剖宫产术后再次妊娠阴道分娩的相关因素分析

目的:探讨影响剖宫产术后再次妊娠妇女阴道分娩是否成功的相关因素。方法:选取2018年1～12月我院产科剖宫产术后再次妊娠阴道分娩的孕妇100例,根据阴道分娩成功与否分为成功组82例和失败组18例。对两组孕妇的临床资料进行统计,利用单因素和多因素Logistic回归模型对影响剖宫产术后再次妊娠阴道分娩结局的影响因素进行分析。结果:孕妇的年龄、新生儿的体重、有无主观的顺产意愿、阴道分娩史、距上次剖宫产的时间间隔、是否是自然临产等多种因素是剖宫产术后再次妊娠妇女阴道分娩是否成功的影响因素,差异均有统计学意义(P<0.05);而多因素Logistic回归分析结果显示孕妇年龄、新生儿体重、阴道分娩史和自然顺产是影响剖宫产术后再次妊娠妇女阴道分娩是否成功的独立危险因素(P<0.05)。结论:孕妇的年龄、新生儿体重、阴道分娩史和自然临产对剖宫产术后再次妊娠阴道分娩是否成功有重要影响,对于剖宫产后选择阴道分娩的孕妇应及时关注上述指标并采取应对措施,以改善妊娠结局。     

应用阴道表面电极研究不同分娩方式对产后妇女盆底肌力的影响

目的 研究经阴道分娩及剖宫产分娩对产后妇女盆底肌力的影响.方法 将184例产妇根据分娩方式分为剖宫产分娩组(n=59)、阴道自然分娩组(n=117)及产钳分娩组(n=8);于产后6～8周进行问卷调查,并应用Femiscan生物反馈治疗仪检测产后盆底肌力.同期选择20例年龄相当的已婚未育女性作为对照组.结果 对照组妇女盆底肌力的各项指标均高于产后妇女,差异有统计学意义(P＜0.05).剖宫产分娩组产妇产后盆底肌力最强,产钳分娩组产妇产后盆底肌力最差,两组盆底肌肉活力值的差异有统计学意义(P＜0.05).剖宫产分娩组及阴道自然分娩组产后左右两侧盆底肌肉活力值的差异无统计学意义(P＞0.05).产钳分娩组产妇左右两侧盆底肌肉活力值比较,差异有统计学意义(P＜0.05).阴道自然分娩组产妇第一产程时间与产钳分娩组比较,差异无统计学意义(P＞0.05);两组第二产程时间比较,差异有统计学意义(P＜0.05).结论 阴道自然分娩产妇产后早期的盆底肌力与选择性剖宫产分娩产妇相当;产钳分娩产妇盆底肌力最差,可能与其第二产程时间过长有关.     

剖宫产术后再次妊娠阴道试产的探讨

对85例剖宫产术后再次妊娠妇女的阴道试产情况进行回顾性分析，并与阴道分娩的初产妇100例（对照组）进行比较。结果试产成功并经阴道分娩65例（阴道分娩组），占76．5％；试产失败再次剖宫产分娩20例（剖宫产组），占23．5％；先兆子宫破裂3例，占3．5％；阴道分娩组新生儿死亡1例。平均总产程阴道分娩组7.51±2.44小时，对照组9.10±3.75,差异有非常显性（P〈0．01）。提示剖宫产再次妊娠时，应给予充分的试产机会。[第一段]     

剖宫产后瘢痕子宫妊娠阴道分娩的临床分析

目的 分析剖宫产后瘢痕子宫妊娠妇女阴道分娩的安全性和可行性.方法 以516例剖宫产后瘢痕子宫妊娠妇女为研究对象,根据指征采取适当的分娩方式,其中376例实施剖宫产手术方式进行分娩(对照组),140例进行阴道分娩(观察组),比较2组产后24 h出血量、住院时间、子宫破裂发生情况及新生儿窒息率.结果 与观察组相比,对照组分娩后24h出血量更多,住院时间更长,差异具有统计学意义(P<0.05);2组均无子宫破裂发生;观察组新生儿窒息率为10.71%,低于对照组的21.01%,差异具有统计学意义(P<0.05).结论 与剖宫产相比,瘢痕子宫孕妇进行阴道分娩具有产后24 h出血量少、住院时间短的特点,可有效降低新生儿窒息率.     

