妇女产后6月盆底肌肉强度相关因素的分析

目的:了解分娩对妇女盆底肌肉强度的影响,以及妇女产后耻骨尾骨肌(PC肌)强度的影响因素,及产后生殖保健服务中盆肌锻炼情况.方法:采用横断面研究方法,将分娩活婴的460位初产妇产后6月PC肌强度及其相关的因素的调查资料进行分析.结果:在产后6月时,PC肌强度与阴道松弛、会阴侧切伤口长度、张力性尿失禁明显相关(P＜0.05),而与分娩方式、第一、二产程时间、会阴损伤形式、产后6月时性交疼痛、性高潮次数无显著关系(P＞0.05).分娩后,76.30%妇女获得医院告知的盆肌保健操知识,在产后42日接受产科随访时,卫生保健人员仅告知8.57%妇女产后需要做盆肌保健操.产后只有11.8%的妇女经常练习盆肌保健操.结论:产时应正确保护盆肌;产后应关注盆肌保健操锻炼.     

Choice and Changes of Contraceptive Methods after Primiparous Delivery in Shanghai

Totally,3 701 primiparous women in Shanghai were followed up for 15 months after delivery to assess their initial and subsequent changes in choice of contraceptive methods.Results showed that 15 months after delivery,95.46% of women had already used a contraceptive method.The leading first choice of contraceptive methodsamong urban women was the condom(50.72%) or IUD(29.09%),while the leading first choice among rural women was IUD(56.65%)or the condom(30.60%).Within 15 months after delivery,women whose first choice had been the condom tended to switch usually to an IUD.But fewer women whose first method was an IUD switched to other methods.At the 15th month follow-up,94.54% of women were all using a method,with 60.76% of urban women and 71.07% of rural women using IUDs.Multinominal logistic regression analysis suggests that women‘s characteristics influence the choice of methods.Urban, well-educated women were more likely to choose condom and rhythm,and less likely to choose OC.Older women tended to use condom and rhythm more often than younger women.Breast feeding women were less likely to use OC.Women who received recommendations regarding postpartum contraception from family planning workers were more likely to use IUD.It was concluded that family planning workers should increase women‘‘s awareness of the advantages and disadvantages of different methods,dispel myths and rumors about some methods and improve women‘‘s knowledge of informed choice.     

娱乐服务行业流动妇女性行为和性观念分析

目的 了解娱乐服务行业流动妇女的性行为和性观念现状。方法 对广州市某区17家桑拿、夜总会989名流动妇女进行匿名问卷调查。结果 调查对象平均年龄22．5岁,文化程度较低,未婚育龄妇女为主(83．0％)。76．4％的未婚妇女有婚前性行为,11．7％的人有多个性伴侣,近半年每次性生活部使用避孕套的妇女仅占23．2％。1．8％的妇女得过性病。结论 娱乐服务行业流动妇女性观念开放,婚前性行为和无保护性行为普遍,有必要在该人群开展生殖健康和安全性行为的健康教育。     

上海妇女分娩前后性行为的比较

通过对影响妇女产后对性生活兴趣变化的因素分析发现，妇女年龄越大对产后的性生活越不感兴趣；有合适的避孕措施的妇女对性生活感兴趣；而妇女自感生活越不愉快，对夫妇性生活的总体感受越差，妇女对产后的性生活越不感兴趣。妇女年龄、节育措施、妇女自感生活是否愉快、妇女对夫妇性生活的总体感受同样影响着产后妇女性生活达到高潮的次数变化（与产前相比）。另外，文化水平越高、妇女与其丈夫父母间的关系越好，妇女产后达到高潮的次数就多；而孩子出生后夫妇的感情越差则妇女产后达到高潮的次数越少。要增进夫妇的性健康除了给她们提供合适的节育措施外，还应注意采取多种综合措施以改善夫妇的感情。     

