产后子宫复旧不全研究现状及展望

本文总结了近年来产科学界对产后子宫复旧不全研究的现状,阐述了子宫复旧不全的主要影响因素,各种促进子宫复旧的措施,提出了一些前瞻性的可行的促进措施.旨在引起更多对子宫复旧问题的关注和研究,不断完善产科护理,促进妇女生殖健康.     

产后子宫复旧不全研究现状及展望

本文总结了近年来产科学界对产后子宫复旧不全研究的现状，阐述了子宫复旧不全的主要影响因素，各种促进子宫复旧的措施，提出了一些前瞻性的可行的促进措施。旨在引起更多对子宫复旧问题的关注和研究，不断完善产科护理，促进妇女生殖健康。     

中药穴位贴敷对产后子宫复旧不全的临床疗效

目的探究中药穴位贴敷对产后子宫复旧的临床疗效,并观察其预后情况。方法选取2012年1月至2013年12月收治的160例产妇作为研究对象,按数字随机法分为观察组与对照组,每组各80例。其中对照组采用常规的产科护理,观察组在对照组的基础上,给予患者中药穴位贴敷进行治疗,观察两组患者产后子宫缩复情况、恶露量以及子宫大小,进行比较分析。结果观察组子宫缩复情况于产后3 d开始显著优于对照组(P均<0.01);观察组产后2 d开始恶露量显著小于对照组(P均<0.01);产后5 d观察组血性恶露的患者比例显著少于对照组,且血性恶露持续时间显著短于对照组(P均<0.01)。观察组产后5 d子宫长径、前后径、横径显著小于对照组(P均<0.01)。结论中药穴位贴敷对于产妇子宫复旧有显著疗效,能够促进子宫的复旧,有效减少恶露的持续时间,可作为产后子宫复旧不全的预防及治疗方法。     

瘢痕子宫对再次剖宫产术及第三次剖宫产术的影响分析

随机抽取产科收治的132例瘢痕子宫产妇行再次剖宫产和第三次剖宫作为观察1组和观察2组,回顾性抽取产科资料库100例非瘢痕子宫产妇作为对照组。对比分析三组剖宫产术发生术中胎儿窒息率、术后盆腔粘连率、术后血栓形成率、术后子宫破裂率;统计并对比三组剖宫产的手术时间、术中及术后24h出血总量及子宫下段厚度;随访6周后对比产后子宫复旧及伤口愈合情况。观察1组和观察2组发生术中胎儿窒息,术后盆腔粘连、血栓形成及子宫破裂率均高于对照组;其手术时间和术中及术后24h出血总量均显著高于对照组,子宫下段厚度均薄于对照组;观察1组和观察2组产妇产后子宫复旧不全分别占4%、18.7%,产后伤口愈合不全率分别为2.0%、9.3%,对照组所有产妇子宫均复旧完全及伤口愈合完全;观察1组以上观察指标均显著优于观察2组,差异均有统计学意义(P<0.05)。相对于无瘢痕子宫产妇行剖宫术,瘢痕子宫产妇再次或三次妊娠再行剖宫产术的难度更大,手术时间较长,术中及术后总出血量多,术后发生子宫破裂及盆腔粘连损伤率、血栓形成率及产后子宫复旧和伤口愈合不全概率更高,此外,第三次剖宫产妇的各项生理指标均显著劣于第二次剖宫产妇。因此,针对即将妊娠的产妇,应尽量避免行剖宫产术,提前做好产前检查及准备,争取阴道自然分娩,减少瘢痕子宫的发生率,减少剖宫产术对产妇身体的再次伤害。     

38例晚期产后大出血伴休克患者的抢救及护理

晚期产后出血是指产妇分娩24h后至产褥期末所发生的子宫阴道大出血,是产科严重并发症,系产妇的四大死亡原因之一,多发生于产后1～2周内,阴道出血可以持续小剂量出血,然后大出血,亦可一次性大出血[1].多见于胎盘胎膜残留,宫腔感染及子宫复旧不全,剖宫产子宫切口裂开,会阴切开缝合术后感染裂开,子宫肌层出血等[1],我院产科自1996年至2002年1月,共收治38例晚期产后大出血伴休克的产妇,其抢救及护理体会探讨如下:     

