瘢痕子宫患者再次足月妊娠的分娩方式选择

目的探讨瘢痕子宫患者再次足月妊娠的分娩方式。方法对415例瘢痕子宫再次妊娠者的分娩方式进行总结分析,并以380例非瘢痕子宫妊娠的剖宫产者作为对照。结果 415例瘢痕子宫再妊娠者中,选择阴道试产46例（11.08%）、剖宫产369例;阴道试产者中转剖宫产13例,试产成功率71.74%;与阴道试产者比较,瘢痕子宫剖宫产者产后出血多、住院时间长、新生儿窒息率高（P均〈0.05）。与非瘢痕子宫剖宫产者比较,瘢痕子宫最终剖宫产分娩者手术及住院时间长、产后出血量大,产褥病率、切口不良愈合率、新生儿窒息率高（P均〈0.05）。结论对有阴道试产指征的瘢痕子宫患者再次足月妊娠患者可行阴道分娩,应尽可能降低二次剖宫产率。     

剖宫产后瘢痕子宫再次妊娠分娩方式探讨

目的探讨剖宫产后瘢痕子宫再次妊娠分娩方式。方法选取中国人民解放军第九五医院2016年6月—2017年6月收治的瘢痕子宫再次妊娠产妇110例,将再次采取剖宫产方式的64例产妇设为观察组a,将经阴道试产成功的46例产妇设为观察组b。选取本院同期首次采取剖宫产产妇64例设为对照组a,首次采取阴道分娩产妇46例设为对照组b。比较两组剖宫产产妇产后出血率、重度粘连率、切口乙级愈合率;比较两组阴道分娩产妇产后出血量及先兆子宫破裂、新生儿窒息发生率。结果观察组a产妇产后出血率、重度粘连率、切口乙级愈合率高于对照组a(P<0.05)。观察组b与对照组b产妇产后出血量及先兆子宫破裂、新生儿窒息发生率比较,差异无统计学意义(P>0.05)。结论瘢痕子宫选择妊娠分娩方式时可在与相关指征相符合的情况下,选择安全性和可行性均较高的阴道试产方式,但需避免子宫破裂发生。     

瘢痕子宫足月妊娠孕妇经阴道分娩可行性探讨

目的探讨瘢痕子宫足月妊娠孕妇经阴道分娩的可行性。方法选择于我院行经阴道分娩的瘢痕子宫孕妇43例(瘢痕组)、非瘢痕子宫孕妇50例(非瘢痕组)。瘢痕组在严格掌握经阴道试产指征的基础上行阴道试产,非瘢痕组行常规经阴道分娩。比较两组宫颈球囊率、阴道助产率、产后子宫下段积血发生率、新生儿Apgar评分<7分发生率、平均产程、产时出血量、产后24 h出血量、新生儿体质量、平均住院时间。结果瘢痕组试产成功40例,试产成功率为93.02%;分娩过程中未发现子宫破裂。瘢痕组产后子宫下段积血发生率高于非瘢痕组(P<0.05)。两组其他观察指标比较均无统计学差异。结论在严格掌握经阴道分娩指征、严密产程监护、做好并发症防治准备的基础上,瘢痕子宫孕妇经阴道分娩是可行的。     

瘢痕子宫再次妊娠产妇阴道分娩的结局及影响因素分析

目的分析瘢痕子宫再次妊娠产妇阴道分娩的结局及影响因素。方法回顾性分析2014-03～2016-08在该院接受分娩的100例瘢痕子宫产妇的临床资料,根据其分娩方式分为经阴道分娩组42例和剖宫产组58例。观察比较两组产妇分娩前后血流动力学的变化和新生儿Apgar评分,分析影响瘢痕子宫经阴道分娩的因素。结果两组产妇分娩前的血流动力学指标无明显差异,分娩后经阴道分娩组的血红蛋白(Hb)、血小板(PLT)水平高于剖宫产组(P0.05),而两组的脉搏血氧饱和度(SpO_2)、呼气末二氧化碳分压(P_(ET)CO_2)和中心静脉压(CVP)水平差异无统计学意义(P0.05);两组新生儿吸入性肺炎、颅内出血发生率和出生后Apgar评分差异均无统计学意义(P0.05);经阴道分娩组分娩后24 h内出血量为(234.45±15.42)ml,明显低于剖宫产组的(385.62±14.56)ml,差异有统计学意义(P0.05)。Logistic回归分析结果显示,距离上次剖宫产的时间、胎儿重量、产前体重指数(BMI)和阴道分娩史是影响瘢痕子宫产妇经阴道分娩的危险因素(P0.05)。结论瘢痕子宫产妇经阴道分娩的安全性较高,且预后较好。距上次剖宫产时间、胎儿重量、产前BMI和阴道分娩史是影响瘢痕子宫产妇经阴道分娩的危险因素。     

