阴道顺产后压力性尿失禁发生的相关危险因素分析

目的 探讨阴道顺产后压力性尿失禁(SUI)发生的相关危险因素,为其防治提供临床参考.方法 入选119例阴道顺产后发生SUI患者(SUI组)及217例阴道顺产后未发生SUI患者(对照组),对相关危险因素进行Logistic回归分析.结果 单因素分析结果显示:SUI组年龄≥30岁、体质指数(BMI)≥25 kg/m2、流产次数≥2次、会阴侧切、孕前或孕期有尿失禁、产后增加腹压、便秘史比例及新生儿体重均高于对照组[67.2％(80/119)比39.6％(86/217)、65.5％ (78/119)比47.5％(103/217)、23.5％(28/119)比13.4％(29/217)、31.1％(37/119)比16.1％(35/217)、46.2％ (55/119)比31.3％(68/217)、28.6％(34/119)比15.2％(33/217)、23.5％(28/119)比13.4％(29/217)、(3.5±0.4) kg比(3.2±0.2) kg,P＜0.01或＜0.05].多因素分析结果显示:流产次数≥2次、会阴侧切、孕前或孕期有尿失禁、产后增加腹压及高新生儿体重是阴道顺产后发生SUI的独立危险因素(P＜0.05).结论 多次流产、会阴侧切、孕前或孕期有尿失禁、产后增加腹压及高新生儿体重是阴道顺产后发生SUI的独立危险因素.对上述危险因素进行必要的干预具有重要的意义,可能降低产后SUI的发生率.     

心理护理干预对产妇产程疼痛及分娩方式的影晌

目的 探讨心理护理干预在产妇产程中的镇痛效果及其对分娩方式的影响.方法 选择我院产科2010年3月～2012年3月收治的产妇106例,分为研究组和对照组,每组各53例.对照组在分娩前及分娩中对产妇进行一般护理；研究组在一般护理的基础上对患者进行心理护理干预.对比两组患者的疼痛情况、顺产率及分娩后的出血情况.结果 研究组的镇痛效果较对照组好；研究组的顺产例数较对照组高.结论 使用心理护理干预能减轻产妇在产程中的疼痛,提高顺产率,减少分娩后的出血量.     

Contradictions of value: between use and exchange in cord blood bioeconomy

Umbilical cord blood (CB) has become established as an increasingly viable clinical alternative to bone marrow in the treatment of leukaemia leading to the construction of a global network of CB banks promoted through a moral ethos of gift. Additionally, some banks offer the opportunity to retain stem cells privately. CB is discursively presented as clinical ‘waste’, a ‘by‐product’ of birthing. In this way CB units are made available to a global exchange‐based bioeconomy. Crucially, CB collection has developed in parallel with several necessary obstetric practices, especially the immediate clamping of the cord following delivery, essential to high volume collection. However, this article strongly suggests the promotional basis of CB banking (such as by gift, waste or donation) is in tension with the growing preference of new parents to delay cord clamping. Based on focus groups with expectant parents, the promotion of CB banking can in fact be seen to feed into critical reflection on the value of CB for newborn infants, potentially reinvigorating a tradition of delayed umbilical cord clamping. Theoretically, these contradictory systems of valuing are conceptualised through recent literature on bioeconomy and Marx’s writings on the contrasting tensions between use and exchange value.     

盆底康复治疗对不同分娩方式再生育妇女盆底功能的影响研究

目的探究盆底康复治疗对不同分娩方式再生育妇女盆底功的影响,为促进产妇盆底康复提供相关临床依据。方法选择2016年1月至2019年12月在潍坊市妇幼保健院分娩的654例二胎产妇进行盆底功能检查,根据分娩方式及初产后是否行盆底康复治疗,分为顺产未治疗组330例,顺产治疗组70例,选择性剖宫产未治疗组204例,选择性剖宫产治疗组50例,比较各组盆腔器官脱垂(pelvic organ prolapse,POP)、压力性尿失禁(stress urinary incontinence,SUI)及四维超声检查情况。结果选择性剖宫产未治疗组及治疗组的Aa、Ba、Ap、Bp及C点测量值均明显高于顺产未治疗组及治疗组(P<0.05)。顺产未治疗组与治疗组比较,以及剖宫产未治疗组与治疗组比较,Aa、Ba、Ap、Bp及C点测量值明显降低(P<0.05)。选择性剖宫产未治疗组与治疗组比较、顺产未治疗组与治疗组比较,选择性剖宫产未治疗组与顺产未治疗组比较,选择性剖宫产治疗组与顺产治疗组比较,静息状态下膀胱颈最下缘距离(bladder neck symphyseal distance,BSD)、膀胱颈移动度及尿道膀胱后角差异均无统计学意义(P>0.05)。顺产未治疗组肛提肌裂孔面积与顺产治疗组及剖宫产未治疗组相比较,差异有统计学意义(P<0.05),其余3组肛提肌裂孔面积之间比较差异无统计学意义(P>0.05)。Valsalva动作下BSD、膀胱颈移动度、尿道膀胱后角及肛提肌裂孔面积比较,选择性剖宫产未治疗组及治疗组的数值均明显好于顺产未治疗组及治疗组(P<0.05)。无论顺产还是剖宫产组的治疗组,Valsalva动作下BSD、膀胱颈移动度、尿道膀胱后角及肛提肌裂孔面积均优于未治疗组(P<0.05)。选择性剖宫产未治疗组及治疗组的子宫脱垂及直肠前壁膨出发生率均明显小于顺产未治疗组及治疗组(P<0.05)。顺产未治疗组与治疗组比较,以及剖宫产未治疗组与治疗组比较,子宫脱垂及直肠前壁膨出发生率明显升高(P<0.05)。选择性剖宫产未治疗组及治疗组的SUI发生率均明显低于顺产组(P<0.05)。顺产未治疗组与治疗组比较,以及剖宫产未治疗组与治疗组比较,SUI发生率差异有统计学意义(P<0.05)。结论顺产和剖宫产均会出现盆底功能障碍。初产后及时实施盆底康复治疗,可以改善产妇盆底功能,减轻二次分娩加重的尿失禁及POP。     

