脐带绕颈阴道试产786例临床观察分析

比较786例脐带绕颈阴道试产者(观察组)与100例无脐带绕颈的正常足月分娩产妇(对照组)产程时间、分娩方式、新生儿出生评分及伴脐带血流异常等情况。结果观察组剖宫产、阴道助产数、胎儿窘迫发生率及脐带血流异常高于对照组(P＜0．01，P＜0．05)，但产程时间、新生儿窒息发生率与对照组差异无显著性意义(P＞0．05)；脐带绕颈伴脐带血流异常时剖宫产率明显增加。提示对脐带绕颈不伴脐带血流异常者分娩时只要观察仔细、处理得当，绝大多数胎儿可以自然顺产。     

剖宫产术与阴道助产术在足月妊娠临产胎儿窘迫中的应用效果探讨

目的探讨剖宫产术与阴道助产术在足月妊娠临产胎儿窘迫中的临床效果。方法选取足月妊娠临产胎儿窘迫的孕妇120例,随机分为观察组60例给予剖宫产术,对照组60例给予阴道助产术,比较两组产妇的分娩结局及新生儿健康情况。结果两组新生儿全部存活,两组方式在拯救新生儿生命安全上差异无统计学意义(P0.05);观察组并发症发生率明显小于对照组,两组比较差异有统计学意义(P0.05);观察组新生儿重度窒息的发生率明显小于对照组,两组比较差异有统计学意义(P0.05)。结论剖宫产术与阴道助产术在足月妊娠临产胎儿窘迫的抢救工作中均可挽救胎儿的生命,但是应用剖宫产的新生儿分娩过程中并发症发生率较低,新生儿Apgar评分较高、重度窒息发生率低,临床效果优于阴道助产术,值得临床上进一步推广应用。     

剖宫产和阴道助产术在足月妊娠临产胎儿窘迫中的应用效果

目的观察剖宫产和阴道助产术在足月妊娠临产胎儿窘迫中的应用效果。方法将60例足月妊娠临产出现胎儿窘迫孕妇随机分为2组,每组30例,对照组实施阴道助产术,观察组实施剖宫产术,观察并比较产后2组母婴结局、围产期并发症及胎儿窘迫改善情况。结果 2组产妇均顺利分娩,无产妇和围产儿死亡。观察组产后新生儿后窒息率等母婴并发症发生率低于对照组,2组比较,差异有统计学意义(P0.05)。结论足月妊娠临产胎儿窘迫剖宫产分娩,母婴围产期并发症较阴道助产低。应根据孕妇具体情况,合理选择剖宫产术或阴道助产术尽快结束分娩,以改善母婴预后,降低产后并发症发生率。     

剖宫产术与阴道助产术在足月妊娠临产胎儿窘迫中的应用效果

目的探讨剖宫产术与阴道助产术在足月妊娠临产胎儿窘迫中的应用效果。方法回顾性分析2019-12—2020-06间在汝州市第一人民医院妇产科分娩的68例足月妊娠产妇的临床资料。按照分娩方法分为阴道助产组(32例)和剖宫产组(36例)。比较2组母婴结局。结果 2组产妇分娩过程顺利,均未发生产妇和围产儿死亡病例。剖宫产组产妇产后并发症发生率低于阴道助产组,差异有统计学意义(P<0.05)。2组产后新生儿窒息率差异无统计学意义(P>0.05)。剖宫产组胎儿窘迫时产妇宫口开大处于潜伏期率高于阴道助产组,处于活跃期减缓阶段率低于阴道助产组,差异有统计学意义(P<0.05)。结论在足月妊娠临产胎儿窘迫中应用剖宫产术与阴道助产术均能有效改善分娩结局,但剖宫产术能减少新生儿头部血肿的发生率,相对安全性更高。应根据产妇宫口开大等具体情况,合理选择分娩方式,以显著提高母婴预后效果。     

疤痕子宫再次妊娠剖宫产临床分析

目的探讨疤痕子宫再次妊娠剖宫产的风险及效果。方法将首次妊娠采取非剖宫产分娩的50例产妇作为对照组,将首次妊娠采取剖宫产的42例产妇作为观察组。2组均实施剖宫产。比较2组手术时间、术中出血量、产后出血率、恶露持续时间、先兆子宫破裂率及新生儿窒息等指标。结果观察组手术时间和术后恶露持续时间长于对照组,术中及术后出血量多于对照组,先兆子宫破裂及新生儿窒息发生率高于对照组。差异均有统计学意义(P0.05)。结论瘢痕子宫产妇再次实施剖宫产的妊娠风险高于非疤痕子宫剖宫产产妇。临床应严格控制和降低不具备剖宫产指征等疤痕子宫产妇的剖宫产率。     

