经产妇分娩巨大儿的相关因素及妊娠结局分析

目的 探讨经产妇分娩巨大儿的相关因素与妊娠结局的关系.方法 对2003年1月至2008年5月北京军区总医院201例非妊娠期糖尿病且无严重内外科合并症经产妇分娩的巨大儿资料进行回顾性分析,并与同期分娩的初产妇巨大儿及随机选择的无合并症经产妇正常体重几进行比较.结果 经产妇巨大儿母亲的孕龄、孕末期体重、剖宫产率、产后出血、异常产程、新生儿窒息率等均高于经产妇正常体重儿组,差异有统计学意义(P<0.05).与初产妇巨大儿组比较,经产妇巨大儿正规产检比例明显降低,过期妊娠、新生儿窒息率增加,择期剖宫产率低(P<0.05).结论 加强经产妇围生期管理,产前正确预测经产妇巨大儿,选择适当的分娩方式,对预防产后出血.降低母婴并发症至关重要.     

巨大儿139例分娩方式回顾性分析

胎儿出生体重达 40 0 0 ｇ称巨大儿 ,属高危妊娠 ,本文对在我院分娩的巨大儿 139例分娩方式进行回顾性分析 ,报道如下。1　临床资料1.1　一般资料　我院自 1995年 1月至 1999年 12月间分娩总数为 476 5例 ,其中巨大儿 139例 ,占分娩总数的2 9% ,139例孕妇的年龄 ,最小 2 1岁 ,最大为 42岁 ,平均2 7岁。初产妇 72例占 5 1 8% ,经产妇 6 7例占 48 2 % ;新生儿出生体重 40 0 0 ｇ者 5 0例 ,占 1 0 5 % ;体重在 410 0～45 0 0 ｇ者 79例 ,占 1 6 6 % ;体重在 46 0 0～ 5 0 0 0 ｇ者 8例 ,占0 17% ;体重在 5 30 0ｇ者 1例 ,占 0 0 2 % ;体重在…     

巨大儿的分娩方式及其预后

巨大儿的分娩方式及其预后韩玉兰汤美芳仲涛张芳高冠峰（潍坊市妇幼保健院）为了提高对巨大胎儿（ｆｅｔａｌｍａｃｒｏｓｏｍｉａ，下称巨大儿）处理的认识，改善巨大儿的预后，我们对１９９２至１９９６年在我院分娩的巨大儿进行了回顾性分析，报告如下。１资料与方法１...     

初产妇巨大儿分娩方式合理性探讨

目的：观察初产妇阴道分娩巨大儿时的产程特点以及对母婴的影响,从而合理安排巨大儿分娩方式,保障母婴安全。方法：对2008年1月—2010年12月在兰州大学第一医院妇产科住院行阴道试产的88例分娩巨大儿的初产妇、60例分娩正常体质量儿的初产妇以及60例择期剖宫产分娩巨大儿的初产妇的临床资料进行回顾性分析。结果：88例初产妇中有43例阴道分娩成功,其余45例阴道分娩失败的初产妇主要表现为活跃期停滞,宫颈口开大3～5 cm。阴道分娩失败改行剖宫产不增加产后出血、产褥感染及新生儿窒息的发生率。结论：对于临床上预测为巨大儿的初产妇,若无明显头盆不称,可进行试产。在产程中若出现活跃期停滞等产程异常,需及时改行剖宫产,从而降低巨大儿分娩对母婴的损伤。     

74例经产妇分娩巨大儿的相关因素及预后分析

目的:探讨经产妇分娩巨大儿相关因素与预后的关系.方法:回顾分析2004年1月至2006年12月分娩的74例非妊娠期糖尿病,无严重内外科合并症的经产妇巨大儿资料,与随机选择的同期分娩的无合并症经产妇正常体重儿作对照分析,并与同期分娩的初产妇巨大儿比较.结果:经产妇巨大儿组平均孕龄、孕末期体重、宫高、腹围、产时及产后2小时出血量、异常产程、剖宫产率、新生儿窒息率都高于经产妇正常体重儿组,差异有显著性(P＜0.05);与初产妇巨大儿组比较,正规产检比例明显降低,过期妊娠、新生儿窒息率增加,择期剖宫产率低.结论:加强经产妇围生期管理,产前正确预测经产妇巨大儿,选择适当的分娩方式,对预防产后出血,降低母婴并发症至关重要.     

