新生儿神经行为评分的围产期影响因素研究

目的 探讨新生儿神经行为能力及其相关围产期影响因素.方法 应用鲍秀兰等建立的新生儿神经行为评定法（neonatal behavioral neurological assessment,NBNA）对298例足月儿进行新生儿神经行为能力评定,使用自编的“基本资料调查问卷”收集新生儿及其家庭资料.以NBNA总分为因变量,19项围产期影响因素为自变量,采用Logistic回归分析筛选影响因素.结果 新生儿NBNA评分的合格率为99.33％,孕周及孕期情绪为新生儿NBNA得分的有利因素,偏回归系数分别为-0.41和-0.33,而孕妇年龄则为新生儿NBNA得分的不利因素.结论 孕周长和孕期情绪好可促进新生儿神经行为发育,而孕妇年龄大则对其神经行为发育造成影响.     

围生期孕产妇保健状况调查和健康教育效果分析

目的：研究围生期孕妇保健状况调查并对健康教育效果进行评价分析。方法选取本院自2012年8月~2013年12月间的120例孕妇进行围生期保健状况调查以及健康教育效果分析研究。对其进行随机分组,分为对照组和观察组,每组患者60例,对照组不采用健康教育,观察组采用健康教育方式,然后对两组患者的保健知识评分、产程时间和出血量进行对比分析。结果经本院的分组调查,观察组的保健知识评分明显高于对照组（P〈0.05）,差异具有统计学意义;观察组的第一产程和第二产程均优于对照组,产后出血量较之对照组要少,且差异具有统计学意义（P〈0.05）。结论根据本院的分组调查研究,根据孕妇的自身情况开展不同的健康教育可以有效的提升生育质量,值得临床的应用以及推广。     

Risk factors and adverse maternal and perinatal outcomes for women with dichorionic twin pregnancies complicated by gestational diabetes mellitus: A retrospective cross-sectional study

Aims/IntroductionThe association between gestational diabetes mellitus (GDM) and adverse maternal and perinatal outcomes in twin pregnancies remains unclear. This study was undertaken to highlight risk factors for GDM in women with dichorionic (DC) twins, and to determine the association between GDM DC twins and adverse maternal and perinatal outcomes in a large homogeneous Taiwanese population.Materials and MethodsA retrospective cross‐sectional study was carried out on 645 women with DC twins, excluding pregnancies complicated by one or both fetuses with demise (n = 22) or congenital anomalies (n = 9), who gave birth after 28 complete gestational weeks between 1 January 2001 and 31 December 2018. Univariable and multiple logistic regression analyses were carried out.ResultsMaternal age >34 years (adjusted odds ratio 2.52; 95% confidence interval 1.25–5.07) and pre‐pregnancy body mass index >24.9 kg/m² (adjusted odds ratio 2.83, 95% confidence interval 1.47–5.46) were independent risk factors for GDM in women with DC twins. Newborns from women with GDM DC twins were more likely to be admitted to the neonatal intensive care unit (adjusted odds ratio 1.70, 95% confidence interval 1.06–2.72) than newborns from women with non‐GDM DC twins. Other pregnancy and neonatal outcomes were similar between the two groups.ConclusionsAdvanced maternal age and pre‐pregnancy overweight or obesity are risk factors for GDM in women with DC twins. Except for a nearly twofold increased risk of neonatal intensive care unit admission of newborns, the pregnancy and neonatal outcomes for women with GDM DC twins are similar to those for women with non‐GDM DC twins.     

妊娠期糖尿病合并妊娠期高血压疾病的围产期管理

目的：探讨妊娠期糖尿病（gestational diabetes mellitus,GDM）合并妊娠期高血压疾病（hypertensive disorders in pregnancy, PIH）的围产期管理。方法：选取60例妊娠期糖尿病合并妊娠期高血压疾病的孕产妇,按照随机数字表法分为对照组和治疗组各30例,对照组采用传统的管理方法。治疗组采用围产期管理方法,比较两组患者的病理妊娠和并发症情况。结果：治疗组的早产、羊水过多、产后感染、羊水过少等病理妊娠发生率均明显低于对照组,且胎儿窘迫、死胎、巨大儿、畸形儿等并发症发生率均明显低于对照组,差异均有统计学意义（P〈0.05）。结论：对妊娠期糖尿病合并妊娠期高血压疾病的孕产妇进行围产期管理,可以减少并发症,保障母婴安全,在临床上有推广应用的价值。     

不同诊断标准诊断妊娠期糖尿病的相关探讨

目的:探讨采用不同诊断标准诊断妊娠期糖尿病(GDM)对围生结局的影响。方法:选取2012年6月~2013年5月和2011年6月~2012年5月两个时段在本院行产前检查并住院分娩的孕妇,前一时段的对象按照国际糖尿病与妊娠研究组(IADPSG)标准诊断GDM(3216例,IADPSG组),后一时段对象按照美国国家糖尿病数据组(NDDG)标准诊断GDM(2985例,NDDG组),比较两组对象GDM发病率、并发症及围生结局。结果:GDM的发病率IADPSG组(15.73%,506/3216)明显高于NDDG组(5.46%,163/2985),NDDG组孕妇子痫前期、妊娠期肝内胆汁淤积症和羊膜腔感染的发病率明显高于IADPSG组,差异有统计学意义(P均0.01)。NDDG组早产儿和新生儿窒息发生率高于IADPSG组(P0.01)。结论:与NDDG标准相比,IADPSG标准诊断GDM发病率明显升高,采用IADPSG标准对减少子痫前期、羊膜腔感染、早产、新生儿窒息等不良围生结局有重要意义。     

不同孕期终止妊娠对妊娠期糖尿病围生儿结局的影响

目的 探讨不同孕期终止妊娠对妊娠期糖尿病围生儿结局的影响.方法 以本院待产的妊娠期糖尿病孕妇为研究对象,根据孕期分为A组（孕周28～36周）、B组（孕周37～39周）、C组（孕周＞39周）,统计各组围生儿疾病发生率、死亡率以及巨大儿的发生率.结果 B组围生儿疾病发生率、围生儿死亡率明显少于其他两组;血糖控制好的孕妇分娩后情况普遍好于血糖控制不好者.结论 严格控制妊娠期糖尿病孕妇的血糖,在孕周37～39周终止妊娠可以明显降低围生儿死亡、疾病以及巨大儿的发生率.     

