合理补充维生素D对胎儿生长发育的影响

选取2014年6月~2015年4月我院孕中期的单胎妊娠妇女183例,根据孕妇自愿用药情况分为观察组(n=98)和对照组(n=85),观察组给予合理补充维生素D,直至分娩,对照组不予处理。比较两组胎儿脐血免疫功能、胎盘重量及新生儿出生体重和身长。结果观察组胎儿出生体重、身长均明显大于对照组(P0.05);观察组白细胞计数及CD4+、CD8+、CD19+含量均明显低于对照组,差异均具有统计学意义(P0.05)。合理补充维生素D有助于提高新生儿免疫功能和体格生长发育,利于新生儿健康成长。     

妊娠中期贫血对新生儿体格发育指标的影响分析

目的 研究妊娠中期贫血对新生儿体格发育指标的影响.方法 选取2019年1月—2019年10月在本院分娩的单胎无其它并发症及合并症的产妇382例作为研究对象,入院待产时回顾性收集妊娠中期血常规结果,分娩后立即测量新生儿出生体重和身长,并计算体质指数.所有数据采用SPSS软件进行统计学分析.结果 贫血组孕妇所分娩新生儿的体重(2730.47±183.94 g vs 3366.78±306.98 g)、身长(48.49±1.39 cm vs 50.64±1.37 cm)以及出生孕周(38.56±1.35周vs 39.38±0.98周)均小于对照组(均P<0.05),而两组的体质指数(BMI)无统计学差异(20.99±4.64 kg/m2 vs 20.98±4.52 kg/m2,P>0.05).贫血孕妇早产及低体重儿的发生率均高于正常孕妇(均为10.59％vs 0％,P<0.05).妊娠中期血红蛋白水平与出生体重及身长均存在正相关(r值分别为0.331和0.377,均P<0.05).结论 妊娠中期贫血是早产和低出生体重儿的危险因素,新生儿出生体重和身长与母体血红蛋白浓度存在正相关.     

孕期地中海贫血与新生儿结局相关性研究

目的分析孕期地中海贫血与新生儿结局的相关性。方法前瞻性收集南川市人民医院2014年1月至2015年3月收治的孕妇2557例,抽静脉血进行地贫基因及血常规检查,确诊为地贫基因携带者128例,入组116例,按照地贫基因分型,将其分为两组,α组61例,β组55例。根据产妇血红蛋白水平,重度贫血1例其余115例分为正常与轻、中度贫血三个亚组,血红蛋白正常组39例,轻度贫血65例,中度贫血11例。随访新生儿结局(新生儿体重、PI、Apgar评分、黄疸指数、羊水粪染、孕周),评估地贫孕妇不同血色素对新生儿结局的关系。结果 2557例孕妇中,确诊地贫人数128例,发病率5.0%;三组新生儿在孕周、出生体重、身长及PI方面差异无统计学意义(P0.05);α型与β型地贫基因携带者所分娩新生儿血红蛋白含量、Apgar评分、黄疸指数差异不明显,无统计学意义(P0.05),α组有2例羊水粪染,新生儿窒息率为3.80%,β组有3例羊水粪染,窒息率为3.92%,两组均高于对照组,但差异无统计学意义(P0.05);血红蛋白的含量与出生体重、Apgar评分、羊水粪染、黄疸指数均无相关性;正常、轻度、中度地地贫组产妇所分娩新生儿孕周、出生体重、身长、PI等与对照组差异不显著(P0.05);四组产妇所分娩新生儿血红蛋白、Apgar评分、黄疸指数、羊水粪染与新生儿窒息率差异无统计学意义(P0.05)。相关性分析结果显示,地贫产妇血红蛋白的含量与出生体重、Apgar评分、羊水粪染、黄疸指数均无相关性。结论与正常孕妇所分娩新生儿相比较,地贫基因携带者孕妇所分娩新生儿体重、孕周、Apgar评分、血红蛋白,差异无统计学意义,表明地贫基因携带孕妇,不影响新生儿出生后结局,对新生儿出生预后无相关性,地贫基因携带孕妇不增加新生儿出生后窒息等风险。     

