自由体位管理模式对枕后位产妇分娩方式及妊娠结局的影响

目的 探讨自由体位管理模式对枕后位产妇分娩方式及妊娠结局的影响。方法 选取600名枕后位产妇为研究对象,根据随机数字表法分为对照组与研究组,各300名。对照组给予常规管理模式,研究组给予自由体位管理模式,比较两组分娩方式、妊娠结局、中转剖宫产指征、疼痛程度及满意度情况。结果 研究组自然分娩率、产妇满意度高于对照组,不良妊娠结局发生率、中转剖宫产指征发生率、疼痛数字评分均低于对照组（P<0.05）。结论 自由体位管理模式能显著提高枕后位产妇的自然分娩率,缓解疼痛,改善妊娠结局,产妇满意度高,值得临床推广与应用。     

拉玛泽减痛法联合自由体位对初产妇分娩疼痛及应激反应指标的影响

目的 研究拉玛泽减痛法联合自由体位对初产妇分娩疼痛及应激反应指标的影响。方法 选取90例分娩的初产妇,根据干预方法不同将初产妇分为对照组与观察组,每组45例。对照组采用自由体位分娩,观察组在自由体位分娩基础上采用拉玛泽减痛法。比较两组初产妇分娩疼痛、产程时间及应激反应指标。结果 观察组分娩疼痛评分(7.48±0.86)分低于对照组的(8.14±0.92)分,差异有统计学意义(P<0.05)。观察组第一产程、第二产程、第三产程及总产程均短于对照组,差异有统计学意义(P<0.05)。分娩前,两组初产妇Cor、NE及Ang-Ⅱ水平比较,差异无统计学意义(P>0.05);分娩后,观察组皮质醇(Cor)、去甲肾上腺素(NE)及血管紧张素Ⅱ(Ang-Ⅱ)指标均低于对照组,差异具有统计学意义(P<0.05)。结论 拉玛泽减痛法联合自由体位对减轻初产妇分娩疼痛有着非常积极的作用,同时还可以显著缩短产程时间,减轻应激反应。     

分阶段自由体位联合垂直体位分娩在初产妇第二产程中的应用效果观察

目的 探究初产妇在第二产程过程中应用分阶段自由体位联合垂直体位分娩的效果。方法 选取120例妇产科就诊的初产妇作为研究对象,将第二产程采用分阶段自由体位进行分娩的产妇纳入对照组,将第二产程在对照组基础上结合垂直体位进行分娩的产妇纳入研究组,各60例。比较两组产妇第二产程时长、产后2 h的阴道出血量、阴道分娩率及会阴侧切率。结果 对照组产妇第二产程时长多于研究组,产后2 h阴道出血量也多于研究组,差异有统计学意义(P<0.05);对照组产妇阴道分娩率低于研究组,会阴侧切率高于研究组,差异均有统计学意义(P<0.05)。结论 在初产妇第二产程中应用分阶段自由体位联合垂直体位进行分娩,可降低剖宫产分娩率,缩短分娩时间,降低产妇痛苦,减少会阴侧切风险,具有较高应用价值。     

助产士一体式全程护理结合自由体位分娩在自然分娩中的应用价值

目的 探讨助产士一体式全程护理结合自由体位在自然分娩中的应用价值。方法 选取本院180例自然分娩产妇为研究对象,随机分为两组,各92例。对照组接受常规助产护理结合分娩体位指导干预,观察组接受助产士一体式全程护理结合自由体位分娩干预,比较两组的分娩效能感、分娩恐惧、疼痛程度及不良分娩结局发生率。结果 干预后,观察组期望效能、结果效能评分高于对照组,差异有统计学意义（P<0.05）;产程中,观察组分娩恐惧量表、现实疼痛强度量表评分均低于对照组,差异有统计学意义（P<0.05）;观察组不良分娩结局发生率为12.22%,低于对照组的25.56%,差异有统计学意义（P<0.05）。结论 助产士一体式全程护理结合自由体位分娩应用于自然分娩中,可提高产妇的分娩效能感,缓解分娩恐惧及分娩疼痛,降低不良分娩结局发生率。     

自由体位结合自主屏气用力分娩在胎膜早破初产妇中的应用效果

目的 探讨自由体位结合自主屏气用力分娩在胎膜早破初产妇中的应用效果.方法 选择2018年2月至2019年2月在安徽省马鞍山市中心医院接受治疗的68例胎膜早破初产妇患者,采用抽签法分为联合组(n=35)和单药组(n=33).对照组给予传统体位和常规指导用力,观察组给予自由体位结合自主屏气用力治疗.比较两组产程用时、产后出...     

