家庭式产房陪伴责任制助产1600例临床分析

目的探讨家庭式产房陪伴责任制助产的临床效果。方法将传统助产模式下分娩的1 300例单胎、头位、初产妇为对照组。家庭式产房责任制助产下分娩的1 600例单胎、头位、初产妇为观察组。将2组阴道分娩率、剖宫产率、产程时间、产后出血率、胎儿窘迫和新生儿窒息率、产妇满意度进行比较。结果观察组较对照组剖宫产率、产后出血率、胎儿窘迫和新生儿窒息率明显降低,产妇满意度提高。结论家庭式产房陪伴责任制助产有利于产科质量的提高,值得推广。     

责任制助产质效观察

目的 探讨责任制助产管理效果。方法 对582例产妇实施责任制助产模式助产(责任组).568例采用传统助产模式助产(传统组).作产科质量指标及工作效率比较。结果责任组产程缩短.阴道助产率下降.产后2 h出血量减少、宫颈撕裂伤发生率明显降低,剖宫产率下降.两组比较,差异有显著性或极显著性意义(P<0.05或P<0.01);助产士年均实际工作时间责任助产弹性工作制比传统排班法减少343.3 h。结论 责任制助产有利于产房工作调控和质量管理,能促进自然分娩,提高工作效率和产科质量。     

责任助产组全程介入的导乐陪伴分娩模式研究

目的 探讨由责任主管护师与助产士组成的责任助产组对孕产妇进行全程导乐陪伴分娩的效果.方法 观察组494例孕产妇由责任助产组实施导乐分娩,责任主管护师负责对孕产妇评估分类,并对助产士进行指导,助产士实施一对一全程"导乐"陪伴分娩.对照组486例孕产妇按常规由1名助产士实施导乐陪伴分娩.观察比较两组孕产妇的分娩方式及分娩结局.结果 观察组剖宫产率、产程时间、阴道助产率、产后出血率、新生儿窒息发生率与对照组比较,差异有显著性意义(P<0.05,P<0.01).结论 由责任助产组介入的全程导乐陪伴分娩模式,适应现代医学模式的需要,以孕产妇为中心,有利于提高产时服务质量,促进母婴健康.     

责任助产组全程介入的导乐陪伴分娩模式研究

目的探讨由责任主管护师与助产士组成的责任助产组对孕产妇进行全程导乐陪伴分娩的效果。方法观察组494例孕产妇由责任助产组实施导乐分娩，责任主管护师负责对孕产妇评估分类，并对助产士进行指导，助产士实施一对一全程“导乐”陪伴分娩。对照组486例孕产妇按常规由1名助产士实施导乐陪伴分娩。观察比较两组孕产妇的分娩方式及分娩结局。结果观察组剖宫产率、产程时间、阴道助产率、产后出血率、新生儿窒息发生率与对照组比较，差异有显著性意义（P〈0．05，P〈0．01）。结论由责任助产组介入的全程导乐陪伴分娩模式，适应现代医学模式的需要，以孕产妇为中心，有利于提高产时服务质量，促进母婴健康。     

促进自然分娩产时服务模式的临床研究

目的降低剖宫产率 ,保护、促进和支持自然分娩。方法按知情同意、自主选择的方法将本院住院分娩的产妇分为两组 ,对照组 4 4 2例沿用常规产时服务模式 ;观察组 4 4 0例实施促进自然分娩产时服务模式。结果观察组自然分娩率为 88.6 % ,对照组为 4 0 .3% ;新生儿窒息率观察组为 1.1% ,对照组 4 .1% ;缩宫素使用、硬膜外麻醉镇痛及人工破膜等产时干预观察组少于对照组 ;产妇对医生、助产士 /导乐员、护士服务质量和分娩环境的满意度高于对照组 ,两组上述各项指标比较 ,差异均有显著性意义 (均P <0 .0 1)。结论促进自然分娩产时服务模式能有效改善分娩结局、减少产时医疗干预 ,促进自然分娩 ,提升服务质量。     

