妊娠合并精神分裂症的孕期保健和围产期处理

妊娠合并精神分裂症是处理起来较棘手的问题.及早识别病例,加强围产保健,正确处理产程和决定分娩方式是处理的关键.应提供人文关怀,努力帮助患者得到婚姻、家庭及社会的支持.     

Risks of pregnancy and birth in obese primiparous women: an analysis of German perinatal statistics

Purpose  

To compare risks of pregnancy and birth in obese (body mass index, BMI ≥ 30) and normal weight women (BMI 18.5–24.99) giving birth to their first child.     

Traditional beliefs about pregnancy and child birth among women from Chiang Mai, Northern Thailand

OBJECTIVE: To examine women's embodied knowledge of pregnancy and birth, women's explanations of precautions during pregnancy and birth and preparations for easy birth and the role of a traditional midwife in a Thai birthing care. DESIGN: In-depth interviews relating to traditional and changed beliefs and practices of pregnancy and childbirth with Thai women in Northern Thailand. SETTING: Chiang Mai city and Mae On sub-district in Chiang Mai province, Northern Thailand. PARTICIPANTS: 30 Thai women living in Chiang Mai in Thailand. FINDINGS: The social meaning of childbirth in Thai culture is part of the larger social system, which involves the woman, her family, the community, society and the supernatural world. Traditional beliefs and practices in Thai culture clearly aim to preserve the life and well-being of a new mother and her baby. It seems that traditional childbirth practices have not totally disappeared in northern Thailand, but have gradually diminished. Women's social backgrounds influence traditional beliefs and practices. The traditions are followed by most rural and some urban poor women in Chiang Mai. IMPLICATIONS FOR PRACTICE: The findings of this study may assist health professionals to better understand women from different cultures. It is important to recognise many factors discussed in this paper within the context of Thai lives and traditions. This will prevent misunderstanding and, consequently, encourage more sensitive pregnancy and birthing care for pregnant women.     

Growth retardation, size at birth and perinatal mortality in twin pregnancy

The records of 194 consecutive pairs of twins were reviewed. Univariate and multivariate analyses of relative risks (RR) of perinatal death were performed. Perinatal mortality rate was higher in small-for-gestational-age twins and in fetuses with discordancy in size at birth more than 20% and 25%. The RR of perinatal death for small-for-gestational-age twins was 4.8 (2.74-8.42 95% CI). For intertwin birth-weight percent differences of 20% and 25%, the RR was 5.48 (3.2-9.38 95% CI) and 7.2 (3.87-13.42 95% CI). Population mortality attributable risk in the two populations (10.36% and 14.5%, respectively) demonstrates the importance of the prenatal assessment of the respective size of twins in preventing perinatal death.     

Influence of rest during pregnancy on birth weight in working women

OBJECTIVE: Birth weight in Sweden has increased during the past decades. We investigated whether rest provided by the combination of time off from work and social benefits among working pregnant women contributed to the observed changes. METHOD: A total of 7,459 consecutively delivered women in 1978, 1986, 1992, and 1997 at 2 delivery wards in southeastern Sweden were studied. RESULTS: Between 1978 and 1997, the average birth weight among the children of the women studied increased from 3,484 to 3,566 grams (P < .001). The in-crease in weight was most evident among infants born to women who were employed during pregnancy. The use of social benefits and increased rest during pregnancy did not significantly influence birth weight (P = .107), even after adjustment for gestational length, parity, smoking, age, and occupation. CONCLUSION: The continuous increase in infants' birth weight among pregnant women in this study did not correlate with rest periods in the form of leave supported by social benefit programs. The effects of social benefit programs on pregnancy outcome may thus be overrated and merits further research.     

