产科急症子宫切除32例临床相关危险因素分析

目的探讨产科急症子宫切除的相关危险因素,分析降低子宫切除发生率的有效方法及临床应用效果。方法回顾性分析我院2006年1月-2011年12月间由于产科急症进行子宫切除的32例患者的临床资料,将其年龄、孕周、分娩方式、产前检查情况、流产次数、分娩次数等,利用单因素分析方法与产科急症子宫切除进行相关性分析。结果除孕周与子宫切除术无明显关系外,产妇的年龄、分娩方式、流产史和分娩次数均与产科急症子宫切除术有明显关系（P〈0．05）。结论多次孕产和清官术是产科急症子宫切除的高危因素,尽可能地加强计划生育的宣传和围生期保健知识的普及能够有效降低产科急症子宫切除的发生率。同时应明确,子宫切除术是抢救产科重症大出血的有效措施。     

产妇急症子宫切除36例的原因分析和手术时机选择

目的分析产妇急症子宫切除的原因和手术时机以及降低产科子宫切除发生率的有效措施。方法对急症子宫切除36例的相关因素进行回顾性分析。结果急症子宫切除的原因主要为胎盘因素、肌瘤、产后感染等。结论急症子宫切除术对不能控制的子宫出血、挽救产妇的生命虽是行之有效的措施,但应严格掌握适应症。加强计划生育教育、严格剖宫产指征是减少产科急症子宫切除的措施。     

超声引导可视无痛人工流产术的应用

目的：探讨在B超引导下（超导）可视操作行人工流产术的临床效果。方法：300例行超导可视无痛人工流产术的早孕患者作为观察组,与150例同期行常规人工流产术患者（对照组）进行比较,观察两组手术时间、术中出血、疼痛、术后随访结果等。结果：观察组与对照组相比,镇痛有效率高、手术时间短、出血量少（P均〈0．05）,术中结合刮宫可以明显减少并发症,无明显后遗症（P〈0．05）。结论：超导可视无痛人工流产术安全可靠,镇痛效果满意,值得推广和应用。     

Ultrasound evaluation of a near-term abdominal ectopic pregnancy.

Ultrasound confirmation of an abdominal ectopic pregnancy was established by the demonstration of an enlarged but empty uterus and the delineation of the fetal head within the abdominal cavity. Other portions of the fetus could not be demonstrated. The margins and attachments of the placenta could not be accurately delineated prospectively.     

不同分娩体位对枕后位/枕横位产妇母婴结局影响的网状Meta分析

目的 采用网状Meta分析方法,评价不同分娩体位对枕后位/枕横位产妇母婴结局的影响。 方法 计算机检索Cochrane Library、PubMed、Web of Science、Embase、CINAHL、中国生物医学文献数据库、中国知网、维普数据库中关于不同分娩体位对枕后位/枕横位产妇分娩结局影响的随机对照试验。经过文献筛选、质量评价、信息提取后,使用R4.1.1软件和Stata16.0软件进行网状Meta分析。 结果 本研究共纳入24篇文献,涉及12种体位,包含4 887名产妇。网状Meta分析结果显示,同侧侧俯卧位与自由体位比较,在胎头旋转为枕前位方面差异具有显著差异（RR=0.45,95%CI为0.22~0.88）;同侧卧位与截石位比较,在阴道分娩方面差异具有显著差异（RR=0.55,95%CI为0.30~0.97）。根据累积排序概率曲线下面积排序结果,同侧卧位、同侧侧俯卧位是改善枕后位/枕横位产妇分娩结局的较优体位。 结论 基于网状Meta分析和排序结果,同侧卧位和同侧侧俯卧位在改善枕后位/枕横位产妇分娩结局效果较好,但还需高质量、大样本的随机对照试验进一步验证。     

Fascial manipulation as an adjunct to physiotherapy management in obstetric brachial plexus palsy: A case report

The integrity of connective tissue sheaths surrounding the nerves influences both the severity and the potential for recovery of brachial plexus lesions.This study presents an innovative, early onset, multidisciplinary approach to obstetric brachial plexus palsy. This approach is aimed at functional recovery of the nerve lesion and includes mobilization of the fascia using the Fascial Manipulation® method.This case study discusses how, in addition to conventional treatment, interventions aimed at the fascial system can potentially affect tension around the neural sheaths, enhance proprioceptive input and facilitate movement to influence obstetric brachial plexus palsy outcomes.     

1例剖宫产术后阵发性睡眠性血红蛋白尿症患者继发脾破裂的护理

总结1例剖宫产术后阵发性睡眠性血红蛋白尿症患者继发脾破裂的护理经验。包括脾破裂后快速建立静脉通路,密切监测血压、腹内压变化;减少输血时的溶血反应并做好栓塞的观察与预防;血浆置换的管理;依库丽单抗注射液的应用,避免不良反应的发生;进行保护性隔离,降低感染风险;做好患者的心理护理及健康宣教,帮助其树立战胜疾病的信心。经过精心的治疗及护理,患者于入院后16 d出院。     

Microsurgical repair and secondary surgery in obstetrical brachial plexus palsy

We present a personal experience with 750 children suffering from obstetrical brachial plexus palsy. The related surgery is described, including early microsurgical nerve reconstruction and secondary procedures including tendon and muscle transfers. The clinical examination, indications and timing for surgery, technical details of primary and secondary operations and the possible outcome are discussed. Both clinical and research work need an interdisciplinary team approach, and diagnostic, therapeutic and prognostic improvement is based on the refinements of microsurgical skills and the continuous exchange of information between specialized centers.     

Predisposing factors in obstetrical fractures

To compare various obstetrical methods with different types of obstetrical fractures, 29 neonates with fractures were evaluated retrospectively. Plain films of skull, limbs and chest were obtained. Transfontanellar ultrasonography was performed in one case and a computed tomographic scan of the skull in two. We reviewed 12 fractures of long bones, 7 fractures of the skull, and 10 fractures of the clavicle. Ten fractures occurred during caesarean sections and 11 in vaginal delivery requiring medical assistance. Depressed skull fractures were associated with manoeuvres and the use of forceps during delivery. Fractures of the long bones were associated with caesarean section, breech delivery with assistance and low birth weight. All fractures were treated conservatively except for skull fractures with depression of more than 2 cm. Early consolidation occurred in all fractures of long bones. The long-term follow-up of all fractures but one revealed no persisting disability. The belief that obstetrical fractures occur primarily in large babies or after breech delivery is not supported by this study.     

Posterior fossa cyst: Prenatal diagnosis by ultrasound

Ultrasound imaging of congenital anomalies in utero is feasible. Fetal intracranial details of a posterior fossa cyst were demonstrated by sonography. To our knowledge, an ultrasonic antenatal diagnosis of a posterior fossa cyst has not yet been reported.