水中分娩保护会阴的意义及手法探讨

目的探讨水中分娩保护会阴的意义。并对保护会阴的手法进行对比,评价实际效果。方法上海市长宁区妇幼保健院2003年3月至2010年5月总计2963例水中分娩病例中符合入选标准者共1991例,以不保护会阴、简单手法保护会阴、单手法保护会阴作为分组依据分为观察组、对照组、保护组3组。结果观察组1055例,其中会阴无裂伤、Ⅰ、Ⅱ、Ⅲ度裂伤分别为35、439、568、5例,行会阴切开术8例;对照组804例,其中会阴无裂伤、Ⅰ、Ⅱ、Ⅲ度裂伤分别为18、305、472、3例,行会阴切开术6例;保护组132例,会阴无裂伤、Ⅰ、Ⅱ、Ⅲ度裂伤分别为7、94、31、0例,无行会阴切开术者。采用多组单向有序分类资料的Ridit分析方法和采用SNK法进行两两比较。结果显示F=31.036,P<0.001,3组产妇会阴裂伤程度差异有统计学意义。两两比较结果保护组平均秩次显著低于其他两组,有统计学意义,观察组平均秩次亦低于对照组,但差异无统计学意义。结论水中分娩保护会阴是必要的。单手法保护会阴会阴Ⅰ度裂伤率明显高于其他两组,Ⅱ度裂伤率明显低于其他两组,无Ⅲ度裂伤发生。可有效防止会阴的严重裂伤。     

水中分娩会阴裂伤相关因素探讨

目的：探讨可能影响水中分娩产妇会阴裂伤的有关因素,为提高水中分娩的安全性提供科学依据。方法：将水中分娩产妇按会阴裂伤程度分组,A组395例,包括会阴完整35例,Ⅰ度裂伤360例；B组187例,为会阴Ⅱ度裂伤。本研究的水中分娩产妇无一例发生会阴Ⅲ度及Ⅳ度撕裂。比较两组产妇的产程、入水时间、水中时间、新生儿出生体重。结果：A组的第一产程及第二产程较B组短,但差异无显著性(P＞0．05),B组中第二产程延长的发生率高于A组,差异有非常显著性(P＜0．01)；A组宫口开至4～6 cm入水的比例高于B组,7～9 cm入水的比例低于B组,差异均有非常显著性(P＜0．01)；A组新生几出生体重低于3500 g的比例高于B组,巨大儿的比例低于B组,但差异均无显著性(P＞0．05)。结论：水中分娩时会阴裂伤程度可能与产妇入水时间及第二产程延长有关。     

水中分娩与硬膜外麻醉无痛分娩的临床效果分析

目的比较水中分娩与硬膜外麻醉无痛分娩的临床效果。方法随机抽取80例河北省秦皇岛市妇幼保健院行水中分娩的产妇为水中分娩组,80例行硬膜外麻醉无痛分娩的产妇为无痛分娩组。观察两组产程时间、会阴裂伤、产妇出血量、分娩前后血红蛋白的变化、疼痛程度、住院天数及新生儿情况。结果水中分娩组第一产程及总产程时间较无痛分娩组短,而第二产程及第三产程差异无统计学意义（P〉0.05）;水中分娩组产后2h的出血量略少于无痛分娩组;两组产程时间、会阴裂伤、产妇失血量及产后恢复比较差异有统计学意义（P〈0.05）。结论行硬膜外麻醉分娩镇痛可提供较好的镇痛效果,但却是一种有创操作,对于产妇患有腰部疾病者或对硬膜外麻醉有排斥者则不宜行此法,水中分娩产妇产程时间短,会阴裂伤程度轻,失血量较少,产后恢复快,住院时间短。     

水中分娩120例母儿结局临床分析

目的探讨水中分娩的安全性和有效性。方法选择孕足月单胎头位无阴道分娩禁忌证并自愿选择水中分娩的120例孕妇作为研究组,传统阴道分娩120例为对照组,比较两组孕妇的疼痛程度、总产程和母儿并发症。结果研究组孕妇Ⅱ＋Ⅲ级分娩疼痛率（3．33％,4／120）低于对照组（96．67％,116／120）,两组比较,差异有统计学意义（P〈O．05）;研究组无会阴侧切,对照组会阴侧切率为45．83％（55／120）,两组比较,差异有统计学意义（P〈0．05）;研究组总产程、产后出血量和新生儿窒息率分别为（456．78±102．90）min、（146．13±18．16）ml和1．67％（2／120）,对照组分别为（480．54±113．85）min、（148．04±21．13）ml和3．33％（4／120）,两组比较,差异均无统计学意义（P〉0．05）;两组均无产褥感染发生。结论水中分娩可降低孕妇分娩疼痛程度,不增加产后出血量、产褥感染率及新生儿窒息的发生,是安全可行的分娩方式。     

