晚期妊娠低位水囊引产效果观察

目的:探讨晚期妊娠低位水囊引产的临床效果。方法:将400例晚期妊娠住院产妇随机分为观察组200例,采用低位水囊引产,适时行人工破膜,给予0.5%的催产素静脉滴注;对照组200例,采用催产素引产。结果:观察组宫颈成熟度、引产成功率、引产时间、剖宫产率与对照组比较差异有极显著性(P<0.01)。结论:低位水囊引产简单、安全、有效。     

低位超小水囊联合地西泮在晚期妊娠引产中的应用

<正>当继续妊娠威胁孕妇或胎儿安全时,则必须终止妊娠,而终止妊娠的方式为剖宫产和引产,为降低逐年上升的剖宫产率[1],寻求一种安全、有效的引产方法则显得尤为重要。我院用超小水囊联合地西泮用于晚期妊娠引产,效果良好。现报道如下:     

中水囊用于晚期妊娠引产的效果分析及护理

宫颈成熟度是引产成败和阴道分娩的先决条件。我院于2002年10月-2003年8月，对70例晚期妊娠者采用中水囊促宫颈成熟引产，取得了良好效果。现将临床观察和护理报告如下。     

低位水囊引产法联合缩宫素在足月妊娠引产中的应用

目的:探讨给予足月妊娠引产产妇低位水囊引产法联合缩宫素引产的效果。方法:选取2017年1月～2019年1月接收的足月妊娠引产产妇60例,采用随机数字表法分为对照组与实验组,各30例。对照组单纯给予缩宫素引产,实验组给予低位水囊引产法联合缩宫素引产。对比两组引产疗效、引产相关指标、产妇产后疼痛程度及新生儿身体状况评分。结果:实验组引产疗效、新生儿阿氏评分高于对照组,引产至临产时间、总产程及宫缩时间短于对照组,产后出血量少于对照组,产后疼痛评分低于对照组,差异均有统计学意义(P0.05)。结论:足月妊娠引产产妇采用低位水囊引产法联合缩宫素引产能够提高引产疗效,缩短产程,缓解疼痛感,减少出血量,提高新生儿身体状况。     

卡孕栓在晚期妊娠引产中的应用

６８例晚期妊娠孕妇除外胎位异常头盆不称和卡孕栓应用禁忌症后，用卡孕栓阴道后穹窿给药终止妊娠。按孕周初定首次给药量根据宫缩强度和产程进展，决定４～６ｈ后给药与否和给药量。最多给药次数５次，最大给药总量２．３３ｍｇ。以给药４８ｈ内出现规律宫缩为引产有效标准，引产有效率为９７．０５％。引产过程中无先兆子宫破裂和子宫破裂发生，无孕产妇死亡和胎婴儿意外死亡，胎儿宫内窒息发生率１１．４８％，新生儿轻重度窒息发生率分别为６．６％和１．６％。研究结果表明：卡孕栓用于晚期妊娠引产是有效的和安全的。加强胎心宫缩监护等措施，及早发现和处理胎儿窘迫，可进一步提高引产的安全性。     

小水囊引产在足月妊娠中的应用

宫颈不成熟是引产失败的主要原因 ,目前常用促宫颈成熟的方法主要以药物为主 ,如米索前列醇、蒂洛安等 ;器械方面最常用者为水囊引产。水囊引产已有近百年历史 ,以往多用于中期妊娠引产 ,现已逐渐用于晚期妊娠促宫颈成熟和引产 ,尤其在计划分娩中具有重要的应用价值。根据水囊内注水量的多少将水囊分为三种类型 :大水囊注水量为 350ｍｌ以上 ;中水囊注水量为 2 0 0ｍｌ～ 2 50ｍｌ;小水囊注水量为10 0ｍｌ～ 1 50ｍｌ。作者设计一小水囊 ,注水量为 50ｍｌ～1 0 0ｍｌ,用于足月妊娠引产效果良好 ,介绍如下。1　适应证足月妊娠、单胎头位、有…     

米索前列醇在晚期妊娠引产中的应用

前列腺素物质有很多种 ,但由于化学结构的不同可与不同的细胞受体结合而发挥不同的作用。随着研究的深入 ,发现前列腺素中Ｆ2α、Ｅ2 与生殖系统关系密切 ,尤其妊娠期间前列腺素具有软化宫颈和收缩子宫的作用。早在 1 973年国外学者将Ｅ2 用于促宫颈成熟 ,并取得一定临床效果 ,但由于天然前列腺素不稳定 ,不易存放 ,代谢快 ,副作用大 ,临床应用受到限制。米索前列醇 (米索 )为前列腺素Ｅ1的衍生物 ,是 80年代人工合成的具有口服活性的前列腺素片剂 ,克服了天然前列腺素作用时间短、副作用大、价格昂贵等缺点 ,起初 ,主要应用于治疗胃溃疡等…     

