Postdates and antenatal testing

The standard definition of a prolonged pregnancy is 42 completed weeks of gestation. The incidence of prolonged pregnancy varies depending on the criteria used to define gestational age at birth. It is estimated that 4 to 19% of pregnancies reach or exceed 42 weeks gestation. Several studies that have used very large computerized databases of well-dated pregnancies provided insights into the incidence and nature of adverse perinatal outcome such as an increased fetal and neonatal mortality as well as increased fetal and maternal morbidity in prolonged pregnancy. Fetal surveillance may be used in an attempt to observe the prolonged pregnancy while awaiting the onset of spontaneous labor. This article reviews the different methodologies and protocols for fetal surveillance in prolonged pregnancies. On the one hand, false-positive tests commonly lead to unnecessary interventions that are potentially hazardous to the gravida. On the other hand, to date, no program of fetal testing has been shown to completely eliminate the risk of stillbirth.     

围生期抑郁信息化管理方案的构建与应用

目的 构建围生期抑郁信息化管理方案并应用于临床,降低孕产妇围生期抑郁的发生。方法 将375例孕产妇按照入院时间分为对照组185例与干预组190例。对照组实施常规干预;干预组汇总围生期抑郁管理的最佳证据,构建围生期抑郁管理方案,开发围生期抑郁信息化管理系统对孕产妇进行干预。干预前后比较两组抑郁评分、抑郁管理知信行评分及分娩结局。结果 对照组157例、干预组155例完成研究。干预组抑郁评分显著低于对照组,抑郁管理知识及行为评分显著高于对照组(均P<0.05),干预组自然分娩及纯母乳喂养率显著高于对照组(均P<0.05)。结论 围生期抑郁信息化管理方案的应用可有效改善孕产妇围生期抑郁水平,从而改善分娩结局。     

单绒毛膜双羊膜囊选择性胎儿生长受限30例临床分析

目的 探讨单绒毛膜双羊膜囊双胎(简称单绒毛膜双胎)选择性胎儿生长受限(简称sFGR)的围生儿结局、临床处理及围生儿死亡的危险因素.方法 回顾性分析2010年1月-2016年8月在该院产科分娩的30例单绒毛膜双胎sFGR的临床资料,根据脐动脉舒张期血流频谱分为Ⅰ、Ⅱ、Ⅲ型.结果 30例单绒毛膜双胎sFGR中,Ⅰ型患者13例,围生儿均存活;Ⅱ型患者10例,发生一胎胎死宫内4例,3例存活胎围生期均死亡,1例孕中期引产,出生后放弃抢救死亡1例,2例围生儿均死亡;Ⅲ型患者7例,发生一胎胎死宫内2例,1例存活胎围生期死亡,1例孕中期引产,出生后放弃抢救死亡1例,2例围生儿均死亡.Ⅰ型大胎体质量明显大于Ⅱ、Ⅲ型,差异有统计学意义(P<0.05),Ⅱ型小胎体质量明显小于Ⅰ、Ⅲ型(P<0.05),Ⅱ型胎儿体质量差值明显大于Ⅰ、Ⅲ型(P<0.05).Ⅱ、Ⅲ型围生儿死亡率明显高于Ⅰ型(P<0.05),静脉导管血流频谱异常者围生儿死亡率明显高于静脉导管血流频谱正常者(P<0.05),发生sFGR<26周者围生儿死亡率明显高于发生sFGR≥26周者(P<0.05).结论 Ⅰ型围生儿预后最好,Ⅱ、Ⅲ型围生儿预后较差.Ⅱ型和Ⅲ型、静脉导管血流频谱异常及发生sFGR<26周是导致单绒毛膜双胎sFGR围生儿死亡的危险因素.     

体验式教学在围产保健管理继续教育培训中的应用

目的/意义 探讨体验式教学模式在围产保健管理继续教育培训中的应用效果。方法/过程 由北京协和医院围产保健团队面向30位来自全国各地的孕产医护人员开展为期4天的体验式课堂教学。通过自制问卷分析学员在体验式课堂后临床技能提高、临床适用性、教育需求满足情况以及对课程教学内容、课程时间、教学设计、课堂氛围、教学形式的满意度,采用李克特量表对教学效果量化反馈。结果/结论 体验式教学模式在围产保健管理继续教育领域教学效果较好,有较好应用前景。未来应与理论式教学相结合,开展更完善、结构化的全国范围内的周期性教学,提升围产保健工作者的相关理论基础和临床技能,以更好地为孕产妇提供健康保健服务。     

流动人口孕产妇围产期保健质量影响因素分析和对策

目的了解流动人口孕产妇围产期保健质量,为采取有效的干预措施提供依据。方法对浙江省长兴县5年来26838例孕产妇的临产资料进行回顾性分析,并对本地孕产妇与流动孕妇的系统管理人数、孕产妇死亡数等资料分别统计后进行对比分析。结果本地孕产妇和流动人口孕产妇在系统保健和分娩结局方面有显著差异;流动人口孕产妇围产期保健质量显著提高。结论通过建立流动人口孕妇围产期保健网络和管理考核制度、降低检查和分娩费用、取缔家庭接生、加强健康教育等干预措施,我县流动人口孕妇系统管理率、高危孕妇筛选率、住院分娩率明显升高,孕产妇和围产期儿病死率、新生儿发生率明显降低。     

Relationship in Japan between maternal grandmothers’ perinatal support and their self‐esteem

This study investigated the influence on their mental well‐being of the perinatal support given by Japanese grandmothers. The Rosenberg self‐esteem and the Center for Epidemiologic Studies Depression (CES‐D) scales were used to assess grandmothers’ mental well‐being before and after their daughters’ childbirth. Of 198 grandmothers, 176 (88.9%) supported their daughters and three patterns of perinatal support were observed: grandmothers’ support at the grandparents’ house before childbirth (n = 95) (Satogaeri bunben; Japanese traditional perinatal support), grandmothers’ support at the grandparents’ house after childbirth (n = 53); and grandmothers’ support at the daughters’ house (n = 28). Those who supported their daughters at the grandparents’ house before childbirth – especially the middle‐aged (less than 60 years old) – showed significantly lower scores of self‐esteem. Scores of CES‐D did not significantly change before and after childbirth in either subgroup of grandmothers. It was concluded that grandmothers play an important role in supporting their daughters, and Satogaeri bunben is a typical event in modern Japan. However, Satogaeri bunben is a burden for middle‐aged grandmothers, and we need to support them.