贵阳市老城区产后抑郁症的现况调查和影响因素分析

目的筛查贵阳市老城区妇女产后抑郁症的阳性率及相关影响因素。方法采用按比例分配分层随机抽样的现况调查方法,抽取产后42 d的产妇875例作为研究对象,采用自行设计的社会人口学调查表及爱丁堡产后抑郁调查量表进行问卷调查,采用卡方或秩和检验及Logistic回归分析产后抑郁症的相关因素。结果筛出产后抑郁的阳性率为12.8%(112/875),95%CI(10.6%,15.0%);影响因素有9个,分别是夫妻月收入、产后睡眠情况、丈夫的关心、妊娠压力较大、居住环境、孕前吸烟、婴儿健康情况、产妇自觉性格内向、不稳定。结论贵阳市产后抑郁症阳性率与其它省市基本一致,影响产后抑郁发生的因素较多,应有针对性地制定相应的干预措施,促进产妇的身心健康。     

Prevalence and Factors Associated with Peripartum Hysterectomy among Iranian Pregnant Women: A Retrospective Study

BackgroundPeripartum hysterectomy (PPH) is one of the effective treatment modalities which is increasingly performed to save the life of pregnant women with uncontrollable severe postpartum hemorrhage. The aim of this study was to assess the prevalence and factors associated with PPH among Iranian pregnant women.MethodsIn a retrospective study, 33 pregnant women with PPH referred to Imam Khomeini Hospital in Sari, Mazandaran province, northern Iran were enrolled. Data were collected using census sampling from March 2017 to 2020. Patients'' sociodemographic and clinical characteristics were collected. Fisher''s exact test, Kruskal-Wallis, and Mann-Whitney tests were used to evaluate the study variables.ResultsThe prevalence of PPH among Iranian pregnant women was 2.81 per 1000 deliveries. The mean length of stay in the hospital and intensive care unit (ICU) was 6.15 (SD=2.91) and 3.17 (SD=1.50) days, respectively. Of the participants, 90.9% had a cesarean section, 51.6% had emergency PPH, 88.2% had emergency PPH in 24 hours after delivery, 9.1% had an induction, and 60.6% had PPH due to placental abnormalities. The mean duration of PPH procedure was 2.51 (SD=1.14) hours. The most common post-operative complication in participants was fever. Participants with older gestational age had more elective PPH (P=0.029). The length of ICU stay was more in patients with total PPH procedure compared to the supracervical (P<0.017). The induction rate was higher in emergency PPH after vaginal delivery compared to cesarean section (P=0.005).ConclusionThis study showed a high prevalence of PPH among pregnant women. Also, there was a significant relationship between the PPH and length of ICU stay, especially after supracervical hysterectomy. The results of this study can help obstetrician-gynecologist to provide a better intervention for managing patients with postpartum hemorrhage requiring PPH.     

7例穿透性胎盘植入的临床分析

目的 探讨穿透性胎盘植入的诊断、处理和预防.方法 对我院1999年1月～2007年2月穿透性胎盘植入7例进行回顾性临床分析.结果 7例穿透性胎盘植入,其中有剖宫产史3例,刮宫史5例,盆腔手术史1例.7例均为术中诊断,术后病理确诊.合并中央性前置胎盘4例,宫颈妊娠1例,宫内感染1例.其中5例行剖宫产加子宫切除术,其中2例再加化疗,2例加膀胱修补术,1例加右卵巢囊肿剔除术.产后出血约605～3000ml.结论 穿透性胎盘的产前诊断较为困难,产后较为明确.治疗首选全宫切除或次全宫切除术.要加强对胎盘植入的预防.     

Postpartum depression: Identifying associations with bipolarity and personality traits. Preliminary results from a cross-sectional study in Poland

The goals of this study have been to determine the prevalence of the bipolar spectrum features in the population of women with postpartum depression (PPD) symptoms, as well as to analyze the personality differences between putative ‘unipolar’ and ‘bipolar’ PPD subjects. The sample enrolled into the cross-sectional study consisted of 344 women at 6–12 weeks postpartum. The authors used the Edinburgh Postnatal Depression Scale (EPDS; cut-off score: 13 pts.) for the assessment of the PPD symptoms, the Mood Disorder Questionnaire (MDQ; cut-off scores: 7 or 8 pts.) for diagnosing the bipolar features, and the NEO-Five Factor Inventory (NEO-FFI) for the assessment of personality traits. The EPDS-positive subjects were more likely to score positively on the MDQ, as compared to the EPDS-negative ones. The EPDS-positive subjects who also scored ≥8 pts. on the MDQ were characterized by higher index of neuroticism, as compared to those who scored positively on the EPDS only. The results suggest that the presence of PPD symptoms is related to significantly higher scores of bipolarity and neuroticism. The more robust trait of neuroticism might be a marker of the ‘bipolar’ PPD, as compared to the ‘unipolar’ form of the disorder.     

