自控硬膜外分娩镇痛的应用效果分析

目的研究自控硬膜外分娩镇痛的应用效果。方法我院拟自然分娩的单胎头位初产妇,根据自愿分为两组,要求行自控硬膜外分娩镇痛的219例产妇为镇痛组,193例不接受分娩镇痛的产妇为对照组,比较两组产妇分娩过程中疼痛情况和母婴结局。结果 1疼痛结果:两组产妇在宫口开3cm左右视觉模拟疼痛评分(VAS)比较差异无统计学意义(P>0.05)。镇痛组活跃期、第二产程、第三产程VAS评分均明显低于对照组(P<0.001)。2产程:镇痛组潜伏期、活跃期、第二产程用时明显短于对照组(P<0.05)。第三产程用时比较差异无统计学意义(P>0.05)。3母婴结局:两组剖宫产率、阴道助产率、产后出血率、会阴撕裂率差异无统计学意义(P>0.05);两组新生儿窒息、新生儿产伤发生率比较差异无统计学意义(P>0.05)。4不良反应:镇痛组尿潴留发生率为25.57%,高于对照组(P<0.05)。其它不良反应发生率与对照组比较差异无统计学意义(P>0.05)。结论自控硬膜外分娩镇痛,满足了产妇个性化镇痛的需求,可缩短产程而对分娩结局无不良影响。     

Bacteria-induced or bacterial product-induced preterm parturition in mice and rabbits is preceded by a significant fall in serum progesterone concentrations

Bacterial products are thought to induce labor by stimulating the production of pro-inflammatory cytokines and prostaglandins in gestational tissues, leading to the onset of preterm parturition. Progesterone withdrawal is a prerequisite of parturition in many species. Yet a role for progesterone in the mechanisms responsible for preterm parturition, in the setting of infection, is unclear. The current studies were conducted to determine if a fall in serum progesterone concentrations occurs before the onset of bacterial product-induced preterm parturition in animals.

Accordingly, pregnant mice at day 15 (70% gestation) were injected i.p. with Escherichia coli lipopolysaccharide (LPS; 50 μg/mouse) and timed-pregnant rabbits were inoculated transcervically with a suspension of E. coli to cause an ascending intrauterine infection. Control animals in both groups received equal volumes of sterile phosphate-buffered saline (PBS) solution. Blood specimens were collected at regular intervals and serum progesterone levels were determined by RIA. Within 14 h of LPS administration, mice delivered their pups. The median concentrations of serum progesterone were significantly lower at 1 h, 4 h, 10 h, and at the onset of preterm parturition (11–12 h) after LPS injection, compared to that in animals given PBS. Similarly, E. coli-inoculated rabbits delivered 1–2 days posttranscervical inoculation and demonstrated 60% decrease in serum progesterone within 12–24 h of inoculation compared to those given PBS. Parturition in both control groups occurred at term, following typical progesterone withdrawal. It is concluded that LPS administration to pregnant mice and ascending intrauterine infection in pregnant rabbits is associated with a dramatic fall in serum progesterone concentrations prior to the onset of parturition.     

The frequency and clinical significance of intra-amniotic inflammation in women with preterm uterine contractility but without cervical change: do the diagnostic criteria for preterm labor need to be changed?

Objective: The objective of this study was to determine the frequency and clinical significance of intra-amniotic inflammation in patients with preterm increased uterine contractility with intact membranes but without cervical change. Methods: Amniocentesis was performed in 132 patients with regular uterine contractions and intact membranes without cervical change. Amniotic fluid was cultured for bacteria and mycoplasmas and assayed for matrix metalloproteinase-8 (MMP-8). Intra-amniotic inflammation was defined as an elevated amniotic fluid MMP-8 concentration (>23?ng/mL). Results: (1) Intra-amniotic inflammation was present in 12.1% (16/132); (2) Culture-proven intra-amniotic infection was diagnosed in 3% (4/132) of patients without demonstrable cervical change on admission or during the period of observation; and (3) Patients with intra-amniotic inflammation had significantly higher rates of preterm delivery and adverse outcomes, and shorter amniocentesis-to-delivery intervals than those without intra-amniotic inflammation (P?<?0.05 for each). Adverse outcomes included chorioamnionitis, funisitis, and neonatal death. Conclusion: Intra-amniotic inflammation was present in 12% of patients with regular uterine contractions without cervical change, while culture-proven intra-amniotic infection was present in 3%. The presence of intra-amniotic inflammation was a significant risk factor for adverse neonatal outcomes. These observations question whether cervical changes should be required for the diagnosis of preterm labor, because patients without modifications in cervical status on admission or during a period of observation are at risk for adverse pregnancy outcomes.     

2031例女性孕前检查甲状腺功能检测结果分析研究

目的探讨甲状腺功能异常与不良孕产史发生的相关性以及孕前甲状腺功能筛查的意义。方法选取2011年10月-2012年10月在我院进行孕前检查的女性2031名,采用固相化学发光酶免疫分析法检测sTSH,对于sTSH在正常范围外的人群,检测FT4、FT3.结果甲状腺功能异常的发生率为9．85％,有不良孕产史女性的甲状腺功能异常所占比例明显高于正常妊娠组,差别有统计学意义;体重指数高的人群甲功异常的发生率高于体重指数低的人群。结论甲状腺功能异常与不良孕产史有明显相关性;进行孕前期甲状腺功能筛查很有必要。     

间苯三酚在分娩第一产程不同时期给药作用的比较

摘要 目的 观察间苯三酚在分娩第一产程潜伏期和活跃期应用对产程和母婴安全的影响。方法 选择我院待产分娩的足月单胎头位初产妇80例,随机分成观察组和对照组各40例。观察组分别在潜伏期和活跃期给予间苯三酚80mg静脉注射,对照组在活跃期给予间苯三酚80mg静脉注射。结果 观察组潜伏期4.03±0.40h,活跃期5.14±0.76h,宫口扩张平均速度;对照组分别为5.26±0.51h、7.16±0.87h和1.82±1.02 cm/h,两组间有显著性差异(P< 0.01)。结论 潜伏期和活跃期应用间苯三酚对于加速宫颈扩张、缩短产程优于活跃期应用该药,并且对产妇和新生儿无不良影响。