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1.
Kavitha Abraham Elsy Thomas Jessie Lionel 《Journal of obstetrics and gynaecology of India》2018,68(5):360-365
Purpose of study
To assess the maternal and perinatal complications associated with meconium-stained amniotic fluid (MSAF) in low-risk women in labor.Methods
This prospective cohort study was conducted at CMC Hospital, Vellore, India. Two hundred low-risk women who had artificial or spontaneous rupture of membranes after admission with MSAF were included in the study. Two hundred similar women with clear liquor were taken as controls. The primary outcomes considered were the incidence of chorioamnionitis and endomyometritis in the mothers. The secondary outcomes included postpartum hemorrhage and retained placenta in the mothers and respiratory distress, meconium aspiration, sepsis, and NICU admission in the newborn. Statistical analysis was done using Fischer exact test. Odds ratio, 95% confidence interval, and P value were estimated.Results
Compared to controls, those with MSAF had significantly higher rates of chorioamnionitis (2 vs. 8%, P = 0.006) and endomyometritis (3 vs. 9.5% P = 0.007). Among the secondary end points, only neonatal respiratory distress (8.5 vs. 1.5%; P = 0.001) and meconium aspiration (4 vs. 0%; P = 0.007) were found to be significantly increased in the meconium group.Conclusion
Statistically significant increased incidence of chorioamnionitis and endomyometritis in women with MSAF in labor established in our study strongly supports the use of prophylactic antibiotics in these women to prevent immediate and long-term consequences.2.
Eryilmaz OG Aksakal FN Cicek N Eyi EG Avci A 《European journal of obstetrics, gynecology, and reproductive biology》2012,161(1):26-29
Objective
To study the arginase, nitric oxide synthase and nitric oxide pathways associated with passage of meconium.Study design
Cord blood samples were collected from 20 newborns with meconium-stained amniotic fluid (MSAF) and from 23 newborns with clear amniotic fluid. Cord blood pH, arginase, nitric oxide synthase and nitric oxide levels were compared between the groups.Result
The differences between the arginase and nitric oxide measurements of the newborns with MSAF and those with clear amniotic fluid were significant. In the MSAF group arginase levels were significantly lower (p = 0.007) and nitric oxide levels were significantly higher (p = 0.032) than the clear amniotic fluid group.Conclusion
Hypoxia may be involved in the pathogenesis of meconium passage due to decreased arginase and increased nitric oxide levels. 相似文献3.
Á. Luengo V. ZornozaA. Fernández-Corona C. González-García 《Clínica e investigación en ginecología y obstetricia》2012
Objective
To determine the obstetric results of labor induction in relation to body mass index (BMI) and gestational weight gain at the Leon Hospital between January and March, 2008.Material and method
We conducted a prospective cohort study of 127 labor inductions. The variables included were the medical reason for induction, the procedures employed for cervical ripening and induction, maternal age at the end of pregnancy, type of labor, parity, initial Bishop's score, BMI, weight, height, gestational weight gain, neonatal weight and Apgar test at 1 and 5 minutes.Results
Inductions were performed in 21.3% of births, while vaginal delivery was achieved in 81.1%. A total of 36.2% of the patients were overweight, 21.2% were obese and 4.7% were morbidly obese.Conclusions
A non-statistically significant association was observed between failure of vaginal delivery and BMI (P = .08) and body weight gain (P = .07). These two variables seem to increase the chances of failure of cervical ripening and induction of labor, increasing the percentage of cesarean sections. 相似文献4.
