Nursing diagnoses and most common collaboration problems in high-risk pregnancy

This study identified the demographic profile, obstetric and clinical diagnoses, nursing diagnosis and most common collaboration problem among pregnant women subject to high-risk at a hospital in S?o Paulo, Brazil. Data were collected by means of a form based on Gordon's Functional Health Patterns. Nursing diagnoses were determined on the basis of the NANDA (North American Nursing Diagnosis Association) taxonomy. The nursing diagnoses found in 50% or more of the pregnant women were: risk for infection (90.1%), altered health maintenance (84.5%), altered comfort (80.3%), risk of ineffective breastfeeding (59.2%), altered sexuality patterns (52.1%), fear (52.1%) and pain (50.7%). The collaboration problem found in 50% or more of the cases was: potential complication: preterm labor (62.0%), potential complication: maternal tachycardia (54,9%) and potential complication: hypotension (54,9%). Thus, these results will allow us to guide the nursing care rendered to these pregnant women.     

Nursing diagnoses of newborns with sepsis in a Neonatal Intensive Care Unit

Objectives

to elaborate the Nursing Diagnoses of newborns with sepsis in a neonatal intensive care unit and characterize the profile of the neonates and their mothers.

Method

a cross-sectional and quantitative study, with a sample of 41 neonates. A physical examination and consultation of the hospital records were undertaken, using an instrument. The elaboration of the Nursing Diagnoses followed a process of diagnostic inference and was based on the North American Nursing Diagnosis Association 2012-2014.

Results

the mothers were around 25 years old, had a low average number of pre-natal consultations, and various complications during the pregnancy; and the newborns were predominantly premature and with very low birth weights. Five Nursing Diagnoses predominated, and all the neonates presented Risk of Shock and Risk of fluid volume imbalance.

Conclusion

the Nursing Diagnoses of the neonates with sepsis can guide the formulating of specific assistential plans. The study contributes to the generation of new knowledge and found various relationships between the Nursing Diagnoses and the variables selected in the characterization of the neonates, which deserve to be elucidated in greater detail based on further research on the issue.     

聊天护理对梅毒孕妇患者抑郁焦虑情绪改善的效果评价

[目的]探讨聊天护理为主的护理干预对性病门诊梅毒孕妇患者焦虑抑郁情绪的影响。[方法]对确诊为梅毒孕妇的66名患者进行聊天心理护理,采用抑郁性量表(HAMD),焦虑性量表(HAMA)对其效果评定。[结果]治愈41例(62.1%),好转22例(33.3%.),未愈3例(4.6%)。[结论]聊天护理可有效的缓解、消除梅毒孕妇不良心理情绪,增进抗病能力,阻断心身疾病的恶性循环,促进护理服务质量的提高,深化整体护理的内涵。     

江门市2009至2015年孕产妇人群艾滋病哨点监测结果分析

目的：了解江门市孕产妇的行为特征及艾滋病感染危险因素流行情况。方法分析2009年至2015年国家级孕产妇监测哨点的数据资料。结果2009年至2015年不同年度孕产妇年龄、婚姻状况、户籍、文化程度、妊娠次数和生育情况构成比均有显著性差异（χ2值分别为43．02、5．04、85．79、194．19、217．82、131．97,均P＜0．05）。2009年至2015年,孕产妇艾滋病知晓率相对较高,总体知晓率为93．47％～99．75％,不同年度间比较差异具有统计学意义（χ2＝15．96,P＜0．01）。2009年至2015年7年连续监测共发现7人承认有吸毒行为,吸毒比例总体为0．24％,各年度比较趋势检验无统计学意义（χ2＝0．785,P＞0．05）。2011年检出3例梅毒抗体阳性者,2014年检出2例梅毒抗体阳性者,梅毒抗体阳性率分别为0．21％（3／469）和0．49％（2／405）,各年度无显著性差异（确切概率P＞0．05）。2012年至2014年分别检出4例、1例和3例HIV抗体阳性者,HIV抗体阳性率分别为1．00％（4／402）、0．25％（1／405）和0．74％（3／405）,各年度无显著性差异（确切概率P＞0．05）。结论江门市孕产妇人群艾滋病呈高流行状态,目前孕产妇人群艾滋病知晓率较高,但既往感染者生育愿望与频次的增加,使艾滋病流行的危险因素加大,应加强孕产妇检测工作,并采取有效干预措施,减少母婴传播危险性。     

