足月妊娠头先露胎膜早破对母儿的影响

足月妊娠头先露胎膜早破对母儿的影响东北电业中心医院（１１００１５）徐克强为了解胎膜早破对母儿的影响，现对我院１３７例足月妊娠头先露胎膜早破病例分析报道如下。１资料与方法１．１一般资料我院１９８７年１１月至１９９５年７月间住院分娩产妇总数为５６７０例，...     

子痫前期终止妊娠的时机和方式

子痫前期严重威胁母儿健康和安全,特别是伴有母体器官功能受累或胎盘-胎儿并发症者.子痫前期的病理生理机制复杂,病程发展迅速,早期识别困难,适时终止妊娠是避免不良妊娠结局的重要措施.选择分娩方式时,应充分考虑母胎状况、胎先露、孕周、宫颈成熟度和产房条件.     

面先露23例分析

面先露是极少见的胎位,发生率约1‰。如误诊或处理不当,可造成母要的严重后果。本文就我院16年来23例面先露进行分析,并就诊断及处理进行探讨.临床资料我院1969～1984年分娩总数39024例,面先露23例,其中初产妇15例,经产妇3例。除2例为第一产     

臀位分娩方式及助产术问题

臀位(臀先露)是最常见的异常胎位,其分娩方式的选择存在很大争议,目前尚无统一标准。应在遵循母儿安全原则基础上,采取个体化处理,最大程度减少臀位分娩并发症。臀位助产必须对孕妇和胎儿进行充分的产前评估,助产人员必须熟练掌握臀位分娩机制,正确处理分娩过程中可能出现的异常情况,以减少母儿并发症。     

444例头位难产的分析

现将我院1980年1月～1982年12月间444例头位难产进行回顾性分析,探讨如何从头先露中尽早地识别难产,及时给予处理,保障母儿健康。临床资料一、头位难产的发生率:本院自1980年1月至1982年12月,三年内分娩总数为3598例,其中头位3344例,占分娩总数的93％;臀位224例,占6.2％;横位30例,占0.8％;头位难产有444例,占分娩总数的12.4％,占头位分娩总数的13.3％。     

非头先露早产胎膜早破42例妊娠结局

目的探讨非头先露早产胎膜早破（preterm premature rupture of membranes,PPROM）的并发症、分娩方式及母婴结局。方法回顾性分析在北京航天总医院分娩的42例非头先露PPROM和178例头先露PPROM的临床资料,对两组并发症、分娩方式及母儿结局进行比较。结果非头先露PPROM在脐带脱垂、羊水过少、1min低Apgar评分、死胎死产、新生儿死亡的发生率显著高于对照组,差异有统计学意义（P值分别为〈0.001、〈0.001、〈0.001、〈0.035、〈0.001）。非头先露PPROM组剖宫产率明显高于对照组（P〈0.001）;采取多因素Logistic回归分析,非头先露PPROM组脐带脱垂（P=0.021,OR=0.073）,1min低Ap-gar评分（P=0.018,OR=0.092）的发生率显著增高,PPROM组脐带脱垂的发生率明显高于同期足月PROM组（4.1%vs0.5%）,且同期非头先露PROM组脐带脱垂的发生率明显高于同期头先露PROM组（2.6%vs0.5%）,差异有高度统计学意义（P〈0.001）。结论非头先露PPROM是脐带脱垂、1min低Apgar评分的危险因素,剖宫产是非头先露PPROM较为安全的分娩方式,如阴道分娩需提高臀位助产技术。     

肩难产的诊断及处理

肩难产(shoulder dystocia)是一种不常见的分娩并发症。胎头娩出后,胎儿前肩被嵌顿于耻骨联合后上方,用常规助产方法不能娩出胎儿双肩,称为肩难产。由于其常在儿头娩出后意外发生,情况危急,贻误时机或处理不当,可造成母儿严重并发症。因此,早期预测、识别和正确处理肩难产是非常重要的问题。 1 肩难产的发生率及病因国外报道肩难产发生率为0.15％～0.6％,国内报道为0.15％。其发生与以下几种因素有关。 1.1 肩难产的发生与胎儿体重密切相关。Benedetti等报道肩难产发生率占所有顶先露阴道分娩的0.37％,如胎儿体重>4000g发生率可高达1.7％,胎     

