手转胎头术纠正枕位异常的临床评价

在头位难产中，以枕位异常发生率最高，为了保障母子健康，降低头位难产发生率，降低剖宫产率，我院对第一产程活跃期胎头下降阻滞的枕位异常，采用手转胎头辅以经腹推儿背联合手法纠正，取得满意效果。现报告如下。     

探讨体位及上推胎头时机对胎头深陷骨盆转剖宫产术患者取胎头成功率及手术并发症的影响

目的 探究体位及上推胎头时机对胎头深陷骨盆转剖宫产术患者取胎头成功率及手术并发症的影响。方法 选取86例因胎头深陷骨盆转剖宫产术的患者,基于SPSS 22.0软件生成的随机分组序列分为对照组与研究组,每组43例。对照组予以平卧位,上推胎头前切开子宫;研究组予以小角度(20°)倾斜头低脚高位,上推胎头后切开子宫。比较两组患者相关指标、不同时段新生儿Apgar评分、取胎头成功率及并发症发生情况。结果 研究组手术时间、胎儿分娩时间及住院时间均短于对照组,术中出血量少于对照组,差异具有统计学意义(P<0.05)。研究组新生儿出生1min与5min的Apgar评分均高于对照组,差异具有统计学意义(P<0.05)。研究组取胎头成功率(100%)高于对照组(90.70%),并发症发生率(4.65%)低于对照组(20.93%),差异具有统计学意义(P<0.05)。结论 针对因胎头深陷骨盆转剖宫产的患者,予以小角度倾斜头低脚高位,上推胎头后切开子宫的方式效果最为理想,其能在促进临床指标的基础上,提升取抬头的成功率,减少并发症的发生。     

胎头高直位阴道分娩3例的体会

胎头高直位分娩难度大，尤其是高直后位，几乎均需要剖宫产结束分娩。故认为是严重的异常胎位。我院1999年9月～2004年9月入院分娩的1260例产妇中，共发现胎头高直位11例，占分娩总数的0．87％，其中高直前位5例，高直后位6例。其中高直前位3例经加强宫缩、手转胎头后经阴道分娩，其余均以剖宫产结束分娩。现将阴道分娩的3例高直前位的处理报告如下。     

头位难产采用徒手胎头旋转术的时机探讨

持续性枕横位、枕后位 ,是导致头位难产的重要原因之一。适时采用手法旋转 ,可缩短产程 ,减少产妇痛苦 ,降低剖宫产率。本文对持续性枕横位及持续性枕后位的产妇在不同时期施行徒手旋转胎头纠正胎方位 ,使难产转为顺产 ,取得了不同的效果 ,现报道如下。1　资料与方法1.1　一般资料　我院自 1997年 5月至 2 0 0 0年 12月分娩总数 3 4 95例 ,难产 14 5 6例 ,发生头位难产 70 9例 ,占难产总数的 4 8 69%,其中 3 2 3例宫颈扩张进入活跃期出现延缓或停止。随机分为三组 ,Ａ组 :宫口扩张 6～ 7ｃｍ ,先露在坐骨棘平至棘下 1 5ｃｍ ,枕横位 12 2例 …     

202例纠正枕横(后)位的临床探讨

目的探讨改变体位结合徒手旋转胎头在胎方位异常时的临床意义。方法选择2010年10月至2012年5月202例单胎头位,枕横(后)位无严重合并症、并发症的产妇,将其分为研究组102例,在首次发现胎方位异常时采取改变体位,待宫口开大>6cm、胎先露>S+1手转胎头;对照组100例,发现胎方位异常时采取改变体位并严密观察产程进展。结果研究组阴道分娩率(96.08%vs83%)明显高于对照组,差异有高度统计学意义(P<0.01)。产程时间缩短[(400±65)minvs(504±98)min]、经阴道分娩的产妇产后出血≥300ml者研究组较对照组明显减少(0%vs6.02%)、软产道裂伤减少(30.61%vs54.22%)、新生儿窒息率降低(1.96%vs50%),差异均有统计学意义(P<0.05)。结论改变体位结合徒手旋转胎头可使枕横(后)位致产程异常者转化为成功的阴道分娩,阴道分娩率明显升高,产程时间缩短,母儿合并症、并发症发生率明显降低。     

