Management of Spigelian hernia caused by necrobiotic fibroma of the uterus in a pregnant woman

INTRODUCTIONSpigelian hernias are a rare type of hernia through the Spigelian aponeurosis. Spigelian hernias are very uncommon and constitute only 0.12% of all abdominal wall hernias. These hernias are located in the aponeurosis of the internal oblique muscle and transverse abdominal muscle.PRESENTATION OF CASEA 30-year-old woman at 28 weeks’ gestation was admitted to the obstetrics department due to pain and swelling in the anterior abdominal right region. On inspection, we suspected either a lipoma, a spontaneous hematoma, a tumor of the abdominal wall, or a Spigelian hernia. A Doppler USG and abdominal and pelvic Magnetic Resonance Imaging revealed necrobiotic fibroma of the uterus in Spigelian hernia. The patient was started on dual analgesic and corticotherapy. Overall, the patient improved one week after the acute episode and had no further pain during her gynecologic follow-up.DISCUSSIONWe have reported a first case of Spigelian hernia that was complicated by uterine fibroid. The clinical presentation varies, depending on the contents of the hernial sac and the degree of herniation. MRI is the preferred method for accurately identifying masses of the abdominal wall. Our treatment options were based on the extent of the acute-phase reaction and the venous thrombosis.CONCLUSIONIt is important to differentiate this rare Spigelian hernia from other hernias as the treatment for this hernia is medical rather than surgical. Before the final choice of treatment is made, digestive surgeons should bear this rare hernia in mind.     

胎盘早剥程度及母儿预后的临床危险因素

目的探讨胎盘早剥程度以及母儿预后的相关临床危险因素,以期改善母儿结局。方法收集2007年1月-2012年12月在该院住院确诊的167例胎盘早剥孕妇的临床资料,采用Logistic回归方法对年龄、产次、外伤、脐带情况、是否催产等影响胎盘早剥程度及母儿预后的高危因素进行单因素和多因素分析。结果 167例胎盘早剥孕妇中,胎盘早剥Ⅰ度91例(轻型组),Ⅱ度38例(中型组),Ⅲ度38例(重型组);单因素回归分析显示,重型组孕妇产次、产时出血量、输血量、子宫胎盘卒中率、新生儿窒息、死胎率与中、轻型组比较,差异有统计学意义(P<0.05)。多因素分析显示,产次、子宫胎盘卒中、休克及死胎是胎盘早剥的独立高危因素(P<0.05)。结论重视发生胎盘早剥的经产妇、休克及死胎孕妇,警惕重度胎盘早剥的发生。     

3099例孕妇的孕期营养知识知晓情况及影响因素分析

目的了解孕妇的营养知识水平及其相关因素,为孕期营养教育提供科学依据。方法采用自行设计的一般情况调查表和孕期营养知识问卷对3 099例产检孕妇进行调查。结果孕期营养知晓率为73.73%。肥胖导致孕期糖尿病、体重指数、正常体重孕妇理想增重范围、早孕反应进食少是否会影响胎儿的生长发育等方面知晓率低,分别为39.98%、33.49%、49.34%、29.85%。本人户籍、本人教育程度、丈夫教育程度、家庭月收入、年龄、分娩史为孕期营养知识知晓率的相关因素。结论要针对不同文化程度、不同地域孕妇开展多种形式的营养知识教育,尤其针对文化程度低及初产妇实施个体化教育,宣传范围应扩展到孕妇的配偶及其他家庭成员,从而全面提高孕妇的孕期营养知识水平,形成正确的行为。     

Central concepts in the midwife-woman relationship

The relationship between the midwife and the woman is essential for a positive experience for woman during childbearing period, i.e. pregnancy, childbirth and the first postpartum phase. Thereby, the aim of this study was to delineate central concepts in the midwife-woman relationship, in normal as well as high-risk situations. A secondary analysis was performed on original texts from eight Swedish qualitative studies, all with a phenomenological or phenomenological-hermeneutic approach. Six pairs of concepts were elucidated; each one describing one aspect from the woman's perspective and one responsive aspect from the midwife. The pairs of concepts are: surrender-availability, trust-mediation of trust, participation-mutuality, loneliness-confirmation, differenceness-support uniqueness and creation of meaning-support meaningfulness. Disciplinary concepts about the midwife-woman relationship have evolved that are essential for care in both normal and high-risk contexts, and we suggest that they should be implemented as a guide for midwifery care.     

