选择性剖宫产术后阴道分娩的产程特点及母婴结局

目的:探讨选择性剖宫产术后经阴道分娩的产程特点及母婴结局。方法:选取2017年1月1日～2018年12月31日于淄博市妇幼保健院选择性剖宫产术后经阴道分娩的孕产妇117例作为观察组,选择同期足月自然临产且无产程干预分娩的初产妇104例作为对照组。比较两组的年龄、孕周、胎儿体重、产程特点及母婴结局。结果:观察组的第一产程及总产程时间短于对照组,差异有统计学意义(P0.05),第二产程及第三产程比较,差异无统计学意义(P0.05)。观察组与对照组的产后出血量、会阴侧切率、会阴裂伤率及新生儿窒息率比较,差异均无统计学意义(P0.05)。结论:选择性剖宫产术后阴道分娩产妇的第一产程时间与经产妇无显著差异,总产程时间与初产妇相比明显缩短。选择性剖宫产术后阴道分娩并不增加不良母婴结局。剖宫产术后再次妊娠经综合评估,孕期加强管理,严密产程监测,经阴道分娩安全可行,可减少重复剖宫产带来的二次损伤。     

产程中饮食对足月分娩孕妇产程及分娩结局的影响

【摘 要】 目的：观察产程中饮食对足月分娩孕妇产程及分娩结局的影响。方法：选取2015年11月-2016年6月于郑州大学第三附属医院住院待产的足月孕妇338例,根据饮食意愿不同分为流质饮食组162例（对照组）和自愿饮食组176例（观察组）,观察2组孕妇第一及第二产程持续时间、产程中呕吐、酮症的发生率及分娩结局。结果：①观察组第一产程和第二产程持续时间均长于对照组,差异均有统计学意义（P＜0.05）。②2组孕妇呕吐发生率比较,差异无统计学意义（P＞0.05）;观察组孕妇酮症的发生率低于对照组,差异有统计学意义（P＜0.05）。③2组孕妇产程中催产素使用情况、会阴侧切率及中转剖宫产率比较,差异均无统计学意义（P＞0.05）,2组孕妇分娩过程中均未使用器械助产。④2组新生儿1 min、5 min Apgar评分及新生儿转入新生儿重症监护病房（NICU）的入住率比较,差异均无统计学意义（P＞0.05）,2组新生儿均未出现窒息等严重并发症。结论：分娩过程中自愿饮食的孕妇虽相对增加第一、第二产程持续时间,但自愿饮食可降低孕妇酮症的发生率、不增加产程干预,且不影响母儿结局,也不增加孕妇呕吐的发生率。     

160例分娩镇痛临床分析

目的:通过对160例产妇实施分娩镇痛,观察其临床效果,探讨分娩镇痛对产程及母儿的影响。方法:选择160例健康、单胎、足月临产自愿接受分娩镇痛的初产妇作为镇痛组,将条件相似未采用任何镇痛措施的自然临产产妇160例作为对照组,对镇痛效果、产程时间、分娩方式、新生儿Apgar评分、产后2小时出血的情况进行比较。结果:镇痛组总产程时间、第一产程时间较对照组显著缩短(P<0.01),两组分娩方式、产后2h出血量及新生儿Apgar评分差异无显著性(P>0.05)。结论:分娩镇痛能减轻孕妇宫缩疼痛程度,缩短产程,提高自然分娩的信心,对母儿无不良影响。     

产程中饮食管理对孕妇产程及分娩结局的影响

目的观察产程中不同饮食对产程及分娩结局的影响。方法选取在我院产科经阴道分娩的孕妇333例,根据饮食意愿分为流质及半流质饮食的营养配餐组185例(观察组)和自愿饮食组148例(对照组),观察两组孕妇产程时间、产后出血量、会阴侧切情况、酮症的发生率及新生儿Apgar评分。结果流质及半流质饮食组的产程持续时间、产后出血量、会阴侧切率及酮体发生率均低于自愿饮食组,新生儿出生1分钟及5分钟Apgar评分无显著差异。结论产程中进食流质及半流质饮食可以缩短产程进展,促进自然分娩。     