阴道助产掌在自然分娩产妇中的应用效果观察

目的探讨阴道助产掌在产妇自然分娩中的应用效果。方法将286例自然分娩产妇随机分为2组,每组143例。对照组实施传统助产方式助产,观察组运用阴道助产掌助产,观察比较2组产妇产后2 h、24 h出血量、软产道损伤情况和新生儿损伤、窒息发生率。结果观察组产后2 h、24 h出血量、软产道损伤情况均优于对照组,新生儿损伤和窒息发生率明显低于对照组。2组比较,差异有统计学意义(P0.05)。结论阴道助产掌在自然分娩产妇中应用,可明显减少母婴损伤,增加母婴健康。     

晚娩肩助产预防新生儿产伤效果观察

目的探讨晚娩肩助产对足月单胎阴道分娩的新生儿产伤的预防效果。方法采用回顾性观察研究,比较1 120例实施晚娩肩助产(观察组)与973例未采用晚娩肩方法助产(对照组)产妇的分娩结果,分析两组新生儿体质量、窒息、锁骨骨折、臂丛神经损伤发生率的差异。结果两组新生儿体质量、窒息发生率比较,差异无统计学意义(均P0.05);观察组新生儿锁骨骨折、臂丛神经损伤发生率显著低于对照组(均P0.05)。结论晚娩肩助产有利于降低新生儿产伤发生率,提高产妇分娩质量。     

胎心监护的临床应用及其对剖宫产率的影响

目的探讨胎心监护的应用及其对剖宫产率的影响。方法选取2017-04—2017-09间在漯河市郾城区人民医院进行产前检查的262例产妇,随机分为2组,每组131例。对照组采取传统产前胎心听诊,观察组采取产前无应激胎心监测(NST)及产时电子胎心监测。比较2组胎儿宫内窘迫、新生儿窒息、剖宫产发生情况。分析NST分型与围产期胎儿异常的关系。结果观察组胎儿宫内窘迫检出率高于对照组,剖宫产率、新生儿轻度窒息及重度窒息率均低于对照组,差异具有统计学意义(P0.05)。NST分级越高,不良反应发生率越低。结论胎心监护有利于医生对产妇宫内情况进行准确判断,及时发现宫内异常情况,并选择最佳的分娩方式,可降低新生儿不良事件以及剖宫产率。     

三种分娩镇痛方式的效果比较

目的：比较自控硬膜外阻滞麻醉、自控静脉麻醉和笑气吸入三种方法的分娩镇痛效果和对产妇及新生儿的影响。方法：随机选取200例产妇为笑气组、自控硬膜外阻滞组、自控静脉麻醉组和对照组,每组各50例。在分娩过程中,笑气组给予吸入含50％笑气与50％氧气的混合气体,自控硬膜外阻滞组联合注入罗哌卡因和芬太尼、自控静脉麻醉静脉注射瑞芬太尼,对照组未给予镇痛药物。分别观察4组产妇的镇痛效果、产程时间、分娩方式、产后出血量、胎儿窘迫及新生儿窒息情况。结果：①镇痛效果比较：自控硬膜外阻滞镇痛分级0级42例,自控静脉麻醉组43例,笑气组6例,对照组0例（1级：阻滞组7例,静脉组6例,笑气组39例,对照组0例）。4组比较,差异有极显著性（P〈0．01）;②产程时间比较：镇痛3组的产程均较对照组缩短,有显著差异性（P〈0．05）;③4组产妇分娩方式、产后出血量、胎儿宫内窘迫及新生儿窒息发生率比较：差异无显著性（P〉0．05）。结论：自控硬膜外阻滞麻醉、自控静脉麻醉用于分娩有确切的镇痛效果,对产妇及新生儿无明显副作用,可在有一定医疗条件的医疗单位应用;笑气吸入用于分娩,有较好镇痛效果,且方法简单,对产妇及新生儿无明显的副作用,值得推广使用,尤其适用于基层单位。     

产时吸氧对母婴影响的研究

为探讨产时吸氧对母婴的影响。将 4 0 0例单胎头位、足月初产妇随机分为观察组与对照组各 2 0 0例。观察组在第一、二、三产程实施氧疗 ,对照组仅在宫内窘迫或窒息后给氧。结果两组总产程时间、分娩方式及胎儿宫内窘迫、新生儿窒息发生率 ,新生儿Apgar评分比较 ,差异均有显著性意义 (均P <0 .0 5 )。提示产时吸氧对母婴均有益 ,可缩短产程 ,提高顺产率 ,减少胎儿宫内窘迫、新生儿窒息发生率。     

