双胎妊娠的分娩方式与妊娠结局探讨

目的　探讨双胎妊娠的分娩方式与妊娠结局的关系。方法　将 1995年 1月至 2 0 0 3年 5月 98例双胎妊娠产妇按分娩方式分为阴道分娩组及剖宫产组 ,对其临床资料进行回顾性分析。结果　两组的孕周、产后出血率比较差异无显著性意义 (P >0 0 5 ) ,剖宫产组新生儿体重显著高于阴道分娩组 (P <0 0 1) ,两组第 1胎分娩新生儿窒息率差异无显著性意义 (P >0 0 5 ) ,而第 2胎分娩新生儿窒息率剖宫产组显著低于阴道分娩组(P <0 0 5 )。结论　正确选择双胎妊娠的分娩方式 ,将有助于降低剖宫产率及新生儿窒息率     

双胎妊娠结局及分娩时机与分娩方式对新生儿窒息的影响

目的:探讨双胎妊娠结局及不同分娩时机与分娩方式对新生儿窒息的影响。方法:回顾性分析本院462例双胎妊娠孕妇晚期流产及分娩结局资料,以1分钟Apgar评分≤7分为标准诊断新生儿窒息,对比分析不同孕周的晚期流产率,及在不同分娩孕周采用不同分娩方式的新生儿窒息率。结果:(1)双胎妊娠孕妇孕28周前流产42例,主要集中于孕26～27~(+6)周(18例)。(2)孕28周后分娩的活产新生儿共834例,其剖宫产新生儿窒息率(2. 16%)低于阴道分娩(12. 77%)(P0. 05),其中孕28～29~(+6)、孕32～33~(+6)周剖宫产与阴道分娩的新生儿窒息率差异有统计学意义(P0. 05)。新生儿窒息率在孕36～37~(+6)周(0. 44%)明显低于其他孕周(P0. 05)。(3)大胎儿和小胎儿的剖宫产新生儿窒息率均低于阴道分娩(P0. 05),剖宫产中大胎儿新生儿窒息率低于小胎儿(P0. 05)。剖宫产中大胎儿在孕34～35~(+6)周的新生儿窒息率(0)明显低于其他孕周(P0. 05),剖宫产中小胎儿在孕36～37~(+6)周的新生儿窒息率(0)明显低于其他孕周(P0. 05)。结论:双胎妊娠应加强孕期监护,防止晚期流产的发生。双胎妊娠无明显并发症时可尽量延长孕周至36～37~(+6)周,但不宜过迟,采取剖宫产方式可降低新生儿窒息率的发生。     

剖宫产术后再次妊娠经阴道试产的母婴结局

目的:了解剖宫产术后再次妊娠经阴道分娩对母婴结局的影响,分析剖宫产术后再次妊娠经阴道试产的利弊.方法:1995～2005年收治的剖宫产术后再次妊娠,并符合试产条件的病例286例,其中74例直接实行剖宫产(剖宫产组),212例行阴道试产(阴道试产组).最终比较两组母婴并发症.结果:在阴道试产组中,有124例成功阴道分娩(阴道试产成功组),有88例阴道试产失败改剖宫产(阴道试产失败组),阴道试产成功率为58.5%.阴道试产组的先兆子宫破裂率显著高于剖宫产组(P＜0.05),但阴道试产组的产后发热率和住院费用明显低于剖宫产组(P＜0.05和P＜0.01).阴道试产失败组的先兆子宫破裂率、产后发热率、新生儿5分钟Apgar评分≤7分的发生率及住院日、住院费用较阴道试产成功组明显增高(P＜0.05).结论:经阴道试产有其优缺点,成功的阴道试产可明显减少术后感染率、住院日和住院费用,但经阴道试产失败则可能会增加先兆子宫破裂、胎儿窘迫等并发症的发生率、住院日以及住院费用.     

