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.

Dural puncture epidural technique provides better anesthesia quality in repeat cesarean delivery than epidural technique:Randomized controlled study

BACKGROUND Repeat cesarean deliverys involve a longer surgery and more severe visceral traction than primary cesarean deliverys.The dural puncture epidural(DPE)technique provides faster and more effective analgesia for labor,but there is no sufficient evidence to indicate whether it is suitable for parturients undergoing repeat cesarean delivery.AIM To determine the efficacy and safety of the DPE anesthesia technique in patients undergoing repeat cesarean delivery.METHODS Patients undergoing repeat cesarean delivery were randomly divided into the DPE and epidural anesthesia(EA)groups.A 25-G spinal needle was used for dural puncture via a 19-G epidural needle.The patients in the two groups were injected with 5 mL of 2%lidocaine followed by 15 mL of a mixture of 1%lidocaine+0.5%ropivacaine as the epidural dosage.The primary outcome was the onset time of sensory block to the T6 dermatome level and the sensory and motor block degree.RESULTS A total of 115 women were included(EA:57,DPE:58).The mean time to sensory block to the T6 Level was significantly shorter in the DPE group than in the EA group(14.7 min vs 16.6 min;95%confidence interval,13.9 to 15.4 vs 15.8 to 17.4;P=0.001).The cranial sensory block level was significantly higher at 5,10,and 15 min after the initial dose in the DPE group than in the EA group(P<0.05).The sacral sensory block level was significantly higher and the modified bromage score was significantly lower in the DPE group at each time point(P<0.05).Adverse effects and neonatal outcomes were comparable between the two groups(P>0.05).CONCLUSION The DPE technique provided higher-quality anesthesia than the EA technique,with a rapid onset of surgical anesthesia,better cranial and sacral sensory block spread and a higher motor block degree,without increasing the incidence of maternal or fetal side effects in patients undergoing repeat cesarean delivery.

Pregnancy Outcomes of Repeat Cesarean Section in Peking Union Medical College Hospital

Objective To evaluate the effect of elective repeat cesarean section on the maternal and neonatal outcomes. Methods A retrospective clinicand hospital-based survey was designed for comparing the maternal and neonatal outcomes of elective repeat cesarean section [RCS group (one previous cesarean section) and MRCS group (two or more previous cesarean sections)] and primary cesarean section (FCS group) at Peking Union Medical College Hospital from January 1998 to December 2007. Results The incidence of repeat cesarean section increased from 1.26% to 7.32%. The mean gestational age at delivery in RCS group (38.1±1.8 weeks) and MRCS group (37.3±2.5 weeks) were significantly shorter than that in FCS group (38.9±2.1 weeks, all P<0.01). The incidence of complication was 33.8% and 33.3% in RCS group and MRCS group respectively, and was significantly higher than that in FCS group (7.9%, P<0.05). Dense adhesion (13.5% vs. 0.4%, OR=7.156, 95% CI: 1.7-30.7, P<0.01) and uterine rupture (1.0% vs. 0, P<0.05) were commoner in RCS group compared with FCS group. Neonatal morbidity was similar among three groups (P>0.05). Conclusions Repeat cesarean section is associated with more complicated surgery technique and increased frequency of maternal morbidity. However, the incidence of neonatal morbidity is similar to primary cesarean section.

Effectiveness of Seprafilm^®in Preventing Adhesions on Repeated Cesarean Sections

Due to the recent advances in assisted reproductive technology therapy and perinatal care, cesarean sections have been increasingly employed. The aim of this study was to elucidate the effectiveness of Seprafilm® in saving time during fetal deliveries and in minimizing the amount of blood loss in cesarean deliveries. In cases of second cesarean section, our results showed that Seprafilm® significantly reduced the fetal delivery time from 7.5 ± 2.8 to 5.4 ± 2.2 min (p = 0.001). The time required for total surgery was shortened from 45.3 ± 10.0 to 39.6 ± 6.5 min (p = 0.003). The blood loss was diminished from 816.4 ± 352.1 to 630.8 ± 255.9 g (p = 0.01). These results demonstrate that Seprafilm® is very effective even in repeated cesarean sections.

