剖宫产术成功用于抢救复合伤濒死孕妇及其胎儿一例

妊娠晚期孕妇突发复合外伤,生命垂危濒临死亡,此种为少见突发事件。本文介绍1例患者收治情况,在对孕妇及其胎儿伤情判断的基础上,着重从患者病情的角度探讨如何对孕妇及胎儿进行抢救,从而更有效地为今后类似病例提供救治参考。通过本例病例发现,对生命垂危的产妇进行积极有效的心肺复苏后,产妇仍无有效的自主循环时应考虑实施围死亡期剖宫产(PMCS),取出胎儿后再对孕妇和胎儿进一步抢救,对孕妇和胎儿均有益。     

产后出血的预防及护理新进展

胎儿娩出后24小时内出血量超过500毫升或以上的诊断为产后出血。产后出血是产妇常见的并发症，通常来势凶猛且发病急促，若不及时诊治就会危及产妇生命健康。产后出血在当前临床孕妇死亡原因中位居首位，为了进一步降低孕妇产后出血死亡率，改善产妇生活及生存质量，对产后出血的产妇给予有效的预防及护理措施尤为关键。对此，本文就产后出血的预防及护理展开讨论，探讨和分析当前临床针对产后出血给予的预防及护理措施，旨在进一步提高产后出血的临床护理水平，保证产妇生命健康。     

忽略性横位致多发性产道裂伤一例

一例双胎妊娠在分娩过程中未得到合理的处理，造成一个胎儿死亡、产妇多发性软产道损伤和膀胱损伤，严重的出血和感染，生命垂危。这一切几乎演示了阴道分娩时难产可能发生的所有最严重的合并症和最悲惨的结局，令人触目惊心!因此教训是深刻的。虽然本病例发生的原因是多方面的，但是作为妇幼保健工作者，责任重大，如果我们的一切工作“以人为本”，我们的妇幼保健网才能真正做到疏而不漏，就有可能最大限度地使这类原本可以避免的病例发生。     

心跳骤停孕妇12例妊娠结局

目的 探讨围死亡期剖宫产的临床意义。 方法 回顾性分析广州市危重症孕产妇救治中心2007－2011年期间收治的12例发生心跳骤停的孕妇,根据其是否进行围死亡期剖宫产分为两组,分析并对比其临床特点、孕妇结局及胎儿结局等情况进行分析。结果 6例进行围死亡期剖宫产者4例新生儿存活、4例孕妇存活;6例未进行围死亡期剖宫产者胎儿均死亡、4例孕妇死亡。 结论 围死亡期剖宫产在一定程度上可以提高心跳骤停孕妇抢救的成功率且能改善围产儿结局。     

孕妇和胎儿的水痘：处理问题

孕妇发生水痘可直接影响胎儿，甚至可致胎儿死亡，故对孕妇及胎儿作合适的处理甚为重要。本文对孕妇和胎儿发病的危险性、被动免疫的效果和抗病毒疗法等作了评价。     

胎儿脐带绕颈产时连续胎心监护132例体会

目的 探讨超声提示胎儿脐带绕颈孕妇临产后连续胎心监护对围生儿预后的影响。方法 对2004年12月至2005年4月辽宁盘锦市第四人民医院产前诊断脐带绕颈的132例孕妇，入产房后，常规采用外监测法进行连续性产时胎心监护。结果 132例超声提示脐带绕颈孕妇中发现重度变异减速及频发晚期减速不祥图形30例（占22．7％），发生在潜伏期者6例（占20％），活跃期21例（占70％），第2产程3例（10％），均及时改行急诊剖宫产。无重度新生儿窒息，轻度新生儿窒息3例，全部复苏成功，无围生儿死亡。结论 对产前超声提示脐带绕颈孕妇进行全产程胎心监护，有助于及时发现胎儿窘迫并及早处理，可有效避免新生儿重度窒息和围生儿死亡。     

浅谈产后出血的急救、预防与护理

在产科，产后出血导致产妇死亡的比例较高，因此，必须重视产后出血的观察。出血多发生在胎儿娩出后，胎盘未剥离、宫缩乏力或凝血功能障碍时，所以，在这期间一定要严密观察，认真了解产妇有无孕期高血压、产程进展、分娩机制及胎盘娩出后出血量、产后子宫收缩情况，熟练掌握出血的抢救原则，一旦发生，及时准确地针对病因给予止血.     