不同分娩镇痛方式对母婴结局的影响

目的 比较不同的分娩镇痛方法对母婴结局的影响.方法 根据纳入标准和排除标准选取2018年3月至2020年3月北京大学第三医院阴道试产的孕足月初产妇397例,根据医患共同决策分为4组:硬膜外镇痛组(镇痛组)102例、导乐陪伴组(导乐组)102例、导乐联合硬膜外镇痛组(导乐+镇痛组)91例和对照组102例,比较各组产妇的产...     

潜伏期实施分娩镇痛对分娩结局的影响

分娩的疼痛给产妇带来很大痛苦，有时还会因此造成初产妇对分娩的恐惧而增加剖宫产。近年来，分娩镇痛已成为国内外研究的重要课题之一。硬膜外麻醉因其镇痛效果满意，深受育龄妇女欢迎，已成为目前国外最广泛采用的方法。在我国大多数医院分娩镇痛均在活跃期宫口开大3cm以后实施。     

导乐仪分娩镇痛结合全程责任制陪伴对母婴结局的影响

<正>2011年5月至11月,我院对200例单胎足月初产的孕产妇实行导乐仪联合全程责任制陪护,效果良好,现报道如下。1资料与方法1.1临床资料上述期间选择我院产科病房住院的单胎足月初产健康的孕产妇,采用随机自愿原则分为3组,导乐仪联合全程责任制陪产(A组);单纯实行全程责任制陪产孕妇作为观察组(B组);传统方法待产孕妇作为对照组(C组)。     

实施硬膜外分娩镇痛时机对初产妇妊娠结局的影响

目的:分析硬膜外分娩镇痛时机对初产妇妊娠结局的影响.方法:选取2019年10月1日至2020年9月30日在山东大学第二医院实施硬膜外分娩镇痛的孕妇共502例.根据硬膜外分娩镇痛时的宫口扩张程度分为3组:Ⅰ组(宫口<2cm,49例),Ⅱ组(2≤宫口<3cm,284例),Ⅲ组(宫口≥3cm,169例).分析3组孕妇的分娩方...     

水中分娩及分娩并发症的探讨

目的:时水中分娩产妇的产程、产道裂伤、产时和产后并发症、产时和产后镇痛药使用及新生儿结局进行分析,以评价水中分娩的安全性.方法:2003年3月1日至2007年6月30日在我院选择水中分娩的1227例产妇作为水中分娩组,将同期的单胎(无妊娠合并症及并发症)顺产的1227例产妇作为对照组.比较两组产程、产道裂伤、产时和产后并发症、产时和产后镇痛药使用及新生儿结局.结果:水中分娩组第一及第二产程时间、产褥病率、产后出血、会阴阴道血肿、产后尿潴留、新生儿轻度及重度窒息与对照组比较,两组差异无统计学意义(P>0.05);水中分娩组均未行会阴切开,对照组会阴切开率66.67%,两组比较,差异有高度统计学意义(P<0.01);水中分娩组下水后用镇痛药及产后用镇痛药与对照组比较明显减少,两组差异有高度统计学意义(P<0.01).结论:水中分娩能减轻分娩疼痛,减少产时、产后镇痛药的使用.减少产道损伤,且未发现对母儿有其他不良结局.     

产程中改变产妇体位矫正胎方位的探讨

目的：探讨产程中改变产妇体位以矫正胎方位的临床效果。方法：选择先兆临产至潜伏期经Ｂ超检查判断为枕后位的初产妇２４０例，随机分为两组，各１２０例。研究组在产程中指导产妇取侧俯卧位，利用胎儿重力、羊水浮力、子宫间歇收缩的合力作用，使胎头在下降时逐渐从枕后位转至枕前位娩出，并与对照组比较。结果：研究组１０６例（８８．３％）胎儿从枕后位转到枕前位经阴道娩出。剖宫产１４例（１１．７％）。对照组经阴道娩出仅２０例（１６．７％），剖宫产１００例（８３．３％）。两组比较，差异有非常显著性（Ｐ＜０．００１）。研究组第一产程平均时间３０２．６分钟，第二产程平均５９．８分钟。对照组第一产程平均４８３．７分钟，第二产程平均１５６．７分钟。两组比较，差异有极显著性（Ｐ＜０．０１）。结论：在产程中指导产妇取侧俯卧位矫正胎头枕后位是降低难产发生率的有效方法。     

Neonatal Outcomes in the Birth Center Setting: A Systematic Review

Introduction

This systematic review investigates the effect of the birth center setting on neonatal mortality in economically developed countries to aid women and clinicians in decision making.