Women’s use of online resources and acceptance of e-mental health tools during the perinatal period

ObjectivesThe women’s professional help-seeking rate for perinatal depression is low, despite the prevalent and disabling nature of this condition. Therefore, new approaches should be implemented to increase women’s access and utilization of treatment resources, namely e-mental health tools. This study aimed to characterize women’s current pattern of use of online resources for mental heal issues and women’s acceptance of e-mental health tools during the perinatal period, and to investigate its main determinants.MethodsThis study used an online cross-sectional survey that was completed by 546 women during the perinatal period.Results31.3% had prior knowledge of websites targeting mental health illness. Women presenting an actual need for help (i.e., a positive screen for depression) reported greater use of online resources and greater engagement in e-health behaviors related to mental health (d = 0.46–0.61), and being more accepting of e-mental health tools, particularly of informative websites. Women’s perceptions concerning the e-mental tools were found to predict their intentions to use them.ConclusionsThe results seem to globally support Portuguese women’s acceptance of e-mental health tools. To improve the level of acceptance, women should be involved as stakeholders in the development of new e-mental health tools and provided with specific information before their utilization.     

Effect of stepwise perinatal immunization education: A cluster-randomized controlled trial

BackgroundPerinatal immunization education is important for improving the immunization outcomes of infants; however, the content of educational materials used at each perinatal period has not been carefully evaluated. We hypothesized that stepwise education offered at different perinatal periods would improve infant immunization status and enhance maternal immunization knowledge.MethodsIn this cluster-randomized controlled trial, pregnant women were recruited from nine obstetric sites in Niigata, Japan. The intervention group received a stepwise, interactive education intervention (prenatally, postnatally, and 1 month after birth). The control group received a leaflet containing general information on immunization. Infant immunization status was evaluated at 6 months of age, and maternal immunization knowledge was evaluated by a written survey after each intervention.ResultsAmong 188 study participants, 151 (80.3%) replied to the final post-intervention survey. At 6 months of age, the percentage of children who completed three doses of inactivated polio, diphtheria, tetanus toxoid, and acellular pertussis (DTaP-IPV) vaccine was higher in the intervention group than in the control (p = 0.04); however, no differences between groups were observed for the Haemophilus influenzae type b (Hib) (p = 0.67) or 13-valent pneumococcal conjugate (PCV13) vaccines (p = 0.20). The duration to the completion of the third dose of the DTaP-IPV, Hib, and PCV13 vaccines was shorter in the intervention group than in the control (p = 0.03, p < 0.01, and p < 0.01, respectively). Furthermore, maternal knowledge scores exhibited significantly greater improvement in the intervention group over time compared with those of the control group (p = 0.02).ConclusionsStepwise perinatal immunization education improved immunization schedule adherence for required vaccines and improved maternal immunization knowledge.     

妊娠合并血小板减少120例临床分析

目的 探讨妊娠合并血小板减少的病因及围生期处理原则.方法 总结1996～2006年本院120例妊娠合并血小板减少患者的临床资料.结果 妊娠合并血小板减少的主要原因有:①妊娠期血小板减少症(GT);②妊娠期高血压疾病;③特发性血小板减少性紫癜(ITP).治疗原则:①针对病因治疗;②用药时尽可能减少对胎儿的不利影响;③GT组一般不需特殊处理;④血小板＜50×109/L,有明显出血倾向时,给予糖皮质激素和/或免疫球蛋白治疗;⑤血小板＜20×109/L,或血小板在(20～50)×109/L之间,伴有明显出血倾向且在分娩及紧急手术前,建议输注血小板;⑥分娩方式视血小板多少及有无产科手术指征而决定.结论 治疗妊娠合并血小板减少应视不同病因及病情轻重的程度而采取不同的处理方式,糖皮质激素、免疫球蛋白及血小板制剂是治疗重度血小板减 少的有效方法.     

胎心率监护计算机分析在临床的应用

目的:探讨胎心率监护计算机分析和目测分析的优缺点及对围产儿结局的预测价值。方法:分析了2003年5月～2004年2月3010份胎心率图型中,长变异各型相对应的短变异数值及361份胎心率图型的计算机分析和目测分析结果预测围产儿结局的敏感度和特异度。结果:NST的计算机分析和目测分析的结果对围产儿结局都有预测作用,但计算机分析的灵敏度和特异度(分别为82%和30%)均高于目测分析(分别为74.5%和26.7%)。计算机分析需要的无负荷试验(NST)监护时间为(14.22+5.69)min,目测分析需要的监护时间为(15.45±5.77)min,有显著性差异(P=0.000)。短变异与长变异的各型之间呈正相关(P=0.000)。结论:应用Sonicaid System8002计算机分析胎心率图型较之目测分析对胎儿宫内窘迫有更好的预测作用,还能缩短产前监护时间,其引入的一个新参数——短变异,能定量反映胎心率基线变异。