Physical abuse of women before, during, and after pregnancy

CONTEXT: Clinicians who care for new mothers and infants need information concerning postpartum physical abuse of women as a foundation on which to develop appropriate clinical screening and intervention procedures. However, no previous population-based studies have been conducted of postpartum physical abuse. OBJECTIVES: To examine patterns of physical abuse before, during, and after pregnancy in a representative statewide sample of North Carolina women. DESIGN, SETTING, AND PARTICIPANTS: Survey of participants in the North Carolina Pregnancy Risk Assessment Monitoring System (NC PRAMS). Of the 3542 women invited to participate in NC PRAMS between July 1, 1997, and December 31, 1998, 75% (n = 2648) responded. MAIN OUTCOME MEASURES: Prevalence of physical abuse during the 12 months before pregnancy, during pregnancy, and after infant delivery; injuries and medical interventions resulting from postpartum abuse; and patterns of abuse over time in relation to sociodemographic characteristics and use of well-baby care. RESULTS: The prevalence of abuse before pregnancy was 6.9% (95% confidence interval [CI], 5.6%-8.2%) compared with 6.1% (95% CI, 4.8%-7.4%) during pregnancy and 3.2% (95% CI, 2.3%-4.1%) during a mean postpartum period of 3.6 months. Abuse during a previous period was strongly predictive of later abuse. Most women who were abused after pregnancy (77%) were injured, but only 23% received medical treatment for their injuries. Virtually all abused and nonabused women used well-baby care; private physicians were the most common source of care. The mean number of well-baby care visits did not differ significantly by maternal patterns of abuse. CONCLUSION: Since well-baby care use is similar for abused and nonabused mothers, pediatric practices may be important settings for screening women for violence.     

Domestic abuse on women in China before, during, and after pregnancy

Background Some researchers found that partner-perpetrated physical violence increased in frequency and severity during the postpartum period compared with the antenatal period, however, limited data exists describing abuse of women in China. The purpose of this study was to examine patterns of abuse in China before, during, and after pregnancy, and explore possible factors related to abuse. Methods A community-based face-to-face survey of a representative group of women who had a child aged 6 to 18 months in 32 communities of Tianjin, Liaoning, Henan, and Shaanxi provinces was carried out between November 1,2001 and February 28, 2002. Results The prevalence of domestic abuse (emotional, sexual, or physical) occurring in any period (before, during, or after pregnancy) was 12.6%. The prevalence of abuse during the approximate 9 months of pregnancy (4.3%) was relatively lower compared with the prevalence of abuse during the 12 months before pregnancy (9. 1%) and after delivery (8.3%) during the mean 11-month postpartum period studied. Abuse before pregnancy was a strong risk factor for abuse during pregnancy and abuse after pregnancy, and abuse during any previous period was a strong risk factor for subsequent abuse. Many women who suffered abuse of any kind generally experienced multiple acts over time and most acts were not severe. The results of logistic regression analysis showed that the factors associated with abuse during pregnancy included women previously witnessing domestic violence, a poor relationship with the panner, socioeconomic level, alcohol consumption, and smoking. Conclusions It is necessary to do in-depth training and to raise awareness of panner abuse among all health professionals. Routine screening of abuse in maternity clinics is advocated to decrease the adverse impact of abuse on women and fetuses.     

Unintended pregnancy among adult women exposed to abuse or household dysfunction during their childhood.

CONTEXT: Studies have identified childhood sexual and physical abuse as a risk factor for adolescent pregnancy but the relationship between exposure to childhood abuse and unintended pregnancy in adulthood has, to our knowledge, not been studied. OBJECTIVE: To assess whether unintended pregnancy during adulthood is associated with exposure to psychological, physical, or sexual abuse or household dysfunction during childhood. DESIGN AND SETTING: Analysis of data from the Adverse Childhood Experiences Study, a survey mailed to members of a large health maintenance organization who visited a clinic in San Diego, Calif, between August and November 1995 and January and March 1996. The survey had a 63.4% response rate among the target population for this study. PARTICIPANTS: A total of 1193 women aged 20 to 50 years whose first pregnancy occurred at or after age 20 years. MAIN OUTCOME MEASURE: Risk of unintended first pregnancy by type of abuse (psychological, physical, or sexual abuse; peer sexual assault) and type of household dysfunction (physical abuse of mother by her partner, substance abuse by a household member, mental illness of a household member). RESULTS: More than 45% of the women reported that their first pregnancy was unintended, and 65.8% reported exposure to 2 or more types of childhood abuse or household dysfunction. After adjustment for confounders (marital status at first pregnancy and age at first pregnancy), the strongest associations between childhood experiences and unintended first pregnancy included frequent psychological abuse (risk ratio [RR], 1.4; 95% confidence interval [CI], 1.2-1.6), frequent physical abuse of the mother by her partner (RR, 1.4; 95% CI, 1.1-1.7), and frequent physical abuse (RR, 1.5; 95% CI, 1.2-1.8). Women who experienced 4 or more types of abuse during their childhood were 1.5 times (95% CI, 1.2-1.8) more likely to have an unintended first pregnancy during adulthood than women who did not experience any abuse. CONCLUSIONS: This study indicates that there may be a dose-response association between exposure to childhood abuse or household dysfunction and unintended first pregnancy in adulthood. Additional research is needed to fully understand the causal pathway of this association.     

