双胎妊娠的分娩方式与妊娠结局探讨

目的　探讨双胎妊娠的分娩方式与妊娠结局的关系。方法　将 1995年 1月至 2 0 0 3年 5月 98例双胎妊娠产妇按分娩方式分为阴道分娩组及剖宫产组 ,对其临床资料进行回顾性分析。结果　两组的孕周、产后出血率比较差异无显著性意义 (P >0 0 5 ) ,剖宫产组新生儿体重显著高于阴道分娩组 (P <0 0 1) ,两组第 1胎分娩新生儿窒息率差异无显著性意义 (P >0 0 5 ) ,而第 2胎分娩新生儿窒息率剖宫产组显著低于阴道分娩组(P <0 0 5 )。结论　正确选择双胎妊娠的分娩方式 ,将有助于降低剖宫产率及新生儿窒息率     

非高危妊娠引产时机的探讨

目的:探讨非高危妊娠的最佳引产时机。方法:收集2017年1月至12月于四川大学华西第二医院及成都市妇女儿童中心医院产科行引产术的孕40～41~(+6)周非高危初产妇456例,按引产孕周分为40～40~(+6)周引产组(研究组,284例)和41～41~(+6)周引产组(对照组,172例),比较两组的剖宫产率、产程情况、引产并发症及母儿结局等,探讨非高危妊娠的引产时机。结果:研究组和对照组的一般情况及引产方式比较,差异无统计学意义(P0.05)。研究组的第一产程、第二产程及总产程时间均明显短于对照组[(391.84±225.73)min vs (471.99±268.86)min;(53.73±31.58)min vs (65.41±38.66)min;(452.98±235.84)min vs (535.75±259.80)min],差异均有统计学意义(P0.05);两组的引产失败率、剖宫产率、产后出血率、新生儿转NICU率等比较,差异均无统计学意义(P0.05)。两组均无围产儿死亡及孕产妇死亡发生。结论:40～40~(+6)周引产与41～41~(+6)周引产相比,产程时间明显缩短,且不增加引产失败率、剖宫产率及其他并发症。对于非高危初产妇,在40～40~(+6)周施行引产是可行的。     

双胎妊娠分娩时机与分娩方式的选择

近年来,双胎妊娠发生率急剧上升,双胎分娩的处理是具有挑战性的临床问题。双胎妊娠分娩方式与分娩时机应结合母胎情况、当地医疗机构医疗水平和医疗条件进行综合考虑。无并发症单绒毛膜双羊膜囊(monochorionic-diamniotic,MCDA)双胎分娩不超过37周为宜,双绒毛膜双羊膜囊(dichorionic-diamniotic,DCDA)双胎可妊娠至38周,单绒毛膜单羊膜囊(monochorionic-monoamniotic,MCMA)双胎为32～33周分娩。对于无并发症MCDA双胎与DCDA双胎可考虑阴道试产,MCMA双胎则建议剖宫产手术终止妊娠。     

双胎妊娠116例分娩时机及分娩方式的探讨

双胎妊娠的孕妇并发症多 ,新生儿窒息、病死率高。积极防治妊娠期各种并发症 ,选择有利分娩的时机及方式对提高双胎围生儿存活率有重要意义。本文就 116例双胎妊娠资料进行回顾性分析 ,报道如下。1　临床资料1 1　一般资料　 1996年 1月至 2 0 0 0年 12月间我院分娩总数 72 5 0例 ,双胎 116例 ,占 1 60 %;单胎 713 1例 ,占98 3 6%。双胎与单胎发生率比为 1∶61 5 0。1 2　双胎分娩方式及剖宫产指征　阴道顺产 5 9例 ,占5 0 86%;阴道助产分娩者共 17例 ,占 14 66%;剖宫产 4 0例 ,占 3 4 48%。主要剖宫产指征有 :①第一胎儿非头位者原则上…     