1988年产钳的重新分类

1988年ACOG组织建议对1965年产钳分类进行重新修订。 1965年产钳分出口、中位和高位。出口产钳阳定胎先露已达盆底,儿头矢状缝在骨盆前后径上。中位产钳胎头衔接,儿头在出口未见到,可以有些旋转。高位产钳胎先露浮动。按此分类的缺点是出口产钳限定面太窄,而中位产钳面太宽,且含糊不清。     

前置胎盘的病因研究及分类

胎盘在正常情况下附着于子宫体部的后壁、前壁或侧壁.孕28周后若胎盘附着于子宫下段,甚至胎盘下缘达到或覆盖宫颈内口,其位置低于胎先露部,临床上称为前置胎盘(placenta previa).前置胎盘是妊娠晚期出血的主要原因之一,是妊娠期的严重并发症,处理不及时会危及母儿生命.     

妊娠期糖尿病酮症酸中毒的预测及预警

妊娠期糖尿病酮症酸中毒是一种少见但却潜在威胁母儿生命安全的疾病。多见于1型糖尿病合并妊娠的患者,也可见于2型糖尿病合并妊娠患者和妊娠期糖尿病患者。对妊娠期糖尿病酮症酸中毒进行早期的识别和诊断,对改善母儿结局意义重大。文章就妊娠期糖尿病酮症酸中毒的病理生理、对母儿的影响、诱发因素、预测因子、早期预警信号及预测模型等进行论述。     

What to do when it is breech? A state-of-the-art review on management of breech presentation

Any non-cephalic presentation in a fetus is regarded as malpresentation. The most common malpresentation, breech, contributes to 3%-5% of term pregnancies and is a leading indication for cesarean delivery. Identification of risk factors and a proper physical examination are beneficial; however, ultrasound is the gold standard for the diagnosis of malpresentations. External cephalic version (ECV) refers to a procedure aimed to convert a non-cephalic presenting fetus to cephalic presentation. This procedure is performed manually through the mother’s abdomen by a trained health care provider, to reduce the likelihood of a cesarean section. Studies have reported a version success rate of above 50% by ECV. The main objective of this review is to present a broad perspective on fetal malpresentation, ECV, and delivery of a breech fetus. The focus is to elaborate all clinical scenarios of breech and to provide an evidence-based clinical approach for them. After discussing breech prevalence, risk factors, diagnosis, and management, an updated review of ECV is presented. Moreover, ECV indications/contraindications, alternatives, clinical techniques on how to perform ECV and breech vaginal delivery, and obstetrical considerations for the delivery of malpresentations are thoroughly discussed.     

前不均倾位的早期识别、诊断与处理

前不均倾位是导致难产的重要原因之一,属严重胎头位置异常,一般需剖宫产分娩。前不均倾位早期难以识别,易误诊和漏诊,对母儿危害极大。本文重点阐述经阴道试产中胎儿前不均倾位的临床特点、诊断和处理方法,旨在加强临床医护人员对前不均倾位的认识和重视,防止诊断、处理不及时对母儿造成严重伤害。     

两种体侧卧位法纠正枕后位的临床观察

目的探讨产程中产妇采用两种不同体侧卧位纠正枕后位的临床效果.方法选择潜伏期经内诊或B超确诊为枕后位的初产妇100例,按随机表法分成同侧卧位组和对侧卧位组(各50例),分别采用同侧和对侧卧位法纠正胎方位,观察两组阴道分娩率、第1产程时间.结果(1)同侧卧位组阴道分娩34例(68%),胎儿转至枕前位27例(54%),对侧卧位组阴道分娩为22例(44%),胎儿转至枕前位12例(24%),两组比较,差异有显著性(P＜0.005).(2)同侧卧位组平均第1产程时间为(13.5±6.5)h;对侧卧位组平均第1产程时间为(17.1±7.2)h,两组比较,差异有极显著性(P＜0.01).结论产程中指导产妇取同侧卧位矫正枕后位,是提高阴道分娩率、缩短第1产程的有效方法.     