全孕期心理管理对出现异常情绪的不良孕产史孕妇妊娠结局的影响

目的 探讨全孕期心理管理对孕期出现异常情绪且具有不良孕产史的孕妇妊娠结局的影响,寻求有效的方法改善异常情绪,从而改善妊娠结局。方法 选取2018年1月至2020年6月期间全孕期在我院定期产检、具有不良孕产史的孕妇,按照抑郁自评量表(Self-rating Depression Scale,SDS)和焦虑自评量表(Self-rating Anxiety Scale,SAS)进行筛查,将有轻、中度抑郁和(或)焦虑的患者作为研究对象,共100例,随机分成两组,试验组在常规产检的基础之上,于早、中、晚孕期进行心理管理,对照组进行常规产检,比较两组剖宫产率、产后2 h阴道出血量、早产率及孕早期、孕晚期抑郁、焦虑评分。结果 试验组孕早期SAS、SDS评分与对照组比较,差异无统计学意义(P0.05)。经过全孕期心理管理后,试验组孕晚期SAS、SDS评分明显低于其孕早期评分(P0.05);对照组孕妇孕晚期SAS、SDS评分与其孕早期评分比较无明显改变,差异无统计学意义(P0.05);孕晚期试验组SAS、SDS评分明显低于对照组SAS、SDS评分(P0.05)。试验组剖宫产率(30.00%)低于对照组(60.00%)(χ2=9.090,P0.05);试验组早产率与对照组比较,差异无统计学意义(χ2=0.560,P0.05);试验组产后2 h出血量(166.70±52.50)mL明显低于对照组(262.80±82.70)mL,差异有统计学意义(P0.05)。结论 全孕期心理管理可以有效改善具有异常情绪的不良孕产史孕妇的妊娠结局。     

Incidence, trends, and risks of ectopic pregnancy in a population of women

In a 20-year longitudinal study on ectopic pregnancy in a defined population of women aged 15-39 years the rate of ectopic pregnancy per 1000 diagnosed conceptions increased from 5.8 during 1960-4 to 11.1 during 1975-9. The mean annual incidence of ectopic pregnancy per 1000 women increased from 0.6 to 1.2 during the same period. The numbers of ectopic pregnancies per 1000 diagnosed conceptions increased with increasing age of the women and were 4.1, in the teenage group 6.9, in women aged 20-29 years, and 12.9 in women aged 30-39. Among 20- to 29-year-old sexually active women at risk of pregnancy who had never had acute salpingitis the rates of ectopic pregnancy per 100 woman-years were the same in those who did not use contraceptives as in those using non-medicated or copper-medicated intrauterine contraceptive devices (IUCDs; 0.3/100 woman years). The risk of an ectopic pregnancy increased sevenfold after acute salpingitis. These findings confirm the increased risk of ectopic pregnancy after salpingitis and suggest that the increase in the incidence of ectopic pregnancy in Lund from 1960 to 1979 was partly accounted for by the use of IUCDs.     

孕期盆底肌锻炼联合产后盆底功能康复治疗对产后女性盆底功能障碍的防治效果

目的 探讨孕期盆底肌锻炼联合产后盆底功能康复治疗对产后女性盆底功能障碍的防治效果.方法 选取2019年1月—2020年6月在我院产科门诊定期产检,B超确认为单胎足月顺产,剔除妊娠合并症及并发症,符合入组标准病例共316例,随机分成观察组和对照组,观察组131例,对照组185例,观察组在孕12周开始宣教孕期定期行盆底肌K...     

