阴道分娩97例初产妇产后尿潴留危险因素临床分析

目的:探讨经阴道分娩产后尿潴留(postpartum urinary retention,PUR)的危险因素,为降低PUR发生率、减少产后并发症提供理论依据。方法:选择天津医科大学宝坻临床学院(我院)2016年1—12月经阴道分娩PUR患者97例为观察组[A组,其中分娩镇痛者83例(A1组),无分娩镇痛者14例(A2组)],随机选择同期经阴道分娩无尿潴留者88例为对照组[B组,其中分娩镇痛者59例(B1组),无分娩镇痛者29例(B2组)]。记录2组患者一般信息、妊娠期合并症及妊娠期并发症、产时情况、产后出血情况及新生儿体质量,进行回顾性分析。结果:2组产妇妊娠期合并症及并发症、孕次、胎膜早破、枕左前(LOA)胎位、第三产程时间和新生儿体质量比较,差异无统计学意义(均P0.05)。孕周、分娩镇痛、产钳助娩、侧切、第一产程时间、第二产程时间和产后出血比较,差异有统计学意义(均P0.05)。发生PUR的危险因素有孕周增大(OR=1.619,95%CI:1.121～2.339)、产钳助娩(OR=4.981,95%CI:2.184～11.361)、产后出血(OR=3.429,95%CI:1.024～11.488)和侧切(OR=2.419,95%CI:1.058～5.531)。PUR危险因素的ROC曲线分析:年龄最佳临界值为26.50岁,孕周最佳临界值为40.36周,新生儿体质量最佳临界值为3 372.50 g,分娩镇痛第一产程最佳临界值为402.50 min,分娩镇痛第二产程最佳临界值为61.50 min,无分娩镇痛第一产程最佳临界值为230.00 min,无分娩镇痛第二产程最佳临界值为34.50 min。结论:对孕周、分娩镇痛、产钳助娩、侧切、第一产程时间、第二产程时间、产后出血诸因素适当干预,可减少PUR的发生。     

阴道分娩产后尿潴留51例的临床观察及护理体会

目的：探讨产后尿潴留的临床观察与护理体会。方法：对2008年8月至2011年12月住院产妇阴道分娩发生尿潴留51例产妇的护理进行回顾性分析。结果：通过心理疏导物理刺激及药物治疗,患者均自解小便。结论：细心观察病情,有效的健康指导及护理干预,可以大大减少产后尿潴留的发病机会。     

分娩性臂丛神经麻痹发病危险因素的探讨

目的 探讨分娩性臂丛神经麻痹(OBPP)的发病危险因素.方法 收集1997年1月至2009年12月山东省医疗事故鉴定办公室进行医疗鉴定并已诊断为OBPP的46例患者为OBPP组,按照1:3的匹配方式随机选取同医院、同时期、同性别的正常分娩138例新生儿作为对照组.采用回顾性病例对照研究的方法,对两组新生儿情况、产妇情况、分娩过程及助产士工作年限等因素进行单因素及多因素logistic回归分析.结果 (1)两组产妇骨盆外测量均在正常值范围,两组新生儿均为单胎头位并经阴道分娩.OBPP组均为单侧臂丛神经损伤,其中左侧22例,右侧24例;全臂型17例,上臂型26例,前臂型3例.两组产妇年龄、孕产次及分娩孕龄比较,差异均有统计学意义(P＜0.05).(2)OBPP组产前体质指数(BMI)、宫高、腹围分别为(29.5±2.4) kg/m2、(34.9±2.4)及(105±6) cm,对照组分别为(26.1±2.5)kg/m2、(33.7±2.2)及(99±5) cm,两组比较,差异有统计学意义(P＜0.05).OBPP组新生儿平均出生体质量[(4390±489)g]明显高于对照组[(3404±360)g],两组比较,差异有统计学意义(P＜0.01).OBPP组助产士工作年限[(5.2±2.3)年]明显低于对照组[(8.9±5.4)年],两组比较,差异有统计学意义(P＜0.01).(3)OBPP组与对照组应用器械助产率分别为28.3％及3.6％,宫缩乏力发生率分别为28.3％及6.5％,第二产程延长发生率分别为8.7％及0.7％,胎方位异常发生率分别为10.9％及2.9％.OBPP组以上各指标均高于对照组,两组比较,差异均有统计学意义(P＜0.05).(4)条件logistic回归单因素分析发现,两组产妇年龄、产前BMI、宫高、腹围、新生儿出生体质量、孕次、第二产程时间、分娩助产、胎位异常、宫缩乏力及助产士工作年限比较,差异均有统计学意义(P均＜0.05).其中,助产士工作年限为保护性因素.(5)将上述各相关指标作为变量,选择逐步回归法进行多因素logistic回归分析,选人界值均为0.10,结果显示,孕妇产前BMI和新生儿出生体质量与OBPP发生有关联(P＜0.10),OR值分别为1.733和1.004.孕妇产前BMI OR值大于新生儿出生体质量OR值,孕妇产前BMI意义大于新生儿出生体质量.结论 孕妇产前BMI是OBPP发病的最重要危险因素,其次,另一个高危因素是新生儿出生体质量.助产士工作年限较长是其保护性因素.     

