Study on nulliparous women's preference for mode of delivery in Shanghai:the influencing factors

目的 了解无剖宫产指征的初产妇分娩意向及分娩方式,并分析其影响因素.方法 采用非概率抽样方法对336例无剖宫产指征的初产妇进行问卷调查.结果 336例无剖宫产指征的初产妇中,256例分娩意向为自然分娩,80例为剖宫产；276例初产妇选择了自然分娩,60例选择了剖宫产.分娩意向和分娩方式呈高度相关(r=0.809,P＜0.01).户籍、是否有医疗保险、分娩方式相关知识、丈夫文化程度、丈夫对分娩态度及朋友的分娩情况对初产妇的分娩意向产生影响,影响程度为43.2％；而年龄、待产时间、产前的分娩意向、与分娩方式相关的知识及丈夫态度对初产妇的实际分娩方式产生影响,影响程度为53.4％.结论 初产妇对分娩方式的选择受到年龄、待产时间、产前的分娩意向、与分娩相关的知识及丈夫态度的影响.因此,应将家属纳入到产前的健康教育中、提高社会对自然分娩的正确认识和信心,并且提供更加人性化的分娩服务,以降低剖宫产率.     

上海市初产妇分娩意向及方式影响因素调查

目的了解无剖宫产指征的初产妇分娩意向及分娩方式,并分析其影响因素。方法采用非概率抽样方法对336例无剖宫产指征的初产妇进行问卷调查。结果336例无剖宫产指征的初产妇中,256例分娩意向为自然分娩,80例为剖宫产;276例初产妇选择了自然分娩,60例选择了剖宫产。分娩意向和分娩方式呈高度相关(r=0.809,P<0.01)。户籍、是否有医疗保险、分娩方式相关知识、丈夫文化程度、丈夫对分娩态度及朋友的分娩情况对初产妇的分娩意向产生影响,影响程度为43.2%;而年龄、待产时间、产前的分娩意向、与分娩方式相关的知识及丈夫态度对初产妇的实际分娩方式产生影响,影响程度为53.4%。结论初产妇对分娩方式的选择受到年龄、待产时间、产前的分娩意向、与分娩相关的知识及丈夫态度的影响。因此,应将家属纳入到产前的健康教育中、提高社会对自然分娩的正确认识和信心,并且提供更加人性化的分娩服务,以降低剖宫产率。     

无医学指征初产妇选择剖宫产动机的质性研究

目的探讨无剖宫产指征初产妇选择剖宫产的动机。方法以立意抽样法选取无医学指征选择剖宫产的初产妇25例为研究对象,采用个人深入访谈法收集资料,运用类属分析法对资料进行整理分析。结果初产妇对分娩方式的观念已发生改变,她们渴望更加人性化的分娩服务,并希望拥有分娩方式的决定权。而产妇选择剖宫产的动机受到心理、社会、生理及医源性因素的影响。结论分娩方式的选择是一个脆弱的易变行为,应通过完善产前教育来引导产妇及家属对分娩的正确认知,并规范产时服务,提供更人性化的围生期服务,重塑社会及产妇对自然分娩的信心,以降低剖宫产率。     

浅析医院降低剖宫产率的措施

目的:探讨医院剖宫产率高的原因,总结医院为降低剖宫产率所采取的有效措施。方法:选择2011年上半年及2012年上半年我院分娩产妇,比较两组产妇的剖宫产率变化,自编问卷进行相关调查。结果:2012年上半年产妇剖宫产率较2011年上半年有所下降。产妇及家属自主选择、医源性因素、医护人员因素及政策因素是导致剖宫产率高的主要原因。结论:加强产妇健康教育和孕产期保健工作,医院内部加强绩效考核,医生正确掌握剖宫产指征,消除产妇和产妇家属的顾虑,尽可能减少因社会因素引起的剖宫产,将有效地降低剖宫产率。     

