产前分娩预演对初产妇自然分娩成功率及产后并发症的影响

[目的]探讨产前分娩预演对初产妇自然分娩成功率和产后并发症的影响.[方法]收集2016年9月至2018年10月在本院妇产科分娩的初产妇86例,按产前分娩教育方式分为观察组(n=42)和对照组(n=44).对照组孕妇产前接受常规产前健康教育课程培训,观察组在对照组的基础上进行分娩预演实践.比较两组自我效能感量表(GSES)、抑郁自评量表(SDS)和焦虑自评量表(SAS)评分及自然分娩成功率和产后并发症发生率等.[结果]与对照组相比,观察组分娩总产程和第一、二、三明显缩短;新生儿窒息率和产后SDS、SAS评分均明显降低;自然分娩成功率、GSES评分均明显提高,其差异均有统计学意义(P<0.05).观察组产后出血、感染、尿潴留、乳汁淤积发生率及总并发症发生率均低于对照组(P<0.05).[结论]采用常规产前健康教育培训结合产前分娩预演实践的产前管理方式,可有效提高初产妇自然分娩成功率,缩短产程,减少产后并发症的发生,值得临床推广应用.     

左旋布比卡因复合舒芬太尼或芬太尼在分娩硬膜外自控镇痛的应用

目的探讨左旋布比卡因复合舒芬太尼硬膜外自控镇痛（PCEA）用于分娩镇痛的临床效果及安全性。方法随机选择120例美国标准协会（ASA）I-Ⅱ级初产妇，随机分为舒芬太尼组（A组）、芬太尼组（B组）、无镇痛组（C组），每组40例。A组和B组采用PCEA，C组不给予镇痛药物。观察各组不同时段视觉模拟评分（VAS）和不良反应的发生，同时记录3组产程时间、分娩方式、缩宫使用情况、产后出血量、新生儿Apgar评分。结果A、B2组和C组在PCEA20、60min及宫口开全时VAS差异有统计学意义（P〈0.05）；PCEA5min，A、B2组VAS差异有统计学意义（P〈0.05），2组Bromage评分、不良反应差异无统计学意义（P〉0.05）。3组产程时间、分娩方式、产后出血量、新生儿Apgar评分比较差异均无统计学意义（P〉0.05）。结论左旋布比卡因复合舒芬太尼或芬太尼用于分娩镇痛安全有效，对母婴无明显不良影响。     

爱母分娩工程初探——产程系列服务模式

爱母分娩工程的核心是产时分娩的管理，除医疗技术水平为重要因素外，改善产科系列服务模式，加强孕妇夫妇有关培训与健康教育，加强保健与临床的结合，对爱母分娩工程的作用亦是举足轻重的。广东省妇幼保健院试运行产时分娩管理新模式、产科系列服务新模式，提高了产科质量和社会效益及经济效益。     

足月妊娠羊水过少对围产结局的影响

目的 :分析足月妊娠孕产妇羊水过少对围产结局的影响。方法 :应用 B超羊水最大深度法及羊水指数法估测羊水量 ,并测定脐动脉收缩期最大血流速度 (S)和舒张末期血流速度 (D)的比值 (S/D) ,比较分析 2 4 0例羊水过少 (观察组 )和 2 4 0例羊水正常的足月妊娠妇女 (对照组 ) B超测量羊水量与实际过少的符合率、分娩情况及新生儿预后。结果 :AFI小于 3.5 cm时 ,B超测量羊水量与实际羊水过少符合率为 10 0 % ;AFI为 3.5～ 5 .0 cm时为 80 % ;AFI为 5～ 8cm时为 5 8% ;观察组择期剖宫产和急诊剖宫产率均显著高于对照组 (P<0 .0 1) ;阴道分娩的成功率明显低于对照组 (P<0 .0 1) ;胎儿宫内窘迫与羊水轻度混浊的发生率明显高于对照组 (P<0 .0 1) ;新生儿轻度窒息发生率明显高于对照组 (P<0 .0 1) ;重度窒息率两组间差异无显著性 (P>0 .0 5 )。结论 :加强对羊水过少的产前及产时监护 ,对重度羊水过少者不予试产 ,对试产的孕产妇产程中出现异常及时行急诊剖宫产而不过度试产。对于羊水过少 ,同时又合并其它高危因素者 ,应禁止试产 ,以剖宫产结束妊娠。     