辅助生殖技术多胎妊娠行减胎术对临床结局的影响

目的:评估辅助生殖技术多胎妊娠选择性经阴道减为单胎的安全性和必要性。方法:回顾分析本中心行辅助生殖技术治疗后获得妊娠的患者,其中单胎妊娠2760例,双胎未减胎1258例,三胎未减胎15例,减胎后单胎18例。比较各组的流产率、早产率、剖宫产率、分娩孕周、新生儿出生体重及低体重儿出生率等。结果:减胎后单胎组与多胎未减胎组比较,早产率、剖宫产率及低体重儿出生率降低(P0.05),分娩孕周延长(P0.05),新生儿出生体重增加(P0.05)。单胎妊娠组与减胎后单胎组患者的年龄、流产率、早产率、剖宫产率、分娩孕周、新生儿出生体重及低体重儿出生率等比较,差异均无统计学意义(P0.05)。结论:多胎妊娠孕早期实施选择性经阴道减胎术,仅保留一个胎儿,可有效降低母婴早产及剖宫产导致的风险,从而改善临床结局。     

GDM孕妇肠道益生菌及氧化应激水平与妊娠结局的相关性研究

目的探讨妊娠期糖尿病(GDM)孕妇肠道益生菌及氧化应激水平与妊娠结局的相关性。方法选取2016年1月至2018年1月于承德医学院附属医院产科分娩的60例健康妊娠妇女为对照组,100例GDM孕妇为观察组,按照血糖控制程度分为观察1组(50例血糖控制较好)和观察2组(50例血糖控制不佳)。检测三组孕妇分娩前肠道乳酸杆菌和双歧杆菌,孕妇氧化应激指标(TAOC、MDA、SOD及GSH)。分析GDM孕妇肠道益生菌及氧化应激水平与妊娠结局的相关性。结果与对照组比,观察1、2组乳酸杆菌、双歧杆菌、MDA、TAOC降低(P 0.05),GSH、SOD、新生儿低血糖、巨大儿及剖宫产发生率均增高(P 0.05),与观察1组比,观察2组乳酸杆菌、双歧杆菌、MDA、TAOC降低(P 0.05),GSH、SOD、新生儿低血糖、巨大儿及剖宫产发生率均增高(P 0.05),早产、胎盘早剥及胎膜早破的发生率差异无统计意义(P0.05)。GDM孕妇乳酸杆菌、双歧杆菌、GSH及SOD与新生儿低血糖呈负相关,乳酸杆菌与剖宫产及巨大儿负相关,MDA与剖宫产及巨大儿正相关,TAOC与新生儿低血糖正相关,GSH与剖宫产负相关,SOD与巨大儿负相关(P 0.05)。结论相比而言,血糖控制较好的GDM孕妇的肠道益生菌数量氧化应激能力及妊娠结局均有改善。     

剖宫产术后瘢痕子宫再次妊娠93例分娩方式探讨

目的:探讨剖宫产术后瘢痕子宫再次妊娠分娩方式的选择.方法:回顾性分析2007年1月1日至2011年10月31日我院收治的剖宫产术后瘢痕子宫再次足月妊娠93例的临床资料,分析瘢痕子宫足月分娩方式的选择.结果:93例孕妇中有38例行阴道试产,试产率为40.86％,试产成功率84.21％ (32/38),再次剖宫产率65.59％(61/93),子宫破裂发生率1.08％(1/93).阴道分娩组的产后24小时出血量及新生儿体重明显低于剖宫产组,差异有统计学意义(P＜0.05);两组孕妇在年龄、孕周、新生儿窒息发生率、产褥病率方面相比较,差异无统计学意义(P＞0.05).结论:对符合阴道分娩条件的剖宫产术后瘢痕子宫再次妊娠孕妇给予阴道试产机会是可行的.     

剖宫产术后再次妊娠分娩方式的临床体会

目的研究产妇在剖宫手术后,再次妊娠分娩方式的选择。方法通过分析2014年3月~2015年2月我院收治的剖宫产术后再次妊娠分娩孕妇130例,其中再次妊娠符合阴道分娩的孕妇47例为阴道分娩组,剩余的83例为再次剖宫产分娩组。分析各组的分娩情况、新生儿Apgar评分。结果两组相互比较,在新生儿窒息、子宫破裂方面比较差异无统计学意义(P0.05),而在住院时间、产后出血率方面再次剖宫产组数据高于阴道分娩组,差异具有统计学意义(P0.05)。结论剖宫产术后再次妊娠,若没有再次剖宫产的指征,应当采用阴道试产,这样能够提升分娩质量,保证安全。     

