针灸治疗臀先露的系统评价

目的系统评价针灸治疗臀先露的疗效。方法计算机检索Cochrane Library（Issue 1,2008）、PubMed（1980～2008．3）、MEDLINE（1966～2008）、Ovid循证医学数据库（1991～2008）,中国生物医学文献数据库（CBMdisc,1978-2008．3）、维普期刊全文数据库（VIP,1989～2008．3）、中国期刊全文数据库（CNKI,1979～2008．3）和万方数据资源系统（1983～2008．3）,手工检索7种中医杂志,检索时限均为1990～2008年3月,语种限制为中文和英文,按纳入排除标准收集针灸治疗臀先露的随机对照试验（RCT）,参照Cochrane系统评价员手册5．0．1推荐的对偏倚风险的评价工具进行文献质量评价,并采用RevMan 5．0软件进行Meta分析。结果最终纳入8个RCT,共1341例患者,其中5个研究质量较高,3个质量较低。6个研究的Meta分析结果显示,针灸治疗臀先露的胎头倒转成功率优于对照组,差异有统计学意义[RR=1．38,95％CI（1．20,1．58）]。结论针灸较之于常规护理或胸膝卧位疗法能提高臀先露的胎头倒转成功率。     

B超监测下臀位外倒转术的临床效果分析

目的:研究B超监测下臀位外倒转术的临床应用效果。方法:选取2020年5月—2022年3月在新余市人民医院接受检查的单臀或混合臀先露孕妇50例当作研究对象,按照孕妇臀位外倒转意愿将其进行分组,将25例同意接受臀位外倒转的孕妇纳入观察组,另25例孕妇为对照组,观察组在B超监测下实行臀位外倒转术,对照组采取常规膝胸卧位操或者艾灸至阴穴对胎儿头位进行转正,比较两组胎位纠正及分娩方式、并发症、新生儿相关指标。结果:观察组胎位纠正成功率为96.00%,阴道自然分娩率为84.00%,均显著高于对照组的76.00%、56.00%(P<0.05);观察组剖宫产率为8.00%,显著低于对照组的32.00%(P<0.05)。观察组并发症总发生率为28.00%,与对照组的16.00%相比无显著差异(P> 0.05)。两组新生儿血糖(BG)、体重、新生儿重症监护室(NICU)入住率比较差异无统计学意义(P>0.05);观察组血氧分压(PaO2)、1 min阿氏(Apgar)评分显著高于对照组(P<0.05)。结论:B超监测下臀位外倒转术能有效降低剖宫产率,增加阴道自然分娩率,且并未...     

一种外倒转术后固定腹绑带的设计和临床应用

臀位是产科中较常见的一种胎位异常,占妊娠足月分娩总数的3％ ～4％[1 ].据统计,在中国臀位妊娠的孕妇中,通过剖宫产终止妊娠约占80％ ～90％[2 ].外倒转术是纠正臀位妊娠的有效方法[3 ].倒转术又称为转胎术,指通过手转动胎儿,使其从不利于分娩的胎位转变为有利于分娩的胎位.但是外倒转术即使倒转成功也存在复转的可...     

B超下行胎儿外倒转术临床观察

本文研究运用在B超定胎儿脊柱位置下行外倒转术,以提高手术成功率,减少难产及剖宫产。目的:探讨B超下行胎儿外倒转术的效果。资料与方法:100例单胎孕32周～40周诊断为胎位不整的孕妇,其中年龄最小的20岁,最大的35岁,诊断为臀位的97例,诊断为横位的3例,在B超定位下行胎儿外倒转术,术后立即听胎心音并在B超下确定胎位及胎心音是否正常,如正常嘱孕妇一周后复查。结果:行外倒转术100例孕妇术后未发生早产,胎膜早破,脐带缠绕及胎盘早     