生物反馈电刺激治疗对阴道分娩妇女性生活质量的影响

目的观察盆底生物反馈电刺激治疗对阴道分娩的产妇产后性生活质量的影响。方法选取2012年6月至2012年9月间阴道分娩的初产妇131例,其中60例产后进行盆底生物反馈电刺激治疗（治疗组）,其余71例无处理（对照组）,另随机选取同期剖宫产初产妇67例（剖宫产组）。3组产妇患者年龄和新生儿出生体质量差异无统计学意义（P〉0.05）。治疗组产后进行1个疗程的生物反馈电刺激治疗,于产后6个月对3组进行性生活质量问卷调查。结果产后6个月随访,治疗组性生活恢复时间短于对照组及剖宫产组（P〈0.01）,对照组肛提肌力量低于治疗组及剖宫产组（P〈0.01）,治疗组肛提肌力量低于剖宫产组（P=0.02）,对照组性生活满意度低于其他两组（P〈0.01）。结论盆底生物反馈电刺激治疗能够改善产妇阴道分娩后性生活质量。     

产后抑郁干预效果分析

目的:可以对产妇实施针对产后抑郁的干预措施并对效果进行分析。方法:选取400名符合条件的产妇,随机分为干预组和对照组各200人。对照组接受常规产后护理,干预组产妇在此基础上还接受产后行为健康教育,其内容包括产后抑郁危险因素或行为的识别以及社会支持、自我效能和管理的强化。利用爱丁堡产后抑郁量表,在随机分组前、分娩后3周、3个月和6个月分别对产妇进行评估。结果:干预组产后抑郁发生率明显低于对照组,产后3次调查结果分别为:8.6%vs16.3%,8.2%vs15.7%,8.8%vs16.1%(P<0.05)。多因素Logistic回归分析显示,行为健康教育能降低产妇产后抑郁发生的危险性,产后3周、3个月和6个月的OR值分别为:0.35、0.44、0.52。结论:行为健康教育能有效降低产妇产后抑郁的发生。     

基于目标群体指数和对应分析的孕产妇母婴保健信息需要研究

背景　母婴保健工作日渐受到人们的重视，孕产妇健康信息需求是母婴保健工作的重要组成部分，了解和掌握孕产妇健康信息需求情况对改善妇幼健康与安全有重要的意义。目的　了解太原市孕产妇母婴保健信息需要，以及信息与获取途径的对应关系，为有效开展母婴健康教育提供参考。方法　采用自行设计的问卷，对2016年11月-2017年8月在太原市1所省级妇幼保健院、1所民营医院及1所乡镇卫生院的门诊就诊的1 100例孕产妇的母婴保健信息需要进行调查。采用目标群体指数（TGI）和对应分析对数据进行分析。收回有效问卷1 048份，有效回收率为95.27%。结果　孕产妇对产前检查（70.90%，743/1 048）、孕期营养（68.42%，717/1 048）、新生儿保健（52.29%，548/1 048）信息的需求较多，对生育保险（23.85%，250/1 048）、分娩镇痛（28.53%，299/1 048）的需求较少；孕产妇获取孕产期心理保健（31.77%，333/1 048）、分娩镇痛（25.19%，264/1 048）、孕期常见身体不适的缓解（24.90%，261/1 048）、生育保险（24.24%，254/1 048）等方面的信息时较困难。不同年龄（χ2=18.331，P=0.787）、学历（χ2=20.139，P=0.065）的孕产妇对母婴保健信息内容的需求比较，差异无统计学意义，但对各类信息需求的TGI有所不同。不同居住地（χ2=23.288，P=0.025）、孕产期（χ2=56.181，P=0.017）的孕产妇对各类信息内容的需求比较，差异有统计学意义。结论　不同特征孕产妇对各类母婴保健信息需求的TGI不同，获取不同类别的母婴保健信息偏好不同的获取途径。为此，健康教育应主动回应孕产妇对母婴保健信息的需求，针对不同孕产妇设计不同的信息内容、采取其偏好的传播途径，实施精准传播。     