初次剖宫产术后阴道分娩的产程和母婴结局分析

目的:分析初次剖宫产术后阴道分娩的产程特点及母婴结局,为规范管理VBAC产程提供依据。方法:选取2018年1月至2019年5月于安徽医科大学附属妇幼保健院初次剖宫产术后阴道分娩的产妇149例作为VBAC组,同期分娩的初产妇和经产妇各149例作为对照组,分为初产妇组和经产妇组,比较分析3组产妇的产程特点及母婴结局。结果:VBAC组的第一产程、第二产程、总产程时长小于初产妇组,差异有统计学意义(P0.05),VBAC组的第二产程时长大于经产妇组,差异有统计学意义(P0.05)。VBAC组的产时干预率低于初产妇组,差异有统计学意义(P0.05)。VBAC组的分娩镇痛率、会阴侧切率、产钳助产率高于经产妇组,差异有统计学意义(P0.05)。VBAC组的新生儿出生体重低于初产妇组和经产妇组,差异有统计学意义(P0.05)。VBAC组的胎儿窘迫发生率高于经产妇组,差异有统计学意义(P0.05)。结论:剖宫产术后阴道试产安全可行,产程时间介于初产妇与经产妇之间,在处理产程时要考虑到。     

水中分娩及分娩并发症的探讨

目的:时水中分娩产妇的产程、产道裂伤、产时和产后并发症、产时和产后镇痛药使用及新生儿结局进行分析,以评价水中分娩的安全性.方法:2003年3月1日至2007年6月30日在我院选择水中分娩的1227例产妇作为水中分娩组,将同期的单胎(无妊娠合并症及并发症)顺产的1227例产妇作为对照组.比较两组产程、产道裂伤、产时和产后并发症、产时和产后镇痛药使用及新生儿结局.结果:水中分娩组第一及第二产程时间、产褥病率、产后出血、会阴阴道血肿、产后尿潴留、新生儿轻度及重度窒息与对照组比较,两组差异无统计学意义(P>0.05);水中分娩组均未行会阴切开,对照组会阴切开率66.67%,两组比较,差异有高度统计学意义(P<0.01);水中分娩组下水后用镇痛药及产后用镇痛药与对照组比较明显减少,两组差异有高度统计学意义(P<0.01).结论:水中分娩能减轻分娩疼痛,减少产时、产后镇痛药的使用.减少产道损伤,且未发现对母儿有其他不良结局.     

第二产程预防性使用葡萄糖酸钙在降低单胎初产妇产时及产后出血量的作用

目的:分析第二产程预防性使用葡萄糖酸钙对单胎初产妇产时及产后出血量的影响。方法:随机将2018年8月2019年5月在天津市第一中心医院产科住院的单胎孕足月临产后进入第二产程的孕妇分为治疗组(282例)和对照组(274例),治疗组在第二产程预防性给予静脉滴注1 g葡萄糖酸钙,对照组孕妇在进入第二产程后立即给予静脉滴注葡萄糖注射液。比较2组孕产妇的分娩结局和新生儿结局。结果:治疗组第二、三产程时间比对照组短,差异均有统计学意义(均P<0.05)。治疗组的产时出血量和产后2 h、6 h、12 h、24 h出血总量均低于对照组,差异均有统计学意义(均P<0.05)。2组新生儿体质量、新生儿脐动脉血pH值、新生儿1 min Apgar评分和新生儿脐动脉血钙浓度比较,差异均无统计学意义(均P>0.05)。结论:第二产程预防性使用葡萄糖酸钙可降低单胎初产妇产时及产后24 h内出血总量。     

