Barriers to effective contraception and strategies for overcoming them among adolescent mothers

Young women often have difficulty accessing and correctly using contraception. However, these difficulties are not primarily the result of lack of knowledge or experience of contraception. In this study, nine adolescent mothers were interviewed about their experience of contraception before and after the birth of their children. These adolescent women faced barriers to effective contraceptive use before the birth of their children. These barriers included indifference to the possibility of pregnancy, perceived invulnerability to pregnancy, and forgetting to use contraception regularly. Analysis also revealed that during the time these women were sexually active prior to pregnancy, many had used a range of strategies to overcome these barriers to effective contraception, including using adult support, allowing an adult to take responsibility for contraception, and using multiple methods of contraception to cover for contraceptive failure. The strategies used by these women to delay childbearing indicate valuable areas for further research in preventing unplanned adolescent pregnancy.     

妊娠期TORCH感染与妊娠结局的相关性分析

目的了解妊娠期TORCH感染状况与不良妊娠结局之间的关系。为本地区开展出生缺陷的预防和干预提供数据及建议。方法采用酶联免疫吸附实验（ELISA）检测孕妇血清中TORCH-IgM抗体,对阳性孕妇进行追踪,并随访其妊娠结局。结果1328例受检孕妇中,血清TORCH-IgM阳性33例,总阳性率2．48％。继续妊娠24例,不良妊娠结局16例,占66．67％。结论TORCH感染可致不良妊娠结局,也是造成出生缺陷常见的不良因素。孕前和孕期进行TORCH血清学筛查,并给予适当干预,可减少不良妊娠的发生和预防出生缺陷。     

围产儿出生缺陷及相关危险因素分析

【目的】探讨围产儿出生缺陷的发生情况并分析与其相关的危险因素。【方法】选取2011年3月至2015年3月于本院出生且发生出生缺陷的围产儿110例作为观察组,根据1∶3的原则选择同时间段出生的正常的新生儿作为对照组,对发生出生缺陷的临床资料进行回顾性分析,将可能与出生缺陷相关的因素进行单因素及Logistic多因素分析。【结果】观察组高文化程度者所占比例、人均收入水平高者所占比例及家庭居住在城市者所占比例显著低于对照组,差异有统计学意义（ P ＜00．5）;单因素分析显示,吸烟或者饮酒、感冒发热、妊娠合并症、服用其他药物、胎产次、孕期体力劳动、暴力与化学物质或者X线、不良孕产史、孕妇孕期有精神病史为出生缺陷的危险因素,而孕检、婚检、营养状况良好及服用叶酸为其保护因素（ P ＜00．5）;多因素Logistic分析显示,孕检、婚检为出生缺陷的保护因素,妊娠期合并症、暴露于化学物质或X线及吸烟或饮酒为出生缺陷的独立危险因素。【结论】围产儿出生缺陷的影响因素较多,可通过提倡孕检、婚检、在围孕期减少化学物质等有害物质的接触、降低孕期合并症的发生等来预防出生缺陷的发生。     

妊娠晚期超声指标与新生儿出生状况的研究进展

妊娠晚期超声检查不仅可以监测胎儿的生长发育情况,其检查指标还可以预测新生儿出生状况,为早期临床干预提供重要依据,提高新生儿的出生质量。本文就妊娠晚期羊水指数、胎儿血流参数、胎心率及胎盘成熟度指标与新生儿出生状况的研究进展进行综述。     

Methylmalonate excretion in a pregnancy at risk for methylmalonic acidaemia

In a pregnant woman, who had given birth to a child with methylmalonic acidaemia previously, urinary methylmalonate was measured at various intervals in the second half of the pregnancy. A significant increase was observed towards term. The child proved to be affected. This procedure enabled the detection of an affected fetus in the third trimester of pregnancy. If a case of methylmalonic acidaemia is detected in this way, treatment can be started immediately after birth.     