剖宫产后瘢痕子宫妊娠早产经阴道分娩的临床对比分析

目的:探讨剖宫产后瘢痕子宫妊娠早产经阴道分娩的可行性与安全性。方法:选择2009年1月至2014年12月在昆明医科大学第一附属医院成功经阴道分娩的瘢痕子宫妊娠(一次剖宫产史)早产(28+1~36+6周)患者50例为观察组,随机选择同时期阴道分娩的非瘢痕子宫妊娠早产患者100例为对照组1,同时期的瘢痕子宫妊娠早产行剖宫产患者35例为对照组2,对3组产妇分娩及新生儿情况进行比较。结果:观察组与对照组1在产程时间、产后出血量、新生儿窒息率、入住NICU率及住院时间方面比较,差异无统计学意义(P0.05)。观察组与对照组2在产后出血量、输血率、新生儿窒息率、入住NICU率、子宫破裂率方面比较,差异无统计学意义(P0.05),而观察组的产褥感染率和住院时间优于对照组2(P0.05)。结论:剖宫产后瘢痕子宫妊娠早产患者经阴道分娩子宫破裂率低、并发症少,安全可行,母儿获得较好妊娠结局。     

剖宫产手术史对体外受精-胚胎移植患者临床结局的影响

目的探讨剖宫产手术史对体外受精-胚胎移植(IVF-ET)患者临床结局的影响。方法回顾性分析2013年1月—2015年12月行IVF-ET且有剖宫产手术史的144例患者的助孕情况、妊娠及分娩结局,对照组为同期行IVF-ET且既往仅有阴道分娩史的166例患者。结果与对照组比较,剖宫产史组基础卵泡刺激素水平(b FSH)、人绒毛膜促性腺激素(h CG)注射日雌二醇(E2)水平、子宫内膜厚度、促性腺激素(Gn)用量、G n刺激时间,获卵率、受精率、卵裂率、优质胚胎率、胚胎移植数、多胎妊娠率、流产率、异位妊娠率差异均无统计学意义(P0.05);但剖宫产手术史组胚胎移植困难比例(6.25%)高于阴道分娩史组(0.00%),胚胎种植率(24.01%)及临床妊娠率(40.28%)明显低于阴道分娩史组(分别为34.98%和54.82%),差异均有统计学意义(P0.05);剖宫产史组双胎妊娠者较对照组双胎妊娠发生前置胎盘、产后出血比例增加(P0.05);无论是剖宫产手术史组还是阴道分娩史组,双胎分娩较单胎分娩新生儿出生孕周、体质量明显降低(P0.01)。结论剖宫产手术史可能降低IVF-ET患者的胚胎种植率和临床妊娠率,增加胚胎移植难度。对疤痕子宫妇女应严格控制移植胚胎数目,妊娠后加强孕期监管。     

原因不明胎儿生长受限分娩方式探讨

目的 探讨原因不明胎儿生长受限(fetal growth restriction,FGR)的适宜分娩方式.方法 收集2002年10月至2007年10月在延边大学附属医院出生的单胎足月原因不明FGR新生儿65例,分为3组;阴道分娩组(25例)、选择性剖宫产组(18例)和急症剖宫产组(22例),分析不同分娩方式新生儿的出生体重、1min和5min的Apgar评分、新生儿气管插管率、儿科住院率以及胎粪污染率.结果 阴道分娩组、选择性剖宫产组和急症剖宫产组新生儿平均出生体重分剐为(2.30±O.15)kg、(2.20±0.29)kg、(2.08±0.14)ks(P相似文献   

Abnormal vaginal colonization by gram-negative bacteria is significantly higher in pregnancy conceived through infertility treatment compared to natural pregnancy

Objective: To compare abnormal vaginal colonization between natural pregnancy and pregnancy by infertility treatment in high-risk parturient women and to examine the association between abnormal vaginal colonization and early-onset neonatal sepsis (EONS).