剖宫产术后再次妊娠阴道分娩产程的初步分析

目的:研究无阴道分娩史的剖宫产术后再次妊娠孕妇阴道分娩的产程特点。方法:回顾性分析2017年7月1日至2018年6月30日在深圳市妇幼保健院产科住院阴道分娩的无新生儿窒息孕妇资料。选取单胎头位、自然临产、既往无阴道分娩史的346例剖宫产术后阴道分娩(VBAC)产妇作为病例组,选取同期住院自然临产阴道分娩、单胎头位的350例正常初产妇作为对照组,比较两组产妇的产程特点。结果:病例组和对照组孕妇的年龄、分娩孕周、新生儿出生体质量、产后出血量、新生儿转科率差异无统计学意义(P0.05)。两组产妇第一产程、第二产程、第三产程及总产程比较,差异无统计学意义(中位数分别为7.00 vs 6.5小时、0.33 vs 0.42小时、0.17 vs 0.15小时和7.45 vs 7.28小时;P0.05)。结论:对于无阴道分娩史的剖宫产术后阴道试产(TOLAC)孕妇的产程观察与处理可与初产妇相同标准,子宫瘢痕不影响产程。     

经阴道羊膜腔灌注治疗单胎初产妇临产后羊水过少的母儿结局分析

目的:分析经阴道羊膜腔灌注治疗临产后羊水过少的单胎初产妇分娩结局和新生儿结局。方法:回顾性分析中国人民武装警察部队特色医学中心2015年4月—2018年3月临产后诊断为羊水过少的358例单胎初孕妇,分为行经阴道羊膜腔灌注的治疗组(166例)和未行羊膜腔灌注的对照组(192例),比较2组的分娩结局(顺产率、产钳助产率、剖宫产率、产后出血率和产褥感染率)和新生儿结局[新生儿脐动脉血pH值、脐动脉血乳酸值、出生后1 min Apgar评分、胎粪吸入综合征(MAS)发生率、入住新生儿科率]。结果:治疗组的顺产率高于对照组,产钳助产率和剖宫产率低于对照组,差异有统计学意义(P0.05)。治疗组的产后出血率和产褥感染率与对照组相比差异无统计学意义(P0.05)。治疗组的新生儿脐动脉血p H值、新生儿1 min Apgar评分高于对照组,而治疗组新生儿脐动脉血乳酸值、MAS发生率和入住新生儿科率低于对照组,差异均具有统计学意义(P0.05)。结论:经阴道羊膜腔灌注治疗单胎初产妇临产后羊水过少是安全有效的,可以显著改善分娩结局和新生儿结局。     

Ritgen接生手法在初产妇经阴道分娩中的临床应用

目的:探讨Ritgen接生手法在初产妇经阴道分娩中第二产程胎头拨露5cm至胎儿娩出时间、会阴侧切率、会阴裂伤程度等方面的研究。方法:将阴道分娩的低危初产妇随机分为研究组(n=73例)和对照组(n=80例),对照组采用传统的会阴保护法接产,研究组采用Ritgen接生手法接产。观察两组产妇的第二产程时间、胎头拨露5cm至胎儿娩出时间;会阴侧切率、会阴裂伤程度;产后出血和分娩后48h及产后42天的疼痛程度;新生儿情况等方面。结果:研究组第二产程胎头拨露5cm至胎儿娩出时间短于对照组(P0.05),会阴侧切率、会阴裂伤Ⅱ度发生率低于对照组(P0.05),分娩后48h会阴疼痛程度显著低于对照组(P0.05)。两组的产后出血及新生儿情况方面比较,差异无统计学意义(P0.05)。结论:Ritgen接生手法接产,第二产程模拟肛提肌作用,外源性加强提肛力量,加快产程进展,降低产妇会阴损伤,减轻会阴部疼痛,是一种有效的接产方法,值得临床推广应用。     

Obstetric gel shortens second stage of labor and prevents perineal trauma in nulliparous women: a randomized controlled trial on labor facilitation

