超声在产房中的应用

超声进产房是现代产科规范化管理的新要求之一。在产科紧急情况下，超声可以帮助临床医师快速准确地对胎儿状况、胎儿胎盘位置、宫腔及腹腔情况做出判断；指导产程管理，选择合适的分娩方式，实施恰当的助产操作；在超声引导下进行介入性操作。近年来超声在产房中的应用也有很多进展，如超声产程评估的新指标、超声引导辅助麻醉穿刺和插管、超声评估容量负荷等，这为母婴安全提供了进一步的保障。     

Use of surfactant in the delivery room

Surfactant supplementation in prevention and treatment of surfactant deficient hyaline membrane disease has been widely studied. This article focuses on the prevention of HMD by preventilatory, tracheal instillation of surfactant in the delivery room.     

Benefits of ultrasonography in the delivery room

Ultrasonography should benefit many pathological events which occur in delivery rooms. The authors analyse the scarce literature about this subject and propose indications in which this complementary examination seems to be interesting.     

Temperature control of premature infants in the delivery room

The body temperature of preterm babies can drop precipitously after delivery, and this hypothermia is associated with an increase in mortality and morbidity. Reports of hypothermia in babies of all birth weights, on admission to neonatal units, have come from all over the world; most also report increased mortality in association with hypothermia. Recent reports that showed that hypothermia on admission to neonatal units is an independent risk factor for mortality in preterm babies have refocused attention on the need for meticulous thermal care immediately after birth and during resuscitation. Their data lend weight to the view that conventional approaches to thermal care of the very preterm and low birth weight baby are outmoded.     

产房内危重症的处理

日常工作中产房发生急救事件较多，其中肩难产、子宫破裂、产后出血、脐带脱垂、子痫、羊水栓塞、胎盘早剥是较常见的一些危重症。为了达到良好的救治效果，产房必须具备技术过硬、反应快速的团队以及随时可用的设备，平时危重症急救的演练是提高产房危重症急救能力的有效措施。     

The feasibility and accuracy of ultrasound assessment in the labor room

Objective: Vaginal examination is widely used to assess the progress of labor; however, it is subjective and poorly reproducible. We aim to assess the feasibility and accuracy of transabdominal and transperineal ultrasound compared to vaginal examination in the assessment of labor and its progress.

Methods: Women were recruited as they presented for assessment of labor to a tertiary inner city maternity service. Paired vaginal and ultrasound assessments were performed in 192 women at 24–42 weeks. Fetal head position was assessed by transabdominal ultrasound defined in relation to the occiput position transformed to a 12-hour clock face; fetal head station defined as head-perineum distance by transperineal ultrasound; cervical dilatation by anterior to posterior cervical rim measurement and caput succedaneum by skin-skull distance on transperineal ultrasound.

Results: Fetal head position was recorded in 99.7% (298/299) of US and 51.5% (154/299) on vaginal examination (p?¹). Bland–Altman analysis showed 95% limits of agreement, ?5.31 to 4.84 clock hours. Head station was recorded in 96.3% (308/320) on vaginal examination (VE) and 95.9% (307/320) on US (p?=?.79¹). Head station and head perineum distance were negatively correlated (Spearman’s r?=??.57, p?p?p?p?Conclusions: We describe comprehensive ultrasound assessments in the labor room that could be translated to the assessment of women in labor. Fetal head position is unreliably determined by vaginal examination and agrees poorly with US. Head perineum distance has a moderate correlation with fetal head station in relation to the ischial spines based on vaginal examination. Cervical dilatation is not reliably assessed by ultrasound except at dilatations of less than 4?cm. Caput is readily quantifiable by ultrasound and its presence is associated with lower fetal head station. Transabdominal and transperineal ultrasound is feasible in the labor room with an accuracy that is generally greater than vaginal examinations.     

Decision-making in the delivery room: a survey of neonatologists.

OBJECTIVE: To examine influences on neonatologists' decision-making regarding resuscitation of extremely premature infants. STUDY DESIGN: A mailed survey of Illinois neonatologists evaluated influences on resuscitation. Personal and parentally opposed (that is, acting against parental wishes) gray zones of resuscitation were defined, with the lower limit (LL) the gestational age at or below which resuscitation would be consistently withheld and the upper limit (UL) above which resuscitation was mandatory. RESULT: Among the 85 respondents, LL and UL of the personal and parentally opposed gray zones were median 22 and 25 weeks, respectively. Neonatologists with an UL personal gray zone <25 completed weeks were significantly more fearful of litigation, more likely to have received didactic/continuing medical education teaching, and less likely to always consider parents' opinions in resuscitation decisions. Neonatologists with an UL parentally opposed gray zone <25 completed weeks were more fearful of litigation. CONCLUSION: Neonatologists perceive a 'gray zone' of resuscitative practices and should understand that external influences may affect their delivery room resuscitation practices.     

