Maternal Physical Activity Is Associated With Improved Blood Pressure Regulation During Late Pregnancy

Background

Cardiovagal baroreflex gain (cBRG) reflects an individual's ability to buffer swings in blood pressure. It is not well understood how this mechanism is influenced by physical activity in pregnancy. Because pregnant women tend to engage in low levels of moderate-to-vigorous physical activity (MVPA) and high levels of sedentary behaviour, we sought to determine the influence of MVPA and sedentary behaviour on cBRG and mean arterial pressure (MAP) in pregnancy.

探讨高龄产妇剖宫产术后出血的危险因素

目的：统计分析高龄产妇剖宫产术后出血的危险因素。方法以2010年1月—2014年6月在该院进行手术的350例高龄产妇作为研究对象,按照出血量分为产后出血组和非出血组,对两组研究对象的出血量进行统计,分析两组患者的年龄、怀孕时间、是否合并妊娠高血压、糖尿病、是否有宫缩乏力、流产史、产后出血史、吸烟、饮酒、巨大儿、前置胎盘以及体重指数等方面的差异。结果该研究的高龄产妇剖宫产后发生出血者38例,发生率为10.90%,产后出血组中术中和术后出血量分别为（1513.45±156.34） mL和（1245.32±55.21） mL;产后非出血组为312例,术中和术后的出血量分别为（221.25±67.21） mL和（108.21±65.24） mL,两组比较差异有统计学意义（P＜0.05）。妊娠高血压、妊娠期糖尿病、流产病史、巨大儿、宫缩乏力和前置胎盘是高龄产妇发生产后出血的危险因素。结论高龄孕妇剖宫产产后出血的发生率较高,在临床中必须对相关危险因素进行严格的控制。     

剖宫产术后早期产后出血相关因素的临床分析

目的：探究剖宫产术后早期产后出血的相关影响因素,为剖宫产术后产后的出血预防和治疗提供参考依据。方法研究并分析回顾2012年1月—2014年1月期间在该院收治的435例剖宫产产妇的临床资料,其中产后出血90例,占20.69%,根据分娩方式的不同,选取了512例自然阴道分娩的产妇临床资料作为参照组,对可能诱发剖宫产术后早期产后出血的相关因素展开分析探讨。结果435例剖宫产产妇中90例产妇在术后早期均出现了出血的问题,占20.69%,在90例剖宫产术后早期出血的患者中,72例患者的出血量在500~1000 mL,占80%,13例患者的出血量为1000~2000 mL,占14.4%,5例患者的出血量＞2000 mL,占5.6%,经过抗炎止血等治疗措施后,患者均于5~9 d内痊愈出院,无死亡病例;主要的产后出血因素包括了产后宫缩乏力,胎盘因素,软产道裂痕和凝血功能障碍等因素,具体为产后宫缩乏力62例,占68.9%,其中双胎8例,巨大儿9例,妊娠高血压疾病11例,胎盘早剥7例,前置胎盘10例,疤痕子宫6例,药物因素6例,全身因素5例;胎盘因素16例,占17.8%,其中胎盘粘连13例,胎膜少许残留3例,7例为软产道裂痕,占7.8%,5例为凝血障碍,占5.5%。结论剖宫产产后早期出血的诱发因素较多,且剖宫产患者产后出血率和出血量要明显多于阴道自然分娩产妇,所以要加强术前风险因素分析,做好相关止血措施以保证产妇生命安全。     

宫缩乏力性产后出血采用欣母沛治疗的临床分析

目的：分析宫缩乏力性产后出血患者采用欣母沛治疗的临床疗效。方法随机选取2011年7月—2013年8月期间该院接收宫缩乏力性产后出血患者100例,按临床意愿平均分成两组（观察组、对照组）,对照组患者给予临床基础性治疗,观察组患者给予欣母沛治疗,比较两组患者临床治疗效果。结果临床治疗结果显示,观察组患者临床好转率优于对照组（96.0%vs80.0%）,差异具有统计学意义（P<0.05）;且观察组患者出血量优于对照组患者,差异具有统计学意义（P<0.05）。结论将欣母沛应用于宫缩乏力性产后出血患者临床治疗过程中,可有效控制出血量,提高临床好转率,意义重大,值得推广。     