妊娠期孕妇亚临床甲状腺机能减退症对妊娠结局的影响分析

目的:探讨妊娠期孕妇亚临床甲减对妊娠结局的影响。方法:分娩的200例妊娠期亚临床甲减孕妇作为观察组,与同期随机收治住院分娩的正常健康孕妇150例作为对照组,观察两组孕妇妊娠结局的影响因素。结果:观察组孕妇孕期及分娩期妊娠期高血压、贫血、早产发生率以及孕晚期胎儿宫内窘迫、低出生体重胎儿均显著高于对照组,差异有统计学意义(P<0.05)。结论:妊娠期合并亚临床甲减疾病发生的同时也会引发其他相关疾病,所以在怀孕初期建议孕妇尽早进行全面检查,尤其是甲状腺功能检查,如发现患亚临床甲减应立即采取有效的措施加以治疗,以降低孕妇相关疾病的发生率,尽量降低对胎儿生长发育及智力等方面的影响,减少新生儿相关并发症。     

孕期及产后妇女高危型人乳头状瘤病毒感染状况分析

目的探讨孕期及产后妇女高危型人乳头状瘤病毒(HPV)检测的临床意义。方法采用快速导流杂交技术和基因芯片技术检测3806例清远地区孕期及产后妇女的宫颈标本,以5岁间隔分组,对不同年龄组进行高危型HPV-DNA检测,以4080例同期非孕期妇科普查妇女作为对照。结果在7886例标本中高危型HPV感染率为12.5%,孕期、产后及非孕期组分别为14.3%、10.5%、11.7%,4个年龄组分别为16.9%、12.1%、13.5%和22.1%。结论孕期高危型HPV感染率与产后及同期非孕期妇女比较差异有显著性,在各年龄组之间比较差异显著,孕期行宫颈HPV筛查安全可行。     

实施孕期规范化管理降低高危孕妇妊娠高血压的发生

目的 探讨孕期规范化管理对高危孕妇妊娠高血压发生率的影响。方法 选取2018年1月至2019年6月邳州市人民医院诊治的142例妊娠高血压高危孕妇为研究对象,随机分为观察组和对照组,每组各71例,对照组在门诊进行常规孕期保健,观察组对孕妇建立系统档案,实施以下干预措施:强化产前检查、完善孕期保健措施、改善生活方式、加强孕期体重管理、进行适当运动、药物干预、心理支持。比较两组焦虑(SAS)及抑郁(SDS)评分、相关知识掌握情况、遵医行为、妊娠高血压疾病发生率、分娩方式、Apgar评分。结果 两组首次产前检查心理状态评分比较[SAS(47.20±8.25)分vs.(47.81±8.33)分、SDS(46.05±7.71)分vs.(46.78±7.66)分],差异无统计学意义(t=0.451、0.411,P0.05),分娩前观察组SAS评分为(38.66±5.26)分、SDS评分为(34.62±5.09)分,低于对照组的(41.68±6.02)分、(40.92±6.15)分,差异有统计学意义(t=3.183、7.072,P0.05);观察组孕妇掌握管理内容为87.32%、遵医行为好为91.55%、阴道分娩为70.42%、新生儿Apgar评分为(9.34±0.79)分,高于对照组的63.38%、70.42%、53.52%、(9.01±0.83)分,差异有统计学意义(χ2/t=10.950、10.287、4.302、2.427,P0.05);妊娠高血压疾病发生率为4.23%,低于对照组的14.08%,差异有统计学意义(χ2=4.145,P0.05)。结论 孕期规范化管理联合心理干预能够改善妊娠高血压高危孕妇的心理状态,掌握相关知识,遵医行为良好,合理分娩,降低妊娠高血压疾病的发生。     

PULMMONARY EMBOLISM DURING PREGNANCY AND THE POSTPARTUM PERIOD：REPORT OF 2 CASES

Objctive.To investigate the high risk factures,diagnosis and treatment of pulmonary embolism（PE) during pregnancy and the postpartum period.Methods.Two caes of PE during pregnacy and postpartum period were reported retrospectively.Results.The first case was a pregnan woman with congenital heart disease at 39-week gestation.She underwent a successful cesarean section(CS)because of heart diease, but she manifested tachycardia,tachypnea,cyanosis,and dyspnea suddenly on the 10th day after CS and died soon after the onset of these symptoms.The diagnosis of PE was highly suspected clinically.The second case was a twin-pregnacy woman at 35-week gestation.Because of severe perinatal myocardiopathy,cesarean section was performed.Unfortunately,the patient died abruptly on the operation table .The diagnosis of PE was confirmed by autopsy.Conclusions.The maternal mortality of PE during pregnacy and postpartum period is quite high .Whenever there is any doubt,objective examination for PE shold be started early order to strive for the chances of the anticoagulant therapy.     

手术干预控制60例瘢痕子宫再次剖宫产产后出血的疗效观察

目的 探讨手术方式预防瘢痕子宫再次剖宫产产后出血的疗效.方法 选取瘢痕子宫再次剖宫产产妇60例(观察组)进行手术干预预防产后出血,与非瘢痕子宫产妇108例(对照组)进行对比,比较两组并发症的发生率及产后出血发生率.结果 观察组并发症的发生率和术中出血量明显高于对照组(P＜0.05),通过术中手术方式干预处理后,两组产后出血发生率比较差异无统计学意义(P＞0.05).结论 手术方式的干预能有效减少瘢痕子宫再次剖宫产产后出血,值得推广.