笑气吸入联合精神性预防对妊娠结局和泌乳功能的影响

目的探讨笑气吸入联合精神性预防对妊娠结局和泌乳功能的影响。方法将住院可经阴分娩的产妇298人为观察组,随机抽取300名未行无痛分娩的产妇300名为对照组,观察镇痛效果、产程时间、分娩方式、产时和产后2小时总出血量、新生儿Apgar评分、羊水情况、产妇血压、泌乳时间、产前和产后血中PRL水平及"笑气"的副作用。结果观察组产妇的疼痛程度、产程、剖宫产率和出入时间明显低于对照组(P<0.05),产后PRL明显高于对照组。笑气吸入嗜睡、头晕等副作用。有其他指标两组间无明显差异。结论笑气吸入联合精神性预防可降低分娩的疼痛程度,缩短产程、降低剖宫产率和促进泌乳,但有轻微副作用。     

剖宫产及术后镇痛对母乳喂养的影响

目的观察剖宫产及术后镇痛对母乳喂养的影响.方法将剖宫产术的足月初产妇120例随机分为A、B组:A组术毕通过硬膜外导管间断注入镇痛药物行术后镇痛,24h后重复一次;B组未行术后镇痛;另选同期阴道自然分娩的足月初产妇60例为对照组观察产妇产后镇痛效果、泌乳哺乳情况、禁食时间、排气时间及婴儿体重下降情况.结果剖宫产术影响产后泌乳.剖宫产术后镇痛,产妇情绪安静,有利于建立产妇泌乳反射,泌乳始动时间早、母乳喂养率高.结论剖宫产术影响产后泌乳,术后镇痛能提高产妇母乳喂养的成功率.     

晚期产后出血与分娩方式的相关性研究

目的 分析晚期产后出血与分娩方式的相关性.方法 本样本回顾分析2005年6月～2010年3月住院治疗的42例晚期产后出血患者的临床资料.结果 阴道分娩组晚期产后出血(820±18)mL,发生休克1例,剖宫产组出血量(1485±33)mL,发生休克3例,剖宫产组平均出血量明显大于阴道分娩组,差异有统计学意义(P<0.01).剖宫产组休克发生率明显高于阴道分娩组,差异有统计学意义(P<0.05).42例中有胎盘胎膜残留 42.86%,子宫复旧不全45.24%,子宫内膜炎或蜕膜炎9.52%,子宫切口感染裂开2.38%.结论 剖宫产术后晚期产后出血较阴道分娩对患者生命威胁更大,采取综合治疗措施治疗不同的分娩方式后的晚期产后出血.     

产前及产后营养对剖宫产术后产妇泌乳的影响

目的探讨产前营养状况及产后营养摄入量与产妇泌乳始动时间及全母乳喂养时间之间的关系.方法待产孕妇30例作营养状况分析,记录产妇剖宫产术后4天内的营养摄入量、泌乳始动时间及母乳分泌情况.结果产前营养状况与泌乳始动时间及全母乳喂养时间之间呈正相关,产后营养摄入量(能量、脂肪、蛋白质、钙)与全母乳喂养时间呈正相关(P＜0.05).结论良好的孕产妇营养是早泌乳、泌乳足的的物质保障.     

顺产与剖宫产产妇血清中泌乳素水平与初乳中抗感染因子浓度的比较

目的:比较顺产与剖宫产产妇血清中泌乳素水平及初乳中抗感染因子的含量的差异。方法:①采用放射免疫COAT-A-COUNT(包被管)法测定顺产与剖宫产组产后48h、96h泌乳素(PRL)的含量。②采用免疫比浊法测定顺产与剖宫产组分娩后48h、96h初乳中SIgA、IgG、IgM、补体C₃、C₄浓度。结果:①血清中PRL的水平,顺产组与剖宫产组对比,产后48h有显著差异(P＜0.01),产后96h两组无显著差异(P＞0.05)。②产后48h剖宫产组初乳中SIgA、IgG、C₃、C₄浓度明显高于顺产组(P＜0.05或P＜0.01);产后96h剖宫产组C₄浓度明显高于顺产组(P＜0.05),其余无显著差异。③产后48h剖宫产组PRL的水平低于顺产组,乳汁分泌少,而抗感染因子都明显高于顺产组。结论:产后48h,产妇血清中PRL的水平顺产组高于剖宫产组,所以剖宫产产后泌乳始动迟于顺产组,乳量少且浓缩,初乳中抗感染因子(SIgA、IgG、C₃、C₄)的含量明显高于顺产组。剖宫产后应坚持母乳喂养,要注意新生儿的喂养,防止新生儿低血糖症的发生。     