The Impact of Spontaneous Labor Before Elective Repeat Cesarean Delivery on Pregnancy Outcome:A Prospective Cohort Study

and neonatal outcomes.Methods:This was a prospective cohort study.All consecutive ERCDs,occurring at≥37 weeks of gestation between July 1,2017 and December 31,2019 in Makassed General Hospital,were evaluated.The maternal and neonatal outcomes of 183 laboring women undergoing unscheduled repeat cesarean delivery(URCD)group were compared with those of 204 women undergoing cesarean delivery(CD)without spontaneous labor(ERCD)group.Primary outcomes were“composite adverse maternal outcome”and“composite adverse neonatal outcome.”Fisher’s exact and Student’s t tests were used to assess the significance of differences in dichotomous and continuous variables,respectively.Two logistic regression models were constructed to identify risk factors with most significant influence on the rate of composite adverse maternal and neonatal outcomes.Results:“Composite adverse maternal outcome”was significantly more common in women who underwent spontaneous labor((40/183)21.9%vs.(19/204)9.3%,P=0.001,relative risk(RR):2.7,95%confidence interval(CI):1.50–4.90).Similarly,“composite adverse neonatal outcome”was significantly increased in the URCD group((24/183)13.1%vs.(12/204)5.9%,P=0.014,RR:2.4,95%CI:1.18–4.98).These adverse effects persisted after adjustment for confounders.Multivariate regression models revealed that,besides labor,CD-order impacted maternal outcome(RR:1.5,95%CI:1.02–2.30,P=0.036),while CD-order and teenage pregnancy influenced neonatal outcome(RR:2.1,95%CI:1.29–3.38,P=0.003,and RR:16.5,95%CI:2.09–129.80,P=0.008,respectively).Conclusion:In our study,spontaneous labor before ERCD,including deliveries at term,was associated with adverse maternal and neonatal outcomes,indicating that it is preferable to conduct ERCD before the onset of labor.Screening women with MRCD may identify those at increased risk for spontaneous labor for whom CD could be scheduled 1–2 weeks earlier.Further large prospective studies to assess the effects of such an approach on maternal and neonatal outcomes are strongly warranted.

多元共享决策模式对瘢痕子宫再次妊娠分娩方式的影响

目的探究决策辅助手册联合在线分娩决策支持的多元共享决策模式对瘢痕子宫再次妊娠女性分娩方式的影响。方法选取2019年9月至2022年10月在某三甲医院产检的94例瘢痕子宫再次妊娠女性为研究对象,采用随机数字表法分为观察组与对照组。对照组接受常规孕期宣教,观察组在常规孕期宣教的基础上接受多元共享决策干预。分别对两组分娩决策冲突程度、分娩方式偏好、分娩后决策后悔程度和最终分娩方式进行比较。结果观察组在接受多元共享决策干预后,决策冲突量表得分降低(P<0.001),在分娩方式偏好调查中表示“不确定”的人数减少,选择经阴道生产的人数增加;最终观察组孕妇行剖宫产者30人(68.2%),阴道分娩者14人(31.8%);观察组孕妇对本次分娩决策后悔程度低于对照组(P<0.001)。结论对瘢痕子宫再次妊娠女性开展多元共享决策可降低其决策冲突程度、增强阴道试产意愿并帮助其做出理性科学的分娩决策。