心理干预对自然分娩的影响

目的探讨心理干预对自然分娩的影响。方法对拟阴道分娩的产妇120例进行产前、产时心理干预,观察产妇产程中疼痛程度、产程时限、分娩方式、产后出血量,并设对照组。结果结果比较,观察组产程中疼痛程度、产程时限、产后出血量、阴道助产及剖宫产率均比对照组显著降低(P<0.01)。结论对产妇在产程中进行心理干预能减轻疼痛,缩短产程,减少出血,降低阴道助产率和剖宫产率,促进自然分娩。     

促进自然分娩产时服务模式实施效果分析

目的探讨促进自然分娩产时服务模式的实施效果。方法将2014年1~12月传统模式分娩孕妇1 580例作为对照组,2015年1~12月采用促进自然分娩产时服务模式分娩孕妇3 396例作为观察组,比较两组自然分娩率、会阴侧切率、产褥期感染率。结果观察组自然分娩率显著高于对照组,会阴侧切率、产褥期感染率显著低于对照组(均P0.01)。结论促进自然分娩产时服务模式有助于促进产妇自然分娩,降低会阴侧切率和产褥期感染率,确保母婴安全。     

心理干预在产妇分娩过程中的应用

目的:探讨助产±在产妇分娩中提供心理护理的效果.方法:将筛选的300例产妇随机分为研究组和对照组各150名,研究组除按助产±提供常规护理外,增加心理护理干预；对照组按照常规护理进行.比较不同护理措施对顺产率及母乳喂养率的效果.结果:研究组产妇顺产率与母乳喂养率高于对照组,与对照组相比差异显著.结论:心理干预能提高孕产妇顺产率及母乳喂养率,值得在产科大力推广.     

全程陪伴联合自控硬膜外镇痛在自然分娩中的临床应用

目的提高顺产率 ,促进自然分娩。方法将 80例正常足月初产妇随机分为观察组和对照组各 4 0例 ,观察组给予全程陪伴分娩 ,联合自控硬膜外镇痛 (PCEA ,输注 0 .1%罗哌卡因 +芬太尼 ) ;对照组采取非全程陪伴并不用PCEA。结果观察组疼痛评分、顺产率、阴道助产率、产后 2h出血量、胎儿宫内窘迫和新生儿窒息发生率显著低于对照组 (P <0 .0 5或P <0 .0 1) ;观察组产妇第一产程、第二产程及总产程时间均短于对照组 (均P <0 .0 1)。结论全程陪伴联合PCEA可以提高顺产率 ,缩短产程 ,减少产科发病率和围产儿发病率等 ,促进自然分娩。     

硬膜外麻醉镇痛联合导乐陪伴分娩的观察

目的减少产时疼痛,减少剖宫产率,促进自然分娩。方法将200例正常足月初产妇随机分为观察组和对照组各100例,观察组给予全程导乐分娩联合硬膜外镇痛(PCEA),对照组采取非全程陪伴并不用PCEA。结果观察组顺产率、阴道助产率、剖宫产率、产后2 h出血量低于对照组(P<0.01)。结论硬膜外麻醉镇痛联合导乐分娩可以减少剖宫产率,缩短产程,促进自然分娩。     

Anaesthetic management of parturients with univentricular congenital heart disease and the Fontan operation

Women with a single ventricle circulation palliated with the Fontan operation require specialist multidisciplinary management. We report 14 such cases with successful pregnancies and detail the pathophysiology encountered. A combined obstetric and cardiac service between Chelsea and Westminster Hospital and Royal Brompton Hospital provides care for women with heart disease, and maintains a prospective database of referred women. We searched this database for women with a known Fontan circulation and reviewed the case notes and electronic patient records between January 1994 and December 2015. Eight women palliated with the Fontan operation delivered 14 live babies over the study period, with detailed peripartum management available for 11. Low-dose combined spinal-epidural or epidural labour analgesia was the intended mode of analgesia or anaesthesia for all deliveries (depending on clinical scenario and clinician preference), and was performed in 79%. Seven cases (50%) had a caesarean delivery. A neuraxial catheter technique was preferred (86%), whether or not vaginal delivery was attempted first. There were no deliveries under general anaesthesia. Fifty percent of cases were complicated by postpartum haemorrhage. Other peripartum complications included arrhythmias (29%), chest pain (14%) and intrauterine growth restriction (57%). Women with a Fontan circulation are increasingly encountered in obstetric practice. A good understanding of the underlying anatomy and its impact on physiology, coupled with meticulous care are essential to allow safe delivery for mother and baby. Multidisciplinary input into peripartum care is required, with anticipation of increased risk of complications such as haemorrhage and arrhythmias.     