A. Cristina Rossi Federico Prefumo 《European journal of obstetrics, gynecology, and reproductive biology》2013
Objective
The management of isolated oligohydramnios (IO) in post/term pregnancies is controversial. The aim of this paper was to review outcomes of term and post-term pregnancies with IO versus normal amniotic fluid (AF) at labor assessment.Study design
A search in PubMed, Medline, EMBASE, and reference lists was performed. Inclusion criteria for articles selection: singleton pregnancy, definition of olgohydramnios as AFI <5 cm, AF assessment at 37–42 gestational weeks. Exclusion criteria: fetal malformations, preterm delivery, premature rupture of membranes, intrauterine growth restriction. Perinatal outcomes were: obstetric intervention for non-reassuring fetal heart rate (cesarean section, operative delivery), meconium-stained AF, Apgar score <7 at 5 min, umbilical artery pH <7.0, small for gestational age infants (SGA), admission to neonatal intensive care unit (NICU) and perinatal death. Meta-analysis compared outcomes of pregnancies with IO vs normal AF. Inter-studies heterogeneity was tested. Pooled odds ratio (OR) and 95% confidence interval (95% CI) were calculated. Differences between the two groups were considered significant if 95% CI did not encompass 1. MOOSE guidelines were followed.Results
Four articles provided 679 (17.2%) cases with IO and 3264 (82.8%) with normal AF. Obstetric interventions occurred more frequently in the IO than normal AF group (IO: 89/679, 13% vs normal; AF: 166/3354, 5%; OR: 2.30; 95% CI: 1.00–5.29). Meta-analysis did not show differences with regard to meconium, Apgar, pH, SGA, NICU and perinatal death.Conclusion
In term or post-term pregnancies, IO is associated with increased risk of obstetric interventions but outcomes are similar to those of pregnancies with normal AF. 相似文献5.
Virginia Benito Reyes Rosaura Hurtado Mendoza Flavia Rodríguez Rodríguez Desiderio Reyes Suárez Eva Elisa Álvarez León José Angel García Hernández 《Progresos de Obstetricia y Ginecología》2010
Objective
To compare elective termination versus expectant management in low-risk prolonged pregnancy.Material and method
We performed a controlled randomized clinical trial comparing the results of active and expectant approaches in the management of low-risk prolonged pregnancy in a sample of 200 women between February 2003 and June 2005 at the Maternity Ward of the Canary Islands University Hospital.Results
The study group consisted of 200 patients. There were 102 in the active management group and 98 in the expectant management group. No between-group epidemiologic differences were found. Labor was not induced in a significantly higher proportion of patients in the active than in the expectant group [51% vs 35.7%, p = 0.02; OR 0.53 (95% CI 0.3-0.94)] i.e. the induction rate was significantly higher in the expectant group. The proportion of patients with meconium-stained amniotic fluid during labor was significantly lower in the active management group [15.7% vs 28.6% p = 0.02; OR 0.47 (95% CI 0.23-0.93)]. No significant differences were found in the type of delivery, although the proportion of cesarean sections was noticeably lower in the active management than in the expectant management group [(12.7% vs 18.4%, p = 0.3; OR 0.65 (95% CI 0.3-1.41)]. No significant differences were found in perinatal outcomes between the two groups.Conclusions
Elective termination of low-risk pregnancies with unfavorable cervical findings at week 42 seems to reduce the rate of cesarean section without impairing perinatal outcome. 相似文献6.
Ezequiel García-Elorrio Alicia Aleman Maria L. Cafferata Mercedes Colomar Giselle Tomasso Yann Lacayo Henry Espinoza Shirley Villadiego Susheela Engelbrecht Fernando Althabe 《International journal of gynaecology and obstetrics》2014
Objective
To assess the effect of a multifaceted intervention among skilled birth attendants on the use of oxytocin during the third stage of labor, the active management of the third stage of labor (AMTSL), and the rate of routine episiotomy during vaginal births in two health districts in Nicaragua.Methods
An uncontrolled before-and-after study design was used. The rates of oxytocin use in the third stage of labor, AMTSL, and episiotomy were measured for vaginal births occurring in eight hospitals and health centers during 2011–2012, before and after implementation of a multifaceted facility-based intervention. The intervention involved the use of opinion leaders, interactive workshops to develop and implement evidence-based guidelines, academic detailing, the use of reminders, and feedback on the rates of oxytocin use and episiotomy.Results
Oxytocin use during the third stage of labor increased significantly from 95.3% to 97.4% (P = 0.003). The episiotomy rate dropped significantly from 31.2% to 21.2% overall, and from 59.6% to 40.5% in primiparous women (P < 0.001 for both comparisons).Conclusion
The multifaceted intervention improved the targeted care practices during childbirth. However, a further decrease in the routine use of episiotomy would be desirable. 相似文献7.