改良式子宫下段切口外下缘娩头法在重复剖宫产术中的临床应用

目的:探究改良式子宫下段切口外下缘娩头法在重复剖宫产术中的临床应用效果。方法:选取2023年1—7月九江市妇幼保健院妇产科收治的重复剖宫产孕妇80例作为研究对象,按照随机数字表法分为研究组(40例)和对照组(40例)。对照组采用常规剖宫产娩头法,研究组采用改良式子宫下段切口外下缘娩头法。比较两组临床效果。结果:研究组剖宫产手术时间、切开子宫至胎头娩出时间及产后住院时间均短于对照组,产妇不良事件发生率低于对照组(P<0.05)。研究组新生儿不良事件发生率与对照组相比,差异无统计学意义(P>0.05)。研究组产后出血量少于对照组,新生儿Apgar评分高于对照组(P<0.05)。结论:对于重复剖宫产临床分娩,改良式子宫下段切口外下缘娩头法能够有效降低产后不良结局的发生风险性,同时可以改善产妇围手术期指标,促进术后恢复与母婴健康。

Effect of China's Universal Two-child Policy on the Rate of Cesarean Delivery: A Case Study of a Big Childbirth Center in China

China's universal two child policy was released in October of 2015.How would this new policy influence the rate of overall cesarcan delivery(CD)in China?The objective of this paper is to investigate the trend of overall CD rate with the increase of number of multiparous women based on a big childbirth center of China(a tertiary hospital)in 2016.In this study,22530 cases from the medical record department of a big childbirth center of China from January 1 to December 31 in 2016 were entolled as research objects.Electronic health records of these selected objects were retrieved.According t0 the history of childbirth,the selected cases were divided into primiparous group containing 16340 cases and multiparous group containing 6190 cases.Chi-square test was carried out to compare the rate of CD,neuraxial labor analgesia,maternity insurance between the two groups;1-test was performed to compare the in-hospital days and gestational age at birth between the two groups.Pearson corrclation coefficient was used to evaluate the rclationship among observed monthly rate of multiparas,overall CD rate,and Elective Repeat Cesarean Delivery(ERCD)rate.The results showed that the CD rate in multiparous group was 55.46%,which was higher than that in primiparous group(34.66%,P<0.05).The rate of neuraxial labor analgesia in multiparas group was 9.29%,which was lower than that in primiparas group(35.94%,P<0.05).However,the rate of maternity insurance was higher in multiparas group(57.00%)than that in primiparas group(41.08%,P<0.05).The hospital cost and in-hospital days in multiparas group were higher,and the gcstational age at birth in multiparas group was lower than in primiparas group(P<0.05).The overall CD rate slightly dropped in the first 4 months of the year(P<0.05),then increased from 36.27%(April)to 43.21%(Dcember)(P<0.05).The rate of multiparas women and ERCD had the same trend(P<0.05).There were linear correlations among the rate of overall CD,the rate of multiparas women and the rate of ERCD rate(P<0.05).With the opening of China's two-child policy,the increasing rate of overall CD is directly related with the high rate of ERCD.Trials of Labor After Cesarean Section(TOLAC)in safe mode to reduce overall CD rate are warranted in the future.

中医特色快速康复外科理念在重复剖宫产围手术期的应用研究

目的 探讨传统中医药联合快速康复理念(ERAS)在促进重复剖宫产术患者术后恢复的临床价值。方法 选择2020年12月—2022年12月本院收治的足月妊娠(37~42周)计划二次剖宫产分娩的孕妇120例作为研究对象,随机分为观察组和对照组两组,每组各60例。观察组患者在围手术期给予ERAS技术支持,同时术前术后给与中医药技术干预措施,对照组患者采用传统围手术期管理方法。比较在两种不同围手术期处理方案下,相关指标的差别如:术中及术后第1天、第3天阴道出血量;术后两组病人的VAS疼痛评分:首次进食流质时间、术后首次肛门排气时间、首次下床活动时间、住院时间、平均住院费用;患者术后不良反应和并发症发生率;术后24 h及72 h化验室指标中WBC及CRP、D-二聚体等化验指标的差异,来评估两种不同围手术期处理方式在重复剖宫产术应用中的优劣。结果 术中及术后第1天、第3天阴道出血量,观察组病人均明显少于对照组,差异具有统计学意义(P<0.05)。在患者自我评价方面,比较两组患者视觉模拟疼痛(VAS)评分,差异有统计学意义(P<0.05)。表明中医穴位针刺协助术后多模式镇痛有确定疗效。术后首次进食流质时间,首次肛门排气时间,首次下床活动及首次排便时间,观察组较对照组均明显缩短,差异有统计学意义(P<0.05)。表明中医联合快速康复组比传统治疗组在促进胃肠功能恢复上更有优势。两组术后72 h实验室检查,白细胞、CRP、D-二聚体均低于对照组,差异有统计学意义,表明中医联合快速康复组较传统治疗能降低创伤应激反应。术后住院时间观察组相比对照组明显缩短,平均住院费用明显下降,差异有统计学意义(P<0.05)。比较两组术后不良反应情况,观察组出现恶心呕吐、肠梗阻、尿潴留等不良反应均较对照组明显减少,差异有统计学意义(P<0.05),观察切口感染、下肢血栓发生率,两组无显著性差异(P>0.05)。结论 中医适宜技术联合快速康复理念应用于重复剖宫产术围术期安全、有效,与传统围手术期治疗方案相比,在促进术后恢复方面有独特的优势,从而能给病人提供更为方便、快捷、舒适的康复体验。