产妇抑郁对泌乳与产后流血的影响

目的：探讨产妇抑郁对泌乳与产后流血的影响。方法：对309例产妇采用自评抑郁量表评分，分成产后抑郁组和对照组，测评泌乳指标、产后流血的差异。结果：抑郁组产妇泌乳始动时间迟，产后24小时泌乳者仅13例；泌乳量少，产后72小时泌乳量多者仅13例；抑郁组产妇产后流血量多，与对照组相比差异有显著性。结论：产妇抑郁对泌乳与产后流血有不利影响，应加强对产妇进行心理健康指导。     

腰硬联合麻醉无痛分娩对产妇血清催乳素和母儿血气的影响

目的探讨腰麻-硬膜外联合麻醉用于分娩镇痛对产妇血清催乳素（PRL）和母儿血气的影响。方法选择100例产妇随机分为观察组（Ⅰ组）和对照组（Ⅱ组）,每组50例。Ⅰ组在宫口开至2-3cm时开始行腰麻-硬膜外联合麻醉,腰麻药为1%罗哌卡因1ml＋20μg芬太尼共2 ml;Ⅱ组按产科常规处理。分别在宫口开全时、产后2h及24h抽取产妇静脉血用放免法测定血清PRL,并观察镇痛效果及哺乳情况。当胎儿娩出后,取母体桡动脉血,脐动脉血各2ml行pH,PCO2和PO2分析。结果腰麻-硬膜外联合麻醉镇痛效果良好,Ⅰ组在宫口开全时血清PRL显著高于Ⅱ组（P〈0.01）,而两组产妇在产后2h及24h血清PRL及泌乳始动时间差异无显著性。结论腰麻-硬膜外联合麻醉用于分娩镇痛无不良反应,提高PRL的水平,但对泌乳始动时间无明显影响。两组产妇桡动脉血及新生儿脐血血气分析结果比较,差异无显著性（P〈0.05）。     

产后出血104例临床分析

产后出血(PPH)是产科常见的严重并发症,影响产妇的健康,危及产妇的生命,是我国孕产妇死亡的首位,我院自1992年1月～1996年10月产后出血104例分析,探讨产后出血的危险因素及防治措施.1 资料、方法与结果我院自1992年～1996年分娩总数3178例(其中阴道分娩2587例、剖宫产591例),按胎儿娩出后24小时内出血量超过500ml)者称为产后出血的定义,发生产后出血104例,发生率3.27%.剖官产18例,3.04%(18/591),阴道分娩86     

