第1产程潜伏期指导对分娩的影响

目的 :观察规范指导对处于分娩第 1产程潜伏期孕妇的影响。方法 :为处于分娩第 1产程潜伏期的 15 0例产妇讲解分娩知识 ,训练助产动作 ,树立自然分娩信心 ,并动态观察产妇的分娩情况。以条件相同 ,未在潜伏期做指导的产妇 15 0例为对照组。结果 :观察组总产程、第 1产程活跃期及第 2产程明显短于对照组 (P <0 0 1) ,新生儿窒息率、剖宫产率明显低于对照组(P <0 0 1)。第 1产程潜伏期、阴道助产率及产后出血发生率两组差异无显著性。结论 :在第 1产程潜伏期对产妇进行规范指导可以缩短产程 ,促进自然分娩 ,降低新生儿窒息发生率。     

Epidemiology of limb-body wall complex in Japan

Limb-body wall complex is a malformation of body and limbs with craniofacial defects. We describe here the epidemiology of this complex using the population-based registry data in the Kanagawa Birth Defects Monitoring Program during the period 1982–1991. Eleven infants (11/428,599 births) with the complex were ascertained in the study. The incidence and spectrum of the defects observed in our cases were similar to those of other studies. The parental ages in the study group were not significantly different from those in the general population. No teratogenic agents and factors were identified in the present study. Most cases were diagnosed prenatally. © 1994 Wiley-Liss, Inc.     

Infant and Neonatal Mortality for Primary Cesarean and Vaginal Births to Women with “No Indicated Risk,” United States, 1998–2001 Birth Cohorts

ABSTRACT: Background: The percentage of United States’ births delivered by cesarean section has increased rapidly in recent years, even for women considered to be at low risk for a cesarean section. The purpose of this paper is to examine infant and neonatal mortality risks associated with primary cesarean section compared with vaginal delivery for singleton full‐term (37–41 weeks’ gestation) women with no indicated medical risks or complications. Methods: National linked birth and infant death data for the 1998–2001 birth cohorts (5,762,037 live births and 11,897 infant deaths) were analyzed to assess the risk of infant and neonatal mortality for women with no indicated risk by method of delivery and cause of death. Multivariable logistic regression was used to model neonatal survival probabilities as a function of delivery method, and sociodemographic and medical risk factors. Results: Neonatal mortality rates were higher among infants delivered by cesarean section (1.77 per 1,000 live births) than for those delivered vaginally (0.62). The magnitude of this difference was reduced only moderately on statistical adjustment for demographic and medical factors, and when deaths due to congenital malformations and events with Apgar scores less than 4 were excluded. The cesarean/vaginal mortality differential was widespread, and not confined to a few causes of death. Conclusions: Understanding the causes of these differentials is important, given the rapid growth in the number of primary cesareans without a reported medical indication. (BIRTH 33:3 September 2006)     

Ultrasonography in the detection of cervical incompetency

In 80 pregnancies with clinical and ultrasonic signs of cervical incompetency, the length of the cervix and the thickness of the anterior wall of a lower uterine segment have been evaluated ultrasonically. We have also measured the width of the endocervical canal and studied the prolapse of fetal membranes (with fetal parts) into the endocervical canal. We evaluated these same parameters in 80 healthy pregnancies. The length of the cervix, the thickness of the anterior wall of a lower uterine segment, and the width of the endocervical canal were followed longitudinally in the patients from the 10th to the 36th gestation week. No statistically significant differences between age groups were found. In four age groups at risk for cervical incompetency, cervical lengths and wall thickness were significantly different (p less than 0.001) from those in comparable controls. Forty-five percent of the patients in the at-risk group, with cervical cerclage, delivered at 37.3 (range: 32 to 41) weeks and 6.25% of pregnancies ended in abortion when the amniotic membrane herniated into the cervical canal, with or without some part of the fetus.     

极低出生体重儿两种喂养效果观察

目的:探讨极低出生体重儿(VLBW)的早期微量持续鼻饲喂养(CNG)与间断鼻饲喂养(ING)的喂养耐受性及喂养效果.方法:将60例VLBW进行随机分组,CNG组起始奶量1-2ml/h,以后泵速增加1-2ml/h.ING组奶量以1-2ml/kg开始, 以后每天增加1-2ml/kg/次.所有VLBW均同时进行部分静脉营养,直至达到完全胃肠道喂养时间(FEF).对比两组喂养不耐受性、达到FEF、停止静脉补液时间及黄疸持续时间.结果:CNG组较ING组患儿发生腹胀、呕吐者明显减少(P＜0.05),黄疸持续时间、吸吮动作出现时间及住院时间较对照组明显缩短(P＜0.05),但两组体重增长情况统计学无差异(P＞0.05).结论:CNG更适合VLBW的早期微量喂养.     

