产妇盆底功能情况调查及产科因素对盆底功能的近期影响分析研究

目的:探讨产后盆底功能情况及产科因素对盆底功能的近期影响。方法:调查2014年1~12月同仁医院分娩并于产后6~8周来院做检查的2023例妇女,出院小结和产后检查记录提取产科相关信息,进行盆底电生理评估,对产妇盆底功能与产科因素进行单因素及多因素分析。结果:2023例产妇产后6~8周盆底功能评估异常率为89.67%。单因素分析结果表明,产次≥2次、会阴切开、足月分娩和新生儿出生体质量≥3500 g的产妇盆底功能更差。多因素分析结果显示,产次≥2次的产妇(OR=2.529,95%CI 1.763~3.628)、新生儿出生体质量≥3500 g(OR=1.636,95%CI 1.184~2.262)、阴道分娩(OR=1.440,95%CI 1.068~1.941)是影响产妇盆底功能的高危因素。对于阴道分娩产妇,产次≥2次(OR=3.460,95%CI 2.059~5.828)、会阴切开(OR=2.297,95%CI 1.484~3.557)和足月分娩(OR=6.248,95%CI 1.824~21.399)是影响盆底功能的高危因素。结论:分娩后6~8周的产妇盆底功能损伤较严重;多产次、新生儿体质量较大和阴道分娩是影响产后6~8周产妇盆底功能的因素。对于阴道分娩者,多产次、足月分娩、会阴切开是另一个影响盆底功能的因素。产科医生应指导孕妇合理控制孕期体重,临近预产期指导孕妇进行kegel训练,降低会阴切开率,以降低盆底功能障碍性疾病发生率。     

Perinatal trauma with and without loss experiences

Objective: The present study explored differences in mental health between women who experienced a trauma which involved a loss of fetal or infant life compared to women whose trauma did not involve a loss (difficult childbirth). Method: The sample consisted of 144 women (mean age = 31.13) from the UK, USA/Canada, Europe, Australia/New Zealand, who had experienced either stillbirth, neonatal loss, ectopic pregnancy, or traumatic birth with a living infant in the last 4 years. Results: The trauma without loss group reported significantly higher mental health problems than the trauma with loss group (F (1,117) = 4.807, p = .03). This difference was observed in the subtypes of OCD, panic, PTSD and GAD but not for major depression, agoraphobia and social phobia. However, once previous mental health diagnoses were taken into account, differences between trauma groups in terms of mental health scores disappeared, with the exception of PTSD symptoms. Trauma groups also differed in terms of perceived emotional support from significant others. Conclusion: The findings illustrate the need for a change in the focus of support for women’s birth experiences and highlighted previous mental health problems as a risk factor for mental health problems during the perinatal period.     

某县免费孕前优生健康检查结果的分析

目的探讨孕前优生健康检查对发现导致不良妊娠结局的风险因素的积极作用。方法采用国家免费孕前优生健康检查项目技术服务要求,对3887份孕前优生健康检查《家庭档案》进行分析。结果 7774例接受孕前优生检查的夫妇,690例异常病史以男性吸烟、饮酒等不良生活习惯和女性不良妊娠史居多;高风险人群668例,女性占64.22%,其中不良妊娠史占34.46%,男、女乙型肝炎病毒感染占高风险人群的27.84%。861例获得妊娠结局,不良妊娠结局15例。不良妊娠结局中自然流产9例、治疗性引产5例,早产1例。结论孕前优生健康检查可以筛选高风险人群,发现可能发生出生缺陷的风险因素,降低不良妊娠结局的发生风险,计划怀孕夫妇参加检查和接受优生优育指导是非常必要的。     

拉玛泽减痛分娩法结合头部按摩对初产妇分娩方式影响的研究

目的探讨拉玛泽减痛分娩法结合头部按摩对初产妇产程、分娩结局的影响。方法选择阴道试产的初产妇170例,采用随机和自愿原则分成实验组（拉玛泽减痛分娩法）85例,对照组85例,运用卡方检验、方差检验等统计方法对两组产妇在产程中的疼痛程度、产程时间、分娩方式等进行统计比较。结果实验组与对照组在分娩过程中的疼痛程度、第一产程与总产程时间、分娩方式上比较差异具有统计学意义（P〈0．01）,而在第二产程与第三产程时间上差异无统计学意义（P〉0．05）。结论拉玛泽减痛分娩法结合头部按摩可减轻分娩疼痛程度、缩短产程时间、提高顺产率,降低剖宫产率,值得临床推广。     

