疤痕子宫经阴道分娩的护理体会

目的总结疤痕子宫再妊娠经阴道分娩产妇的护理体会。方法选取2015年8月-2016年1月疤痕子宫再妊娠经阴道分娩产妇39例,采取严密监护及加强心理护理。结果 39例疤痕子宫再次妊娠经阴道分娩的产妇中,足月产37例,早产2例,均顺利阴道分娩,新生儿平均体重(3.2±0.62)kg,无产后出血,无子宫破裂,产后恢复良好,母婴安全,结局满意。结论在疤痕子宫产妇行阴道试产过程中加强产程护理和心理护理,有助于提高阴道试产成功率,提升护理工作质量。     

剖宫产术后再次妊娠分娩方式探讨

目的探讨剖宫产术后再次妊娠分娩方式。方法选取450例分娩的剖宫产术后再次妊娠产妇,将其中100例疤痕子宫阴道分娩产妇作为观察组,350例疤痕子宫二次剖宫产产妇作为对照组,比较两组产妇出血量、住院时间及新生儿情况。结果观察组平均出血量及住院时间均低于对照组,差异比较有统计学意义(P<0.05);两组新生儿转至重症监护病房发生率、窒息率及住院时间差异比较有统计学意义(P<0.05)。结论剖宫产术后再次妊娠分娩剖宫产并不是唯一的方式,在合理的条件下,疤痕子宫阴道分娩是安全的,可在临床上推广应用。     

剖宫产术后疤痕子宫再次妊娠分娩方式的临床研究

目的:探讨剖宫产术后疤痕子宫再次妊娠分娩方式,从而提高瘢痕子宫孕妇阴道分娩的成功率,降低再次剖宫产率。方法:回顾性分析2017年1月至2018年9月本院产科收治并符合条件的680例剖宫产术后疤痕子宫再次妊娠患者的临床资料。结果:在680例剖宫产后瘢痕子宫再次妊娠产妇的分娩选择中,有280例产妇选择阴道生产,剖宫产产妇为400例。所有产妇最后均生产成功,母婴状况良好,未出现产妇产后大出血以及胎儿出生后窒息或死亡现象,生产成功率为100.00%。结论:对于剖宫产术后疤痕子宫再次妊娠产妇而言,分娩方式的选择应综合既往病史、产妇身体状况等因素进行全面分析,选择最适宜的方式,以减少对母婴的损伤,确保分娩质量。     

护理程序在疤痕子宫产妇试产中的应用

目的运用护理程序对疤痕子宫产妇进行护理,以达到降低剖宫产率,减轻产妇痛苦的目的。方法对要求经阴道分娩的疤痕子宫产妇,从入院到出院均按照产妇的生理、心理、社会需求对产妇应用护理程序的方法进行全方位的整体护理。结果8例疤痕子宫产妇试产中,有4例经阴道分娩,新生儿体重有3例达4000g以上,4例产妇再次以剖宫产结束分娩。结论应用护理程序模式,对疤痕子宫产妇进行全方位护理,既能提高阴道分娩率降低剖宫产率,又能确保母婴安全。     

疤痕子宫足月妊娠60例临床分析

目的：探讨剖宫产术后疤痕子宫再次妊娠分娩方式的选择。方法：对三年中收住院60例疤痕子宫再次妊娠分娩病历资料进行回顾性分析。结果：选择性阴道试产25例，阴道分娩成功23例，试产过程发生子宫疤痕破裂2例。再次剖宫产37例，择期剖宫产25例，急诊剖宫产12例。因子宫疤痕破裂致胎儿死亡1例，产妇全部痊愈出院。结论：剖宫产术后疤痕子宫再次妊娠分娩，隐藏着新的更大风险，阴道试产要严格掌握适应症。产程由专人负责，密切观察宫缩，胎心及子宫形态，防止子宫破裂。对子宫疤痕愈合不良，存在产科并发症应放宽再次剖宫产尺度。只有对病人具体情况综合分析，才能合理决定分娩方式，有效降低母婴围产期死亡率。     