产前宣教对初产妇分娩方式的影响

目的 探讨产前宣教对初产妇分娩方式的影响。方法 选取55例分娩的初产妇,采用随机数字表法将其分为对照组（28例）与观察组（27例）。对照组实施常规护理,观察组在对照组基础上实施产前宣教。对比两组分娩方式、母婴并发症情况及产程。结果 观察组自然分娩率74.1%明显高于对照组35.7%,剖宫产率14.8%明显低于对照组50.0%,母婴并发症发生率3.7%明显低于对照组25.0%,差异有统计学意义（P<0.05）,两组阴道助产率对比,差异无统计学意义（P>0.05）。观察组第一产程、第二产程、第三产程及总产程均明显短于对照组,差异有统计学意义（P<0.05）。结论产前宣教可提高初产妇自然分娩率,降低剖宫产率及母婴并发症,具有临床应用价值。     

实施硬膜外分娩镇痛时机对初产妇妊娠结局的影响

目的:分析硬膜外分娩镇痛时机对初产妇妊娠结局的影响.方法:选取2019年10月1日至2020年9月30日在山东大学第二医院实施硬膜外分娩镇痛的孕妇共502例.根据硬膜外分娩镇痛时的宫口扩张程度分为3组:Ⅰ组(宫口<2cm,49例),Ⅱ组(2≤宫口<3cm,284例),Ⅲ组(宫口≥3cm,169例).分析3组孕妇的分娩方...     

瘢痕子宫再次妊娠不同分娩方式近远期并发症比较

目的:探讨瘢痕子宫再次妊娠不同分娩方式的近远期并发症。方法:选择2002年2月至2017年12月苏州大学附属第一医院妇产科收治的瘢痕子宫孕妇2617例,其中择期再次剖宫产2246例(ERCD组),阴道试产成功334例(VBAC组),阴道试产失败转急诊剖宫产37例(TOLAC失败组)。对3组患者的妊娠结局及产后近远期并发症进行比较分析。结果:3组患者中,TOLAC失败组剖宫产患者并发症发生率最高(18. 92%),其次是ERCD组患者(6. 99%),而VBAC组患者并发症发生率最低(3. 29%)。VBAC组出现输血、产后发热和尿潴留的比例明显低于ERCD组(分别为0 vs 1. 65%、1. 20%vs 4. 14%、0. 30%vs 2. 98%,P <0. 05);发生子宫破裂、输血、尿潴留、肠梗阻的比例低于TOLAC失败组(分别为0 vs 10. 81%、0 vs 8. 11%、0. 30%vs 5. 41%、0 vs 5. 41%,P <0. 05); TOLAC失败组发生子宫破裂、输血、肠梗阻的比例显著高于ERCD组(分别为10. 81%vs 0. 31%、8....     

不同分娩方式对母儿健康的影响

分娩方式包括经阴道自然分娩、经阴道助产和剖宫产.经阴道自然分娩是人类进化的一种本能;阴道助产包括胎吸、产钳器械助产、臀位助产和臀位牵引术;剖宫产作为解决难产的重要手段,对降低孕产妇及新生儿死亡率起到重要作用,但任何一种分娩方式均存在利弊.不同分娩方式对母儿健康的影响不一,对公众应该根据循证医学证据,改变卫生策略,以促进合理地选择分娩方式;对单独的个体,应该根据具体的情况权衡利弊,帮助孕妇选择最佳的分娩方式.     

双胎妊娠的分娩方式与妊娠结局探讨

目的　探讨双胎妊娠的分娩方式与妊娠结局的关系。方法　将 1995年 1月至 2 0 0 3年 5月 98例双胎妊娠产妇按分娩方式分为阴道分娩组及剖宫产组 ,对其临床资料进行回顾性分析。结果　两组的孕周、产后出血率比较差异无显著性意义 (P >0 0 5 ) ,剖宫产组新生儿体重显著高于阴道分娩组 (P <0 0 1) ,两组第 1胎分娩新生儿窒息率差异无显著性意义 (P >0 0 5 ) ,而第 2胎分娩新生儿窒息率剖宫产组显著低于阴道分娩组(P <0 0 5 )。结论　正确选择双胎妊娠的分娩方式 ,将有助于降低剖宫产率及新生儿窒息率     

The influence of macrosomia on the duration of labor, the mode of delivery and intrapartum complications