双胎妊娠结局及分娩时机与分娩方式对新生儿窒息的影响

目的:探讨双胎妊娠结局及不同分娩时机与分娩方式对新生儿窒息的影响。方法:回顾性分析本院462例双胎妊娠孕妇晚期流产及分娩结局资料,以1分钟Apgar评分≤7分为标准诊断新生儿窒息,对比分析不同孕周的晚期流产率,及在不同分娩孕周采用不同分娩方式的新生儿窒息率。结果:(1)双胎妊娠孕妇孕28周前流产42例,主要集中于孕26～27~(+6)周(18例)。(2)孕28周后分娩的活产新生儿共834例,其剖宫产新生儿窒息率(2. 16%)低于阴道分娩(12. 77%)(P0. 05),其中孕28～29~(+6)、孕32～33~(+6)周剖宫产与阴道分娩的新生儿窒息率差异有统计学意义(P0. 05)。新生儿窒息率在孕36～37~(+6)周(0. 44%)明显低于其他孕周(P0. 05)。(3)大胎儿和小胎儿的剖宫产新生儿窒息率均低于阴道分娩(P0. 05),剖宫产中大胎儿新生儿窒息率低于小胎儿(P0. 05)。剖宫产中大胎儿在孕34～35~(+6)周的新生儿窒息率(0)明显低于其他孕周(P0. 05),剖宫产中小胎儿在孕36～37~(+6)周的新生儿窒息率(0)明显低于其他孕周(P0. 05)。结论:双胎妊娠应加强孕期监护,防止晚期流产的发生。双胎妊娠无明显并发症时可尽量延长孕周至36～37~(+6)周,但不宜过迟,采取剖宫产方式可降低新生儿窒息率的发生。     

剖宫产后再次妊娠的分娩方式探讨

目的 :探讨剖宫产后再次妊娠的最佳分娩方式。方法 :对 15 6例剖宫产后再次妊娠孕妇的分娩方式进行回顾性分析。结果 :88例孕妇阴道试产 ,试产成功率者 88 6 %。选择再次剖宫产 6 8例。结论 :剖宫产史作为再次妊娠剖宫产的指征是不合理的 ,如无剖宫产指征 ,应给予试产 ,因为阴道分娩可减少再次开腹手术给患者带来的各种危险和并发症 ,减少患者手术痛苦和经济负担。     

双胎妊娠适宜的分娩时机与分娩方式

双胎妊娠的分娩仍是产科最具挑战性的事件。双胎妊娠的分娩时机与分娩方式应根据孕周、当地的医疗条件（产科条件是否为区域性医疗中心、新生儿重症监护病房救治水平等）及母胎的具体情况（绒毛膜性,有无并发症或合并症、复杂双胎等,甚至患者经济情况）等综合考虑,制定适宜的个体化分娩方案。对于无并发症及合并症的双绒毛膜双羊膜囊双胎,38～39+6周分娩较适宜;对于无并发症及合并症的单绒毛膜双羊膜囊双胎,适宜的分娩时机为37～38周;复杂性双胎（如单羊膜囊双胎、双胎输血综合征、选择性胎儿生长受限、贫血-红细胞增多序列征、单绒毛膜双胎减胎术或宫内治疗后）,需结合孕妇及胎儿的具体情况制定个体化的分娩方案,分娩时机为32～36周。双胎择期剖宫产指征包括单羊膜囊双胎、连体双胎（除外早中孕者）、第一胎非头位、具有单胎的剖宫产指征者,除此之外,均可考虑阴道分娩。     

活跃期时限对分娩方式和妊娠结局的影响

目的 了解活跃期时限的处理对分娩方式以及妊娠结局的影响. 方法 2009年1月1日至12月31日,在北京大学第一医院分娩,进入产程的足月、单胎妊娠、头先露初产妇共1744例.回顾性分析其中417例活跃期时限出现异常(包括活跃期停滞和活跃期延长)者的病历资料,采用卡方检验分析活跃期停滞时间对阴道分娩和剖宫产分娩者妊娠结局的影响. 结果 417例活跃期停滞者中,剖宫产者205例,阴道分娩者212例.活跃期停滞发生率为23.9％(417/1744).其中50例伴活跃期延长,发生率为2.9％(50/1744).阴道分娩者中活跃期≥6h者新生儿转儿科率高于活跃期＜6 h组[20.6％(26/126)与8.1％(7/86),x2＝6.07,P＜0.05],剖宫产者中活跃期＜6h者宫内感染发生率高于活跃期≥6h者[22.7％(30/132)与6.8％(5/73),x2=8.37,P＜0.01].阴道分娩孕妇中,宫口开大6 cm之前停滞者产后出血发生率(4.8％,9/186)、产妇并发症率(3.8％,7/186)和新生儿转儿科率(15.6％,29/186)与官口开大≥6 cm停滞者[分别为6.2％(1/16)、0.0％(0/16)和12.5％(2/16)]比较,差异均无统计学意义(x2分别为0.12、0.01和0.00,P均＞0.05).剖官产孕妇中,宫口开大6 cm之后行剖宫产者新生儿转儿科率明显高于宫口开大6 cm之前停滞者,差异有统计学意义[60.0％(6/10)与(19.9％(34/171),x2=8.83,P＜0.05].剖宫产孕妇宫口开大3 cm时停滞时间≥4h和＜4 h相比,孕妇年龄、分娩孕周、分娩时体重指数、产后出血量、新生儿出生体重等差异均无统计学意义(P均＞0.05).单纯以活跃期停滞为指征的剖宫产者新生儿转儿科率较低(11.2％,9/80),而以活跃期停滞合并宫内感染为指征的剖宫产者新生儿转儿科率较高(42.1％,16/38).结论 宫口扩张6 cm以下出现活跃期异常者,母儿情况良好,可适当延长产程观察时限.阴道分娩者如活跃期时限≥6h,要注意新生儿情况.     