助产士全程陪伴对初产妇疼痛评定量表(VAS)评分及产后焦虑抑郁的影响

目的:研究助产士全程陪伴对初产妇VAS评分及产后焦虑抑郁的影响.方法:选取2019年12月至2020年10月在某院住院就诊的初产妇86例,将2019年12月至2020年5月住院初产妇选取43例作为对照组,2020年6-10月住院初产妇选取43例作为观察组.对照组住院期间采用常规分娩管护干预,观察组采用助产士全程陪伴干预,均干预至产妇出院.采用疼痛评定量表(VAS)评分比较两组产痛水平;记录并比较两组分娩情况(产程、产后24h出血量和剖宫产率);采用抑郁自评量表(SDS)、焦虑自评量表(SAS)比较两组干预前后心理状态;记录并比较两组母乳喂养情况(产后泌乳始动时间、产后24h泌乳量、产后48h母乳喂养率);记录并比较两组产后并发症发生情况.结果:观察组分娩过程中VAS评分、产程、产后24h出血量和剖宫产率均明显低于对照组(t =-4.420,-7.438,-8.980,X2=4.914;P＜0.05);观察组干预后 SAS、SDS 得分明显低于对照组(t =-6.840,-8.046;P＜0.05);产后泌乳始动时间明显低于对照组(t=-7.661,P＜0.05),产后24h泌乳量、产后48h母乳喂养率明显高于对照组(t = 5.343,X2=4.497;P＜0.05);产后并发症发生率显著低于对照组(X2 =4.962,PP＜0.05).结论:采用助产士全程陪伴干预可缓解初产妇产痛水平和产后负面情绪水平,对改善分娩结局和母乳喂养情况、降低产后并发症发生风险效果显著.     

产妇血清PRL含量的检测

产妇血清ＰＲＬ含量的检测张弘，郭才临床研究发现，产妇血清ＰＲＬ水平时乳汁分泌的始动时间起关键性作用，且与产妇的乳汁分泌呈正相关［１］。本文通过检测剖宫产、经阴道分娩的产妇产后２４小时内血清ＰＲＬ含量及产前皿清ＰＲＬ含量，探讨其临床意义。资料与方法１．...     

Prostaglandin E2 gel In ripening of cervix in induction of labour

A study was done in 75 patients who underwent induction of labour with Prostaglandin E2 gel. All these patients had an unripe cervix. The commonest indications were post-datism, intrauterine growth retardation and pregnancy-induced hypertension. All patients were primigravidas with singleton pregnancy and beyond 35 weeks of pregnancy. The mean Bishop score at the time of instillation was less than three. The improvement of another 2-3 points within six hours and by 7-8 points within 12 hours was found after instillation of the gel. 92% of the patients went into spontaneous labour and 8% required reinstillation. The incidence of failed induction was 1.33%. The mean duration of latent phase was 10.34 hours. Induction delivery time was 16.43 hours. 68.1% patients required augmentation of labour and 31.9% did not require augmentation of labour with oxytocin drip. The incidence of vaginal delivery was 81.33% and that of caesarean section was 17.33%. The commonest indication of caesarean section was foetal distress.     

分娩方式对妊娠合并重型肝炎产妇预后的影响

目的 探讨不同分娩方式对妊娠合并重型肝炎产妇预后的影响。方法 回顾1994—2007年间60例妊娠合并重型肝炎病例的资料，按分娩方式分为阴道分娩组、剖宫产组以及剖宫产加子宫切除组，其中阴道分娩组22例，剖宫产组20例，剖宫产加子宫切除组18例，对比三组患者分娩前、分娩后的情况及病死率。统计方法采用方差分析，卡方检验、Fisher’s精确概率法和秩和检验。结果 三组患者分娩前血清胆红素、血清胆固醇、凝血酶原活动度、血清肌酐、血清胆碱酯酶、肝性脑病及肝肾综合征发生情况差别无显著性；分娩后血清胆固醇、血清胆碱酯酶及肝性脑病在各组间差别无显著性；分娩后阴道分娩组与剖宫产组的血清胆红素、凝血酶原活动度、血清肌酐、肝肾综合征、产后出血、产褥感染、病死率差异无显著性，而阴道分娩组或剖宫产组与剖宫产加子宫切除组相比，上述指标差异均有显著性。结论 妊娠合并重型肝炎产妇采用剖宫产加子宫切除预后较好。     

Non-invasive evaluation of the adaptations of cardiac function in the neonatal period: a comparison of healthy infants delivered by vaginal route and caesarean section