Methods

We searched the Google Scholar, CINAHL, and PubMed databases using key terms birth/birthing center or out of hospital with perinatal/neonatal outcomes. Ancestry searches identified additional studies, and an alert was set for new publications. We included primary source studies in English, published after 1980, conducted in a developed country, and researching planned birth in centers with guidelines similar to American Association of Birth Centers standards. After initial review, we conducted a preliminary analysis, assessing which measures of neonatal health, morbidity, and mortality were included across studies.

Results

Neonatal mortality was selected as the sole summary measure as other measures were sporadically reported or inconsistently defined. Seventeen studies were included, representing at least 84,500 women admitted to a birth center in labor. There were substantial differences of study design, sampling techniques, and definitions of neonatal outcomes across studies, limiting conclusive statements of the effect of intrapartum care in a birth center. No reviewed study found a statistically increased rate of neonatal mortality in birth centers compared to low‐risk women giving birth in hospitals, nor did data suggest a trend toward higher neonatal mortality in birth centers. As in all birth settings, nulliparous women, women aged greater than 35 years, and women with pregnancies of more than 42 weeks’ gestation may have an increased risk of neonatal mortality.

Discussion

There are substantial flaws in the literature concerning the effect of birth center care on neonatal outcomes. More research is needed on subgroups at risk of poor outcomes in the birth center environment. To expedite research, consistent use of national and international definitions of perinatal and neonatal mortality within data registries and greater detail on adverse outcomes would be beneficial.     

The Effect of Very Advanced Maternal Age on Maternal and Neonatal Outcomes: A Systematic Review

Objective

To summarize information on the maternal and perinatal outcomes among pregnant women with a maternal age greater or equal to 45 years old compared with women with a maternal age of less than 45.

The Effects of Prenatal Secondhand Smoke Exposure on Preterm Birth and Neonatal Outcomes

ObjectiveTo examine the relationship between prenatal secondhand smoke (SHS) exposure, preterm birth and immediate neonatal outcomes by measuring maternal hair nicotine.DesignCross‐sectional, observational design.SettingA metropolitan Kentucky birthing center.ParticipantsTwo hundred and ten (210) mother–baby coupletsMethodsNicotine in maternal hair was used as the biomarker for prenatal SHS exposure collected within 48 hours of birth. Smoking status was confirmed by urine cotinine analysis.ResultsSmoking status (nonsmoking, passive smoking, and smoking) strongly correlated with low, medium, and high hair nicotine tertiles (ρ=.74; p<.001). Women exposed to prenatal SHS were more at risk for preterm birth (odds ratio [OR]=2.3; 95% Confidence Interval [CI] [.96, 5.96]), and their infants were more likely to have immediate newborn complications (OR=2.4; 95% CI [1.09, 5.33]) than nonexposed women. Infants of passive smoking mothers were at increased risk for respiratory distress syndrome (RDS) (OR=4.9; 95% CI [1.45, 10.5]) and admission to a Neonatal Intensive Care Unit (NICU) (OR=6.5; CI [1.29, 9.7]) when compared to infants of smoking mothers (OR=3.9; 95% CI [1.61, 14.9]; OR=3.5; 95% CI [2.09, 20.4], respectively). Passive smokers and/or women with hair nicotine levels greater than .35 ng/ml were more likely to deliver earlier (1 week), give birth to infants weighing less (decrease of 200‐300 g), and deliver shorter infants (decrease of 1.1‐1.7 cm).ConclusionsPrenatal SHS exposure places women at greater risk for preterm birth, and their newborns are more likely to have RDS, NICU admissions, and immediate newborn complications.     

