No caesarean section on demand without a proper indication

The risk/benefit ratio of caesarean section versus vaginal birth does not justify performing the operation solely on demand of the woman without a medical indication. Underlying fear of childbirth should be addressed by other means rather than simply performing the operation. These considerations should not be outweighed by women's freedom to decide.     

1431例剖宫产指征分析

目的:分析2004年剖宫产指征构成及医生对剖宫产指征的掌握情况。方法:对1431例剖宫产病例进行回顾性分析。结果:剖宫产率为47.7%。,主要指征依此为:胎儿窘迫(12.3%)、羊水过少(10.4%)、臀位(9.9%)、巨大儿(9.4%)、头盆不称(9.2%)、脐带绕颈(9.1%)、疤痕子宫(7.7%)、产程异常(5.7%)、胎膜早破(5.2%)、要求手术(3.2%)。其中臀位的剖宫产率为97.9%,疤痕子宫的剖宫产率为97.3%,巨大儿的剖宫产率为74.0%,多胎妊娠的剖宫产率为73.9%。新生儿窒息率为1.3%。结论:应正确掌握剖宫产指征,避免剖宫产指征扩大化,降低剖宫产率,保障母儿身心健康。     

无剖宫产指征产妇不同分娩方式住院费用的分析

目的：分析无剖宫产指征产妇不同分娩方式的住院费用,为有效降低产科医疗成本提供参考依据。方法：选择本院2012年1月至2013年7月3000例分娩的产妇,其中无医学指征剖宫产术、会阴切开顺产分娩、非会阴切开顺产分娩各1000例,对3组分娩方式住院费用进行分析。结果：无指征剖宫产术医疗费用最高,其次是会阴切开术,非会阴切开术所需费用最少,导致前者远远高于后两者的主要因素是手术费、药费及材料费。结论：应采取有效措施降低无指征剖宫产率,减少住院费用,节约医疗资源,为产科医疗体制的改革提供参考。     

Breech presentation at term: the caesarean section that is routinely advised is ultimately not safe for the child

Recently, the results have become available on both the neonatal and the maternal outcome of deliveries after randomisation in the Term breech trial. At 2 years, in contrast to the original results in which perinatal death and serious neonatal morbidity were higher in the planned vaginal delivery group, no differences were evident in the combined outcdme variable, including death after delivery and neurodevelopmental delay. There were also no apparent differences between the two groups in neurodevelopmental abnormalities as screened by the ASQ postal enquiry. These are the most important findings that should be discussed with the parents during counselling regarding the mode of delivery of a foetus in breech presentation.     

"二孩政策"实施前后剖宫产率及剖宫产指征的变化分析

目的 了解"单独二孩政策"实施前后成都市龙泉驿区妇幼保健院的剖宫产率及剖宫产指征的变化趋势.方法 选取成都市龙泉驿区妇幼保健院2014年与2015年1到8月的1930份分娩病历资料进行回顾性分析.结果 单独二孩政策实施前后,成都市龙泉驿区妇幼保健院剖宫产率分别是46.70%和52.17%(χ2=5.75,P=0.016<0.05),其中医学指征剖宫产所占比例分别是63.31%和82.07%(χ2=42.977,P=0.000<0.001),非医学指征剖宫产所占比例分别是36.69%和17.93%(χ2=60.537,P=0.000<0.001),差异均具有统计学意义.瘢痕子宫是剖宫产的最主要医学指征.结论 单独二孩政策实施后,成都市龙泉驿区妇幼保健院的剖宫产率增加,其中医学指征剖宫产所占比例增加,非医学指征剖宫产所占比例降低.     

剖宫产产妇产前剖宫产偏好及原因分析

目的 了解剖宫产产妇产前剖宫产偏好率、偏好原因、分娩并发症知识水平及影响因素。方法 研究者于2014年4~6月在北京某三甲妇产专科医院调查门诊产检的孕妇,采用自行设计的问卷收集资料。调查一般人口学信息、孕产史、分娩方式偏好原因及分娩并发症知识等。结果 共调查192名剖宫产产妇,其中70人产前偏好剖宫产。偏好剖宫产的主要理由为减少胎儿宫内窒息的危险,偏好阴道产的主要理由为阴道产是自然过程、阴道产后恢复更快、阴道产婴儿更健康。多因素结果显示,在所有孕妇中孕次>1次者（OR_adjusted=2.8,95% CI：1.5~5.3）、判断要选用何种分娩方式时只选一种信息源者（OR_adjusted=2.5,95% CI：1.0~5.9）、认为医生无权决定自己的分娩方式者（OR_adjusted=2.2,95% CI：1.0~4.8）报告更偏好剖宫产。在初产妇中高龄孕妇（OR_adjusted=3.4,95% CI：1.5~7.7）、认为医生无权决定自己的分娩方式者（OR_adjusted=2.1,95% CI：1.1~6.0）更偏好剖宫产。结论 本研究中调查对象剖宫产偏好率高达36.5%,将来有必要针对产前偏好剖宫产者进行干预以降低实际剖宫产率。     

