脐带脱垂30例围产儿结局分析

目的:探讨脐带脱垂类型、脱垂时间及产前检查与新生儿窒息和复苏结局的关系,以指导其处理和预防。方法:回顾性分析2002年1月～2011年12月10年间我院发生的30例脐带脱垂的病例资料。结果:隐性脱垂6例,新生儿窒息1例(16.7%);显性脱垂24例,死胎1例,新生儿窒息16例(66.7%),两组新生儿窒息发生率差异显著(P<0.05)。显性脐带脱垂中脱垂时间≤25min 14例,新生儿窒息7例(50%);脱垂时间>25min 10例,死胎1例,新生儿窒息9例(90%),两组新生儿窒息发生率差异显著(P<0.05)。显性与隐性脐带脱垂组窒息新生儿5min和10min复苏结局均良好,无显著差异。结论:隐性脐带脱垂患者的新生儿窒息发生率显著低于显性脱垂;脐带脱垂时间越长新生儿窒息发生率越高;尽快结束分娩是抢救胎儿的关键,剖宫产是结束分娩的较好选择。     

RRT模式下21例显性脐带脱垂孕妇临床资料总结分析

目的:研究显性脐带脱垂孕妇的临床表现、救治过程和母婴结局,为临床提供救治经验。方法:回顾分析2012年12月至2016年11月在济南市妇幼保健院住院分娩的21例显性脐带脱垂孕妇的临床资料。结果:快速反应团队(RRT)模式管理下,18例显性脐带脱垂患者行紧急剖宫产手术,无产后出血及感染的发生;1例经阴分娩;2例胎死宫内。脐带脱垂的发生时间、发生地点、胎位及脱垂类型均与新生儿1min Apgar评分无关(P均0.05)。胎心正常者的新生儿出生后1min Apgar评分高于胎心减速者,差异有统计学意义(P0.05)。确诊脐带脱垂至胎儿分娩所间隔的时间(DDI)为12～31min,平均(19.14±12.89)min。结论:脐带脱垂时团队快速反应并合作,紧急剖宫产术,母婴结局良好。RRT建立,定期模拟培训是产科重要的管理模式,可改善母婴结局。     

英国皇家妇产科医师学会《脐带脱垂指南》2014版要点解读

脐带脱垂是在胎膜破裂情况下,脐带脱至子宫颈外,位于胎先露一侧（隐性脐带脱垂）或越过胎先露（显性脐带脱垂）,是导致围产儿死亡的重要原因,发生率为0.1%～0.6%。导致脐带脱垂的主要原因包括胎位不正、多次分娩、胎膜早破、羊水过多、产科干预等因素,其导致的胎儿不良结局包括早产、新生儿窒息甚至新生儿死亡。     

头先露脐带脱垂诊治分析—附5例病例报告

目的：加深对头先露脐带脱垂的认识,及早发现并有效预防脐带脱垂的发生。方法回顾两所医院7年中发生的5例头先露前置胎盘的临床资料,分析其临床经过。结果 5例显性脱垂病例,发生率为0.01%,3例新生儿死亡,经阴道分娩;2例经剖宫产获活婴。结论加强预防,警惕脐带脱垂的发生,早期发现,正确处理。     

脐带先露与脐带脱垂的诊断和治疗

胎膜未破,脐带位于胎先露部前方者称脐带先露;胎膜已破,脐带脱出于子宫颈口外、降至阴道甚至外阴者称脐带脱垂;上述两者属于真性脐带脱垂.凡脐带旁置于胎先露部之一侧,夹在胎先露与子宫下段软组织间,一般检查不能触及者称隐性脐带脱垂.脐带一旦脱垂,脐带处于胎先露与骨盆壁之间,脐带受压血流受阻,可致胎儿宫内窘迫或死亡,是分娩期威胁胎儿生命的严重并发症.我院1983年至1990年间7342例分娩中发生脐带脱垂11例,发病率为0.15%,11例中胎儿死亡5例,围产儿病死率为450‰.与国外的90～490‰相近,高于国内报道的369.8‰.     