伴有母胎合并症及并发症妊娠的分娩时机

当继续妊娠伴随的母胎风险高于终止妊娠所带来的母婴风险时,就具有终止妊娠的指征,即分娩时机正合适。当母胎出现合并症和并发症时,大多数未能自然临产,临床中需要引产,因此,在决定引产前,确定最佳的分娩时机不仅是关乎围产结局的关键因素,也是产科精准医疗的临床再现。分娩时机不是一成不变的,也不是机械刻板的,遵循母婴安全为第一要务的宗旨,采取个体化医疗的原则,最适宜的才是最好的。文章从胎儿因素（胎儿生长受限、双胎妊娠）、母体及产科因素（妊娠期高血压疾病、妊娠合并糖尿病、胎膜早破、曾有不明原因的死胎或死产）、胎盘及子宫因素（前置胎盘、胎盘植入、瘢痕子宫、子宫破裂）三方面总结伴有母胎合并症及并发症妊娠的分娩时机。     

正常骨盆形态单胎足月初产活跃早期胎头浮动对分娩影响的研究

初产妇足月妊娠单胎头位临产后胎头高浮称为胎头浮动。我们对５６１例骨盆正常活跃早期头浮动的分娩经过进行了观察,以冀了解其发生原因及对分娩的影响,探讨产时应采取的措施,以利分娩。１　资料与方法１．１　临床资料　１９９２年６月至１９９８年６月在我院产科分娩正常单胎头位,孕龄≥３７周的初产妇５８４３例。临产进入活跃期,肛查宫颈口扩张２．５～３ｃｍ,腹部检查头高浮５６１例,称浮动组。随机抽样同期分娩单胎头位孕周相同的初产妇临产胎头衔接５７０例为对照组称入盆组（病理产科和骨盆狭窄不在本研究范围）。１．２　方…     

胎头位置异常与梗阻性难产

胎头位置异常是引起难产的首要原因。根据1985年国内19个协作单位33182例分娩资料统计，头位难产占分娩总数的23．98％，又占难产总数的81．63％，另据我院头位难产资料统计，胎头位置异常占85％。以胎头为先露分娩时，正常和异常的界限有时难以截然划分，常常需要在产程中才能发现。因此，在处理头位分娩时，应注意头位难产，警惕胎头位置异常，以做到及早诊断和及时处理胎头位置异常，这对减少母儿损害是十分重要的。     

第二产程预防性使用葡萄糖酸钙在降低单胎初产妇产时及产后出血量的作用

目的:分析第二产程预防性使用葡萄糖酸钙对单胎初产妇产时及产后出血量的影响。方法:随机将2018年8月2019年5月在天津市第一中心医院产科住院的单胎孕足月临产后进入第二产程的孕妇分为治疗组(282例)和对照组(274例),治疗组在第二产程预防性给予静脉滴注1 g葡萄糖酸钙,对照组孕妇在进入第二产程后立即给予静脉滴注葡萄糖注射液。比较2组孕产妇的分娩结局和新生儿结局。结果:治疗组第二、三产程时间比对照组短,差异均有统计学意义(均P<0.05)。治疗组的产时出血量和产后2 h、6 h、12 h、24 h出血总量均低于对照组,差异均有统计学意义(均P<0.05)。2组新生儿体质量、新生儿脐动脉血pH值、新生儿1 min Apgar评分和新生儿脐动脉血钙浓度比较,差异均无统计学意义(均P>0.05)。结论:第二产程预防性使用葡萄糖酸钙可降低单胎初产妇产时及产后24 h内出血总量。     