瘢痕子宫再次妊娠阴道分娩的结局与可行性研究

目的探讨瘢痕子宫再次妊娠阴道分娩的结局与可行性。方法选取2017-01～2017-12该院收治的52例瘢痕子宫再次妊娠阴道试产患者作为观察组,选择同期于该院进行阴道分娩的健康产妇52名作为对照组。观察瘢痕子宫患者的分娩方式,对比两组产妇产程时间、失血量、住院时间、产后感染与尿潴留的发生率,以及两组新生儿Apgar评分。结果两组产妇产程时间、失血量及住院时间比较差异无统计学意义(P0.05)。观察组阴道分娩成功率(90.38%)与对照组(100.00%)比较差异无统计学意义(P0.05)。两组新生儿1 min Apgar评分、产后感染及尿潴留发生率比较差异均无统计学意义(P0.05)。结论瘢痕子宫不是剖宫产的绝对指征,只要严格控制分娩适应证与禁忌证,完善各项监护工作,再次阴道分娩安全可行。     

瘢痕子宫再次妊娠分娩方式选择的效果观察

目的探讨瘢痕子宫再次妊娠的合理分娩方式,减少母婴近期和远期并发症。方法对该院近3年来收治的168例剖宫产术后再次足月妊娠孕妇按分娩方式分为阴道试产组（观察组）48例和择期剖宫产术组（对照组）120例。对比分析两种分娩方式术中及术后并发症、产后出血、新生儿并发症等发生情况。结果观察组48例阴道试产成功42例,成功率为87.5%,未发现子宫破裂现象;术中及术后并发症、产后出血发生率低于对照组（P均〈0.05）;住院时间短于对照组（P〈0.01）;住院费用也少于对照组（P〈0.01）。结论阴道分娩具有无术后并发症、产后出血发生率低、住院时间短、住院费用少等优点,瘢痕子宫再次妊娠在符合试产条件下实施阴道分娩是可行和安全的。     

瘢痕子宫再次妊娠63例分析

近年来,我国中小城市剖宫产率不断上升,因此剖宫产后瘢痕子宫再次妊娠者也随之增加。正确处理瘢痕子宫再次分娩的问题,是围生医学值得研究的课题之一,也是产科医生非常关注的问题之一。现就瘢痕子宫再次妊娠相关因素作以初步探讨。     

剖宫产术后再次妊娠经阴道分娩的观察及护理

［摘要］　目的　探讨剖宫产术后再次妊娠经阴道分娩的可行性及护理措施。方法　对2013-01～2014-12收治的58例剖宫产术后再次妊娠并同意阴道试产者的产程和护理措施进行回顾性分析。结果　阴道试产成功者45例,占77.59%（45/58）,再次剖宫产术者13例,占22.41%（13/58）;经阴道分娩产妇住院时间、住院费用、产后出血量均明显少于剖宫产产妇（P<0.05）,两组新生儿窒息、Apgar评分比较差异无统计学意义（P>0.05）。结论　对于具有阴道试产条件的剖宫产后再次妊娠者,可在严密监护下进行阴道试产,有利于降低剖宫产率。     

98例疤痕子宫再次妊娠分娩方式的选择

子宫疤痕形成的常见原因有剖宫产、子宫肌瘤剔除术、子宫畸形矫治术等，其中以剖宫产术最为常见。近年来剖宫产率急居上升，而再次剖宫产已跃居剖宫产指征第2位。因此，如何解决有剖宫产史患者的分娩，将直接影响整个剖宫产率的高低2000～2003年，我们对98例有剖宫产史再次妊娠者的临床资料进行回顾性分析，探讨影响疤痕子宫阴道分娩的可能因素及剖宫产术后阴道分娩(VBAC）成功率。     