脐带脱垂预测及紧急处理

脐带脱垂是严重危及胎儿的产科急症,对具有发生脐带脱垂高危因素的孕产妇密切监护,早期诊断和及时有效处理脐带脱垂,不但能降低围产儿死亡率,还可大大改善其结局。该文从脐带脱垂的预测和处理两方面进行阐述。     

电子胎心监护诊断脐带先露的意义

脐带异常是造成胎儿宫内缺氧的重要原因;脐带脱垂尤其是隐性脱垂对胎儿的危害更大,可造成胎儿急性宫内缺氧、新生儿窒息或围产儿死亡。目前,脐带脱垂及隐性脱垂仍无理想的产前诊断方法,Ｂ超及彩色多普勒检查虽能诊断部分患者,但多数脐带脱垂及隐性脱垂患者不能在产前得到诊断。电子胎心监护（ｅｌｅｃｔｒｏｎｉｃ　 ｆｅｔａｌ ｈｅａｒｔ　ｍｏｎｉｔｏｒ　,　ＥＦ－ＨＭ）是产前、产时监测胎儿宫内窘迫的有效方法。１９９４年１月至１９９９年１２月我院诊断足月分娩并发脐带脱垂或隐性脱垂共８６例,其中５０例行ＥＦ－ＨＭ,现将…     

显性脐带脱垂77例临床分析

1977年至1991年15年间,我院分娩总数28420次,共发生显性脐带脱垂77例,发生率为0.27%,围产儿病死率为223.7‰.脐带脱垂的原因主要为胎位异常,以臀位足先露较多,其次为胎头高浮,脐带过长,低体重儿等.处理原则为:一旦发生脐带脱垂,应立即取臀高位,经阴道上推先露部,如不能立即分娩,确认胎儿尚存活者,即刻就地行剖宫产术,获活产儿成功率较高.对宫口已开全具备经阴道分娩条件者,立即阴道助产分娩比等待自然分娩围产儿结局要好.     

臀位脐带脱垂综合防治的研究

臀位脐带脱垂综合防治的研究３５０００１福建省妇幼保健院陈捷，陈水仙，王梅英为减少臀位脐带脱垂，降低新生儿窒息率及围产儿死亡率，我们在对１９８２～１９８８年臀位脐带脱垂１１４例临床分析研究的基础上，指导１９８９～１９９３年的临床实践，取得明显成效。资料...     

新生儿窒息

新生儿娩出后一分钟内仅有心跳而无呼吸,或未建立规则呼吸的缺氧状态,称为新生儿窒息。世界卫生保健机构将新生儿娩出后发生缺氧、碳酸增多及酸中毒等现象称为窒息,这是偏重于说明病理机制。 1 新生儿窒息的病因 1.1 母体因素:母亲急性失血、贫血、低血压、妊高征、慢性高血压或呼吸功能不全等疾患造成低氧血症。 1.2 多胎、羊水过多使子宫膨胀或胎盘灌注不足,脐带血流中断。正常脐带长30～70Cm,凡相对或绝对脐带过短或过长,如脐带打结、扭转、绕颈、脐带脱垂等,     

Clinical risk factors for poor neonatal outcomes in umbilical cord prolapse

Objectives: To clarify the clinical risk factors associated with poor neonatal outcomes due to umbilical cord prolapse (UCP).

Methods: A postal questionnaire survey was attempted in Japan. The clinical risk factors and managements associated with poor neonatal outcomes were analyzed in cases of UCP treated in Japan.

Results: A total of 267 cases of UCP (out of 2?037?460 total deliveries) were analyzed. The rates of intrauterine death, neonatal death and survival with disability were 3.4%, 5.6% and 7.1%, respectively. The multivariate regression analysis for these poor neonatal outcomes revealed that the significant risk factors included a prolapsed amniotic sac (adjusted odds ratio (aOR), 4.49), preterm labor (aOR, 2.99) and replacement of the prolapsed umbilical cord into the uterus (aOR, 2.87). However, UCP that occurred during labor (aOR, 0.28) and emergency cesarean section (aOR, 0.11) were associated with a reduction in the rates of poor outcomes. The interval between the diagnosis of UCP and delivery was significantly longer in the infants with a poor outcome than intact survival (median 30 versus 24?min, p?=?0.048).

Conclusion: An emergency cesarean section should be carried out immediately to ensure a better outcome for the infant.     

Umbilical cord prolapse after preterm premature rupture of membranes

ObjectiveTo investigate the incidence of umbilical cord prolapse (UCP) and its influence on infant prognosis in pregnant women with preterm premature rupture of membranes (PPROM).Materials and methodsWe conducted a retrospective cohort study in a single tertiary perinatal center between 2009 and 2017. Singleton pregnancies with PPROM that occurred between 22 and 33 weeks of gestation were included. Infantile composite adverse outcome consisted of death, severe intraventricular hemorrhage, cystic periventricular leukomalacia, necrotizing enterocolitis, and sepsis before discharge. Infantile outcomes were compared between pregnancies that were complicated by UCP and those that were not.ResultsOut of 208 singleton pregnancies included in the analysis, UCP occurred in 12 (5.8%) cases. The gestational age of pregnancies with UCP was significantly lesser than that of those without UCP. The incidence of infantile composite adverse outcome in patients with UCP was 16.7%, and this was not significantly higher than the incidence in patients without UCP (6.6%, P = 0.21). UCP was not shown to be associated with infantile composite adverse outcome in a multivariate regression model. Gestational age <25 weeks at delivery was significantly associated with infantile composite adverse outcome.ConclusionsThe incidence of UCP was 5.8% among singleton pregnancies, with PPROM being managed expectantly between 22 and 33 weeks’ gestation. Preterm UCP may not be associated with infantile adverse outcomes provided emergency cesarean delivery is available at all time.     