不同分娩方式对产后早期盆底肌力影响及电刺激联合生物反馈等盆底肌康复治疗体会

目的分析顺产与剖宫产分娩方式对初产妇产后近期盆底肌力的影响及电刺激联合生物反馈等盆底肌康复治疗的效果。方法选取2017-12—2018-06间在黄河中心医院分娩的80例初产妇。根据分娩方式分为顺产组和剖宫产组,每组40例。产后6周应用PHENIX USB2检测仪量化评估盆底肌力后,对初筛结果盆底肌力下降(≤Ⅲ级)的初产妇均采用电刺激联合生物反馈等盆底肌康复治疗后再次检测产妇盆底肌力。结果剖宫产组产后42 d后盆底肌力下降率低于顺产组,差异有统计学意义(P0.05)。剖宫产组中肌力下降的初产妇治疗后有效率(盆底肌力Ⅲ级)高于顺产组,但差异无统计学意义(P0.05)。结论剖宫产初产妇产后盆底肌力下降率低于顺产产妇,但不能成为避免盆底肌肉受损程度而选择分娩方式的依据。无论何种分娩方式,术后出现盆底肌力受损的初产妇通过电刺激联合生物反馈治疗,可有效改善盆底功能障碍。     

顺产与剖宫产对母婴的影响

目的比较分析顺产与剖宫产对母婴健康的影响。方法选取500例产妇,根据临床分娩方式分为顺产组和剖宫产组,各250例。观察不同分娩方式对母婴健康的影响。结果顺产组产妇的产后出血、产褥病、尿潴留、切口延期愈合等产时和产后并发症发生率明显比剖宫产组产妇低,两组差异具有统计学意义(P0.05)。两组产妇的输血发生率差异无统计学意义(P0.05)。顺产组产妇娩出的新生儿胆红素指数及Apgar评分≤7分的发生率均低于剖宫产组(P0.05)。结论顺产比剖宫产母婴安全性高,应提倡顺产,减少剖宫产,以保证母婴健康。     

阴道产钳助产对剖宫产率及母婴结局的影响

目的探讨阴道产钳助产对剖宫产率及母婴结局的影响。方法随机选取2016年5月至2017年5月本院收治的产妇80例,依据治疗方法将这些产妇分为阴道产钳助产组(n=40)和剖宫产手术组(n=40)两组,剖宫产手术组产妇分娩困难时直接进行剖宫产手术,阴道产钳助产组产妇分娩困难时优先考虑阴道产钳助产,然后对两组产妇的分娩方式、操作时间、母婴结局进行统计分析。结果阴道产钳助产组产妇的顺产率72.5%(29/40)显著高于剖宫产手术组35.0%(11/40)(P0.05),剖宫产率27.5%(14/40)显著低于剖宫产手术组65.0%(26/40)(P0.05),操作时间显著短于剖宫产手术组(P0.05),术后切口感染率、新生儿面部创伤率12.5%(5/40)、22.5%(9/40)均显著高于剖宫产手术组2.5%(1/40)、0(P0.05),新生儿头皮水肿率显著低于剖宫产手术组20.0%(8/40)(P0.05)。结论阴道产钳助产能够有效降低产妇剖宫产率,改善母婴结局。     

第二产程指导用力和自主用力对初产妇分娩结局及疲倦度的影响

目的探讨第二产程指导用力和自主用力对初产妇分娩结局及疲倦度的影响。方法将经阴道分娩的176例产妇采用随机数字表法分为自主用力组(87例)和指导用力组(89例),于第二产程分别采取自主用力和指导用力进行分娩。比较两组产妇的第二产程时间,母婴结局(分娩方式、产后出血、新生儿Apgar评分、脐血血气分析等)及产后疲倦度等指标。结果自主用力组第二产程时间短于指导用力组,但差异无统计学意义(P0.05);而分娩方式上自主用力组顺产率显著高于指导用力组,产后出血发生率、产后疲倦度显著低于指导用力组,差异有统计学意义(P0.05,P0.01)。结论第二产程产妇自主用力能够改善母儿结局,减轻产后疲倦。     

社会因素与剖宫产原因及护理对策

目的分析社会因素剖宫产原因,减少剖宫产给产妇带来的痛苦或并发症。方法对2006年至2008年分娩例数、剖宫产例数、社会因素剖宫产例数阶段统计并计算剖宫产率。结果剖宫产率呈逐年上升趋势,平均45.6%,社会因素剖宫产率占总数的82.7%。主要原因是产妇及家属对自然分娩及剖宫产缺乏科学认识、高龄初产妇、巨大儿及珍贵儿的增加,产科医师对剖宫产指征把握不严,医疗纠纷的逐年增多,产前缺乏宣教。结论树立正确的生育观,更新产科医务人员的服务观念,提高医院产科整体质量,积极开展无痛分娩及导乐陪伴分娩,严格掌握剖宫产指征多可控制社会因素剖宫产。     