Methods: The clinical characteristics, vaginal culture result, and delivery outcome of patients who admitted to our high-risk unit between 2005 and 2014 were retrospectively reviewed and compared. We investigated the prevalence of EONS according to maternal vaginal colonization and examined the concordance between maternal vaginal bacteria and etiologic microorganism causing EONS.

Results: Among 1096 pregnancies, the rate of vaginal colonization by gram-negative bacteria, especially Escherichia coli was significantly higher in pregnancies by infertility treatment after adjustment of confounding variables (E. coli, OR [95% CI]: 2.47 [1.33–4.57], p?=?0.004). The rate of EONS was significantly higher in neonates with maternal abnormal vaginal bacteria colonization (OR [95% CI]: 3.38 [1.44–7.93], p?=?0.005) after adjusting for confounding variables. Notably, among microorganisms isolated from maternal vagina, E. coli and Staphylococcus aureus were consistent with the results from neonatal blood culture in EONS.

Conclusions: Our data implicate a possible association between gram-negative bacteria colonization and infertility treatment and suggest that maternal vaginal colonization may be associated with EONS of neonates in high-risk pregnancy.     

妊娠期外阴阴道念珠菌病及其对新生儿的影响

目的　了解妊娠期外阴阴道念珠菌病(Vulvovaginal Candidiasis ,VVC)的发生率,母婴垂直传播及新生儿相关病率。　方法　2002年至2003年在北京妇产医院产前检查和分娩的252 例孕妇行阴道真菌涂片、培养及菌种鉴定,其分娩新生儿行皮肤真菌培养及菌种鉴定,并随诊新生儿。　结果　252例孕妇阴道真菌涂片和/或培养阳性109例,阳性率43.25%。妊娠期VVC的发病率为19.05%(48/252)。109例阳性患者中,剖宫产与阴道分娩儿皮肤真菌携带率分别为20.76%(11/53)和35.71%(20/56), P>0.05;孕期VVC组与真菌携带组新生儿皮肤真菌携带率分别为16.67%(8/48)和37.71%(23/61),P<0.05;孕期治疗组新生儿无真菌携带;未治疗组新生儿真菌携带率为50.82%(31/61)。252例中新生儿真菌培养(+)31例,真菌携带率为12.30%;真菌培养(+)的新生儿尿布皮炎、鹅口疮的发生率为12.90%(4/31)和6.45%(2/31);与新生儿真菌培养(-)组[3.62%(8/221)和0%]相比,P<0.05。阴道真菌涂片和/或培养阳性109 例中,剖宫产组新生儿脐炎、尿布皮炎、鹅口疮的发病率[分别为3.77%(2/53)、15.09%(8/53)和1.87%(1/53)]与阴道分娩组[分别为1.79%(1/56)、7.14%(4/56)和1.79%(1/56)]相比无统计学意义(P>0.05)。孕期真菌阳性未治疗组新生儿脐炎、尿布皮炎、鹅口疮的发病率[分别     

Preprandial versus postprandial blood glucose monitoring in type 1 diabetic pregnancy: a randomized controlled clinical trial

OBJECTIVE: This study was undertaken to compare preprandial and postprandial capillary glucose monitoring in pregnant women with type 1 diabetes. STUDY DESIGN: Sixty-one women with type 1 diabetes were randomly assigned at 16 weeks' gestation to preprandial or postprandial blood glucose monitoring using memory-based glucose reflectance meters throughout pregnancy. Serial measurements of hemoglobin A1c and fructosamine were obtained throughout pregnancy. Insulin, glucose, and insulin-like growth factor-I (IGF-I) were measured in cord blood at delivery. Neonatal anthropometric measures were performed within 72 hours of delivery RESULTS: Maternal age, parity, age of onset of diabetes, number of prior miscarriages, smoking status, social class, weight gain in pregnancy, and compliance with therapy were similar in the two groups. The postprandial monitoring group had a significantly reduced incidence of preeclampsia (3% vs 21%, P<.048), a greater success in achieving glycemic control targets (55% vs 30%, P<.001) and a smaller neonatal triceps skinfold thickness (4.5+/-0.9 vs 5.1+/-1.3, P=.05). CONCLUSION: Postprandial capillary blood glucose monitoring in type 1 diabetic pregnancy may significantly reduce the incidence of preeclampsia and neonatal triceps skinfold thickness compared with preprandial monitoring.     

