脐带绕颈经阴道试产180例临床分析

目的:对胎儿脐带绕颈者经阴道分娩的安全性及可行性进行探讨。方法:收集脐带绕颈初产妇180例为研究组,抽取同期无脐带绕颈初产妇100例为对照组,对两组孕妇的产程进行动态观察,对其分娩方式、胎儿宫内状况、新生儿情况进行对比分析。结果:阴道分娩率,研究组为76.1%,对照组为82.0%,胎儿窘迫发生率,研究组为13.9%,对照组为9.0%;新生儿窒息率,研究组为6.1%,对照组为4.0%。两组的阴道分娩率、胎儿窘迫率、新生儿窒息率差异无显著性。结论:单纯脐带绕颈不能成为剖宫产指征,在严密监护下进行阴道试产是安全、可行的,其阴道分娩率可达76.1%。     

头位妊娠脐带绕颈309例临床分析

目的 :探讨脐绕颈孕妇不同分娩方式对新生儿的影响。方法 :3 0 9例脐绕颈新生儿分为选择剖宫产组、急诊剖宫产组和自然分娩组 ,从胎心、羊水粪染程度等方面探讨脐带绕颈不同分娩方式对新生儿的影响。结果 :3 0 9例中5 4.70 %的头位妊娠脐绕颈病例自然分娩 ,产程中未发生胎儿窘迫 ,提示 >5 0 %的病例可经阴道自然分娩而无脐带拉紧致胎儿缺血缺氧之忧。结论 :妊娠脐带绕颈孕妇应鼓励阴道试产。     

剖宫产术后再次妊娠阴道试产情况调查

【目的】探讨剖宫产术后再次妊娠阴道试产的情况。【方法】回顾性分析2017年1月至2017年12月在本院住院分娩的847例产妇,其中瘢痕子宫(剖宫产术后)再次妊娠产妇424例为观察组,非瘢痕子宫(首胎顺产)再次妊娠产妇423例为对照组。比较两组孕妇分娩情况、产程、母婴结果及手术指征,分析瘢痕子宫分娩方式的影响因素。【结果】观察组424例中,有247例(58.25%)行阴道试产,160例(64.78%)阴道试产成功,87例(35.22%)因试产失败转为剖宫产分娩;对照组423例中,有382例(90.31%)行阴道试产,286例(74.87%)成功阴道分娩,96例(25.13%)因试产失败转为剖宫产分娩;两组阴道试产成功孕妇的第一产程、第二产程、第三产程、新生儿重度窒息与新生儿出生体质量比较差异均无统计学意义(P>0.05);但观察组孕妇产后出血、子宫破裂比例明显高于对照组孕妇,其差异具有统计学意义(P<0.05)。观察组因个人意愿行剖宫产率最高,且显著高于对照组,因前置胎盘行剖宫产率也显著高于对照组;观察组因胎儿窘迫、宫缩乏力因素行剖宫产的比率明显低于对照组,其差异均有统计学意义(P<0.05);两组因疼痛难忍、脐带绕颈、子宫肌瘤、胎位异常、骨产道异常、妊娠高血压和巨大儿因素行剖宫产率比较差异均无统计学意义(P>0.05)。【结论】剖宫产术后再次妊娠的阴道试产率和阴道试产成功率均显著低于非瘢痕子宫,个人意愿成为剖宫产术后再次剖宫产分娩的主要因素。瘢痕子宫产妇孕期应定期产检、科学饮食、防治并发症,医务人员加大阴道试产的宣传教育,减轻孕妇心理恐惧,降低剖宫产率。     

剖宫产术后足月妊娠阴道分娩方式分析

目的 探讨剖宫产术后足月妊娠阴道分娩的可行性.方法 对2011年7月至2012年6月临颍县人民医院收治的109例剖宫产术后足月妊娠符合阴道试产者的分娩方式等进行分析,将剖宫产术后足月妊娠阴道试产成功者与足月妊娠阴道生产者进行对照,将剖宫产术后足月妊娠阴道试产成功者与术后再次剖宫产分娩者进行对照.结果 剖宫产术后阴道分娩者与非剖宫产经阴道分娩者出血量及产程时间比较差异无统计学意义(P＞0.05).剖宫产术后经阴道分娩者与术后再次剖宫产者出血量、住院时间及费用比较差异有统计学意义(P＜0.01).结论 产前对剖宫产术后足月妊娠进行充分评估分析,严格掌握阴道试产指征,严密产程监护,部分剖宫产术后足月妊娠阴道分娩是安全可行性的.     