剖宫产术后再次妊娠阴道分娩产程的观察及护理

目的总结剖宫产术后再次妊娠阴道分娩产程观察及护理要点。方法对具备阴道试产指征的60例剖宫产术后再次妊娠阴道分娩的孕妇，做好产程观察和心理护理等护理。观察记录产妇产程、分娩方式、产后出血量等情况。结果60例阴道试产孕妇54例成功阴道分娩，其中自然阴道分娩42例（77．78％），阴道助产12例（22．22％）；6例阴道试产不成功改为行剖宫产。产程过程中应用催产素加强宫缩40例，1例发生产后出血，无1例发生子宫破裂、新生儿窒息等并发症。结论加强产程的监护和做好心理护理是提高剖宫产术后再次妊娠经阴道分娩成功的关键。     

剖宫产术后瘢痕子宫再次妊娠阴道试产失败的危险因素分析及护理对策

目的 探究剖宫产术后瘢痕子宫再次妊娠阴道试产失败的危险因素,并制定护理对策.方法 选取2018年5月-2020年3月在我院进行阴道试产的264例剖宫产术后瘢痕子宫再次妊娠产妇,根据产妇最终是否为阴道分娩,将产妇分为成功组216例和失败组48例.采用自制《产妇基本情况调查表》对产妇进行调查,比较两组产妇相应指标,并进行多...     

281例瘢痕子宫再次剖宫产的临床观察及护理对策

目的:通过对瘢痕子宫再次剖宫产产妇的观察及加强护理,减少并发症的发生。方法:观察281例瘢痕子宫再次剖宫产产妇术前术后出现的各种情况,分析原因,找出对策。结果:发现瘢痕子宫再次剖宫产产妇易出现子宫破裂情况,产后出血多,切口愈合差。结论:对瘢痕子宫再次剖宫产产妇一定要加强孕期保健知识宣教,做好心理护理,早期下床活动,督促排尿、排便等护理措施,才能保障母婴安全,促进产妇康复。     

首次剖官产术后再次妊娠阴道试产的产程观察及护理

随着剖官产率的上升,剖宫产后再次妊娠的产妇越来越多,许多产妇由于对分娩过程的不了解,过度担心子宫破裂,故选择再次剖宫产术.2003-2007年,我院对46例首次剖宫产术后再次妊娠阴道分娩的产妇,根据瘢痕子宫的特点,对不同产程采取相应的护理措施,现报道如下.     

剖宫产术后再次妊娠妇女子宫瘢痕状态及分娩方式选择

目的:探讨剖宫产术后再次妊娠妇女子宫瘢痕状态及分娩方式的选择.方法:对160例剖宫产术后再次妊娠妇女的子宫瘢痕状态进行B超检测分级,评价子宫瘢痕修复情况、手术指征及妊娠并发症,选择安全分娩方式.结果:本组160例产妇中Ⅰ级瘢痕子宫78例,经阴道自然分娩66例、再次剖宫产12例;Ⅱ级瘢痕子宫47例,经阴道自然分娩或助产分娩25例、再次剖宫产22例;Ⅲ级瘢痕子宫35例,适时行计划剖宫产术.结论:初次剖宫产史不是再次剖宫产的绝对指征,根据产妇具体情况行阴道分娩是安全可行的.     