剖宫产与阴道分娩对产妇近期并发症的影响

目的：探讨剖宫产和阴道分娩对产妇近期并发症的影响。方法选取2010年7月~2012年6月在本院分娩的1878例产妇,根据产妇的要求按分娩方式将产妇分成阴道分娩组（782例）和剖宫产组（1096例）,比较两组的并发症发生率。结果两组的子宫破裂发生率差异无统计学意义（P>0.05）,阴道分娩组的产褥感染、产后出血、产后尿潴留发生率明显低于剖宫产组（P<0.05）。结论剖宫产方式会明显增高产后并发症发生率,阴道分娩的产后并发症发生率则明显较低,应提倡阴道分娩。     

储存式自体输血在前置胎盘患者中应用的安全性分析

目的:通过研究储存式自体输血对前置胎盘患者血红蛋白(Hb)、血细胞比容(HCT)、血小板(PLT)以及凝血功能的影响,探讨储存式自体输血在前置胎盘患者中应用的安全性。方法:收集2012-03-2013-09在孝感市中心医院住院的20例前置胎盘患者,比较其在进行储存式自体输血前后Hb、HCT、PLT以及凝血指标的变化有无显著性。结果:采血前后及血液回输后各项血液及凝血指标差异均无统计学意义;新生儿血常规及凝血指标均无异常;19例患者进行自体回输后均无不良反应。结论:储存式自体输血对自身状态良好、满足储存式自体输血基本要求的前置胎盘孕妇母婴均安全,不影响孕妇妊娠结局。     

不同孕妇人群B族链球菌携带率差异分析

目的 分析不同孕妇人群B族链球菌（GBS）携带率的差异.方法 选取2013年1月-2014年7月间我院产科收治的孕35～37周的孕妇1 282例作为研究对象,分别取阴拭子及肛拭子送检.结果 1 282例孕妇中,GBS阳性106例,平均年龄为（26.72±3.55）岁,GBS阴性1 176例,平均年龄为（27.29±2.86）岁,组间比较年龄无显著性差异（P＞0.05）.经产妇131例,GBS阳性12例,携带率为9.2％,初产妇1 151例,GBS阳性94例,携带率为8.2％,组间比较携带率未见显著性差异（P＞0.05）.汉族987例,GBS阳性78例,携带率为7.9％;少数民族295例,GBS阳性28例,携带率为9.5％,组间比较携带率未见显著性差异（P＞0.05）.城区居住孕妇814例,GBS阳性52例,携带率为6.4％;非城区居住468例,GBS阳性84例,携带率为11.5％,组间比较非城区居住孕妇GBS携带率显著高于城区居住者（P＜0.05）.结论 GBS的携带率与孕妇年龄、经产或初产及民族等均无显著相关性,但非城区居住孕妇GBS携带率显著高于城区居住者,因此,应将非城区居住孕妇作为GBS筛查的重点对象.     

Are we still woman-centred? Changing ideologies,a history of antenatal education in Australia

BackgroundThe medicalisation of childbirth that began in the early 20th century continues to this day. As birth moved from home to the medical environment, antenatal education that prepared families for childbirth and parenting has also changed with little evidence of its effectiveness.AimTo document historical influences underpinning contemporary antenatal education practice to inform future directions.FindingsPersistent medicalisation and commercialisation of antenatal education raises professional and quality related issues with regards to educational content and delivery. In Australia, as in other countries, there are no requirements for antenatal educators to have any formal training or qualifications; this poses questions about the need for professional regulation.DiscussionAntenatal education remains a significant component of antenatal care, despite evaluations of antenatal education demonstrating variable efficacy to date. Changing ideologies have led to the need for professional specialisation for antenatal educators. It is recommended that the Competency Standards for Childbirth and Early Parenting should be implemented to enable evaluation of and compliance with antenatal education programs. Antenatal educators have changed their strategies in providing education within some of the newer models of care; however, without recognition, regulation or a research agenda that could confirm or change these models, evidence-based practices remain elusive.ConclusionThe history of antenatal education is important to the care of women and their families. Knowing what has preceded the current situation can help health practitioners develop appropriate classes in the future, ensuring that antenatal education continues to be woman centred.     

女性缺血性心脏病的研究现状及展望

心血管系统疾病在女性中的发病率逐年升高,已成为女性死亡的最主要原因,却没有引起足够的重视,由于女性心血管病患者的临床症状及发病机理具有一定特异性,临床诊断与治疗过程往往被延误。因此更好的理解性别差异在诊断心血管疾病中的作用是改善女性冠心病患者预后的第一步。该文对女性心血管病的临床症状、发病机理、临床诊断等方面进行阐述。