Contents of childbirth-related fear among couples wishing the partner's presence at delivery

In order to explore the contents of childbirth-related fears, a survey was carried out among 216 pairs of prospective parents who opted for the presence of the partner at delivery. Each couple took part in a three-class parentcraft course during the third trimester. During the first antenatal class, couples were asked to fill in a questionnaire with inquiries about specific contents of fear they might have in relation to pregnancy, childbirth and relationship with their partner after childbirth. Each item of the questionnaire called for an answer from a five-grade scale of fear such as ‘absolutely not’, ‘slightly’, ‘quite’, ‘quite strongly’ and ‘very much’. Their worries were ranked according to the weighted average of the frequency of positive answers. More than 80% of both men and women had some fears relating to childbirth. Women were most worried about, in order of significance, having a malformed or injured baby, assisted or operative delivery, being lonely in a strange environment, doing something wrong, and facing the uncertainties of how the delivery was going to happen. The wife having severe pain and suffering, operative delivery, fetal birth injuries, helplessness, powerlessness and the wife's death in childbirth were the most significant subjects of men's fears. Eighty per cent of women and 16% of men felt that the presence of the partner at delivery would have no adverse effect on their future personal relationship.     

Another look at religious objections to obstetric anaesthesia

Starting with the earliest biographies of James Young Simpson, the topic of religious opposition to obstetric anaesthesia in 1847 was gradually embellished in historical articles. Objective data are lacking and it has been suggested that this is a myth of recent medical history. A search for more information led to a contemporaneous case-book of the maternity hospital in Edinburgh, which was examined. The provision of anaesthesia in the 11 months before publication of Simpson’s pamphlet Answer to the Religious Objections was compared with that in the 11 months after. This revealed a marked increase (P<0.01) in the provision of anaesthesia for childbirth after the publication of Simpson’s pamphlet in December 1847. This analysis supports the existence of opposition to obstetric anaesthesia and the success of Simpson’s pamphlet in overcoming it, but the introduction of chloroform about six weeks earlier, may also have contributed.     

Pregnancy and after: what women want from their partners – listening to women in Uyo,Nigeria

Background: A qualitative survey was conducted among childbearing women at three public health facilities in Uyo, Nigeria. We aimed to determine (i) women’s expectations of partner support during pregnancy and the postpartum period; (ii) predictors of partner presence during childbirth. Methods: From May to mid-July 2011, 387 eligible women were recruited serially during visits to the child welfare clinic at each facility. Interviews were conducted using semistructured questionnaires. Responses were extracted and categorized into eight distinct themes with corresponding examples. Results and discussion: The most desired form of partner support was assistance with domestic chores during and after pregnancy; followed by financial support during pregnancy and providing/caring for the baby in the postpartum period. Partner support during pregnancy was high 98.0% (351). While 73% of respondents expected partner presence during childbirth, 69.4% reported actual partner presence. Women with no experience of pregnancy before marriage, a husband in formal employment, and regular assistance at home had a two- to three-fold likelihood of expecting partner presence at childbirth compared to those without these attributes. Expecting partner presence increased the likelihood of partner presence at childbirth. Results suggest that women have specific expectations of partner involvement during and after pregnancy.     

Cross-cultural invariance of the Birth Satisfaction Scale-Revised (BSS-R): comparing UK and US samples

Objective: This research sought to test the measurement invariance of the Birth Satisfaction Scale-Revised (BSS-R) across United States (US) and United Kingdom (UK) samples. Multiple-group measurement was tested and latent means analysis compared levels of birth satisfaction across the samples. Method: Using Confirmatory Factor Analysis (CFA), data previously collected from 409 mothers (181 US mothers; 228 UK mothers) were used to examine the multiple-group measurement invariance of the BSS-R across US and UK samples. Results: A correlated factors BSS-R model demonstrated partial measurement invariance. US mothers had significantly lower birth satisfaction levels on the three BSS-R subscales. Conclusions: This research demonstrates that the BSS-R is a robust tool that can be used to reliably measure women’s birth satisfaction within and across the US and UK.