OBJECTIVE: To determine whether the obstetric gel shortens the second stage of labor and exerts a protective effect on the perineum. METHOD: A total of 251 nulliparous women with singleton low-risk pregnancies in vertex position at term were recruited. A total of 228 eligible women were randomly assigned to Group A, without obstetric gel use, or to Group B, obstetric gel use, i.e., intermittent application into the birth canal during vaginal examinations, starting at the early first stage of labor (prior to 4 cm dilation) and ending with delivery. RESULTS: A total of 183 cases were analyzed. For vaginal deliveries without interventions, such as C-section, vaginal operative procedure or Kristeller maneuver, obstetric gel use significantly shortened the second stage of labor by 26 min (30%) (P=0.026), and significantly reduced perineal tears (P=0.024). First stage of labor and total labor duration were also shortened, but not significantly. Results did not show a significant change in secondary outcome parameters, such as intervention rates or maternal and newborn outcomes. No side effects were observed with obstetric gel use. CONCLUSION: Systematic vaginal application of obstetric gel showed a significant reduction in the second stage of labor and a significant increase in perineal integrity. Future studies should further investigate the effect on intervention rates and maternal and neonatal outcome parameters.     

多功能气囊腹压带助产仪助产及预防产后出血应用研究

目的 探讨多功能气囊腹压带在助产和预防产后出血中的作用。方法 选择2014年4至9月在广东省妇幼保健院住院的初产、单胎、足月、头位、胎方位正常阴式分娩产妇100例,随机分为2组,第二、三产程中使用多功能气囊腹压带的50例为观察组,未使用的50例为对照组,观察两组产妇及胎儿的分娩结局。结果 观察组平均第二产程时间、胎头拨露至胎头娩出时间、胎盘娩出时间及产后出血量明显较对照组短(P<0.05)。两组产妇会阴侧切率、产后2 h内体征和新生儿Apgar评分、出生时脐血血气分析结果比较,差异无统计学意义(P>0.05)。并且第二产程中观察组产妇在不同囊内压时的体征及胎心变化差异亦无统计学意义(P>0.05)。 结论 多功能气囊腹压带通过严密监测,适时合理调节囊内压力,可安全加快第二、第三产程进展,预防产后出血,促进自然分娩。     

Epidural analgesia and the course of delivery in term primiparas

OBJECTIVES: Epidural analgesia provides the most effective pain control during labor. Of great concern is its influence on the course of delivery and perinatal complications. DESIGN: The aim of the study was to assess the effect of epidural analgesia on the course of delivery and perinatal outcome. MATERIALS AND METHODS: 609 deliveries among 1334 (323 women with epidural analgesia (53%) and 548 without epidural analgesia (47%)) met the following criteria: primipara, singleton, live pregnancy, > =37 weeks' gestation, cephalic presentation of a fetus, lack of contraindication for vaginal delivery. The incidence of instrumental deliveries and fetal distress, duration of the first, second and third stage of labor, perinatal outcome, perinatal complications and perinatal blood loss and were analyzed. RESULTS: The incidence of fetal distress during second stage of labor was significantly higher in the epidural group (12.69 vs. 6.99%, P=0.02). The incidence of fetal distress during first stage of labor did not differ in both groups (10.53% vs. 8.74%, NS). Cesarean sections rate was similar in epidural and non-epidural group (17.7 vs. 18.2%, NS). Among vaginal deliveries duration of the first and second stage of labor was longer in epidural group (6.5+/-2.4 vs. 5.4+/-2.5 godz., P=0,000003 and 47.3+/-34.8 vs. 29.1+/-25.8 min., P=0.000003) and this was independent of period of time between onset of first stage of labor and epidural analgesia. Oxitocin use was significantly more frequent in the epidural group (20.6 vs. 10.3%, P<0.004). There were no statistically significant differences in the rates of instrumental vaginal deliveries, 1 and 5-minute Apgar scores, length of third stage of labor and perinatal blood loss in patients with and without epidural analgesia. Perinatal outcome did not depend on previous use of epidural analgesia or mode of analgesia for the operation in cesarean section subgroup. CONCLUSION: Epidural labor analgesia is associated with slower progress of labor but has no adverse effect on perinatal outcome and perinatal complications.     