全程责任制助产护理模式在自然分娩中的应用进展

分娩是育龄期妇女自然生产的生理过程，自然分娩过程中孕产妇会产生较大疼痛感，加之孕产 妇缺乏保健知识，容易产生抑郁、焦虑等不良情绪。全程责任制助产护理是指“一对一全程专责陪伴分 娩”助产责任制管理模式，是一种新的产时服务模式，能够缩短产程时间，降低产后出血量，缓解孕产妇 焦虑、恐惧等负性情绪，从生理、心理等方面满足患者的服务需求，提高护理质量，提高患者对护理服务 的满意度。本文主要对全程责任制助产护理模式含义、服务内容、实践效果及临床应用价值作一综述，旨 在为自然分娩孕产妇的护理提供相关经验，进一步提高产科护理服务质量。 娩     

Risk factors for severe perineal injury during childbirth: a case–control study of 60 consecutive cases

Aim The study aimed to evaluate the current risk factors for severe perineal tears in a single university‐affiliated maternity hospital. Method An obstetric database of 31 784 consecutive women who delivered from January 2007 to December 2009 was screened for cases of third‐degree or fourth‐degree perineal tears. Four controls, matched by time of delivery, were selected for each case of third‐ or fourth‐degree perineal tear. Maternal and obstetric parameters were analyzed and compared between the study and control groups. Results Sixty women (0.25% of all vaginal deliveries) had a third‐degree (53 women) or a fourth‐degree (seven women) perineal tear. The control group comprised 240 matched vaginal deliveries without severe tears. Primiparity, younger maternal age, Asian ethnicity, longer duration of second stage of labour, vacuum‐assisted delivery and heavier newborn birth weight were significantly more common among women who had third‐ or fourth‐degree perineal tears. Of the variables that were found to be statistically significant in the univariate analysis, only primiparity (OR = 2.809, 95% CI: 1.336–5.905), vacuum delivery (OR = 10.104, 95% CI: 3.542–28.827) and heavier newborn birth weight (OR = 1.002, 95% CI: 1.001–1.003) were found to be statistically significant independent risk factors for severe perineal trauma. Conclusion Identification of women at risk may facilitate the use, or avoidance, of certain obstetric interventions to minimize the occurrence of childbirth‐associated perineal trauma.     

单叶产钳腹部加压阴道助产的临床应用研究

目的探讨单叶产钳辅以腹部加压阴道助产的临床应用效果。方法采用回顾分析法对采用腹部加压配合单叶产钳助产的200例进行统计分析。结果单叶产钳辅以腹部加压阴道助产200例无严重并发症发生、软产道损伤、新生儿产伤、窒息发生率低、母婴无不良影响。结论采用单叶产钳腹部加压阴道助产技术母婴损伤小,是科学的阴道分娩适宜技术,操作简单,易掌握,值得在基层医院推广。     

Effect of stress on birth weight in two Johannesburg populations

The effect of stress on birth weight was assessed in mothers delivering at Johannesburg (predominantly white) and Baragwanath (exclusively black) Hospitals. The Social Readjustment Rating Scale of Holmes and Rahe was used to assign maternal stress scores established during an interview conducted within 36 hours of delivery. Only mothers without medical problems who had delivered liveborn infants were included. Maternal age, obstetric history, smoking history and stresses present during the 12 months preceding delivery were recorded. Of 535 Johannesburg and 662 Baragwanath mothers studied, 48% and 55% respectively reported significant stresses. Analysis of the two groups revealed that for the Johannesburg mothers, smoking, cumulative stress score and previous preterm birth were important determinants of birth weight. Of the stress factors studied, marital separation and death of a spouse were significantly associated with a lower birth weight. For Baragwanath mothers the major determinants of low birth weight were maternal age, loss of income through being dismissed from work, or having to leave school as a consequence of the pregnancy.     