3613例瘢痕子宫再次妊娠分娩结局分析

目的探讨瘢痕子宫对再次妊娠分娩结局的影响。方法回顾性收集3613例瘢痕子宫临床资料,按最终的分娩方式分为选择性再次剖宫产(ERCS组)和剖宫产后阴道分娩(VBAC组)组,分析两组妊娠期、分娩期的合并症及并发症发生情况。结果3613例瘢痕子宫再次妊娠,妊娠分娩合并症和并发症的发病率前10位依次是妊娠糖尿病(26.7%)、贫血(22.5%)、胎膜早破(13.1%)、产后出血(8.8%)、早产(6.7%)、巨大儿(6.5%)、妊娠高血压(6.4%)、前置胎盘(4.6%)、臀位(4.3%)及妊娠合并子宫肌瘤(3.8%)。ERCS组妊娠高血压、臀位、前置胎盘、产后出血发病率均高于VBAC组(P均<0.05);而VBAC组的妊娠合并甲状腺功能减退、胎膜早破、早产、子宫破裂发病率均高于ERCS组(P均<0.05)。结论瘢痕子宫会增加再次妊娠分娩合并症与并发症的发生,分娩方式的选择需权衡利弊,以改善母婴预后。

GDM孕妇剖宫产术后再次妊娠阴道分娩对母儿结局的影响

目的探讨妊娠期糖尿病孕妇剖宫产术后再次妊娠阴道分娩对母儿结局的影响。方法选择2016年1月—2021年12月在厦门市妇幼保健院收治的血糖控制正常的妊娠期糖尿病剖宫产术后再次妊娠产妇200例,按照不同的分娩方式分为剖宫产术后阴道分娩(vaginal birth after cesarean,VBAC)组和再次剖宫产(elective repeat cesarean,ERCS)组,其中VBAC组100例,ERCS组100例,分析不同分娩方式对母儿结局的影响。结果VBAC组和ERCS组比较,住院时间、费用以及产后出血量,ERCS组比VBAC组高,差异有统计学意义(P<0.05)。产褥感染、新生儿Apgar评分、新生儿窒息、新生儿低血糖症、新生胆红素血症,差异均无统计学意义(P>0.05)。结论在血糖控制好的情况下,妊娠期糖尿病剖宫产术后再次妊娠孕妇实施阴道分娩是较为理想的分娩方式,住院时间更短、费用更少,且母儿结局良好。