托烷斯琼预防全麻术后恶心呕吐有效性和安全性的Meta分析

目的系统评价托烷斯琼预防全麻术后恶心呕吐的临床效果和安全性。方法电子检索PubMed、EBSCO、Springer、Ovid、CNKI等数据库,并查阅所获文献的参考文献,收集1995～2009年发表的有关托烷斯琼预防全麻术后恶心呕吐的随机对照试验（RCT）。按Cochrane Handbook 5.0.1对纳入文献进行质量评价和资料提取,统计学分析采用RavMan 4.2.10软件。结果共纳入17个RCT,包括4？678例患者。Meta分析结果显示：①有效性：托烷司琼单次静注能降低全麻术后恶心呕吐的发生率[RR=0.41,95%CI（0.29,0.60）]和全麻术后应用阿片类药物镇痛患者恶心呕吐的发生率[RR=0.30,95%CI（0.15,0.60）];单次静注或分次泵注均能降低全麻术后应用曲马多镇痛患者恶心呕吐的发生率[RR（95%CI）分别为0.41（0.29,0.56）和0.10（0.06,0.19）];托烷司琼与地塞米松联用较托烷司琼单用能更有效降低全麻术后患者恶心呕吐的发生率[RR=0.27,95%（0.13,0.57）]。②安全性：托烷司琼静注能减少头晕头迷的发生率[RR=0.35,95%CI（0.16,0.75）],但在减少术后瘙痒、嗜睡方面差异无统计学意义;所有纳入研究患者均未出现椎体外系、排尿困难等症状。结论托烷司琼能明显降低全麻患者术后恶心呕吐的发生率,且不增加瘙痒、嗜睡等不良反应,并可减少头晕头迷的发生。     

孕晚期B超引导下臀位外倒转术的应用效果观察

目的探讨孕晚期B超引导下臀位外倒转术的临床。方法将2016年12月～2018年12月于本院行B超引导下臀位外倒转术的80例臀位孕妇设为观察组,按照1:1选取同期80例拒绝接受臀位外倒转的臀位孕妇作为对照组,不做特殊处理。统计并比较两组分娩时的自然分娩率及分娩结局,同时记录观察组孕妇不良反应发生情况。结果观察组胎位倒转率62.5%,显著高于对照组的2.5%(P0.05);观察组剖宫产发生率37.5%、胎膜早破发生率为8.6%,均显著低于对照组的96.2%和31.3%(P0.05),两组均未发生胎盘早剥。两组新生儿窒息、脐带脱垂率等不良反应发生率比较,无显著性差异(P0.05)。结论对臀位孕妇于孕晚期在B超引导下行外倒转术能有效纠正异常胎位,降低剖宫产率。     

硝酸甘油用于内转胎位和胎盘滞留

目的探讨硝酸甘油在内转胎位与滞留胎盘的人工取出中应用的可行性及效果。方法回顾分析硝酸甘油在4例肩先露内倒转与3例胎盘滞留的临床资料。结果内转胎位的成功率为100%,手取胎盘的成功率为100%。结论硝酸甘油可以使宫颈肌肉松弛,使宫口扩张。     

胸膝卧位矫正臀先露的效果观察

目的：对孕28～38周臀先露的孕妇行胸膝卧位纠正胎位并对其分娩过程进行临床观察。方法：对孕28～38周确诊为臀位无其他禁忌证的孕妇嘱其排空膀胱,松解裤带,胸膝卧位,每日2次,每次15min,连做1周后复查。然后跟踪观察孕妇的胎位、分娩方式、脐带情况等。结果：孕28～31周成功率为97.92%,孕32～34周成功率为89.43%,孕35～38周成功率为76.40%,脐带扭转率为12.88%。结论：孕28～31周矫正率最高（P〈0.01）,胸膝卧位矫正胎位较易发生脐带扭转（P〈0.05）。     