Postnatal adaptations of cardiac hemodynamics in infants born vaginally or by caesarean section may be different. These cardiac functions were evaluated by Doppler echocardiography to assess adaptation differences. Cardiac output, heart rate, stroke volume, mean arterial pressure, total systemic vascular resistance, ejection fraction, and ductus arteriosus diameter were determined and compared at 1, 24 and 72 h of life in 22 infants born vaginally (group 1) and 23 born by caesarean section (group 2). One hour after delivery, heart rate, mean blood pressure, and total systemic resistance were found to be higher in group 1 infants (P < 0.01, P < 0.05, P < 0.05 respectively). Stroke-volume measurements were significantly higher in group 2 (P < 0.05). The ejection fraction and cardiac output values were similar in both groups. At 24 and 72 h, no significant differences were observed in measurements of infants born vaginally or by caesarean section. We did not find a parameter negatively affecting healthy newborns in either mode of delivery. However, under pathological conditions affecting the cardiovascular system at 1 h of life, including perinatal infections and hypoxemia, a lower stroke volume, higher heart rate, higher mean blood pressure, and higher peripheral resistance may cause additional work load to the cardiovascular system in infants born vaginally.     

Teenage pregnancy in the Rotunda Hospital

The primary aim of this study was to investigate obstetric outcomes in teenagers delivered in the Rotunda Hospital and to identify whether younger teenagers have a poorer obstetric outcome. Delivery record details were recorded from the years 1992-96. These included the number of teenage mothers, maternal age, parity, gestation, mode of delivery, birth weight and Apgar scores. Teenagers were classified into those aged under 17 years and those aged 17 and over. Overall 2,228 teenage mothers were delivered in the Rotunda hospital, representing 17.2% of the total teenage population delivered in Ireland during the study period. Ten percent of mothers were under 17 years; 10.6% were multiparous with 2.6% of these under 17 years. There was a significant difference in the preterm delivery rate when the teenagers were compared as a whole with matched controls aged 20-24 years (p = 0.0411). However this did not translate into a poorer neonatal outcome as on average only 5% of babies were low birth weight and only 3% had Apgar scores < 3. Overall 70.2% of deliveries were spontaneous, 20.2% were instrumental. Less than 10% of deliveries were by caesarean section. However the rate of caesarean section increased with age from 14 (5.7%) to 19 (13.5%) years and this trend was statistically significant (p = 0.013). In conclusion, this study does not support the view that younger teenage mothers have a poorer obstetric and neonatal outcome. It has also been shown that there has been a large increase in the number of multiparous patients in this teenage population.     

蛛网膜下腔-硬膜外联合阻滞分娩镇痛(CSEA)对产程及新生儿影响的研究

目的探讨蛛网膜下腔———硬膜外联合阻滞分娩镇痛(CSEA)对产程及新生儿出生并发症的影响。方法对55例初产妇实施蛛网膜下腔———硬膜外联合阻滞分娩镇痛(CSEA),选择同时期分娩的55例初产妇及其新生儿作为对照组。对两组的产程、剖宫产率以及新生儿窒息、吸入性肺炎、颅内出血等出生并发症的发生率进行对照。结果产程时间镇痛组较对照组短,有显著性差异(P<0.05);剖宫产率镇痛组较对照组低,有显著性差异(P<0.05);新生儿出生并发症发生率两组相同,无显著性差异(P>0.05)。结论蛛网膜下腔———硬膜外联合阻滞分娩镇痛(CSEA)效果显著、安全可靠,可缩短产程,降低因社会因素导致的剖宫产率,对新生儿出生并发症发生率无明显影响。     

循证护理对妊娠期高血压患者分娩方式及并发症的影响

目的 探讨循证护理对妊娠期高血压（HDP）患者分娩方式及并发症发生率的影响。方法 选取2017年1月~2018年12月我院HDP患者106例,随机分为观察组和对照组,各53例。对照组采用常规护理,观察组采用循证护理,比较两组分娩方式及并发症发生率。结果 观察组顺产率（94.34%）高于对照组（81.13%）,剖腹产率为5.66%,低于对照组的28.30%,差异有统计学意义（P＜0.05）;观察组并发症发生率为7.55%,低于对照组的22.64%,差异有统计学意义（P＜0.05）。结论 循证护理可有效提升HDP产妇的顺产率,降低剖腹产率及并发症发生率。     