阴道无张力尿道中段悬吊带术后尿潴留发生及危险因素研究

目的:确定阴道无张力尿道中段悬吊带术(TVT)后尿潴留的发生率,探讨影响膀胱排空功能障碍的相关因素及其防治措施。方法:回顾性分析136例行TVT手术患者的病例资料,其中97例同时行子宫切除或阴道壁修补术等其他妇科手术,术后第2天测残余尿,记录患者临床资料。结果:17例术后发生尿潴留,恢复时间平均为5.2天,13例术后1周内恢复正常排尿功能,2周内全部恢复正常。单因素分析显示年龄、产次及最大尿流率(≤20 ml/s)两组间差异有显著性,多因素分析显示只有最大尿流率有统计学意义(OR=0.076,P=0.040)。结论:行TVT术后发生尿潴留的患者大多在1周之内膀胱排空功能恢复正常,术前最大尿流率值对预测术后尿潴留发生有价值。     

综合护理干预对分娩镇痛产后尿潴留的影响分析

目的 探讨分娩镇痛产后尿潴留产妇采用综合护理干预后的应用效果。方法 选取380例分娩镇痛产后尿潴留产妇,根据随机数字表法将其分为对照组（采用常规护理）与观察组（在常规护理基础上采用综合护理干预）,每组190例。对比两组产妇血性恶露时间、首次排尿时间、第二产程疼痛情况、导尿率、尿潴留发生率及护理满意度。结果 观察组血性恶露时间、首次排尿时间均短于对照组,差异有统计学意义（P<0.05）,两组第二产程疼痛评分比较,差异无统计学意义（P>0.05）。观察组导尿率2.63%和尿潴留发生率3.68%显著低于对照组10.53%、13.16%,护理满意度94.74%高于对照组86.84%,差异有统计学意义（P<0.05）。结论 分娩镇痛产后尿潴留产妇采用综合护理干预效果显著,值得推广与应用。     

初产妇产后早期盆腔器官脱垂的高危因素分析

目的：探讨初产妇足月阴道分娩后产后早期盆腔器官脱垂（POP）发生的高危因素。方法：选取2017年1-4月在上海交通大学医学院附属国际和平妇幼保健院产后6～8周复诊的经阴道足月分娩的初产妇1 216例。同时行盆腔器官脱垂定量分度法（POP-Q）评分,按评分结果分为POP组（644例）和对照组（572例）,采用单因素和多因素Logistic回归分析各种产科因素与产后早期发生POP的相关性。结果：在1 216例阴道分娩的初产妇中,POP的发生率为52.96%（644/1 216）;POP组的年龄、分娩孕周、新生儿出生体质量以及产钳助产率显著高于对照组,差异有统计学意义（均P＜0.05）;而2组产妇孕前体质量指数（BMI）、孕期体质量增加量、产时BMI、第二产程时间、是否会阴裂伤和是否会阴侧切比较,差异均无统计学意义（均P＞0.05）。多因素Logistic回归分析显示,与年龄＜28岁的产妇相比,年龄≥36岁的产妇产后早期POP的发生风险显著升高（OR=2.352,P=0.010,95%CI：1.222～4.526）;与新生儿出生体质量＜3 000 g的产妇相比,新生儿出生体质量为3 500～3 999 g和≥4 000g的产妇产后POP的发生风险均显著增加（OR=2.039,P=0.000,95%CI：1.385～3.003;OR=2.676,P=0.007,95%CI：1.303～5.495）;与自然分娩的产妇相比,行产钳助产的产妇产后POP发生风险显著升高（OR=1.760,P=0.019,95%CI：1.097～2.823）。结论：初产妇阴道分娩产后POP的发生与年龄、新生儿出生体质量以及产钳助产有关。阴道分娩产后POP发生率高,应加强产妇盆底疾病的预防及重视产后康复训练,尤其是有高危因素的产妇。     