围产期营养管理与胎儿健康关系分析

目的:探讨围产期营养管理与胎儿健康的关系。方法:将100例于我院行产前检查及分娩孕妇随机分为实验组和对照组各50例,实验组采取围产期营养管理措施,对照组采用常规的护理干预。观察、记录两组孕晚期孕妇腹围、胎儿肱骨长和股骨长及新生儿出生体重、身长、胎龄。结果:两组孕晚期孕妇腹围及胎儿肱骨长、股骨长比较差异有统计学意义(P<0.05);两组新生儿出生体重、身长及胎龄比较差异有统计学意义(P<0.05)。结论:围产期营养管理与胎儿健康有着较大的相关性,对孕妇进行系统、全面的围产期营养管理可有效地促进胎儿的生长发育,对胎儿的健康发展有着重要的意义,值得临床推广应用。     

不同孕期孕妇体重指数与分娩及新生儿的相关性分析

目的:探讨孕妇在不同阶段体重指数(BMI)及其变化情况与分娩方式和新生儿出生体重的关系,从而指导孕妇在妊娠的不同阶段通过调整饮食和运动控制新生儿出生体重的作用.方法:选择2009年1～6月在宣武医院产科住院分娩产妇共200例,以分析孕妇孕前体重、怀孕早期、怀孕中期、怀孕晚期及分娩时的BMI与分娩方式、产时出血、新生儿体重进行相关性分析.结果:分娩时BMI超过27的为138例,占69%,提示多数孕妇BMI均值已超过体重过重标准;孕妇孕前体重、怀孕早期、怀孕中期、怀孕晚期及分娩时的BMI与分娩方式呈不同程度的正相关性,而与产时出血量、新生儿体重无相关性.结论:孕前和孕期BMI超标增长,孕妇BWI≥27应加强产程监护,一旦发现产程进展缓慢应采取剖宫产结束分娩,但对妊娠期的BWI的监测,随时指导饮食、运动,能改善妊娠结局,降低与其相关的剖宫产率.     

对糖耐量异常孕妇实施饮食控制和运动指导的护理实践

目的：探讨对糖耐量异常孕妇实施护理干预的效果。方法：将我院产前糖筛查结果异常的90例孕妇随机分为研究组40例和对照组50例,研究组给予饮食控制和运动指导,对照组不进行任何干预。观察两组孕妇孕期体重增加情况、分娩孕周、新生儿出生体重及母婴并发症发生情况。结果：研究组孕妇体重增加及新生儿出生体重明显优于对照组,并发症发生明显少于对照组,均P〈0.05;分娩孕周两组比较无显著差异。结论：通过饮食控制和运动指导,可有效控制血糖,明显改善了孕妇的预后,降低了母婴并发症。     

孕妇孕前肥胖及孕期体重增长过度对分娩结局的影响

目的探讨孕妇孕前肥胖及孕期体重增长过度对分娩结局的影响。方法选择经筛选符合孕前肥胖及孕期体重增长过度的孕妇98例作为观察组,并随机抽取280例孕妇作为对照组。分别观察两组孕产妇的分娩方式,新生儿体重及产妇产后出血的发生情况。结果两组孕产妇分娩方式、新生儿体重及产妇产后出血情况比较,经统计学分析．P〈0.01,差异具有统计学意义。结论孕前肥胖及孕期体重增长过度对孕产妇和新生儿体重均产生不利影响,增加了分娩期并发症、巨大儿和剖宫产的发生率。     

饮食控制和运动对糖耐量受损孕妇的影响

目的：探讨饮食控制和运动对糖耐量受损孕妇母婴的的影响。方法将2012年1月~2013年12月于本院行产前糖筛查结果异常的孕妇按自愿原则分成两组：研究组40例,对照组40例。研究组孕妇实施饮食控制和运动指导,对照组不进行饮食控制和运动指导。结果研究组孕妇孕期体重增加及新生儿出生体重明显优于对照组,差异有统计学意义（P<0.05）,孕期并发症发生明显少于对照组,差异有统计学意义（P<0.05）;分娩孕周两组比较,差异无统计学意义（P>0.05）。结论通过对研究组孕妇实施饮食控制和运动指导,能够控制孕妇孕期体重增加,控制血糖,达到改善孕妇预后,降低母婴并发症发生的目的。     