Multifetal pregnancy in older women and perinatal outcomes

OBJECTIVE: To examine multifetal pregnancy in older women and perinatal outcomes.DESIGN: A cross-sectional study.SETTING: A nationwide vital registry.PATIENT(S): A national population-based database that links the live birth, fetal, and infant death certificates reported of multiple gestations in the United States from 1995 to 1997. It includes 155,777 twin and 5,630 triplet pregnancies.INTERVENTION(S): None.MAIN OUTCOME MEASURE(S): Very preterm birth (<33 weeks), very low birthweight (<1,500 g), and perinatal and infant deaths.RESULT(S): Compared with those with singleton pregnancies, women with multifetal gestation tended to be older, non-Hispanic white, better educated, married, and nulliparous and to have earlier and more frequent prenatal care. Pregnancies conceived by assisted reproductive technology accounted for an increasing number of multiple gestations in older women. In women with lower socioeconomic status, older age was associated with higher risks of poor perinatal outcomes in twin pregnancy (relative risks ranging from 1.0 to 1.9 with a dose-response pattern). However, in women with higher socioeconomic status, older women did not have a higher risk of poor perinatal outcomes than younger women.CONCLUSION(S): The effect of older maternal age on perinatal outcomes in multifetal pregnancies may have been altered by assisted reproductive technology, frequent prenatal surveillance, and advanced neonatal care.     

Optimal weight gain during twin pregnancy in Japanese women with favorable perinatal outcomes

Objective: We examined the optimal weight gain in the healthy Japanese women with favorable perinatal outcomes of (dichorionic) twin pregnancy.

Methods: We calculated the average weight gain in the women whose height was 150–164?cm with favorable perinatal outcomes of dichorionic twin pregnancy set for this study. The women were categorized to underweight, normal, overweight and obese based on the pre-pregnancy body mass index (BMI) categories according to the Institute of Medicine (IOM) and the World Health Organization (WHO) body mass index (BMI) cutoffs.

Results: The average GWG in the normal-weight women with the favorable perinatal outcomes was 13.9?±?3.6?kg. It was significantly different from that in the underweight, overweight and obese women according to the both 2 BMI cutoffs by Student’s t-test (p?Conclusion: There are optimal ranges of weight gain during twin pregnancy based on the BMI classification.     

Smoking during pregnancy and preterm birth

Objective To evaluate the association between smoking during pregnancy and preterm birth.
Design A follow up study.
Setting Department of Gynaecology and Obstetrics, Aarhus University Hospital, Denmark.
Participants Four thousand one hundred and eleven nulliparous women with singleton pregnancies who returned questionnaires about smoking habits at 16 weeks of gestation.
Results The overall rate of preterm delivery was 4.3 %. Smokers had a 40 % higher risk of preterm birth compared with nonsmokers. A dose response relationship was found between smoking and risk of preterm birth. Adjustment for women's height, prepregnancy weight, age of the mother, marital status, education, occupational status, and alcohol intake did not change the results. Among women with an intake of less than 400 mg of caffeine per day no difference in the risk of preterm birth between smokers and nonsmokers was found. However, among women with an intake of more than 400 mg of caffeine per day, the risk of preterm birth was increased almost threefold among smokers compared with nonsmokers. Furthermore, among women with a high intake of caffeine a dose-response relationship was found; women smoking one to five cigarettes per day had no increased risk of preterm birth compared with nonsmokers with the same intake of caffeine, women smoking six to ten cigarettes per day had almost three times higher risk of preterm birth, and women smoking more than 10 cigarettes per day had almost five times higher risk of preterm birth compared with nonsmokers with the same intake of caffeine.
Conclusions Smoking increases the risk of preterm birth. The association between smoking and preterm birth was only present among women with a high intake of caffeine. However, whether smoking alone influences the risk of preterm birth among heavy consumers of caffeine needs further investigation.     