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。     

新生儿窒息相关产科因素探讨

目的探讨与新生儿窒息相关的产科因素,以减少新生儿窒息的发生率。方法选取笔者所在医院2006年3月~2010年8月分娩的100例新生儿,采用回顾性研究方法进行调查研究。选取产妇的分娩方式以及妊娠并发症作为新生儿发生窒息的相关因素。结果剖腹产比起阴道助产可以显著降低新生儿窒息的发生率;羊水少、脐带异常以及头位难产等显著增加了新生儿窒息的发生率。结论产妇的生产方式以及妊娠并发症是影响新生儿窒息发生的重要因素,可在产前进行全面监护并及时采取措施以减少新生儿窒息的发生率。     

Anaesthesia for Caesarean section in patients with uncontrolled hyperthyroidism

The anaesthetic management of two patients with uncontrolled hyperthyroidism requiring Caesarean section is described. The first patient was diagnosed as hyperthyroid during pregnancy but was resistant to medical management with propylthiouracil (PTU). At 38 weeks' gestation, after optimizing her heart rate with intravenous propranolol, she received an epidural anaesthetic for the Caesarean section. The baby had manifestations of hypothyroidism immediately after birth but later became hyperthyroid. The second patient's hyperthyroidism was well controlled but she stopped her medication one week before delivery. The Caesarean section was performed under general anaesthesia for fetal distress. The baby died in the neonatal period of extreme prematurity. The anaesthetic management of the hyperthyroid parturient is discussed. Preoperative control of hyperthyroidism, bearing in mind pregnancy and time constraints, is essential. The use of PTU, propranolol, iodine, and glucocorticoids is described in the preparation of the parturient. Fetal and neonatal effects of these drugs are discussed.     

Epidural ropivacaine 1% with and without sufentanil addition for Caesarean section

BACKGROUND: So far only ropivacaine concentrations of 0.5 and 0.75% have been used for Caesarean section. This prospective double-blind trial evaluated the anaesthetic quality of ropivacaine 1% with and without sufentanil addition. METHODS: Three groups of patients (n=20 each) scheduled for an elective Caesarean section were studied. The patients received initially 120 mg ropivacaine, or 120 mg ropivacaine plus 10 microg or 20 microg sufentanil. Additional epidural ropivacaine was injected if necessary. Primary outcome parameter was time to achieve sensory block at T4. Moreover, pain intensity at delivery (visual analogue scale, VAS), incidence of maternal side-effects (hypotension, bradycardia, nausea, vomiting, shivering, pruritus), and neonatal outcome (Apgar score, neurologic and adaptive capacity score, umbilical cord blood-gas values) were recorded. RESULTS: The onset time for the sensory block was not significantly different among the groups. Also, VAS scores at delivery did not differ significantly between the plain ropivacaine 1% group (18 +/- 29 mm), the 10-microg sufentanil group (1 +/- 5 mm), and the 20-microg sufentanil group (6 +/- 18 mm). The total dose of ropivacaine was significantly higher in the plain ropivacaine 1% group (145 +/- 19 mg) compared to the patients receiving additional 10 microg sufentanil (130 +/- 15 mg, P = 0.02) or 20 microg sufentanil (129 +/- 16 mg, P = 0.01). The incidence of maternal side-effects and neonatal outcome were similar in all groups. CONCLUSION: Ropivacaine 1% alone provided sufficient analgesia. Sufentanil addition did not significantly improve the quality of epidural anaesthesia with ropivacaine 1.0% for Caesarean section.     

早发型子痫前期应用低分子肝素期待治疗的临床效果分析

目的分析早发型子痫前期应用低分子肝素期待治疗的临床效果。方法回顾分析2017-01—2018-12间在郑州大学第一附属医院产科终止妊娠的95例早发型子痫前期患者的临床资料。按终止妊娠前是否应用低分子肝素分为2组。对照组(47例)给予降压、解痉等治疗;观察组(48例)在对照组基础上加用低分子肝素。结果2组分娩孕周、妊娠延长时间、妊娠并发症发生率、新生儿出生体质量、新生儿窒息及胎儿宫内窘迫发生率、新生儿Apgar评分等,差异均无统计学意义(P>0.05)。结论对早发型子痫前期患者在常规治疗基础上短期应用低分子肝素,不能延长妊娠时间,不改善母婴结局。     

Epidural anesthesia for Cesarean section in a patient with von Hippel-Lindau syndrome

Von Hippel-Lindau (VHL) disease is an autosomal dominant disorder with variable penetrance. It is mainly characterized by haemangioblastomas of the retina and central nervous system. Because of physiological effects of uterine contractions, labour and spontaneous vaginal delivery increase the risk of disrupting central nervous system haemangiblastomas. We report the case of a 28-year-old woman with an history of VHL disease who had an epidural anaesthesia for labour and for Caesarean section performed because of failure to progress and of fetal distress. The overall maternal and neonatal outcomes were excellent.     