经阴道羊膜腔灌注治疗单胎初产妇临产后羊水过少的母儿结局分析

目的:分析经阴道羊膜腔灌注治疗临产后羊水过少的单胎初产妇分娩结局和新生儿结局。方法:回顾性分析中国人民武装警察部队特色医学中心2015年4月—2018年3月临产后诊断为羊水过少的358例单胎初孕妇,分为行经阴道羊膜腔灌注的治疗组(166例)和未行羊膜腔灌注的对照组(192例),比较2组的分娩结局(顺产率、产钳助产率、剖宫产率、产后出血率和产褥感染率)和新生儿结局[新生儿脐动脉血pH值、脐动脉血乳酸值、出生后1 min Apgar评分、胎粪吸入综合征(MAS)发生率、入住新生儿科率]。结果:治疗组的顺产率高于对照组,产钳助产率和剖宫产率低于对照组,差异有统计学意义(P<0.05)。治疗组的产后出血率和产褥感染率与对照组相比差异无统计学意义(P>0.05)。治疗组的新生儿脐动脉血p H值、新生儿1 min Apgar评分高于对照组,而治疗组新生儿脐动脉血乳酸值、MAS发生率和入住新生儿科率低于对照组,差异均具有统计学意义(P<0.05)。结论:经阴道羊膜腔灌注治疗单胎初产妇临产后羊水过少是安全有效的,可以显著改善分娩结局和新生儿结局。     

Intermittent Auscultation of the Fetal Heart Rate During Labor: An Opportunity for Shared Decision Making

Electronic fetal heart rate monitoring is the most common form of intrapartal fetal assessment in the United States. Intermittent auscultation of the fetal heart rate is an acceptable option for low‐risk laboring women, yet it is underutilized in the hospital setting. Several expert organizations have proposed the use of intermittent auscultation as a means of promoting physiologic childbirth. Within a shared decision‐making model, the low‐risk pregnant woman should be presented with current evidence about options for fetal heart rate assessment during labor.     

阴道分娩97例初产妇产后尿潴留危险因素临床分析

目的：探讨经阴道分娩产后尿潴留（postpartum urinary retention,PUR）的危险因素,为降低PUR发生率、减少产后并发症提供理论依据。方法：选择天津医科大学宝坻临床学院（我院）2016年1-12月经阴道分娩PUR患者97例为观察组[A组,其中分娩镇痛者83例（A1组）,无分娩镇痛者14例（A2组）],随机选择同期经阴道分娩无尿潴留者88例为对照组[B组,其中分娩镇痛者59例（B1组）,无分娩镇痛者29例（B2组）]。记录2组患者一般信息、妊娠期合并症及妊娠期并发症、产时情况、产后出血情况及新生儿体质量,进行回顾性分析。结果：2组产妇妊娠期合并症及并发症、孕次、胎膜早破、枕左前（LOA）胎位、第三产程时间和新生儿体质量比较,差异无统计学意义（均P＞0.05）。孕周、分娩镇痛、产钳助娩、侧切、第一产程时间、第二产程时间和产后出血比较,差异有统计学意义（均P＜0.05）。发生PUR的危险因素有孕周增大（OR=1.619,95%CI：1.121～2.339）、产钳助娩（OR=4.981,95%CI：2.184～11.361）、产后出血（OR=3.429,95%CI：1.024～11.488）和侧切（OR=2.419,95%CI：1.058～5.531）。PUR危险因素的ROC曲线分析：年龄最佳临界值为26.50岁,孕周最佳临界值为40.36周,新生儿体质量最佳临界值为3 372.50 g,分娩镇痛第一产程最佳临界值为402.50 min,分娩镇痛第二产程最佳临界值为61.50 min,无分娩镇痛第一产程最佳临界值为230.00 min,无分娩镇痛第二产程最佳临界值为34.50 min。结论：对孕周、分娩镇痛、产钳助娩、侧切、第一产程时间、第二产程时间、产后出血诸因素适当干预,可减少PUR的发生。     

Fetal fibronectin for evaluation of preterm labor in the setting of cervical cerclage

Objective: To evaluate the efficacy of fetal fibronectin (fFN) testing in cervical cerclage patients presenting with acute signs or symptoms of preterm labor. Methods: A total of 71 fFN tests were performed in 48 women between 23 and 34 weeks’ gestation who presented at two institutions at risk for imminent delivery with cerclage in situ. Results: The sensitivity, specificity, positive predictive value, and negative predictive value for delivery within 2 weeks of fFN testing were 100, 77, 28 and 100%, respectively. For delivery before 34 weeks sensitivity, specificity, positive predictive value, and negative predictive value were 91, 78, 56 and 97%, respectively. The relative risk of delivery <34 weeks with positive fFN was 16.7 (P < 0.001). Conclusions: For patients with cervical cerclage, fFN testing is a valid diagnostic tool in the evaluation of preterm labor.     