The use of intrapartum electronic fetal heart rate monitoring: a national survey

This study describes the use of intrapartum electronic fetal monitoring in Ireland. Electronic fetal monitoring (EFM) has become routine in the assessment of fetal wellbeing during labour. Current evidence indicates that the routine use of EFM leads to an increased caesarean section and operative vaginal delivery rate and a reduction in the rate of neonatal seizures. Practices and service provision related to the use and interpretation of and educational provision for electronic fetal monitoring have not been investigated in Ireland. A national survey of all (n = 22) maternity units in Ireland was undertaken using a self-reported questionnaire amended, with permission, from that used in the 8th CESDI report. The questionnaire sought information on unit birth rate in 2002, number of cardiotocograph (CTG) monitors available in delivery units, use of the admission CTG, use of continuous EFM for women with various risk factors for pregnancy and/or labour, availability of fetal blood sampling facilities, use of umbilical cord blood sampling and availability of guidelines on the use of EFM. All units responded to the survey giving a national picture of the use of EFM during labour. All units had cardiotocograph (CTG) monitors available in the delivery area (median 6, range 3-14). An admission CTG was performed on all women by 96% (n=21) of units. Thirty six per cent of units (n=8) used continuous EFM routinely during labour in women who did not have risk factors for labour. Fetal blood sampling (FBS) was used in 36% (n=8) of units in cases of suspicious CTG tracings. Umbilical cord blood gases were sampled routinely following emergency caesarean section in 46% (n= 10) of units while 64% (n= 14) did so if the baby's condition was poor at birth. A departmental guideline on the use of EFM was available in 73% (n= 16) units. The findings of this survey indicate wide variations in the use of intrapartum EFM in Ireland. The use of continuous EFM for specific high-risk indications was variable and EFM was used by a third of units for women who did not have risk factors for labour. The admission CTG was used by 21 of the 22 units despite evidence of no benefit. The absence of FBS in the majority of units surveyed and the low rate of umbilical cord blood sampling is of concern.     

早产男婴和早产女婴的早产率及预后分析

目的探讨早产男婴和早产女婴的早产率及预后。方法198例单胎早产儿的母婴临床资料进行回顾性分析。结果(1)男婴早产率、自然早产率分别为3.25%(115例)、2.43%(86例)均显著高于女婴组的2.40%(83例)、1.73%(60例),P均<0.05。(2)早产男婴母亲的本次孕期先兆流产率15.65%(18例)均明显高于女婴组的6.02%(5例),P<0.05。(3)早产男婴的围产儿死亡率(8.70%)是早产女婴的1.80倍(4.82%)。结论早产男婴的早产率、先兆流产率高,胎儿因素是分娩机制中的一个重要因素。早产男婴的围产儿死亡率相对较高。严禁进行非医学需要的胎儿性别鉴定和选择性别的人工终止妊娠。     

仿生气囊助产技术在自然分娩中的应用价值分析

目的 探讨仿生气囊助产技术在自然分娩中的应用价值。方法 选取2013年5月~2015年12月在我院分娩的400例孕妇,按照随机数字表法分为观察组和对照组。观察组238例使用仿生气囊助产,对照组162例自然分娩。观察两组产程时间、分娩方式、新生儿情况、产妇会阴情况、产后出血情况、宫颈裂伤情况、产褥感染、产后尿潴留情况。结果 观察组的第一产程时间、第二产程产程时间、总产程时间均短于对照组,差异有统计学意义（P＜0.05）。观察组剖宫产率为8.40%,低于对照组的11.73%,差异有统计学意义（P＜0.05）。观察组新生儿平均出生体重、1 min Apgar评分均优于对照组,差异具有统计学意义（P＜0.05）。观察组阴道分娩率、会阴侧切率、产后出血量均低于对照组,差异有统计学意义（P＜0.05）。两组患者宫颈裂伤发生率相比,差异无统计学意义（P＞0.05）。两组均未发生产褥感染和产后尿潴留。结论 仿生气囊助产技术能提高自然分娩率,降低剖宫产率,减少了母婴并发症,提高分娩安全系数,有利于母婴身心健康。