低位水囊联合缩宫素用于晚期引产的临床观察

引产是晚期妊娠一种人工的促分娩方法,目前许多医院较为普遍的是采用单纯缩宫素引产,但缩宫素需严格控制剂量和滴数,需要由专业知识人员严密观察并根据宫缩情况调整缩宫素用量,使用不当可引起一系列并发症,增加了阴道助产率及剖宫产率,甚至可危及母婴安全[1]。低位水囊引产是将水囊放置在产妇宫颈内,对子宫下段及子宫颈进行压迫,通过机械性刺激宫颈管,诱发子宫收缩从而使宫口扩张,终止妊娠[2]。     

住院部孕晚期护士心理状态分析及自我护理

目的了解住院部孕晚期护士的心理状况,并探讨自我护理模式。方法采用症状自评量表（SCL-90）评估厦门大学附属第一医院28名住院部孕晚期护士及28名已婚未孕护士的心理状况。结果孕晚期护士的躯体化（22．3±4．9）分、强迫症状（18．5±4．4）分、人际关系敏感（16．7±3．9）分、焦虑（18．7±4．7）分和恐怖（12．4±2．8）分,因子得分高于已婚未孕护士的（17．3±4．7）分,（15．5±3．5）分,（14．0±3．2）分,（15．1±4．3）分,（8．7±4．6）分,两组比较差异有统计学意义（t分别为3．90,2．82,2．83,2．99,3．64;P〈0．05）。结论住院部孕晚期护士易产生各种心理障碍,应定期监测心理状况并及时自我护理。     

Persistant corpus luteum cyst of pregnancy: sonographic evaluation of cause of third trimester bleeding.

Corpus luteum cysts are frequently observed in pregnant patients evaluated with diagnostic ultrasound. They are usually regarded as incidental findings because of their limited size and usual pattern of regression by ten weeks. The presence and persistence of larger corpus luteum cysts or other extrauterine masses may complicate pregnancy. A case of a large persistent corpus luteum cyst associated with third trimester bleeding is presented.     

米索前列醇用于足月妊娠引产的效果观察

目的观察米索前列醇对足月妊娠引产的效果及安全性。方法选择正常单胎、头位、足月妊娠且有引产指征而无禁忌证的184例初产妇,随机分为两组,观察组100例,用米索前列醇50μg阴道后穹隆置药引产;对照组84例,用催产素引产。结果观察组引产总有效率（92％）与对照组（78．6％）比较,差异具有显著性（P〈0．05）,观察组临产发动时间及总产程均明显短于对照组（P〈0．05）。结论米索前列醇用于足月妊娠引产安全、有效,具有推广价值。     

妊娠晚期不同状况羊膜腔内细菌学临床研究

目的 研究妊娠晚期和分娩期不同状况下羊膜腔内细菌状况,从而为母婴感染的防治提供对策.方法 随机对不同原因进行剖宫产的患者,用无菌方法于术中取羊水10 ml,行细菌培养,对细菌进行鉴定并作药物敏感试验.所有病例术前、术中未使用抗生素,术后常规使用抗生素.根据患者剖宫产术前孕产状况分为3组:胎膜早破组34例,试产组(无胎膜早破)34例,待产组(无胎膜早破)27例.对3组的细菌阳性率,细菌种类及分布,以及细菌敏感性进行统计学分析.结果 不同状况下羊膜腔内细菌培养阳性率:胎膜早破组61.8%(21/34),试产组52.9%(18/34),待产组11.1%(3/27),3组阳性率比较差异有统计学意义(χ2=17.29,P=0.000),提示破膜和试产是细菌感染的重要诱因;胎膜早破组与胎膜完整试产组阳性率比较,差异无统计学意义(χ2=0.541,P=0.462).不同状况下羊膜腔内细菌种属和分布情况:最多见为表皮葡萄球菌,其次为金黄色葡萄球菌、链球菌,大肠埃希菌、假单胞菌.胎膜早破组与胎膜完整试产组细菌种类分布比较,差异无统计学意义(χ2=11.9,P=0.535).胎膜早破组与试产组细菌感染率差异无统计学意义,且细菌种类和分布差异无统计学意义,提示经阴道上行至羊膜腔感染为主要感染途径.各种细菌敏感试验结果:头孢类抗生素、青霉素衍生物、克林霉素、奎奴普丁、万古霉素、呋喃妥因、夫西地酸、替考拉宁、阿米卡星、美罗培南等对多种细菌敏感;青霉素、红霉素、链霉素、庆大霉素对多种细菌耐药.结论 经阴道上行至羊膜腔感染为主要感染途径.对胎膜早破患者、对试产后手术患者应使用敏感抗生素,严格无菌操作、术中冲洗宫腔和切口、术后使用有效抗生素是预防术后感染的必要措施.