Cesarean vs. vaginal birth for term breech presentation in 2 different study periods.

OBJECTIVE: To compare outcomes for fetuses at term in breech presentation during 2 periods when different delivery policies were in effect. METHODS: Outcomes of the 392 planned vaginal deliveries and 1160 elective cesarean sections (CSs) performed from January 1, 1988, through December 31, 2000, were compared with those of the 24 emergency vaginal deliveries, the 403 planned CSs, and 75 emergency CSs performed from January 1, 2001 through December 31, 2004 at Alexandra Hospital, Athens, Greece. RESULTS: A significant difference was found in rates of low 5-minute Apgar score, birth trauma, serious neonatal morbidity, and admission to the neonatal intensive care unit (0% vs. 1.02% [P=0.004], 1.02% vs. 0% [P=0.004], 3.06% vs. 0.43% [P<0.001], and 2.8% vs. 0.43% [P<0.001], respectively) between neonates born by planned vaginal delivery and those born by elective CS during the first period. Only a reduction in rates of admission to the neonatal intermediate care unit was found between the first and second periods. CONCLUSIONS: Planned CS was found to be safer than planned vaginal delivery for fetuses at term in breech presentation. However, the study did not demonstrate that the change in policy improved neonatal outcome.     

Obstetric and neonatal infection

Recent advances in prevention, diagnosis, and treatment of infection-associated preterm labor are discussed. This includes antepartum treatment of vaginal infections, amniocentesis for culture and glucose levels, and adjunctive antibiotic treatment of preterm labor and preterm premature rupture of the membranes. Risk factors for neonatal group B streptococcus sepsis are described and testing for rapid detection of maternal group B streptococcus colonization is discussed, as are recent prospective studies of pregnancy outcome following human parvovirus B19 infection. Studies quantifying the transmission of herpes simplex virus to neonates following vaginal delivery to mothers with recurrent infections are discussed, as well as the results of several studies using rapid detection kits for the virus.     

分娩对产妇和新生儿免疫状况的影响

应用流式细胞技术检测了共４０例正常孕妇分娩前后和新生儿脐血的白细胞和淋巴细胞亚群。其中阴道分娩组２０例，造反性剖宫产组２０例。结果：分娩前后母体白 数和中性粒细胞，ＮＫ细胞活性以及ＣＤ８、ＣＤ１９亚群均相关不显著，而产后母血ＣＤ４业群升高，ＣＤ３、ＣＤ４／ＣＤ８亦升高，剖宫产或阴道分得母体和新生儿淋巴细胞亚嫩相差不显著，但阴道分娩新生儿的白细胞总数，中性粒细胞比例、单核细胞和ＮＫ细胞显著升高。提示     

导乐陪伴分娩对剖宫产率影响的临床研究

目的探讨导乐陪伴分娩对剖宫产率的影响。方法对796例导乐陪伴分娩和800例非导乐陪伴分娩的剖宫产原因、剖宫产率、难产率及新生儿窒息率进行比较。结果两组剖宫产的主要原因均为胎儿窘迫、头盆不称及胎位异常、宫缩乏力等。导乐陪伴分娩组的剖宫产率(24.37％)显著低于非导乐陪伴分娩组(38.25％)(P＜0.01),前者因宫缩乏力剖宫产的比率显著低于后者,因胎儿窘迫剖宫产的比率显著高于后者(P均＜0.05),前者经阴道分娩的难产率(6.00％)显著低于后者(9.72％,P＜0.05)。两组新生儿窒息率也无显著性差异(P＞0.05)。结论导乐陪伴分娩可显著降低剖宫产率且不增加新生儿窒息率,是一种值得推广的方法。     

Shoulder dystocia and the next delivery: outcomes and management.