经产妇产后早期压力性尿失禁的临床危险因素分析北大核心CSCD

目的分析经产妇产后早期(6～8周)压力性尿失禁(Stress urinary incontinence, SUI)的临床危险因素。方法回顾性分析于北京大学第三医院2016年1月至2017年10月分娩及产后复查的141例经产妇临床资料,依据尿失禁简表(ICIQ-UI)确诊SUI 81例,非SUI即对照组60例,比较两组的相关危险因素。结果单因素分析显示,与非SUI组相比,经产妇产后早期SUI组的前次阴道分娩和末次阴道分娩比例明显升高(63.2%vs 36.8%,P=0.016;63.3%vs 36.7%,P=0.009)。前次阴道分娩合并会阴侧切和会阴裂伤经产妇发生产后早期SUI比例升高(66.1%vs 33.9%,P=0.014;76.2%vs 23.8%,P=0.009)。末次阴道分娩无会阴侧切或裂伤、合并会阴侧切、合并会阴裂伤三种情况的经产妇产后早期SUI是末次剖宫产分娩的1.6倍、2.0倍以及1.7倍(RR:1.594,P=0.095;RR:1.939,P=0.043;RR:1.723,P=0.014)。末次妊娠时年龄、孕前体质指数、孕期体重增加、新生儿体重、妊娠期糖尿病等因素,在两组之间差异均无统计学意义(P>0.05)。多因素分析显示,末次阴道分娩是经产妇产后早期SUI的独立危险因素(OR=2.939 95%CI:1.232～7.009,P=0.015)。结论末次分娩方式为阴道分娩的经产妇发生产后早期SUI风险明显增加,并及时给予指导和必要的干预。     

低置胎盘产妇阴道分娩产后出血高危因素分析

目的:探讨低置胎盘产妇阴道分娩产后出血的高危因素。方法:分析上海市第一妇婴保健院2014年1月至2015年12月阴道分娩的345例低置胎盘活产单胎患者临床资料,按产后出血与否分为两组行单因素分析,并使用多因素Logistic回归分析评估各项高危因素。结果:产后出血共47例,总产后出血率13.6%。单因素分析显示辅助生殖受孕、产前出血史、胎盘距宫颈内口距离、胎盘粘连与产后出血有关(P0.05),Logistic多因素回归分析中则表明辅助生殖受孕(OR=8.181,95%CI 3.072~21.791)及胎盘粘连(OR=6.543,95%CI 3.107~13.775)为低置胎盘产后出血的独立高危因素。结论:低置胎盘患者应进行系统产前检查和分娩前经阴道超声检查,对各种高危因素进行分析评估,可能能提供更好的低置胎盘患者分娩方式的选择及对产后出血风险的预测,从而降低其产后出血率。     

改良产后出血预测评分表在阴道分娩中的预测价值

目的探讨产后出血高危因素及改良产后出血预测评分表在阴道分娩中的预测价值。 方法回顾性分析2017年12月至2018年5月在中山大学附属第三医院产科行阴道分娩并纳入研究的产妇616例,根据是否发生产后出血分为研究组(36例)和对照组(580例),收集两组患者的产前、产时及产后资料,使用Logistic回归筛选危险因素;运用改良产后出血预测评分表对产后出血各高危因素进行评估,计算产前、产时、产后各阶段评分及总评分,计算并比较两组各阶段评分及总评分预测产后出血的ROC曲线下面积。 结果两组患者在产程时长是否正常(aOR＝3.12,95%CI：1.14~8.50)、是否自然临产(aOR＝2.57,95%CI：1.05~6.30)、产后进食少(aOR＝12.27,95%CI：2.52~58.82)方面的比较,P值均<0.05。总评分对产后出血预测效果最好,ROC曲线下面积为0.734(0.697~0.768)。当总评分≥5分时,预测产后出血的敏感度为77.78%,特异度为57.93%。 结论产程异常、人工引产、产后进食少是产后出血的独立危险因素。改良的产后出血预测评估表具有良好的预测效果。     