Vladimir Banović Snježana Škrablin Maja Banović Marko Radoš Snježana Gverić-Ahmetašević Ivan Babić 《International journal of gynaecology and obstetrics》2014
Objective
To determine the incidence of fetal brain injury by fetal brain magnetic resonance imaging (MRI) in pregnancies complicated with preterm labor (PL), preterm premature rupture of the membranes (PPROM), and intrauterine growth restriction (IUGR), and to compare fetal brain MRI with prenatal surveillance methods, and with immediate and long-term neurodevelopmental outcome.Methods
Between February 2007 and January 2009, high-risk pregnancies were analyzed by MRI at 1.5 Tesla after 24 weeks of gestation at the Clinical Hospital Center Zagreb, Croatia. Long-term outcome was defined as neurodevelopmental outcome at 24 months.Results
Among 70 pregnancies analyzed, 40.0% had abnormal fetal brain MRI. The highest incidence occurred in the PL group. There was no correlation between abnormal MRI and fetal surveillance methods (ultrasound, Doppler blood flow analysis, cardiotocography, biophysical profile) or immediate neonatal outcome (1-minute Apgar score, umbilical cord pH). Via MRI, fetal brain injury would have been diagnosed for 45.7% of fetuses with a long-term neurodevelopmental handicap. Binary logistic regression showed that, as compared with other surveillance methods, fetal brain MRI was the best predictor of long-term neurodevelopmental disability.Conclusion
PL, IUGR, and PPROM were associated with an early intrauterine CNS insult that was not accurately detected by existing prenatal testing options. 相似文献8.
María Cerrillo Martínez Esteban González MirasolMaría Dolores Díaz Serrano Azucena Tello MuñozGaspar González de Merlo 《Progresos de Obstetricia y Ginecología》2007
Objective
To determine the outcomes of twin pregnancies resulting from in vitro fertilization (IVF) compared with those resulting from spontaneous conception.Material and methods
We performed a historical cohort study comparing neonatal outcomes of twin pregnancies resulting from IVF (n = 44) with those resulting from spontaneous conception (n = 109) in the Complejo Hospitalario Universitario de Albacete (Spain) in 2001, 2001 and 2003. The primary variable was perinatal mortality. Secondary variables were fetal morbidity (neonatal abnormalities, Apgar < 7, acidotic arterial pH, admission to the neonatal unit), preterm delivery, maternal complications, and type of delivery.Results
No differences in perinatal mortality and morbidity were found between spontaneous twin pregnancies and twins resulting from assisted reproductive techniques. The rate of preterm labor was significantly higher in spontaneous twin pregnancies (75.2 versus 52%; p = 0.006). The incidence of gestational diabetes was significantly higher in twin pregnancies resulting from IVF than in spontaneous twin pregnancies (25.5 versus 9.7%;p = 0.01).Conclusions
Perinatal and maternal outcomes in twin pregnancies resulting from IVF are similar to those of spontaneous twin pregnancies. 相似文献9.
10.
Catarina Policiano Ana Costa Alexandre Valentim-Lourenço Nuno Clode Luís M. Graça 《International journal of gynaecology and obstetrics》2014
Objective
To evaluate the delivery route and the indications for cesarean delivery after successful external cephalic version (ECV).Methods
A retrospective matched case–control study was conducted at a hospital in Lisbon, Portugal, between 2002 and 2012. Each woman who underwent successful ECV (n = 44) was compared with the previous and next women who presented for labor management and who had the same parity and a singleton vertex pregnancy at term (n = 88). The outcome measures were route of delivery, indications for cesarean delivery, and incidence of nonreassuring fetal status.Results
Attempts at ECV were successful in 62 (46%) of 134 women, and 44 women whose fetuses remained in a cephalic presentation until delivery were included in the study. The rates of intrapartum cesarean delivery and operative vaginal delivery did not differ significantly between cases and controls (intrapartum cesarean delivery, 9 [20%] vs 16 [18%], P = 0.75; operative vaginal delivery, 14 [32%] vs 19 [22%], P = 0.20). The indications for cesarean delivery after successful ECV did not differ; in both groups, cesarean delivery was mainly performed for labor arrest disorders (cases, 6 [67%] vs controls, 13 [81%]; P = 0.63).Conclusion
Successful ECV was not associated with increased rates of intrapartum cesarean delivery or operative vaginal delivery. 相似文献11.