The role of the neonatal intensive care nurse in the delivery room

The experienced Neonatal Intensive Care Unit (NICU) nurse is a crucial member of the delivery room resuscitation team. In a survey of tertiary centers, the neonatal nurse was the most consistent member of the team in attendance at high risk deliveries. This nursing role, including rationale, preparation for, and future potential, is explored in this article.     

Heat loss prevention for preterm infants in the delivery room.

OBJECTIVE: Preterm infants are prone to hypothermia immediately following birth. Among other factors, excessive evaporative heat loss and the relatively cool ambient temperature of the delivery room may be important contributors. Most infants <29 weeks gestation had temperatures <36.4 degrees C on admission to our neonatal unit (NICU). Therefore we conducted a randomized, controlled trial to evaluate the effect of placing these infants in polyurethane bags in the delivery room to prevent heat loss and reduce the occurrence of hypothermia on admission to the NICU. METHODS: After parental consent was obtained, infants expected to be <29 weeks gestation were randomized to intervention or control groups just prior to their birth. Infants randomized to the intervention group were placed in polyurethane bags up to their necks immediately after delivery before being dried. They were then resuscitated per NRP guidelines, covered with warm blankets, and transported to the NICU, where the bags were removed and rectal temperatures were recorded. Control infants were resuscitated, covered with warm blankets, and transported without being placed in polyurethane bags. Delivery room temperatures were recorded so this potentially confounding variable could be assessed. RESULTS: Intervention patients were less likely than control patients to have temperature < 36.4 degrees C on admission , 44 vs 70% (p<0.01) and the intervention group had a higher mean admission temperature, 36.5 degrees C vs 36.0 degrees C (p<0.003). This effect remained significant (p<0.0001) when delivery room temperature was controlled in analysis. Warmer delivery room temperatures (>/=26 degrees C) were associated with higher admission temperatures in both intervention and control infants, but only the subgroup of intervention patients born in warmer delivery rooms had a mean admission temperature >36.4 degrees C. CONCLUSIONS: Placing infants <29 weeks gestation in polyurethane bags in the delivery room reduced the occurrence of hypothermia and increased their NICU admission temperatures. Maintaining warmer delivery rooms helped but was insufficient in preventing hypothermia in most of these vulnerable patients without the adjunctive use of the polyurethane bags.     

Teamwork and quality during neonatal care in the delivery room.

OBJECTIVE: Experts believe good teamwork among health care providers may improve quality. We sought to measure the frequency of team behaviors during delivery room care and to explore how these behaviors relate to the quality of care. STUDY DESIGN: We video recorded neonatal resuscitation teams then used independent observers to measure teamwork behaviors and compliance with Neonatal Resuscitation Program (NRP) guidelines (a measure of quality of care). RESULTS: Observer agreement was either fair or good for all teamwork behaviors except workload management, vigilance, and leadership, for which agreement was slight. All teams (n=132) exhibited the behaviors information sharing and inquiry, and all but one team exhibited vigilance and workload management. Other behaviors were present less often: assertion in 19.9% of teams, teaching 16.7%, leadership 19.7%, evaluation of plans 12.9%, and intentions stated 9.1%. Factor analysis identified three fundamental components of teamwork: communication (comprised of information sharing and inquiry); management (workload management and vigilance); and leadership (assertion, intentions shared, evaluation of plans, and leadership). All three components were weakly but significantly correlated with independent assessments of NRP compliance and an overall rating of the quality of care. CONCLUSION: Most team behaviors can be reliably observed during delivery room care by neonatal resuscitation teams, and some are infrequently used. We found weak but significant and consistent correlations among these behaviors with independent assessments of NRP compliance and an overall rating of the quality of care. These findings support additional efforts to study team training for delivery room care and other areas of healthcare.     

Methods of adequate evaluation of the fetal status in modern delivery room

In this review are followed the basic methods for evaluation of the fetal status during delivery in modern delivery room. Here are shown methods for following of fetal heart rate, fetal pulsoxymetry, acid base balance and amnioscopy. It has been revealed the up-to-date abilities of technique, the performance of these methods, the clinical interpretation of the evaluated parameters from the point of view of the delivery room medical staff.     

The importance of Doppler ultrasound in delivery planning

With respect to the power of nature and the fact that it can still surprise us, even with all anticipated measures of safety, it is necessary to expand a range of true indications for surgical delivery. Thus complications of the delivery itself and conditions of increased morbidity can be reduced. By following Doppler flow with a biophysical profile, cardiotocography and pH metry of the head (if available), indications for cesarean section can be expanded in time so the morbidity and mortality of the newborn population can be decreased. It is a fact that controlled vaginal delivery leads to additional maturation of the fetus. By provoking contractions, acts of hypoxia crisis under the influence of stress hormones cause larger and faster surfactant production. However, the danger of walking on a tightrope is decreased if it is anticipated that delivery can not be accomplished per vias naturalis and that it is more advisable and safer to perform cesarean section.