Objective  This study assessed the perinatal outcome in a series of macrosomic fetuses with mothers from a general obstetric population in whom vaginal delivery was planned. Methods  In all, 215 women with macrosomic infants were included from a total of 2,622 deliveries. The pattern of maternal weight gain in pregnancy, the influence of fetal macrosomia on the duration of labor and the delivery outcome were investigated in this group. The main issues studied were the impact of fetal weight on the mode of delivery, the duration of the two stages of delivery and the incidence of intrapartum complications in fetuses larger than 4,000 g in comparison with normal-weight fetuses. Results  Complete data were obtained for 594 patients, including 215 macrosomic infants and 379 randomly assessed normal-weight infants. With regard to the mode of delivery, a direct correlation was observed between maternal weight gain and the incidence of secondary cesarean section (P < 0.014) when vaginal delivery was initially planned. There was also a direct correlation between increasing birth weight and a higher incidence of secondary cesarean section and assisted vaginal delivery (P < 0.002). In the first stage of labor, there was a statistically significant difference for obstructed labor between the two groups (P < 0.03). The rate of perineal injuries and the incidence of postpartum hemorrhage were similar in the two groups. Conclusions  As some of the risk factors identified are known prior to delivery, every woman in whom there is a suspicion that the fetus may weigh up to 4,500 g should receive individual guidance regarding special intrapartum and perinatal conditions.     

双胎妊娠适宜的分娩时机与分娩方式

双胎妊娠的分娩仍是产科最具挑战性的事件。双胎妊娠的分娩时机与分娩方式应根据孕周、当地的医疗条件（产科条件是否为区域性医疗中心、新生儿重症监护病房救治水平等）及母胎的具体情况（绒毛膜性,有无并发症或合并症、复杂双胎等,甚至患者经济情况）等综合考虑,制定适宜的个体化分娩方案。对于无并发症及合并症的双绒毛膜双羊膜囊双胎,38～39+6周分娩较适宜;对于无并发症及合并症的单绒毛膜双羊膜囊双胎,适宜的分娩时机为37～38周;复杂性双胎（如单羊膜囊双胎、双胎输血综合征、选择性胎儿生长受限、贫血-红细胞增多序列征、单绒毛膜双胎减胎术或宫内治疗后）,需结合孕妇及胎儿的具体情况制定个体化的分娩方案,分娩时机为32～36周。双胎择期剖宫产指征包括单羊膜囊双胎、连体双胎（除外早中孕者）、第一胎非头位、具有单胎的剖宫产指征者,除此之外,均可考虑阴道分娩。     

妊娠期高血压疾病终止妊娠时机与方式

妊娠期高血压疾病是一组妊娠期特有的多器官损害的临床疾病,严重危害母儿健康。终止妊娠是惟一有效的治疗方法,选择恰当的分娩时机与方式是改善母婴结局的关键。文章复习国内外文献,结合作者的处理经验,就相关问题进行探讨。     

Differences in levels of oxidative stress in mothers and neonate: the impact of mode of delivery

Abstract

Objective: To determine there are differences in the production levels of oxygen free radical between mothers and neonates by the mode of delivery, we measured oxygen free radical concentrations in maternal vein and umbilical artery.

Methods: Forty-four women with singleton term pregnancies were prospectively recruited and classified into two groups: those who had a spontaneous uncomplicated vaginal delivery (VD group; n?=?21), and those who had an elective cesarean delivery (CD group; n?=?23). We determined maternal and fetal oxidative stress levels by measuring concentrations of derivatives of reactive oxygen metabolites (d-ROMs) in maternal vein before delivery and on postnatal day 5, and in umbilical artery at delivery. We also measured the pH, partial pressure of oxygen (PaO₂), partial pressure of carbon dioxide (PaCO₂) and base excess (BE) in umbilical artery blood collected at delivery.

Results: The concentrations of d-ROMs in maternal vein on postnatal day 5 were significantly decreased in the VD group, but were significantly increased in the CD group, compared to before delivery. The concentrations of d-ROMs in umbilical artery were significantly higher in the VD group than the CD group. Compared to the CD group, umbilical artery pH tended to be lower (p?=?0.07), and BE significantly lower (p?<?0.005), in the VD group. There were no significant differences in umbilical artery PaO₂ and PaCO₂ between the two groups.

Conclusion: Our findings indicate that those production levels of oxygen free radical in mothers are greater by CD than by VD, while those in neonates are greater by VD than by CD.     

