可行走分娩镇痛应用于潜伏期的临床研究

目的评价可行走分娩镇痛在潜伏期应用的临床效果。研究宫口开张不同大小应用分娩镇痛后的产程进展，对子宫收缩力的影响及新生儿Apgar评分情况。方法确认已临产无内科合并症的初产妇共75例，随机分为三组。Ⅰ组：宫口开张1cm左右；组：宫口开张2～3cm；Ⅲ组为正常对照组未采用分娩镇痛。观察镇痛起效时间、子宫收缩力的变化、总产程、产后出血量、分娩结局及新生儿Apgar评分。结果Ⅰ组与Ⅲ组比较总产程差异无统计学意义。Ⅰ组与Ⅱ组第一产程比较时间延长，差异有统计学意义（P〈0．05），Ⅱ组与Ⅲ组比较子宫收缩力无明显降低，第一产程中Ⅰ组与Ⅲ组比较子宫收缩力显著降低，P（0．05，Ⅰ组催产素使用率为100％。三组间产后出血、新生儿Apgar评分各组间差异无统计学意义。结论舒芬太尼合并低浓度的罗哌卡因引导下无痛分娩，从潜伏期应用，有明显的分娩镇痛作用，不增加产后出血量，对新生儿的Apgar评分无影响。     

剖宫产术中娩出胎儿前膀胱下推法在凶险性前置胎盘手术中的应用效果

目的评价剖宫产手术时娩出胎儿前膀胱下推法在凶险性前置胎盘手术中的应用效果。方法选择2016年1月至2017年12月安徽医科大学第一附属医院产科收治凶险性前置胎盘孕产妇89例,根据剖宫产时下推膀胱的时机不同,分为A组(47例)与B组(42例),A组为娩出胎儿前膀胱下推组,B组为娩出胎儿后下推膀胱组。比较两组孕产妇一般情况(年龄、孕次、产次、孕周、胎盘植入率)、平均手术出血量、平均输血量、手术时间、术后住院时间、产褥病率、子宫切除、膀胱损伤和新生儿窒息方面的差异。结果 A、B组孕产妇术中出血量分别为(1 927. 76±356. 31) mL、(2 859. 55±477. 80) mL,输血量分别为(861. 72±91. 58) mL、(1 285. 73±162. 69) mL,手术时间分别为(1. 83±0. 87) h、(2. 71±0. 94) h,术后住院时间分别为(5. 37±1. 72) d、(6. 83±1. 56) d,产褥病率分别为10. 64%、28. 57%,子宫切除率分别为14. 89%、35. 71%,新生儿窒息发生率分别为4. 26%、19. 05%,两组差异有统计学意义(P <0. 05)。结论凶险性前置胎盘娩出胎儿前膀胱下推法疗效满意,值得临床推广应用。     

艾盐包热熨结合推法作用于八穴治疗产后癃闭的应用研究

目的 探讨艾盐包热熨结合推法作用于八髎穴对于产后癃闭排尿的临床疗效。方法 选择2018年1月至2019年1月在我院经阴道分娩后出现常规物理刺激诱导排尿无效的产后癃闭产妇120例为研究对象,随机分为治疗组和对照组,每组各60例,对照组在常规护理基础上采用艾盐包热熨尾骶部,治疗组在对照组基础上增加八髎穴穴位按摩,比较两组产妇排尿功能恢复等情况。结果 两组一般情况比较,差异无统计学意义(P0.05),治疗组总有效率(98.33%)高于对照组(85.00%);残余尿量治疗组为(16.25±3.71)mL,明显少于对照组的(35.62±8.26)m L;不良反应治疗组为0,明显低于对照组的8.33%,差异均有统计学意义(P0.05)。结论 艾盐包热熨结合推法作用于八髎穴治疗产后癃闭,有助于对产后正常排尿功能的恢复,操作简便,不良反应少,可减轻产妇心理负担,提高护理满意度。     

Postpartum Thyroiditis

Post partum thyroiditis occurs in 50% of TPO AB+ve women and is characterised by transient hyperthyroidism followed by transient hypothyroidism during the first six months, post partum. A third of the latter group develop permanent hypothyroidism. The syndrome is seen in 5-9% of women and post partum thyroid dysfunction (PPTD) reoccurs in 75% of women in a subsequent pregnancy. An increase in depressive symptomatology is seen in women with PPTD as well as in ante TPO Ab+ve women without PPTD. The immunology of PPT is associated with the presence of TPO antiboides with those IgG subclasses best able to activate the complement cascade. The HLA-DR frequencies seen in PPT suggest that PPT may be related to Hashimoto's thyroiditis. TPO Ab driven complement fixation is seen in PPT and complement activation relates to the extent and progression of thyroid damage. Recent studies have shown an increase in both Th2 and Th1 cytokine release from lymphocytes in ante partum women destined to develop PPTD. More data are required on the cellular immune changes both ante partum and post partum in PPT.     