外倒转术纠正单胎臀位妊娠产妇胎位的应用价值评价

目的 研究外倒转术纠正单胎臀位妊娠产妇胎位的临床应用效果。方法 该研究选择2018年7月—2020年7月该院收治的单胎臀位妊娠产妇100例为研究对象,按照随机数表法分为观察组和对照组,各50例。对照组采用自然纠正法,观察组采用外倒转术纠正胎位。比较两组的分娩方式、分娩时头位率、并发症发生率;分析观察组外倒转成功率、外倒转成功后分娩方式。结果 观察组分娩时头位率为76.0%(38/50),高于对照组的46.0%(23/50),差异有统计学意义(χ²=9.458,P<0.05);观察组顺产率为62.0%(31/50),高于对照组的4.0%(2/50),剖宫产率为38.0%(19/50),低于对照组的96.0%(48/50),差异有统计学意义(χ²=38.037,P<0.05);观察组并发症发生率为10.0%(5/50),低于对照组的26.0%(13/50),差异有统计学意义(χ²=4.336,P<0.05)。结论 单胎臀位妊娠产妇通过外倒转术纠正胎位,可以有效提升头位分娩率、顺产率,且并发症发生率低,应用价...     

B超监视下外倒转术18例的体会

本文对18例单胎臀位胎儿的孕妇,在B超监视下进行外倒转术,结果成功16例,成功率88. 9%.通过胎儿矫正的情况,我们认为:①B超能较准确地显示孕妇宫内胎儿的情况,对筛选手术适应症提供可靠的依据.②在B超指导下进行操作,观察更为直观,避免了一定的盲目性.③对术后进行追踪观察,及时发现并发症的发生.所以在B超监视下进行外倒转术矫正胎位是一种简便、可信的方法,它有助于提高外倒转术的成功率.     

椎管内麻醉分娩镇痛的现状调查与分析

目的 了解椎管内麻醉分娩镇痛的现状.方法 自行设计问卷,调查浙江省62家医院产科椎管内麻醉分娩镇痛开展情况及影响因素.结果 仅39家开展椎管内麻醉分娩镇痛,其中16家实施率低于1%、17家实施率为1%~20%、6家实施率>20%.开展椎管内麻醉分娩镇痛与产科年分娩量、镇痛管理模式、麻醉师及助产士人员配备、提供镇痛服务...     

右旋美托咪啶用于椎管内麻醉随机对照试验的Meta分析

目的系统评价右旋美托咪啶用于椎管内麻醉的有效性和安全性。方法计算机检索PubMed、EBSCO、Springer、Ovid、CNKI和万方数据库,并辅以手工和机检查找相关文献的参考文献,查找右旋美托咪啶用于椎管内麻醉的随机对照试验(RCT),文献检索起止时间均从建库至2011年2月。在按纳入与排除标准进行资料提取和文献质量评价后,采用RevMan 5.0软件进行Meta分析。结果纳入13个RCT,共计672例患者。Meta分析结果显示:与生理盐水相比,右旋美托咪啶能明显缩短椎管内麻醉感觉达到T10的平均时间[WMD=–2.39,95%CI(–4.40,–0.39)]和运动阻滞达到Bromage 3的平均时间[WMD=–5.30,95%CI(–7.18,–3.43)],并延长感觉阻滞消退两个节段的平均时间[WMD=51.14,95%CI(44.96,57.32)]和运动阻滞消退至Bromage 0的平均时间[WMD=68.46,95%CI(38.56,98.35)],同时明显增加心动过缓发生率[RR=3.03,95%CI(1.64,5.59)],减少寒战发生[RR=0.47,95%CI(0.28,0.80)];但在低血压以及术后恶心呕吐的发生率方面两者差异无统计学意义。结论现有研究表明,右旋美托咪啶可明显缩短椎管内麻醉的阻滞起效时间并延长其作用时间,同时可以降低寒战发生率,但也会明显增加心动过缓的发生率。     

Cesarean delivery

Cesarean delivery rates rose from 20 to 33% of births in the United States from 2006-2009 without an accompanying improvement in neonatal outcomes. The cesarean rate may be safely decreased by increasing vaginal birth after cesarean, encouraging external cephalic version for breech presentation, maintaining operative vaginal delivery skills, and applying stricter criteria for operative intervention in labor dystocia. A variety of cesarean operative techniques are supported by randomized controlled trials. Optimal maternity care outcomes depend on sound medical decision-making, appropriate operative technique and skills, and effective communication between maternity care team members.     