妊娠糖尿病对母婴的危害(附43例临床分析)

目的:探讨妊娠糖尿病对母婴的危害。方法:对43例妊娠糖尿病的临床资料进行分析,在孕周、新生儿出生时体重、剖宫产率方面与50例对照组进行统计学比较。结果:妊娠糖尿病组平均孕周明显小于对照组(P<0.01),出生时体重明显高于对照组(P<0.01),剖宫产率明显高于对照组(P<0.01),围产儿死亡率增高。结论:妊娠糖尿病对母婴危害巨大,故对所有孕妇孕24～28周行50g糖筛查,对高危因素孕妇孕32～34周复查,可及早诊断妊娠糖尿病。对妊娠糖尿病及早诊断和治疗、合理控制血糖水平、适时终止妊娠,可减少母婴并发症、降低围产儿死亡率。     

多指标联合筛查在早产预测中的应用及评价

目的探讨胎儿纤连蛋白（fFN）和宫颈长度联合测量在先兆早产及正常人群中预测价值。方法选择先兆早产孕妇160例及无任何先兆早产症状的正常孕妇328例,按改良Creasy评分法将正常孕妇分为早产高危组147例、早产低危组181例,各组孕妇分别超声下测量宫颈长度及检测阴道分泌物fFN定性情况,分析各指标与早产的关系。结果当宫颈长度〈30 cm时,先兆早产组、正常高危组、正常低危组各组孕妇的早产率分别为67.8%、58.8%、31.3%;以宫颈长度〈3 cm预测早产时,在无症状早产低危组中仍可筛查出31.3%的早产率。当fFN阳性时,先兆早产组、正常高危组、正常低危组各组孕妇的早产率分别为72.0%、63.5%、34.7%,显著高于fFN阴性时的早产率。阴道分泌物fFN阳性联合宫颈长度〈3 cm预测早产时,先兆早产组、正常高危组、正常低危组的特异性分别为86%、89.6%、87.8%。结论超声宫颈长度与fFN定性在早产低危人群中应常规检测。二者联合检测可提高早产预测的准确性。     

Maternal prepregnant body mass index and weight gain related to low birth weight in South Carolina

OBJECTIVES: The primary purpose of this study was to describe the proportion of low birth weight that could be potentially prevented by programs focusing on maternal prepregnant body mass index (BMI) and/or weight gain during pregnancy. METHODS: In this historic cohort design, study data consisted of birth certificates linked to the Pregnancy Risk Assessment Monitoring System for South Carolina resident women delivering in South Carolina during 1998 and 1999. Statistical analysis was conducted with the use of chi2, population-attributable risk, and logistic regression. The analysis was performed using SUDAAN to accommodate the analysis weight and extrapolate the sample data to the South Carolina state population. RESULTS: Eight percent of the very low birth weight (VLBW) rate in South Carolina can be attributed to inadequate weight gain in pregnancy. Approximately 19% of the state's VLBW rate can be attributed to either underweight or overweight BMI at conception. Women with less than adequate weight gain were 1.4 times more likely to deliver a VLBW baby and 1.9 times more likely to deliver a moderately low birth weight baby as compared with women with adequate weight gain. CONCLUSIONS: Appropriate maternal BMI at conception followed by adequate weight gain during pregnancy may have a substantial influence on reducing the number of low birth weight deliveries.     

影响低出生体重儿发生率的相关危险因素分析

目的分析影响低出生体重儿（low birth weight infant,LBWI）发生率的危险因素,以便采取相应预防措施。方法用病例对照的研究方法,通过病例资料和产科分娩登记本,比较分析405例LBWI儿与381例正常出生体重儿在产妇年龄、胎数、孕周、胎膜早破、妊娠高血压综合征、务工、孕期食欲、产检次数等方面的差异。结果产妇的年龄（〈20岁）、胎数、孕周、胎膜早破、妊娠高血压综合征、务工、孕期食欲差、产检次数〈6次与LBWI儿的发生率有相关性（P〈0．05）,多因素逐步Logistic回归分析显示：产妇的年龄（〈20岁）、多胎、早产、妊娠高血压综合征、务工、孕期食欲差、产检次数〈6次是引起LBWI儿的较危险因素。结论LBWI儿由孕期食欲差、早产、多胎、产妇年龄等独立危险因素引起,可采取相应的预防措施以降低其发生率。     

Prenatal genetic screening

This article presents a discussion of screening principles and techniques available to screen for common birth defects during pregnancy. Sixty-five to 70% of women have serum screening and /or ultrasound during pregnancy to evaluate the health and well-being of the developing fetus. The most common birth defects identified by screening include neural tube defects and chromosome abnormalities. Nurses employed in prenatal care settings need to have accurate information they can provide to women so they understand the benefits and limitations of screening. Timely presentation of information and identification of available resources will help nurses minimize confusion and provide support for women as they proceed with pregnancy screening.     

The Safety of Sumatriptan and Naratriptan in Pregnancy: What Have We Learned?