卵巢动脉造影及栓塞在妇产科疾病介入治疗中的意义

经导管作髂内动脉栓塞术是目前治疗盆腔肿瘤所致阴道大出血和产科大出血的首选方法 ,近年选择性子宫动脉栓塞术(UAE)已成为替代外科手术治疗子宫肌瘤的有效方法 .文献报道,无论是治疗妇产科大出血还是栓塞子宫肌瘤,髂内动脉-子宫动脉栓塞术有一定失败率(4%～19%),后者与盆腔内存在丰富的侧支循环有重要关系,其中卵巢动脉(OA)是主要的侧支血管之一.另外,OA与子宫动脉之间的吻合支是UAE术中误栓塞卵巢、导致闭经的原因.OVA开口变异发生率为2%～10%.正常OA直径＜1.1 mm,多不为腹主动脉造影所显示,但当存在子宫或盆腔病变、对血液供应需求增加时,OA可增粗.OA参与盆腔疾病供血的高发因素有子宫底部巨大肌瘤、有盆腔手术史、曾做过子宫动脉栓塞术、一侧或两侧子宫动脉发育不良.当存在前述情况时,将猪尾导管插至肾动脉水平做腹主动脉造影和选择性OA插管造影是必要的.一旦确认有OA参与病变供血,应考虑作超选择栓塞术,一般认为用直径＞500 μm栓塞剂是安全的.做OA近侧栓塞,尤其是联合两侧UAE,可能导致医源性卵巢功能不全.对于绝经前患者、又确有必要做OA栓塞时,应尽可能做单侧、接近病变处栓塞,术前应签署知情同意书.     

上海市剖宫产出血计量研究

目的研究剖宫产手术至术后24h出血总量.方法上海市6所医院用吸引器抽吸及纱布称重法分阶段测量剖宫产手术,术后2h,术后4h及术后24h以及两者的出血总量.结果539例剖宫产手术至术后24h失血总量为(494.34±211.16)ml,失血总量大于500ml、600ml及700ml者各为43.79%,23.94%及12.44%.6所医院剖宫产至术后24h失血量在(387.94±161.32)ml至(797.7±205.52)ml,手术中的失血量约占总失血量的三分之二,失血量与前置胎盘及巨大儿有明显关系,并可能与促子宫收缩剂的剂量有关.结论本研究的剖宫产手术至术后24h平均失血总量约为500ml,建议剖宫产的产后出血定义应修改为≥600ml.     

晚期产后出血45例临床分析

目的：探讨晚期产后出血的病因及防治措施。方法：回顾性分析45例晚期产后出血的病因及处理。结果：主要病因依次为胎盘、蜕膜残留，子宫内膜炎和(或)蜕膜炎，子宫复旧不良以及剖宫产术后的子宫切口感染、裂开出血等。结论：治疗以清宫为主，对急性出血者可行经皮髂内动脉栓塞术或子宫切除术。     

正清风痛宁配合功能锻炼治疗产后腰痛45例分析

目的：分析正清风痛宁配合功能锻炼治疗产后腰痛的疗效。方法：采用正清风痛宁局部注射加腰背功能锻炼的方法治疗。结果：采用JOA评分标准，本组病例优33例，良12例。结论：局部治疗加功能锻炼能有效地恢复下腰部稳定性，取得满意疗效。     

缩宫素联合欣母沛防治高危产妇剖宫产术后出血的疗效观察

目的 观察缩宫素联合欣母沛防治高危产妇剖宫产术后出血的疗效.方法 按入院先后顺序,将178例有产科剖宫产指征、具产后出血潜在因素的高危产妇随机分为观察组和对照组各89例.在胎儿娩出后,对照组给予静滴缩宫素20 U及宫体注射缩宫素20 U,如宫缩仍不佳,继续应用缩宫素20 U;而观察组给予静滴缩宫素20 U及宫体注射欣母沛250μg,如宫缩仍不佳则间隔15 min继续应用欣母沛250μg.比较两组术后2、24 h的出血量及产后出血的发生率.结果 产后2、24 h的出血量,观察组[（221.3±59.7）ml和（299.1±72.8）m1]明显低于对照组[（358.3±62.7）ml和（457.5±82.9）ml];产后出血发生率,观察组（19.1％）亦低于对照组（42.7％）,组间差异均有统计学意义（均P＜0.05）.结论 具产后出血高危因素的剖宫产患者,应用静脉滴注缩宫素的同时宫体注射欣母沛,可预防和治疗产后出血,并具有快速、安全的特点,具有重要临床价值.     

心理干预对产后抑郁症患者预后的影响

目的探讨心理干预对产后抑郁症患者预后的影响。方法选择产后抑郁症患者42例作为研究对象,随机分为心理干预组和常规护理组,比较两组预后情况。结果两组治疗前后SDS抑郁自评量表得分比较,差异均有统计学意义(P<0.05或<0.01),治疗后两组比较,差异也有统计学意义(P<0.05)。结论心理干预能够改善产后抑郁症患者的预后。