Cardiovascular malformations and organic solvent exposure during pregnancy in Finland

In order to investigate the possible association between cardiovascular malformations and maternal exposure to organic solvents during the first trimester of pregnancy, 569 cases and 1,052 controls were retrospectively studied. The cases represented all infants with diagnosed cardiovascular malformations born in Finland in 1982-1984, and the controls were randomly selected from all normal births in the country during the same period. All mothers were interviewed approximately 3 months after delivery by a midwife using a structured questionnaire. Exposures to organic solvents at work during the first trimester of pregnancy were slightly more prevalent among the mothers of affected infants (10.4%) than among those of controls (7.8%). Logistic regression analysis of exposure to organic solvents showed an adjusted relative odds ratio of 1.3 (95% confidence interval, 0.8-2.2). In the analysis of ventricular septal defect, exposure to organic solvents showed an adjusted relative odds ratio of 1.5 (95% confidence interval, 1.0-3.7).     

Abnormal cardiac histology in severe intrauterine growth retardation infants

Four infants with severe intrauterine growth retardation (IUGR) weighing less than 1000 g at birth developed heart failure and died in our unit, where heart failure of IUGR infants is the main reason of death in extremely low birth-weight infants. The causes of their heart failure are one of the main themes in current neonatal medicine. The subjects of this study were four small for gestational age infants; all died due to heart failure 5 to 10 days after birth. Microscopic specimens of hearts from autopsies were evaluated with respect to the following characteristics: thickness of myocardial fibers, maturation of nuclei, presence of dysgenesis or necrosis in myocardium, and amount of glycogen in the heart. Neither dysgenesis nor infarction of the heart was found but hypoplasia in myocardial fibers and decreased glycogen levels were observed. Maturation delay in myocytes' nuclei did not appear to be severe. We conclude that these infants' hearts failed to adapt to postnatal hemodynamic changes because of inadequate myocardial function and inadequate glycogen reserves.     

小剂量氯胺酮咪唑安定辅助硬膜外下剖腹产手术的临床探讨

目的对比观察剖腹产选用连续硬膜外麻醉时，辅助麻醉用药镇静及对牵拉反应抑制效果。方法选择行剖腹产手术产妇60例在硬膜外麻醉效果满意后，随机分两组各30例。Ⅰ组：哌替啶50mg，异丙嗪25mg单次静注。Ⅱ组：氯胺酮28．5mg，咪达唑仑1．42mg单次静注。分组记录用药前，1min，5min，15min及术毕产妇SpO2、RR、HR、MAP值；记录手术时间、术毕苏醒例数、术中恶心躁动例数；记录术毕产妇OAA／S评分；记录新生儿娩出时Apger评分。结果两组术中镇静、抑制牵拉反应效果均满意。两组RR、BP、HR、SpO2均平稳；术毕两组OAA／S评分均为4-5分；新生儿Apger评分均正常。结论两组方法效果确切，对产妇和新生儿安全。     

Cardiovascular malformations, work attendance, and occupational exposures during pregnancy in Finland

To explore for associations between occupational factors and cardiovascular malformations, information on the parents of 160 infants with cardiovascular malformations and 160 control parents was studied. The case infants had been reported consecutively to the Finnish Register of Congenital Malformations. All mothers were interviewed identically after delivery, using both open and pro forma questions about detailed work tasks, exposures, and leisure activities during pregnancy. The interview information was evaluated blindly. Neither parental occupational titles nor maternal working per se gave new clues to the teratogenic risk; nor did shift working, wearing of personal protective equipment, or the mother's own opinion on exposures during pregnancy. Identified occupational exposures, as categorized by an industrial hygienist, showed no remarkable associations to cardiovascular malformations. Few mothers were exposed substantially to specific occupational hazards. Comparing mothers who used medications in the first trimester with those who did not showed an odds ratio of 2.2 (95% confidence interval 1.3-3.9) when adjusted for potential confounding by multivariate logistic methods.     

Skilled birth attendant competence: an initial assessment in four countries, and implications for the Safe Motherhood movement.

OBJECTIVES: Percentage of deliveries assisted by a skilled birth attendant (SBA) has become a proxy indicator for reducing maternal mortality in developing countries, but there is little data on SBA competence. Our objective was to evaluate the competence of health professionals who typically attend hospital and clinic-based births in Benin, Ecuador, Jamaica, and Rwanda. Methods: We measured competence against World Health Organization's (WHO) Integrated Management of Pregnancy and Childbirth guidelines. To evaluate knowledge, we used a 49-question multiple-choice test covering seven clinical areas. To evaluate skill, we had participants perform five different procedures on anatomical models. The 166 participants came from facilities at all levels of care in their respective countries. Results: On average, providers answered 55.8% of the knowledge questions correctly and performed 48.2% of the skills steps correctly. Scores differed somewhat by country, provider type, and subtopic. Conclusion: A wide gap exists between current evidence-based standards and current levels of provider competence.