剖宫产后再次妊娠分娩方式的探讨

目的：探讨剖宫产后再次妊娠的合理分娩方式。方法：将146例剖宫产后再次妊娠分娩的妇女分为两组,A1组符合阴道试产条件,为阴道试产组;B1组为再次剖宫产组。选择同期无剖宫产史的分娩妇女146例,也分为两组,A2组为阴道试产组,B2组为剖宫产组。比较A1组与A2组,B1组与B2组在分娩方式、产时及产后情况、母婴并发症方面的差异。结果：A1组与A2组在试产成功率、总产程、产后出血量、新生儿窒息率方面无明显差异;B1组在手术时间、术中出血量、平均住院天数方面均高于B2组,B2组新生儿窒息的发生率稍高。结论：剖宫产术后再次妊娠分娩,对符合试产条件者,应在严密监护下允许其阴道试产。     

孕妇并发羊水偏少的分娩方式及结局

目的 探讨足月妊娠妇女并发羊水偏少时,对分娩方式及分娩结局的影响。方法 比较B超诊断羊水偏少者（研究组）140例和同期B超检查羊水量正常的足月妊娠妇女（对照组）160例分娩方式及分娩结局。结果 羊水偏少组产钳率、剖宫产率、胎儿窘迫率均高于对照组（P〈0.05）,但两组新生儿重度窒息和轻度窒息的发生率差异无显著性（P〉0.05）。结论 羊水偏少的足月妊娠妇女易发生胎儿宫内窘迫,剖宫产率及阴道助产率增加,但在严密监护下可经阴道试产。     

剖宫产术后再次妊娠分娩88例临床分析

目的探讨剖宫产术后再次分娩方式的选择情况。方法选择我院2009年4月至2011年4月剖宫产术后再次妊娠妇女88例,根据产妇情况进行阴道试产,阴道试产失败转为急诊剖宫产,或者根据患者剖宫产指征直接行剖宫产。并将阴道分娩成功的产妇作为观察组,另随机抽取同期无剖宫产手术史阴道分娩32例,作为对照组。观察并比较两组产妇的产后出血量、产程时间以及新生儿情况。结果阴道试产成功率为80.0%。观察组新生儿感染、新生儿窒息和产褥感染发生率与对照组比较,差异无统计学意义(P>0.05);观察组产后出血量与对照组比较,差异无统计学意义(P>0.05)。结论剖宫产术后再次妊娠选择分娩方式时,可根据产妇具体情况进行阴道试产,但要严格掌握适应证。     

剖宫产术中放置节育器60例临床观察

近年来剖宫产率直线上升,剖宫产术解决了妇女因阴道分娩困难、阴道分娩失败而恐惧阴道分娩的问题,但手术创伤使子宫受到损伤形成瘢痕,存在再次妊娠时子宫破裂、子宫切口部位妊娠等风险,传统观点认为术后2年内不宜妊娠,因此剖宫产术后避孕成为妇女密切关注的问题。     

宫颈LEEP术后孕妇经阴道分娩观察

目的探讨宫颈LEEP术后妊娠妇女经阴道分娩情况。方法回顾性分析产科因宫颈病变行LEEP术治疗后妊娠并经阴道分娩的34例(观察组)产妇的产程、出血量、宫颈裂伤、新生儿体重等评分,同期产科35例正常经阴道分娩产妇为对照组。结果两组在产程、出血量、宫颈裂伤比较,观察组高于对照组,但差异无显著性(P>0.05);两组在新生儿体重比较,差异无显著性(P>0.05)。结论 LEEP术后对妊娠结局、新生儿无不良影响,但需长期随访。     

剖宫产术后再次妊娠阴道分娩22例分析

近年来,剖宫产率逐年升高,剖宫产后再次妊娠分娩方式也成为产科突出问题。现就剖宫产后再次妊娠阴道分娩22例进行分析。报告如下。1临床资料我院2005年1月—2010年1月共收治剖宫产术后再次妊娠妇女60例,其中阴道分娩成功22例。年龄24～35岁,孕周37～41周。对此22例入院待     

Recurrent postcoital lower-extremity streptococcal erythroderma in women. Streptococcal-sex syndrome

Two women with underlying distortion of their lower-body lymphatic systems from neoplasia and surgery or radiation therapy had recurrent episodes of lower-extremity erythroderma temporally associated with sexual intercourse. Both women had vaginal colonization with Streptococcus agalactiae (group B); one was shown to have recurrent bacteremia with this organism at the time of the episodes. Erythroderma developed in these women possibly because of seeding of S agalactiae in the vaginal soft tissues during coitus.     