妊娠风险评估分级对母婴妊娠结局影响临床分析

目的分析不同妊娠风险评估分级对母婴妊娠结局的影响。方法收集2018年10月-2019年5月在南开区各社区医疗服务中心接受妊娠风险评估及系统管理的4 118例孕产妇的临床资料,统计各妊娠风险评估等级孕产妇例数、构成比和导致孕产妇高风险评估等级的前十位高风险因素,并选取其中妊娠风险评估为绿色(低风险)、黄色(一般风险)及橙色(较高风险)共计4 094例孕产妇为研究对象,分别从剖宫产率、早产率、低出生体重儿发生率、巨大儿发生率及出生缺陷儿发生率等方面进行回顾性分析。结果妊娠风险评估低风险、一般风险及较高风险的孕产妇其剖宫产率、早产率、低出生体重儿发生率、巨大儿发生率差异均有统计学意义(P<0.01)。其出生缺陷儿发生率差异无统计学意义(P>0.05)。结论不同妊娠风险评估分级对母婴妊娠结局产生影响,实施妊娠风险评估及分级管理对规范孕产妇围生期管理具有重要意义。     

Self-reported vaginal discharge among pregnant women in an urban area in Southern Brazil: prevalence and associated factors

The purpose of this study was to determine the prevalence and risk factors associated with self-reported vaginal discharge among pregnant women in the city of Rio Grande, South Brazil. Using a cross-sectional design, a standard interview was applied to pregnant women at home by previously trained interviewers, covering the following: demographic, reproductive, and socioeconomic data, household conditions, health care, and illnesses during pregnancy, including vaginal discharge. The chi-square test was used to compare proportions, and Poisson regression was used in the multivariate analysis. Among the 339 pregnant women interviewed, 52% reported vaginal discharge. The following variables were significantly associated with the outcome: age (prevalence rate, PR = 1.49), marital status (PR = 1.31), urinary tract infection (PR = 1.56), hyperglycemia (PR = 1.48), use of an intrauterine device (PR = 2.35), and history of preterm delivery (PR = 1.37), with oral contraception showing a protective effect (PR = 0.79). Prevalence of self-reported discharge was high among this group of pregnant women. Several risk factors were also identified for the disease under study. These findings can contribute to the implementation of preventive interventions.     

孕晚期GBS感染不良妊娠结局影响因素及IL-8水平

目的探讨孕晚期B族链球菌(GBS)感染血清降钙素原(PCT)、白细胞介素-8(IL-8)水平与妊娠结局的关系。方法选取2018年6月-2019年12月在杭州师范大学附属医院进行孕晚期(35~37周)GBS感染筛查的726例孕妇为研究对象,收集孕妇临床资料进行分析,统计GBS感染情况,比较GBS感染与未感染及不同GBS感染分级孕妇血清PCT、IL-8水平差异,单因素及多因素Logistic回归分析GBS感染孕妇不良妊娠结局的危险因素。结果 726例孕晚期女性中,GBS感染者占11.85%;GBS感染者年龄≥35岁、妊娠期糖尿病所占比例显著高于未感染者(P<0.05);孕晚期GBS感染者血清PCT、IL-8水平均高于未感染者(P<0.05),并随着GBS感染程度加重血清PCT、IL-8水平逐渐升高(P<0.05);孕晚期GBS感染者不良妊娠结局发生率显著高于未感染者(P<0.05),多因素Logistic回归分析结果显示,年龄≥35岁、血清PCT、IL-8水平升高是孕晚期GBS感染者不良妊娠结局发生的独立危险因素(P<0.05)。结论孕晚期GBS感染者血清PCT、IL-8水平显著升高,其也是不良妊娠结局发生的独立危险因素,血清PCT、IL-8进行联合检测对孕晚期GBS感染者不良妊娠结局具有较好的预测价值,可为临床早期诊疗提供参考依据。     

社区妊娠风险预警评估方法实施与作用

目的:了解《妊娠风险预警评估管理》方法对预防和控制高危孕妇的产时风险与降低孕、产妇及围产儿死亡率的效果。方法:采用上海市《妊娠风险预警评估管理》的方法对社区妊娠妇女进行风险预警评估,重点孕妇的转诊和分类重点管理。结果:2010年黄浦区3 308例社区妊娠孕妇风险预警评估结果按颜色显示,黄色为10.852%,红色为0.060%,橙色为0.695%,紫色为0.121%;实施妊娠风险预警评估管理方法后,危重孕妇抢救成功率提高2.70%,围产儿死亡率下降1.96‰;结论:在社区实施妊娠孕妇风险预警评估管理方法,对提高孕妇管理水平起到了较好的作用。     

Varicose veins of lower extremities in pregnant women and birth outcomes

The objective of the study was to estimate the association of pregnant women with varicose veins of lower extremities (VVLE) and the possible risk for adverse birth outcomes and among them different congenital abnormalities (CAs) in their children. Prospectively and medically recorded VVLE were evaluated in 332 pregnant women who delivered infants with CA (case group) and 566 pregnant women with VVLE who delivered infants without CA (control group) and matched to cases were compared in the population-based data set of the Hungarian Case-Control Surveillance System of Congenital Abnormalities, 1980-1996. About one-quarter of pregnant women had chronic VVLE while new onset VVLE occurred in the rest of pregnant women. There was no higher risk for adverse birth outcomes of pregnant women with VVLE, in fact the rate of preterm birth and low birth weight was somewhat lower than in the newborns of pregnant women without VVLE. The comparison of VVLE occurrence in pregnant women who had offspring with 21 different CA groups and in pregnant women who later delivered babies without CA showed a higher risk only for pectus excavatum, a mild CA. In conclusion, VVLE in pregnant women does not associate with obvious hazard for their fetuses.     