Helen De Nobrega-Correa Mery Guerra-VelásquezEduardo Reyna-Villasmil Jorly Mejia-MontillaNadia Reyna-Villasmil Duly Torres-CepedaJoel Santos-Bolívar Juan Perozo-Romero 《Progresos de Obstetricia y Ginecología》2010
Objective
To compare the effects of intravenous hyoscine butylbromide-oxytocin or oxytocin on the duration of labor in term pregnancies.Method
Ninety patients were selected and randomly assigned to receive intravenous hyoscine butylbromide-oxytocin (n = 45) or intravenous oxytocin (n = 45). We evaluated maternal adverse effects, effects on neonatal Apgar score, cervical dilatation 1 hour after drug administration and the interval between the onset of labor and delivery.Results
There were no significant differences between the two groups in maternal age, gestational age, or Bishop score at drug administration (p = ns). No significant differences were observed in the duration of the first, second or third phases of labor between the two groups (p = ns). No significant differences were found between the groups in Apgar scores at 1 and 5 minutes (p = ns). No maternal adverse effects were observed or reported due to the use of hyoscine-butylbromide or oxytocin.Conclusion
The effect of hyoscine butylbromide-oxytocin on the duration of labour in term pregnancies is similar to that of oxytocin. The drug does not alter Apgar score or produce maternal adverse effects. 相似文献12.
J. Boujenah J. Oliveira C. De La Hosseraye A. Benbara A. Tigaizin A. Bricou 《The journal of maternal-fetal & neonatal medicine》2016,29(23):3875-3878
Objective: To investigate the effect of using fetal scalp blood sampling on the risk of neonatal respiratory distress syndrome (NRDS) with meconium-stained amniotic fluid (MSAF).Methods: Prospective data collection with regard to MSAF during labor for low-risk term cephalic singleton live birth from 2012 to 2014. Maternal, obstetric and neonatal data were compared according to the occurrence of respiratory distress syndrome (RDS group) or not (no RDS group).Results: Of 515 newborns born through MSAF, 46 experienced RDS and from them 10 experienced meconium aspiration syndrome. No difference was observed according to maternal characteristic, abnormal fetal heart rate tracing pattern irrespective of its category and cesarean rate. Apgar at one?minute was lower in the group RDS (7.6 versus 8.5, p?<?0.05). The mean umbilical artery pH values did not differ between the two groups. Significant difference between newborns with and without RDS in terms of fetal scalp lactate sampling during the labor (71.1% versus 55.1%, p?<?0.05), and neonatal care unit (NCU) admissions (22.8% versus 10.8%, p?<?0.05). Secondary rather than primary meconium was associated with RDS when performing fetal scalp blood assessment (p?<?0.05). A significant correlation between RDS, fetal scalp blood assessment and MSAF diagnosed during the first stage of labor (after spontaneous rupture of membranes or at amniotomy) was found.Conclusion: In case of MSAF, fetal scalp blood sampling did not reduce the risk of RDS. 相似文献
13.
Rajendra Karkee Andy H. Lee Vishnu Khanal Paras K. Pokharel Colin W. Binns 《International journal of gynaecology and obstetrics》2014
Objective
To determine the incidence of obstetric complications, the stillbirth rate, and the factors associated with cesarean delivery in central Nepal.Methods
A community-based prospective cohort study was undertaken in the Kaski district during 2011–2012. In total, 701 women who were at least 5 months pregnant were recruited and interviewed. Participants were followed-up and interviewed again within 45 days after delivery.Results
Of the 658 women who remained in the cohort after 43 were lost to follow-up, 12 (1.8%) had stillbirths. Cesareans accounted for 13.3% of the total deliveries. Age, urban residency, college-level education, and particularly presence of intrapartum symptoms significantly increased the likelihood of cesarean delivery. Prepartum, intrapartum, and postpartum symptoms were reported by 21.1%, 24.4%, and 10.2% of women, respectively. Common danger signs included prolonged labor, severe abdominal pain, swollen hand and body, and heavy bleeding.Conclusion
Obstetric complications and stillbirth rates were relatively high in central Nepal. Cesarean delivery appeared to meet obstetric need and was performed with medical indication, particularly after the onset of labor. 相似文献14.