Fee exemption for caesarean section in Morocco

Financial barriers are an important obstacle for access to emergency obstetric care and a contributing factor to too slow a reduction in the level of maternal mortality. In Morocco, in 2009, a fee exemption policy for delivery and caesarean section was implemented in public maternity hospitals. As in most countries where a fee exemption policy has been implemented, fee exemption is considered synonym to free care. However, other direct costs may subsist. The objective of this study was to get an estimate of the actual cost of caesarean sections from the patients' perspective.     

医用显示器的选择不容忽视

本文对数字化医学影像系统中的终端显示器从技术参数、性能特点等方面作了分析对比,阐述了医学影像诊断工作选用医用显示器的重要性.强调在医学影像数字化系统建设中,医用显示器和普通显示器在应用中的区别.并指出,在数字化医学影像系统中,如果终端显示器选择不当,将会带来医院整体医疗质量的下降.     

Urgency of caesarean section: a new classification

A new classification for caesarean section was developed in a two-part study conducted at six hospitals. Initially, 90 anaesthetists and obstetricians graded ten clinical scenarios according to five different classification methods--visual analogue scale; suitable anaesthetic technique; maximum time to delivery; clinical definitions; and a 1-5 rating scale. Clinical definitions was the most consistent and useful, and this method was then applied prospectively to 407 caesarean sections at the same six hospitals. There was close agreement (86%) between anaesthetists and obstetricians for the five-point scale (weighted kappa 0.89), increasing to 90% if two categories were combined (weighted kappa 0.91). We suggest that the resultant four-grade classification system--(i) immediate threat to life of woman or fetus; (ii) maternal or fetal compromise which is not immediately life-threatening; (iii) needing early delivery but no maternal or fetal compromise; (iv) at a time to suit the patient and maternity team--should be adopted by multidisciplinary groups with an interest in maternity data collection.     

An indication for a process dimension in medical problem-solving

Several recent studies have concluded that medical problem-solving, as evidenced in a written simulation, is heavily influenced by the medical content of the particular case. The method employed in these studies did not allow process and content aspects to be separated, so the contribution of each could not be independently assessed. The present study employed a method that allowed such a separation.
Medical students were required to write problem lists, to order laboratory tests and to choose a final diagnosis for each of five casts. They were given corrective feedback after each part (e.g. after writing problem lists they were given the correct problem list) so that all students were working with the same information as they began each section of the case. The results on factor analysis showed more similarity in performance on the same aspect of problemsolving across different clinical cases than on the different processes within a given case. The present study clarifies some issues, but more work is needed to define further the specific processes in problemsolving.     

剖宫产术后发生褥疮的临床分析

报道了剖宫产术后发生的褥疮1例.该文就剖宫产术后的产妇褥疮发生的病因、预防、处理及护理要点进行介绍.     

重建医疗机构的基本产权制度

医疗机构基本产权制度的重建,是卫生机构产权制度改革的核心问题。本文试图从理论与实践的结合上予以探讨。 1 建立自主的劳动关系,实现社会主义的自主劳动形式,是重建医疗机构基本产权制度的基础 医疗机构制度创新的实质,是从搞活医疗机构中的国有资本,提高国有资本运作效率出发,构建公有资本与劳动之间相互制衡的机制。在产权制度改革的研究中,必须确立个人的主体地位,进而展开对主体之间形成的产权关系的探     

Ending a patient's life without a request: time for a good assessment procedure

Empirical studies have shown that in approximately 900 cases per year, Dutch physicians end a patient's life without his or her explicit request. These cases involve mostly incompetent patients with cancer, but also severely handicapped newborns. In 1994, the Dutch government made it mandatory for physicians to report these cases to the public prosecutor. This policy has not been successful. Every year, only a handful of cases are reported. The regulatory problem has two dimensions: on the one hand, in contrast to euthanasia and assisted suicide, terminating life without a request cannot be legitimised by the national government, notably in view of international aspects. On the other hand, terminating life without a request is legally qualified as murder. However, the murder section in criminal law is perceived to be intended for other cases entirely. One option might be to introduce a separate category in criminal law. The medical profession favours a system in which the reported cases are analysed by a multidisciplinary committee consisting of a lawyer, a physician, and an ethicist. It is expected that such a system would increase the willingness to report cases.