Traditional care of the perineum during birth. A prospective,randomized, multicenter study of 1,076 women

OBJECTIVE: To investigate the influence of the traditional hands-on versus the innovative hands-poised method on the risk of perineal trauma during vaginal delivery and on neonatal outcomes. STUDY DESIGN: In a prospective, randomized, multicenter study, 1,161 of 1,505 women giving birth at the Departments of Obstetrics and Gynecology of the University Hospital of Vienna and Semmelweis Women's Hospital, Vienna, between February and September 1999, were randomized into the trial. In the hands-on method, the left hand of the midwife puts pressure on the infant's head, and the right hand is placed against the perineum. In the hands-poised method, the midwife guides the parturient through the birth without touching the perineum, prepared to apply light pressure on the infant's head. RESULTS: One hundred eighty-seven of 574 women (32.5%) in the hands-on group and 180 of 502 women (35.8%) in the hands-poised group experienced perineal tears (P = .5). Sixteen women (2.7%) treated with the hands-on method developed third-degree perineal tears as compared with five women (0.9%) treated with the hands-poised method (P < .05). In the hands-on group, 103 women (17.9%) underwent episiotomy as compared with 51 cases (10.1%) in the hands-poised group (P < .01). No significant differences in neonatal outcomes were observed between the two groups. CONCLUSION: Our data suggest that a policy of hands-poised care is more suitable for preserving the perineum during birth and is a safe and effective birthing alternative for women.     

农村妇女孕期体重对妊娠结局的影响

目的:探讨农村妇女孕期体重与妊娠结局的关系,为农村孕妇的体重管理提供理论依据。方法:收集2014年2月至2015年2月禹城市人民医院产一科住院分娩的单胎妊娠农村初产妇896例,按孕前体重指数(BMI)分为孕前消瘦组(≤18.5kg/m~2)、孕前体重正常组(18.5kg/m~2BMI24kg/m~2)、超重组(24kg/m2≤BMI28kg/m~2)、肥胖组(≥28kg/m~2);按孕期体重增长分为体重增长适宜组及体重增长过度组。分析各组孕妇妊娠结局及并发症的发生情况。结果:孕前超重组与孕前体重正常组比较,孕期体重增长过度组与孕期体重增长适宜组比较,均显著增加妊娠期高血压疾病、妊娠期糖尿病、剖宫产、产后出血、巨大儿的风险,差异有统计学意义(P0.05)。结论:孕前超重与孕期体重增长过度是导致农村孕妇不良妊娠结局的危险因素,应加强孕妇的体重管理,降低妊娠不良结局发生。     

Maternal and perinatal complications in neurofibromatosis during pregnancy.

A total of ten patients with lesions of neurofibromatosis during pregnancy were followed up for pregnancy complications. Seven cases (70%) had hypertensive disorders of pregnancy; four had severe PET (pre-eclamptic toxemia) including one case of eclampsia, one had mild PET and the other two had only mild gestational hypertension. A total of 60% had preterm labor and in none of these did the baby survive; thus perinatal mortality was 600/1000. Mean gestation was 33.0 weeks and mean birthweight was only 1.924 kg. Thus, neurofibromatosis during pregnancy is associated with poor obstetrical outcome and requires greater care.     

Dipyrone use during pregnancy and adverse perinatal events

Objective  To evaluate the risk of adverse perinatal events among newborns exposed to dipyrone during gestation. Design and Setting  The present study is a secondary analysis of Brazilian study of gestational diabetes (EBDG), a cohort of women attended at healthcare units of the Brazilian national health system (SUS) located in six Brazilian state capitals, between February 1991 and June 1995. Sample  A total number of 5,564 women aged 20 years and over who were between their 21st and 28th week of pregnancy were followed up. Methods  A structured questionnaire was used to obtain data on the pregnant women, their pregnancies, and their use of medications. Other data and the outcomes congenital abnormalities, intrauterine death, preterm birth, or low birth weight were obtained from the medical records. To estimate the odds ratios after adjustment for the potential confounding factors, logistic regression modeling was developed. Main outcome measures  Congenital abnormalities, intrauterine death, preterm birth, and low birth weight. Results  Dipyrone use was reported by 555 pregnant women (11.5%). Their exposure to this medication did not present any association with the outcomes of congenital abnormalities (OR 1.11; 95% CI, 0.58–2.10), intrauterine death (OR 0.69; 95% CI, 0.33–1.43), preterm birth (OR 0.94; 95% CI, 0.73–1.20), or low birth weight (OR 0.88; 95% CI, 0.64–1.22), in the crude analysis. This absence of associations was maintained after performing logistic regression analysis. Conclusions  The data suggest that the exposure to dipyrone during pregnancy does not increase the risk of congenital abnormalities and other adverse events as outcomes from pregnancy.     