Hendrik Cammu Guy Martens Georges Van Maele Jean-Jacques Amy 《European journal of obstetrics, gynecology, and reproductive biology》2010
Objective
To assess, in a homogenous population of primiparous women, how fetal and infant (=first year of life) mortality varied by the mothers’ level of education.Study design
We conducted an observational study in Flanders (Northern Belgium) involving 170,948 primiparous women who delivered in Flanders during the period 1999–2006, and their 174,495 babies. We linked the maternal education (3 levels) with a series of obstetrical and perinatal events, with special emphasis on fetal and infant death. A logistic regression analysis was performed to adjust for confounders.Results
The incidence of fetal (0.21% – high level of education; 0.35% – medium level; 0.84% – low level) and infant mortality (0.32%; 0.41%; 0.70%, respectively), followed an inverse maternal educational gradient: higher with a lower level of education. However, neonatal death (0–27 days) was independent of the educational level of the mother. The age of the woman at delivery, the use of assisted reproductive technology and the incidence of twin birth increased while the rates of preterm birth (7.7% – high level; 8.9% – medium level; 10% – low level) and low birth weight (7.2%; 9.5%; 11.8%, respectively) decreased with the mother's educational level.Conclusion
Perinatal and obstetrical outcome differ according to the level of the education of the mother, which is a determinant of the incidence of fetal and post-neonatal death but not of early and late neonatal death (0–27 days). 相似文献15.
Objective
to compare experiences with early labour assessment and support at home vs. by telephone.Design
a randomised controlled trial of nurse home visits vs. telephone support for assessment and support of women in early labour.Setting
hospitals serving obstetrical populations in metropolitan and suburban Vancouver, British Columbia, Canada.Participants
healthy nulliparous women in labour at term with uncomplicated pregnancies participating in the third and fourth year of the trial.Intervention
women were randomised to receive early labour assessment and support at home (n=241) and or to receive assessment and support by telephone (n=182).Measurement
the Early Labour Experience Questionnaire (ELEQ), a 26-item self-administered questionnaire that measures women's experience with early labour care across three domains: emotional well-being, emotional distress and perceptions of nursing care.Findings
women who received home visits rated their early labour experience more positively overall compared to women who received telephone support (103.14±12.45 vs. 99.67±13.11, p<.01)including perceptions of nursing care that they received (38.64±2.90 vs. 36.82±4.09, p<.001). However, women's affective experiences did not differ.Key conclusions
early labour nursing care provided at home is associated with a more positive experience of early labour compared to telephone support. 相似文献16.
S. Ortega Marcilla B. Royo ArillaE.L. Tejero Cabrejas R. Savirón CornudellaB. Rodriguez Solanilla S. Castán MateoJ.M. Campillos Maza 《Clínica e investigación en ginecología y obstetricia》2014
Objective
To analyze the perinatal results in our hospital comparing vaginal delivery and cesarean section in breech presentation singleton pregnancies at term.Material and Methods
All live ante-partum singleton fetuses in breech presentation, at 37 to 41+6 weeks and days who delivered between July 2006 and August 2010 were included in the study. We compared perinatal results between cesarean section and vaginal delivery.Results
There were no differences in Apgar score at 5 minutes < 7, pH umbilical cord < 7, base deficits and lactate, neonatal intensive care unit admission or perinatal mortality.Conclusions
With appropriate maternal and fetal conditions and a qualified medical team, a breech vaginal delivery could be propose obtaining good perinatal outcomes. 相似文献17.