Transabdominal encephalocentesis of hydrocephalus associated with breech presentation

Two cases of transabdominal encephalocentesis in hydrocephalic breech presentation are reported and the literature reviewed.It seems that the simple procedure of early transabdominal decompression of the hydrocephalic head, resulted in accelerated cervical dilatation and uncomplicated deliveries.This method of management is probably safer than the puncture of the aftercoming head.     

Perinatal mortality in breech presentations as compared to vertex presentations in singleton pregnancies: an analysis based upon 57819 computer-registered pregnancies in The Netherlands

In 1982, nationwide registration of obstetric data was instituted in The Netherlands with about 70% of all Dutch hospitals participating. The resultant data from 57819 singleton pregnancies in vertex or breech presentation at delivery was studied. The vertex and breech groups were compared. The proportion of breech presentations relative to vertex presentations was greater in low gestational age infants and those of low birthweight. After correction for gestational age and birthweight, the perinatal mortality was higher in the breech groups than in the vertex groups. Congenital malformations occurred more frequently in the breech group but, even after exclusion of infants with congenital malformations, perinatal mortality remained higher in the breech group at any gestational age. Caesarean section was more frequently performed in the breech group than in the vertex group but did not appear to improve the outcome of breech presentation. It is possible that breech presentation is not coincidental but is a consequence of poor fetal quality, in which case medical intervention is unlikely to reduce the perinatal mortality associated with breech presentation to the level associated with vertex presentation.     

Longitudinal ultrasound assessment of fetal presentation: a review of 1010 consecutive cases

BACKGROUND: Abnormal presentation (detected in the early third trimester) causes concern for pregnant women and their carers. Definitive ultrasound-based data on the risk of persistence of abnormal presentation is lacking to allow appropriate counselling. Comparison of pregnancy outcome was made on the basis of maternal age at delivery. METHODS: Notes of 1010 women (426 primigravidae, 584 multigravidae), with singleton pregnancies, confined between 1997 and 2005 were reviewed to extract: (i) the gestation based on 18-20-week ultrasound in conjunction with the patient's recorded last menstrual period, and (ii) the presentation of each antenatal visit from 28+ weeks until delivery. Previous obstetric history, maternal age, mode of delivery, birthweight and outcomes were also documented. RESULTS: At 28-30 weeks, 216 babies presented abnormally. By 38+ weeks, 54 persisted as either a breech or a transverse lie. Thus, an abnormal presentation in the early trimester carries a 22.2% chance of persisting at term. Continuance of abnormal presentation at each subsequent week of the third trimester increased the risk of a Caesarean delivery at term. Conversely, in only six cases, a cephalic presentation at 28-30 weeks converted to a breech or other presentation during the third trimester-- a risk of 0.75%. CONCLUSION: These statistics provide a useful tool in advising women of the chances of abnormal presentation at term based on the presentation at various stages of the third trimester, and prepare them for the potential requirement of a Caesarean section.     

Linear association between maternal age and spontaneous breech presentation in singleton pregnancies after 32 weeks gestation

Purpose: To investigate the association between maternal age and spontaneous breech presentation.

Material and methods: Fifteen-year observational study over (2001–2015). All consecutive singleton births delivered at the Centre Hospitalier Universitaire Sud Reunion’s maternity. The only single exclusion criterion was uterine malformations (N?=?123) women.

Results: Of the 60,963 singleton births, there was a linear association (χ² for linear trend, p2 for linear trend?=?64, p?p?Conclusion: Maternal age (x) is an independent factor for breech presentation in singleton pregnancies after 32 weeks gestation with a linear association that may be approximated at y?=?0.1x. (y: incidence, percent).     