产后康复操训练对剖宫产产妇产后子宫修复的影响

目的探讨产后康复操训练对剖宫产产妇产后子宫修复的影响。方法选取2015年1月~2016年12月我科分娩的120例剖宫产产妇,根据随机数字表法将产妇分为观察组和对照组,各60例。对照组在产褥期行产科常规护理干预。观察组在对照组的基础上行产后康复操训练。比较两组产后子宫复旧及康复情况。结果观察组产后第5、7、14d宫底高度低于对照组(P<0.05),产后第5、7、14d恶露量少于对照组(P<0.05)。观察组产后泌乳始动时间、子宫复旧时间、恶露持续时间、体重恢复至产前时间短于对照组(P<0.05)。结论产后康复操训练能有效促进剖宫产产妇产后子宫复旧,促进恶露排出,有利于产后康复。     

产科急症子宫切除32例临床分析

目的：探讨产科急症子宫切除的原因、手术指征和价值。方法：回顾性分析1993年1月至2007年6月间32例产科急症子宫切除病例的临床资料。结果：产科急症子宫切除的原因主要为胎盘因素、子宫破裂、子宫收缩乏力、晚期产后出血、羊水栓塞、产科DIC等。手术方式为子宫次全切除19例，子宫全切除13例。结论：产科急症子宫切除是治疗产科大出血，降低孕产妇死亡率的重要措施。     

产科急症全子宫切除术的病因学研究及相关危险因素

正产科急症是造成孕产妇死亡的主要原因,治疗产科急症孕产妇的重要措施是全子宫切除术~([1-2])。本研究选取在本院住院的产科急症子宫切除患者40例,对其发病原因及危险因素进行分析,现报告如下。1资料与方法1.1一般资料选取2008年1月—2014年12月在本院住院分娩的产妇,其中40例因出现产科急症而需行子宫全切除术,年龄20~41岁,平均年龄(28.5±     

母婴皮肤接触对新生儿喂养和母亲子宫复旧的影响

目的:探讨母婴皮肤接触对新生儿喂养和母亲子宫复旧的影响.方法:在宁夏医科大第二附属医院产科选取顺产的产妇60例,按照分段随机分组方法分为干预组和对照组各30例,干预组产妇接受常规产科护理后与新生儿进行1 h的母婴皮肤接触,并在随后住院的3 d内每天进行母婴皮肤接触两次,每次1 h,对照组产妇只进行常规产科护理.测量两组产妇产后2 h、第1天、第2天的宫底高度;用母乳喂养测量工具(BAT)评估首次母乳喂养成功率;电话随访产妇产后42 d时新生儿的喂养方式.结果:干预组产妇产后首次母乳喂养成功率、42 d纯母乳喂养率、子宫复旧的程度好于对照组(P<0.05).结论:母婴皮肤接触可以提高纯母乳喂养率,促进产妇子宫恢复.     

早期应用产后康复治疗仪促进产褥期妇女康复的效果

目的：探讨早期应用产后康复治疗仪对产褥期妇女康复的效果.方法：选取在我院自然分娩的健康产妇400例,按照随机原则等分为对照组和试验组.对照组在产褥早期（产后1～5d）接受产科常规护理和产褥期保健知识健康教育,试验组在对照组的基础上应用产后康复治疗仪进行治疗,比较两组患者在产后3d时乳汁分泌、子宫复旧情况.结果：试验组患者在产后3d时乳汁分泌、子宫复旧效果优于对照组（P＜0.05）.结论：早期应用产后康复治疗仪对促进产妇乳汁分泌和子宫复旧有明显作用,并且操作简便,值得推广应用.     

