前不均倾位40例临床分析

胎头以前顶骨下降入盆呈倾势不均称前不均倾位。前不均倾位属头位难产,过去人们对此种胎头位置缺乏认识与重视,国内文献少有报道。本症绝大多数需剖宫产结束分娩,延误诊断与处理则危及母儿安全。临床资料一、发生率我院1984年1月至12月住院分娩总数为2907例,前不均倾位为40例,其发生率为1.38%,而头位分娩总数为2705例,则其发生率为1.48%,比国内凌氏报道为高。二、发生原因本文前不均倾位40例中,有明显诱因者22例,其中骨盆狭窄4例,头盆不称(?)例,双胎1例,巨大胎儿2例,胎膜早破7例,催产素点滴引产4例。原因不明者18例。     

胎头左右不均倾势的诊断与处理

头位分娩时,胎头不论取枕横位,枕后位或枕前位通过产道,均可发生不均倾势,以枕横位中的前不均倾为多见。前不均倾势危害较大,已逐渐被人们重视,枕后位、枕前位中的胎头不均倾势较少报道。1985年下半年,我们前瞻性观察了75例头位阴道手术产,发现左右不均倾势13例,其中枕前位9例,枕后位5例。现把我们的经验及教训总结如下: (1)胎头左右不均倾势的判断标准:①胎头达S~( 3)后作阴道检查,胎头为枕前位或枕后位,但矢状缝偏向一侧。矢状缝偏向骨盆左侧者为左不均倾势;偏向骨盆右侧者为右不均倾势。②胎儿两耳不在骨盆同一平面上,如先露顶骨同侧的耳朵位置低,易触及,     

何谓前不均倾位?

答:前不均倾位是头位难产的一种.其发病率为0.3～40.7％,可见其在临床实践中具有重要意义.在枕横位中,当胎头的矢状缝与骨盆入口横径相平行时,胎头后顶骨先入盆,矢状缝靠近耻骨联合,称为后不均倾位.正常情况骶骨有一向后的弧度称骶凹,有利于后顶骨向后退让,前顶骨即可滑到耻联后方呈头盆均倾位,接着胎头向前旋转90°,以枕前位完成分娩机转.当枕横位时若胎头以前顶骨先入盆,矢状缝靠近骶岬即形成前不均倾位.由于耻联内面平直无陷凹,前顶骨紧紧嵌于耻骨联合后方卡在骶岬上,胎头很难     

胎头位置异常的诊断及分娩处理

持续性扰后位、持续性枕横位,前不均倾位,胎头高直位,额位和面位都属于胎头位置异常,常常引起难产,也容易招致胎儿窘迫。现就诊断与处理分述如下。一、持续性枕后位传统的概念是胎头以枕后位衔接,至分娩后期,胎头达盆底时仍为枕后位者称为持续性枕后位。目前认为:正式临产后,胎头不论居任何平面,试产一段时间,当     

妊娠合并糖尿病酮症酸中毒的识别和处理

妊娠合并糖尿病酮症酸中毒是产科严重的合并症,如未能及时诊断及处理,会造成母儿严重的不良结局.本文就妊娠合并DKA的临床识别及处理进行讨论.     

超声测量胎儿脾脏在红细胞同种免疫性妊娠中的应用

妊娠合并胎儿免疫性溶血的处理包括:检测母血抗体水平,超声检查以及羊膜腔穿刺和脐带穿刺等创伤性诊断手段。创伤性诊断手段对母儿的危险性较大,包括:急性胎儿窘迫、胎儿心动过缓、感染、母儿间输血导致母血抗体水平升高等。采用超声预测胎儿贫血的严重程度可以克服羊膜腔穿刺和脐带穿刺之不足,并能确定胎儿血管内输血的时间。 对28例重度免疫性溶血胎儿进行胎血取样前超声测量胎儿脾脏大小。共进行85次胎血取样,其中     

重型胎盘早剥的诊断和处理

胎盘早剥病因未明,是妊娠晚期严重并发症,起病急,发展快,甚至危及母儿生命。尽早发现胎盘早剥能够避免母儿不良结局,如果发生重型胎盘早剥,及时的诊断及处理能够改善母儿预后。     

HELLP综合征和HUS-TTP的诊断和鉴别诊断

<正>HELLP综合征与溶血性尿毒症综合征(hemolytic uremia syndrome,HUS)-血栓性血小板减少性紫癜(thrombotic thrombocytopenic purpura,TTP)均是妊娠严重并发症,其发病急骤,严重威胁孕产妇及胎儿生命。临床上二者因其相似的发病机制及临床症状,易引起临床医师混淆,给临床诊断、治疗带来困难。因此,充分认识HELLP综合征和HUS-TTP的诊断和鉴别诊断,对疾病的临床处理,降低患者死亡率和改善母儿预后具有重大意义。     

重症母儿血型不合溶血病428例孕期监测及处理

目的：探讨重症母儿血型不合溶血病的孕期监测及处理。方法：回顾性分析428例重症母儿血型不合溶血病的产科临床资料。结果：428例孕妇,治疗前获存活儿158个,经孕期和新生儿期监测和治疗后获存活儿416个。结论：对于高危人群应早期诊断、早期治疗,加强孕期及新生儿期监测及处理,可明显改善围生儿结局。     

胎头高直后位的早期诊断价值

胎头高直后位的早期诊断价值锦州医学院附属第一医院妇产科（１２１００１）王琴立李健胎头高直位属严重胎头位置异常。尤其是高直后位，多难以经阴道分娩，如不早期识别，恰当处理，会给母儿带来严重危害。现将我院处理的２５例高直后位，分析报道如下。１资料与方法１．...     