剖宫产术引起后腹膜血肿1例

1病例报道患者31岁。因“剖宫产术后6小时,昏迷1小时”于2004年9月14日入院。患者末次月经2003年12月3日,预产期2004年9月10日。孕妇因“胎儿窘迫”于2004年9月14日凌晨在外院行子宫下段剖宫产术,术中因娩出胎儿困难,子宫切口出现右侧角撕裂,裂口达右侧阔韧带,缝合子宫切口后子宫收缩差,出血约1600m l,当地医院给予输全血600 m l,术中血压维持在51~76/40~65 mmHg,术后血压维持在60~97/40~65 mmHg,产妇一直诉腰痛,未引起重视,术后6小时产妇出现意识淡漠,血压继续下降,心率166/m in,因患者休克难纠正,故转我院抢救治疗。入院时查:T 36.8℃,P…     

会阴Ⅲ度裂伤1例临床分析心得

通过分析该产妇会阴Ⅲ度裂伤原因，探讨有效的预防措施。经过分析患者的撕裂情况和成因还有当时护理人员所采取的护理方法是否得当以及护理后的成果能不能达到预期效果，归纳整理出会阴裂伤的成因和治疗会阴Ⅲ度撕裂的关键原因和有效护理方案。如今会阴撕裂的常见因素多为难产、助产人员的专业技术和纯熟程度等。产妇的胎儿大小、胎儿体位也是造成会阴Ⅲ度撕裂的重要因素。通过提前对产妇在孕期做预防护理和与患者进行良好沟通，配合做好心理疏导。同时提高本院助产人员的专业技术，可有效预防会阴Ⅲ度撕裂，在撕裂后做好修补术，在良好护理条件下可愈合良好。加强助产人员在产妇护理中的助产技术，在分娩时可降低会阴Ⅲ度裂伤的发生率，减轻产妇的痛苦，并减少产后并发症的发生。     

浅谈如何有效减少X线对孕妇胎儿的刺激

X线检查是医学上常用的辅助检查方法之一，通过对于X线各种表现的分析可以协助医生综合其他临床资料对疾病进行有效的诊断。X线在孕妇胎儿的身体检查中应用比较频繁，但是孕妇如果接受了过量的X线照射，在怀孕初期会导致胎儿畸形、死胎及流产等不良后果，严重危害了孕妇胎儿的健康。因此如何减少或避免孕妇胎儿的X线辐射已成为医学的热点问题。本文通过对X线辐射孕妇胎儿进行原因分析，总结辐射机理，提出有效的防护方法来减少X线对孕妇胎儿的刺激。     

Gunshot wounds to the gravid uterus. A case report

A pregnant woman sustained an abdominal gunshot wound during the second trimester; the bullet injured multiple loops of bowel and passed through the uterus, placenta and fetus. Although the stillborn fetus was delivered by cesarean section, a review of the literature indicated that operative delivery is not indicated when the fetus has died already. Labor and delivery are well tolerated, and an unnecessary hysterotomy is thus avoided. If labor does not ensue spontaneously, it can be induced. Approximately 40% of fetuses will survive the initial injury. In past reviews the risk of prematurity often outweighed the benefits of delivery of those infants. Advances in neonatology now make survival routine after 28 weeks' gestation, and viable fetuses should be delivered promptly by cesarean section to decrease the risk of delayed death from fetal or placental injury.     

剖宫产后阴道分娩的现况

剖宫产后阴道分娩(vaginal birth after cesarean section,VBAC)是指既往有剖宫产史者,再次妊娠时采用阴道分娩的方式。因对VBAC安全性的疑虑,以往绝大部分产妇以再次剖宫产终止妊娠,但经临床实践和研究证实,VBAC的主要影响因素有剖宫产切口类型及缝合方式、剖宫产次数、既往有无阴道分娩、孕产妇年龄及体质量、胎儿体质量及是否多胎妊娠和本次阴道试产是否采用缩宫素及前列腺素E2引产。只要严格把握VBAC的指征,认真评估VBAC的母婴风险,严密监护和及时处理异常情况,VBAC是安全、有效、经济的分娩方式。正确应用VBAC,可提高其安全性和成功率,进而降低异常升高的剖宫率。     

Maternal–Fetal Conflict: Court-Ordered Cesarean Section

Advances in prenatal care have created areas of conflict between the pregnant woman and her fetus. Court orders mandating cesarean section have denied to pregnant women rights that are accorded to all other competent adults in the United States. The caregiver–patient relationship can become adversarial in such situations. Nurses participating in the decision-making process when judicial involvement is being considered must be informed about the issues.     