中药泡足与穴位按摩对产后宫缩痛临床疗效的应用研究

目的 研究分析中药泡足及穴位按摩减轻经产妇产后宫缩痛的临床疗效.方法 入组2013年阴式分娩的经产妇200例,随机分成4组各50例,中药泡足组选用艾叶加宽筋滕粉热水泡足,穴位按摩组选用三阴交、足三里和血海穴位按摩,中药泡足+穴位按摩组采用艾叶加宽筋滕粉热水泡足加三阴交、足三里和血海穴位按摩,对照组给予基础治疗如改变体位、腹部热敷或按摩等,采用视觉模拟量表评分(visual analog scale,VAS)对4组产妇在产后第1～3天进行疼痛强度评估.结果 中药泡足组、穴位按摩组、中药泡足+穴位按摩组在产后第1天产后宫缩痛疼痛评分显著低于对照组,差异具有统计学意义(P＜0.05).结论 对经产妇选用中药泡足、穴位按摩或联合使用能有效减轻产后宫缩痛,增加产妇舒适度,促进产妇康复.     

Increasing postpartum rate of vaccination with tetanus,diphtheria, and acellular pertussis vaccine by incorporating pertussis cocooning information into prenatal education for group B streptococcus prevention

BackgroundTo evaluate whether incorporating pertussis cocooning information into prenatal education for group B streptococcus (GBS) prevention increased postpartum rate of vaccination with tetanus, diphtheria, and acellular pertussis (Tdap) vaccine.MethodsWe performed a retrospective pre-intervention/post-intervention study of postpartum women at a teaching hospital in Taiwan. We compared the frequency of Tdap vaccination during the pre-intervention (May 1, 2009 to December 31, 2010) and post-intervention (March 1, 2011–March 31, 2012) time periods. The clinical intervention was incorporation of pertussis cocooning information into prenatal education for GBS prevention to pregnant women presented during a prenatal visit at 35–37 weeks of gestation. Postpartum Tdap vaccination rate during the pre-intervention and post-intervention periods was compared. We also specifically examined group differences in the percentage of women who received postpartum Tdap vaccination to explore factors that influenced their decision regarding Tdap vaccine.ResultsTdap vaccination was more likely during the post-intervention period compared with the pre-intervention period (2268 of 3186 [71.2%] compared with 2556 of 5030 [55.6%]; p < .001). Comparisons between each subgroup of pre-intervention and post-intervention women showed that incorporating pertussis information into prenatal education for GBS prevention was beneficial except for women of maternal age 30–34 years and women living in rural areas.ConclusionsPrenatal GBS screening activities represent an opportunity for healthcare providers to offer pertussis cocooning information to eligible pregnant women to improve rates of postpartum Tdap vaccination.     

外周血血红蛋白、血小板计数、血浆纤维蛋白原及D-二聚体检测预测孕晚期产妇产后出血的价值分析

目的:探讨孕晚期纤维蛋白原(Fib)、D-二聚体(D-D)、血小板(PLT)计数、血红蛋白(Hb)检测对产后出血的预测价值.方法:选择37例产后出血产妇为产后出血组(包括严重产后出血11例);选择40例正常产妇为对照组.比较两组产妇孕晚期Fib、D-D、PLT及Hb水平.结果:产后出血组D-D水平显著高于对照组(P＜0.05);两组Fib、PLT及Hb水平比较差异无统计学意义(P＞0.05).普通产后出血产妇Fib、PLT及Hb水平显著高于严重产后出血产妇,D-D水平显著低于严重产后出血产妇(P＜0.05).Fib及D-D对产后出血具有一定预测价值.Fib水平越高,发生产后出血的几率越低(P＜0.05);D-D水平越高,发生产后出血的几率越高(P＜0.05).PLT及Hb对产后出血无预测价值(P＞0.05).结论:检测孕晚期Fib及D-D水平对产后出血具有一定预测价值.     