有剖宫产史孕妇再次妊娠分娩方式的探讨

目的：探讨剖宫产术后再次妊娠分娩的最佳方式。方法：回顾分析上海交通大学医学院附属瑞金医院2004年1月—2012年9月剖宫产术后再次妊娠的286例孕妇的分娩方式,其中剖宫产234例,阴道试产52例,并随机抽取同期首次行剖宫产术300例孕妇为对照组。结果：286例孕妇中258例（90.2%）再次行剖宫产术,28例阴道分娩,试产成功率53.9%。阴道分娩组无大出血发生,再次剖宫产组发生10例（3.88%）,对照组发生2例（0.67%）,差异有统计学意义（P〈0.05）。再次剖宫产组术中出血量（325.4±12.5）mL,高于对照组（225.6±26.8）mL及阴道分娩组（148.4±15.7）mL,差异有统计学意义（P〈0.05）。再次剖宫产组平均手术时间（59.2±20.5）min,高于对照组（30.9±14.6）min;腹腔粘连146例（56.59%）,高于对照组0例,差异均有统计学意义（P〈0.05和0.01）。再次剖宫产组住院时间（7.2±0.9）d,与对照组（6.8±1.2）d和阴道分娩组（3.5±1.8）d比较,差异有统计学意义（P〈0.05）。结论：瘢痕子宫再次妊娠不是剖宫产的绝对指征。有剖宫产史孕妇再次妊娠后,若无剖宫产指征,应增加阴道试产机会;而提高剖宫产手术水平,是降低剖宫产史孕妇再次剖宫产并发症的关键。     

Changes in uterine flexion caused by cesarean section: correlation between post-flexion and deficient cesarean section scars

Purpose

To investigate changes in uterine flexion after cesarean delivery in comparison with vaginal delivery, and their relationship with the presence of deficient cesarean section scars.

Methods

In 147 women who had a vaginal delivery and 101 women who had a cesarean delivery, transvaginal ultrasonographic photographs of the uterus were obtained at the first trimester of pregnancy and at 1 month postpartum, and they were reviewed to determine changes in uterine flexion. The presence of a deficient cesarean section scar was also reviewed in women with a cesarean section.

Results

Changes in uterine flexion were observed more frequently among the woman with a cesarean delivery than in those with a vaginal delivery. The incidence of post-flexed uterus during puerperium tended to increase depending on the number of cesarean sections the woman had undergone. In the women with a cesarean section, changes in uterine flexion were more frequently observed in the women with a deficient cesarean section scar than in those without one.

Conclusion

Changes in uterine flexion after birth occurred more frequently in the women who had a cesarean delivery than in those who had a vaginal delivery, especially in the presence of a deficient cesarean section scar.

     

全程连续性助产护理对剖宫产术后阴道分娩妊娠结局及护理满意度的影响

目的 评价全程连续性助产护理在改善剖宫产术后阴道分娩(VBAC)妊娠结局及护理满意度中的临床意义。 方法 选取2014年3~10月剖宫产术后再次妊娠产妇90例,随机分为对照组和观察组。对照组行传统分段式护理,观察组行全程连续性助产护理服务。比较2组产程时间、自然分娩率、胎儿窘迫发生率、新生儿窒息率、产后出血率及护理满意度。 结果 观察组产程时间缩短,自然分娩率提高,胎儿窘迫、新生儿窒息发生率低,产后出血发生率降低,对护理工作的满意度提高。 结论 实施全程连续性助产护理,可有效缓解产妇的不良情绪,提高自然分娩率,减少相关并发症,提高产妇对护理工作的满意度。     

Application of predictive model for vaginal birth after caesarean delivery

Medical practitioners are concerned with the selection of delivery mode after caesarean delivery. Several researchers have developed numerous models for predicting vaginal birth after caesarean delivery. This study selected seven widely used and representative advanced models, such as those of Grobman, Troyer and Parisi, Schoorel, Flamm, Gonen, Weinstain and Smith et al., analysed the constitutions and clinical applications of the models and identified the factors associated with patients to provide midwives a scientific reference for vaginal delivery evaluation of pregnant women after caesarean delivery.     

