剖宫产术对母乳喂养影响的前瞻性研究

目的研究剖宫产术对母乳喂养的影响.方法采用前瞻性研究方法,选择剖宫产（剖宫产组）、阴道分娩（阴道分娩组）各301例产妇为研究对象,比较两组产妇产后泌乳始动时间、产后1年内母乳喂养情况;用放射免疫法测定两组产妇产后血清催乳素含量.结果在分娩后6～24 h内的白天,剖宫产组产妇血清催乳素均值为8.48 nmol/L（95%CI：7.80～9.21 nmol/L）、阴道分娩组为9.61 nmol/L（95%CI：8.99～10.26 nmol/L）.剖宫产组产妇产后泌乳始动中位时间为产后12 h,晚于阴道分娩组的产后2 h.剖宫产组产妇产后1个月时乳量仅为阴道分娩组的90%.产后1、6、12个月时,剖宫产组母乳喂养率均低于阴道分娩组;剖宫产组产妇产后1年内母乳喂养失败的风险是阴道分娩组的1.21倍（95%CI：1.10～1.33）. 结论与阴道分娩组比较,剖宫产术后产妇泌乳始动时间晚,血清催乳素含量低,产后1年内母乳喂养失败的风险高.对剖宫产产妇更应加强促进泌乳、催乳的措施,以提高母乳喂养成功率.     

重症监护病房住院产妇母乳喂养的影响因素

目的分析重症监护病房(intensive care unit, ICU)住院产妇母乳喂养的影响因素。方法本研究为现况调查, 研究对象为2020年3月1日至8月31日在湖北省妇幼保健院重症医学科住院的产妇。通过电子病历系统收集产妇的分娩信息及收住ICU的原因;产后第3～7天进行母乳喂养自我效能量表(Breastfeeding Self-Efficacy Scale, BSES)、情绪调节量表(Emotion Regulation Scale, ERS)和爱丁堡产后抑郁量表(Edinburgh Postnatal Depression Scale, EPDS)评分;产后半年通过问卷星获取产妇的基本情况、母乳喂养知识来源和母乳喂养信息。采用t检验、秩和检验、χ2检验(或校正χ2检验, 或Fisher 精确概率法)及趋势检验及二分类logistic回归分析等方法进行统计学分析。结果共138例产妇纳入分析, 包括母乳喂养组117例(母乳喂养≥6个月67例, 母乳喂养<6个月50例)和人工喂养组21例。母乳喂养组与人工喂养组比较, 产后食欲好[2组"一般""较好"和"非常好"分别为21.4%...     

个性化中医护理对初次剖宫产产妇母乳喂养的影响研究

目的分析个性化中医护理对初次剖宫产产妇母乳喂养的影响。方法纳入本院自2018年6月~2019年6月期间接收的初次剖宫产产妇(n=60)作为研究对象,以硬币投掷法为基准,分为观察组和对照组,对照组予以常规护理,观察组予以个性化中医护理,对60例产妇母乳喂养率、负性情绪及产妇依从性评估。结果观察组母乳喂养率及产妇依从性高于对照组,P<0.05;观察组负性情绪低于对照组,P<0.05。结论对初次剖宫产产妇采用个性化中医护理干预,可以明显提高母乳喂养率,减少产妇负性情绪,提高依从性,值得进一步推广。     

产妇抚触婴儿对自身恢复及母乳喂养的影响

目的 了解产妇抚触婴儿对自身恢复及母乳喂养的影响。方法 选择2004年6月-2005年12月在我院住院分娩的262例初产妇，将她们随机分成抚触组和对照组进行对照研究。结果 抚触组产妇的泌乳量、睡眠质量明显优于对照组，两组比较差异有非常显著性（P〈0．01）。抚触组的产后浆液性恶露消失时间明显早于对照组，婴儿生后24h吃奶次数、48h吃奶次数明显多于对照组，两组比较差异有非常显著性（P〈0．01）。结论 抚触不仅使产妇乳汁分泌量增加、婴儿吃奶次数明显增多，有利于新生儿健康成长，而且可以缩短产妇浆液性恶露消失的时间、促进产妇产后自身的恢复。     

产妇母乳喂养的影响因素及护理措施

目的：提高产后母乳喂养成功率。方法：对产妇母乳喂养不足的原因进行分析,提出了相应的护理措施。结果：母乳喂养不仅有利于婴儿生长和健康,而且还能促进母体子宫收缩,减少产后出血,加速子宫复旧。结论：积极主动地配合母乳喂养,保障母乳喂养的成功率。     

