产褥期妇女育儿胜任感的影响因素

目的了解嘉兴市产褥期妇女育儿胜任感的现状,并研究其影响因素,为制定有针对性的护理干预措施提供参考依据。方法采用自制一般资料问卷、中文版育儿胜任感量表(Chinese version of parenting sense of competence scale,C-PSOC)及社会支持评定量表(social support rating scale,SSRS)对嘉兴市293名产褥期妇女进行调查。结果嘉兴地区产褥期妇女的育儿胜任感量表总得分为(72.25±2.51)分;社会支持评定量表的总分为(42.21±2.23)分,其3个维度得分分别为主观支持维度(24.45±4.17)分、客观支持维度(10.14±3.23)分、社会支持的利用度维度(8.11±2.57)分。社会支持评定量表总分及其各维度与产褥期妇女育儿胜任感呈正相关(P0.05)。多元逐步回归分析显示:社会支持评定量表总得分、籍贯、产次、职业、是否足月产、社会支持利用度以及文化程度是产褥期妇女育儿胜任感的影响因素(均P0.05)。结论嘉兴市产褥期妇女产后育儿胜任感得分较低,影响因素较多,医疗保健部门应针对不同人群采取有效措施,制定合理方案,提高产褥期妇女社会支持利用度,从而促进其母亲角色的完好达成。     

Elevated glucose levels in early puerperium,and association with high cortisol levels during parturition

Background Gestational diabetes is one of the commonest metabolic problems associated with pregnancy and an accurate diagnosis is critical for the care. Research has shown that pregnant women have high levels of cortisol during the last stage of parturition. As cortisol is a diabetogenic hormone causing increased glucose levels, we wanted to study the association between cortisol and glucose levels during parturition. Materials and methods Glucose and cortisol were analyzed during parturition in 50 females divided according to slow (n?=?11) and normal labors (n?=?39). Blood samples were analyzed three times during the parturition and four times in the first day after delivery. Glucose levels were also measured once in each trimester. Results In the normal group, the glucose concentration increased from 6.2 (IQR 5.6–8.0) mmol/L in the latency phase to 11.6 (10.0–13.3) mmol/L at aftercare (p?Conclusions The changes associated with birth cause significant elevations of cortisol and glucose around parturition.     

正常妊娠妇女妊娠晚期及产后血脂水平变化分析

目的观察正常妊娠妇女在妊娠晚期及其产后血脂水平的变化。方法收集150例正常妊娠妇女分别在妊娠晚期及产后1周的标本作为实验组,40例健康未孕妇女的标本作为对照组。三酰甘油、总胆固醇采用氧化酶法,高密度脂蛋白胆固醇、低密度脂蛋白胆固醇采用直接测定法,载脂蛋白A(ApoA)、ApoB采用免疫透射比浊法,测定3组标本血清中6项指标的含量,并采用统计学方法比较分析各组血脂水平变化。结果正常妊娠妇女妊娠晚期6项血脂指标均高于其产后血脂水平,差异有统计学意义(P0.05);正常妊娠妇女妊娠晚期和产后期血脂水平均明显高于未孕对照组,差异有统计学意义(P0.01)。结论妊娠晚期孕妇血脂维持在较高水平,但产后1周内脂代谢水平明显下降,因此监测其血脂水平变化对预测产后高脂血症有一定意义。     

基于微信平台的延续性护理对剖宫产产妇产褥期心境、自护能力及母婴健康状况的影响

目的探讨基于微信平台的延续性护理对剖宫产产妇产褥期心境、自护能力及母婴健康状况的影响。方法随机将在我院进行剖宫产分娩的86例产妇分为观察组(43例,基于微信平台的延续性护理)与对照组(43例,常规护理),比较两组的护理效果。结果护理后,两组的紧张、生气、疲乏、抑郁、困惑、活力评分均改善,且观察组优于对照组(P<0.05)。护理后,两组的自我概念、自护责任、自我护理技能、健康知识水平评分均升高,且观察组高于对照组(P<0.05)。观察组产妇及婴儿并发症总发生率均低于对照组(P<0.05)。结论基于微信平台的延续性护理有利于改善剖宫产产妇的产褥期心境,提高其自护能力,促进母婴健康。     

Can we identify risk factors during pregnancy for thrombo-embolic events during the puerperium and later in life?

Objectives: To investigate parturients at risk to develop venous thrombo-embolic events (VTE) in the puerperium or later in life, during a follow-up of more than a decade and compare risk factors for VTE during the puerperium with VTE later in life.

Methods: A nested case–control study was conducted to profile parturients at risk for VTE and a secondary analysis to compare risk factors for VTE during or after puerperium. We used a cohort of 95?257 women who gave birth between the years 1988 and 1998.

