产妇不同胎位对产程及新生儿预后的相关性研究

目的 探讨产妇不同胎位持续性枕后位、持续性枕横位对产程及新生儿预后的的影响.方法 回顾性分析100例持续性枕后位产妇的临床资料,选取同期住院分娩的100例持续性枕横位产妇作为对照,比较两组产妇的分娩方式、产程异常情况及对围生儿预后的影响.结果 观察组第1产程、第2产程所用时间明显长于对照组,且总产程时间也长于对照组.其中观察组发生潜伏期延长、活跃期延长、第2产程延长及活跃期宫颈扩张延缓和阻滞的发生率均明显高于对照组,不同指标在两组间的差异均有统计学意义（P〈0.05或P〈0.01）.观察组新生儿窒息、胎儿窘迫、新生儿产伤、产后出血、剖宫产的发生率明显高于对照组,差异均有统计学意义（P〈0.01）.结论 持续性枕后位对母婴危害严重,应通过科学有效的管理和预防,降低持续性枕后位的发生率.     

会阴侧斜切开术后伤口再撕裂的危险因素及护理对策

目的对会阴侧斜切开术后伤口再撕裂的危险因素进行探讨,以有效降低会阴侧斜切开术后伤口的再撕裂率。方法回顾性分析住院分娩的97例产妇会阴侧斜切开术后伤口再撕裂的发生原因。结果持续性枕后位、枕横位等头位不正致会阴侧斜切开术后伤口再撕裂率占16．49％,耻骨弓过低、胎儿体质量≥3500g均占15．46％,手抱肩娩出占13．40％0。结论正确估计胎儿大小、胎位和先露部位情况,充分了解骨产道和软产道的情况,是预防会阴侧斜切开术后伤口再撕裂的关键。     

产程早期枕后位分娩结局临床观察

目的:探讨产程早期枕后位的分娩结局.方法:选择在我院产科分娩,确诊为枕后位的初产妇为观察组,给予无创干预,选择同期阴道试严枕前位孕妇为对照组,比较两组分娩方式及母儿结局.结果:两组第一产程,第二产程及总产程比较差异有显著性,枕后位组手术助产率、继发性宫缩乏力、产程停滞以及新生儿头皮血肿率明显高于对照组,而两组剖宫产率,会阴裂伤,产后出血,胎儿窘迫,新生儿窒息率等比较差异无显著性.结论:枕后位在难产中发生率较高,如及早发现,早期合理干预,可使胎头转位成功,阴道分娩率大大提高.     

胎吸弧形牵引356例临床观察

在产科领域里,由于围生期保健工作的深入开展,产前检查已成为孕妇的主要监测手段,胎位难产明显下降,头位难产日益增加,胎吸牵引术普遍应用于临床,其成功与否直接影响着胎儿的生命,更重要的是所引起的并发症及后遗症.我院从1988年2月对356例持续性枕横位行弧形牵引术,进行临床观察、对照、分析,结果如下.     

会阴侧斜切开术后伤口再撕裂的危险因素及护理对策

目的 对会阴侧斜切开术后伤口再撕裂的危险因素进行探讨,以有效降低会阴侧斜切开术后伤口的再撕裂率.方法 回顾性分析住院分娩的97例产妇会阴侧斜切开术后伤口再撕裂的发生原因.结果 持续性枕后位、枕横位等头位不正致会阴侧斜切开术后伤口再撕裂率占16.49%,耻骨弓过低、胎儿体质量≥3 500 g均占15.46%,手抱肩娩出占13.40%.结论 正确估计胎儿大小、胎位和先露部位情况,充分了解骨产道和软产道的情况,是预防会阴侧斜切开术后伤口再撕裂的关键.     