基于WeChat的NBASS-APS在二次剖宫产产妇术后镇痛中的应用

目的探讨基于WeChat的NBASS-APS在二次剖宫产产妇术后镇痛中的应用效果。方法采用便利抽样法,选取2020年1月-8月在我院接受二次剖宫产手术的100例产妇为研究对象,其中入住产二科的50例产妇为对照组,采用常规疼痛管理模式;入住产一科的50例产妇为实验组,采用基于WeChat的NBASS-APS。比较两组术后疼痛、术后恢复情况及满意度。结果实验组术后12、24、48h疼痛评分显著低于对照组(P<0.05),实验组首次下床活动时间显著早于对照组(P<0.05),不良反应发生率显著低于对照组(P<0.05),实验组护理满意度显著高于对照组(P<0.05)。结论基于WeChat的NBASS-APS疼痛管理模式有助于减轻二次剖宫产产妇术后疼痛、缩短产妇下床活动时间、降低不良反应发生率,促进产妇康复,提高其护理满意度,可应用于临床。

剖宫产后阴道试产失败的影响因素分析

目的:探讨剖宫产后阴道试产(TOLAC)失败的影响因素。方法:回顾性分析2017年1月至2020年12月在首都医科大学附属北京积水潭医院妇产科住院分娩的TOLAC患者的病例资料共174例。根据此次分娩结局分为剖宫产后阴道分娩(VBAC)组(122例)和TOLAC失败组(52例),对两组的一般资料进行单因素分析,对TOLAC失败的影响因素进行Logistic回归分析;再根据此次分娩是否自然临产,分为自然临产组(124例)和引产组(50例),比较两组在TOLAC失败率上是否有差异;分析引产组中VBAC(26例)和TOLAC失败者(24例)一般资料的差异性;分析TOLAC失败组中自然临产(28例)和引产者(24例)的再次剖宫产指征构成比有无差异。结果:VBAC组与TOLAC失败组在分娩孕周[39^(+3)(38^(+5),40^(+1))周vs.40^(+1)(39^(+2),40^(+4))周,P=0.002]、新生儿出生体质量(3308.44±451.57 g vs.3469.23±334.04 g,P=0.022)、自然临产率(78.69%vs.53.85%,P=0.001)差异有统计学意义;在年龄、2次分娩间隔时间、前次分娩是否临产差异均无统计学意义(P>0.05)。经Logistic回归分析自然临产是TOLAC失败的保护因素(OR 0.395,95%CI 0.186~0.838,P=0.015)。引产组的TOLAC失败率高于自然临产组(48.00%vs.22.58%,P=0.001),但两组在年龄(P=0.612)、分娩孕周(P=0.704)、子宫颈评分(P=0.120)、新生儿出生体质量(P=0.688)差异均无统计学意义。TOLAC失败组中自然临产和引产者再次剖宫产指征的构成比差异无统计学意义(P=0.924)。结论:自然临产降低TOLAC失败的风险,需引产者TOLAC失败率升高。但对于有引产指征的TOLAC孕妇,引产仍然是一种可行的选择。仅孕周>40周不应排除TOLAC。

心理干预联合无痛分娩技术在剖宫产术后再次妊娠患者中的应用效果观察

目的:观察剖宫产术后再次妊娠阴道分娩中心理干预联合无痛分娩技术的应用效果。方法:选取2023年1—10月康美医院妇产科收治的入院剖宫产术后再次妊娠产妇60例作为研究对象,产前随机分为对照组和观察组,各30例。对照组采用常规产程观察及相关护理,观察组在对照组基础上给予无痛分娩技术。比较产妇情绪状态、产程时间及分娩结局。结果:临产前,两组抑郁症筛查量表(PHQ-9)、焦虑症筛查量表(GAD-7)量表评分比较,差异无统计学意义(P>0.05);产中、产后即刻,观察组PHQ-9、GAD-7量表评分低于对照组,差异有统计学意义(P<0.001)。观察组第一、第二、第三产程及总产程时间均低于对照组,差异有统计学意义(P<0.001)。观察组阴道分娩成功率高于对照组,且产后出血率、新生儿窒息率均低于对照组,差异有统计学意义(P<0.05)。结论:心理干预联合无痛分娩技术在剖宫产术后再次妊娠阴道分娩中可积极改善产妇分娩期间的不良情绪,促进产程进展,增加产妇选择阴道分娩的信心,提高阴道分娩成功率。