既往分娩史对剖宫产后阴道试产结局的影响

目的:探讨既往分娩史对剖宫产后阴道试产(TOLAC)患者成功率的影响。方法:回顾性分析2013年7月至2016年3月尝试TOLAC的瘢痕子宫孕妇的资料(妊娠≥28周),共506例,其中阴道分娩成功414例(TOLAC成功组),中转剖宫产92例(TOLAC中转剖宫产组)。比较两组前次剖宫产时间、剖宫产指征、阴道分娩史、新生儿存活情况等。结果:TOLAC中转剖宫产组的孕前体质量指数(BMI)及新生儿出生体质量大于TOLAC成功组(P0.05),两组平均妊娠间隔时间比较差异无统计学意义(P0.05),两组在妊娠间隔1年、1~2年、2~3年、3年的比例分别比较,差异无统计学意义(P0.05)。两组的前次剖宫产指征分别比较,差异均无统计学意义(P0.05)。TOLAC成功组有阴道分娩史患者比例明显高于TOLAC中转剖宫产组(P0.05),新生儿未存活的比较差异无统计学意义(P0.05)。结论:既往有阴道分娩史是TOLAC成功的有利因素,而既往分娩史的其他因素对TOLAC的成功率影响较小。     

瘢痕子宫再次妊娠分娩时机和分娩方式选择的影响因素分析

目的：探讨瘢痕子宫再次妊娠分娩时机和分娩方式选择的影响因素。方法：选取2015年1月-2017年12月于深圳市龙华区人民医院妇产科待产并选择阴道试产的瘢痕子宫再次妊娠孕妇228例为研究对象,根据最终分娩方式分为再次剖宫产组（121例）及阴道分娩组（107例）,收集并比较2组孕妇的临床资料。结果：228例孕妇中,107例顺利完成阴道分娩,成功率为46.93%,且所有孕妇均无子宫破裂发生;单因素分析发现,2组孕妇在年龄、文化程度、产前体质量指数（BMI）、距离上次剖宫产时间、阴道分娩史、定期产前检查、使用催产素、瘢痕厚度、现孕周、新生儿体质量等因素间差异有统计学意义（P＜0.05）;多因素分析发现,年龄、产前BMI、距离上次剖宫产时间、阴道分娩史、定期产前检查、瘢痕厚度、新生儿体质量是分娩方式选择的影响因素。结论：瘢痕子宫再次妊娠阴道分娩较为安全,对于35岁以下、BMI＜30 kg/m2、距离上次剖宫产时间超过2年、瘢痕厚度≥3 mm、预计新生儿体质量＜2 500 g且行定期产前检查的瘢痕子宫再次妊娠孕妇可选择阴道分娩。     

Mode of delivery and other pregnancy outcomes of patients with documented scoliosis

