产科质量变化及剖宫产率上升原因的临床分析

目的探讨我院剖宫产率高的原因,寻找降低剖宫产率的措施。方法选择我院2011年1月-2012年12月住院分娩剖宫产的产妇1836例．统计分析剖宫产率及指征。结果我院剖宫产率高达56．13％,社会因素比率高达50％／）2上。结论合理掌握剖宫产指征,降低社会因素的剖宫产,通过医患双方及社会的共同努力,才能更好地降低剖宫产率。     

产钳在再次剖宫产协助胎头娩出的应用

目的：探讨产钳在再次剖宫产时协助胎头娩出的临床应用价值。方法：回顾分析2006年1月-2012年12月244例再次剖宫产胎头娩出困难患者,其中产钳协助胎头娩出（观察组）122例,未采用产钳助娩（对照组）122例。分析2组子宫切开至胎儿娩出时间（U-DI）,产后出血量,新生儿窒息、新生儿头皮外伤、子宫切口撕裂的发生率。结果：观察组U-DI和产后出血量低于对照组（均P＜0.05）,新生儿轻度窒息、新生儿重度窒息、新生儿头皮外伤、子宫切口撕裂发生率小于对照组（均P＜0.05）。结论：再次剖宫产徒手助胎头娩出困难时及时应用产钳协助胎头娩出,能有效缩短U-DI,降低新生儿窒息发生率,减少母婴损伤,是一种安全、有效、可行的方法。     

Trends in the medicalisation of childbirth in Flanders and the Netherlands

Objective

in this paper we offer new insights about the medicalisation of childbirth by closely examining the trends in obstetric intervention rates in Flanders and the Netherlands and by considering the influence of contextual factors – including the organisation of the medical system, professional guidelines, and cultural ideas – on the way maternity care is delivered.

Design

a comparative study using perinatal statistics from the National Perinatal Databases of the Netherlands and Flanders and historical and qualitative data about the organisation and culture of maternity care in each country.

Setting and participants

in the Netherlands data are gathered from practices of the participating midwives, general practitioners and obstetricians. In Flanders the registration of data takes place in Flemish maternity units and independent midwifery practices.

Measurements and findings

in the Netherlands the home birth rate is still by far the highest in Europe and some interventions (e.g. caesarean section and epidural) are among the lowest. However, some perinatal statistics – such as in the use of epidural analgesia during labour – suggest an increasingly medical approach to birth in the Netherlands. Other trends in the Netherlands include an increasing use of inductions and augmentation in labour, and a decreasing number of births in primary care. The practice of home birth is being challenged by critical discussions in the popular media and ‘scientific’ debates among professionals. In Flanders, there have been some efforts to reduce medicalisation of childbirth, focussed on specific interventions such as induction and episiotomy.

Key conclusions

in recent years the obstetric intervention rates in Belgium and the Netherlands are slowly converging.

Implications for practice

because the lives of women, midwives, and obstetricians (among others) are significantly affected by patterns of medicalisation and de-medicalisation, it is important that we understand the drivers of the medicalising process.     

分娩镇痛对产妇血清IL-6、IL-8、IL-1O水平的影响

目的 观察应用罗哌卡因连续硬膜外阻滞麻醉进行分娩镇痛对产妇血清中IL-6、IL-8、IL-10的影响.方法 选择200例产妇随机分为观察组(Ⅰ组)和对照组(Ⅱ组),每组100例.Ⅰ组在宫口开至2～3 cm时开始采用连续硬膜外阻滞麻醉方法进行分娩镇痛;Ⅱ组按产科常规处理.观察分娩镇痛前30 min、分娩镇痛后2h、分娩后24h、48 h和72 h五个时点患者血清中白细胞介素-6(IL-6)、白细胞介素-8(IL-8)、白细胞介素- 10( IL- 10)水平的变化.结果 两组患者分娩镇痛后血清1L-6、IL-8、IL-10水平与分娩镇痛前值比较均升高(P＜0.01),一般在分娩后24 h达峰值.比较血清IL-6、IL-8、IL-10浓度变化,Ⅱ组较Ⅰ组升高更为明显(P＜0.05).结论 应用罗哌卡因连续硬膜外阻滞麻醉进行分娩镇痛可有效地降低产妇分娩后炎性应激反应.     