The ethical debate of maternal choice and autonomy in cesarean delivery

Cesarean delivery as a result of maternal request is increasingly popular, leading to important ethical questions. One of the challenging issues is balancing respect for the autonomy of a pregnant woman with concerns of beneficence and nonmaleficence for her and the fetus. The perceived benefit of cesarean section is protection of the pelvic floor. Increased rates of respiratory morbidity in infants born by cesarean section cannot be ignored. Societal concerns of distribution of resources must be considered in ongoing discussions of this critical issue. This article reviews the current ethical debate of maternal choice and autonomy in elective cesarean delivery.     

Postmortem cesarean: report of our successful neonatal outcomes after severe trauma during pregnancy and review of the literature

Postmortem cesarean is delivering of a child by cesarean section after the death of the mother. A prompt decision for cesarean delivery is very important in such cases. The survival of both the mother and the baby is dependent on a number of factors, including the time between maternal cardiac arrest and delivery, the underlying reasons for the arrest, the location of the arrest and the skills of the medical staffs. The earlier the fetus is delivered following maternal arrest the better is the fetal survival. Cesarean section should be performed no later than 4 minutes after initial maternal arrest. A fetus delivered within 5 minutes from initiation of CPR (cardiopulmonary resuscitation) has the best chance for survival. We reported 2 cases of successful postmortem cesarean section done 45 and 15 minutes after maternal death. The 1st case was a 29-year-old pregnant woman at 37 weeks gestation with cardiopulmonary arrest following gunshot head injuries. The baby survived with neurological sequels and ongoing treatment at our newborn intensive care unit. Second case admitted to the emergency service was a 28-year-old primigravida of 31 weeks gestation with cardiopulmonary arrest due to massive brain and thoracic hemorrhage after a road traffic accident. The baby recovered without neurological sequels.     

Fetal growth retardation after gastric banding

A 35-year-old woman became pregnant 15 months after gastric banding, during which time she lost 55 kg in weight. During the third trimester, severe vomiting was noted and she lost a further 6 kg. Ultrasound examination showed oligohydramnions and fetal growth retardation of 38%. Enteral nutrition was given until delivery and ultrasound verified normalization of the oligohydramnions and weight gain for the fetus. The woman was delivered by cesarean section of a female infant with birthweight 2,470 g. It is concluded that special care must be taken with regard to the nutritional status of pregnant women who have previously been operated on with gastric procedures for obesity, in order to diminish the risk of fetal growth retardation. Ultrasound examinations should be performed on wide indications and enteral nutrition must start immediately once fetal growth retardation is discovered.     

Acute ethanol intoxication during pregnancy and consecutive fetal cardiac arrest: a case report

Chronic alcohol exposure during pregnancy and the resulting toxic effects for the fetus has been the subject of many investigations. In contrast, acute alcohol intoxication during pregnancy is a rare event and less is known about the consequences for fetal life. We report a case of the acute ethanol intoxication of a pregnant woman at the 35th week of gestation and the consecutive cardiac arrest of the neonate. Despite the life threatening event, the newborn recovered after resuscitation and intensive care treatment and could be discharged from hospital in good physical condition. We suggest that acute alcoholized pregnant women should be transferred to Perinatal Centers to cater for the possible need for emergency cesarean section and resuscitation of the newborn.     

Pregnancy in a woman with a prior myocardial infarction: a case report]

Myocardial infarction during pregnancy is a rare event but is considered to be associated with very high mortality of both mother and fetus. We report uncomplicated cesarean section in the 3rd pregnancy in woman with a prior myocardial infarction that occurred during the first hours after cesarean section delivery of the 2nd pregnancy. Intensive cardiological and obstetrical supervision are required for correct management of the pregnancy.     

剖宫产术中麻醉意外并发症及处置

剖宫产手术麻醉不仅需要全面考虑妊娠妇女所出现的一系列特殊生理改变，同时也要考虑麻醉用药对胎儿的影响，所选用的麻醉方式应力求简单、安全、有效。文章就目前剖宫产手术麻醉方法的选择、常见麻醉意外并发症的预防及处置做一归纳总结，以期应用于指导临床实践，降低因剖宫产麻醉而引起的并发症发生率，保障母婴安全，达到舒适化医疗的目的。