家庭探访对初产妇产褥期生活质量的影响

目的探讨家庭探访对初产妇产褥期生活质量的影响。方法将110例单胎出院进行家庭探访的初产妇设为家访组,将过去未做家庭探访,只做电话随访的110例单胎初产妇设为对照组。比较两组产后4周时生理问题和生活质量。结果产后4周家访组发生产褥期常见生理问题的例数较对照组明显减少（P〈0.05）。家访组生活质量明显优于对照组,差异有统计学意义（P〈0.01或P〈0.05）。结论家庭探访对促进初产妇产褥期生理机能恢复和维护心理健康具有明显作用,可有效提高初产妇的生活质量。     

城乡妇女产褥期生活及卫生习惯分析

目的 了解城乡妇女产褥期生活及卫生习惯情况,探讨现代妇女科学的产褥期行为方式。方法采用整群随机抽样方法,抽取山东省青岛市市区(城市组)及莘县农村地区(农村组)2 342名产后1年以内的妇女进行问卷调查。结果 农村组有2.6%的妇女产褥期从不下床活动,高于城市组的1.5%(P<0.05);农村组平均每天下床活动时间为2.59 h,低于城市组的3.35 h(P<0.05);农村组比城市组更注重保暖(P<0.05);农村组不洗澡、不洗头、不洗脚等行为发生率分别为52.0%、49.9%、26.6%,高于城市组的41.3%3、3.0%6、.7%,而不做产后体操、不做简单家务等行为的发生率分别为70.2%、26.4%,低于城市组的76.9%5、2.4%(P<0.05);农村组认为串门、吹风为产褥期行为禁忌的人数比例高于城市组,而认为晒太阳、洗澡、碰凉水、下床为禁忌的人数比例低于城市组(P<0.05)。结论 城乡妇女产褥期不良行为发生率均较高,差异亦有统计学意义,需要引起足够的重视。     

产后延续性护理的实施及护理效果评价

目的了解产后延续性护理的实施及护理效果。方法将医院2016年4月-2018年7月的100例产妇,随机分组,对照组给予常规护理干预,观察组开展产后延续性护理干预。比较两组纯母乳喂养率;产后自我护理认知水平、产后的遵医行为水平;护理前后HAMD抑郁量表分值以及SDS量表分值;产褥期并发症发生率。结果观察组纯母乳喂养率、HAMD抑郁量表分值以及SDS量表分值、产后自我护理认知水平、产后的遵医行为水平、产褥期并发症发生率对比对照组有优势,P<0.05。结论产妇实施产后延续性护理干预效果确切,并提高产妇自理能力和遵医行为,减少产褥期并发症的发生,提高产妇的纯母乳喂养率水平。     

产褥期模块式营养干预治疗产后缺乳的效果研究

目的探讨产褥期模块式营养干预治疗产后缺乳和防止乳汁淤积的效果。方法将84例分娩出现缺乳的产妇,按随机数字表法分为干预组和对照组,各42例。对照组接受常规护理。干预组进行产褥期模块式营养干预,包括咨询、优化营养干预、饮食习惯行为调整和个性化营养方案干预。并对两组泌乳量、乳房充盈程度、产褥期间食物摄取情况及健康结局进行比较。结果产后14d、28d干预组产妇泌乳量、乳房充盈程度明显高于对照组,有显著性差异(P0.05);干预组薯类、蛋类、豆制品、绿叶蔬菜、坚果摄入量显著高于对照组(P0.05);而粮谷类、奶类、虾蟹类、畜肉类、动物内脏、水果摄入量也高于对照组,但无显著性差异(P0.05);追踪随访显示,干预组产褥期间乳腺疾病、营养性贫血的发生率分别为14.29%、2.38%,显著低于对照组33.33%、30.95%,有显著性差异(P0.05),且干预组子宫复旧改善率97.62%明显高于对照组83.33%(P0.05)。结论模块式营养干预能有效纠正产妇缺乳,预防乳汁淤积,提高了产妇母乳喂养认知和纠正不良饮食结构,同时也增强了护士的护理水平,明显提高了护理的有效性。     

Ultrasound assessment of puerperal uterine involution.