不同分娩方式对低血糖高风险新生儿的影响

目的 探讨不同分娩方式对低血糖高风险新生儿的影响。方法 选择2019年6～12月在四川省妇幼保健院住院分娩符合纳入标准的新生儿335例,其中经阴道分娩163例,剖宫产172例,收集相关资料,包括孕周、分娩方式、母亲诊断、新生儿诊断、出生体重、出生1、2、3、6、12、24、36及48小时监测的血糖值。结果 在出生1小时两种分娩方式新生儿低血糖发生率比较,差异有统计学意义(P<0.05),其余时间点低血糖发生率比较差异无统计学意义(P>0.05);剖宫产娩出的新生儿出生1小时与出生2小时、出生2小时与出生3小时、出生3小时与出生6小时低血糖发生率比较,差异有统计学意义(P<0.05);经阴道分娩的新生儿出生2小时与出生3小时、出生36小时与出生48小时低血糖发生率比较,差异有统计学意义(P<0.05)。结论 对所有新生儿进行低血糖高危因素的筛查,低血糖高风险新生儿进行连续性血糖监测,对及时纠正新生儿低血糖、预防新生儿低血糖脑病有重要意义。     

孕妇体操配合拉玛泽减痛分娩法对分娩方式的影响

目的探讨孕妇体操配合拉玛泽减痛分娩法促进初产妇自然分娩、降低剖宫产率的作用。方法将研究对象随机分组,研究组100例孕妇于16~28周作孕妇体操,28周练习拉玛泽减痛分娩法,产时配合产程运用。对照组100例孕妇常规孕前检查、接受健康教育。观察两组孕妇分娩结局、新生儿出生体重。结果研究组阴道分娩率为70%,新生儿出生平均体重(3 258.20±402.12)g,对照组阴道分娩率为34%,新生儿出生平均体重(3 494.50±464.77)g,两组比较有显著性差异(P<0.01)。结论产前孕妇体操配合拉玛泽减痛分娩法可提高初产妇自然分娩率、降低剖宫产率和新生儿出生体重,可在初产妇保健中推广使用。     

门诊干预进行孕期体质量管理对妊娠结局的影响

目的：探讨门诊干预新生儿体质量及妊娠结局的影响。方法选取200例单胎20～24周的孕中晚期初产妇,随机分为对照组（100例）和观察组（100例）。对照组只进行常规的产前检查,观察组定期接受门诊指导,实施孕期体质量控制。观察2组新生儿体质量、新生儿窒息、孕妇妊娠方式、产程阻滞、产后大出血等情况。结果观察组巨大儿、剖宫产、产程阻滞、新生儿窒息、产后大出血发生率均低于对照组。结论孕妇接受门诊指导进行孕期体质量管理,有利于妊娠结局。     

骨盆倾斜度异常孕妇分娩的处理方法

目的：探讨对骨盆倾斜度异常孕妇合适的处理方法。方法：将274例骨盆倾斜度异常孕妇随即分成两组,对照组137例顺其自然分娩不进行任何处理,处理组在产前用高弹性腹带将孕妇腹部包裹,力度适中,分娩时将骶骨下2/3处垫高,将大腿压向腹部,保证胎轴压力线与骨盆轴相重叠或基本一致。结果：处理组孕妇绝大多数均能顺利衔接,仅2例不衔接。对照组孕妇先露顺利衔接的78例,59例均不能顺利衔接。处理组剖宫产率明显下降,第二产程明显缩短,会阴裂伤明显少于对照组。新生儿情况,两组体重无差异,新生儿窒息、新生儿头颅皮下血肿处理组均较对照组减少。结论：在产前用高弹性腹带将孕妇腹部包裹,分娩时采取将骶骨下2/3处垫高,将大腿压向腹部,保证胎轴压力线与骨盆轴相重叠或基本一致等处理方法,有利于胎头衔接及分娩,降低剖宫产率,减少阴道分娩时母婴损伤。     

Improved birth weight table for neonates developed from gestations dated by early ultrasonography