妊娠期糖尿病患者分娩后代谢综合征的患病率及其与血清淀粉蛋白、C-反应蛋白等因素的相关性研究

目的:研究妊娠糖尿病(GDM)患者产后代谢综合征(MS)患病率与血清淀粉蛋白A(SAA)、C反应蛋白(CRP)的相关性.方法:选取河南省妇幼保健院2008年10月～ 2010年11月分娩的50例GDM产妇为研究组,同期分娩的45例未患GDM产妇为对照组,两组均随访24个月,对两组孕前、产后24个月的各项指标进行对比分析.结果:研究组怀孕年龄、胎儿出生体重与对照组比较,差异无统计学意义(P＞0.05),研究组心血管病、糖尿病家族史与对照组比较,差异有统计学意义(P＜0.05).研究组产前体重指数、体脂、腰臀比、FPG与对照组比较,差异有统计学意义(P＜0.05),研究组血压、腰围、臀围、TG、TC、HDL-C、LDL-C、HOMA-IR、HbAlc、SAA、CRP与对照组比较,差异无统计学意义(P＞0.05).产后24个月,研究组10例发生MS,发生率为20.0％,对照组3例发生MS,发生率为6.7％,两组呈明显差异(P＜0.05).产后24个月,研究组体重指数、体脂、腰围、腰臀比、FPG、TG、LDL-C、HOMA-IR、HbAlc、SAA、CRP与对照组相较,差异有统计学意义(P＜0.05),研究组血压、臀围、TC、HDL-C与对照组相较,差异无统计学意义(P＞0.05).Logistic多元回归分析显示,MS的相关因素为孕前体重指数、怀孕年龄、糖尿病家族史、GDM病史,以及产后24个月的SAA、CRP (P＜0.01).结论:GDM患者产后MS患病率与血清SAA、CRP具有密切关系,两者为MS的发生和发展提供了慢性炎症环境.结合产妇体重指数、怀孕年龄、GDM病史等因素,可以对将要发生的MS进行早期诊断,实施积极的预防控制方案,有利于GDM患者产后恢复,应予推广.     

女性围产期抑郁动态观察及相关因素研究

目的:观察女性围产期抑郁情绪动态变化及探讨女性孕期压力水平、应对方式与围产期抑郁的相关性.方法:采用便利抽样法选取在合肥市某三甲医院门诊孕期检查的162例孕妇为调查对象,运用妊娠压力量表(PPS)、简易应对方式问卷(SCSQ)评估孕期压力水平和孕妇应对压力的方式,运用爱丁堡产后抑郁量表(EPDS)评估孕期、产后的抑郁情绪.结果:孕产妇孕期抑郁、产后抑郁的发生率分别为47.53％ (77/162)、48.77％ (79/162);纵向追踪发现,孕期77例抑郁女性中,在产后有24例女性(31.17％)转为非抑郁;孕期85例非抑郁女性中,在产后有26例女性(30.59％)转为抑郁.其次,妊娠晚期孕妇妊娠总体压力为轻度水平[中位数(M)=1.57].孕妇应对方式总分(1.57 ±0.03)分,积极应对方式评分为(1.93±0.04)分,消极应对方式评分为(1.03±0.03)分.与常模比较,其中,积极应对方式评分比常模评分高,差异有统计学意义(t=1.96,P＜0.01).孕妇孕期抑郁情绪与妊娠压力总分、各压力因子得分呈正相关,与应对方式总分、积极应对分值呈负相关.产妇产后抑郁情绪与妊娠压力总分、各压力因子得分呈正相关,与积极应对分值呈负相关.多元逐步回归分析显示,孕期抑郁情绪是产后抑郁的危险因素,家庭关系是产后抑郁情绪的保护因素.结论:在产前对孕妇做好心理健康水平的筛查和干预,对于产后抑郁的预防有着重要意义.     

Episiotomy healing assessment: Redness,Oedema, Ecchymosis,Discharge, Approximation (REEDA) scale reliability

OBJECTIVE:

to analyse the Redness, Oedema, Ecchymosis, Discharge, Approximation (REEDA) scale reliability when evaluating perineal healing after a normal delivery with a right mediolateral episiotomy.

METHOD:

observational study based on data from a clinical trial conducted with 54 randomly selected women, who had their perineal healing assessed at four time points, from 6 hours to 10 days after delivery, by nurses trained in the use of this scale. The kappa coefficient was used in the reliability analysis of the REEDA scale.

RESULTS:

the results indicate good agreement in the evaluation of the discharge item (0.75< Kappa ≥0.88), marginal and good agreement in the first three assessments of oedema (0.16< Kappa ≥0.46), marginal agreement in the evaluation of ecchymosis (0.25< Kappa ≥0.42) and good agreement regarding redness (0.46< Kappa ≥0.66). For the item coaptation, the agreement decreased from excellent in the first assessment to good in the last assessment. In the fourth evaluation, the assessment of all items displayed excellent or good agreement among the evaluators.

CONCLUSION:

the difference in the scores among the evaluators when applying the scale indicates that this tool must be improved to allow an accurate assessment of the episiotomy healing process.