氨氯地平与硝苯地平治疗妊娠合并高血压疗效比较

目的比较氨氯地平与硝苯地平治疗妊娠合并高血压疗效。方法回顾性分析58例妊娠合并高血压患者的临床资料。28例采用氨氯地平口服治疗为研究组,30例采用硝苯地平口服治疗为对照组。比较两组的临床疗效。结果治疗后,两组收缩压和舒张压均较治疗前显著下降（P〈0.01）。治疗后,两组间比较差异无统计学意义（P〉0.05）。两组早产、胎盘早剥、产后出血、胎儿生长受限、胎儿窘迫、新生儿窒息、围产儿死亡、剖宫产发生率差异无统计学意义（P〉0.05）。两组并发症发生率差异无统计学意义（P〉0.05）。结论氨氯地平治疗妊娠合并高血压临床疗效及安全性与硝苯地平相似,但其服用更方便,依从性更好。     

General anaesthesia versus epidural anaesthesia for primary caesarean section--a comparative study.

Forty-seven healthy parturients undergoing elective Caesarean section were randomly allocated to either general anaesthesia (n = 24) or epidural anaesthesia (n = 23) under standardized anaesthetic and surgical conditions. Seven women of the epidural group required additional systemic analgesia or sedation following delivery of the neonate. Nine of 24 newborns obtained 1-min Apgar scores below 7 after general anaesthesia compared to only 3/23 after epidural anaesthesia. The time period to establish normal colour in the babies was 2.2 min after epidural and 4.9 min after general anaesthesia. Three of the 24 general-anaesthesia newborns demonstrated a tendency to hypotonia compared to only one in the epidural group. Twenty-four hours and 7 days after delivery all infants of both groups were completely normal. At the time of delivery maternal PO2 was higher in the general anaesthesia compared to the epidural group, due to higher inspired oxygen concentrations. Comparable results were obtained in umbilical PO2 venous values; lower pH values, however, were observed in the umbilical artery after general anaesthesia. There were no significant differences in the glucose levels between the groups. A significant correlation was established between uterine incision-delivery interval and 1-min neonatal Apgar scores in the general-anaesthesia group, but not in the epidural group. Our investigation did not show either the incision-delivery interval or the start of operation-delivery interval to play a role in neonatal outcome. Epidural anaesthesia is superior to general anaesthesia in Caesarean section under normal conditions with regard to neonatal outcome. Whether this is also true for critical conditions cannot be concluded from this study.     

Propanidid for anaesthetic induction at Caesarean section.

In 50 healthy mothers scheduled for elective Caesarean section, anaesthesia was induced with propanidid (7 mg/kg body weight). Thereafter, ventilation was controlled with nitrous oxide, oxygen and muscle relaxants. A further dose of propanidid (1 mg/kg body weight) was administered 3 minutes after the initial injection of this drug, as a means of preventing maternal awareness during equilibration with the anaesthetic gas mixture. The acid-base status of the mothers before the induction of anaesthesia, and at delivery, revealed a mild degree of respiratory alkalosis with a compensatory metabolic acidosis. Umbilical cord blood gas results indicated the presence of significant fetal acidosis, both respiratory (mean pCO2 Uv 46,3 torr (SD 11,3) and Ua 54,3 torr (SD 12,0)), and metabolic (mean base excess Uv-9 mEq/l (SD 4,2) and Ua-11,8 mEq/l, (SD 5,0)) in origin. The average umbilical cord blood oxygen tensions were Uv 25,9 torr (SD 10), and Ua 15,4 torr (SD 8,5); mean maternal to fetal base-excess gradients were Ma-Uv 4,1 mEq/l (SD 2,8) and Ma-Ua 6,5 mEq/l (SD 3,5). Five mothers (10%) offered convincing evidence of factual recall during surgery, and 3 of these were aware of pain. Nausea and vomiting occurred in 5 patients and in 4 there were clinical signs of postoperative chest infection. The degree of fetal biochemical asphyxia, and the incidence of maternal awareness during surgery, were significantly greater than previously reported when thiopentone was used for the induction of anaesthesia for Caesarean section. The results obtained are discussed, and the conclusion is drawn that propanidid for anaesthesia appears to offer no advantage over thiopentone in obstetric practice.