妊娠期急腹症的紧急处理

妊娠期急腹症缺乏典型的症状和体征,加上妊娠因素导致的生理和解剖上的变化,诊断较为困难。妊娠期急腹症病情发展快,严重者可危及母体和胎儿的生命安全。其治疗方案应根据急腹症的疾病种类,多学科共同协作,权衡母体和胎儿的利与弊,进行个体化治疗。     

Routine preoperative ultrasonography and cesarean section

This prospective investigation was undertaken to determine whether routine ultrasound visualization of the gravid uterus shortly before cesarean section would provide useful information in determining the site for uterine incision. Complete data were gathered on 124 pregnancies using a portable real-time ultrasound machine. Determination of the placenta and umbilical cord locations, fetal presentation, and amniotic fluid volume were reliable. Compared with a matched group without ultrasonic visualization, the eventual site for uterine incision and morbidity to the mother and fetus were not significantly different. Although routine visualization of the intrauterine contents before surgery is not necessary, worthwhile information may be gained in select cases to confirm a previously suspected noncephalically presenting fetus or a low anterior placenta.     

Intrapartum sonography for fetal head asynclitism and transverse position: sonographic signs and comparison of diagnostic performance between transvaginal and digital examination

Objective: The primary goal of this study was to determine the ultrasonographic signs of asynclitic and transverse head positioning. In addition, we compared the performance of intrapartum ultrasound to vaginal digital examination. Material & Methods: 150 women were evaluated by 2D transabdominal and translabial ultrasound (US) to detect the asynclitic and deep transverse positions. Transvaginal sterile digital examinations were performed immediately after each intrapartum US assessments, the examinations were repeated at intervals of 45–90 minutes. Examiners were blinded to each other’s findings (clinical or sonographic). Data were reviewed and analyzed by an independent reviewer. Results: The efficacy of digital examination was significantly lower than US evaluation for the detection of either transverse position or asynclitism. The most frequent transverse position was the left one, while the most frequent asynclitism was the anterior one. Conclusions: Digital pelvic examination for detection of fetal head transverse position during labor is inferior to US, especially in the deep transverse positioning, where caput succedaneum occurs and reduces the diagnostic accuracy of vaginal digital examination. The US examination leads to early detection of persistent transverse position allowing for earlier timing and optimal technique for the operative vaginal delivery. We describe two signs for diagnosing asynclitism. The “squint sign” and the “sunset of thalamus and cerebellum signs” are two simple US signs allowing detection of anterior and posterior asynclitism.     

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.     

External version from breech position to head presentation near term

The external version of fetus from breech into a head presentation is one of the methods to avoid maternal and fetal risk by Cesarean section and by vaginal delivery. As a supposition, we see a technique which is undangerous for mother and fetus. Our procedure corresponds in many points with a practice, which is published by B. Westin. The sober patient is positioned head down on the side of fetus small parts. Then an intravenous infusion is given over 30 min with 2 micrograms fenoterol (Partusisten)/min. The version is performed in many single and little steps. It needs time, a soft hand and the readiness of the Cesarean section. In 104 of 242 patients with breech presentation there was the indication with fulfilled suppositions for such a version. The success-rate was nearly 50%. In no case there was a complication. The rate of Cesarean section past turning was clearly reduced in contrary to breach presentation. The fetal outcome was clearly better. The version of breach presentation is recommended.     

Asynclitism: a literature review of an often forgotten clinical condition

Asynclitism is defined as the “oblique malpresentation of the fetal head in labor”. Asynclitism is a clinical diagnosis that may be difficult to make; it may be found during vaginal examination. It is significant because it may cause failure of progress operative or cesarean delivery. We reviewed all literature for asynclitism by performing an extensive electronic search of studies from 1959 to 2013. All studies were first reviewed by a single author and discussed with co-authors. The following studies were identified: 8 book chapters, 14 studies on asynclitism alone and 10 papers on both fetal occiput posterior position and asynclitism. The fetal head in a laboring patient may be associated with some degree of asynclitism; this is seen as usual way of the fetal head to adjust to maternal pelvic diameters. However, marked asynclitism is often detected in presence of a co-existing fetal head malposition, especially the transverse and occipital posterior positions. Digital diagnosis of asynclitism is enhanced by intrapartum ultrasound with transabdominal or transperineal approach. The accurate diagnosis of asynclitism, in an objective way, may provide a better assessment of the fetal head position that will help in the correct application of vacuum and forceps, allowing the prevention of unnecessary cesarean deliveries.     

胎方位异常的管理：面先露

面先露发病率低,但处理不当极易出现严重母儿合并症。面先露时胎头俯屈不良,下降及内旋转均发生困难,足月儿很难自然分娩。如不能及早识别与妥善处理,面先露危害母儿生命安全。本文就面先露早期识别与处理进行阐述。     

Psychosis and pregnancy: some new ethical and legal dilemmas for the physician

Physicians who treat women of childbearing age may encounter the presentation of psychosis in a pregnant woman that presents special problems in diagnosis and treatment, particularly ethical and legal considerations that center on the rights of the mother as well as the continually evolving definition of fetal rights. This article represents a collaborative effort to address these considerations. Representative case material from the treatment of a psychotic pregnant patient is presented with a focus on the nature of the contractual relationship of the treating physician with the mother and fetus.     

A prospective randomized study of induction of labor

In a prospective randomized study spontaneous and oxytocin induced labor have been compared with respect to duration of labor and the condition of the fetus and the newborn infant. The study consists of 166 normal patients at full term. No significant differences between the two groups were found, and the results of the study showed that induction of labor between the 40th and 41st week of pregnancy was safe for the fetus. It is concluded that there seems to be no increased risks to mother or fetus from induction of labor compared to normal labor provided that there is cephalic presentation and a normal pregnancy.