正常阴道分娩和选择性剖宫产对初产妇下尿路解剖位置的影响

目的探讨正常阴道分娩和选择性剖宫产对初产妇下尿路解剖位置的影响,以及选择性剖宫产是否对产后压力性尿失禁有预防作用。方法正常阴道分娩组孕妇(16例)和选择性剖宫产组孕妇(15例)于孕38~40周、产后6~8周、产后2年分别进行会阴超声及尿动力检查,分析尿道膀胱连接部移动度(UVJ-M)的变化,及其在两种分娩方式间的差异。无分娩史的非妊娠女性20名为对照组,于排卵期行会阴超声及尿动力检查。结果妊娠晚期的UVJ-M较对照组明显增加(P<0.01),并持续到产后2年。两种方式分娩后6~8周的UVJ-M均较妊娠晚期轻度下降,但差异均无统计学意义(P>0.05);仅选择性剖宫产组的UVJ-M在产后2年较妊娠晚期下降明显(P<0.05)。两种分娩方式相比,UVJ-M在产后6~8周和产后2年的差异均无统计学意义(P>0.05)。结论初产妇在妊娠晚期膀胱颈活动度明显增加,并持续到产后2年,选择性剖宫产对其并无明显的保护作用;妊娠本身可能是产后压力性尿失禁的主要致病因素。     

2008—2012年1466例早产回顾性临床分析

目的：探讨不同孕周和不同类型早产的变化趋势,及其与早产相关因素、分娩方式、早产儿出生体质量、新生儿窒息的关系。方法：回顾性分析2008年1月—2012年12月在南京医科大学第一附属医院住院分娩的早产病例1466例,对不同孕周早产（妊娠早、中、晚期早产）和不同类型早产（自发性早产、治疗性早产）的变化趋势、早产相关因素、分娩方式、早产儿出生体质量及新生儿窒息率进行统计分析。结果：①2008—2012年早产的年发生率呈逐年升高趋势（χ2=65.69,P＜0.001）,不同孕周早产发生率和不同类型早产发生率均呈升高趋势。②不同孕周自发性早产主要相关因素为胎膜早破、多胎妊娠、胎位异常、妊娠期糖尿病及不明原因等,不同孕周治疗性早产主要相关因素为妊娠期高血压疾病、胎盘因素、妊娠合并症、多胎妊娠、妊娠期肝内胆汁淤积症和胎儿窘迫等。③不同孕周早产的阴道分娩率和剖宫产率差异无统计学意义（P＞0.05）,不同类型早产的阴道分娩率和剖宫产率差异有统计学意义（P＜0.05）,治疗性早产剖宫产率高于自发性早产（P＜0.05）。④不同孕周早产的新生儿体质量和新生儿窒息率差异均有统计学意义（P＜0.05）。妊娠早期早产的新生儿窒息率（53.01%）高于中期早产（33.46%）和晚期早产（28.61%）,差异有统计学意义（均P＜0.05）,中期早产与晚期早产的新生儿窒息率差异无统计学意义（P＞0.05）。结论：应及早识别早产潜在高危因素,加强围生期管理,以减少早产的发生,改善围生儿结局。     

盆底康复治疗对不同分娩方式再生育妇女盆底功能的影响研究

目的 探究盆底康复治疗对不同分娩方式再生育妇女盆底功的影响,为促进产妇盆底康复提供相关临床依据.方法 选择2016年1月至2019年12月在潍坊市妇幼保健院分娩的654例二胎产妇进行盆底功能检查,根据分娩方式及初产后是否行盆底康复治疗,分为顺产未治疗组330例,顺产治疗组70例,选择性剖宫产未治疗组204例,选择性剖宫...     