Results: Independent risk factors to develop VTE were peripartum hysterectomy, stillbirth, cesarean delivery (CD), obesity, pregnancy-related hypertension, grandmultiparity and advanced maternal age. Women undergoing CD and those receiving blood transfusion were more likely to develop early versus late VTE (OR?=?2.0, 95% CI?=?1.15–3.5 and OR?=?11.0, 95% CI?=?2.25–55.5; respectively). Patients that encountered VTE during the puerperium had more pulmonary emboli and less deep vein thrombosis, compared with the late VTE group (p?Conclusions: Maternal age, grandmultiparity, pregnancy-related hypertension, CD, obesity, stillbirth and peripartum hysterectomy are independent risk factors for the development of VTE. CD and blood transfusion were predictive of early versus late VTE.     

Acute Stroke During Pregnancy and Puerperium

BackgroundAcute stroke during pregnancy or within 6 weeks of childbirth is devastating for the mother and her family, yet data regarding incidence and contemporary trends are very limited.ObjectivesThis study sought to investigate the incidence and outcomes of acute stroke and transient ischemic attack during pregnancy or within 6 weeks of childbirth in a large database.MethodsThe National Inpatient Sample was queried to identify women age ≥18 years in the United States with pregnancy-related hospitalizations from January 1, 2007, to September 30, 2015. Temporal trends in acute stroke (ischemic and hemorrhagic)/transient ischemic attack incidence and in-hospital mortality were extracted.ResultsAmong 37,360,772 pregnancy-related hospitalizations, 16,694 (0.045%) women had an acute stroke. The rates of acute stroke did not change (42.8 per 100,000 hospitalizations in 2007 vs. 42.2 per 100,000 hospitalizations in 2015; p_trends = 0.10). Among those with acute stroke, there were increases in prevalence of obesity, smoking, hyperlipidemia, migraine, and gestational hypertension. Importantly, in-hospital mortality rates were almost 385-fold higher among those who had a stroke (42.1 per 1,000 pregnancy-related hospitalizations vs. 0.11 per 1,000 pregnancy-related hospitalizations; p < 0.0001). The rates of in-hospital mortality among pregnant women with acute stroke decreased (5.5% in 2007 vs. 2.7% in 2015; p_trends < 0.001).ConclusionsIn this contemporary analysis of pregnancy-related hospitalizations, acute stroke occurred in 1 of every 2,222 hospitalizations, and these rates did not decrease over approximately 9 years. The prevalence of most stroke risk factors has increased. Acute stroke during pregnancy and puerperium was associated with high maternal mortality, although it appears to be trending downward. Future studies to better identify mechanisms and approaches to prevention and management of acute stroke during pregnancy and puerperium are warranted.     

孕产期综合护理干预预防产后抑郁的研究

目的：探讨孕产期综合护理干预对产后抑郁的影响。方法：经初筛后,将593例孕妇被随机分为对照组和干预组。对照组进行常规保健检查及护理,干预组在常规护理基础上接受综合护理干预。产后6周末,采用自评量表对两组进行测评并比较。结果：干预组产后抑郁症发病率6．9％,显著低于对照组（P〈0．05）,其SCL-90各因子分、SDS分、负性生活事件刺激量得分也显著低于对照组（P〈0．05）,客观支持因子分与积极应付方式因子分显著高于对照组（P〈0．05）。结论：孕产期综合护理干预能有效改善孕产妇抑郁情绪,减少产后抑郁症的发生。     

重庆地区278例产褥期妇女高危型HPV感染状况及对HPV认知情况调查分析

目的调查重庆地区产褥期妇女高危型人乳头状瘤病毒（HR-HPV）感染状况及对HPV的认知情况,为制定不同人群的宫颈癌筛查防治方案提供理论依据。方法采用第2代杂交捕获法（HC-2）检测技术对2011年11月至2012年6月在重庆市妇幼保健院产科门诊就诊的278例产褥期妇女进行HR-HPV检测,同时采用问卷调查的方式了解其对HPV的认知情况。结果 278例产妇中共检出HR-HPV阳性者22例,阳性率为7.91%,随着年龄的增高,人群HR-HPV阳性率有逐渐增高趋势,35岁以上产妇HR-HPV阳性率最高为12.50%（6/48）。85.25%（237/278）的妇女未接受过宫颈癌防治宣教,44.96%（125/278）的妇女对HPV完全不了解,仅20.14%（56/278）的妇女愿意主动接受HC-2检测。受教育程度高（〉12年）、高收入（〉5 000元/月）人群对HPV的认知程度相对较好,差异有统计学意义（P〈0.01）。结论产褥期妇女HR-HPV总体阳性率较低,但高龄产妇HR-HPV阳性率相对较高,极大部分产妇对HPV认知程度差,应加强宣传教育并积极与医疗服务相结合,提高妇女防癌普查意识,加强对高龄产妇的宫颈癌筛查。