西部地区女性产后排便情况及其影响因素研究

探究女性产后排便情况及相关影响因素。方法筛选内蒙古包头、巴彦淖尔地区健康单胎、足月分娩的产妇为调查对象,在产后3 和12 个月时对产妇进行现场问卷调查。膳食部分采用半定量膳食频率法,计算出产妇过去1 个月每日膳食及营养素摄入量;分析饮食、体重滞留等因素与产后排便情况的关系。结果产妇平均年龄（29.27±4.40）岁。产后3 和12 个月的排便情况比较,差异有统计学意义（p <0.05）。产后12 个月时,排便≥7 次/ 周的产妇饮食与产后3 个月时对比,结果显示,蔬菜摄入量、总膳食纤维摄入量比较,差异有 统计学意义（p <0.05）,每日蛋白质摄入量比较,差异有统计学意义（p <0.05）。产后3 和12 个月不同排便情况的产妇体重滞留量比较,差异无统计学意义（p >0.05）;不同分娩、喂养方式的产妇排便情况比较,差异无统计学意义（p >0.05）。结论女性产后排便情况与饮食相关;与产后体重滞留、分娩方式及喂养方式无关。     

农村外来妇女艾滋病知识态度及相关行为调查

目的了解农村外来妇女艾滋病基本知识、态度和个人性行为的现状。方法对农村外来妇女进行普查,用匿名调查表收集个人一般资料以及有关艾滋病的基本知识、态度和个人性行为资料。对不同文化程度人群的艾滋病基本知识正确率和不同态度的分布情况及危险性行为进行评价。结果共普查1783名农村外来妇女。对艾滋病三条传播途径的知识正确率为45.88%～90.13%,非传播途径知识正确率为39.2%～53.06%;两条预防方法知识正确率为50.59%～56.65%,非预防方法知识正确率为51.88%～67.53%。63.83%的人认为检测艾滋病抗体是一种有效的预防措施。认为应该公开感染者身份和允许感染者继续工作的人分别占55.75%和19.29%。艾滋病基本知识和对艾滋病感染者的正确态度同文化程度呈正相关。至少同2个人发生过性行为者占36.9%,已婚者过去6个月发生婚外性行为者占4.94%。结论农村外来妇女掌握的艾滋病基本知识比较少,不正确认识较多,应开展形式多样、符合农村群众需求的预防艾滋病宣传工作。     

Recovery after childbirth: a preliminary prospective study

This prospective study examined the time for 93 women to cease to feel discomfort in their perineal areas after the births of their first babies. Sixty-two of the women had experienced a spontaneous delivery that did not require forceps assistance. In 58 patients, an episiotomy was performed. Of the 35 women in whom an episiotomy was not performed, 24 women required sutures and only four women did not suffer any perineal damage. The median time for perineal comfort in general (including walking and sitting) was one month (range, zero to six months); 20% of women took more than two months to achieve general perineal comfort. For comfort during sexual intercourse, the median time was three months (range, one to more than 12 months); 20% of women took longer than six months to achieve comfort during sexual intercourse. Factors that were associated with discomfort for longer than the median time were delivery by forceps; spontaneous vaginal (not perineal) tears; and, in the three to four days after the birth, oedema and the breakdown of muscle or skin sutures. There was no significant difference in these times between patients who did not undergo an episiotomy and those who underwent an episiotomy without a forceps delivery.     

基于广义估计方程探讨长沙市开福区产妇产后体重滞留现状及其影响因素

目的：了解长沙市开福区产妇产后体重滞留(postpartum weight retention,PPWR)的现状,基于广义估计方程探讨PPWR的影响因素。方法：采用整群抽样法,选取2015年1至12月在湖南省长沙市开福区3个街道社区卫生服务中心分娩的产妇作为研究对象。根据纳入和排除标准,最终纳入研究的样本为783例。采用前瞻性队列研究方法,应用自制调查问卷收集产妇产后1,3,6及8个月的PPWR资料;并进一步采用广义估计方程分析PPWR的影响因素。 结果：产妇PPWR随产后时间的推移而逐渐降低,有34.6%的妇女在产后8个月恢复到孕前体重。由广义估计方程结果可知,产后体重滞留的影响因素有孕期增重、孕前体重指数、分娩方式及喂养方式(P<0.05),尚未发现年龄、文化程度、家庭人均收入、产次和产后抑郁与PPWR有关(P>0.05)。结论：孕期增重是影响PPWR的重要因素。减少PPWR的关键在于监控孕期增重。重视对孕产妇身心健康的宣传教育和科学指导,加强对妇女产后1年内的体重管理,尤其是剖宫产和母乳喂养的产妇,有利于减小因PPWR带来的超重或肥胖的风险。     