无创产前基因检测筛查胎儿染色体非整倍体疾病结果分析

目的 分析孕妇外周血胎儿游离DNA无创产前基因检测(NIPT)技术在胎儿染色体非整倍体疾病筛查中的应用价值。方法 选取2020年于本院接受NIPT孕妇6 370例,分析不同年龄段、孕周的孕妇染色体异常风险情况,统计与羊水细胞染色体核型分析结果的符合情况。结果 6 370例孕妇中,共筛查出染色体异常高风险90例(1.41%),其中21-三体综合征22例(0.35%)、18-三体综合征12例(0.19%)、13-三体综合征高风险8例(0.13%)、性染色体异常高风险26例(0.41%)、其他常染色体异常高风险22例(0.35%)。年龄≥35岁孕妇染色体异常高风险率(2.71%)高于＜30岁组(0.98%)和30～34岁组(1.36%),差异有统计学意义(χ2=18.727, P＜0.01)。孕周≤12周的染色体异常高风险率为10.00%, 13～20周组为1.18%, 21～28周组为2.64%,差异有统计学意义 (χ2=17.596,P＜0.01)。66例NIPT高风险孕妇进行了羊水细胞染色体核型分析,诊断结果阳性31例(46.97%),其中21-三体综合征阳性预测值为87.50%、18-三体综合征为88.89%、13-三体综合征为0%、性染色体异常为50.00%、其他常染色体异常为0%。结论 NIPT对21-三体综合征、18-三体综合征具有较高的检测价值。但对于13-三体、性染色体、以及其他染色体异常的阳性预测值较低。NIPT可以作为胎儿染色体疾病的主要筛查手段,测序结果为高风险孕妇仍需行羊水/脐血穿刺,以有效地避免染色体异常患儿的出生。     

孕中期产前筛查的价值

目的:探讨产前筛查在孕中期产前诊断中的价值。方法:2006年1月～2009年9月对2 880例孕16～20周的妇女行产前筛查,检测其血清中甲胎蛋白(AFP)、游离β绒毛膜促性腺激素(F-βHCG)和游离雌三醇(μE3)浓度,结合年龄、体重等因素,评定危险系数。高危孕妇进行羊膜腔穿刺,羊水细胞染色体核型检查以确诊。结果:共有2 880例孕妇接受筛查。其中筛出唐氏综合征(DS)高风险5例,经羊水细胞染色体核型分析确诊2例;18-三体高风险2例,确诊1例:神经管缺陷(NTD)高风险2例,确诊2例。所有筛查孕妇均随访至胎儿出生,1例筛查阴性的孕妇分娩唐氏儿。结论:产前筛查可提高先天缺陷儿的检出率,是提高出生人口素质的有效技术措施。     

Characteristics and Pregnancy Outcomes of Pregnant Women Asymptomatic for Bacterial Vaginosis

Study Design To determine the clinical, behavioral or demographic factors associated with asymptomatic bacterial vaginosis (BV) and to examine if women with asymptomatic BV had a higher risk of a variety of pregnancy outcomes compared to symptomatic BV positive women. For this study, 1916 pregnant women who were 12 weeks’ gestation or less were enrolled. Interviewers facilitated vaginal swab collection for BV assessment, and completed the baseline questionnaire. BV was identified by Gram stain. Results Forty percent of pregnant women screened positive for BV and a substantial proportion of BV positive pregnant women were asymptomatic (67%). Asymptomatic BV positive women reported lower stress scores (RR = 0.78, 95% CI: 0.67–0.89), slightly more prior STD’s (RR = 1.03, 95% CI: 1.01–1.07), and a higher quantity of Mobiluncus (RR = 1.04 95% CI: 1.01–1.07) compared to symptomatic BV positive women. We did not find an increase in adverse pregnancy outcomes related to BV symptomatology. Conclusion Among first trimester pregnant women, only stress, STD history, and quantity of Mobiluncus were associated with symptom reports among BV positive pregnant women. We also found that women with asymptomatic BV did not have an increased risk of a variety of adverse pregnancy outcomes compared to symptomatic BV positive women. An erratum to this article can be found at     

