北京密云地区264例新生儿窒息的产科因素分析

目的探讨近10年密云地区新生儿窒息的产科因素及变化,为降低新生儿窒息发生率、提高产科质量提供依据。方法回顾性分析2003年1月至2012年12月在北京市密云县妇幼保健院分娩的264例新生儿窒息的病例资料,探讨10年间新生儿窒息发生率的变化趋势,以及造成新生儿窒息的产科因素及变化。结果10年间新生儿窒息率明显下降（χ2＝102．46,P＜0．001）;新生儿窒息的主要产科因素分别为羊水污染、产程异常、妊娠期高血压疾病和肩难产,肩难产导致新生儿窒息的构成比上升（确切概率法P＝0．026）。结论羊水污染、产程异常、妊娠期高血压疾病和肩难产是导致新生儿窒息的主要因素,肩难产导致新生儿窒息应引起产科重视。     

Conservative management of tracheal rupture after intubation

A case is reported of a newborn with tracheal rupture resulting from a complicated delivery requiring vacuum extraction and two attempts at intubation. Despite the severity of the situation the infant was successfully managed conservatively with orotracheal intubation.     

持续性枕后位产程中的处理

目的 根据持续性枕后位的产程特点,寻找最佳处理方法,减少剖宫产率,改善母儿预后.方法选择2013年1-3月在南京市妇幼保健院临产后确诊为枕后位产妇260 例,随机分为两组：观察组予侧卧位纠正胎方位,对照组不予干预,充分试产,两组待宫口开全后若仍为枕后位,徒手旋转抬头,失败者选择剖宫产.结果 观察组胎头自行纠正47例（36.2%）,徒手旋转抬头成功65例（50%）;对照组自行纠正0例,徒手旋转抬头成功87例（66.9%）,两组比较,差异有统计学意义（P〈0.05）.结论 临产后通过进行体位纠正及徒手旋转胎头术,使大多数难产转为顺产,降低了剖宫产率.     

胎膜早破与分娩关系探讨

目的 :探讨胎膜早破与分娩结局的相互关系。方法 :用回顾性调查方法对 1 86例胎膜早破孕妇进行统计分析。结果 :胎膜早破孕妇难产率及产褥病率均较对照组照高 ,且新生儿感染亦较对照组明显增加 ,差异均有显著性(P<0 .0 5)。结论 :胎膜早破使难产增加 ,其产褥病率及新生儿病率也明显增高。     

Maternal factors associated with labor dystocia in low-risk nulliparous women. A systematic review and meta-analysis

ObjectiveTo identify maternal factors associated with labor dystocia in low-risk nulliparous women.MethodsMEDLINE, Embase, ClinicalTrials.gov, Cochrane, and CINAHL were searched for intervention studies and observational studies published from January 2000 to January 2022. Low-risk was defined as nulliparous women with a singleton, cephalic birth in spontaneous labor at term. Labor dystocia was defined by national or international criteria or treatment. Countries were restricted to OECD members. Two authors independently screened 11,374 titles and abstracts, extracted data, and assessed risk of bias using the Newcastle-Ottawa Scale. Results were presented narratively and by meta-analysis when compatible.ResultsSeven cohort studies were included. Overall, the certainty of the evidence was moderate. Three studies found that higher maternal age was associated with an increased frequency of labor dystocia (relative risk 1.68; 95% CI 1.43–1.98). Further three studies found that higher maternal BMI was associated with increased frequency of labor dystocia (relative risk 1.20; 95% CI 1.01–1.43). Maternal short stature, fear of childbirth, and high caffeine intake were also associated with an increased frequency of labor dystocia, while maternal physical activity was associated with a decreased frequency.ConclusionMaternal factors associated with an increased frequency of labor dystocia were mainly maternal age, physical characteristics, and fear of childbirth. Maternal physical activity was associated with a decreased frequency. Intervention studies targeting these maternal factors would need to be initiated before or early in pregnancy to test the causality of the identified factors and labor dystocia.