703例水中分娩对新生儿窒息的影响分析

目的:了解水中分娩是否会增加新生儿窒息的风险.方法:纳入从2012年4月至2013年3月在四川省妇幼保健院水中分娩的703例产妇(其中水中待产153例,水中生产550例)作为研究组,同期常规分娩无妊娠合并症、并发症足月单胎头位产妇658例作为对照组.比较研究组和对照组间新生儿窒息及严重呼吸并发症的发生情况.结果:研究组703例水中分娩共有13例发生新生儿窒息,发生率为1.8％(13/703),其中水中待产组有5例(3.3％,5/153),根据Apgar评分有1例为重度窒息,其余均为轻度窒息;水中生产组有8例(1.5％,8/550)新生儿窒息,均为轻度.对照组658例常规分娩发生新生儿窒息的有6例,均为轻度,发生率为0.9％.研究组新生儿窒息发生率高于对照组,但差异无统计学意义(P＞0.05).水中待产组新生儿窒息发生率高于水中生产组,但差异也无统计学意义(P＞0.05).水中待产组1例重度窒息使用了经鼻持续气道正压通气(NCPAP),水中生产组有2例窒息新生儿发生严重的胎粪吸入综合征,使用呼吸机辅助通气.结论:水中分娩可能会增加新生儿窒息的发生率,但本研究差异无统计学意义,尚需扩大样本进一步研究.     

水中分娩51例分析

目的:探讨水中分娩对孕母的减痛作用及对母儿安全性的影响。方法:自愿水中分娩且符合条件的孕妇5 1例,随机取同期阴道分娩、足月、头位的孕妇5 1例为对照组。分析水中分娩的产程、减痛程度、失血量,以及会阴裂伤、产褥感染、新生儿窒息情况。结果:水中分娩孕妇无一例接受会阴切开术,3例会阴完整,1 7例Ⅰ度会阴裂伤,31例Ⅱ度会阴裂伤,按疼痛等级分类,Ⅰ度4 3例,Ⅱ度8例。结论:水中分娩有减轻分娩疼痛的作用,但尚需扩大水中分娩例数来评价水中分娩对母儿的安全性。     

水中分娩的研究进展

水中分娩在促进人类分娩回归自然的过程中,具有划时代的意义。水中分娩是指在产妇分娩发动以后,使其浸入特制的分娩池或浴盆中,采用非药物性减轻产妇在整个分娩过程中的疼痛,在水中待产或分娩。为了保证水中分娩安全、有效、顺利的开展及普及,本文从水中分娩的发展历史、临床应用、安全性分析逐一阐述。     

经阴道头位分娩中倡导限制会阴切开

介绍国内外头位分娩中会阴切开的现状及研究概况,说明限制会阴切开在产科临床推行的意义。通过限制会阴切开在头位分娩的临床实施,客观分析其关键技术环节及难点。     

分娩镇痛的研究进展

分娩镇痛争议较多，其方法、用药趋向多样化，灵活化。硬膜外镇痛效果好，运动阻滞轻；蛛网膜下腔一硬膜外联合镇痛用药量小，起效快，可灵活掌握镇痛时问；产妇自控硬膜外镇痛可按需给药，降低医护工作量。硬膜穿破是最常见并发症，某些因素可降低其风险及危害。分娩镇痛对产程和分娩结果的影响仍有争议，多数研究认为分娩镇痛延长产程，但不增加剖宫产及器械助产率。良好的分娩镇痛可以改善新生儿酸碱状态。     

分娩镇痛与分娩安全

椎管内分娩镇痛在中国越来越普及。医护人员和产妇及家属对分娩安全和麻醉并发症颇为关注,尤其是对第二产程的影响、新生儿临床结局及严重麻醉并发症。权衡利弊在是否实施各项医疗干预或采取“自然疗法”的决定中至关重要。以患者为中心,以循证医学为基础,以“不伤害产妇”为前提,预见性的临床模式,对分娩安全意义非凡。提供安全有效椎管内分娩镇痛的产科麻醉已经成为现代产房的临床标准。     

Water Birth Maternal and Neonatal Outcomes Among Midwifery Clients in Alberta,Canada, from 2014 to 2017: A Retrospective Study