Adverse Maternal and Neonatal Outcomes in Adolescent Pregnancy

Study ObjectiveTo investigate the outcomes of adolescent pregnancy.DesignRetrospective cohort study from the Consortium on Safe Labor between 2002 and 2008.SettingTwelve clinical centers with 19 hospitals in the United States.ParticipantsNulliparous women (n = 43,537) younger than 25 years of age, including 1189 younger adolescents (age ≤ 15.9 years), 14,703 older adolescents (age 16-19.9 years), and 27,645 young adults (age 20-24.9 years).InterventionsAdjusted odds ratio (aOR) with 95% confidence interval (CI) were calculated, controlling for maternal characteristics and pregnancy complications (young adults as a reference group).Main Outcome MeasuresMaternal, neonatal outcomes, cesarean indications, and length of labor.ResultsYounger adolescents had an increased risk of maternal anemia (aOR = 1.25; 95% CI, 1.07-1.45), preterm delivery at less than 37 weeks of gestation (aOR = 1.36; 95% CI, 1.14-1.62), postpartum hemorrhage (aOR = 1.46; 95% CI, 1.10-1.95), preeclampsia or hemolysis, increased liver enzyme levels, and low platelet syndrome (aOR = 1.44; 95% CI, 1.17-1.77) but had a decreased risk of cesarean delivery (aOR = 0.49; 95% CI, 0.42-0.59), chorioamnionitis (aOR = 0.63; 95% CI, 0.47-0.84), and neonatal intensive care unit admission (aOR = 0.80; 95% CI, 0.65-0.98). Older adolescents had an increased risk of maternal anemia (aOR = 1.15; 95% CI, 1.09-1.22), preterm delivery at less than 37 weeks of gestation (aOR = 1.16; 95% CI, 1.08-1.25), and blood transfusion (aOR = 1.21; 95% CI, 1.02-1.43), but had a decreased risk of cesarean delivery (aOR = 0.75; 95% CI, 0.71-0.79), chorioamnionitis (aOR = 0.83; 95% CI, 0.75-0.91), major perineal laceration (aOR = 0.82; 95% CI, 0.71-0.95), and neonatal intensive care unit admission (aOR = 0.89; 95% CI, 0.83-0.96). Older adolescents were less likely to have a cesarean delivery for failure to progress or cephalopelvic disproportion (aOR = 0.89; 95% CI, 0.81-0.98). For adolescents who entered spontaneous labor, the second stage of labor was shorter (P < .01).ConclusionAdolescents were less likely to have a cesarean delivery. Failure to progress or cephalopelvic disproportion occurred less frequently in older adolescents. Adolescents who entered spontaneous labor had a shorter second stage of labor.     

Water Birth Maternal and Neonatal Outcomes Among Midwifery Clients in Alberta,Canada, from 2014 to 2017: A Retrospective Study

ObjectivesThis study sought to evaluate retrospectively the maternal and neonatal outcomes of water births (WBs) managed by Registered Midwives in Alberta compared with traditional or “land” vaginal birth outcomes for clinical evidence or knowledge and to assist in health care management planning.MethodsThis study was a retrospective cohort comparison of maternal and neonatal outcomes of WB (1716) and traditional or land birth (non-WB) (21 320) from selected low-risk maternal cohorts with spontaneous onset of labour and vaginal delivery in Alberta (2014-2017) using Alberta Perinatal Health Program data sets. Anonymized client and patient records linked the Alberta Perinatal Health Program data with inpatient Discharge Abstract Database for newborn and/or maternal personal health number (PHN/ULI) analyzed using SPSS 19.0 software (IBM Corp., Armonk, NY) (Canadian Task Force Classification II-2).ResultsThe WB group had fewer and less severe perineal lacerations despite increased macrosomia. The non-WB group had increased maternal factors (age <20 years, third- to fourth-degree perineal tears, excessive blood loss) and neonatal factors (Apgar scores <7 at 5 minutes and neonatal intensive care unit admission). No significant difference was identified between the birth groups for maternal age >35 years, primiparous status, maternal fever, maternal puerperal infection, maternal intensive care unit admission, low birth weight, neonatal resuscitation, and neonatal intensive care unit admission <28 days of life.ConclusionsA low-risk maternal cohort of WBs (1716) managed by midwives had equivalent or improved neonatal outcomes compared with a low-risk maternal cohort of land or traditional births (21 320) managed by midwives and other maternity providers.     

半坐卧位结合其它自由体位在分娩中的应用

目的：观察半坐卧位结合其它自由体位对促进产程及自然分娩的效果。方法：选择单活胎,枕先露,无严重并发症合并症孕妇800例,随机分为观察组和对照组,每组各400例,观察组在第一产程采取行走、蹲、坐、卧等自由体位,第二产程采取床头抬高,半坐卧位。对照组采取常规平卧,截石位分娩。观察两组患者三个产程、出血量、试产失败转剖宫产率、胎儿体重及Apgar评分。结果：观察组较对照组产程时间缩短,先露下降快,新生儿评分好,两组比较差异有统计学意义（P〈0．01）,转剖宫产率,观察组低于对照组,差异有统计学意义（P〈0．05）,出血量,胎儿体重两组无明显差异,无统计学意义（P〉0．05）。结论：自由体位分娩可缩短产程,减少母儿并发症,降低剖宫产率,提高产妇舒适度。