Most previously published tables of birth weight percentiles as a function of gestational age have been derived from neonates with imprecise gestational dating. In order to improve the accuracy of neonatal birth weight percentiles, we developed a birth weight table based on measurements from a group of neonates who had accurate gestational dating by prenatal first trimester ultrasonography. By matching a database of obstetrical ultrasonograms over a 5 year period to birth records at our institution, 3718 newborn infants with gestational dating by first trimester ultrasonography were identified. Statistical smoothing and regression techniques were applied to gestational age at birth and birth weight data to develop a table for the 10th, 50th, 90th, and other weight percentiles for 25 weeks of gestation onward. The weight table developed from our population has lower 50th and 90th percentile weights, and narrower 10th to 90th percentile ranges, at 25 to 35 weeks than in prior tables. At 39 to 43 weeks, our 10th, 50th, and 90th percentile weights are higher than those in previous tables. Our weight table for newborn infants, based on measurements from neonates with accurate dating, permits improved assignment of weight percentiles for gestational age and more accurate diagnosis of growth disorders in fetuses and neonates.     

Baby massage ameliorates neonatal jaundice in full-term newborn infants

Neonatal jaundice is a common physiological problem affecting over half of all full term and most preterm infants. Thus, newborn infants must be monitored for signs of hyperbilirubinemia to prevent acute bilirubin encephalopathy or kernicterus. Evidence exists supporting the benefits of baby massage as a form of mild hand to skin contact, to increase neonatal physical and mental development. In the present study, the effects of gentle baby massage on neonatal jaundice in full term newborn infants were evaluated by a controlled clinical trial. The inclusion criteria of newborn neonates were as follows: (1) gestational age of 37-41 weeks, (2) birth weight of 2,800-3,600 g, (3) Apgar score at birth of 8-10, and (4) being a healthy neonate without neonatal asphyxia and hemolytic condition. Breastfed newborns without phototherapy were included: 20 in the massage group and 22 in the control group. We found the mean stool frequency of the massaged infants on day 1 and day 2 (4.6 and 4.3) was significantly higher than that of the control group (3.3 and 2.6) (p<0.05). The transcutaneous bilirubin levels on the second to fifth day and serum total bilirubin levels on fourth day were significantly decreased in the massage group, compared to the control group. In conclusion, baby massage at an early stage after birth could reduce neonatal bilirubin levels. We suggest baby massage is beneficial for ameliorating neonatal jaundice.     

影响新生儿高胆红素血症的高危因素调查与护理措施

目的探讨影响新生儿高胆红素血症的高危因素并制定针对性护理干预。方法选取2017年5月至2019年5月在本院出生的新生儿394例为研究对象,记录有无窒息史与缺氧史、新生儿性别、是否母子血型不合、胎龄、排尿次数、出生体质量、母乳喂养频率、排出胎便时间、新生儿体质量下降率及开奶时间等相关资料,其中132例出现高胆红素血症的作为发生组,262例未发生的作为未发生组,对影响高胆红素血症相关因素行单因素和多因素logistic回归分析。结果两组母子血型不合、体质量下降率、窒息史与缺氧、排尿次数、母乳喂养频率比较差异有统计学意义(P<0.05)。结论母子血型不合、体质量下降率>7%、窒息史与缺氧是新生儿高胆红素血症独立危险因素,临床应加强针对性护理干预,以降低新生儿高胆红素血症发生率。     

Maternal serum placental alkaline phosphatase as a marker for low birth weight: results of a pilot study.

In a pilot study, maternal serum was analyzed for placental alkaline phosphatase (PLAP) to evaluate the possibility of using PLAP values as a prenatal marker to predict low birth weight in neonates. Study subjects were selected from among women whose newborns were of low birth weight. These women were screened for maternal serum alpha-fetoprotein (MSAFP) between 15 and 20 weeks of gestation. Of the mothers of low-birth-weight neonates, 43% had PLAP values of 2.0 multiples of the median (MoM) or higher; only 22% of the mothers in the control group had such high values. The adjusted odds ratio was 2.6 (95% confidence interval, 1.1 to 6.5) and was not confounded by race, age, or weight. Odds ratios were improved by selecting more extreme cutoff values, with fewer cases identified as positive. In 14% of the cases of low birth weight, both MSAFP and PLAP values were elevated, compared with 5.6% of those in the control group. These data suggest that PLAP elevations, with or without measurements for MSAFP, may be a useful indicator during the second trimester of pregnancy for the risk of low birth weight.     