对促宫颈成熟与引产孕产妇的全程分娩管理模式

目的 探讨在全程分娩管理模式下,为孕产妇提供促宫颈成熟与引产服务的可行性。方法 选择2018年1月1日至2020年12月31日,在南京大学医学院附属鼓楼医院接受待产、分娩到产后康复(LDRP)一体化全程分娩管理模式(以下简称为LDRP管理)的848例孕产妇为研究对象。根据孕产妇进入产房时是否进入自然产程,将其分为自然临产组(n=441)和引产组(n=407)。采用回顾性分析法,对2组孕产妇的一般临床资料,如分娩年龄、孕次、孕龄、妊娠并发症,以及母儿结局进行比较。本研究遵循的程序符合2013年修订的《世界医学协会赫尔辛基宣言》的要求,并经过南京大学医学院附属鼓楼医院伦理委员会审核批准(审批文号：201702001)。结果 (1)2组孕产妇分娩年龄、孕次和高龄孕产妇所占比例比较,差异无统计学意义(P>0.05)。2组孕产妇分娩孕龄、经产妇占比、早产率、缩宫素使用率、分娩时长比较,差异有统计学意义(P<0.05)。(2)引产组孕产妇均使用前列腺素类药物促宫颈成熟或缩宫素进行引产,其中使用地诺前列酮栓、米索前列醇、缩宫素、地诺前列酮栓+米索前列醇分别为26.5%(108/407)、...     

A qualitative analysis of women's short accounts of labour and birth in a Western Australian public tertiary hospital

This paper reports the findings of the postnatal qualitative arm of a larger study, which investigated women's prenatal and postnatal levels of childbirth fear. Women's expectations and experiences of labour and birth in a Western Australian public tertiary hospital were identified following thematic analysis of short written accounts from 141 participants who had given birth in the previous 6 to 14 weeks. Four major categories emerged to describe features and mediating factors in the trajectory of childbirth and the early puerperium. "Anticipating Labour and Birth," "Labour and Birth Depicted," "Mediating Factors and their Consequences," and "Evaluating, Resolving, and Looking Ahead" portray women's comparative reflections on expectations and realities of birth, on mediating influences, and on moving on from their experience. These findings will provide maternity care professionals with insight into the personal and environmental features of the childbirth setting which colours women's recollections. Being aware of what women value during labour and birth will reinforce the need for professionals to provide care using a mindful approach that considers the potential psychological, emotional, and behavioural implications of events.     

Predictors of women's perceptions of the childbirth experience

OBJECTIVE: To determine the factors that predict women's perceptions of the childbirth experience and to examine whether these vary with the type of birth a woman experiences. DESIGN: Prospective cohort study. SETTING: The postpartum units of two eastern Canadian hospitals. PARTICIPANTS: Six hundred fifty two women and their newborns. DATA COLLECTION: Data were collected in hospital at 12 to 48 hours postpartum using self-report questionnaires and chart review. MAIN OUTCOME MEASURE: Perception of the childbirth experience was measured for women having a vaginal and emergency cesarean birth using the Questionnaire Measuring Attitudes About Labor and Delivery and planned cesarean birth using the Modified Questionnaire Measuring Attitudes About Labor and Delivery. RESULTS: Of the 20 predictors of women's childbirth perceptions, the strongest were type of birth; degree of awareness, relaxation, and control; helpfulness of partner support; and being together with the infant following birth. CONCLUSIONS: Of the predictors of a quality birth experience, most were amenable to nursing interventions: enhancement of patient awareness, relaxation, and control; promotion of partner support; and provision of immediate opportunities for women to be with their babies.     

The natural caesarean: a woman-centred technique

Although much effort has gone into promoting early skin-to-skin contact and parental involvement at vaginal birth, caesarean birth remains entrenched in surgical and resuscitative rituals, which delay parental contact, impair maternal satisfaction and reduce breastfeeding. We describe a 'natural' approach that mimics the situation at vaginal birth by allowing (i) the parents to watch the birth of their child as active participants (ii) slow delivery with physiological autoresuscitation and (iii) the baby to be transferred directly onto the mother's chest for early skin-to-skin. Studies are required into methods of reforming caesarean section, the most common operation worldwide.     

