推拿治疗小儿脑性瘫痪20例

推拿治疗小儿脑性瘫痪２０例,疗程１年。结果：１岁内患儿（４例）,治愈１例,显效３例,１￣３岁者（１３例）,治愈１例,显效９例,好转３例;３岁以上者（３例）,仅１例好转,２例无效。提示早期推拿治疗疗效显著。     

心理干预在产妇分娩期的应用

目的 探讨心理干预在产妇分娩期的应用价值。方法 将256例产前有各种心理障碍的产妇随机分为心理干预组（206例）和非心理干预组（320例），心理干预组采取群体心理辅导、放松疗法、暗示疗法或音乐疗法等；非心理干预组只作一般宣教，不作心理干预。观察两组难产发生情况。结果 心理干预组206例中发生难产29例（14．07％），非心理干预组320例中发生难产67例（20．94％），两组比较（P〈0．05），有显著性差异。结论 心理干预在产妇分娩期有重要的临床应用价值。     

Cesarean birth: How to reduce the rate

The cesarean section rate, which approached 25%, has stabilized and started a modest decline. A stated United States national goal by the year 2000 is rate of 15%. Suggested rates are 12% for primary and 3% for repeat cesarean sections. The major indications for cesarean section are prior cesarean delivery (8%), dystocia (7%), breech presentation (4%), fetal distress (2% to 3%), and others. The major areas of reduction must occur in the categories of prior cesarean delivery and dystocia. An expanded use of trial of labor and vaginal birth after a prior cesarean section will produce further reductions. Countries in Europe achieve> 50% vaginal birth after a prior cesarean section compard with 25% in the United States. A heightened awareness must occur regarding the decision to perform the first cesarean section. The residual impact, a scanned uterus, affects 12% to 14% of women seen for delivery. Even if 50% achieve a vaginal birth after a prior cesarean section, the national goals are unachievable. The obstetrician must consciously consider the impact of “once a cesarean, always a scar.”     

The Zavanelli maneuver: a potentially revolutionary method for the resolution of shoulder dystocia

Shoulder dystocia is a perilous complication for the fetus. Suffocation and death are imminent. For the obstetrician, there is insufficient time for consultation. Either he or she is ready with an array of manipulative remedies for sequential application or a disorganized chaos will ensue and chance will determine the outcome. Worthy accoucheurs will have planned for this event and will have selected from the numerous procedures touted for its correction that group he or she intuitively feels will be most effective or, at a minimum, most easily remembered. The Zavanelli maneuver deserves to be on every obstetrician's list. It must occupy a bottom priority, however, until its virtue and applicability, demonstrated to date in but a single case, can be confirmed. All current maneuvers for the treatment of shoulder dystocia are directed to completion of vaginal delivery. The Zavanelli maneuver is predicated on cephalic replacement with subsequent delivery by cesarean section.     

等待至少一次宫缩自然娩肩法预防肩难产和新生儿产伤的效果观察

目的 探讨等待至少一次宫缩自然娩肩法在预防肩难产及新生儿产伤中的效果.方法 选取2009年1～12月于深圳市龙华新区人民医院(以下简称“我院”)采用自然分娩法进行分娩的5330例产妇为对照组,另以2010年1～12月于我院采用等待至少一次宫缩自然娩肩法进行分娩的5014例产妇为观察组,观察比较两组中不同新生儿体重者、经或初产妇的产伤发生率、Apgar评分、新生儿行为神经评分.结果 观察组不同新生儿体重(＜3000g、3000～4000 g、＞4000 g)的产伤发生率(0、0.03％、0.41％)及经或初产妇的产伤发生率(0.06％、0)均低于对照组,差异有统计学意义(均P＜0.05);而观察组的Apgar评分总窒息率(0.22％)及新生儿行为神经评分异常率(0.16％)虽略优于对照组,但两组差异无统计学意义(均P＞ 0.05).结论 等待至少一次宫缩自然娩肩法在预防肩难产及新生儿产伤中的效果较好,且未增加新生儿窒息率及其他不良情况发生率,临床应用价值较高.     

头位难产的产程护理干预对分娩结局的影响

目的探讨产程护理干预措施对头位难产产妇分娩结局的影响,寻找缩短产程、提高分娩质量、增加产妇舒适度的护理方法。方法2006年10月～2008年10月在我院住院分娩的产妇共240例发生头位性难产,随机将之分为观察组和对照组各120例,观察组除常规护理外加强了产程观察、心理支持和采取最适体位。观察两组产妇分娩方式、产程时间、产妇舒适度和新生儿窒息率。结果观察组阴道分娩明显高于对照组,产程时间明显短于对照组（P〈O．05）,且产妇舒适度和新生儿窒息率均明显优于对照组（P〈0．05）。结论产程中及时采取护理干预措施对缩短产程、提高分娩舒适度和降低新生儿窒息率均有明显效果。     

Tracheal rupture in complicated delivery: A case report and review of the literature

A case of distal tracheal rupture is described, literature review reveals two previously reported cases of neonatal distal tracheal rupture, as well as 14 cases of anterior subglottic rupture. All patients had shoulder dystocia, and 59% had associated brachial plexus injury. Delayed diagnosis (>3 days) was common in the distal tracheal group (66%), compared to 0% in the anterior subglottic group. The 2 distal tracheal rupture patients were initially managed conservatively, but ultimately required open repair. Distal tracheal rupture is exceedingly rare and more difficult to diagnose and manage than the more common anterior subglottic rupture.     

No mutations found in candidate genes for dystocia.

Dystocia is a disorder characterized by prolonged or dysfunctional labour. Delivery that starts late or not at all, leads to an increased risk for Caesarean section, infant morbidity and mortality. Familial aggregations of dystocia suggest a polygenic background. We have studied three candidate genes for dystocia, i.e. the genes for testosterone 5-alpha reductase type 1, prostaglandin F2alpha receptor and endothelin 1 and performed mutational screening in 23 women with dystocia, of which 12 have affected relatives. No mutations were found, making it unlikely that any of these genes represent a major cause of dystocia in man.     

Brachial plexus injury: a 23-year experience from a tertiary center

OBJECTIVE: The purpose of this study was to analyze the data on brachial plexus injury and its relationship with shoulder dystocia from a tertiary center for a 23-year period. STUDY DESIGN: A review of the logbooks on labor and delivery and the nursery and the International Classification of Diseases codes identified all newborn infants with brachial plexus injury who were delivered at our center. RESULTS: During the 23 years (1980-2002), there were 89,978 deliveries, of which there were 85 cases of brachial plexus injury (1/1000 births) with vaginal delivery. The injury was permanent (> or =1 year) in 12% of the cases, and only 2 cases have been litigated. Newborn infants that weighed > or =4 kg were significantly more common among those infants who had shoulder dystocia and brachial plexus injury than those infants without injury (odds ratio, 6.55; 95% CI, 2.30, 18.63). The rate of permanent brachial plexus injury was similar between the 2 groups. CONCLUSION: A case of brachial plexus injury occurs 1 time in every 1000 births, is permanent in 1 of every 10,000 deliveries, and is litigated 1 time for every 45,000 deliveries. The infrequent nature of injury may preclude prevention.