The Webster Technique: a chiropractic technique with obstetric implications

OBJECTIVE: To survey members of the International Chiropractic Pediatric Association (ICPA); regarding the use of the Webster Technique for managing the musculoskeletal causes of intrauterine constraint, which may necessitate cesarean section. METHODS: Surveys were mailed to 1047 US and Canadian members of the ICPA. RESULTS: One hundred eighty-seven surveys were returned from 1047 ICPA members, constituting a return rate of 17.86%. Seventy-five responses did not meet the study inclusion criteria and were excluded; 112 surveys (11%) provided the data. Of these 112 surveys, 102 (92%) resulted in resolution of the breech presentation, while 10 (9%) remained unresolved. CONCLUSION: The surveyed doctors reported a high rate of success (82%) in relieving the musculoskeletal causes of intrauterine constraint using the Webster Technique. Although the sample size was small, the results suggest that it may be beneficial to perform the Webster Technique in month 8 of pregnancy, when breech presentation is unlikely to spontaneously convert to cephalic presentation and when external cephalic version is not an effective technique. When successful, the Webster Technique avoids the costs and/or risks of external cephalic version, cesarean section, or vaginal trial of breech.In view of these findings, the Webster Technique deserves serious consideration in the health care management of expectant mothers exhibiting adverse fetal presentation.     

Moxibustion in breech version--a descriptive review

The management of breech presentation at term remains controversial. It appears logical that maternal and perinatal outcomes would be improved if breech presentation could be avoided. External cephalic version is considered a safe procedure if cases are selected appropriately and anaesthesia avoided. Moxibustion is a traditional Chinese method of treatment, which utilizes the heat generated by burning herbal preparations containing the plant Artemisia vulgaris to stimulate the acupuncture points. It is used for breech version with a reported success rate of 84.6% after 34 weeks gestation. Moxibustion technique is cheap, safe, simple, self-administered, non-invasive, painless and generally well tolerated. Although many studies give encouraging results regarding the use of moxibustion in inducing cephalic version of breech presentation, a definitive conclusion cannot be made as most involve small sample sizes and are not randomised. Moxibustion could be an extra option offered to women with breech presentation along with vaginal delivery, caesarean section and external cephalic version. This article discusses the possible role of moxibustion in correction of breech presentation in the hope that, some interest will be stimulated in what is a very interesting area for future research.     

文化程度对初产妇分娩镇痛时经产道试产依从性的影响

目的探讨不同文化程度对初产妇分娩镇痛时经产道试产依从性的影响,为初产妇经产道试产实施分娩镇痛提供个体化依据。方法将孕38～40周单胎头位住院临产并自愿要求行硬膜外分娩镇痛的初产妇,按文化程度分为大专及以上、高中及以下两组,每组各20例。对两组产妇的人口学资料、焦虑状态/习性调查表(State-Trait Anxiety Inventory,STAI)评分、自控镇痛情况和分娩结局进行比较分析。结果两组产妇在年龄、身高、体重方面差异均无统计学意义(P>0.05);两组产妇的SIAI评分中,焦虑习性评分差异无统计学意义(P>0.05),焦虑状态评分差异有统计学意义(P<0.05);两组产妇分娩镇痛过程中加药渴求和平均加药次数比较差异无统计学意义(P>0.05),但在因不能忍受疼痛要求剖宫产方面,差异有统计学意义(P<0.05)。结论文化程度较高的初产妇,焦虑状态自评分较高;分娩镇痛时,经产道试产的依从性较差。     