剖宫产率升高的原因分析及预防

目的探讨剖宫产率升高的原因及预防对策。方法随机选择2004年6月至2007年6月存档剖宫产病案1000例,依据术前小结分析其剖宫产的原因并提出预防对策。结果高龄初产、珍贵儿、瘢痕子宫、妊娠合并内科病、剖宫产手术及麻醉技术的提高、产妇及家属的强烈要求择期手术等是造成剖宫产率升高的原因。结论加强围生期保健和系统管理,提高产前健康教育普及率,开展产前咨询,提高孕妇及家属对阴道分娩的信心。严密观察产程,提高待产和分娩质量,实施导乐镇痛分娩,严格掌握剖宫产指征,才能控制并降低剖宫产率,提高自然分娩率。     

Cesarean section: Does it really prevent the development of postpartum stress urinary incontinence? a prospective study of 363 women one year after their first delivery

AIMS: Stress urinary incontinence (SUI) in young women is usually the result of pelvic floor injury during vaginal delivery. Whether cesarean section delivery may prevent such injury is questionable. We undertook a prospective study to compare the prevalence of SUI among primiparae 1 year after spontaneous vaginal delivery versus elective cesarean section, or cesarean section performed for obstructed labor. METHODS: Three hundred and sixty-three consecutive primiparae were recruited immediately after delivery and were followed for 1 year. Women were asked upon recruitment whether they had ever experienced SUI before pregnancy. Those who had SUI before pregnancy were excluded. Thus, only cases of de novo childbirth-associated SUI were analyzed. Patients were divided into three subgroups according to the mode of delivery: spontaneous vaginal delivery (n = 145), elective cesarean section (n = 118), and cesarean section performed for obstructed labor (n = 100). Patients who underwent elective cesarean section were not given a trial of labor. Cesarean sections for obstructed labor were performed at a mean cervical dilatation of 8.7 +/- 1.6 cm and arrest of 184 +/- 24 min. Prevalence, frequency, and severity of postpartum SUI, as well as demographic and obstetric parameters, were analyzed in each subgroup. RESULTS: The three subgroups were comparable with respect to maternal age, weight, and height. Prevalence of postpartum SUI was similar after spontaneous vaginal delivery (10.3%) and cesarean section performed for obstructed labor (12%). However, SUI was significantly less common following elective cesarean section with no trial of labor (3.4%, P < 0.05). Approximately half of the symptomatic patients in each subgroup reported either moderate or severe symptoms, however, only 15-18% expressed their desire for further evaluation. CONCLUSIONS: Prevalence of postpartum SUI is similar following spontaneous vaginal delivery and cesarean section performed for obstructed labor. It is quite possible that pelvic floor injury in such cases is already too extensive to be prevented by surgical intervention. Conversely, elective cesarean section, with no trial of labor, was found to be associated with a significantly lower prevalence of postpartum SUI. Whether the prevention of pelvic floor injury should be an indication for elective cesarean section is yet to be established.     

First vaginal delivery at an older age: Does it carry an extra risk for the development of stress urinary incontinence?

AIMS: First delivery at an older age is not an uncommon event in modern obstetric practice. The present study was undertaken to compare the prevalence of postpartum stress urinary incontinence (SUI) according to maternal age and mode of delivery. METHODS: Fifty two consecutive elderly primiparae (mean age 40.0 +/- 1.8) who underwent spontaneous vaginal delivery, 42 consecutive elderly primiparae (mean age 40.7 +/- 3.6) who underwent elective cesarean section, and 92 consecutive young primiparae (mean age 26.2 +/- 2.5) who underwent spontaneous vaginal delivery were interviewed 1-2 years postpartum about the symptom of SUI. Women who had SUI before pregnancy were not enrolled. Obstetric data were collected from computerized hospital records. RESULTS: The prevalence of SUI 1-2 years after spontaneous vaginal delivery was significantly higher in elderly compared with younger primiparae (38.5% vs. 9.8%, respectively). Elderly primiparae who underwent elective cesarean section had a significantly lower prevalence of postpartum SUI than those delivered vaginally (16.7% vs. 38.5%, respectively). Further comparison of stress-incontinent versus continent elderly primiparae failed to reveal significant demographic or obstetric differences, except for increased prevalence of SUI during pregnancy among incontinent patients (45% vs. 19%, respectively). CONCLUSIONS: First vaginal delivery at an older age carries an increased risk for postpartum SUI. Stress-incontinent women also had higher prevalence of SUI during pregnancy. This finding implies that the pathophysiologic process of SUI begins during pregnancy, prior to active labor and delivery. Nonetheless, elective cesarean section in these women has a protective effect and lowers the risk of developing postpartum SUI.     