孕妇体内5种元素测定结果分析

目的 探讨该地区孕妇在不同孕期血清微量元素的变化规律,掌握该地区孕妇微量元素的缺乏状况,制定干预措施.方法 按孕周将720名孕妇分为早孕(小于12周)、中孕(13～27周)、晚孕(大于28周)3个实验组,112名正常体检妇女做为对照组,采用原子吸收光谱法测定孕妇及对照组妇女血清微量元素含量,比较实验组及对照组血清中微量元素的缺乏状况.结果 孕妇体内微量元素钙、铁、锌的缺乏率与非妊娠期妇女比较有明显差异(P＜0.05),而且随着孕周的变化,孕妇微量元素钙、铁、锌的缺乏情况也有不同.孕妇体内铜、镁的缺乏状况与非妊娠期妇女比较无显著性差异.结论 孕妇是微量元素缺乏的高危人群,应加强围产期保健工作,指导其合理饮食,根据血清测定结果,必要时,孕中期额外补充一定量的铁剂和钙剂,注意含锌食品的摄入,以保证各种微量元素的均衡摄入.     

产前筛查先天性缺陷与胎儿染色体异常的研究

目的:探讨孕中期血清标志物在产前筛查先天性缺陷与胎儿染色体异常中的作用和价值。方法:对2 555例孕中期(14～22周)孕妇血清AFP、β-hCG、和uE3三项指标进行检测,并结合孕妇年龄、孕周、体重、是否双胎、有无糖尿病等,采用仪器配套软件计算风险概率,对高风险孕妇进行染色体检查确认。结果:2 555例孕妇中筛查出唐氏综合征高风险210例,占8.2%,18-三体高风险26例,占1.0%,NTD高风险29例,占1.1%,高风险孕妇中有207例自愿进行了羊水细胞染色体检查或胎儿脐血染色体检查,检测出染色体异常核型12例,异常率为5.8%。结论:孕中期血清三联标志物筛查胎儿先天缺陷是行之有效的方法,可以作为产前筛查的常规手段。     

孕早期亚临床甲状腺功能减退及年龄与早产的相关性研究

目的分析年龄及孕早期亚临床甲减(SCH)与早产及其亚型的相关性,为不同年龄孕早期亚甲减患者孕期监测制定个体化策略提供科学依据。方法以2016年2月-2018年6月在甘肃省妇幼保健院高危产科产检的单胎活产孕妇2 868例为研究对象,使用Logistic回归模型分别分析年龄及孕早期亚甲减与早产的相关性。结果控制混杂因素后,与适龄孕妇相比,高龄孕妇(≥35岁)发生早产风险增加0.67倍(OR=1.67,95%CI:1.32～2.13);年龄较小孕妇发生早期/极早期早产风险升高2.65倍(OR=3.65,95%CI:2.21～6.05)。与甲功正常孕妇相比,亚甲减孕妇发生早产风险增加2.07倍(OR=3.07,95%CI:2.28～4.12)、发生中晚期早产风险增加1.67倍(OR=2.67,95%CI:1.86～3.83)。交互作用分析显示,年龄与亚临床甲减对早产的发生风险存在相乘的交互作用。结论不同年龄亚甲减孕妇发生早产及其亚型的风险不一致。建议对孕早期亚甲减患者应根据年龄进行风险分层,开展个体化孕期管理和用药指导。     

Pregnancy outcomes following hospitalization for motor vehicle crashes in Washington State from 1989 to 2001

This retrospective cohort study evaluated the risk of adverse pregnancy outcomes following motor vehicle crashes during pregnancy. The authors assessed outcomes of pregnant women hospitalized for motor vehicle crashes in Washington State from 1989 to 2001 (n = 582). They used the Injury Severity Score (ISS) to classify 84 severely injured (ISS > or =9), 309 non-severely injured (ISS 1-8), and 189 uninjured (ISS 0) pregnant women and compared them with pregnant women who had not been hospitalized for a motor vehicle crash (n = 17,274). Of pregnant women in motor vehicle crashes, 82.9% were hospitalized and discharged without delivering, and 17.1% delivered at hospitalization. Compared with women not in motor vehicle crashes, severely and non-severely injured women were at increased risk of placental abruption and cesarean delivery, and their infants were at increased risk of respiratory distress syndrome and fetal death. Uninjured women were also at increased risk of preterm labor (relative risk = 7.9, 95% confidence interval: 6.4, 9.8) and placental abruption (relative risk = 6.6, 95% confidence interval: 3.9, 11.2) compared with women not in motor vehicle crashes. Pregnant women hospitalized following motor vehicle crashes are at increased risk of adverse pregnancy outcomes, regardless of the presence or severity of injuries.