宫颈癌根治性切除术后合并尿失禁的危险因素分析

目的：探讨宫颈癌根治性切除术后合并尿失禁的影响因素,为其预防和个性化综合治疗提供依据。方法：回顾性分析2013年1月—2018年12月就诊于北京大学人民医院行宫颈癌根治性切除术后合并尿失禁的ⅠA1～ⅡA2期患者共14例（尿失禁组）,另选取同期就诊接受宫颈癌根治性切除术治疗且未合并尿失禁的患者43例为对照组。记录患者一般资料及临床病理资料,对宫颈癌患者术后合并尿失禁的危险因素进行分析。结果：单因素分析显示,2组手术前后血红蛋白差值、淋巴结切除数目、手术时间、阴道断端长度和术者年手术量差异有统计学意义（均P＜0.05）。多因素Logistic分析结果显示,手术前后血红蛋白差值大（OR=1.164,95%CI：1.006～1.348,P=0.042）、手术时间长（OR=79.896,95%CI：2.033～3 139.492,P=0.019）、术者年手术量少（OR=13.116,95%CI：1.046～164.436,P=0.046）是患者术后发生尿失禁的独立危险因素。结论：对于合并手术前后血红蛋白差值大、手术时间长和术者年手术量少的宫颈癌患者,应及时采取有效的综合措施,预防术后尿失禁的发生。     

Risk Factors for Urinary Incontinence in Primiparous Adolescents after Vaginal Delivery: A Cohort Study

Study ObjectiveTo evaluate urinary incontinence (UI) risk factors in primiparous adolescents between 7 and 48 months after vaginal delivery.DesignCohort study.SettingPhysical Therapy Laboratory on Women's Health and Pelvic Floor at the Federal University of Pernambuco.Participants, Interventions, and Main Outcome MeasuresCohort follow-up time was 7-48 months after delivery, guaranteeing that no participant presented with UI until 7 months after the infant's birth. Primiparous adolescents aged 10-19 years were included in the study, and those who had UI during pregnancy were excluded. Sample size was estimated at 140 volunteers, considering the calculation for logistic regression, with 20 observation units for each of the 7 variables proposed in the theoretical model developed for the study. The volunteers answered the evaluation form, providing information on the outcome of interest and possible risk factors. Univariate logistic regression analysis was performed.ResultsThe following risk factors for UI were identified in primiparous adolescents after vaginal delivery: episiotomy (Relative risk [RR]_a, 2.75; 95% confidence interval [CI], 1.22-6.06), large newborn for gestational age (RR_a, 4.58; 95% CI, 1.68–12.46) and less than six prenatal appointments (RR_a, 2.51; 95% CI, 1.05–6.04).ConclusionProfessionals working in maternal health care should pay special attention to primigravid mothers, guide prenatal appointments, avoid routine episiotomy, and use obstetric practices recommended by the World Health Organization.     

剖宫产术后再次妊娠阴道试产的研究进展

随着生育政策的转变,剖宫产术后再次妊娠孕妇逐渐增多.如何选择分娩方式引起了产科学界的广泛思考与讨论.既往此类孕妇推荐选择性重复剖宫产术作为终止方式,虽可规避子宫破裂风险,但其造成的母体二次损伤及较高的产后出血风险仍不可忽视.近年逐渐推广的剖宫产术后再次妊娠阴道试产及分娩在母儿预后方面展现出更高的价值.通过转变围生保健模...     

Study of the Risk Factors for Cesarean Delivery in Induced Labors at Term

Background

Induction of labor has become one of the most common interventions in obstetrics. Induction is indicated when the benefits to either mother or fetus outweigh those of continuing the pregnancy. Maternal complication rates that are increased in association with labor induction include cesarean delivery, chorioamnionitis, abruptio placentae, and uterine atony. So identifying those pregnancies that can be induced with low risk of cesarean delivery is important. The aim of this study was to identify those factors which influence the risk of emergency cesarean delivery in induced labors at term.

Methods

It is a case–control study conducted at Tertiary care center and affiliated hospitals. In this study, odds ratio with 95 % confidence interval is taken as a measure of relative risk. Patients were evaluated for risk factors for cesarean section using logistic regression. Cases include all women who were induced at term and delivered by emergency cesarean section. Controls include all women who were induced at term and delivered vaginally.

Results

The risk factors for cesarean delivery are advanced maternal age at delivery (≥35 years), high early pregnancy body mass index (≥30 kg/m²), nulliparity, low preinduction Bishops score (<5), gestational diabetes mellitus, and intrauterine growth restriction.

Conclusion

Women with multiple risk factors for cesarean can be taken up for elective cesarean section rather than inducing them at term.     