Abstract：

Objective To study bacterial conditions in amniotic cavity of the third trimester and the delivery. Methods Patients underwent cesarean section due to various reasons were randomly enrolled in the study. Ten ml aqua amnii taken from using aspesis were cultured and the bacteria were identified and tested for drug sensitivity. All patients were not treated with antibiotics before and during operation,conventional antibiotics treatnent was used after operation. The patients were divided into 3 groups based on their status: 34 cases of premature rupture of membrane ( PROM ), thirty-four cases of labor without PROM, and 27 cases of pregnancy without PROM. The positive rate, species , distribution and drug sensitivity of bacteria in the 3 groups were analyzed. Results The positive rate was 61.8% (21/34) in PROM ,52. 9% ( 18/34 ) in labor without PROM,11.1% (3/27)in pregnancy without PROM. The positive rates were significantly different among the 3 groups (x2 = 17.29 ,P =0.000). However, there was no significant difference between the labor without PROM group and the pregnancy without PROM group ( x2 = 0.541 , P = 0.462 ). Staphylococcus epidermidis was the most common isolated bacteria, following by staphylococcus aureas, streptococcus, colon bacillus, and pseudomonas. There were no significant differences of bacterial species between labor without PROM and pregnancy without PROM( x2 = 11.9,P =0.535 ). The relative higher positive rate in the labor without PROM and PROM indicated that they were important inducement of bacteria infection. There were no significant difference on positive rate and bacteria species distribution between the PROM and labor without PROM group,which suggested that up-bound along vagina to amniotic cavity was the most common route of infection. Sensitive antibiotics should be given to the patients of PROM and labor without PROM targeted at staphylococcus,streptococcus, colon bacillus and monad. Antibiotics such as Cephems, Penicillins and Clindamycin were sensitive to various bacteria and safe to both mother and baby, thus were recommended. Quinupristin, Vancomycin,Furantoin, Fusidic ,Teicoplanin, Amikacin and Meropenem were also sensitive to various bacteria, but due to their side effects and the principle of ladder antibiotics using, they were recommended as second line antibiotics. Conclutions Up-bound along vagina to amniotic cavity is the most common route of infection. For rupture of membrane and labor without PROM patients, antibiotics should be given, and strict aseptic technique,washing cavity and incision, using antibiotics after operation are necessary to prevent infection.     

宫颈扩张球囊在晚期妊娠引产术中的应用效果

目的 探讨宫颈扩张球囊在晚期妊娠引产术中的应用效果。 方法 将具有引产指征的52例孕妇随机分为对照组和实验组各26例。对照组采用人工破膜联合小剂量缩宫素引产,实验组采用宫颈扩张球囊促宫颈成熟并引产。比较2组宫颈成熟、分娩方式、产程时间、新生儿Apgar评分、产后出血及患者满意度。 结果 实验组产妇宫颈成熟评分、宫颈成熟率、阴道分娩率均高于对照组(t=6.913,P<0.001; χ²=7.239,P=0.007;χ²=5.778,P=0.016),产妇第一产程、总产程均短于对照组(t=21.177,P<0.001; t=31.532,P<0.001),孕妇满意度高于对照组(Z=-2.342,P=0.019)。 结论 宫颈扩张球囊促宫颈成熟安全有效,不良反应少,是一种可靠的促宫颈成熟及引产的方法。     

孕晚期干预支持对孕妇产时认知行为及分娩结局的影响

目的 探讨孕晚期干预支持对孕妇产时认知行为及分娩结局的影响.方法 选择在妇产医院建卡并定期产检的初产妇100例,分为观察组和对照组,每组50例.观察组除接受常规产前检查和孕期指导外,还在孕晚期参加互动式分娩教育课程,对照组只进行常规产前检查和孕期指导.比较两组认知行为情况、分娩方式、产后2h出血量、新生儿Apgar评分等.结果 干预前两组分娩知识与态度得分的差异无统计学意义(P>0.05);干预后观察组分娩知识、态度及产时行为得分均高于对照组,差异有统计学意义(P<0.01或P<0.05).观察组阴道分娩率高于对照组,产后2h出血量也少于对照组,差异有统计学意义(P<0.05),两组新生儿Apgar评分差异无统计学意义(P>0.05).结论 孕晚期干预支持可有效促进孕妇产时认知行为,在一定程度上改善了分娩结局,提高了孕产妇及家属的满意度,从而进一步保护、支持并促进自然分娩,提升孕产妇对分娩的正性体验.     

自由体位排胎对妊娠中期产妇引产效果及情感状况影响

目的 探究自由体位排胎对妊娠中期产妇的引产效果及情感状况的影响.方法 选取于2017年9月至2018年8月南京医科大学附属无锡妇幼保健院收治的符合纳入标准的妊娠中期引产女性42例,设为对照组,予以传统的引产护理;选取于2018年9月至2019年8月收治的符合纳入标准的妊娠中期引产女性45例,设为研究组,实施基于自由体位...     