椎管内低剂量药物镇痛对基因型A118G-AA型的剖宫产再孕孕妇足月妊娠经阴道分娩的临床探讨

目的探讨椎管内低剂量药物镇痛对基因型A118G-AA型且剖宫产再孕孕妇足月妊娠经阴道分娩的可行性及安全性。方法选取剖宫产再孕且妊娠37周后在该院自愿要求阴道分娩孕妇200例,产科门诊评估其有阴道试产条件且自愿要求抽其静脉血检测基因型A118G-AA型,外送贝瑞基因应用PCR-RFLP法。根据OPRM1外显子1第118位点处的碱基情况判定孕妇基因型,选取AA型(野生型)共62例临产后均进入阴道试产,根据镇痛方式不同分为观察组(n=30)和对照组(n=32)。观察组采用椎管内低剂量药物镇痛。对照组采用导乐仪镇痛。对比分析两组的产程、阴道分娩成功率、分娩结局及产后满意度。结果观察组分娩成功率为86.7%,高于对照组的59.4%(P<0.05)。观察组孕妇在第一产程时间、会阴裂伤程度、视觉模拟疼痛评分、产后满意度调查和泌乳始动时间方面均优于对照组(P<0.05)。结论对A118G-AA型剖宫产再孕足月妊娠孕妇阴道分娩应用低剂量药物椎管内镇痛安全有效,镇痛效果优于导乐仪镇痛。     

Myeloid sarcoma of the uterus presenting as vaginal bleeding

Extramedullary relapse of acute myeloid leukaemia may occur in sites such as the central nervous system, testes, and skin. Presentations in the female genital tract are uncommon and usually asymptomatic. In contrast, symptomatic uterine myeloid sarcoma is very rare. Treatment of this is generally unsuccessful, but is improved when systemic therapies are used. We study a case of a uterine relapse of acute myeloid leukaemia presenting as vaginal bleeding and successfully managed by local irradiation. The mechanism of preferential infiltration of uterine tissue requires further study.     

不同分娩方式对产后妇女盆底功能影响的临床分析

目的通过盆底功能评估了解产后妇女盆底功能障碍状况,分析比较剖宫产与阴道产两种分娩方式对产后盆底功能的影响,为盆底功能障碍性疾病(PFD)的防治提供理论依据。方法选取2014-01~2014-06间在该院分娩并于产后6~8周来产后门诊复查的800例产妇,根据分娩方式的不同分为剖宫产组288例和阴道产组512例做盆底功能常规评估,对其评估所获得的指标进行回顾性分析比较。结果手法检查辅以盆底肌评估筛查800例患者中,剖宫产组Ⅰ类肌纤维受损185例,Ⅱ类肌纤维受损168例;阴道产组Ⅰ类肌纤维受损504例,Ⅱ类肌纤维受损502例,两组比较差异有统计学意义(P0.01);阴道产组肌力收缩失调、肛提肌损伤、疲劳度异常、阴道动态压力值80 cm H2O均高于剖宫产组(P0.01)。结论相对于阴道分娩,剖宫产可在一定程度上降低对产妇盆底功能的影响,但盆底功能可通过进行产后康复锻炼来促进恢复,因此不应以此为依据进行分娩方式的选择。     

Vaginography—Investigation of choice for clinically suspected vaginal fistulas

PURPOSE: Vaginal fistulas are rare but can cause extremely distressing symptoms for patients and prove difficult to define anatomically. Barium studies have been reported as having a maximum sensitivity of only 34 percent for detection of vaginal fistulas. Vaginography is an alternative method for diagnosis and evaluation of suspected vaginal fistulas, which has been reported to have a sensitivity of 100 percent. We reviewed our total experience of vaginography to fully assess its capabilities. METHODS: Twenty-seven patients with clinically suspected vaginal fistulas were investigated with vaginography during a six-year period. Results of vaginograms were compared with final operative or clinical diagnosis and with results of other radiologic investigations. RESULTS: Vaginography successfully identified 19 of 24 fistulas, giving a sensitivity of 79 percent. In our series, barium enema was only able to identify 9 percent of fistulas arising from the colon. CONCLUSIONS: In this, the largest series of vaginograms, apparent reduction in sensitivity from the 100 percent quoted in earlier series to 79 percent probably represents a more accurate assessment of vaginography as a diagnostic investigation. Even allowing for this reduction, vaginography is still the most sensitive, economic, and informative investigation for identification and delineation of vaginal fistulas. We recommend that vaginography be the initial investigation of choice in patients with clinically suspected vaginal fistulas.Mr. Drew was supported by a Yorkshire Health Research Fellowship.Poster presentation at the meeting of The American Society of Colon and Rectal Surgeons, Montreal, Quebec, Canada, May 7 to 12, 1995.     