腰方肌阻滞应用于剖宫产手术术后镇痛效果的系统评价

目的 系统评价腰方肌阻滞应用于剖宫产手术术后镇痛的有效性和安全性.方法计算机检索PubMed、The Cochrane Library、Embase、中国生物医学数据库(CBM)、万方数据库、中国知网和维普网数据库,收集从建库到2020年4月所有关于腰方肌阻滞用于剖宫产手术术后镇痛效果的随机对照试验.由两位评价员独立筛...     

控制剖宫产率前后的手术指征变化分析

目的分析控制剖宫产率前后的手术指征所占比例的变化，总结有效的措施降低剖宫产率。方法回顾性分析2012年11月～2013年10月我院住院经剖宫产分娩的病例，2012年11月1日～2013年4月30日剖宫产分娩病例作为对照组，2013年5月1日～2013年10月31日剖宫产分娩病例作为研究组，比较两组剖宫产率、两组剖宫产指征所占的比例是否有统计学差异。结果两组剖宫产率有统计学差异（P〈0．05），社会因素、羊水过少、胎儿窘迫、瘢痕子宫、胎位异常、产程异常及其他因素剖宫产率差异有统计学意义（P〈0．05），巨大儿、胎盘异常、妊娠合并症剖宫产率无统计学差异（P〉0．05）。结论加强宣教和高危产妇的监管，提高医务人员技术水平，严格控制剖宫产率，可以有效降低剖宫产率。     

催乳汤对产妇泌乳量及新生儿体重的影响

为观察术后饮食对泌乳量及新生儿体重的影响，将８２例剖宫产产妇随机分为两组。观察组术后６ｈ于饮用催乳汤，辅以主食；对照组按常规饮食护理。结果：观察组产后不同时间段泌乳量均明显多于对照组（均Ｐ〈０．００１），新生儿体重恢复快。提示：加强剖宫产术后营养摄入可使乳母增加泌乳量，促进其肠功能恢复，提高母乳喂养率。     

Induction of labor with oxytocin increases cesarean section rate as compared with oxytocin for augmentation of spontaneous labor in nulliparous parturients controlled for lumbar epidural analgesia

STUDY OBJECTIVES: To study labor outcomes in parturients receiving oxytocin for augmentation or induction of labor, in the presence of labor epidural analgesia. DESIGN: Retrospective study of data from a continuous quality improvement database. SETTING: Tertiary-care hospital with more than 8000 deliveries per annum. MEASUREMENTS AND MAIN RESULTS: Of the 1671 healthy nulliparous women with singleton pregnancies and who requested labor epidural analgesia at our institution, 675 patients received oxytocin during elective induction of labor, whereas 996 patients received oxytocin for augmentation of spontaneous labor. Measured variables were cervical dilatation at time of epidural analgesia request, epidural insertion to 10-cm time, duration of stage 2 of labor, normal spontaneous vaginal delivery rate, cesarean section rate, operative vaginal delivery rate, and baby weight. Women admitted for induction of labor requested epidural analgesia sooner than those who had their labor augmented (p < 0.001). The incidence of cesarean section was higher in the induced group (p = 0.008). CONCLUSION: Patients who have their labor induced request analgesia sooner and are at a higher risk of cesarean section than are patients who go into labor spontaneously. Any study that purports to assess the effects of epidural analgesia in labor should distinguish between induced and augmented/spontaneous labor.     