The aim of this study was to explore whether scoliosis is a risk factor for adverse obstetric outcomes and specifically for cesarean delivery (CD) and labor dystocia. Association between scoliosis and pregnancy outcome was studied before. Confounding conclusions prevent proper counseling of patients. Appropriate statistical analysis of a suitable cohort is helpful in resolving this issue. A retrospective population-based study comparing all singleton pregnancies of women with and without documented scoliosis was conducted. Deliveries occurred between the years 1988 and 2009. Multiple logistic regression models were used to control for confounders. Out of 229,116 patients which were included in our cohort, 0.043% (n?=?98) had a documented scoliosis. These patients had higher rates of fertility treatments (7.1% vs. 1.6%; p?<?0.001). Scoliosis was found to be significantly associated with labor induction (36.7% vs. 26.3 %; p?=?0.02) and cesarean deliveries (21.4% vs. 13.1%; p?=?0.014). Using multiple logistic regression models, with CD as the outcome variable, controlling for confounders such as nulliparity, labor induction and maternal age, scoliosis was not found to be an independent risk factor for CD (OR?=?1.56, 95% CI 1.9–2.7; p?=?0.121). Scoliosis is not a risk factor for adverse pregnancy outcome, and specifically for labor dystocia.     

Mode of delivery in nulliparous women with gestational hypertension undergoing early term induction of labor

Objective: To evaluate perinatal outcomes in nulliparous women undergoing induction of labor for gestational hypertension at term.

Study design: Retrospective cohort study of nulliparous women with gestational hypertension undergoing induction of labor ≥37 weeks. Mode of delivery and perinatal outcomes were compared for women who delivered at 37^0–6/7, 38^0–6/7, and ≥39^0/7 weeks gestation.

Results: The cohort included 320 women: 67 (21%) at 37^0–6/7, 76 (24%) at 38^0–6/7, and 177 (55%) at ≥39^0/7. There was no increase in cesarean delivery (CD) in women delivering earlier, with 26.9% (37^0–6/7), 19.7% (38^0–6/7) and 29.9% (≥39^0/7) requiring CD (p values?=?0.39). Compared to ≥39 weeks, composite maternal morbidity was lowest in women delivering at 38^0–6/7 (adjusted odds ratio [aOR] 0.45, 95% confidence interval (CI) 0.24–0.84). Composite neonatal morbidity was similar among the groups. When compared to women delivering at ≥39^0/7 weeks, women delivered at 38^0–6/7 were less likely to experience any adverse maternal or neonatal outcome (aOR 0.50, 95% CI 0.28–0.90).

Conclusions: Compared to induction of labor at ≥39 weeks, early term induction of labor was not associated with an increased risk of CD in nulliparous women with gestational hypertension.     

IVF-ET助孕后的妊娠及分娩结局分析

目的研究影响IVF-ET助孕后妊娠和分娩结局的因素。方法回顾性分析IVF-ET后获妊娠的233个周期,根据年龄分为A、B、C三组。A组;21～30岁,B组31～35岁,C组26～42岁。比较不同年龄的妊娠率及妊娠丢失率,分娩率。结果 36～42岁组,妊娠率为25.96%,显著低于31～35岁组(39.69%)和21～30岁组(50.99%);该组的妊娠丢失率为44.44%,显著高于31～35岁组(37.66%)和21～30岁组(16.28%);38例双胎妊娠分娩中,3例均有其中的1婴儿畸形;133例单胎妊娠分娩均获得正常活婴。结论年龄和多胎妊娠是影响IVF-ET助孕后妊娠及分娩结局的重要因素。     

Planned cesarean delivery compared to induction of labor in women with class III obesity: a cost-minimization analysis*

Objective: To compare the costs between planned cesarean delivery (CD) and induction of labor (IOL) in women with class III obesity.

Methods: We conducted a cost-minimization analysis using data from a previous study of women with a BMI?≥40 kg/m² delivering term singletons via planned CD or after IOL. Decision trees were built with branches for two “treatments”: planned CD and IOL (probabilities derived from parent study). Direct and total costs were obtained for each mother–infant pair. Sensitivity analyses for probability of successful IOL were performed.

Results: A total of 661 mother–infant pairs were included – 399 IOLs and 262 planned CDs. Of 399 IOLs, 236 (59%) delivered vaginally and 163 (41%) had a CD. IOL was slightly less costly. For IOL and planned CD, respectively, direct costs were $7416 versus $7474, and total costs were $11 545 versus $11 665. Sensitivity analyses indicated that IOL was the least costly strategy if the probability of vaginal delivery after IOL was?>57% (0.575 for direct costs; 0.570 for total costs). There was, however, a slight cost advantage to planned CD in women with a prior cesarean.

Conclusions: In women with class III obesity, IOL is less costly than planned CD if the probability of vaginal delivery after IOL in an individual patient is greater than 57%.