The optimal mode of delivery for the haemophilia carrier expecting an affected infant is vaginal delivery

Summary. The optimal mode of delivery of a haemophilia carrier expecting a child is still a matter of uncertainty and debate. The aim of this commentary/review is to suggest that normal vaginal delivery should be the recommended mode of delivery for the majority of carriers, based on review of studies on obstetric aspects of haemophilia. About 2.0–4.0% of all haemophilia boys born in countries with a good standard of health care will suffer from ICH during the neonatal period. This is an average figure including all modes of delivery and regardless of whether the carrier status of the mother or the haemophilia status of the foetus was known or not at the time of delivery. On the basis of current literature, one may conclude that the risk of serious bleeding in the neonate affected with haemophilia is small in conjunction with normal vaginal delivery. It should be possible to further reduce the low frequency of complications if appropriate precautions are taken when planning the delivery in pregnant woman with known carrier status, if the sex of the foetus is known and, even more, when the haemophilia status of the foetus is known. Instrumental delivery such as use of vacuum extraction and foetal scalp monitors must be avoided at delivery of carriers.     

Follow-up evaluation of the effect of vaginal delivery on the pelvic floor

PURPOSE: The aim of this study was to evaluate the effect of vaginal delivery on the pelvic floor by serial measurement of pudendal nerve terminal motor latency, perineal descent, and anal pressure before and after delivery. METHODS: Eighty pregnant females (40 primigravidae, 40 multigravidae) expecting vaginal delivery were prospectively evaluated. Measurements of pudendal nerve terminal motor latency, perineometry, and manometry were performed two to three months before delivery and two to three days, two months, and six months after delivery. RESULTS: Before delivery, pudendal nerve terminal motor latency showed no significant difference between primigravidae and multigravidae. Perineal plane at straining was lower and the descent was larger in multigravidae than primigravidae. Anal squeeze pressure was also lower in multigravidae than primigravidae. Two to three days after delivery, regardless of the group, pudendal nerve terminal motor latency was prolonged, perineal plane at straining became lower, the descent increased, and anal squeeze pressure decreased. Two months after delivery, pudendal nerve terminal motor latency recovered to the level before delivery. Perineal descent also recovered somewhat, but remained increased after six months had passed. In primiparae, perineal plane at straining remained lower after six months had passed. However, in multiparae the plane remained lower only for two months and recovered by six months postpartum. Anal squeeze pressure also showed a moderate recovery, but still remained significantly lower at six months postpartum. CONCLUSIONS: Pudendal nerve damage and functional impairment in the pelvic floor sphincter musculature occurs during vaginal delivery. Pudendal nerve terminal motor latency recovers after two months, whereas functional disturbance in the pelvic floor persists at least until six months.Poster presentation at The American Society of Colon and Rectal Surgeons' 100th Anniversary and Tripartite Meeting, Washington, D.C., May 1 to 6, 1999.     

Clinical profile of patients presenting with uterus inversion

Inversion uterus is an unusual complication of vaginal delivery. Mismanaged third stage of labor is the most commonly identified predisposing risk factor. The condition requires immediate intervention. This retrospective study was conducted in Lady Hardinge Medical College and Associated Hospitals, New Delhi, India with the aim to study the clinical profile and outcome of patients admitted with inversion uterus. A total of six cases of inversion uterus were managed during the five year period reviewed. All patients had acute inversion and were managed successfully by manual reposition except one with chronic inversion which required laparotomy. In this case Huntington's technique was used to reposit back uterus. The patients were discharged in satisfactory condition with a mean hospital stay of nine days. Early diagnosis, resuscitation and replacement of inverted uterus are essential components of management of this rare but life threatening situation. Proper management of third stage is recommended.