疤痕子宫再次妊娠经阴道分娩的可行性探讨

对2011年1月~2013年12月我院收治的140例疤痕子宫再次妊娠的分娩方式、分娩结局进行回顾性分析,将疤痕子宫阴道试产成功42例与同期非疤痕子宫阴道分娩488例进行比较,再次剖宫产98例与同期首次剖宫产312例进行比较。结果疤痕子宫经阴道分娩与非疤痕子宫经阴道分娩比较产时出血量、产程时间、新生儿评分、新生儿窒息、住院时间等指标均无显著差异(P0.05),再次剖宫产与首次剖宫产比较,再次剖宫产产时出血多、手术时间长、切口愈合差、住院时间长(P0.05)。产前对疤痕子宫妊娠孕妇进行充分评估,严格掌握阴道试产条件,产程中严密监护,部分孕妇阴道分娩是安全可行的。     

剖宫产术后再次妊娠分娩方式的分析

目的:探讨剖宫产术后再次妊娠的分娩方式。方法:对2013年1月~2014年3月在我院产科住院分娩的192例剖宫产术后再次妊娠孕妇的分娩方式进行回顾性分析。结果:152例选择再次剖宫产,40例经阴道试产,其中1例阴道助产,试产成功19例,试产成功率47.5%。结论:对有剖宫产病史的孕妇有阴道试产意愿,并有阴道试产条件者,应鼓励在严密监护下阴道试产,降低剖宫产率。     

剖宫产术后再次妊娠阴道分娩产程的观察及护理

目的总结剖宫产术后再次妊娠阴道分娩产程观察及护理要点。方法对具备阴道试产指征的60例剖宫产术后再次妊娠阴道分娩的孕妇，做好产程观察和心理护理等护理。观察记录产妇产程、分娩方式、产后出血量等情况。结果60例阴道试产孕妇54例成功阴道分娩，其中自然阴道分娩42例（77．78％），阴道助产12例（22．22％）；6例阴道试产不成功改为行剖宫产。产程过程中应用催产素加强宫缩40例，1例发生产后出血，无1例发生子宫破裂、新生儿窒息等并发症。结论加强产程的监护和做好心理护理是提高剖宫产术后再次妊娠经阴道分娩成功的关键。     

头位妊娠脐带绕颈与围产儿预后的关系

目的:通过对头位妊娠脐带绕颈中围产儿预后的分析,探讨脐带绕颈是否应成为剖宫产指征。方法:将正常头位妊娠1 348例分为两组(脐带绕颈组468例,无脐带绕颈组880例)进行分析,了解脐带绕颈对围产儿预后的影响。结果:两组在阴道分娩和产程的不同阶段,其胎儿窘迫、新生儿窒息、新生儿缺血缺氧性脑病及新生儿吸入性肺炎等发生率差异无显著性;但脐带绕颈组剖宫产率显著升高,剖宫产中胎儿窘迫率脐带绕颈组反而低于无脐带绕颈组,差异有显著性;此外,脐带绕颈中阴道分娩者胎儿窘迫率明显低于剖宫产分娩者。结论:脐带绕颈显著增加了选择性剖宫产率,但脐带绕颈与围产儿预后不良之间无特异性关系,因此不应成为剖宫产指征。     