Aromatherapy in childbirth: a pilot randomised controlled trial

Objectives  We aimed to determine the feasibility of conducting a randomised controlled trial (RCT) on the use of aromatherapy during labour as a care option that could improve maternal and neonatal outcomes.
Design  RCT comparing aromatherapy with standard care during labour.
Setting  District general maternity unit in Italy.
Sample  Two hundred and fifty-one women randomised to aromatherapy and 262 controls.
Methods  Participants randomly assigned to administration of selected essential oils during labour by midwives specifically trained in their use and modes of application.
Main outcome measures  Intrapartum outcomes were the following: operative delivery, spontaneous delivery, first- and second-stage augmentation, pharmacological pain relief, artificial rupture of membranes, vaginal examinations, episiotomy, labour length, neonatal wellbeing (Apgar scores) and transfer to neonatal intensive care unit (NICU).
Results  There were no significant differences for the following outcomes: caesarean section (relative risk [RR] 0.99, 95% CI: 0.70–1.41), ventouse (RR 1.5, 95% CI: 0.31–7.62), Kristeller manoeuvre (RR 0.97, 95% CI: 0.64–1.48), spontaneous vaginal delivery (RR 0.99, 95% CI: 0.75–1.3), first-stage augmentation (RR 1.01, 95% CI: 0.83–1.4) and second-stage augmentation (RR 1.18, 95% CI: 0.82–1.7). Significantly more babies born to control participants were transferred to NICU, 0 versus 6 (2%), P = 0.017. Pain perception was reduced in aromatherapy group for nulliparae. The study, however, was underpowered.
Conclusion  This study demonstrated that it is possible to undertake an RCT using aromatherapy as an intervention to examine a range of intrapartum outcomes, and it provides useful information for future sample size calculations.     

Why Do Supportive Birth Attendants Become Directive of Maternal Bearing-Down Efforts in Second-Stage Labor?

A supportive approach to care for women during the second stage of labor that primarily relies on the laboring woman's involuntary expulsive urges has been advocated. We aimed to learn about the clinical circumstances surrounding the caregiver shift from being primarily supportive to directing women regarding their bearing-down efforts. This research analyzed the communications of 10 birth attendants and women during the expulsive phase of labor using videotapes recorded from two studies carried out between 1986 and the present. The occasions when a birth attendant shifted verbalizations were identified, and categories of the rationales that may have influenced the modification in caregiver behavior were developed. Birth attendants most frequently provided directions to help the woman push effectively, that is, to focus the woman's bearing-down efforts during maternal distress, fatigue, fear, and pain to expedite the labor process (38% of the occasions of caregiver change in verbalizations). The next most frequent clinical situations when caregivers offered directions about "pushing" were diminished urge to bear-down with epidural analgesia (10%), routine arbitrary practices (9% caregiver and 6% by supportive companion), and fetal distress (<1%). A category of "supportive direction" (20%) was identified. This care strategy has not been previously reported. It combined direction with support in a way that was supportive rather than overriding the woman's involuntary efforts.     

Outcomes of planned home birth: an integrative review

Current evidence indicates the critical importance of several factors that contribute to improved perinatal outcomes: a facilitating environment at the place of birth, skilled birth attendance, and the continuum of perinatal care for women and newborns. This level of care is often referred to as "first-level" care, and is most readily provided in birthing centers and primary level health facilities. However, there is a body of evidence that has been compiled over the past several decades that addresses the safety of planned home birth, under circumstances that emulate these elements of "first-level" care. These studies demonstrate a remarkable consistency in the generally favorable results of maternal and neonatal outcomes, both over time and among diverse population groups. These outcomes are also favorable when viewed in comparison to various reference groups (birth center births, planned hospital births, and vital statistics). These data should influence policy in support of planned home birth, including policy that endorses building or sustaining a home birth infrastructure in parallel to the efforts to build capacity for facility-based birth. Such public policy would also be in keeping with the fundamental right of women to have choice in childbirth, particularly when options are equally good.