The experience of pregnancy, labour and birth of Thai women in Australia.

OBJECTIVE: To identify the perceptions and experience of pregnancy care, labour and birth of Thai women in Melbourne, Australia. DESIGN: An ethnographic interview and participant observation with women in relation to pregnancy, labour and birth. SETTING: Melbourne Metropolitan Area, Victoria, Australia. PARTICIPANTS: 30 Thai women who are now living in Melbourne. FINDINGS: Thai women saw antenatal care as an important aspect of their pregnancy and sought care as soon as they suspected they were pregnant. They were more concerned about the well-being of their babies than their own health, therefore they attended all antenatal appointments. In general, these women were satisfied with care during labour, but some also had negative experiences with their caregivers and hospital routine. When asked to compare maternity services between Thailand and Australia, most of the women believed that services in Australia were better. However, women who had had good experiences of childbirth in Thailand, tended to have negative feelings about the Australian experience. There was also evidence in this study that most of these Thai women did not receive adequate information about care. IMPLICATIONS FOR PRACTICE: Women's perceptions and experiences of antenatal care, labour and birth deserve attention, if appropriate and sensitive care is to be provided to women in Australia and elsewhere. It is only when women's voices are heard in all aspects of health-care delivery that we may see better and appropriate health services for women in childbirth.     

Smoking during pregnancy and the perinatal cadmium burden

The association between maternal smoking and both morphometric birth parameters and the perinatal cadmium burden were studied. The cadmium concentrations were measured by atomic absorption spectrometry in 100 samples of maternal whole blood (MB) and in 93 samples of umbilical cord blood (CB). In the group of nonsmokers, significantly higher birth weight and decreased relative placental weight were noted as compared to the group of smokers who smoked more than 6 cigarettes a day (p less than 0.05). In both maternal and cord blood samples, the measured Cd levels were found to be significantly higher in smokers than in the nonsmoking subjects (for MB and CB p less than 0.01 and p less than 0.01 respectively). The average number of cigarettes smoked daily by the women had little effect on the levels of the metal. The Cd-MB strongly correlated with the Cd-CB (p less than 0.001). The cadmium values determined in MB and CB did not significantly affect any of the studied fetoplacental parameters. The reported findings give support for placental permeability to cadmium in humans and confirm that smoking during pregnancy leads to elevated Cd concentrations in both the mother and the fetus.     

Obstetric and perinatal outcome in women with twin pregnancy and gestational diabetes

Objective: The aim of this study was to evaluate pregnancy complications and obstetric and perinatal outcomes in women with twin pregnancy and GDM. Study Design: An observational multicentre retrospective study was performed and 534 pregnant woman and 1068 twins infants allocated into two groups, 257 with GDM and 277 controls, were studied. Main Outcome Measures: Pregnant women characteristics, hypertensive complications, preterm delivery rate, mode of delivery and birthweight were analysed. Results: Pregnant women with GDM were older (p?<?0.001) and had higher body mass index (p?<?0.001) than controls. GDM was associated with higher risk of prematurity in twin pregnancy (odds ratio 1.64, 95% confidence interval [1.14–2.32], p?=?0.005). This association was based on the association with other pregnancy complications. Birthweight Z-scores were significantly higher in the GDM group (p?=?0.02). The rate of macrosomia was higher in the GDM group (p?=?0.002) and small for gestational age (SGA) babies were significantly less frequent (p?=?0.03). GDM was an independent predictor of macrosomia (p?=?0.006). Conclusion: The presence of GDM in twin pregnancy was associated with a higher risk of hypertensive complications, prematurity and macrosomia, but significantly reduces the risk of SGA infants. Prematurity was related to the presence of other associated pregnancy complications.