Term pregnancy with umbilical cord prolapse

ObjectiveTo investigate the incidence, management, and perinatal and long-term outcomes of term pregnancies with umbilical cord prolapse (UCP) at Mackay Memorial Hospital, Taipei, from 1998 to 2007.Materials and MethodsFor this retrospective study, we reviewed the charts, searched a computerized birth database, and contacted the families by telephone to acquire additional follow-up information.ResultsA total of 40 cases of UCP were identified among 40,827 term deliveries, an incidence of 0.1%. Twenty-six cases (65%) were delivered by emergency cesarean section (CS). Of the neonates, 18 had an Apgar score of <7 at 1 minute, 10 of these scores being sustained at 5 minutes after birth, and three infants finally died. Eleven UCPs occurred at the vaginal delivery of a second twin, and nine with malpresentation. All of the infants who had good perinatal outcomes also had good long-term outcomes. Poor perinatal outcomes occurred in cases where there was a delayed diagnosis, or an inability to carry out an emergency CS or a prompt vaginal delivery.ConclusionEarly detection of UCP and expeditious delivery are crucial to good perinatal outcomes. An emergency CS remains the mainstream management. Multiparous women whose cervixes are nearly fully dilated and who are expecting babies relatively smaller than their elder brothers or sisters born vaginally may still have vaginal deliveries managed by well-experienced birth teams, with good perinatal outcomes. Otherwise, vaginal delivery is not recommended and CS is the wiser choice.     

Nursing Management of Umbilical Cord Prolapse

Advances in the management of umbilical cord prolapse hold promise for reducing perinatal morbidity and mortality. This article reviews traditional nursing management of umbilical cord prolapse and introduces the use of real-time ultrasound and bladder filling as additional methods of nursing management. A case report is provided.
Time is of the essence in the nursing management of UCP. Although traditional nursing interventions are effective for the management of UCP, real-time ultrasound and bladder filling have been proven in the medical literature and clinical studies to reduce the perinatal morbidity and mortality in such instances. In accordance with nurse practice acts and institutional policies, nurses can be qualified to perform these advanced assessments and implementations. For nurses in offices, clinics, and rural hospitals, bladder filling can be an effective intervention that will allow time for the necessary transportation of the patient and preparations for cesarean delivery. With these advances in patient care, nurses can be instrumental in promoting positive perinatal outcomes for patients with UCP.     

Scheduled deliveries: avoiding iatrogenic prematurity

The balance of maternal, fetal, and neonatal risks of continued pregnancy versus iatrogenic delivery must be based on best evidence. Although avoiding elective deliveries prior to 39 weeks is well established to improve neonatal outcomes, several "soft" conditions are commonly considered to require delivery prior to 39 weeks. Review of existing literature suggests that with some of these conditions, delivery can be safely delayed until later in pregnancy or even allowed to proceed without intervention. Late preterm and early term deliveries contribute substantially to neonatal morbidity and health care costs and should be considered only if the risks of continuing the pregnancy exceed the neonatal risks related to early birth. In this article, we review some the common clinical scenarios that may result in scheduled early term or late preterm births, with a focus on practice strategies for improving maternal and neonatal outcomes.     

Kjelland's forceps in the new millennium. Maternal and neonatal outcomes of attempted rotational forceps delivery

Background:  The use of Kjelland's forceps is now uncommon, and published maternal and neonatal outcome data are from deliveries conducted more than a decade ago. The role of Kjelland's rotational delivery in the 'modern era' of high caesarean section rates is unclear.
Aims:  To compare the results of attempted Kjelland's forceps rotational delivery with other methods of instrumental delivery in a tertiary hospital.
Methods:  Retrospective review of all instrumental deliveries for singleton pregnancies 34 or more weeks gestation in a four-year birth cohort, with reference to adverse maternal and neonatal outcomes.
Results:  The outcomes of 1067 attempted instrumental deliveries were analysed. Kjelland's forceps were successful in 95% of attempts. Kjelland's forceps deliveries had a rate of adverse maternal outcomes indistinguishable from non-rotational ventouse, and lower than all other forms of instrumental delivery. Kjelland's forceps also had a lower rate of adverse neonatal outcomes than all other forms of instrumental delivery.
Conclusions:  Prudent use of Kjelland's forceps by experienced operators is associated with a very low rate of adverse maternal and neonatal outcomes. Training in this important obstetric skill should be reconsidered urgently, before it is lost forever.     