基层医院开展护理查房演示的方法与成效

目的探讨右枕后住的危险因素，保障母婴安全。方法回顾性分析3755例分娩产妇的病例资料。结果3755例中枕后位513例，其中右枕后位405例，占78．95％；正常分娩159例，占30．99％。不同年龄及妊娠期不同偏好卧位产妇右枕后位的发生率比较，差异有显著性意义（均P〈0.01）。结论右枕后住的危险因素可能与孕妇的年龄及偏好卧位有关，应进行相关健康教育，及时准确地识别及正确处理，以保证母婴健康。     

腰椎穿刺术后垫枕与去枕对颅内压的影响

目的为腰椎穿刺术后患者提供安全、舒适的体位。方法选择脑出血行侧脑室引流的患者90例，测定颅内压后分为高颅压组、正常颅压组和低颅压组各30例；腰穿后每组均分别予以垫枕与去枕干预各15例．接受垫枕干预者腰穿后于枕下垫软枕（厚7～8cm），并每2小时翻身1次；接受去枕干预者按护理常规去枕平卧6h，每2小时将手伸至患者背部按摩皮肤。各组均在腰穿前，腰穿后30min、60min、2h、4h、6h分别监测脑室颅内压变化。结果高颅压和低颅压组患者垫枕和去枕对颅内压影响显著（均P〈0．05）；正常颅压组患者垫枕和去枕对颅内压影响无显著性意义（均P〉0．05）；接受去枕干预者皮肤反应发生率显著高于接受垫枕干预者（P〈0.01）。结论高颅压患者腰穿后采取垫枕位更合适，正常颅压患者腰穿后可以垫枕，低颅压患者腰穿后不宜垫枕。     

抱膝仰卧位在第二产程中的应用

传统的分娩体位取膀胱截石位。产妇进入第二产程后，常发生胎头下降困难，尤其是耻骨弓低。骨盆倾斜度大的产妇，易导致第二产程延长、胎儿宫内窘迫，行产钳术结束分娩又增加了新生儿窒息发生率及产后出血率［1］。1995年始，我院采取抱膝仰卧位，使第二产程平均缩短25min，难产发生率下降10．71％，新生儿窒息率下降5．90％，产后大出血发生率下降5．09％。现报告如下。1临床资料与方法1993～1994年113例分娩产妇取膀胱截石位（对照组），1995～1996年209例取抱膝仰卧位（观察组）。两组产妇年龄最大33岁，最小23岁，平均28岁。无内科及产…     

枕颈区减压融合Cervifix内固定术治疗枕颈部畸形

目的 探讨Cervifix内同定在枕颈融合术中的价值。方法6例枕颈部畸形伴脊髓压迫症患者行寰椎后弓切除枕骨大孔扩大减压，枕骨瓣翻转加自体髂骨植骨融合Cervifix内崮定。结果6例患者均得到随访，时间9-24个月，平均18个月。术后颈髓压迫症状均有不同程度的改善，按JOA17分法评定，优（改善率≥80％）2例，良（改善率50-79％）3例，无变化（改善率〈5％）1例。全部患者均获骨性融合。无一例发生内固定螺钉松动等并发症。结论Cervifix内固定可提供坚强有效的节段性固定，提高植骨融合率，适用于枕颈部畸形伴脊髓压迫症的治疗。     

脐静脉推注催产素缩短第三产程的观察

产后出血大多发生于第三产程，缩短第三产程时间．可减少产后出血，利于产妇健康[1,2]。1994～1996年，我科对186例产妇来用脐静脉推注健产素缩短第三产程，防治产后出血，现报告如下。1资科与方法186例孕妇年龄23～35岁。孕周38～41周，均系单胎头位顺产。胎儿体重2450～3860g。其中二胎一产49例。随机分为A、B、C3组，每组62例．A组胎儿娩出断脐后，立即通过脐静脉推注0．9％氯化钠注射液20ml加化产素20U；B组胎儿娩出1min内于母体肘静脉推0．9％氯化钠注射液20ml加催产素20U；C组若出现宫缩乏力，则用1U催产素封闭合谷穴。3组产妇在…     