分娩镇痛的临床证据

目的探讨分娩镇痛的方法和药物的选择以及分娩镇痛对产程、器械助产率、分娩方式及母儿的影响。方法计算机检索Cochrane图书馆(2006年第4期)、MEDLINE (1978-2006．10)和中国生物医学文献数据库(1980-2006．10),查找与分娩镇痛有关的系统评价、Meta分析等,获取最佳证据用于临床治疗。结果共检索到8篇Cochrane系统评价和6篇Meta分析。分析结果表明,硬膜外分娩镇痛会造成第二产程延长、催产素使用量的增加、器械助产率增加以及产妇发热,但不会造成第一产程的延长,剖宫产率的增加。结论硬膜外分娩镇痛较其他镇痛方法具有优势。     

AAI与DDD起搏模式治疗病窦综合征的系统评价

目的 系统评价AAIR 和DDDR 两种生理性起搏模式比较治疗病窦综合征的有效性及安全性。 方法 采用Cochrane 系统评价方法,计算机检索Cochrane 图书馆临床对照试验数据库（2009 年第2 期）、MEDLINE（1980 ～ 2009.6）、EMbase（1980 ～ 2009.6）、CBM（1990 ～ 2009.6）,同时手工检索相关期刊,纳入AAIR 对比DDDR 起搏治疗病窦综合征的随机对照试验、半随机对照试验及随机交叉试验,评价所有纳入研究的方法学质量,并提取有效数据采用RevMan 5.0 软件进行Meta 分析。 结果 共纳入AAIR 对比DDDR 起搏治疗病窦综合征的随机对照试验6 个和随机交叉试验2 个,合计509 例患者,但研究质量均不高。Meta 分析结果显示：AAIR 起搏模式较之DDDR 起搏模式治疗不伴房室传导阻滞的病窦综合征可能更能缩小左房直径［MD=2.09,95%CI （0.22,3.97）］、左室舒张末内径［MD=3.00,95%CI（– 1.58,7.58）］和减低房颤的发生（P=0.026）,改善患者生活质量（P〈0.05）,但在治疗中由于患者发生房室传导阻滞需要重调或更换起搏器事件较多;对于患者的全因病死率（P=0.51）、心血管原因病死率（P=0.43）、心衰（P=0.17）、中风（P=0.32）、左室收缩末内径［MD=1.21,95%CI（– 0.85,3.28）］及左室射血分数［MD= – 2.91,95%CI（– 6.53,0.70）］的改善二者相似;未见明显副作用。 结论 AAIR 起搏模式较之DDDR起搏模式治疗病窦综合征可能更能缩小患者左房直径及左室舒张末径,减低房颤的发生,改善生活质量,但同时也存在较多的重调或更换起搏器事件。由于纳入研究质量普遍偏低,样本量普遍偏少,尚不能确定其疗效及安全性,今后尚需开展大样本、高质量的随机对照试验以证实。     

Which patients should be offered caesarean section?

Caesarean section (CS) rates have steadily risen from 10% of all deliveries in the 1980s to a current figure of around 23.8%. Approximately 75% of CS are emergency procedures and only 25% are elective planned deliveries. When deciding whether to offer CS, it is important to consider the psychological implications for the patient as well as the physical and mental sequelae in future pregnancies. Clinicians should provide pregnant women with evidence-based information and support. Information should include details about the true indication(s) for the CS and what it implies, including its risks and benefits. The updated NICE guideline does not advocate CS in uncomplicated pregnancies. However, it supports CS on maternal request when attempts to empower the mother to have a vaginal birth have not been successful. CS on maternal request only represented 1.4% of all CS in 2001. CS may reduce perineal and abdominal pain during birth and 3 days postpartum. It may also reduce injury to the vagina, early postpartum haemorrhage and obstetric shock. The following patients should be offered a planned elective CS: singleton breech presentation at term, after external cephalic version has failed, has been declined or is contraindicated; multiple pregnancies when the first twin is not cephalic; placenta praevia, minor or major, (close to or covering the os); HIV-positive women who are not on any antiretroviral therapy, have a high viral load or co-infection with hepatitis C irrespective of viral load; and women with primary genital herpes simplex virus infection occurring in the third trimester.