The natural caesarean: a woman-centred technique

Although much effort has gone into promoting early skin-to-skin contact and parental involvement at vaginal birth, caesarean birth remains entrenched in surgical and resuscitative rituals, which delay parental contact, impair maternal satisfaction and reduce breastfeeding. We describe a 'natural' approach that mimics the situation at vaginal birth by allowing (i) the parents to watch the birth of their child as active participants (ii) slow delivery with physiological autoresuscitation and (iii) the baby to be transferred directly onto the mother's chest for early skin-to-skin. Studies are required into methods of reforming caesarean section, the most common operation worldwide.     

Is a long period without childbirth a risk factor for developing endometriosis?

Endometriosis was found in 42 (20%) of 206 symptom-free, parous Norwegian women with a mean age of 37 years at the time of sterilization. Case-control analysis between the 42 women with endometriosis and the 164 without endometriosis revealed an increased risk of endometriosis with increasing number of years since the last childbirth. After 10 years without a birth, the odds ratio for endometriosis was 4.5 compared with the first 5 years after the last delivery. An increased risk of endometriosis with increasing age of the women could not be detected. If these findings from women with voluntary infertility are transferred to women with endometriosis associated with involuntary infertility, endometriosis could be a consequence of a long period without childbirth. This might explain why endometriosis is often diagnosed in infertile women.     

汾西县实施“降消”项目妇幼保键工作成效分析

目的：了解汾西县自2005年被山西省列入实施“降低孕产妇死亡率和消除新生儿破伤风”（简称“降消”）项目县以来妇幼保健工作发展情况。方法：从项目实施过程中组织领导，强化培训，转诊制度，贫困救助，健康教育，监督指导等几方面着手。结果：汾西县2005-2009年孕产妇死亡率、新生儿破伤风发生率连续5年为0，住院分娩率提高30．19％，婴儿死亡率下降32．69％，出生缺陷发生率下降42．29％。结论：“降消”项目是一项福泽万民的民心工程，得到广大群众的认可，巩固项目成果继续加强三级妇幼保健网络建设，提高孕产妇系统管理率和儿童系统管理率是降低孕产妇死亡率和婴儿死亡率的主要举措。     

The experience of motherhood and the development of depression in the postnatal period

Summary

• ? This paper reports on an investigation of women's experience of motherhood as a possible factor in the development of postpartum depression.
• ? Several aspects of the experience of motherhood were found to be associated with depression in a sample of 60 first-time mothers. These included:

• — the social impact of motherhood,
• — the extent to which expectations of motherhood were met,
• — the adequacy of support received from partners or from the mothers' wider social networks.

• ? It is argued that these findings, while tentative, are consistent with a social model of depression.
• ? Implications for health professionals and other care providers are discussed.

     

分娩球在临产产妇中的应用

目的观察分娩球在孕产妇临产后使用的效果。方法随机选择本院2005年6月~2006年2月住院分娩的初产妇122例作为观察组,98例为对照组。观察组在临产后,在子宫收缩间歇期,由助产士(师)负责指导孕产妇坐或半坐卧位在分娩球上。对照组在孕产妇临产后采取常规体位,即卧位(平卧位、交替左右侧卧位)。结果观察组孕产妇第一产程时间及总产程比对照组缩短,观察组孕产妇疼痛缓解的效果比对照组好,观察组阴道分娩率比对照组高、剖宫产率比对照组低,两组比较有统计学意义(P<0.05)。结论应用分娩球可加速产程进展,缓解疼痛,提高阴道分娩率,降低剖宫产率,促进自然分娩。     

心理契约式产前教育促进自然分娩率的效果观察

目的探讨心理契约式产前教育促进自然分娩率的效果。方法将168名孕妇分为观察组和对照组各84例,对照组给予常规产前教育,观察组通过激发孕妇对分娩知识的渴望,建立共同的心理契约目标,发挥心理契约的作用,实现共同心理契约目标。结果观察组孕妇对自然分娩的认识、产前教育后依从性和自然分娩率均高于对照组(P0.01)。结论心理契约式产前教育可提高自然分娩率,具有良好的临产应用价值。