ObjectivesThis study sought to evaluate retrospectively the maternal and neonatal outcomes of water births (WBs) managed by Registered Midwives in Alberta compared with traditional or “land” vaginal birth outcomes for clinical evidence or knowledge and to assist in health care management planning.MethodsThis study was a retrospective cohort comparison of maternal and neonatal outcomes of WB (1716) and traditional or land birth (non-WB) (21 320) from selected low-risk maternal cohorts with spontaneous onset of labour and vaginal delivery in Alberta (2014-2017) using Alberta Perinatal Health Program data sets. Anonymized client and patient records linked the Alberta Perinatal Health Program data with inpatient Discharge Abstract Database for newborn and/or maternal personal health number (PHN/ULI) analyzed using SPSS 19.0 software (IBM Corp., Armonk, NY) (Canadian Task Force Classification II-2).ResultsThe WB group had fewer and less severe perineal lacerations despite increased macrosomia. The non-WB group had increased maternal factors (age <20 years, third- to fourth-degree perineal tears, excessive blood loss) and neonatal factors (Apgar scores <7 at 5 minutes and neonatal intensive care unit admission). No significant difference was identified between the birth groups for maternal age >35 years, primiparous status, maternal fever, maternal puerperal infection, maternal intensive care unit admission, low birth weight, neonatal resuscitation, and neonatal intensive care unit admission <28 days of life.ConclusionsA low-risk maternal cohort of WBs (1716) managed by midwives had equivalent or improved neonatal outcomes compared with a low-risk maternal cohort of land or traditional births (21 320) managed by midwives and other maternity providers.     

Neonatal Outcomes in the Birth Center Setting: A Systematic Review

Introduction

This systematic review investigates the effect of the birth center setting on neonatal mortality in economically developed countries to aid women and clinicians in decision making.

Methods

We searched the Google Scholar, CINAHL, and PubMed databases using key terms birth/birthing center or out of hospital with perinatal/neonatal outcomes. Ancestry searches identified additional studies, and an alert was set for new publications. We included primary source studies in English, published after 1980, conducted in a developed country, and researching planned birth in centers with guidelines similar to American Association of Birth Centers standards. After initial review, we conducted a preliminary analysis, assessing which measures of neonatal health, morbidity, and mortality were included across studies.

Results

Neonatal mortality was selected as the sole summary measure as other measures were sporadically reported or inconsistently defined. Seventeen studies were included, representing at least 84,500 women admitted to a birth center in labor. There were substantial differences of study design, sampling techniques, and definitions of neonatal outcomes across studies, limiting conclusive statements of the effect of intrapartum care in a birth center. No reviewed study found a statistically increased rate of neonatal mortality in birth centers compared to low‐risk women giving birth in hospitals, nor did data suggest a trend toward higher neonatal mortality in birth centers. As in all birth settings, nulliparous women, women aged greater than 35 years, and women with pregnancies of more than 42 weeks’ gestation may have an increased risk of neonatal mortality.

Discussion

There are substantial flaws in the literature concerning the effect of birth center care on neonatal outcomes. More research is needed on subgroups at risk of poor outcomes in the birth center environment. To expedite research, consistent use of national and international definitions of perinatal and neonatal mortality within data registries and greater detail on adverse outcomes would be beneficial.     

Outcomes of Planned Hospital Birth Attended by Midwives Compared with Physicians in British Columbia

ABSTRACT: Background: The impact of midwifery versus physician care on perinatal outcomes in a population of women planning birth in hospital has not yet been explored. We compared maternal and newborn outcomes between women planning hospital birth attended by a midwife versus a physician in British Columbia, Canada. Methods: All women planning a hospital birth attended by a midwife during the 2‐year study period who were of sufficiently low‐risk status to meet eligibility requirements for home birth as defined by the British Columbia College of Midwives were included in the study group (n =488). The comparison group included women meeting the same eligibility requirements but planning a physician‐attended birth in hospitals where midwives also practiced (n =572). Outcomes were ascertained from the British Columbia Reproductive Care Program Perinatal Registry to which all hospitals in the province submit data. Results: Adjusted odds ratios for women planning hospital birth attended by a midwife versus a physician were significantly reduced for exposure to cesarean section (OR 0.58, 95% CI 0.39–0.86), narcotic analgesia (OR 0.26, 95% CI 0.18–0.37), electronic fetal monitoring (OR 0.22, 95% CI 0.16–0.30), amniotomy (OR 0.74, 95% CI 0.56–0.98), and episiotomy (OR 0.62, 95% CI 0.42–0.93). The odds of adverse neonatal outcomes were not different between groups, with the exception of reduced use of drugs for resuscitation at birth (OR 0.19, 95% CI 0.04–0.83) in the midwifery group. Conclusions: A shift toward greater proportions of midwife‐attended births in hospitals could result in reduced rates of obstetric interventions, with similar rates of neonatal morbidity. (BIRTH 34:2 June 2007)     