West Berkshire perineal management trial: three year follow up

Women who had participated in a randomised controlled trial of policies of restricted (10%) versus liberal (51%) episiotomy during spontaneous vaginal delivery were recontacted by postal questionnaire three years after delivery. Altogether 674 out of 1000 responded, and there was no evidence of a differential response rate between the two trial groups. Similar numbers of women in the two groups reported further deliveries, almost all of which had been vaginal and spontaneous. Fewer women allocated to restrictive use of episiotomy required perineal suturing after subsequent delivery, but this difference was not significant. Pain during sexual intercourse and incontinence of urine were equally reported in the two groups. The similarity in incontinence rates persisted when severity, type of incontinence, and subsequent deliveries were taken into account. Liberal use of episiotomy does not seem to prevent urinary incontinence or increase long term dyspareunia.     

120例孕产妇孕期保健的临床观察

目的:探讨孕期保健对孕产妇及新生儿的影响。方法:选取我院120例孕产妇,对其实行孕期保健指导。实施时间为6个月,分析孕产妇的难产、早产、产后出血、胎膜早破的发生情况和新生儿感染、新生儿窒息的发生情况。结果:发生难产的例数为4例,占3.33%;早产的例数为6例,占5.00%;发生产后出血的有2例,占1.67%;发生胎膜早破的有1例,占0.83%;发生新生儿感染的有2例,占1.67%;发生新生儿窒息的有1例,占0.83%。结论:对孕产妇加强孕期保健措施能降低孕妇的难产、早产、产后出血及胎膜早破的发生,同时也可以减少新生儿的窒息和感染的发生。     

Hysterectomy and sexual functioning

CONTEXT: Women considering hysterectomy often are concerned about its potential effects on their sexual functioning but the effects of hysterectomy on sexual functioning remain unclear. OBJECTIVE: To examine changes in sexual functioning after hysterectomy. DESIGN AND SETTING: A 2-year prospective study (Maryland Women's Health Study) of hysterectomy, which included measures of sexual functioning prior to hysterectomy and at 6, 12, 18, and 24 months after hysterectomy, performed during 1992 and 1993. PATIENTS: Of 1299 women interviewed prior to hysterectomy, 1101 (84.8%) completed the study and provided information about their sexual functioning. Most were between the ages of 35 and 49 years, white, married or living with a partner, and high school graduates. MAIN OUTCOME MEASURES: Frequency of sexual relations, dyspareunia, orgasm, vaginal dryness, and sexual desire. RESULTS: The percentage of women who engaged in sexual relations increased significantly from 70.5% before hysterectomy to 77.6% and 76.7% at 12 and 24 months after hysterectomy. The rate of frequent dyspareunia dropped significantly from 18.6% before hysterectomy to 4.3 % and 3.6% at 12 and 24 months after hysterectomy. The rates of not experiencing orgasms dropped significantly from 7.6% before hysterectomy to 5.2% and 4.9% at 12 and 24 months after hysterectomy. Low libido rates also decreased significantly from 10.4% before hysterectomy to 6.3% and 6.2% at 12 and 24 months after hysterectomy. The distribution of women not reporting vaginal dryness in the past month improved significantly from 37.3% before hysterectomy to 46.8% and 46.7% at 12 and 24 months after hysterectomy. Prehysterectomy depression was associated with experiencing dyspareunia, vaginal dryness, low libido, and not experiencing orgasms after hysterectomy. CONCLUSIONS: Sexual functioning improved overall after hysterectomy. The frequency of sexual activity increased and problems with sexual functioning decreased.     