Powell Perng Wei Perng Twalib Ngoma Crispin Kahesa Julius Mwaiselage Sofia D. Merajver Amr S. Soliman 《International journal of gynaecology and obstetrics》2013
Objective
To investigate promoters and barriers for cervical cancer screening in rural Tanzania.Methods
We interviewed 300 women of reproductive age living in Kiwangwa village, Tanzania. The odds of attending a free, 2-day screening service were compared with sociodemographic variables, lifestyle factors, and knowledge and attitudes surrounding cervical cancer using multivariable logistic regression.Results
Compared with women who did not attend the screening service (n = 195), women who attended (n = 105) were older (OR 4.29; 95% CI, 1.61–11.48, age 40–49 years versus 20–29 years), listened regularly to the radio (OR 24.76; 95% CI, 11.49–53.33, listened to radio 1–3 times per week versus not at all), had a poorer quality of life (OR 4.91; CI, 1.96–12.32, lowest versus highest score), had faced cost barriers to obtaining health care in the preceding year (OR 2.24; 95% CI, 1.11–4.53, yes versus no), and held a more positive attitude toward cervical cancer screening (OR 4.64; 95% CI, 1.39–15.55, least versus most averse).Conclusion
Efforts aimed at improving screening rates in rural Tanzania need to address both structural and individual-level barriers, including knowledge and awareness of cervical cancer prevention, cost barriers to care, and access to health information. 相似文献18.
Ana Luisa B. da Silva Elisangela Arbo Renato Fanchin 《European journal of obstetrics, gynecology, and reproductive biology》2012
Objectives
To verify non-inferiority of the clinical pregnancy rate of Early hCG administration (leading follicle sizes within 16.0–16.9 mm in diameter) compared to Late hCG administration (leading follicle sizes within 18.0–18.9 mm in diameter).Study design
Prospective randomized trial. Six hundred and twelve infertile women candidates for intrauterine insemination (IUI) received HP-hMG 75 IU/day SC from cycle days 4 to 8 and then as per ovarian response. Ovulation was randomly triggered (hCG 5000 IU, IM) when the leading follicle diameter ranged between either 16.0 and 16.9 mm (Early hCG group, n = 227) or 18.0 and 18.9 mm (Late hCG group, n = 207) and IUI was performed approximately 36 h later.Results
Whereas population and sperm characteristics were comparable in both groups, the number of follicles ≥14 mm in diameter (P < 0.007) and serum estradiol levels (P < 0.001) on the day of hCG were lower in the Early versus the Late hCG groups. Clinical (11.9% versus 12.1%) and ongoing (11.0% versus 8.6%) pregnancy rates per randomized women were similar in the two groups and statistical non-inferiority of clinical and ongoing pregnancy rates was demonstrated.Conclusion
These results suggest that hCG administered when the largest follicle size reaches 16.0–16.9 mm leads to similar clinical and ongoing pregnancy rates as when it reaches 18.0–18.9 mm in IUI cycles. 相似文献19.
Aim
To evaluate the benefits of allowing oral intake of clear liquids in terms of labor duration, the cesarean section rate, and personal satisfaction.Methods
A randomized controlled trial was carried out to assess the effects of a clear liquid diet in a low risk population. The primary outcome was labor duration. The secondary outcome was the incidence of cesarean section. A satisfaction survey was performed within the first 2 h after delivery to evaluate the patient's perception of labor.Results
A total of 348 patients were randomized. The mean duration of labor was 257.75 min in the liquid diet group and 288.40 min in the fasting group (p = NS). There was no statistically significant difference (per-protocol analysis and intention-to-treat analysis) in the cesarean section rate.Patients reported greater satisfaction when allowed to drink during labor than when fasting.Conclusion
A clear liquid diet during labor did not alter the duration of labor or the cesarean section rate. Allowing a liquid diet during labor was associated with a better perception of the birth process and a higher degree of satisfaction. 相似文献20.
Vasileios Pergialiotis Dimitrios VlachosAthanasios Protopapas Kaliopi PappaGeorgios Vlachos 《International journal of gynaecology and obstetrics》2014