Neonatal Omphalitis After Lotus Birth

Lotus birth, or umbilical nonseverance, is the practice wherein the umbilical cord is not separated from the placenta after birth, but allowed instead to dry and fall off on its own. Lotus birth may result in neonatal omphalitis. This article describes the history and rationale for lotus birth as well as the etiology, incidence, clinical presentation, and management of neonatal omphalitis. Recommendations for educating families how to perform lotus birth safely are presented. Additionally, signs and symptoms that warrant newborn assessment and treatment are reviewed.     

Perinatal Outcomes of Women Intending to Give Birth in Birth Centers in Australia

Abstract: Background: A recent Australian study showed perinatal mortality was lower among women who gave birth in a birth center than in a comparable low‐risk group of women who gave birth in a hospital. The current study used the same large population database to investigate whether perinatal outcomes were improved for women intending to give birth in a birth center at the onset of labor, regardless of the actual place of birth. Methods: Data were obtained from the National Perinatal Data Collection (NPDC) in Australia. The study included 822,955 mothers who gave birth during the 5‐year period, 2001 to 2005, and their 836,919 babies. Of these, 22,222 women (2.7%) intended to give birth in a birth center at the onset of labor. Maternal and perinatal factors and outcomes were compared according to the intended place of birth. Data were not available on congenital anomalies, or cause, or timing of death. Results: Women intending to give birth in a birth center at the onset of labor had lower rates of intervention and of adverse perinatal outcomes compared with women intending to give birth in a hospital, including less preterm birth and low birthweight. No statistically significant difference was found in perinatal mortality for term babies of mothers intending to give birth in a birth center compared with term babies of low‐risk women intending to give birth in a hospital (1.3 per 1,000 births [99% CI = 0.66, 1.95] vs 1.7 per 1,000 births [99% CI = 1.50, 1.80], respectively). Conclusions: Term babies of women who intended to give birth in a birth center were less likely to be admitted to a neonatal intensive care unit or special care nursery, and no significant difference was found in other perinatal outcomes compared with term babies of low‐risk women who intended to give birth in a hospital labor ward. Birth center care remains a viable option for eligible women giving birth at term. (BIRTH 37:1 March 2010)     

自由体位分娩对母婴分娩结局影响的Meta分析

目的:系统评价初产妇在产程中实施自由体位分娩对母婴结局的影响。方法:计算机检索Pub Med、Embase、CENTRAL、Web of Science、CINAHL、CBM、CNKI、VIP、Wan Fang Data数据库中有关自由体位分娩的随机对照试验,检索时间均为建库至2017年4月4日。由2名研究者独立按纳入、排除标准筛选文献、提取资料、评价纳入研究的偏倚风险后,采用Rev Man 5.3软件进行Meta分析。结果:共纳入18项随机对照试验,3 603例患者。Meta分析结果显示:自由体位分娩与常规卧位分娩在总产程时间(MD=-2.98,95%CI:-3.29^-2.68,P<0.000 01)、剖宫产率(RR=0.43,95%CI:0.37~0.51,P<0.000 01)、自然分娩率(RR=1.33,95%CI:1.27~1.39,P<0.000 01)、产后出血发生率(RR=0.25,95%CI:0.15~0.40,P<0.000 01)、会阴Ⅲ度裂伤发生率(RR=0.33,95%CI:0.17~0.67,P=0.002)、宫颈裂伤发生率(RR=0.34,95%CI:0.21~0.55,P<0.000 01)、新生儿窒息率(RR=0.31,95%CI:0.21~0.47,P<0.000 01)、新生儿颅内出血发生率(RR=0.22,95%CI:0.08~0.57,P=0.002)比较,差异有统计学意义;新生儿吸入综合征发生率(RR=0.73,95%CI:0.30~1.80,P=0.50)比较差异无统计学意义。结论:与常规卧位分娩相比,初产妇产程中采用自由体位分娩可缩短总产程时间,提高自然分娩率,降低剖宫产率,减少产后出血、软产道损伤,降低新生儿窒息和颅内出血的发生率,并且不会增加新生儿吸入综合征的风险。但受纳入研究质量限制,上述结论尚需开展更多高质量研究予以验证。