Prevalence and correlates of three types of pelvic pain in a nationally representative sample of Australian women

OBJECTIVE: To identify the prevalence and correlates of three types of pelvic pain (dysmenorrhoea, dyspareunia, and other chronic pelvic pain [CPP]) in a nationally representative sample of Australian women. DESIGN AND SETTING: The CPP survey was part of a broader national study of health and relationships. Computer-assisted telephone interviews were administered to a random sample of 8656 Australian households; 4366 women aged between 16 and 64 years were interviewed in 2004 and 2005. Eighteen of the more than 200 potential survey questions related to pelvic pain. MAIN OUTCOME MEASURES: Self-reports of dysmenorrhoea, dyspareunia, and any other CPP not associated with sexual intercourse or menstruation. RESULTS: Data on 1983 women aged 16-49 years who were still menstruating and sexually active were analysed. Prevalences were 71.7% for dysmenorrhoea, 14.1% for dyspareunia and 21.5% for other CPP; 23.3% of women reported no pelvic pain of any kind. Severe pain was reported by 15.0% (95% CI, 13.0%-17.1%) of women with dysmenorrhoea, 7.8% (95% CI, 5.0%-11.9%) of women with dyspareunia and 20.0% (95% CI, 16.1%-24.6%) of women with other CPP. Just over a third (34.2%) of women who reported any pain had sought advice from a health professional. Women reporting CPP were also likely to report other health conditions, most notably depression and anxiety. There were clear associations between CPP and sexual difficulties, pregnancy and pregnancy outcomes. CONCLUSIONS: Rates of pelvic pain in Australian women are high. General practitioners need to be ready to discuss these issues with patients, particularly in relation to underlying anxiety and depression.     

孕产妇女自测健康的研究

目的了解孕产妇女的自测健康状况。方法应用自测健康评定量表（SRHMS V1．0）对50名一般育龄妇女人群。55名孕妇在产前、产后1周及42d的健康状况进行评定。结果产前孕妇与一般育龄妇女在日常生活功能、身体活动功能及生理健康子量表总分方面的评分存在统计学意义（P〈0．01）；孕妇产后1周在日常生活功能、身体活动功能、生理健康子量表总分及自测健康评定量表总分方面的评分与其产前存在统计学意义（P〈0．01）；产后第42天在身体活动功能、生理健康子量表总分及自测健康评定量表总分方面的评分与其产前存在统计学意义（P〈0．01）。结论孕妇产前虽然在生理健康方面比一般育龄妇女人群差，但自测健康总体上两者并不存在差异。孕妇产后1周的自测健康比产前差。产后第42天的自测健康明显好于产前。自测健康评定量表是用于评价孕产妇女健康状况的一个有效方法和工具。     

瘢痕子宫再次妊娠阴道分娩的临床分析

目的 分析瘢痕子宫再次妊娠经阴道分娩的产程特点及母婴结局。方法 分析2019年3月1日至2020年2月29日在泰州市人民医院产科收治的瘢痕子宫再次妊娠后孕足月经阴道分娩者30例（瘢痕子宫组）,并收集同期孕足月自然临产经阴道分娩的初产妇30例（初产组）及经产妇30例（经产组）,比较分析三组产妇的产程特点、新生儿结局及产后出血情况。结果 瘢痕子宫组分娩成功率90%（27/30）。瘢痕子宫组的第一产程、第二产程均短于初产组（P<0.05）且均长于经产组（P<0.05）;而第三产程、新生儿出生体重、Apgar 1 min评分、产妇产后住院时间方面,三组均无显著差异（P>0.05）;瘢痕子宫组的产后2 h、24 h出血量,多于初产组及经产组,差异均有显著性（P<0.05）;经产组产后2 h出血量多于初产组（P<0.05）,而两组产后24 h出血量无明显差异（P>0.05）。结论 瘢痕子宫再次妊娠经阴道分娩具有一定的安全性和可行性,需严格把握试产标准,产程中须严密监测,并做好产后出血的预防处理措施。     