Vaginal atrophy in the postmenopausal woman. The importance of sexual activity and hormones

The effect of sexual activity on vaginal atrophy was investigated in a group of 52 postmenopausal women (mean age, 57 years). Subjects were divided into two groups: sexually active (intercourse frequency, three or more times monthly) and sexually inactive (intercourse frequency, less than ten times yearly). Two gynecologists examined all subjects and completed an index of vaginal atrophy that assessed six genital dimensions. Blood samples were also analyzed by radioimmunoassay for levels of circulating estrone, estradiol, androstenedione, testosterone, follicle-stimulating hormone, and luteinizing hormone (LH). As predicted, less vaginal atrophy was apparent in the sexually active women as opposed to the sexually inactive women. Further, women with less vaginal atrophy had significantly higher mean levels of androgens (androstenedione and testosterone) and gonadotropins (particularly LH). We discuss herein the implications of this study, particularly the importance of androgens in reducing atrophy and maintaining sexual interest.     

Increased risk of postnatal depression after emergency caesarean section.

OBJECTIVE: To examine whether women having an emergency caesarean section are at increased risk of developing postnatal depression at one, three and six months postpartum. DESIGN: Participants were part of a larger study examining the relationship between personality dysfunction and postnatal depression. All women were recruited at an antenatal clinic in the first trimester of their pregnancy. These women were followed up at one, three and six months postpartum to identify cases of postnatal depression, defined by the Edinburgh Postnatal Depression Scale (EPDS). RESULTS: Data were collected from 188 women, who were divided into three groups by method of delivery: 21 women had an emergency caesarean section, 49 had a forceps delivery and 118 had a spontaneous vaginal delivery. Comparison of the groups indicated a significant difference at three months postpartum only. Women having an emergency caesarean section had significantly higher EPDS scores than women who had forceps or spontaneous vaginal delivery (9.15 +/- 6.18 v. 5.05 +/- 3.81 v. 5.79 +/- 4.47; F(2,143) = 4.2, P less than 0.02). Analysis of postnatal depression at three months indicated that women in the emergency caesarean section group had a relative risk of 6.82 (95% confidence interval, 2.85-16.15) compared with women in the other groups. CONCLUSIONS: When compared with women having spontaneous vaginal or forceps deliveries, women having an emergency caesarean section had more than six times the risk of developing postnatal depression three months postpartum. Special attention to this group appears warranted.     

Carcinoma of the cervix among women in their twenties. A 14% prevalence deserves our respect!

The purpose of this study was to estimate the value of routine vaginal cytology in women under 30 years of age. Over a five-year period, 18,160 vaginal cytological examinations were made on women aged 20 through 29 years, and 424 women (2.3%) were found to have Papanicolaou smears class III, IV, or V. Of these 424 patients, 122 (28.8%) were found to have carcinoma of the cervix. A tissue diagnosis of intraepithelial carcinoma was obtained in 103 women. The remaining 19 patients proved to have invasive carcinoma of the cervix. Approximately one third of this group of women with positive cytology failed to return for tissue diagnosis so the true prevalence of cancer was probably in the region of 40%. The findings suggest that women deserve routine vaginal cytological examinations irrespective of age.     

Systemic absorption and sustained effects of vaginal estrogen creams.

Systemic absorption and sustained effects of two estrogen vaginal cream preparations (Premarin and Estrace) were measured in 29 postmenopausal women receiving daily applications. With both preparations, vaginal absorption of estrogens into the systemic circulation was rapid, efficient, and sustained. It is apparent that estrogen vaginal cream preparations, as widely used in clinical practice for their local effects on the vaginal mucosa, actually result in sustained high estrogen levels in the systemic circulation. The vaginal route shows promise when systemic estrogen therapy is indicated, but is dangerous when estrogen is contraindicated.     

5060例妇女阴道物的检验结果分析

目的探讨妇女阴道分泌物感染的情况。方法回顾性分析妇科2010年10月～2010年12月进行阴道分泌物检查的5060例的临床资料,分析其清洁度、滴虫、霉菌、细菌性阴道病的情况。结果该组受检妇女中白细胞3＋至4＋2668例,占52.7%;阴道毛滴虫阳性40例,占0.79%;霉菌阳性668例,占18.1%;细菌性阴道病阳性916例,占13.2%。结论该组妇女阴道分泌物主要病原菌为细菌和念珠菌,病原菌在WBC3＋以上患者中检出率较高。早发现、早治疗有利于降低宫颈炎、盆腔炎等妇女疾病的发生。     