脐带绕颈产妇分娩方式分析

脐带绕颈是产程中造成急性胎儿窘迫的重要因素之一,严重时可引起新生儿窒息,甚至围生儿死亡,及时剖宫产可保障母婴安全。近年来,脐带绕颈作为剖宫产指证有逐渐扩展趋势。我们选择产后诊断单纯脐带绕颈单胎头位初产妇资料45例,与同期分娩无脐带绕颈45例正常产妇资料进行对比分析,探讨脐带绕颈产妇采取阴道分娩与母婴预后之间的关系。     

瘢痕子宫再次妊娠的分娩方式选择及经阴道分娩可行性、安全性研究

目的:对瘢痕子宫再次妊娠的分娩方式选择及经阴道分娩可行性及安全性进行探讨。方法:以60例瘢痕子宫再次妊娠的产妇为对象,就诊时间段为2015年2月至2019年2月,根据不同的分娩方式将产妇分为观察组与对照组,其中26例再次行剖宫产手术的产妇纳入对照组,另外34例经阴道分娩的产妇纳入观察组,比较产妇的试产成功率及并发症发生率。结果:观察组34例产妇,经阴道试产成功27例,成功率79.4%;比较后得知,观察组产妇并发症发生率为11.8%,明显低于对照组的46.2%,差异显著(P<0.05)。结论:针对瘢痕子宫再次妊娠的产妇,经阴道分娩试产成功率较高,同时,并发症发生率得以减少。     

非药物镇痛对产妇分娩质量的影响

目的:研究非药物镇痛对孕产妇产程的影响。方法:选择2013年1~4月在本院要求实行分娩镇痛的孕妇300例,随机分为观察组和常规组各150例,观察组实行导乐陪伴分娩加豆袋热敷、按摩止痛,对照组实行常规分娩。结果:观察组产妇出血量少,产程进展好,剖宫产率低。对照组产程进展长,容易宫缩乏力,剖宫产率高。结论:非药物镇痛分娩操作简单,对产程的缩短具有促进作用,减少出血量,降低剖宫产率。     

双模块匹配护理管理在妊娠期糖尿病病人中的应用研究

目的:观察双模块匹配护理管理在妊娠期糖尿病病人中的应用效果。方法:选择2018年2月—2019年3月于某院建立围产档案并拟于医院分娩的妊娠期糖尿病孕妇88例为研究对象,采用随机数字表法分为对照组与试验组各44例。对照组按常规产前保健管理服务,试验组接受双模块匹配护理管理。统计比较两组孕妇分娩前空腹血糖检测结果、分娩前体重控制达标率。生产后对两组孕妇母婴结局进行评价比较,包括胎膜早破率、巨大儿率、胎儿窘迫率、剖宫产率及产后出血率。结果:试验组病人分娩前空腹血糖明显低于对照组,孕期体重控制达标率明显高于对照组,胎膜早破率、巨大儿率、胎儿窘迫率、剖宫产率及产后出血率明显低于对照组(P<0.05)。结论:采用双模块匹配护理管理对妊娠期糖尿病病人施加干预,可获得较好的血糖与体重控制效果,改善母婴结局。     

Prenatal color Doppler sonographic evaluation of nuchal encirclement by the umbilical cord