硬膜外阻滞麻醉镇痛对产程的影响

为探讨硬膜外阻滞麻醉镇痛对产程的影响,将100例初产妇随机分为观察组（行硬膜外阻滞麻醉分娩）和对照组（正常分娩）各50例,观察两组产妇的总产程及第一产程时间,活跃期宫口扩张速率和胎头下降速率。结果观察组产妇的部产程及每产程时间均较对照组明显缩短;宫口扩张和胎头下降速率较对照组显著增快（均P＜0．01）,表明硬膜外阻滞麻醉用于分娩镇痛的同时能明显促进产程进展。     

Lumbar sympathetic blocks speed early and second stage induced labor in nulliparous women

BACKGROUND: Rapid cervical dilation reportedly accompanies lumbar sympathetic blockade, whereas epidural analgesia is associated with slow labor. The authors compared the effects of initial lumbar sympathetic block with those of epidural analgesia on labor speed and delivery mode in this pilot study. METHODS: At a hospital not practicing active labor management, full-term nulliparous patients whose labors were induced randomly received initial lumbar sympathetic block or epidural analgesia. The latter patients received 10 ml bupivacaine, 0.125%; 50 microg fentanyl; and 100 microg epinephrine epidurally and sham lumbar sympathetic blocks. Patients to have lumbar sympathetic blocks received 10 ml bupivacaine, 0.5%; 25 microg fentanyl; and 50 microg epinephrine bilaterally and epidural catheters. Subsequently, all patients received epidural analgesia. RESULTS: Cervical dilation occurred more quickly (57 vs. 120 min/cm cervical dilation; P = 0.05) during the first 2 h of analgesia in patients having lumbar sympathetic blocks (n = 17) than in patients having epidurals (n = 19). The second stage of labor was briefer in patients having lumbar sympathetic blocks than in those having epidurals (105 vs. 270 min; P < 0.05). Nine patients having lumbar sympathetic block and seven having epidurals delivered spontaneously, whereas seven patients having lumbar sympathetic block and seven having epidurals had instrument-assisted vaginal deliveries. Cesarean delivery for fetal bradycardia occurred in one patient having lumbar sympathetic block. Cesarean delivery for dystocia occurred in five patients having epidurals compared with no patient having lumbar sympathetic block (P = not significant). Visual analog pain scores differed only at 60 min after block. CONCLUSIONS: Nulliparous parturients having induced labor and receiving initial lumbar sympathetic blocks had faster cervical dilation during the first 2 h of analgesia, shorter second-stage labors, and a trend toward a lower dystocia cesarean delivery rate than did patients having epidural analgesia. The effects of lumbar sympathetic block on labor need to be determined in other patient groups. These results may help define the tocodynamic effects of regional labor analgesia.     

Continuous epidural analgesia with bupivacaine 0.125% or bupivacaine 0.0625% plus sufentanil 0.25 microg.mL(-1): a study in singleton breech presentation

Epidural analgesia is the most efficient technique for labor pain relief. However, its resultant motor block might impair the mode of delivery, particularly in breech presentation where the risk of dystocia is high. In this trial, we compared bupivacaine 0.125% with a combination of a low concentration of bupivacaine (0.0625%) and sufentanil (0.25 microg.mL(-1)) both administered by continuous infusion. Analgesia, maternal and fetal/neonatal side effects and obstetric outcome were compared between group bupivacaine (n = 23) and group bupivacaine-sufentanil (n = 35). A greater number of patients in the bupivacaine 0.125% group required more than two top-ups (32 vs. 8% of patients, P = 0.03) while pain scores were similar. Motor block at delivery was more pronounced in the bupivacaine 0.125% group. Nausea and pruritus were more often encountered in the bupivacaine-sufentanil group. There was a trend toward a decreased rate of assisted or operative delivery in the bupivacaine-sufentanil group (92% vs. 74%, P = 0.09). Fetal/neonatal data did not differ between groups. Epidural analgesia with bupivacaine-sufentanil required fewer additional top-ups and produced less motor block than did bupivacaine 0.125%. However, there was no significant difference in mode of delivery between the two analgesic regimens.     