OBJECTIVE: To evaluate delivery mode management decisions and the rate of shoulder dystocia recurrence for women with a prior delivery complicated by shoulder dystocia. STUDY DESIGN: We used a computerized perinatal database and ICD-9 codes to identify all vaginal deliveries complicated by shoulder dystocia from 1996 to 2001. Subsequent deliveries over the next three years were identified and reviewed for relevant clinical, obstetric, and delivery outcomes. Management including use of labor induction, labor augmentation, operative vaginal delivery, and delivery mode (elective cesarean section (CS) vs. trial of labor (TOL)) were reviewed. The recurrence rate of shoulder dystocia was calculated and the characteristics of these cases further described. RESULTS: Over the initial 5-year study, there were 25 995 vaginal deliveries, 205 shoulder dystocia cases (0.8%), 36 (17.5%) with neonatal injury. Of the 205 initial shoulder dystocia cases, 39 patients had 48 subsequent deliveries at our institution (a subsequent delivery rate of 23% at our institution, significantly less than the overall population (42%, p < 0.001)). Complete data were available for 47 deliveries. Four women had elective CS without labor (one due to prior shoulder dystocia), 43 (91.5%) had a TOL, and 42 (88%) achieved vaginal delivery. Recurrent shoulder dystocia complicated 9.5% (4/42) of deliveries; one case included neonatal brachial plexus injury that resolved prior to hospital discharge. Of the four recurrent shoulder dystocia cases, none were complicated by maternal diabetes, macrosomia, prolonged second stage of labor, or underwent an operative vaginal delivery. No statistically significant univariate differences were seen between the recurrence group and the no-shoulder dystocia vaginal delivery group; however birth weight and nulliparity at initial shoulder dystocia pregnancy jointly demonstrated a relationship of recurrence (p = 0.048). CONCLUSION: In TOL cases that result in a vaginal delivery, the rate of recurrence of shoulder dystocia is high--approximately 10 times higher than the rate for the general population. Often the only identifiable risk factor is the prior history itself, which may influence delivery management in subsequent pregnancies. Birth weight and nulliparity at initial shoulder dystocia pregnancy may influence clinical decision-making in cases of prior shoulder dystocia.     

Vaginal breech delivery: is it still an option?

OBJECTIVE: To provide local data on term breech delivery for future guidance. STUDY DESIGN: Retrospective, 'intended-mode-of-delivery' analysis of 711 antenatally uncomplicated singleton breech deliveries at >or=37 weeks: 445 (63%) planned for vaginal delivery (VD) (no fetal growth restriction, fetal weight 2000-4000 g, adequate pelvic size, maternal consent) and 266 for cesarean section (CS). OUTCOME MEASURES: Apgar score, cord blood acid-base status, childhood deaths and disability. RESULTS: Perinatal mortality was nil in both groups. Low 1-min Apgar scores and low arterial cord blood pH were significantly more frequent in planned VD, but not low Apgar scores at 5 or 10 min or low venous pH. Metabolic acidosis, neonatal intensive care, neonatal seizures, birth trauma, childhood death (CS=1), and neurodevelopmental handicaps (CS=2, VD=1) were equally common. CONCLUSION: Our results do not disqualify selective vaginal breech delivery at term and beyond as an option.     

Efficacy of tranexamic acid in decreasing blood loss in elective caesarean delivery

Objective: To evaluate the efficacy of tranexamic acid (TA) in decreasing blood loss during and after elective caesarean section (CS).

Methods: This prospective randomized trial was conducted among 124 pregnant women subjected to term elective CS. Patients were equally divided into two groups. Study group received 10?mg/kg TA intravenously 5?min before skin incision while the control group did not. In addition, both groups received 10 units oxytocin and 1?ml ergometrine after delivery of the fetus. Blood loss in both groups was measured from placental delivery to end of the surgery and from end of the surgery to 2?h postpartum. Hemoglobin and hematocrit values were determined preoperatively and on the third day postpartum (before discharge) for all cases. Maternal and neonatal adverse effects in study groups were recorded.

Results: TA group showed lower amount of blood loss (391?ml) when compared to control group (597?ml). Risk estimation has revealed that treatment with TA resulted in decrease in risk of postpartum blood loss by 30%. Hemoglobin and hematocrit levels were significantly lower in the control group on the third post-operative day.

Conclusion: TA reduces blood loss during and immediately after CS. Its use in caesarean delivery may be considered especially in cases where blood loss is expected to be high or in anemic patients.