PURPOSE: The aim of this study was to assess whether Doppler flow velocimetry of the fetal middle cerebral and umbilical arteries is affected by nuchal encirclement by the umbilical cord (nuchal cord) in the prenatal period. PATIENTS AND METHODS: The position of the fetal umbilical cord was assessed on color Doppler sonography in pregnant women who were referred to our radiology department between September 14, 1998, and January 14, 2000. Pulsatility and resistance indices and the ratio of peak systolic blood flow velocity to diastolic velocity of the umbilical arteries and middle cerebral arteries of all fetuses were prospectively obtained with Doppler flow velocimetry. The fetuses were categorized into 2 groups: group 1 consisted of fetuses without sonographic evidence of nuchal cord and group 2 of fetuses with sonographic evidence of nuchal cord. The results were statistically analyzed with independent-groups t test. A p value of less than 0.05 was considered significant. RESULTS: During the study period, 230 pregnant women underwent sonographic examination of the fetus, and 68 fetuses were delivered. The sonographic examinations were performed at 24-41 weeks' menstrual age. Of the 46 fetuses in group 1, 1 fetus had nuchal cord at delivery; of the 22 fetuses in group 2, 4 did not have nuchal cord at delivery. The sensitivity of color Doppler sonography in detecting nuchal cord was 95% (18 of 19 fetuses), the specificity was 92% (45 of 49), the negative predictive value was 98% (45 of 46), and the positive predictive value was 82% (18 of 22). No statistically significant differences in middle cerebral artery or umbilical artery Doppler flow velocimetry values were detected between the 2 groups. CONCLUSIONS: Color Doppler sonography is a sensitive and specific method of diagnosing nuchal cord, but fetal middle cerebral artery and umbilical artery Doppler flow velocimetry values are not affected by the presence of nuchal cord in the prenatal period.     

Ultrasound detection of nuchal cord prior to labor induction and the risk of Cesarean section.

OBJECTIVES: To investigate the ability of ultrasound to detect the presence of a nuchal cord immediately prior to induction of labor and the association of its presence with delivery by Cesarean section. METHODS: A transabdominal ultrasound scan using gray-scale and color Doppler imaging was performed immediately prior to induction of labor in 289 women in a prospective study to assess the presence of a nuchal cord. The presence of a nuchal cord was classified as present, absent or uncertain. The outcomes of labor, delivery and the neonates were obtained from the patient notes after delivery. RESULTS: A nuchal cord was present at 18% of deliveries. The incidence was not affected by parity, fetal position or reduced amniotic fluid volume. The sensitivity of ultrasound in diagnosing a nuchal cord was 37.5%, with specificity, positive and negative predictive values of 80%, 29% and 85%, respectively. The presence of a nuchal cord did not significantly increase the risk of delivery by Cesarean section (35% vs. 28%; relative risk = 1.22; 95% CI, 0.80-1.87), instrumental delivery for fetal distress, an abnormal cardiotocograph in labor or at delivery, an Apgar score < 7 at 1 min, arterial cord pH < 7.1 or neonatal unit admission. CONCLUSIONS: The sensitivity of the ultrasound diagnosis of a nuchal cord is low prior to induction of labor at term. A nuchal cord does not appear to increase the risk of Cesarean section or of poor neonatal outcome. The low ultrasound detection rate of a nuchal cord limits its use in decision making prior to induction of labor in high-risk pregnancies.     

剖宫产术后再次妊娠并发前置胎盘26例临床分析

目的总结剖宫产术后再次妊娠并发前置胎盘的处理及对母儿的影响。方法回顾分析2004年3月至2008年3月,本院收治的26例剖宫产术后再次妊娠并发前置胎盘及合并植入性胎盘,产后大出血的处理。结果26例患者均行剖宫产术结束分娩,早产13例,围产儿窒息15例,围产儿死亡3例,合并胎盘植入17例,产后大出血16例,子宫全切11例。结论降低剖宫产率,可减少前置胎盘,同时降低胎盘植入患病率,降低孕产妇及围产儿并发症发生率及危险性。     

脐带过度扭转产前检查及妊娠结局分析

目的探讨脐带过度扭转对母婴结局的影响。方法对照组（n=215）为正常足月分娩产妇,观察组（n=105）为产后确定为脐带过度扭转的产妇,比较两组的产前胎心监护检查、彩超检查、分娩方式、围产儿结局。结果观察组彩超检查具有特征声像图的发生率、胎心监护异常率高于对照组,观察组脐动脉S／D值高于对照组,差异均有显著性（P〈0．05）;观察组剖宫产率、围产儿并发症发生率显著高于对照组（P〈0．05）。结论产前胎监、彩超检查可为诊断脐带过度扭转提供参考,适时终止妊娠有望改善母婴结局。     