Comparison of Adverse Maternal and Neonatal Outcomes in Women Affected by Placenta Previa With and Without a History of Cesarean Delivery: A Cohort Study

ObjectiveComprehensive comparison of maternal and neonatal outcomes between placenta previa with and without a history of caesarean delivery is sparse in the literature. The objective of this study was to conduct such an analysis.MethodsWe conducted a retrospective cohort study involving all cases of placenta previa among 56 070 singleton births at two tertiary care hospitals in Guangdong, China, between January 2014 and December 2018. Placenta previa cases were divided into two groups: those with a history of caesarean delivery and those without. We first compared baseline characteristics and then compared maternal and neonatal outcomes between the two groups. Multiple log binomial regression and multiple linear regression analyses were performed to estimate independent association between a history of caesarean delivery and adverse maternal and neonatal outcomes.ResultsA total of 773 placenta previa cases were included in the final analysis. Of them, 546 had a history of cesarean delivery and 227 did not. Compared with placenta previa cases without a history of cesarean delivery, placenta previa cases with a history of caesarean delivery were at increased risks of placenta accrete and increta, uterine rapture, shock, severe anemia, hysterectomy, and increased bleeding and hospital costs. No differences in neonatal outcomes between the two groups were observed.ConclusionsHistory of caesarean delivery is associated with an increased risk of adverse maternal outcomes but not with neonatal outcomes with placenta previa.     

妊娠期糖尿病患者的分娩时机及方式

妊娠期糖尿病(gestational diabetes mellitus,GDM)的发病率逐年上升,已成为妊娠期最常见的合并症之一,严重影响了围产期母儿的妊娠结局.合适的分娩时机及分娩方式,能有效降低GDM围产期并发症的发生率,有利于改善孕妇和新生儿不良结局.本文主要就近年来关于GDM的分娩时机、分娩方式及其影响因素研...     

Route of breech delivery and maternal and neonatal outcomes.

OBJECTIVE: To compare maternal and neonatal outcomes in elective cesarean vs. attempted vaginal delivery for breech presentation at or near term. METHODS: We reviewed the maternal and neonatal charts of all singleton breech deliveries of at least 35 weeks' gestation or 2000 g delivered between 1986 and 1997 at our institution. Patients delivered by elective cesarean were compared to those attempting a vaginal delivery. The neonatal outcomes analyzed were: corrected mortality; Apgar scores less than 7 at 5 min; abnormal umbilical cord blood gases; birth trauma; and admissions to the intensive care nursery. Maternal morbidity was also assessed and compared. RESULTS: Of 848 women meeting criteria for evaluation, 576 were delivered by elective cesarean while 272 attempted a vaginal delivery. Of 272 women undergoing a trial of labor, 203 (74.6%) were delivered vaginally, while 69 (25.4%) failed an attempt at vaginal delivery and underwent a cesarean. When comparing patients delivered by elective cesarean with those attempting a vaginal delivery, no significant differences were noted in neonatal outcomes. However, maternal morbidity was higher among women delivered by cesarean, regardless of the indications for the procedure. Similar neonatal and maternal results were noted when nulliparous patients were analyzed separately. CONCLUSIONS: Cesarean delivery of selected near-term infants presenting as breech is associated with increased maternal morbidity without corresponding improvement in neonatal outcomes.     

Quality improvement for neonatal resuscitation and delivery room care

Quality improvement has become a foundation of neonatal care. Structured approaches to improvement can standardize practices, improve teamwork, engage families, and improve outcomes. The delivery room presents a unique environment for quality improvement; optimal delivery room care requires advanced preparation, adequately trained providers, and carefully coordinated team dynamics. In this article, we examine quality improvement for neonatal resuscitation. We review the published literature, focusing on reports targeting admission hypothermia, delayed cord clamping, and initial respiratory support. We discuss specific challenges related to delivery room quality improvement, including small numbers, data collection, and lack of benchmarking, and potential strategies to address them including simulation, checklists, and state and national collaboratives. We examine how quality improvement can target equity in delivery room outcomes, and explore the impact of the COVID-19 pandemic on delivery room quality of care.