Objectives.— To monitor for a signal of major teratogenicity by determining the risk of all major defects following in utero exposure to sumatriptan and naratriptan. To monitor for unusual patterns of birth defects that might suggest teratogenicity. Background.— The prevalence of migraine is highest in women of childbearing age. Coupled with the recurrent nature of migraine attacks and the high proportion of unplanned pregnancies, intentional and inadvertent exposure to these drugs in pregnancy is likely. The Sumatriptan and Naratriptan Pregnancy Registry captures data on women exposed to those drugs during pregnancy to monitor for evidence of major teratogenicity. Methods.— Healthcare professionals from anywhere in the world can enroll, on a voluntary basis, women exposed to sumatriptan or naratriptan during their pregnancies in this primarily prospective, observational study. Only pregnancies with unknown outcomes at the time of enrollment were included in the analysis. The percentage of infants or fetuses with major birth defects was calculated as the total number of infants/fetuses with major birth defects divided by the sum of the number of infants/fetuses with major birth defects + the number of live births without defects. The risk of major birth defects was further stratified by earliest trimester of pregnancy exposure. Results.— Data are available on pregnancy outcomes from 599 exposed women. Among 479 first‐trimester exposures to sumatriptan, 20 outcomes with major birth defects were reported (4.6%, 95% confidence interval [CI] 2.9‐7.2%). The risk of major birth defects following exposure to sumatriptan during any trimester was 4.7% (95% CI 3.1‐7.0%). No distinctive pattern of major birth defects among exposed infants was noted. There were 50 first‐trimester exposures to naratriptan with 1 reported birth defect in a fetus with exposure to both sumatriptan and naratriptan. Conclusions.— The risk of all major birth defects following first‐trimester exposure to sumatriptan was 4.6% (95% CI 2.9‐7.2%). This coupled with a consistent failure of additional epidemiological studies to observe a signal for major teratogenicity gives a level of reassurance concerning the safety of sumatriptan in pregnancy. There are too few data on naratriptan to draw definitive conclusions, and the sample size for sumatriptan remains too small to detect any but very large increases in specific birth defects.     

超声检测宫颈长度预测早产的临床价值

目的探讨超声检测宫颈长度（cervicallength,CL）对先兆早产孕妇发生早产的预测价值。方法对2147例单胎先兆早产初产孕妇,分别经腹部、经阴道、经会阴超声检测CL,以CL〈2．6cm为宫颈缩短,追踪妊娠结局,比较三种方法对早产的预测价值。结果经腹部超声检测747例,CL〈2．6cm者早产率40．93％,CL≥2．6cm者早产率4．51％;经阴道超声检测689例,CL〈2．6cm者早产率69．85％,CL≥2．6cm者早产率1．45％;经会阴超声检测711例,CL〈2．6cm者早产率61．54％;CL≥2．6cm者早产率1．98％,三种检测方法检测的CL〈2．6cm组与CL≥2．6cm组的早产率差异均有统计学意义（P〈0．05）;经腹部、经阴道、经会阴超声测量预测早产的敏感性分别为78．57％、92．23％、89．72％,特异性分别为80．00％、93．00％、90．07％,阳性预测值分别为40．93％、69．85％、61．54％,阴性预测值分别为95．49％、98．55％、98．02％,经会阴、经阴道超声测量预测早产的敏感性、特异性、阳性预测值、阴性预测值均显著高于经腹部（P〈0．05）。结论超声检测CL对先兆早产孕妇发生早产有一定的预测意义。经会阴、经阴道超声预测早产的准确性优于经腹部超声。经会阴超声检测可以替代经阴道超声检测,从而提高患者治疗依从性。     

2016－2020年海口市新生儿出生缺陷的监测结果及危险因素研究

  目的   了解2016—2020年海南省海口市新生儿出生缺陷发生情况及相关危险因素，为制定预防措施提供参考依据。  方法   选取2016年1月至2020年12月在海南省妇幼保健院和海口市妇幼保健院出生的新生儿31 860名进行回顾性分析，对新生儿出生缺陷的检出率进行统计。 将有出生缺陷患儿设为病例组，另选取与病例组性别、年龄、出生时间匹配的健康新生儿为对照组，采用logistic逐步回归分析新生儿出生缺陷的危险因素。  结果   31 860名新生儿中共检出出生缺陷患儿419例，出生缺陷发生率1.32%。 出生缺陷发生率前5位依次为先天性心脏病、多指（趾）、唇腭裂、神经管缺陷、尿道下裂。 logistic逐步回归分析显示，2016—2017年（OR=2.903，95%CI:1.815～4.612）、异常生育史（OR=2.518，95% CI:1.604～3.805）、出生体质量（OR=5.182，95% CI:3.627～8.519）、孕期饮酒（OR=4.257，95% CI:3.106～6.115）、孕期吸烟（OR=4.613，95% CI:3.327～7.185）、孕早期病毒感染（OR=3.526，95% CI:2.413～5.114）、孕期服药史（OR=8.903，95% CI:5.275～15.927）、孕期有毒物质接触史（OR=7.602，95% CI:4.713～13.165）、孕期营养不良（OR=6.127，95% CI:3.952～11.864）及孕期不良精神刺激（OR=2.308，95% CI:1.462～3.287）是发生出生缺陷的危险因素。  结论   海南省海口市新生儿出生缺陷发生率仍较高，影响新生儿出生缺陷发生的危险因素众多，应针对性地加强孕期健康教育，降低出生缺陷的发生率。     

