以胎儿窘迫为指征的剖宫产416例分析

目的 分析探讨以胎儿窘迫为指征而行剖宫产术诊断的准确性及手术的合理性,降低以胎儿窘迫为指征的剖宫产率.方法 对1993年10月至2003年10月间416例以胎儿窘迫为指征的剖宫产病例资料进行回顾性分析.结果 以胎儿窘迫为指征者占剖宫产总教的20.90%,居首位.术前术后胎儿窘迫诊断符合率较低,表明对胎儿窘迫存在有诊断过度的问题,提示有一部分不合理的操之过急的剖宫产存在,缺乏合理性,诊断标准欠妥当.单纯根据胎心率或羊水情况诊断胎儿窘迫欠妥当,而胎心监护仪准确度亦有一定局限性.结论 诊断胎儿窘迫尚需多方面其他因素综合判断,采用产前多项指标联合监测及产时全程监护方法,探索医学规范的评判标准,结合孕妇的具体情况进行全面分析,提高胎儿窘迫的诊断符合率.正确掌握剖宫产指征,降低剖宫产率.     

胎儿宫内窘迫与剖宫产相关分析

胎儿宫内窘迫是指胎儿在子宫内因急性或慢性缺氧危及其健康和生命的综合征.围产儿死亡的20%～30%与胎儿宫内窘迫或胎儿宫内窘迫合并其他因素有关[1].及时剖宫产,可降低围生儿死亡率.由于目前对胎儿宫内窘迫的诊断方法还不够完善,胎儿危险状态也缺乏明确界限,因此,胎儿宫内窘迫与临床出现新生儿窒息现象有时并不一致.     

Can umbilical and arcuate artery Doppler velocimetry predict fetal distress among prolonged pregnancies?

We studied umbilical and arcuate artery Doppler velocity waveforms in 30 uncompromised prolonged pregnancies (greater than 41 weeks of gestation). Normal systolic/diastolic ratios in these vessels had a negative predictive value similar to other antepartum tests. The positive predictive value, though, was not high enough to consider Doppler studies of the umbilical and arcuate arteries as the only test to identify the group of prolonged pregnancies that have uteroplacental insufficiency. There is a possibility that the combination of Doppler velocimetry with other antepartum tests may improve our ability to predict poor outcome. Further study is needed.     

甘油灌肠剂在剖宫产术后的应用

[目的]探讨甘油灌肠剂对防治剖宫产术后并发症的作用。[方法]将剖宫产术后拔管3h不能自解小便的产妇169例随机分为观察组86例、对照组83例，观察组用甘油灌肠剂110mL经肛门注入，对照组将开塞露40mL按常规方法经肛门注入。[结果]观察组与对照组比较，排尿有效率提高，腹胀发生率低，排便、排气时间提前，泌乳量增加。[结论]甘油灌肠剂在剖宫产术后的应用明显减少了术后并发症，提高了母婴生活质量。     

甘油灌肠剂在剖宫产术后的应用

[目的]探讨甘油灌肠剂对防治剖宫产术后并发症的作用.[方法]将剖宫产术后拔管3 h不能自解小便的产妇169例随机分为观察组86例、对照组83例,观察组用甘油灌肠剂110 mL经肛门注入,对照组将开塞露40 mL按常规方法经肛门注入.[结果]观察组与对照组比较,排尿有效率提高,腹胀发生率低,排便、排气时间提前,泌乳量增加.[结论]甘油灌肠剂在剖宫产术后的应用明显减少了术后并发症,提高了母婴生活质量.     

Levels of free and conjugated catecholamines in amniotic fluid and in umbilical and maternal blood in patients undergoing cesarean section

A new radioenzymatic assay was used to evaluate free and conjugate catecholamines in six pregnant women who underwent cesarean section at term, in their newborns and in the amniotic fluid. Free adrenaline in maternal plasma was higher while noradrenaline and dopamine were lower at the moment of surgery than 24 hours before the operation. In umbilical plasma adrenaline and noradrenaline are higher than in maternal plasma while only traces of free dopamine and salsolinol are present. In the amniotic fluid high levels of free and conjugated salsolinol are found. The high level of free and conjugated catecholamines found in the umbilical plasma demonstrates that fetal sympathetic nervous system is strongly activated at delivery. Furthermore the presence of sulfoconjugating activity similar to that of the adult is confirmed.     