The effect of pregnancy and mode of delivery on the prevalence of urinary and fecal incontinence

OBJECTIVE: The purpose of this study was to determine the relative effects of pregnancy and mode of delivery on the prevalence of urinary and fecal incontinence. STUDY DESIGN: This was a prospective, observational multicenter study of women presenting to 6 gynecology clinics. Demographic data collected included: height, weight, gravidity, parity, and number of vaginal deliveries. Patients were diagnosed with incontinence by questionnaire. Standard univariate logistic regression analyses' were performed to determine the contribution of pregnancy, mode of delivery, and BMI on the prevalence of urinary and fecal incontinence. RESULTS: One thousand and four women were enrolled over an 18-month period. Two hundred and thirty-seven and 128 subjects had urinary and fecal incontinence, respectively. Odds ratio (95% CI) calculated for the prevalence of urinary incontinence by pregnancy and mode of delivery were: any term pregnancy vs no term pregnancy was 2.46 (1.53-3.95), any term pregnancy but no vaginal deliveries (cesarean section only) vs no term pregnancy was 1.95 (0.99-3.80), any term pregnancy and at least 1 vaginal delivery vs no term pregnancy was 2.53 (1.57-4.07), and any term pregnancy but no vaginal delivery (cesarean section only) vs any term pregnancy, and at least 1 vaginal delivery was 1.30 (0.77-3.95). Odds ratio (95% CI) calculated for the prevalence of fecal incontinence by pregnancy and mode of delivery were: any term pregnancy vs no term pregnancy was 2.26 (1.22-4.19), any term pregnancy but no vaginal deliveries (cesarean section only) vs no term pregnancy was 1.13 (0.43-2.96), any term pregnancy and at least 1 vaginal delivery vs no term pregnancy was 2.41 (1.30-4.49), and any term pregnancy but no vaginal deliveries (cesarean section only) vs any term pregnancy, and at least 1 vaginal delivery was 2.15 (0.97-4.77). BMI and age did not impact these results. CONCLUSION: Pregnancy increases the risk of urinary and fecal incontinence. Cesarean section does not decrease the risk of urinary or fecal incontinence compared to pregnancy with a vaginal delivery.     

徐州地区近10年出生体重与分娩方式动态观察

目的分析徐州地区近10年活要出生体重及分娩方式变化趋势，探讨要儿出生体重对分娩方式的可能影响及需要采取的对策。方法分析徐州地区10年内3000例晚期妊娠临床资料，绘制低出生体重和高出生体重趋势图，以统计学方法分析出生体重与分娩方式的关系。结果随年份递增，徐州地区近10年足月活要出生体重呈上升变化趋势；分娩方式中的阴道顺产率、胎吸及产钳助产率均呈下降趋势，而剖宫产率呈明显上升趋势。结论高、低出生体重可能影响分娩方式，孕期应该积极监测胎儿体重，减少低、高出生体重发生率。     

Fetal macrosomia: mode of delivery

This study was provided among 1847 deliveries from January, 1 to December, 31, 2003. The aim of the study was to examine the correlation between antenatal diagnosis "fetal macrosomia" and the mode of delivery. We found that among the cases with birth weight > or = 4000 g and antenatal diagnosis "fetal macrosomia" the rate of cesarean section was fourfold higher than among the cases without such a diagnosis. There weren't statistically significant correlation between the cases with antenatal diagnosis "fetal macrosomia " and the cases with estimated birth weight < or = 3999g in reference to the mother's age and weight, parity, fundal height and abdominal circumference. There are insignificant differences between both of groups in reference to gestacional age and birth.     

妊娠合并心脏病妊娠风险及分娩方式评估

妊娠合并心脏病是导致孕产妇死亡发生的重要原因之一,此类患者妊娠前及围产期的评估管理对降低孕产妇死亡率、改善母儿预后有重要作用。文章就目前国内外妊娠合并心脏病妊娠风险评估及分娩方式选择做一总结,为广大临床工作者对妊娠合并心脏的诊疗及管理提供参考。     

妊娠合并妇科恶性肿瘤分娩时机及分娩方式的选择

宫颈癌和卵巢癌是妊娠期最常见的妇科恶性肿瘤,近年来随着生育年龄的推迟及促排卵药物的应用,妊娠合并妇科恶性肿瘤的发生率呈上升的趋势。既往在诊断恶性肿瘤后立即终止妊娠,而目前决定治疗方案时会充分考虑母体和胎儿二者的预后,从而将母胎死亡率和并发症降到最低。妊娠合并妇科恶性肿瘤分娩时机与分娩方式的选择没有统一的指南。文章结合相关文献,阐述妊娠合并宫颈癌、卵巢肿瘤、外阴癌的分娩时机与分娩方式,以供临床参考。