Does relaxation education in anxious primigravid Iranian women influence adverse pregnancy outcomes?: a randomized controlled trial

Maternal anxiety and stress are found to be predictors of adverse pregnancy outcomes, including low birth weight and prematurity. OBJECTIVE: The aim of the study was to determine whether relaxation education in anxious pregnant Iranian women in their first pregnancy affects selected pregnancy outcomes, including birth weight, preterm birth, and surgical delivery rate. SUBJECTS: A total of 110 obstetrically and medically low-risk primigravid women in Iran with a high anxiety level demonstrated by Spielberger's State-Trait Anxiety Inventory were randomly assigned into experimental and control groups. METHOD: In this randomized controlled trial, the experimental group received routine prenatal care along with 7-week applied relaxation training sessions, while the control group received only routine prenatal care. Anxiety and perceived stress were measured by pre-educational and post-educational intervention. Data related to pregnancy outcomes include birth weight, gestational age at birth, and type of delivery. RESULTS: Significant reductions in low birth weight, cesarean section, and/or instrumental extraction were found in the experimental group compared with the control group. No significant differences were found in the rate of preterm birth. CONCLUSION: The findings suggest beneficial effects of nurse-led relaxation education sessions during the prenatal period. This intervention could serve as a resource for improving pregnancy outcomes in women with high anxiety.     

4例剖宫产术后急性肺水肿临床分析及预防

回顾性分析总结4例剖宫产术后急性肺水肿患者的诱发因素。认为妊娠高血压病,妊娠合并心脏病,及精神过度紧张,输液速度过快是剖宫产术后急性肺水肿的主要诱因。防治产科严重并发症,做好病情观察,严格操作规程,加强心理护理,以减少剖宫产术后急性肺水肿的发生。     

孕期体质量管理对母婴体质量及妊娠结局的影响

目的探讨孕期体质量管理对母婴体质量及妊娠结局的影响。方法便利选取2014年1-6月首次在合肥市第一人民医院妇产科门诊确诊为早孕的557例妇女作为研究对象。在研究期限内,双月首次行产前检查且自愿接受孕期体质量管理的279例孕早期妇女为研究组,同期单月首次行产前检查的278例孕早期妇女为对照组(接受常规产前检查);两组产妇阴道分娩时均由助产士对母婴进行全面评估,符合条件者实施无创接生。比较两组研究对象的体质量增加值、新生儿体质量、分娩方式、妊娠及产后并发症的发生情况等。结果研究组孕妇孕期体质量增加、新生儿体质量及妊娠和产后并发症的发生率均低于对照组,剖宫产率及会阴切开率也低于对照组,差异均有统计学意义(均P0.05)。结论孕期进行体质量管理,能有效控制母婴体质量,减少妊娠及产后并发症的发生,对于改善孕产妇的妊娠结局具有十分重要的意义。     

孕期多样化健康教育对自然分娩的影响

目的：观察孕期实施多样化健康教育对自然分娩的影响。方法：将2010年度自然分娩的168例孕妇设为对照组,2011年度实施孕期多样化健康教育后的孕妇中随机选择168例设为观察组,两组一般资料比较差异无统计学意义（P〉0.05）,比较两组孕期健康教育知识问卷调查得分、孕期增长的体重指数、胎儿重量、产程时间、分娩中转剖宫产比例及胎儿窘迫发生比例。结果：两组健康教育知识问卷调查得分、孕期增长的体重指数、胎儿重量、产程时间、分娩中转剖宫产比例及胎儿窘迫发生比例比较差异有统计学意义（P〈0.05）。结论：通过孕期多样化健康教育,使孕妇获得了有关分娩知识及分娩的技巧,建立了自信心,减轻或消除焦虑、恐惧的心理,缩短了产程,提高了孕妇自然分娩率,减少了新生儿并发症。