Cerebral, umbilical, and uterine resistance using Doppler velocimetry in postterm pregnancy

The purpose of this study is to assess alterations in vascular resistance as measured by Doppler ultrasound in the postterm fetus. Forty-five postterm patients (greater than or equal to 287 days gestation by "good" dates) underwent Doppler velocimetry and calculation of systolic to diastolic (S/D) ratios of the umbilical, internal carotid, and uterine artery waveforms within 7 days of delivery. Patients were divided into two groups. Group 1 consisted of 26 patients with normal antepartum fetal surveillance that included reactive nonstress test and an amniotic fluid index (using the four-quadrant technique) equal to or greater than 5 cm. Group 2 consisted of 19 patients with antepartum compromise on the antepartum fetal surveillance tests. There was significantly greater (p less than .05) morbidity in group 2 compared to group 1 as judged by cesarean section for fetal distress (47% vs 15%), meconium at delivery (53% vs 4%), and 5-minute Apgar score less than 7 (30% vs 4%). There were no significant differences in the umbilical and uterine artery S/D ratios in the two groups, although patients in group 2 had significantly lower cerebral S/D ratios (3.6 +/- .5) compared to group 1 (4.4 +/- 0.4) (p less than .05). The ratio of cerebral to placental (umbilical) resistance in group 2 was significantly lower (1.1 +/- .3) compared to group 1 (1.8 +/- .3) (p less than .05). There was a low incidence of abnormal umbilical (greater than 3) and uterine (greater than 2.6) S/D ratios in both groups.(ABSTRACT TRUNCATED AT 250 WORDS)     

Short-term versus long-term cefuroxime prophylaxis in patients undergoing emergency cesarean section

A prospective randomized clinical trial was conducted to test the effectiveness of long-term and short-term prophylaxis with cefuroxime in preventing morbidity after cesarean section. Sixty patients who required emergency cesarean section were randomly assigned to one of three treatment groups: a control group of 20 patients receiving no prophylactic antibiotics; a group of 20 patients receiving 24 hours of cefuroxime prophylaxis (0.75 gm 30 to 60 minutes before surgery and at 8 hours and 16 hours after surgery); and a group of 20 patients receiving five days of cefuroxime prophylaxis (0.75 gm three times a day, the first dose being given postoperatively). The short-term and long-term prophylaxes were equally effective in reducing morbidity, assessed by postoperative temperatures, presence or absence of endometritis, and duration of postoperative hospital stay.     

剖宫产产妇术后用药及其护理

近年来,我国的剖官产手术率大幅度提高.据粗略统计,我院2007年全年剖宫产率高达55%.原因是多方面的.有医院、医生方面的因素,也有产妇自身及家属方面的因素.与自然分娩相比,剖宫产的产妇需要更多的药物治疗或预防,而几乎所有存在于母亲血液中的药物都可能通过血乳屏障(由毛细血管,内皮间质、基底膜、细胞膜、腺上皮细胞组成)转运到乳汁<'[1]>.化学物质,特别是药物对新生儿的影响已是公众关注的问题.尤其现在新药大量涌入市场.对医务人员也是一个难题.因此,医务人员应该对围产期用药原则有所了解.     

Cesarean section due to fetal distress increases the number of stem cells in umbilical cord blood

BACKGROUND: Umbilical cord blood (UCB) can be used as hematopoietic stem cell source for transplantation. The success of a transplantation is highly correlated with the number of total nucleated cells (TNCs) and CD34+ cells in the UCB. Certain obstetric factors increase the yield of stem cells in the UCB. It is necessary to evaluate optimal conditions in labor to decrease the rate of sample rejection due to low cell count. No data exist regarding the difference between primary and secondary Cesarean sections in terms of efficacy of stem cell harvesting. STUDY DESIGN AND METHODS: Seventy-nine consecutive UCB units from women who had a Cesarean section between 1997 and 2003 were included. The number of TNCs, CD34+ cells, colony-forming units (CFUs), white blood cells (WBCs), nucleated red blood cells (NRBCs), and the total collection volume were compared between cases with primary and secondary Cesarean section. RESULTS: UCB obtained after a Cesarean section due to fetal distress has significantly higher numbers of TNCs, CD34+ cells, NRBCs, and WBCs compared to elective Cesarean section. Of the cases with secondary Cesarean section due to fetal distress, 67 percent resulted in UCB units with sufficient TNC numbers (> or =80 x 10(7) TNCs) compared to 42 percent of the cases with primary Cesarean section. CONCLUSION: Fetal distress increases the number of hematopoietic stem cells mobilized into UCB. Particular effort should be made to collect UCB from newborns who experienced fetal distress.     

妊娠合并肝硬化患者剖宫产围手术期的护理

随着医学科学的不断发展,肝硬化的治疗有了很大提高.妊娠合并肝硬化在积极治疗的同时做好围生期监测,患者会有较好的预后.我院妇产科2006年6月-2008年6月共收治妊娠合并肝硬化患者28例,其中22例行剖宫产术.     