复发性剖宫产瘢痕妊娠的诊断及治疗

目的：总结分析复发性剖宫产瘢痕妊娠（RCSP）的临床表现、诊断、治疗及预后等,从而为临床诊治提供参考。方法：利用Pub Med数据库、万方数据库及中国期刊全文数据库检索关于RCSP报道的所有文献。通过阅读全文,总结分析RCSP的临床表现及诊断方法,重点探讨其治疗方法及预后。结果：共收集RCSP患者21例,其中自然妊娠19例。初次CSP治疗后至再次CSP的时间间隔6~64月,其中13例时间间隔小于12月。RCSP的治疗方案种类较多,但与初次CSP基本相同。16例患者采用与初次CSP时相同的治疗方法。两次治疗方案中均包含有UAE的9例患者中,4例再次手术时因子宫动脉闭锁,无法完成预期手术。患者均治疗成功并保留了子宫。结论：CSP患者治疗后再次妊娠时发生RCSP的几率将明显升高。RCSP的临床表现与超声诊断标准与CSP基本相同。RCSP治疗方案的选择需综合考虑患者前次CSP时的治疗方法等,尤其是拟再次选用UAE者。剖宫产子宫瘢痕的切除并不能防止RCSP发生。

子宫下段修补术在瘢痕子宫妊娠患者再次剖宫产术中的临床应用

目的：探讨再次剖宫产术中行子宫下段修补术在瘢痕子宫妊娠患者中的临床应用价值。方法：回顾性分析我院2014年1~12月产科就诊的80例瘢痕子宫妊娠患者,随机分组,40例患者术中行子宫下段修补术为修补组,另外40例未修补下段者为非修补组。比较两组患者术后24小时内出血量、术后再次使用强效宫缩剂例数、手术时间、新生儿体重、新生儿出生5分钟Apgar评分、产褥病率及术后住院时间等。结果：修补组产后出血量为376.00±107.00ml,非修补组为432.00±135.56ml,差异有统计学意义（P〈0.05）,两组患者在手术时间、新生儿体重、出生5分钟Apgar评分、产褥病率、再次使用强效宫缩剂例数、术后住院时间等比较均差异无统计学意义（P〉0.05）。结论：瘢痕子宫妊娠患者再次剖宫产中行子宫下段修补术可以减少产后出血量,其方法简便有效。

重复性剖宫产术中放置吉娜宫内节育器80例的临床分析

目的探讨重复性剖宫产术中放置吉娜固定式宫内节育器（Gyne Fix PP IUD）的可行性及安全性,为瘢痕子宫妇女提供一种较好的避孕措施。方法选择2013年4月~2015年1月扬州大学附属医院扬州市妇幼保健院收治的重复性剖宫产术中放置Gyne Fix PP IUD的80例患者作为观察组,选择同期重复性剖宫产术中未放置节育器的患者80例作为对照组。观察两组手术时间、产后24 h出血量、产褥病率、抗生素使用时间、血性恶露持续时间及42 d复查子宫复旧情况;并进行1年随访,观察Gyne Fix PP IUD的续用率。结果两组手术时间、产后24 h出血量、产褥病率、抗生素使用时间、血性恶露持续时间比较,差异均无统计学意义（P〉0.05）。观察组随访期间,IUD脱落2例,IUD下移1例未取出在随访中,带器妊娠1例,异位妊娠2例,月经异常终止使用者1例,1年后续用率92.5%。结论重复性剖宫产术中放置Gyne Fix PP IUD,是一种简便、安全的避孕措施。