Length of the second stage of labor as a predictor of perineal outcome after vaginal delivery

OBJECTIVE: To evaluate possible risk factors for spontaneous and induced perineal damage during vaginal delivery. STUDY DESIGN: A prospective, observational study was conducted with 300 patients at 37-42 weeks of singleton gestation who presented in active labor. Sociodemographic data, birth circumstances and past medical history were obtained upon admission. Perineal damage was assessed before repair and 24 hours postpartum. A multiple logistic regression model was constructed to investigate independent risk factors for spontaneous perineal lacerations. RESULTS: Of 300 women included, 139 were primiparas. Episiotomy was performed in 32% of the population (62% in primiparas, 6% in multiparas). Spontaneous perineal tears requiring suturing occurred in 28%. Severe perineal tears (grades 3 and 4) occurred in 1%. Risk factors for adverse perineal outcome in the nonepisiotomy group included younger maternal age, non-Israeli ethnic background, use of epidural analgesia, nulliparity, shorter interval since last vaginal delivery, longer active phase and prolonged second stage. Prolonged second stage (> 40 minutes) and low parity were independent risk factors for perineal tears in a multivariable analysis. CONCLUSION: Identifying women in specific subgroups at high risk for perineal lacerations may minimize perineal damage. Women with a prolonged second stage of labor and low parity are prone for spontaneous damage and therefore deserve special attention.     

How long is too long: Does a prolonged second stage of labor in nulliparous women affect maternal and neonatal outcomes?

OBJECTIVE: The purpose of this study was to examine maternal and neonatal outcomes in relation to lengthening intervals of the second stage of labor. STUDY DESIGN: This is a retrospective cohort study of 15,759 nulliparous, term, cephalic, singleton births at the University of California, San Francisco, between 1976 and 2001. The second stage of labor was divided into 1-hour intervals. Maternal and neonatal outcomes were compared with the use of chi-squared and Student t tests, and a probability value of < or =.05 was used to indicate statistical significance. Potential confounders were controlled for with multivariate logistic regression. RESULTS: Increasing rates of cesarean delivery, operative vaginal delivery, and perineal trauma were associated with the second stage beyond the first hour. In multivariate analysis, the >4-hour interval group had higher rates of cesarean delivery (odds ratio, 5.65; P < .001), operative vaginal deliveries (odds ratio, 2.83; P < .001), 3rd- or 4th-degree perineal lacerations (odds ratio, 1.33; P = .009), and chorioamnionitis (odds ratio, 1.79; P < .001). There were no differences in neonatal acid-base status associated with length of second stage. However, there were fewer neonates with a 5-minute Apgar score of <7 (odds ratio, 0.45; P = .01). CONCLUSION: Although the length of the second stage of labor is not associated with poor neonatal outcome, a prolonged second stage is associated with increased maternal morbidity and operative delivery rates.     

椎管内分娩镇痛对瘢痕子宫阴道分娩的影响

目的探讨实施椎管内分娩镇痛对瘢痕子宫阴道分娩产程以及母儿结局的影响。 方法回顾性分析2017年1月至2020年6月在我院定期产检并住院分娩的221例瘢痕子宫患者的临床资料，其中行椎管内分娩镇痛110例，未行椎管内分娩镇痛111例。统计研究对象的一般情况，比较椎管内分娩镇痛对瘢痕子宫阴道分娩的产程及母儿结局影响。 结果两组研究对象的年龄、体重指数、孕周、产时出血量、新生儿体重和分娩前住院时间均无统计学差异(P>0.05)；镇痛组第一产程时间[(379.35±145.85)min]明显大于无镇痛组[(334.61±150.65)min](P＝0.012)，第二产程时间镇痛组[(63.57±26.20)min]明显大于无镇痛组[(54.61±27.32)min](P＝0.002)；人工破膜率镇痛组[27例(24.55%)]高于无镇痛组[14例(12.61%)](P＝0.023)；缩宫素催产率镇痛组[33例(30.00%)]高于无镇痛组[20例(18.02%)](P＝0.037)；中转剖宫产率无镇痛组[14例(12.61%)]高于镇痛组[5例(4.55%)]，差异具有统计学意义(P＝0.032)；产时发热率镇痛组[18例(16.36%)]明显高于无镇痛组[7例(6.31%)]，差异具有统计学意义(P＝0.018)；两组间的1和5 min Apgar评分、新生儿窒息率、会阴Ⅱ度裂伤、产后出血和产妇产后腰痛率差异均无统计学意义(P>0.05)。 结论瘢痕子宫阴道分娩孕妇实施椎管内分娩镇痛可以明显缓解疼痛并降低阴道试产的中转剖宫产率，第一和第二产程时间可能会延长，但并不影响母儿分娩结局，是一种安全有效的分娩镇痛方式。     

Anal sphincter laceration at vaginal delivery: is this event coded accurately?