Neonatal Outcomes Associated With in Utero Exposure to Oxycodone,Overall and by Trimester of Exposure: A Retrospective Cohort Study

Oxycodone is commonly used by pregnant women for the treatment of pain. However, the potential risk associated with its use in pregnancy have not been robustly evaluated. The objective of this study was to examine neonatal outcomes associated with prenatal oxycodone exposure. State dispensing records were matched with midwives records to identify women who had been dispensed oxycodone during pregnancy (n=302). A matched comparison group of women who had been prescribed oxycodone prior to pregnancy was also identified (n=604). Hospital, mortality and congenital abnormality data were obtained for each mother-child dyad. Neonatal outcomes were examined for association with any exposure during pregnancy and trimester specific exposure, using generalized linear models. First trimester exposure was not associated with a significant increased risk of congenital anomalies (OR: 1.74 95%CI: 0.78, 3.87). Second trimester exposure to oxycodone was associated with reduction in average length of gestation (aCoef:-0.83, 95%CI: -1.26, -0.41) and birth weight (aCoef:-188, 95%CI: -299, -76). Second trimester exposure was also associated with an increased risk of very preterm birth (<32 weeks) (OR: 5.03, 95%CI: 1.95, 12.98) and admission to the special care nursery (aOR:1.99, 95%CI: 1.30, 3.03). Third trimester exposure to oxycodone was associated with a reduction in average length of gestation (aCoef:-0.33, 95%CI: -0.63, -0.02) compared with the comparison group. The use of oxycodone in pregnancy was not associated with an increased risk of congenital anomalies. However, oxycodone exposure was associated with a short period of gestation, preterm birth, and NAS, which likely contributed to a longer period of hospitalization following birth.PerspectiveThis article assesses the neonatal risks associated with prenatal exposure to oxycodone, providing clinicians and patients with important information on the safety of oxycodone in the treatment of pain in pregnancy.     

Second-trimester intra-abdominal bowel dilation in fetuses with gastroschisis predicts neonatal bowel atresia.

OBJECTIVE: To determine in fetuses with gastroschisis the association between intra-abdominal bowel dilation in the second trimester and neonatal bowel atresia. METHODS: We reviewed ultrasound and medical records of fetuses with gastroschisis from January 1998 to August 2004. Fetuses with intra-abdominal bowel dilation in the second trimester were identified and followed into the neonatal period. RESULTS: We identified 58 mother-infant pairs showing fetal gastroschisis, with at least one prenatal ultrasound at our hospital and which were delivered there, or were transported there as newborns. Forty-eight of the 58 fetuses had no intra-abdominal bowel dilation and none of these neonates had bowel atresia. Ten of the 58 fetuses had intra-abdominal bowel dilation and all had bowel atresia at birth (P<0.0001). In eight cases in which ultrasound was performed at <25 weeks' gestation, intra-abdominal bowel dilation was already present. CONCLUSION: Intra-abdominal bowel dilation in the second trimester predicts neonatal bowel atresia in fetuses with gastroschisis.     

新生儿游泳＋抚触疗法对新生儿胆红素的影响

目的：探讨新生儿游泳＋抚触疗法对新生儿胆红素的影响。方法：对200例生理产出生的足月正常新生儿随机分为两组，对照组100例给予单纯沐浴护理，研究组100例给予游泳＋抚触疗法。观察两组新生儿胆红素的动态变化及24h后母乳喂养次数、新生儿体重、睡眠时问。结果：研究组新生儿胆红素指数明显低于对照组，研究组有2例出现高胆红素血症，对照组13例出现高胆红素血症；研究组新生儿母乳喂养次数、新生儿体重、睡眠时问明显优于对照组。结论：新生儿游泳＋抚触疗法可减少“肠一肝”循环，降低高胆红素血症的发生率，促进新生儿生长发育。