产妇认知与母婴皮肤接触对剖宫产儿早期体温的影响

目的:探讨产妇认知与母婴皮肤接触对剖宫产儿早期体温的影响,确保剖宫产儿早期保暖复温。方法:知情同意原则下随机选择400例健康孕妇分为两组,干预组比对照组新生儿皮肤接触早30分钟。结果:两组新生儿末次体温具有显著性差异,P<0.01。结论:母婴皮肤接触利于剖宫产儿早期保暖复温。     

系统护理对妊娠合并症产妇母乳喂养知识掌握水平及母乳喂养率的影响

目的探讨在妊娠合并症产妇中系统护理对于母乳喂养知识掌握水平、母乳喂养率等产生的影响。方法抽选我院在2017年1月~2019年10月间医治的妊娠合并症产妇(96例)开展研究,单双号法分成乙组、甲组,各48例。乙组产妇常规护理,甲组产妇系统护理,总结母乳喂养率、母乳喂养知识掌握程度。结果对比母乳喂养率,乙组低于甲组(P<0.05)。对比母乳喂养知识总掌握度,乙组低于甲组(P<0.05)。结论给予妊娠合并症产妇系统护理,可提高产妇对于母乳喂养知识的掌握水平,并提高母乳喂养率。     

围生期健康教育对孕产妇健康素养与母乳喂养自我效能的影响分析

目的 探讨围生期健康教育对孕产妇健康素养及母乳喂养自我效能的影响。方法 选取92例建档孕产妇,根据随机数字表法分为对照组与干预组,每组46例。对照组采用常规检查和随访,干预组采用围生期健康教育。比较两组孕产妇健康素养、母乳喂养自我效能。结果 干预组沟通评分（58.7±4.1）分、功能评分（94.6±5.5）分、批判评分（63.8±5.9）分均显著高于对照组的（51.3±6.1）、（83.7±6.9）、（55.7±4.3）分,母乳喂养技巧评分（71.1±3.2）分、心理活动评分（68.9±6.4）分均高于对照组（63.8±6.9）、（60.4±5.4）分,差异有统计学意义（P<0.05）。结论 围生期健康教育在孕产妇中可协助提高健康素养和母乳喂养自我效能,具有重要应用价值。     

产后乳房护理对初产妇母乳喂养情况及乳汁淤积发生率的影响

目的 探究初产妇产后乳房护理对母乳喂养情况及乳汁淤积发生率的影响。方法 选取96例初产妇,采用随机数字表法分为对照组与观察组,各48例。对照组采用常规护理,观察组在对照组基础上采用产后乳房护理。比较两组产后母乳喂养率及乳汁淤积发生率。结果 观察组初产妇产后母乳喂养率为95.83%,明显高于对照组的83.33%,差异有统计学意义（P<0.05）。观察组初产妇产后乳汁淤积发生率为2.08%,明显低于对照组的12.50%,差异有统计学意义（P<0.05）。结论 在初产妇产后护理中应用乳房护理可提高母乳喂养率,预防乳汁淤积情况,具有临床应用价值。     

影响产后早期母乳喂养的因素及干预措施

分析影响当今住院产妇早期母乳喂养的原因,给予干预措施,从而提高早吸吮母乳喂养率。方法:分析486例住院分娩产妇早吸吮母乳存在的问题,制定护理对策。结果:产后早期母乳喂养不足的因素与产妇缺乏母乳喂养知识、缺乏喂养技巧、缺乏医护人员的有效支持有关。采取干预措施,早吸吮母乳率提高到100%。结论:住院期间给予孕产妇耐心细致的健康宣教及床旁一对一的母乳喂养技巧指导,做到早接触、早吸吮、按需哺乳,对于促进母乳喂养成功非常关键。     

Immediate breastfeeding and skin-to-skin contact during cesarean section decreases maternal oxidative stress,a prospective randomized case-controlled study

Objective: Immediate skin-to-skin contact (ISSC) and early breastfeeding are recommended for the wellbeing of the neonate. In this study, we aimed to evaluate the effect of ISSC and early breastfeeding on maternal oxidative stress and postoperative pain.

Methods: A total of 90 patients were randomized into two groups based on the timing of skin-to-skin contact and breastfeeding. Group 1 (n?=?45) was provided ISSC and breastfeeding in the operating room during the cesarean section (C/S). Group 2 (n?=?45) breastfed their babies 1?h after the C/S. As markers of oxidative stress, maternal serum levels of total antioxidant status (TAS), total oxidant status (TOS) and oxidative stress indices (OSI) were evaluated. Maternal oxytocin levels and the relation between these parameters and postoperative pain were also evaluated.