剖宫产术后B超检查结果分析

本文通过６７例剖宫产孕妇术后Ｂ超检查，发现术后子宫复旧不良、子宫切口愈合欠佳、官腔积血和宫旁血肿发生率分别为２２．４％、７．５％、３２．８％和７．５％。Ｂ超所见宫腔积血、宫旁血肿及子宫切口愈合欠佳均不能从术后体温反映且多无明显临床征象。认为剖宫产术后实际存在的并发症较临床诊断者高。剖宫产术后Ｂ超检查能起早期诊断和监护作用，可及时为临床提供客观依据。     

Uterine necrosis,infection, and subinvolution: complications observed after combined application of modified B-Lynch suture and vascular ligation

Compression sutures are primarily used to treat atonic postpartum hemorrhage. We herein describe three cases of selective arterial ligation combined with B-Lynch or modified B-Lynch suture for the treatment of intractable postpartum hemorrhage unresponsive to available conservative interventions. Three pregnant women underwent a cesarean section for a macrosomic fetus, fetal distress, and oligohydramnios, respectively. All three women developed intractable postpartum hemorrhage due to uterine atony with no chance of embolization therapy. B-Lynch or modified B-Lynch suture and additional selective arterial ligation were performed using braided absorbable suture. The first woman developed postoperative hematometra and infection without response to drainage and antibiotic therapy. Although laparoscopic exploration was performed to loosen the suture line and drain the hematometra and pyometra, the necrosis and infection could not be controlled. Subtotal hysterectomy was therefore conducted, and the necrotic uterine adnexa was removed. The other two women developed subinvolution of the uterus resulting in prolonged menstruation and amenorrhea, although the uterus was preserved and the bleeding was controlled. Modified B-Lynch suture combined with vascular ligation is an invaluable technique for women with severe intractable postpartum hemorrhage. However, it can lead to serious complications such as uterine necrosis, infection, and subinvolution.     

Subinvolution of placental bed vessels: case report and review of the literature

Subinvolution of placental bed vessels, a well-recognized cause of postpartum and postabortal hemorrhage, is defined with prolonged or excessive uterine hemorrhage beginning after the delivery or abortion. Although physiological changes in uteroplacental parts of spiral arteries are well known, the sequence of events in involution of these vessels is not yet clearly understood. In this article we present two cases of subinvolution of placental bed vessels in which we were able to demonstrate the presence of extravillous trophoblast in and around the placental bed vessels. The disease is supposed to be the result of abnormal interaction between maternal uterine cells and fetal trophoblast.     

不同放尿方法对剖宫产术后病人膀胱功能的影响

目的 :探讨剖宫产术后不同放尿方法对病人膀胱功能的恢复、子宫复旧及产后出血的影响。方法 :将 12 0例剖宫产术后病人随机分为3组 ,甲组采用开放式引流法 ,乙组采用自主性放尿法 ,丙组采用定时性放尿与自主性放尿相结合的方法。结果 :开放式引流法对剖宫产术后病人膀胱功能的恢复有影响 ,对子宫复旧、产后出血无影响 ;自主性放尿法对剖宫产术后病人膀胱功能的恢复、子宫复旧、产后出血均有影响 ;定时性放尿与自主性放尿相结合的方法可促进剖宫产术后病人膀胱功能的恢复 ,不影响子宫复旧及产后出血。结论 :定时性放尿与自主性放尿相结合的方法优于开放式引流法和单纯自主性放尿法 ,适用于剖宫产术后病人。     