自由舒适型体位待产对产妇分娩的影响

目的研究自由舒适型体位待产对产妇分娩的影响。方法选取2013年1-9月在本院住院经阴道试产的初产妇1900例,采用随机数字表法将其随机分为观察组和对照组,每组950例。观察组产妇在第一产程采用自由舒适型体位待产,对照组产妇采取传统床上卧位体位待产,两组均在待宫口开全进入第二产程后,回到产床取膀肌截石位直至娩出胎儿。结果观察组第一产程时间和总产程时间均明显短于对照组,差异有统计学意义（P〈0．05）。观察组产妇剖宫产率、胎吸率、产钳率、产后2h阴道出血量、新生儿窒息率均明显低于对照组,差异有统计学意义（P〈0．05）。结论产妇在第一产程中应用自由舒适型体位待产,能够明显缩短产程时间,降低剖宫产率,减少产后2h出血量,降低胎儿窘迫发生率,该体位符合孕产妇身心需求,有利于自然分娩．值得临床开展应用。     

Negotiating risky bodies: childbirth and constructions of risk

Policy makers, practitioners and researchers have identified risk as a key concept in relation to maternity care and childbirth. There is however a lack of research exploring women’s discursive constructions of risk and childbirth in relation to sociological risk theories. In this article we explore pregnant women’s everyday negotiations of risk in relation to the self-chosen plan to birth either at home or via an elective Caesarean section. We use sociocultural risk theories to contextualise our findings. This article draws on data from a study conducted in 2005–2006 in which we interviewed 24 pregnant middle-class South African women who were planning a home birth or elective Caesarean section and used social constructionist discourse analysis to analyse the data. We found that women’s risk constructions were related to three different conceptions of birthing embodiment: technocratic bodies, vulnerable bodies and knowing bodies. Women who planned Caesarean sections were committed to biomedical constructions of risk and birth. Woman who planned home births shifted between endorsing and subverting biomedical models of risk. They also resisted definitions of birthing bodies as inherently abject (unclean, polluting, unruly) and constructed the process of giving birth as risky in medicalised settings. In such settings, the birthing body was constructed as vulnerable to objectification, loss of dignity and shaming. Women who planned to give birth at home constructed an alternative approach to birth which emphasised embodied ways of knowing, relational connection and empowerment over normative and medicalised risk constructions. In the process, biomedical risk definitions were destabilised.     

Pregnancy,birth and risk: an introduction

In this introduction, I use my nearly 40 years of work in the area to reflect on the total medicalisation of pregnancy and childbirth that informs even the critical sociology that purports to examine the issue. The risks that are faced in pregnancy and birth are not only the inherent dangers that midwives have worked with across time and space but also those particular risks introduced by medicalisation itself. Medicalisation blinds us to those risks on the one hand, while it blinds us to the skills and knowledge that midwives and birthing women themselves have on the other. The women and midwives researched in these articles show us that in pregnancy and birth, as in most of life, it is not just a matter of ‘real risk’ versus ‘perceived risk’ as risk theorists (too) often describe it. There is rather an intelligent balancing of risks, weighing of risks and contextualising of risks. What we see in this issue is a glimpse into the ways in which people intelligently, creatively and determinedly balance risks.     

拉玛泽分娩减痛呼吸法对母儿影响的研究

目的：探讨拉玛泽分娩减痛呼吸法对母儿的影响。方法将孕7个月后自愿接受拉玛泽分娩减痛呼吸法的孕妇57例设为观察组,同期未接受拉玛泽分娩减痛呼吸法的60例孕妇为对照组,比较两组产妇分娩方式、经阴道分娩产程时间、分娩时疼痛程度及新生儿窒息发生率等。结果观察组自然分娩率为92．98％,高于对照组的68．33％（χ2＝11．24,P＜0．01）,剖宫产率为7．02％,低于对照组的30．00％（χ2＝10．11,P＜0．01）;第一产程、第二产程及总产程时间少于对照组（ t＝8．94,8．16,9．96, P＜0．05）;第一产程活跃期及第二产程疼痛程度轻于对照组（z＝3．02,4．57,P＜0．05）;新生儿窒息发生率为1．75％,低于对照组的8．33％（χ2＝5．70,P＜0．05）。结论孕后期进行拉玛泽分娩减痛呼吸法训练,可有效提高自然分娩率,降低剖宫产率,缩短产程,减轻分娩疼痛,降低新生儿窒息发生率,适合临床推广应用。