Stress urinary incontinence: prevalence among nulliparous compared with primiparous and grand multiparous premenopausal women.

The study was conducted to assess the prevalence of stress urinary incontinence in premenopausal nulliparae, primiparae, and grand multiparae, and to examine possible obstetric risk factors. Three hundred consecutive nulliparae, primiparae, and grand multiparae, 20 to 43 years of age, were interviewed during the third postpartum day of their consequent delivery about the symptom of stress urinary incontinence. Women were asked whether they had experienced stress urinary incontinence before, during, or after previous pregnancies and how troubled they were by their incontinence. Details of general and gynecologic history, parity, mode of previous deliveries, and birth weights were sought. Main outcome measures included prevalence of pregnancy-related and (persistent) nonpregnancy-related stress urinary incontinence. Prevalence of persistent stress urinary incontinence was significantly higher in grand multiparae compared with nulliparae (21% vs. 5%, respectively; P = 0.0008). Prevalence of persistent stress urinary incontinence among grand multiparae who had been delivered of at least one baby weighing more than 4,000 g was significantly higher than in those who did not (29.4% vs. 16.7%, respectively). The birth weight of the first newborn and operative vaginal delivery were not found to be associated with increased risk of stress urinary incontinence. Grand multiparity was found to be associated with an increased risk of developing persistent stress urinary incontinence during reproductive ages. The delivery of at least one baby weighing more than 4,000 g seems to be a predominant factor. Neurourol. Urodynam. 18:419-425, 1999.     

Effect of one interval vaginal delivery on the prevalence of stress urinary incontinence: a prospective cohort study

AIMS: To analyze the effect of one interval vaginal delivery on the prevalence of stress urinary incontinence amongst a cohort of nulliparous women. METHODS: A cohort of 276 nulliparous women without incontinence was recruited consecutively in 1996, after they had vaginal delivery, and were followed-up for urinary incontinence in 2000. The age, obstetric variables of the 1996 delivery (mode of delivery, genital tract trauma, birth weight, epidural analgesia, episiotomy, durations of labor, postpartum urinary retention), and the presence of interval vaginal delivery during the follow-up period were recorded. The obstetric factors and the prevalence of urinary stress incontinence at follow-up were then compared between women with and without interval vaginal delivery. Logistic regression analysis was performed to test the independence of the obstetric variables in the index pregnancy and the presence of one interval vaginal delivery, with urinary stress incontinence being the dependent variable. RESULTS: A total of 148 (53.6%) women were followed-up. The prevalence of urinary incontinence was 28.6% in women without interval delivery and 21.1% in women with one interval delivery. There was no significant difference in the prevalence of urinary incontinence between the two groups (chi(2) test, P = 0.31). Logistic regression showed that none of the obstetric variables or the presence of one interval vaginal delivery was significantly associated with urinary incontinence. CONCLUSIONS: One interval vaginal delivery does not increase risk of urinary stress incontinence 4 years after the index vaginal delivery.     

拆台式助产联合母婴接触对初产妇分娩结局的影响

目的改善初产妇分娩体验与结局。方法将单胎足月自然分娩的80例初产妇随机分为两组各40例。对照组采取助产士右侧站立助产及母婴接触30 min的常规法;干预组采取拆台、助产士对面站立助产及母婴接触90 min的联合法。结果两组新生儿评分、转入新生儿重症监护室率比较,差异无统计学意义(均P0.05);干预组新生儿觅食、含接及吸吮开始时间显著早于对照组,产妇会阴裂伤程度及产后2 h出血量显著低于对照组(P0.05,P0.01)。结论拆台式助产联合母婴接触法安全,可促进新生儿早吸吮,减轻产妇会阴裂伤程度及产后出血量。