产后出血不同时段出血量的危险因素分析

目的:探讨产后出血不同时段出血量的危险因素。方法:整理156例产后出血产妇临床资料,比较胎盘娩出前、胎盘娩出时、产后30分钟、产后30分钟～1小时、产后1～2小时、产后2～4小时、产后4～6小时、产后6～24小时8个时段的出血量,多元线性回归分析其与相关临床资料的相关性。结果:①胎盘娩出时出血量最多(均P<0.05);产后30分钟次之(均P<0.05);余时段出血量渐少,但差异均无统计学意义(均P>0.05)。②入院时体重指数(BMI)、宫高分别与胎盘娩出前、胎盘娩出时出血量呈明显正相关(B=0.341和0.345,均P<0.05);入院时血红蛋白(Hb)及红细胞(RBC)、孕期产前检查次数分别与胎盘娩出时、产后30分钟出血量呈明显负相关(B=-0.354、-0.751和-0.237,均P<0.05);有异常妊娠史胎盘娩出前出血量明显升高(P<0.05);剖宫产或胎盘娩出异常者胎盘娩出时出血量明显升高(均P<0.05);并发羊水过多、宫高≥40cm、双胎或巨大儿之一产后2小时内各时段出血量均明显升高(均P<0.05)。结论:产后30分钟内出血最显著,产后不同时段出血量的危险因素不同。     

Risk factors for obstetric fistula in the Far North Province of Cameroon

Objective

To describe the circumstances of occurrence and identify potential risk factors for obstetric fistula in northern Cameroon.

Methods

A case series study of 42 obstetric fistula patients seeking services at the Provincial Hospital of Maroua, Cameroon, between May 2005 and August 2007. Structured interviews were conducted prior to surgical intervention.

Results

Among obstetric fistula patients, 60% had lived with obstetric fistula for more than 5 years at the time of surgery. Eighty-one percent of patients had received no formal education and 86% were teenagers at their first delivery. Regarding the pregnancy and delivery preceding the occurrence of the fistula, 50% of women reported that they had received no prenatal care and 76% were in labor for more than 12 hours. The majority (83%) of women delivered a stillborn baby.

Conclusions

Obstetric fistula patients in the Far North Province of Cameroon had a low level of education, were married at a young age, and had poor access to quality maternal healthcare services.     

Prediction of Preeclampsia and Delivery of Small for Gestational Age Babies Based on a Combination of Clinical Risk Factors in High-Risk Women

Objective. To develop clinical risk tools for preeclampsia and small for gestational age (SGA) in high-risk women. Methods. Individual risk scores based on clinical risk factors were calculated using logistic regression and validated in 1687 women with obesity in first pregnancy, chronic hypertension, or previous preeclampsia. Results. The risk of preeclampsia varied from 7% in obese primiparae without hypertension to 30% when previous preeclampsia and chronic hypertension occurred together. A prediction model incorporating these risk factors had a sensitivity of 48 and 89% for preeclampsia delivered <34 weeks' gestation. Conclusion. Multiple clinical risk factors increase the risk of preeclampsia and SGA.     

Awareness,Beliefs and Perspectives Regarding Weight Retention and Weight Gain among Postpartum Women in India: A Thematic Analysis of Focus Group Discussions and In-Depth Interviews

Background and AimsThe pregnancy weight is usually retained in the form of abdominal fat during the postpartum period. The willingness to lose weight is influenced by knowledge, attitude, beliefs and practices. This study aims to comprehend the awareness, beliefs and perspectives of postpartum women regarding their perceived factors, barriers and facilitators associated with post-pregnancy weight status.MethodsOverweight and obese postpartum women aged between 20 and 40 years and had delivered an infant in the last 2 years were recruited via convenience and purposive sampling techniques. The final sample comprised 27 participants with a mean age of 29.96 ± 4.50 years. Four focus group discussions and eight in-depth interviews carried out were audio-recorded and transcribed verbatim. Codes, sub-themes and themes were generated using Atlas.ti 9 software.ResultsMajor themes identified were perceived factors causing postpartum weight retention/weight gain including social and cultural beliefs related to diet and exercise specifically associated with this period, perceived motivators and deterrents of weight loss including eagerness to lose weight and perceived facilitators and barriers to weight loss including intrinsic and extrinsic factors such as time, energy, evidence-based knowledge about diet and physical activity, family support and obligation to family’s advice.ConclusionThe unique challenges and barriers associated with postpartum weight loss efforts should be taken into consideration by healthcare professionals and public health policy-makers to design strategies specific to postpartum women.Supplementary InformationThe online version contains supplementary material available at 10.1007/s13224-022-01644-9.