OBJECTIVE: To determine the error rate for discharge coding of anal sphincter laceration at vaginal delivery in a cohort of primiparous women. METHODS: As part of the Childbirth and Pelvic Symptoms study performed by the National Institutes of Health Pelvic Floor Disorders Network, we assessed the relationship between perineal lacerations and corresponding discharge codes in three groups of primiparous women: 393 women with anal sphincter laceration after vaginal delivery, 383 without anal sphincter laceration after vaginal delivery, and 107 after cesarean delivery before labor. Discharge codes for perineal lacerations were compared with data abstracted directly from the medical record shortly after delivery. Patterns of coding and coding error rates were described. RESULTS: The coding error rate varied by delivery group. Of 393 women with clinically recognized and repaired anal sphincter lacerations by medical record documentation, 92 (23.4%) were coded incorrectly (four as first- or second-degree perineal laceration and 88 with no code for perineal diagnosis or procedure). One (0.3%) of the 383 women who delivered vaginally without clinically reported anal sphincter laceration was coded with a sphincter tear. No women in the cesarean delivery group had a perineal laceration diagnostic code. Coding errors were not related to the number of deliveries at each clinical site. CONCLUSION: Discharge coding errors are common after delivery-associated anal sphincter laceration, with omitted codes representing the largest source of errors. Before diagnostic coding can be used as a quality measure of obstetric care, the clinical events of interest must be appropriately defined and accurately coded.     

延期妊娠终止妊娠时机及方式探讨

目的探讨延期妊娠终止妊娠时机,以确定适当的处理措施。方法回顾性分析我院产科2005年10月-2007年9月分娩的妊娠41-41州周且无妊娠合并症的初产妇278例的临床资料。结果延期妊娠组羊水过少、羊水Ⅲ度污染、胎儿窘迫、新生儿窒息、巨大儿和剖宫产率均较足月分娩组高（P〈0．05）;延期妊娠引产干预组羊水Ⅲ度污染、剖宫产率均较延期妊娠自然临产组高,而阴道自然分娩率低（P〈0．05）;用地诺前列酮做引产前预处理＋催产素引产较直接催产素静点引产组有较高的自然分娩率和较低的剖宫产率及引产失败率（P〈0．05）。结论延期妊娠属于高危妊娠,在综合监测提示胎盘功能良好状态下仍可继续妊娠,不适当的干预可增加难产率,引产前的预处理可增加自然分娩机会。     

妊娠期子宫颈细胞学检查异常与妊娠结局的关系

目的　研究妊娠期宫颈细胞学检查异常对妊娠结局的影响。方法　回顾性分析首都医科大学附属北京朝阳医院 1999年 1月至 2 0 0 1年 5月间孕中期行宫颈细胞学检查并分娩的初产妇10 6 9例 ,比较宫颈细胞学检查正常 (A组 )和异常 (B组 )初产妇分娩期并发症、分娩方式、阴道分娩者的第一产程、胎儿窘迫及孕期宫颈细胞学检查异常者的产后转归情况。结果　B组中胎膜早破(39 39% )和胎儿窘迫 (30 30 % )的发生率显著高于A组 (5 2 1%和 15 2 5 % ,P均 <0 0 1) ;A组和B组早产、剖宫产的发生率分别为 3 38%和 3 0 3%、4 4 11%和 30 30 % ,阴道分娩者的第一产程分别为7 3h和 7 7h ,两组间比较 ,差异均无显著性 (P >0 0 5 ) ;孕中期宫颈细胞学检查异常者的产后逆转率为 6 2 %。结论　孕期宫颈细胞学检查异常对胎膜早破和胎儿窘迫有影响 ;孕期行宫颈细胞学检查是必要的 ,应作为常规检查