静音型电动吸乳器刺激乳头用于晚期妊娠引产的效果观察

目的探讨静音型电动吸乳器刺激乳头用于晚期妊娠引产的效果。方法选取具有引产特征的足月妊娠孕妇90例作为本次研究对象,按照随机数表法分为观察组和对照组各45例,观察组采用静音型电动吸乳器刺激孕妇乳头引产,对照组采用催产素引产,比较2组孕妇的宫颈评分、分娩情况以及新生儿结局和临床疗效。结果治疗后,观察组孕妇的宫颈评分显著高于对照组(P0.05),观察组临床疗效的有效率高于对照组(P0.05);2组孕妇采用剖宫产、阴道分娩以及使用缩宫素的情况比较,差异不具有统计学意义(P0.05);观察组孕妇产后出血量显著低于对照组(P0.05),但2组产妇的新生儿体质量以及新生儿评分比较,差异不具有统计学意义(P0.05)。结论静音型电动吸乳器刺激乳头用于晚期妊娠引产的效果显著,可以显著改善孕妇的宫颈评分,避免不良反应的发生。     

Osteoprotegerin,interleukin and hepatocyte growth factor for prediction of diabetes and hypertension in the third trimester of pregnancy

BACKGROUNDGestational diabetes mellitus (GDM) raises the risk of high blood pressure and may cause a series of life-threatening complications in pregnant women. Screening and management of GDM and gestational hypertension (GH) in pregnancy helps to control and reduce these risks and prevent adverse effects on mothers and their fetuses. Currently, the majority criteria used for screening of diabetes mellitus is oral glucose tolerance tests, and blood pressure test is usually used for the screening and diagnosis of hypertension. However, these criteria might not anticipate or detect all GDM or GH cases. Therefore, new specific predictive and diagnostic tools should be evaluated for this population. This study selected three biomarkers of osteoprotegerin (OPG), interleukin (IL) and hepatocyte growth factor (HGF) for GDM and GH predication and diagnosis.AIMTo explore the feasibility of changes in placental and serum OPG, IL and HGF as tools for prediction and diagnosis of diabetes and hypertension in pregnant women.METHODSFrom January 2018 to January 2019, 44 pregnant women with GDM and GH were selected as an observation group, and 44 healthy pregnant women were selected as a control group in the same period. Serum OPG, IL and HGF were compared between the two groups.RESULTSThe levels of OPG and HGF in the observation group were lower than in the control group, and the level of IL-1β was higher in the observation group than in the control group (all P < 0.05). Furthermore, OPG and HGF were negatively associated with gestational diabetes and gestational hypertension, while IL-1β was positively associated with GDM complicated with GH (all P < 0.05).CONCLUSIONThe evaluation of serum OPG, HGF and IL-1β levels in patients with coexistent gestational diabetes complicated with hypertension can predict the degree of disease and play an important role in the follow-up treatment and prognosis prediction.     

Foley导尿管水囊引产效果的预测模型建立

目的：探讨 Foley 导尿管水囊用于妊娠晚期孕妇引产效果的影响因素,并建立风险预测模型。方法：选择 2019 年 1 月 1 日至 2021 年 12 月 31 日在常熟市第一人民医院采用Foley 导尿管水囊进行引产的单胎产妇1149 例,对比分析年龄、身高、体重、产时BMI、孕次、产次、孕周、宫高、腹围、Bishop 评分、胎先露衔接、新生儿体重以及引产指征（包括羊水偏少及过少、妊娠期高血压疾病、妊娠期肝内胆汁淤积症、妊娠期糖尿病）等各项危险因素,通过Logistic 回归分析确定影响因素,应用列线图建立预测模型。结果：本研究通过放置Foley导管后48小时内的阴道分娩率评估引产效果,最终纳入研究的 1149 例妊娠晚期产妇引产成功率为 83.55%（960/1149）。通过单因素回归分析发现,身高、孕次、产次与引产效果呈正相关（p＜0.05）,年龄、体重、产时 BMI、宫高、腹围、妊娠期高血压病与引产效果呈负相关（p＜0.05）,由此将年龄、身高、BMI 和产次纳入Logistic 回归方程,基于最终多因素分析构建出列线图,偏倚校正 c 指数为 0.748（95%可信区间 0.716~0.788）。结论：身高、孕次、产次、年龄、体重、产时 BMI、宫高、腹围、妊娠期高血压可作为 Foley 导尿管水囊引产效果的预测指标,基于年龄、身高、BMI 和产次所绘制的列线图可作为Foley 导尿管水囊引产效果的评估手段。