、Valsalva状态及缩肛状态下肛提肌裂孔面积与POP-Q分度呈正相关(r=0.414、0.617和0.345,P<0.05)。结论肛提肌裂孔面积的监测在POP的评估中具有良好的价值。阴道分娩产妇中分娩周期≥37周、胎儿体重>4 kg更易发生POP。剖宫产分娩产妇中经阴道试产产妇更易发生POP。临床医师应予以相关产妇密切关注,积极宣教,有效干预,以期减少POP的发生。

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。

阴道试产失败转剖宫产的影响因素分析

目的探究产妇阴道试产失败中转为剖宫产的影响因素,为后续临床研究提供参考。方法回顾性选取2022年1月—2023年6月江苏省人民宿迁医院收治的2343例产妇的临床资料,按生产方式将产妇分为两组,对照组(阴道顺产成功)2205例,观察组(阴道顺产失败中转剖)138例。将研究对象的年龄、文化程度、孕周、宫颈情况、孕周体重增加值、有无羊水污染及胎膜早破、有无使用催产素、人工破膜情况等信息进行汇总,分析产妇阴道顺产转剖宫产发生的影响因素。结果单因素回归分析表明,年龄、孕期体重增值、孕周、新生儿出生体重、是否存在胎膜早破、是否存在羊水污染、入院宫颈Bishop评分、阴道分娩史均为产妇阴道顺产转剖宫产发生的影响因素(P均<0.05)。多因素Logistic回归分析显示:年龄≥35岁(OR=1.527,95%CI:1.467~8.216)、孕周>40周(OR=1.347,95%CI:1.235~21.459)、孕期体重增值≥15 kg(OR=3.394,95%CI:3.251~8.027)、新生儿出生体重>4 kg(OR=1.725,95%CI:1.520~7.005)、胎膜早破(OR=1.256,95%CI:1.132~3.251)均为阴道试产失败转剖宫产的独立危险因素。结论阴道试产失败转剖宫产的影响因素为年龄、体重增值、孕周、新生儿体重及存在胎膜早破。助产人员应按照院内规定严格执行辅助操作步骤,避免过度干预,加强产程中的监护,通过科学管理降低中转剖率,降低妊娠不良结局的发生率。

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。