Child disciplinary actions and women exposure to marital violence in Egypt

Objective： To investigate the association of women＇s exposure to marital violence with their child disciplinary actions in the 2005 EDHS. Methods： A sub-sample of 5249 currentlymarried women were investigated for ever and the 12 months prior to survey exposure to physical and sexual violence by their current husbands, and its association with their child disciplinary actions specifically hitting or slapping the child on the body and/or the face to address child behavior problem adjusting for the effect of respondents age, education, work, residence, wealth index, number of children ever borne, and empowerment in household decisions. Results： Around 29.4% and 5.2% of the studied women have been ever exposed to physical and sexual violence by their current husbands; of them 60% and 65.7% have been subjected to it the 12 months prior to the survey respectively. Around 70% of women were slapping or hitting their children aged 3-17 years on their body or face as an action to address behavior problems the month prior to the survey. Around 40 % of women were slapping their children on face, head, or ears. Logistic regression models showed that exposure to marital violence predicted hitting or slapping the child on the body and/ or the face to address behavior problems the month prior to the survey adjusted to other confounders. Conclusion： Marital Violence is significantly associated with child maltreatment. The study highlights the need for effective screening and identification of marital violence in families in which child maltreatment has occurred and vice versa.     

Increased risk of postnatal depression after emergency caesarean section.

OBJECTIVE: To examine whether women having an emergency caesarean section are at increased risk of developing postnatal depression at one, three and six months postpartum. DESIGN: Participants were part of a larger study examining the relationship between personality dysfunction and postnatal depression. All women were recruited at an antenatal clinic in the first trimester of their pregnancy. These women were followed up at one, three and six months postpartum to identify cases of postnatal depression, defined by the Edinburgh Postnatal Depression Scale (EPDS). RESULTS: Data were collected from 188 women, who were divided into three groups by method of delivery: 21 women had an emergency caesarean section, 49 had a forceps delivery and 118 had a spontaneous vaginal delivery. Comparison of the groups indicated a significant difference at three months postpartum only. Women having an emergency caesarean section had significantly higher EPDS scores than women who had forceps or spontaneous vaginal delivery (9.15 +/- 6.18 v. 5.05 +/- 3.81 v. 5.79 +/- 4.47; F(2,143) = 4.2, P less than 0.02). Analysis of postnatal depression at three months indicated that women in the emergency caesarean section group had a relative risk of 6.82 (95% confidence interval, 2.85-16.15) compared with women in the other groups. CONCLUSIONS: When compared with women having spontaneous vaginal or forceps deliveries, women having an emergency caesarean section had more than six times the risk of developing postnatal depression three months postpartum. Special attention to this group appears warranted.     

A population survey of sexual activity, sexual dysfunction and associated help-seeking behavior in middle-aged and older adults in Germany

The Global Study of Sexual Attitudes and Behaviors was a survey of 27,500 men and women aged 40 to 80 years in 29 countries. Here we report the sexual activity, the prevalence of sexual problems and related help-seeking behaviour among subjects in Germany. A telephone survey was conducted in 2001 and 2002, using a standardised questionnaire covering demographics, general health, relationships, and sexual behaviours, attitudes and beliefs. A total of 1,500 individuals in Germany (750 men and 750 women) completed the survey. Eighty-six percent of men and 66% of women had engaged in sexual intercourse during the year preceding the interview. The most common male sexual problems were early ejaculation (15%), a lack of sexual interest, erectile dysfunction and non-pleasurable sex (each 8%). The most common female sexual problems were a lack of sexual interest (18%), non-pleasurable sex (14%) and lubrication difficulties (13%). Most sexual problems were less common among men and women in Germany than in other European regions. Increasing age was a significant predictor of a lack of sexual interest and erectile difficulties in men. Only 18% of men and 15% of women had talked to a doctor about their sexual problem(s). In conclusion, many middle-aged and older German adults reported continued sexual interest and activity. Overall, sexual problems were less prevalent in Germany compared with other European regions. Of those who experienced sexual problems, however, few had sought medical help. This was often due to a lack of perception of a problem.