剖宫产术与阴道助产术在足月妊娠临产胎儿窘迫中的疗效观察

目的研究和分析剖宫产术与阴道助产术在足月妊娠临产胎儿窘迫中临床疗效。方法选取50例2013年1～6月来我院进行足月妊娠临产胎儿窘迫治疗的患者,将其按挂号的流水号随机抽查分为对照组与试验组,每组各25例患者。试验组的患者采用剖宫产术,对照组的患者使用阴道助产术。将试验组与对照组两组产妇的母婴结局进行分析与对比。结果两组患者在脐带因素方面具有明显的差异,差异有统计学意义（P〈0.05）。结论患者一旦出现临产胎儿窘迫,应按照孕妇具体情况选择剖宫产术或阴道助产术尽快结束分娩,同时做好新生儿抢救等后续工作,避免新生儿窒息,减少围产儿死亡率。     

The incidence of fetal heart rate changes after intrathecal fentanyl labor analgesia

We performed a retrospective review to compare the incidence of new fetal heart rate abnormalities after institution of either intrathecal fentanyl or conventional epidural labor analgesia. In chronological order, the first 100 parturients in active labor who had received epidural analgesia and had recorded fetal heart rate (FHR) traces for 30 min before and after injection were identified, as were the first 100 parturients who had received intrathecal fentanyl analgesia. A perinatologist blinded to the anesthetic technique evaluated each recording and identified any changes in the FHR between the before and after tracings. The incidence of new "negative" (implying worsened fetal status) changes was 6% in the epidural group and 12% in the intrathecal group (P > 0.05, not significant). There were no differences in incidence or degree of blood pressure change, need for cesarean delivery, neonatal outcome, parity, or oxytocin use. No parturient required urgent or emergent cesarean delivery, and all changes resolved within the 30-min observation period. A much larger study would be required to determine whether this six percentage point difference represents a true difference between groups, and its clinical significance. IMPLICATIONS: We compared the incidence of fetal heart rate changes after two techniques of labor analgesia. Both techniques were associated with a low (6%-12%) incidence of changes, but a much larger series would be required to determine whether this represents a true difference. No difference in neonatal outcome was found.     

神经刺激减痛法在自然分娩中的应用效果观察

目的评估神经刺激法用于初产妇自然分娩的镇痛效果及对产科结局的影响。方法将自然分娩初产妇按其意愿分组,自愿采用神经刺激法镇痛的120例作为观察组,未使用神经刺激法镇痛的108例作为对照组。比较两组镇痛FPS-R评分、剖宫产率、产程时间、阴道流血量。结果观察组初产妇宫口开大到3～4cm、宫口开全时,FPS-R评分分别为3.51±0.50和4.53±0.50,显著低于对照组同阶段的4.31±0.46和5.31±0.46(均P0.01)。两组产程时间和阴道流血量比较,差异有统计学意义(P0.05,P0.01)。结论神经刺激减痛法可有效减轻初产妇分娩疼痛,降低剖宫产率,缩短产程,减少阴道流血量。     

An association between severe labor pain and cesarean delivery

The relationship between epidural analgesia and cesarean delivery remains controversial. Several studies have documented an association, although others have not. This inconsistency may result from an association between severe labor pain and dystocia. We hypothesized that dystocia causes severe labor pain, such that more epidural medication is required to maintain comfort. We examined the relationship between labor outcome and severe pain, defined by the number of supplemental epidural boluses. We retrospectively reviewed the anesthesia records of 4493 parturients who received small-dose labor epidural analgesia. An independent association was found between operative delivery and maternal age, body mass index, nulliparity, fetal weight, induction of labor, and the number of boluses required during labor. By using multivariate analysis, the odds ratio of cesarean delivery among women who required at least three boluses was 2.3 compared with those who required two boluses or less. No association was found between the concentration of bupivacaine in the epidural infusion and operative delivery. Because women with cesarean deliveries appeared to have more pain, degree of labor pain may be a confounding factor in studies examining epidural analgesia and outcome. Implications: This is a retrospective observational study demonstrating an association between labor pain and cesarean delivery. Our results provide an alternative explanation of why epidural analgesia is associated with cesarean delivery.     