Vaginal birth after caesarean section (VBAC): exploring women's perceptions

Aims and objectives. This study was designed to complement local audit data by examining the lived experience of women who elected to attempt a vaginal birth following a previous caesarean delivery. The study sought to determine whether or not women were able to exercise informed choice and to explore how they made decisions about the method of delivery and how they interpreted their experiences following the birth. Background. The rising operative birth rate in the UK concerns both obstetricians and midwives. Although the popular press has characterized birth by caesarean section as the socialites’ choice, in reality, maternal choice is only one factor in determining the method of birth. However, in considering the next delivery following a caesarean section, maternal choice may be a significant indicator. While accepted current UK practice favours vaginal birth after caesarean (VBAC) in line with the research evidence indicating reduced maternal morbidity, lower costs and satisfactory neonatal outcomes, Lavender et al. point out that partnership in choice has emerged as a key factor in the decision‐making process over the past few decades. Chaung and Jenders explored the issue of choice in an earlier study and concluded that the best method of subsequent delivery, following a caesarean birth, is dependent on a woman's preference. Design and methodology. Using a phenomenological approach enabled a holistic exploration of women's lived experiences of vaginal birth after the caesarean section. Results. This was a qualitative study and, as such, the findings are not transferable to women in general. However, the results confirmed the importance of informed choice and raised some interesting issues meriting the further exploration. Conclusions. Informed choice is the key to effective women‐centred care. Women must have access to non‐biased evidence‐based information in order to engage in a collaborative partnership of equals with midwives and obstetricians. Relevance to clinical practice. This study is relevant to clinical practice as it highlights the importance of informed choice and reminds practitioners that, for women, psycho‐social implications may supersede their physical concerns about birth.     

瘢痕子宫再次妊娠经阴道试产患者472例的产程观察与护理

目的分析并总结瘢痕子宫再次妊娠经阴道试产患者的产程观察要点,以提高其自然分娩率,并降低二次剖宫产率。方法回顾性分析2014年9月至2015年8月在我院生产的472例瘢痕子宫妊娠阴道试产者的病例资料,包括年龄、孕周、产程、新生儿体质量、产时及产后2h出血量、子宫下段厚度、距前次剖宫产时间、前次剖宫产原因以及阴道试产的结局。结果472例瘢痕子宫病例中顺产417例(88.3%),吸引产6例(1.3%),故阴道试产成功率为89.6%;剖宫产49例(10.4%),均未发生子宫破裂和新生儿窒息。结论在充分考虑孕妇自身情况的前提下,应用全程连续性助产护理,做好产前健康教育、产时监护和产后观察,可保障瘢痕子宫再妊娠者阴道试产的安全性和成功率。     

妊娠期糖尿病患者阴道分娩的安全性分析及护理

目的探讨妊娠期糖尿病患者阴道分娩的安全性及护理经验。方法总结2004年1月-2005年6月自愿选择阴道分娩的85例妊娠期糖尿病(GDM)产妇作为GDM组,同期选择阴道分娩的非GDM产妇4 506例作为非GDM组,对两组母婴的安全性进行分析。结果妊娠期糖尿病产妇选择阴道分娩,其剖宫产率、胎儿宫内窘迫发生率、新生儿窒息率、死产及新生儿病率与非GDM组相比无显著性差异(P>0.05)。而≥41周分娩胎儿宫内窘迫发生率增加,差异有显著性(P<0.01)。结论妊娠期糖尿病积极控制血糖,加强产时护理监测,阴道分娩是安全的,≥41周者应终止妊娠。     

Therapeutic options of caesarean scar pregnancy: Case series and literature review

We describe our experience with the treatment of 4 caesarean scar pregnancies and provide an overview of current literature. Four women diagnosed with a caesarean scar pregnancy in our hospital between 1996 and 2007 were treated with local or systemic methotrexate and had a steady decline of the serum β‐hCG level. The uterus was preserved in all women and 3 of them had an uneventful subsequent pregnancy and delivery. We suggest that transcervical needle aspiration of amniotic fluid followed by intra‐amniotic injection of methotrexate should be the treatment of choice, followed by surgical treatment only if methotrexate fails. © 2009 Wiley Periodicals, Inc. J Clin Ultrasound 2010