早期护理干预在产褥期妇女康复中的应用

目的：采取早期护理干预,减少产后并发症发生,促进产后康复。方法：选取2012年4月1日至12月31日在本院住院自然分娩的健康初产妇200例,按照随机原则设立实验组和对照组。对照组在产褥早期（分娩当天至产后5d）,接受产科常规护理和产褥期保健知识健康教育;实验组在对照组的基础上,产后l～5d进行早期护理干预,主要包括：产后中药足疗、产后康复综合治疗仪的使用、产后体形恢复训练。在产后第4d调查乳汁分泌、子宫底高度、子宫复旧、恶露排出、食欲等情况。随访至产后42d,记录并发症情况。结果：实验组和对照组相比,产妇产褥期乳汁分泌多,食欲明显增加,子宫复旧、恶露排出快（P〈0．05）。产后并发症的发生率明显降低（P〈0．05）。结论：早期护理干预可以促进产褥期妇女康复,能减少产后并发症的发生。     

Real-time ultrasonographic analysis of the normal postpartum uterus: technique,variability, and measurements.

We evaluated normal uterine involution prospectively with real-time ultrasonography in 100 women after uncomplicated term vaginal delivery. Transducers easily distorted the spongy uterus during early postpartum scanning, an effect minimized with sector transducers that are superior to linear or convex probes for accurate early postpartum uterine measurement. Long-axis measurements correcting for uterine angulation were the most reproducible and accurate, irrespective of bladder distention. Uterine contractions caused instability of particularly the transverse dimension. Increasing maternal parity was associated with slightly but significantly larger uterine dimensions up to 4 weeks post partum. The uterus reassumed nongravid dimensions by 6 to 8 postpartum weeks. Uterine involution was unrelated to infant birth weight or breast feeding.     

Ultrasonic evaluation of the uterus and uterine cavity after normal, vaginal delivery.

OBJECTIVE: To describe uterine and uterine cavity changes throughout the puerperium, as revealed by ultrasound. METHODS: This was a prospective, longitudinal study in which 42 women with uncomplicated vaginal term deliveries were examined serially by ultrasound on postpartum days 1, 3, 7, 14, 28 and 56. The first four examinations were performed transabdominally and the last two transvaginally. The involution process of the uterus was assessed by measuring the anteroposterior diameter of the uterus and uterine cavity. Morphological findings were recorded. The influence on the involution process of parity, breast-feeding, maternal smoking and infant's birth weight were also evaluated. RESULTS: The maximum anteroposterior diameter of the uterus diminished substantially and progressively from 92.0 mm on day 1 postpartum to 38.9 mm on day 56. The maximum anteroposterior diameter of the uterine cavity diminished from 15.8 mm on day 1 to 4.0 mm on day 56. However, the anteroposterior diameter of the uterine cavity, 5 cm from the fundus, typically increased on days 7 and 14 postpartum. The position of the uterus and the shape and the appearance of the cavity change in a unique way during the normal puerperium. The uterus was most often retroverted and empty in the early puerperium. Fluid and debris in the whole cavity were seen in the middle part of the puerperium. In late puerperium the cavity was empty and appeared as a thin white line. Endometrial gas was occasionally visualized. No correlation was found between the involution of the uterus and parity, breast-feeding and the infant's birth weight. CONCLUSION: Transabdominal sonography is suitable for examination of the uterus during the first 14 days postpartum but from day 28 the transvaginal route is preferable. The uterine body and position, as well as the cavity, are easy to examine by ultrasound. Accumulation of fluid and debris in the uterine cavity is a common and insignificant finding of the involuting uterus. It is located in the cervical area in the early puerperium and in the whole uterine cavity in the middle part of the puerperium. Findings from uncomplicated vaginal deliveries are needed as a reference when the diagnostic efficacy of ultrasound for pathological conditions is to be tested.     

产褥期合理营养保健对产妇产后恢复的影响

目的 分析产褥期合理营养保健对产妇产后恢复的影响.方法 将于我院分娩的110例产妇根据产褥期护理方法不同分为常规组和干预组,各55例.常规组给予常规产褥期护理,干预组在常规产褥期护理基础上给予合理营养保健.比较两组的干预效果.结果 干预组产妇对产褥期正确饮食的认知优良度高于常规组(P<0.05).干预组产妇的子宫底高度...