Results: The postoperative TAS levels were significantly higher, whereas TOS and OSI levels were lower in Group 1 than Group 2. Negative correlations between oxytocin level and postoperative TOS and OSI were observed, as was a positive correlation between oxytocin level and postoperative TAS.

Conclusions: The effect of ISSC and early breastfeeding on mothers was documented for the first time in this study. Our results demonstrated ISSC and early breastfeeding during C/S reduce maternal oxidative stress.     

The effect of educational package on functional status and maternal self-confidence of primiparous women in postpartum period: a randomized controlled clinical trial

Objective: The aim of this study was to determine the effect of a training package on functional status and self-confidence of primiparous women in the postpartum period.

Method: This randomized controlled clinical trial was conducted on 136 primiparous women who were referred to health centers in Tabriz, Iran, for their second postpartum care (10–15 days after delivery). These women were randomly assigned to education (n=?68) and control (n?=?68) groups. The education group was provided with a face-to-face training session, three phone sessions, and a booklet. The control group received the routine postpartum care on days 1–3, 10–15 and 42–60. Participants completed the functional status and maternal self-confidence questionnaires before the interventio n and eight weeks postpartum. Independent t, chi-square and Fisher’s exact tests were used for data analysis.

Results: No statistically significant difference was observed between the two groups in terms of sociodemographic characteristics, except for infant’s gender (p?>?.05). At six weeks after the intervention and by adjusting for baseline scores and infant’s sex, mean scores of functional status (adjusted mean difference: 0.9; 95% CI: 0.8–1.03, p?p?Conclusion: This study showed that training women has a positive effect in increasing their self-confidence and improving their functional status.     

Foley尿管水囊促宫颈成熟用于足月妊娠引产的前瞻性随机对照研究

目的 比较Foley尿管水囊与普贝生栓促宫颈成熟用于足月妊娠引产的安全性和有效性. 方法 采用前瞻性随机对照研究方法,选择2009年6月至12月在本院待产的孕足月、单胎头位、有引产指征、阴道清洁度≤Ⅱ度、胎膜完整、官颈Bishop评分＜6分的初产妇,签署随机对照研究知情同意书后,随机分为2组,最终纳入分析的共126例,分别予Foley尿管水囊(64例)和普贝生栓(62例)促官颈成熟,Foley尿管水囊组与普贝生栓组孕妇的孕周、引产前宫颈评分、引产指征差异无统计学意义.采用t、x2检验或Fisher精确概率法比较2组孕妇的引产成功率、分娩方式、产程时间及母儿结局. 结果 Foley尿管水囊组与普贝生栓组宫颈评分改善、引产成功率、阴道分娩率、总产程、产后出血量差异均无统计学意义(P＞0.05).Foley尿管水囊组较普贝生栓组引产24 h内阴道分娩率低[28.1％(18/64)与56.5％(35/62),t=10.37,P＜0.05],宫缩过频过强发生率也较低[0.0％(0/64)与17.7％(11/62),P＜0.05],但缩宫素使用率高[87.5％(56/64)与21.0％(13/62),x2 =56.27,P＜0.05].2组新生儿Apgar评分、羊水胎粪污染发生率、新生儿体重差异均无统计学意义(P＞0.05).2组孕妇无一例发生产褥感染. 结论 严格掌握Foley尿管水囊促宫颈成熟的指征及执行无菌操作规程,可以取得与普贝生栓相似的促官颈成熟效果及引产母婴结局,未发生过频过强官缩,具有安全性高及成本低廉等优点.     