二次剖宫产术后口服膳食纤维促进肠功能恢复效果研究

目的 :观察二次剖宫产术后口服膳食纤维(DF)以促进术后排气、排便,降低腹胀发生的效果,对纯母乳喂养的影响以及不良反应。方法 :选取2016年12月至2017年3月在陕西省人民医院产科住院行二次剖宫产手术产妇80例,电脑随机抽样分为两组,DF组40例,术后6 h,200 ml温开水溶解1袋DF(15 g)溶解,10 min左右逐渐喝完,术后8~12 h重复服用1袋;对照组术后6 h逐渐饮200 ml温开水,术后8~12h重复1次。DF组与对照组其它的饮食指导、护理、医疗措施均相同,比较两组术后的肠鸣音恢复、排气、排便情况以及腹胀发生率、纯母乳喂养率,收集服用DF后的不良反应。结果 :DF组与对照组的首次肠鸣音时间<12 h例数为(38,97.4%:25,62.5%),排气时间<24 h例数为(30,76.9%:12,30.0%),排便时间<48 h例数为(22,56.4%:7,17.5%),结果均为Р<0.01,差异有统计学意义;两组胃肠道反应情况比较,腹胀例数为(3,7.7%:12,30.0%),恶心例数为(3,7.7%:10,25.0%),Р<0.05,差异有统计学意义,呕吐例数为(1,2.6%:4,1.0%),Р>0.05,差异无统计学意义;母乳喂养率(56.%:52.5%),Р>0.05,差异无统计学意义;1例DF服用者服用后10 min左右出现有恶心、呕吐的不良反应。结论 :口服可溶性DF可以明显缩短二次剖宫产术后排气、排便时间,腹胀等发生率低,不良反应有恶心、呕吐,肠易激惹人群慎用。

中国部分地区剖宫产后阴道分娩的影响因素研究

目的：探讨中国部分地区剖宫产后阴道分娩（VBAC）的情况及其影响因素，为剖宫产术后妊娠的分娩方式提供参考依据。方法：选取全国4个研究中心10年间VBAC孕妇共142例作为研究对象，采用1：3配对的病例对照设计方案，收集孕产妇及新生儿的相关资料，并通过logistic回归模型进行多因素分析，分析VBAC的影响因素。结果：本研究剖宫产术后妊娠分娩方式中VBAc的比例约为1．3％（142／10452），多因素logistic回归结果显示产妇年龄（OR=0．885，95％CI=0．788～0．994）和产妇分娩前体质指数（BMI）越小，分娩孕周小于37周（OR=9．578，95％CI=3．060～29．975），宫口开大（OR=11．632，95o．4CI=4．544～29．778）、宫颈管消退（OR=2．152，95％CI=1．471～3．149）和先露位置（OR=2．079，95％CI=0．772～5．596）评分较高，则VBAC成功率较高。结论：VBAc与产妇年龄、分娩前BMI、分娩孕周和宫颈成熟度评分相关。

剖宫产后阴道试产的产时及产后评估

目的：探讨剖宫产后阴道试产（TOLAC）患者自然临产时及产后的评估及监测。方法：选择四川大学华西第二医院产科就诊的成功剖宫产后阴道分娩的患者42例（VBAC组）,及同期就诊的瘢痕子宫急诊剖宫产患者50例（CS组）和阴道分娩的初产妇50例（正常分娩组）为研究对象,对3组患者的母儿相关情况进行比较。结果：3组患者的年龄、孕周、孕前体质量指数（BMI）及妊娠合并症情况比较,差异无统计学意义（P〉0.05）,VBAC组胎儿双顶径（BPD）小于其他两组（P〈0.05）,宫颈Bishop评分高于其他两组（P〈0.05）。与正常分娩组比较,VBAC组产后2小时内出血量多（P〈0.05）,但产后2-24小时内出血量和新生儿5分钟Apgar评分差异无统计学意义（P〉0.05）。与CS组比较,VBAC组患者24小时出血量少且住院天数短（P〈0.05）,而新生儿5分钟Apgar评分差异无统计学意义（P〉0.05）。结论：自然临产后,胎儿双顶径较小且宫颈成熟度较高的瘢痕子宫患者可以进行阴道试产,与再次剖宫产相比可以减少产后出血量及住院天数。在TOLAC过程中需要动态观察,严密监护,尤其要注意预防产时和产后2小时出血。