剖宫产术后实施早期乳房推拿的效果观察

[目的]观察剖宫产术后实施早期乳房推拿对乳汁分泌的影响。[方法]将71例剖宫产病人按床号的不同分为观察组35例和对照组36例。观察组在常规护理早吸吮、按需哺乳等基础上,从术后24h起对产妇进行乳房推拿疗法(每次10min～15min,每天3次或4次,连续2d),对照组在常规护理早吸吮、按需哺乳等基础上,从48h起即乳房充盈胀痛时对产妇进行乳房推拿疗法(每次10min～15min,每天3次或4次,连续2d),比较两组推拿前及推拿48h后乳房胀痛发生率、血清泌乳素、乳房体积及始乳时间的变化。[结果]观察组乳房胀痛发生率明显低于对照组(P<0.05),血清泌乳素水平明显高于对照组(P<0.01),始乳时间早于对照组(P<0.01),乳房体积大于对照组(P<0.01)。[结论]剖宫产术后实施早期乳房推拿疗法,可有效防治乳房胀痛,促进泌乳。     

剖宫产术后留置导尿管拔除方法探讨

[目的]观察剖宫产术后两种不同方法拔除气囊导尿管对产妇舒适度的影响.[方法]将180例剖宫产术后产妇随机分成实验组和对照组,实验组(90例)采用新方法即自行排出气囊导尿管;对照组(90例)按照传统方法即护士辅助拔除气囊导尿管.比较两组产妇拔管后尿道疼痛、自行排尿等情况.[结果]实验组产妇舒适度明显高于对照组(P＜0.05).[结论]剖宫产产妇术后拔除留置气囊导尿管时采取自行随尿液排出的拔管方法,可大大降低拔管时带来的不适感.     

双氯芬酸钠栓对剖宫产术后舒适度的影响

[目的]观察双氯芬酸钠栓提高剖宫产术后舒适度的效果。[方法]选择同期剖宫产术后病人100例,随机分为实验组和对照组各50例。术前均常规留置导尿管,术后24h拔除导尿管。对照组采用传统的拔除尿管法,实验组术毕给予双氯芬酸钠栓50mg塞肛,拔除尿管时,再予双氯芬酸钠栓50mg～100mg塞肛。比较两组的镇痛效果及术后恢复情况。[结果]实验组术后镇痛效果及满意度明显优于对照组(P<0.05),且术后24h内的睡眠时间较对照组延长,拔除尿管后排尿时间、下床活动及肛门排气时间均提前(P<0.05),术后舒适度提高。[结论]双氯芬酸钠栓塞肛用于剖宫产术后镇痛效果满意,对提高产妇术后舒适度和满意度有重要意义。     

临床护理路径在剖宫产产妇中的应用

目的：探讨临床护理路径在剖宫产产妇中的应用效果。方法：通过抽签的方法将200例剖宫产术产妇随机分为对照组（100例）和实验组（100例）,对照组沿用传统护理模式,按护理程序制定护理计划进行护理;实验组采用临床护理路径,从产妇入院至出院,每天进行标准化护理。结果：实验组平均住院日、平均住院费用明显低于对照组（P〈0.01）;产妇对于健康知识的掌握情况和满意度明显高于对照组（P〈0.05）。结论：临床护理路径在确保护理质量的情况下,降低了医疗成本,提高了产妇满意度。     

健康教育路径在择期剖宫产术产妇中的应用

[目的]探讨健康教育路径在择期剖宫产术产妇中的应用效果.[方法]将180例行择期剖宫产术分娩的产妇随机分为实验组和对照组各90例, 对照组采用传统健康教育方式,实验组按照健康教育路径进行健康教育.[结果]两组住院时间、住院费用、产妇满意度和健康知识评分比较差异有统计学意义.[结论]健康教育路径的实施,使产妇接受系统、科学的医疗护理照护,可缩短住院时间,降低住院费用,提高产妇满意度和护理工作质量.     

急诊剖宫产产妇分娩过程心理体验的质性研究

目的了解急诊剖宫产产妇分娩过程的心理体验。方法采用质性研究中现象学研究法,对12例行急诊剖宫产的产妇进行半结构式访谈,并用现象学分析方法进行资料分析。结果通过阅读、分析、反思、分类和提炼,得出急诊剖宫产产妇分娩心理体验5个主题:不确定感,焦虑与恐惧,自责内疚与负罪感,疼痛,情感支持。结论急诊剖宫产产妇分娩心理感受负向。     

健康教育路径在择期剖宫产术产妇中的应用

[目的]探讨健康教育路径在择期剖宫产术产妇中的应用效果。[方法]将180例行择期剖宫产术分娩的产妇随机分为实验组和对照组各90例,对照组采用传统健康教育方式,实验组按照健康教育路径进行健康教育。[结果]两组住院时间、住院费用、产妇满意度和健康知识评分比较差异有统计学意义。[结论]健康教育路径的实施,使产妇接受系统、科学的医疗护理照护,可缩短住院时间,降低住院费用,提高产妇满意度和护理工作质量。