新型口服避孕药屈螺酮炔雌醇片的多中心随机对照临床观察

目的 观察屈螺酮炔雌醇片(商品名:优思明)用于健康育龄期妇女的避孕效果、出血模式、副作用及避孕以外的其他作用.方法 采用多中心随机对照的研究方法对768例要求避孕的健康育龄期妇女,以3:1的比例随机分配到屈螺酮组(服用屈螺酮炔雌醇片,573例)和去氧孕烯组(服用去氧孕烯-炔雌醇,195例),均服药13个周期,在服药后的第4、7、10和13个周期进行随访,观察身高、体重、月经情况等.在服药前和服药后第7、13个周期完成月经不适问卷(MDQ).结果 屈螺酮组的方法失败率(Pearl指数)为0.208/百妇女年,优于去氧孕烯组的0.601/百妇女年.两组受试者的出血模式相似,发生出血和(或)点滴出血、仅有点滴出血的天数、次数及每次出血最长时间在各个参考时相基本相似.第7个周期与服药前比较,两组受试者用药后在经期水潴留和食欲增加方面的MDQ量表评分变化、月经间期水潴留和身心健康感方面的MDQ量表评分变化,屈螺酮组(分别为-0.297、-0.057、0.033、0.150分)较去氧孕烯组(分别为-0.108、0.023、0.231、-0.023分)改善明显,两组分别比较,差异均有统计学意义(P<0.05).在皮肤异常方面,第13个周期月经前期时,屈螺酮组的改善率(18.0%,89/494)较去氧孕烯组(11.3%,19/168)明显增高,两组比较,差异有统计学意义(P<0.05);在乳房疼痛或触痛方面,在第7个周期经期时,屈螺酮组改善率(12.6%,62/494)较去氧孕烯组(5.4%,9/168)明显增高,两组比较,差异也有统计学意义(P<0.05).屈螺酮组妇女的体重呈下降趋势,去氧孕烯组反之;在第13个周期随访时,两组体重的变化(与服药前比较)分别为-0.28、0.57 kg,两组比较,差异有统计学意义(P<0.01).结论 屈螺酮炔雌醇片和去氧孕烯.炔雌醇均具有良好的避孕效果,出血模式相似,而在体重变化、经前期症状改善等方面,屈螺酮炔雌醇片优于去氧孕烯.炔雌醇.     

Routine cervical dilatation during elective cesarean section and its influence on maternal morbidity: a randomized controlled study

AIM: To determine the effect of routine intraoperative cervical dilatation during elective cesarean section on maternal morbidity. SUBJECTS AND METHODS: Patients with even numbers in the operative elective cesarean section list were included in the study. Of these, every second patient underwent intraoperative cervical dilatation. All participants in the two groups had otherwise similar preoperative care, operative procedures and subsequent clinical care. Blood loss was estimated and maternal infection status was assessed postoperatively by any rise of temperature or wound infection. RESULTS: Of the 131 patients included in the study, 67 underwent cervical dilation and 64 served as controls. There was no significant difference in postoperative hemoglobin, incidence of fever, or wound infection between the two groups. Only two of the cervical dilation group and one control patient developed postoperative fever. A hemoglobin drop of more than 0.5 g/dL was noted in 27 and 26 patients in the cervical dilation and the no dilation groups, respectively (NS). None of the study patients had signs of wound infection. CONCLUSION: Intraoperative cervical dilatation during elective cesarean section did not reduce the risk of postoperative maternal fever, wound infection or change in hemoglobin concentration.     

Effect of an extended midwifery postnatal support programme on the duration of breast feeding: a randomised controlled trial

Objective

to evaluate the effects of an extended midwifery support (EMS) programme on the proportion of women who breast feed fully to six months.

Design

randomised controlled trial.

Setting

large public teaching hospital in Australia.

Participants

849 women who had given birth to a healthy, term, singleton baby and who wished to breast feed.

Intervention

participants were allocated at random to EMS, in which they were offered a one-to-one postnatal educational session and weekly home visits with additional telephone contact by a midwife until their baby was six weeks old; or standard postnatal midwifery support (SMS). Participants were stratified for parity and tertiary education.

Measurements

the main outcome measures were prevalence of full and any breast feeding at six months postpartum.

Findings

there was no difference between the groups at six months postpartum for either full breast feeding [EMS 43.3% versus SMS 42.5%, relative risk (RR) 1.02, 95% confidence interval (CI) 0.87–1.19] or any breast feeding (EMS 63.9% versus SMS 67.9%, RR 0.94, 95%CI 0.85–1.04).

Conclusions

the EMS programme did not succeed in improving breast-feeding rates in a setting where there was high initiation of breast feeding. Breast-feeding rates were high but still fell short of national goals.

Implications for practice

continuing research of programmes designed to promote breast feeding is required in view of the advantages of breast feeding for all mothers and babies.     

Dienogest is as effective as triptorelin in the treatment of endometriosis after laparoscopic surgery: results of a prospective, multicenter, randomized study

OBJECTIVE: To compare the efficacy of Dienogest versus Decapeptyl at 3.75 mg as consolidation therapy for surgery in the treatment of endometriosis. DESIGN: Multicenter, open, randomized, parallel-group clinical trial. SETTING: Volunteer patients in an academic research environment. PATIENT(S): Women with grade 2, 3, and 4 (相似文献