Arterial catheterization and embolization for management of emergent or anticipated massive obstetrical hemorrhage

PURPOSE: The aim of this study was to evaluate the indications, efficacy, and safety of arterial catheterization and embolization for the management of emergent or anticipated massive obstetrical hemorrhage and its effects on menses and fertility. MATERIALS AND METHODS: Eighteen patients underwent arterial catheterization and embolization for intractable obstetrical hemorrhage between January 2001 and December 2005. Three groups of patients were identified: group 1 (n = 6) experienced postpartum hemorrhage; group 2 (n = 5) had anticipated severe postpartum hemorrhage; and group 3 (n = 7) had a risk factor for anticipated severe hemorrhage after dilation and evacuation. Gynecological information after embolization was obtained from medical records and telephone interviews. RESULTS: All patients in group 1 had a favorable outcome after treatment with a single embolization. All patients in group 2 had a placenta previa with an estimated blood loss of 1215-3250 ml. In group 3, bleeding was controlled in six patients; one patient had a hysterectomy because embolization was not possible. There were no short-or long - term complications, and normal menstruation resumed. Four patients became pregnant after embolization. CONCLUSION: Arterial catheterization and embolization is an effective, safe method for treating intractable obstetrical hemorrhage and might eliminate the need for hysterectomy and maintain reproductive ability.     

膝胸卧位、氧疗对妇科腹腔镜术后患者肩痛的影响

目的探讨膝胸卧位、氧疗对妇科腹腔镜术后患者肩痛的影响。方法将150例妇科腹腔镜术后患者随机分为3组,每组50例,分别采取膝胸卧位(试验1组)、氧疗(试验2组)和除氧疗和膝胸卧位以外的常规护理(对照组)。3组均采用通用的视觉模拟评分(VAS)于术后第1天的不同时段(8:00、16:00、20:00)进行肩痛评分,两个试验组还于干预前、后分别进行肩痛评分。结果3组患者首次干预前肩痛VAS评分无显著性差异(P0.05)。第1次干预后,试验1组和试验2组在同一时段的肩痛评分均低于对照组,差异有统计学意义(P0.01)。2个试验组干预前、后肩部VAS评分的变化明显,差异均有统计学意义(P0.001)。结论术后膝胸卧位、氧疗能够显著改善妇科腹腔镜术后患者肩痛的情况。     

Chronic kidney disease in pregnancy

Parturients with renal insufficiency or failure present a significant challenge for the anesthesiologist. Impaired renal function compromises fertility and increases both maternal and fetal morbidity and mortality. Close communication amongst medical specialists, including nephrologists, obstetricians, neonatologists and anesthesiologists is required to ensure the safety of mother and child. Pre-existing diseases should be optimized and close surveillance of maternal and fetal condition is required. Kidney function may deteriorate during pregnancy, necessitating early intervention. The goal is to maintain hemodynamic and physiologic stability while the demands of the pregnancy change. Drugs that may adversely affect the fetus, are nephrotoxic or are dependent on renal elimination should be avoided.     

产科高危因素与新生儿窒息的相关性分析

目的 探讨产科高危因素与新生儿窒息的相关性.方法 研究对象为2009年8月～2010年8月在某院分娩的1 216例新生儿,其中新生儿窒息34例(2.8％),回顾性分析新生儿窒息与产科高危因素的相关性.结果 在导致新生儿窒息的产科高危因素中,脐带缠绕32.4％,羊水异常占26.5％,胎盘因素占20.6％,早产占8.7％,胎位异常占5.9％,其他占5.9％.脐带缠绕所占比例最高,其中中度窒息占81.8％.结论 新生儿窒息是产科常见的、多发的并发症,是围生儿死亡的首要危险因素,需要积极预防,以保障母婴安全.     

与分娩方式有关的影响因素探讨

目的：探讨与分娩方式有关的影响因素，寻求降低剖宫产率的有效对策。方法：以调查问卷、查阅病例和个别访谈的形式调查了在北京市２所区级妇幼保健院分娩的产妇共４８６例。结果：剖宫产率为４３．０％，产妇年龄、胎儿体重在剖宫产组明显高于阴道分娩组（Ｐ＜０．０１）；产妇害怕宫缩痛，缺乏有关剖宫产并发症的知识，盲目要求手术，医生为避免医疗纠纷放宽手术产指征是造成剖宫产率较高的主要原因。结论：要加强孕期合理膳食及临产心理准备的健康教育，提高医生对剖宫产并发症的认识，严格掌握剖宫产指征