A Randomized Study of Combined Spinal-Epidural Analgesia versus Intravenous Meperidine during Labor: Impact on Cesarean Delivery Rate

Background: Combined spinal-epidural (CSE) analgesia produces rapid-onset pain relief and allows ambulation in early labor. Epidural local anesthetics may contribute to an increase in operative deliveries by decreasing perineal sensation and causing motor weakness. Operative delivery rates might be reduced with CSE, by avoiding or delaying administration of local anesthetics. This study compares the operative delivery rates associated with a CSE technique and those associated with intravenous meperidine for labor analgesia.

Methods: Healthy parturients at full term were assigned randomly to receive CSE or intravenous meperidine analgesia. The CSE group received 10 [micro sign]g intrathecal sufentanil, followed by epidural bupivacaine and fentanyl at their next request for analgesia. Parturients receiving intravenous meperidine had 50 mg on demand (maximum, 200 mg in 4 h). Labor and delivery outcomes in both groups were recorded and compared.

Results: An intent-to-treat analysis of 1,223 women indicated that CSE does not increase the rate of cesarean delivery for dystocia in nulliparous and parous women (CSE, 3.5% vs. intravenous meperidine, 4; P = not significant) or in nulliparous women alone (CSE, 7% vs. intravenous meperidine, 8%; P = not significant). Profound fetal bradycardia that necessitated emergency cesarean delivery within 1 h of the time the mother received sufentanil occurred in 8 of 400 parturients (compared with 0 of 352 who received meperidine; P < 0.01). However, the method of fetal monitoring differed between the two groups. Despite this, neonatal outcomes were similar overall.     

Prospective case control comparison of fetal intrapartum oxygen saturations during epidural analgesia

BackgroundThe purpose of this study was to compare fetal oxygen saturation by fetal pulse oximetry in parturients with and without epidural labor analgesia in a prospective case control study.MethodsFetal oxygen saturation values were compared in term pregnant women who received epidural analgesia (epidural group) with those in women who did not (control group). Mode of delivery, Apgar score, fetal oxygen saturation, cord blood gas analysis and fetal outcomes were also compared.ResultsA total of 150 pregnant women (75 in each group) gave written consent and were enrolled. The average fetal oxygen saturation during the first stage of labor (active phase) was 45.6 ± 8.1% for the epidural group and 45.9 ± 7.4% for the control group (NS); saturations for the second stage of labor were 44.9 ± 8.8% and 45.3 ± 6.7%, respectively (NS). In the epidural group, the duration of the first stage of labor was significantly longer (565 ± 217 min) than the control group (434 ± 222 min; P= 0.001). Cesarean delivery rates, neonatal cord blood gas analysis, Apgar scores, and neonatal outcomes were similar in the two groups.ConclusionsFetal oxygen saturation values are similar in the first and second stage of labor in the presence or absence of epidural labor analgesia.     

Improved epidural analgesia in the parturient in the 30° tilt position

PURPOSE: To compare the incidence of incomplete analgesia when epidural local anesthetic is administered with the parturient supine in a 30 degree leftward tilt or in the left lateral decubitus position. METHODS: After placement of a multiorifice catheter 5 cm into the epidural space, 293 women in active labour were randomly positioned either to the left lateral decubitus position (lateral group) or supine with a 30 degree leftward tilt (tilt group) and then received 13 mL bupivacaine 0.25%. The success of the epidural block was determined by asking the patient if she required additional medication 15 min later. The incidence of complications (fetal heart rate decelerations, hypotension, and ephedrine usage) was noted. RESULTS: In the lateral group, 38% required additional medication compared with 24% in the tilt group (P = 0.006). There were no differences between groups in the incidence of maternal hypotension or fetal heart rate decelerations, but more women (10%) received ephedrine in the lateral than in the tilt group (4%), P = 0.035. CONCLUSIONS: Placing the parturient supine with a 30 degree leftward tilt is associated with a greater success rate of labour epidural analgesia without an increase in complications than in women in the left lateral decubitus position. This advantage should be considered when positioning the parturient after epidural catheter placement.