Examination of the Pharmacology of Oxytocin and Clinical Guidelines for Use in Labor

The use of exogenous oxytocin to induce or augment labor has increased in recent years. This literature‐informed review examines the action of this medication and the potential associated complications, with an evaluation of current professional practice guidelines. A brief history of the use of exogenous oxytocin for labor induction or augmentation is presented. In addition, risk management strategies for the prevention of oxytocin‐related adverse outcomes and subsequent litigation are identified.     

Fetal ultrasound biometry for pregnant population in the County of Primorje-Gorski Kotar (Croatia)

Objective.?To create curves of three most commonly used biometric parameters for singleton pregnancies from 22 to 41 weeks of gestation in the County of Primorje-Gorski Kotar (Croatia) and to compare results with other studies.

Methods.?From January 2002 to December 2009, ultrasound examination was performed on fetuses of 1248 pregnant women with uncomplicated pregnancy. Values for biparietal diameter, femur length, and fetal abdominal circumference were measured. Results were compared with studies pertaining to European and North American population. Mean, percentile scale, and Wilcoxon's matched pairs test were used. Regression analysis was applied to analyze data correlation and to determine correlation quotients.

Results.?Total of 2178 measurements for fetal biometry charts were performed. Established mean and centile values for fetal biometry parameters are reported numerically and graphically. Comparison of obtained values with values of identical fetal biometric parameters of other world populations has revealed statistically significant differences (p?<?0.01).

Conclusion.?Normal fetal biometry charts for population of pregnant women in the northern coastal region of Croatia were constructed. Due to existence of statistically significant differences in ultrasound fetal biometry values among various populations under comparison, construction of own charts and their implementation in routine obstetrical work are justified.     

缓释型前列腺素E2栓用于足月妊娠引产的临床观察

目的 :研究缓释型前列腺素E2 栓用于足月妊娠引产的有效性及安全性。方法 :随机单盲安慰剂对照研究。选择 2 0例 2 5～ 34岁单胎足月无引产禁忌证产妇 ,随机分为用药组 (10人 )和安慰剂组 (10人 )。记录宫颈Bishop评分、用药至临产时间、2 4小时引产成功率、经阴道分娩率、新生儿Apgar评分和产后出血量等。结果 :用药组 4小时宫颈成熟 ,用药至临产平均 8小时 5 5分钟 ,引产成功 9例 ,经阴道分娩率 7例 ,新生儿Apgar评分 1分钟全部 10分 ,产后出血量平均15 5ml;安慰剂组宫颈无变化 ,引产全部失败。结论 :首次于国内通过小样本临床观察后 ,认为缓释型前列腺素E2 栓用于足月引产效果好 ,副反应小 ,使用方便而安全     

Validation of Fetal Medicine Foundation algorithm for prediction of pre-eclampsia in the first trimester in an unselected Brazilian population

Objective: The objective of this study is to evaluate the predictive performance of the Fetal Medicine Foundation (FMF) algorithm for prediction of preeclampsia (PE) between 11 and 14 weeks of gestation in an unselected Brazilian population.

Methods: We conducted a prospective cohort study with 617 singleton pregnancies of unselected risk. Biophysical markers (mean pulsatility index, mean arterial pressure) and biochemical markers (placental growth factor (PLGF) and PAPP-A) were inserted into the FMF software and converted into multiples of the median (MoM). The subjects were divided into five groups: early-onset PE, parturition <34 weeks’ gestation; preterm PE, parturition <37 weeks; PE, parturition at any gestational age; gestational hypertension (GH); and control group. Areas under the receiver operating characteristics curve (AUC) were calculated for the outcomes.

Results: Among 617 patients, seven developed early-onset PE, 18 developed preterm PE (seven early PE plus 11 delivered between 34 and 36?+?6 weeks gestation), 34 developed PE (18 preterm PE plus 16 delivered after 37-week gestation), 12 pregnant women developed GH, and 517 women comprised the control group. The best predictive performance using the FMF algorithm occurred in the early-onset PE group, with AUC?=?0.946 (95% CI 0.919–0.973) and the detection rate of 28.6% and 85.7% for 5% and 10% false-positive (FP), respectively.

Conclusions: The FMF algorithm to predict PE was effective in a Brazilian population, mainly in the early-onset form of the disease at 10% FP.