Echographic measurement of the early postpartum uterus was performed, mainly to investigate whether involution patterns correlate with parity, the administration of oxytocin during labor, and lactation. Our findings suggest that these factors do not have a marked effect on uterine involution.     

Thyroid Dysfunction after Delivery: Incidence and Clinical Course

ABSTRACT In a prospectively planned study of 591 Danish women thyroid dysfunction after delivery was found in 23 (3.9%). Seven women were hypothyroid and 16 were thyrotoxic. In seven of the thyrotoxic subjects a hypothyroid phase followed. Thyroid dysfunction was mostly transient with complete resolution within a year but persisted in three women (13%). Three months after delivery a positive titre of thyroid microsomal antibodies (TMAb) was found in 38 women (6.4%). Positive titres of TMAb were more often found in women with thyroid dysfunction than in those without (20/38 vs. 3/553). Maximal TMAb titres were seen 5–6 months after delivery and were associated with the occurrence of hypothyroidism. Postpartum thyroid dysfunction was found more often in women with a personal or family history of autoimmune thyroid disorder.     

Plasma exchange for preeclampsia: III. Immediate peripartal utilization for selected patients with hellp syndrome

OBJECTIVE: To explore the potential efficacy of plasma exchange as an ancillary interventive therapeutic tool immediately before or after delivery in the patient with severe preeclampsia/eclampsia and hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome. STUDY DESIGN: Two gravidas with complicated severe preeclampsia/eclampsia/HELLP syndrome were treated emergently in the immediate peripartal period with single-volume plasma exchange and fresh frozen plasma fluid replacement using the IBM 2997 Cell Separator. RESULTS: Despite multiple platelet unit infusions, one primigravida in active labor at 5 cm cervical dilatation and 39 weeks' gestation remained at a platelet count of 14,000/μL and began to ooze from her gums. A second primigravida remained obtunded, oliguric, and thrombocytopenic with epistaxis and hematuria following cesarean delivery and platelet transfusions. A single expedited 3-liter plasma exchange procedure reversed the rapidly deteriorating clinical situation for each patient and accelerated recovery from HELLP syndrome. Both patients and progeny suffered no permanent sequelae. CONCLUSION: Based on our experience, we believe that the therapeutic modality of plasma exchange with fresh frozen plasma can be employed effectively for the pregnant patient with severe atypical HELLP syndrome that progressively worsens during labor or the early puerperium despite the use of conventional transfusion therapy.     

《孕期和产褥期孕产妇衰竭指南(2019)》要点解读

2019年12月,英国皇家妇产科医师学会(RCOG)发布《孕期和产褥期孕产妇衰竭指南(2019)》(Maternal Collapse in Pregnancy and the Puerperium:Green-Top Guideline No.56),总结孕期和产褥期孕产妇衰竭(MCPP)的相关循证医学证据,详细探讨如何早期识别发生MCPP高风险与导致MCPP的病因、影响MCPP孕产妇复苏的孕期生理与解剖生理变化,以及如何进行MCPP最佳初始和持续管理,并对其围死亡期剖宫产术(PMCS)进行深入描述。该指南还特别强调MCPP救护的多学科团队人员组成与职责。笔者拟结合我国产科临床实践,对该指南涉及的MCPP风险如何早期识别及其病因、影响复苏的孕期生理与解剖生理变化、最佳初步处理措施、PMCS、持续管理、对于母儿的影响、多学科救护团队人员组成等产科临床关注的相关问题要点,进行解读、讨论。     

Recurrent myocardial infarction in a postpartum patient receiving bromocriptine.

Myocardial infarction in puerperium is infrequently reported. Spasm, coronary dissection, or atheromatous etiology has been described. Bromocriptine has been implicated in several previous case reports of myocardial infarction in the puerperium. Our case (including an inadvertent rechallenge) suggests such a relationship. Although generally regarded as "safe," possible serious cardiac effects of bromocriptine should be acknowledged.