Oclusión temporal con balón de las arterias hipogástricas en una paciente con acretismo placentario

Placenta accreta spectrum is an abnormal placentation that results in an increase in maternal morbidity and mortality, which mostly occurs due to severe haemorrhage. We present the case of a patient diagnosed prenatally with placenta accreta spectrum, premature rupture of membranes and bleeding, who was managed by a multidisciplinary team. Temporary bilateral hypogastric balloon occlusion was placed before caesarean hysterectomy, with good results for the mother.     

Postpartum psychological distress after emergency team response during childbirth

Purpose: To evaluate the feasibility and acceptability of a protocol determining the relationship between emergency team response (ETR) during childbirth and acute stress disorder (ASD) and post-traumatic stress disorder (PTSD) symptoms.

Methods: In a prospective, observational, cohort design, women experiencing ETR during childbirth were approached and recruited on postpartum day-1 and followed for six weeks. Demographics, obstetric and birth characteristics, ASD scores and PTSD scores (by Impact of Events Scale, IES and PCL-civilian) were recorded. Recruitment and retention rates were recorded, and scores were compared to women who did not experience ETR.

Results: Three hundred sixty-nine were approached and 249 were enrolled (67.5% recruitment rate). One hundred twenty-five completed all procedures (50.2% retention). Twenty experienced ETR (3.5% event rate), 12 enrolled (60.0% recruitment rate) and 8 completed the study (66.7% retention). The ETR group had higher PCL and IES scores (PCL: ETR median 12, non-ETR median 2, p?=?.08; IES: ETR median 22.5, non-ETR median 20, p?=?.08). ASD scores were similar between groups.

Conclusions: Methodology investigating the link between ETR and postpartum psychological distress is feasible and acceptable. A relationship between ETR and PTSD symptoms appears to exist, with ETR being associated with higher PTSD scores compared to non-ETR childbirths. Methods that incorporate awareness of the unique concerns of vulnerable populations are needed.     

46例产后尿潴留原因分析及护理对策

目的 探讨产后尿潴留发生的原因及护理对策.方法 对我院2011年1至12月46例产后尿潴留患者资料进行回顾性分析.结果 产后尿潴留的发生与产程延长、会阴情况、无痛分娩、精神因素等密切相关.结论 通过有效的宣教、指导、护理,可以降低产后尿潴留的发生.     

Is third trimester serotonin reuptake inhibitor use associated with postpartum hemorrhage?

As serotonin reuptake inhibitor (SRI) use may decrease platelet function, previous research has shown a relationship between SRI use and an increased risk for bruising and bleeding. The literature regarding the association between SRI use during pregnancy and increased bleeding at delivery, referred to as postpartum hemorrhage (PPH), is mixed. In secondary analyses from two prospective observational studies of pregnant women with mood disorders, 263 women were exposed to an SRI (n = 51) or not (n = 212) in the third trimester. To be precise, we used the terminology estimated blood loss (EBL) >600 cc rather than the term PPH because the current definition of PPH differs. The occurrence of EBL >600 cc was determined using the Peripartum Events Scale (PES) completed from obstetrical records by a blinded medically trained member of the study team. EBL >600 cc occurred in 8.7% of women in this cohort. There was no statistically significant difference in the rates of EBL >600 cc in the 24 h after delivery in women taking SRIs during the third trimester (9.8%) compared to non-exposed women (8.5%). Utilizing generalizing estimating equations, the odds of EBL >600 cc in each group were not significantly different (OR 1.17, CI-0.41-3.32, p = 0.77). When the SRI group was limited to women with exposure at the time of delivery, the difference in the odds of EBL >600 cc was unchanged (OR 1.16, CI = 0.37–3.64, p = 0.79). In population, both third trimester and use at delivery of SRIs during pregnancy was not associated with an increased risk of excessive blood loss.