盆底超声评估初次经阴道分娩与剖宫产产后盆底功能

目的观察盆底超声评估阴道分娩与剖宫产初次产后盆底功能的价值。方法选取176名产妇,根据初次分娩方式将其分为经阴道分娩组(n=100)和剖宫产组(n=76);对比2组静息态及最大瓦尔萨尔瓦动作下超声各参数,包括肛提肌裂孔左右径、前后径及面积,左、右侧耻骨直肠肌厚度及膀胱颈移动度,观察盆底超声评估初次产后盆底功能的价值。结果静息态及最大瓦尔萨尔瓦动作下,经阴道分娩组肛提肌裂孔左右径、前后径及面积均大于剖宫产组(P均<0.05),左、右侧耻骨直肠肌厚度均小于剖宫产组(P均<0.05);阴道分娩组膀胱颈移动度大于剖宫产组(t=2.177,P=0.031)。结论盆底超声对评估初次产后盆底功能具有一定价值;初次经阴道分娩对盆底功能的影响大于剖宫产;肛提肌裂孔面积增大、膀胱颈移动度增大及耻骨直肠肌厚度变薄可早期提示产后盆底功能障碍可能。     

母乳哺育支持系统对初产妇产后母乳喂养的影响

目的探讨母乳哺育支持系统对初产妇产后母乳喂养的影响。方法将69例自然分娩的初产妇随机分为观察组35例和对照组34例,观察组新生儿出生后给予持续性母婴皮肤接触1h,由母乳哺育支持团队成员提供母乳喂养护理支持,出院后哺乳顾问持续跟踪并给予帮助;对照组则行皮肤接触至产妇会阴伤口缝合并检查完毕,给予常规产后护理。比较产后不同时间纯母乳喂养率及母乳喂养率。结果观察组出院时、产后7d、4个月及6个月的纯母乳喂养率显著高于对照组(P0.05,P0.01),观察组产后7d、4个月及6个月的母乳喂养率显著高于对照组(均P0.05)。结论医院母乳哺育支持系统能有效提高初产妇产后纯母乳喂养率和母乳喂养率。     

经皮穴位电刺激对剖宫产产妇机体功能恢复的影响

目的观察经皮穴位电刺激(TEAS)对剖宫产产妇常见并发症和机体功能恢复的影响。方法择期行剖宫产术初产妇80例,年龄22~40岁,BMI 18~32 kg/m^2,ASAⅠ或Ⅱ级,采用随机数字表法随机分为TEAS联合麻醉组(T组)和常规麻醉组(C组),每组40例。两组均采用腰-硬联合阻滞,术后镇痛方法相同:采用患者自控硬膜外镇痛(PCEA)。T组于术前30 min给予经皮穴位电刺激双侧内关、合谷穴,术中持续刺激至术毕;C组不贴电极片。记录两组产妇年龄、体重、手术时间、出血量、术中液体输注量等一般情况,术后PCEA维持VAS评分≤3分,记录产妇48 h内PCEA镇痛药用量、羟考酮补救镇痛消耗量,恶心呕吐发生率和评分、寒战发生率和评分。记录两组初乳时间,首次排气时间,住院时间和住院费用。结果两组产妇一般情况、48 h内PCEA镇痛药用量、羟考酮补救镇痛消耗量差异无统计学意义。T组恶心呕吐发生率,寒战发生率明显低于C组(P<0.05)。T组初乳时间、术后首次排气时间和住院时间明显短于C组(P<0.05),住院费用明显少于C组(P<0.05)。结论 TEAS可减少剖宫产产妇恶心呕吐、寒战等常见并发症的发生率及发生程度,有助于产妇早泌乳早排气,缩减住院时间和费用。     

剖宫产及硬膜外吗啡术后镇痛对产妇泌乳的影响

目的：观察剖宫产及硬膜外吗啡术后镇痛产妇的泌乳状况及血清泌乳素（ＰＲＬ）变化。方法：足月初产妇１２０例均分为四组：Ⅰ组术毕行硬膜外吗啡镇痛;Ⅱ组术毕硬膜外吗啡镇痛,２４小时后追加１次;Ⅲ组未行术后镇痛;阴道自然分娩３０例为Ⅳ组。结果：产后５分钟、２４值变化各组间无显著性差异。Ⅳ组产后２４小时内开发泌乳发生率（４０％）,高于同期所有剖宫产组（２０％）;但４８小时内开始泌乳及７２小时乳汁分泌不足发生率