剖宫产术后再次妊娠分娩266例临床分析

目的探讨剖宫产术后再次妊娠分娩方式及对产妇结局的影响。方法对我院3年来266例剖宫产术后再次妊娠的孕妇住院分娩资料进行回顾性分析。结果阴道试产22例,阴道分娩14例,成功率为63．64％,发生先兆子宫破裂2例,占9．09％。再次剖宫产252例,占95．45％,发生不完全性子宫破裂5例,占1．98％。再次剖宫产产后出血率（6．35％）及量（≥1500ml,1．19％）均高于首次剖宫产组（5．21％,0．87％）、阴道组（3．82％,0．03％）（P〈0．05,P〈0．01）。瘢痕子宫再次妊娠前置胎盘发生率（2．65％）显著高于非瘢痕子宫再次妊娠组（0．52％）（P〈0．01）。结论单纯剖宫产史不能作为瘢痕子宫再次妊娠剖宫产的指征,符合试产条件者,严密监护下可阴道试产,以降低剖宫产率、产后出血率及前置胎盘发生率。     

Outcomes of pregnancies with sonographically detected nuchal cords remote from delivery.

OBJECTIVE: To evaluate the outcomes of pregnancies with sonographically detected nuchal cords remote from delivery during the second and third trimesters of gestation. METHODS: A retrospective study of patients with and without nuchal cords detected by sonography during the second and third trimesters of gestation (17-36 weeks) was conducted. Variables included maternal age, parity, gestational age at sonography and at delivery, method of delivery, intrapartum fetal heart abnormalities, meconium-stained amniotic fluid, birth weight, 5-minute Apgar score, and neonatal intensive care unit admissions. RESULTS: A total of 233 patients were included in this study, of which 118 had sonographically detected nuchal cords identified in our department during the study period. There were no statistically significant differences between patients with sonographically detected nuchal cords and control patients with respect to maternal age, estimated gestational age at sonography, method of delivery, meconium-stained fluid, birth weight, intrapartum fetal heart abnormalities, 5-minute Apgar scores of less than 7, and neonatal intensive care unit admissions. Patients with nuchal cords detected by sonography were more likely to give birth before 37 weeks' gestation than control patients (21% versus 11%; P = .040). CONCLUSIONS: A sonographically detected nuchal cord is not associated with important perinatal complications.     

剖宫产术中应用产钳的体会

目的:探讨剖宫产术中取头困难时应用产钳的优势。方法:选择手娩胎头失败改用产钳助产291例为观察1组,因胎儿窘迫情况紧急、胎头高浮和深嵌直接使用产钳助产159例为观察2组,徒手取胎头1565例为对照组。比较3组术中情况。结果:观察组应用产钳均1次助娩成功,娩头时间缩短,无一例发生产伤或因取头时间过长导致新生儿窒息。结论:剖宫产术中应用产钳,可安全地娩出胎头,减少手术并发症。     

多维度镇痛对分娩过程及结局的影响

目的探讨多维度镇痛对分娩过程及结局的影响。方法选取2017年7月至2018年8月在我院分娩的110例产妇作为研究对象,随机等分为试验组和对照组,试验组在分娩全程中采用多维度镇痛,对照组产妇宫口开张≥3 cm,进入活跃期之后进行活跃期硬膜外阻滞麻醉,观察两组产妇产程镇痛效果以及分娩结局。结果试验组产妇潜伏期VAS评分与对照组相比明显较低(P<0.05);试验组活跃期时间、第二产程时间及缩宫素使用率明显低于对照组(P<0.05);试验组剖宫产率低于对照组(P<0.05);在第二产程时,试验组外周血β-EP高于对照组、去甲肾上腺素(NE)和血糖浓度均明显低于对照组(P<0.05);两组产妇新生儿Apgar评分比较差异无统计学意义(P>0.05)。结论全产程多维度镇痛可有效降低产妇分娩过程中的疼痛程度,降低剖宫产的发生率,是临床上安全有效的镇痛方法,值得应用和推广。