Brow and face presentations

Experience with 50 face and 34 brow presentations of the fetus at delivery in the Mayo Clinic agrees with that reported by others. The presence of a small pelvis, a small fetus, a large fetus, cranial abnormalities, placenta previa or a low-lying placenta, and twins seemed to contribute alone or in combination to the occurrence of these deflection attitudes. Premature rupture of membranes, looping of the cord, hydramnios, and pelvic tumors were not as common in this series as in others.The possibility of face or brow presentation should be kept in mind when the fetal head remains high during labor as well as when the fetal cephalic prominence is palpated on the same side as the fetal back. With early recognition and proper management, such a presentation should mean little, if any, additional risk to the mother or fetus. The patient should be given a trial of labor with frequent evaluation of uterine contractions and physical status of mother and fetus, with careful observation of progress during labor. Unless there is arrest of labor or signs of maternal or fetal distress, most of these patients can be expected to be delivered vaginally. Prolonged labor from combined dystocia and uterine inertia was common both in patients with face presentation and in those with brow presentation, but most of these also were delivered vaginally.Manual and forceps rotation or flexion or further extension of the extended fetal head is occasionally successful in converting the presentation to a more favorable one so that subsequent vaginal delivery becomes possible. The most frequent need for cesarean section in this series arose in the primiparas, particularly in those with the fetus in the mentoposterior position.     

Spinal cord injuries at birth: A multicenter review of nine cases

Objective. To report a multicenter study of nine cases of children presenting with a birth-related spinal injury.

Methods. The medical charts of nine patients identified by a questionnaire sent to the members of the French Society of Pediatric Orthopedics (SOFOP) were reviewed.

Results. The pregnancy was uneventful in all cases. The fetal presentation was cephalic in three cases, a breech presentation in four cases, and a face presentation in two cases. The lesion involved the cervical spine in six cases. Three patients presenting upper cervical injuries died before the age of six years. The six remaining patients experienced no neurological improvement.

Conclusions. These rare conditions occur during difficult deliveries with abnormal presentations, the most common being a breech presentation with entrapment of the fetal head. In a child with hypotonia, flaccid quadriplegia or high thoracic paraplegia after a difficult delivery, a spinal cord injury must be suspected and plain radiographs and MRI must be performed.     

Factors affecting the success of moxibustion in the management of a breech presentation as a preliminary treatment to external cephalic version

Objectives

to explore the effects of moxibustion treatment, to examine the predictors of its use in causing a breech presentation to spontaneously turn to a cephalic presentation which will result in a vaginal birth (the paper will refer to this as ‘successful’) and offer external cephalic version (ECV) subsequently after moxibustion treatment when the fetus remains in a breech presentation.

Design

a prospective study over a two-year time period from February 2004 until January 2006.

Participants

76 pregnant women from various acupuncture practices in the UK, with a third trimester breech presentation.

Interventions

the acupuncturist taught the women how to apply moxibustion (sticks of compressed dried herbs—Artemisia vulgaris) treatment at home by stimulating the acupoint on the outer edge at the base of the little toe nail for seven days twice a day (morning and afternoon). If the breech presentation persisted after treatment, ECV was carried out towards the end of the pregnancy. The obstetricians offered this during the routine antenatal hospital visits.

Findings

the results show that following treatment with moxibustion, 31 (40.8%) of the breech presentations spontaneously turned to cephalic presentations, and a further 33 (43.4%) breech presentations were turned by ECV. Women who involved other people in the administration of moxibustion were twice as likely to be successful. Multiparous women were also 16% more likely than primiparous women to succeed in achieving a spontaneous version with the use of moxibustion. Fewer side effects reported when using moxibustion were the strongest predictor of successful spontaneous cephalic version with an odds ratio of 12% (p=0.02).

Key conclusions

moxibustion creates a better chance of vaginal birth for expectant mothers. Of the women who were successful in turning their babies using moxibustion, 88% went on to have a normal birth and 12% had a caesarean section. Moxibustion treatment also significantly increases version from a breech presentation to a cephalic presentation where there are fewer side effects reported, if the woman is multiparous and has support during the administration of moxibustion treatment.

Implications for practice

moxibustion treatment should be offered to all women with a breech presentation because it is non-invasive and can be self-administered by the woman. It is therefore a simple, cost-effective technique that requires no medical intervention.