三种不同途径的子宫切除术手术结果评价

目的 比较非脱垂子宫经阴道子宫切除术、腹腔镜辅助下经阴道子宫切除术及经腹子宫切除术的手术结果。方法 有子宫切除指征的非脱垂子宫经阴道子宫切除术患者66例，腹腔镜辅助下经阴道子宫切除术患者47例，经腹子宫切除术患者50例，比较3组患者的手术时间、术中估计出血量，手术前、后Hb下降值及术后肠蠕动恢复时间、术后发热率、术后出院时间等各项指标。结果 腹腔镜组手术时间显著长于经阴道子宫切除术组和经腹子宫切除术组（P＜0．05）；术中估计出血量各组之间差别无显著性意义（P＞0．05）；术前、后血Hb下降值腹腔镜组略高于经阴道手术组和经腹手术组（均P＜0．05）；术后肠蠕动恢复时间、术后发热率、术后出院时间等指标腹腔镜组和经阴道手术组均显著低于经腹手术组（P＜0．05）。结论 经阴道子宫切除术和腹腔镜辅助下经阴道子宫切除术与经腹手术相比，具有术后恢复快，发热病例少，住院时间短，腹部不留疤痕或疤痕很小，符合微创手术原则，均可称为微创性子宫切除术。     

克林霉素磷酸酯阴道凝胶与磺胺乳膏治疗细菌性阴道炎疗效比较

目的：比较克林霉素磷酸酯阴道凝胶与磺胺乳膏治疗细菌性阴道炎的疗效。方法：使用随机双盲试验,纳入无妊娠、无哺乳、16岁以上有细菌性阴道炎的患者,使用7 d克林霉素磷酸酯阴道凝胶与磺胺乳膏,治疗完成后5-10d及25-39d随访。结果：在25-39d随访时,80名接受克林霉素磷酸酯阴道凝胶患者中的70名,78名接受磺胺乳膏患者中的38名治愈或缓解（ P＜0．05）。大部分的差异出现在有病史组。副作用发生率在两组间无差异。结论：克林霉素磷酸酯阴道凝胶治疗细菌性阴道炎的疗效优于磺胺乳膏。     

宫腔镜检查老年妇女阴道异常流血病因的可行性及安全性研究

目的探讨官腔镜在老年妇女阴道流血病因检查及治疗中的应用价值。方法选择2008年10月～2011年12月本院收治的老年妇女阴道流血患者120例,均进行官腔镜检查及病理诊断。选择同期育龄期阴道流血妇女120例为对照组,也进行官腔镜手术治疗。对比分析老年患者阴道流血出现的病因。结果两组患者均完成官腔镜检查．两组操作时间、出血量差异均无统计学意义（P〉0．05）,但老年妇女组妇女宫腔镜检查时心率明显下降者多于对照组,差异有统计学意义（P〈0．05）。老年阴道出血妇女子宫内膜息肉、萎缩性子宫内膜炎、子宫内膜癌发病率明显高于育龄妇女,差异有统计学意义（P〈0．05或P〈0．01）,而子宫黏膜下肌瘤,官腔粘连、子宫内膜不典型增生发病率明显低于育龄妇女,差异有统计学意义（P〈0．05或P〈0．01）。结论宫腔镜检查用于老年阴道出血患者,可尽早明确出血原因,准确度也优于传统B超,值得应用。     

复发性外阴阴道假丝酵母菌病患者阴道微生物的动态变化

目的 探究复发性外阴阴道假丝酵母菌病(RVVC)患者阴道菌群的动态变迁.方法 不同时间点采集RVVC患者(6例)以及正常对照女性(5例)阴道分泌物,分别对每个样本进行细菌总基因组DNA提取、16S rRNA V4区基因扩增及采用Illumina高通量测序技术对扩增的PCR产物进行测序等步骤,然后通过BIPES、TSC、GAST等程序,分析比较两组阴道菌群物种丰度和结构以及菌群动态变化.结果 正常对照女性阴道菌群以乳酸杆菌为主,其中惰性乳杆菌和卷曲乳杆菌比例相当,同时存在少量加德纳菌属、普氏菌属和其它菌属;或者以加德纳菌属、普氏菌属、奇异菌属、纤毛菌属等为主要菌属;而RVVC患者阴道菌群丰富度明显降低,以惰性乳杆菌为优势菌属,卷曲乳杆菌含量明显减少.正常对照女性阴道菌群随月经周期的变化出现波动,其中在月经期的波动最为明显,其优势菌属在月经周期中呈现相互交替或保持绝对优势的变化模式;而RVVC患者阴道菌群的波动性减弱,不随月经周期的变化而变化,且在疾病发作期和间歇期的菌群结构相似.结论 RVVC患者阴道菌群结构不随月经周期发生变化,在疾病发作期和间歇期相似.诱导卷曲乳杆菌产生或抑制惰性乳杆菌定植,从而恢复阴道菌群比例,可能可以治愈RVVC.