第一产程异常胎心监护图形与新生儿结局的关系

目的　探讨第一产程异常胎心监护图形与新生儿结局的关系。方法　回顾分析 2 0 0 2年 8月至 2 0 0 3年 6月在我院足月单胎头位分娩产妇 ,第一产程中胎心率 (FHR)异常图形 2 1 7例 (观察组 )和FHR正常图形的2 6 9例 (对照组 )的临床资料。结果　第一产程异常FHR图形的发生率为 4 4 7% ,常见类型为轻度变异减速(6 4 5 % )、基线变异减弱 (2 1 6 % )和轻度心动过速 (1 2 0 % )。晚期减速、基线变异减弱和重度变异减速是导致新生儿窒息的危险因素。观察组羊水过少 (5 1 % )、脐带缠绕 (2 2 6 % )、羊水粪染 (1 0 6 % )、新生儿窒息 (6 5 % )、新生儿转入NICU(1 0 1 % )的发生率和剖宫产率 (31 8% )明显高于对照组 (P <0 0 5 )。结论　第一产程异常FHR图形的发生率较高 ,其中晚期减速、基线变异减弱、重度变异减速与新生儿窒息的发生相关 ,其他图形可在严密监护下继续试产     

Human chorionic gonadotropin assay in cervical secretions for accurate diagnosis of preterm labor.

OBJECTIVES: We planned to determine whether the concentration of human chorionic gonadotropin (hCG) in cervical secretions could be a useful marker for accurate diagnosis of preterm labor, and whether the use of cervical hCG assay in combination with the Bishop score would improve the prediction of delivery within 7 days, and to determine the cut-off values for hCG in prediction of delivery within 100 h, 7 and 14 days, as well as before 35 and 37 weeks of gestation in a group of women at high risk for preterm delivery. METHODS: The study was conducted in the perinatology department of Zeynep Kamil Women and Children Diseases Education and Research Hospital between February 2002 and February 2003. One hundred and two subjects with a diagnosis of threatened preterm labor with intact membranes were included in the study. For hCG measurements, a cotton swab was rolled intracervically for 10 s to absorb fluid. Bishop scores were assessed. The correlation test was employed for the variables influencing hCG values. The ROC curve analysis was used to establish an optimal cut-off concentration for cervical hCG and an optimal cut-off level for Bishop score. The continuous variables were analyzed by the unpaired, independent, two-tailed t-test and categorical data were analyzed by the chi-square test. RESULTS: A significant positive correlation was present between the cervical hCG concentrations and Bishop scores (r=0.72, P<0.0001), and a highly negative correlation between the cervical hCG concentrations and the time interval from sampling time until delivery (r=-0.80, P<0.0001) was detected. The cut-off value for cervical hCG concentration and its sensitivity, specificity, positive and negative predictive values, accuracy, relative risk and likelihood ratio for accurate determination of delivery within 100 h were > or =32 mIU/ml, 98%, 55%, 70%, 96%, 77%, 19.68 and 2.18, respectively. However, these values were > or =32 mIU/ml, 97%, 84%, 89%, 95%, 92%, 17.37 and 6.06, respectively, for prediction of delivery within 7 days; > or =30 mIU/ml, 97%, 79%, 87%, 94%, 89%, 15.15 and 4.62, respectively, for prediction of delivery within 14 days; > or =33 mIU/ml, 89%, 92%, 94%, 83%, 90%, 5.83 and, 11.55, respectively, for prediction of delivery before 35 weeks; and finally > or =27 mIU/ml, 76%, 50%, 85%, 37%, 71%, 1.34 and 1.52, respectively, for prediction of delivery before 37 weeks. CONCLUSIONS: Cervical hCG expression seems to be rewarding in accurate diagnosis of preterm labor. This test has the advantage of low cost and wide availability.     

流动人口对产科质量因素的影响

目的分析流动人口和本地人口对产科质量的影响,寻找危害孕产妇安全的主要因素。方法对我院2003年9月至2005年6月产科流动人口和本地人口的病例资料进行回顾性分析。结果我院本地人口孕产妇产检率为841．87‰,明显高于流动人口的210．78‰(P＜0．05)。流动人口孕产妇胎儿宫内窘迫、早产、过期妊娠、产后出血、胎：盘早剥、新生儿窒息、低出生体重儿的发生率均明显高于本地人口(P值均＜0．05)。结论继续提高流动人口高危孕产妇检出率、管理好流动人口孕产妇将是提高上海市产科质量工作的新重点。     

单硝酸异山梨醇酯结合依沙吖啶应用于中期妊娠引产的临床观察

目的观察NO供体-单硝酸异山梨醇酯结合依沙吖啶应用于中期妊娠引产的临床效果及其安全性。方法研究组于依沙吖啶羊膜腔注射前24h阴道应用单硝酸异山梨醇酯60mg,对照组依沙吖啶羊膜腔注射前无任何处理,比较两组临床结局。结果研究组引产时间及产程均短于对照组,单硝酸异山梨醇酯阴道用药对母体血压及心率均无明显影响,不增加胎盘、胎膜残留率。结论单硝酸异山梨醇酯阴道用药可缩短依沙吖啶引产时间及产程,无明显副作用。     

Safety of vaginal birth after cesarean delivery.

OBJECTIVE: To compare the outcomes of labor induction in women with a history of 1 cesarean section (CS) who undergo trial of labor. METHODS: A prospective observational study of 702 pregnant women who had 1 previous CS was conducted at Women's Hospital, Hamad Medical Corporation, Doha, Qatar, between April 2003 and April 2004. Those with no history of vaginal delivery were assigned to one group and those with a history of vaginal delivery were assigned to another group, and the latter group was then divided into 2 subgroups according to the results of trial of labor. RESULTS: Of these 702 women with a history of 1 CS, 62.4% also had a history of vaginal delivery. After trial of labor, vaginal delivery occurred more often among women with no history of vaginal delivery (64.8%). Moreover, trial of labor resulted in a vaginal delivery more often in women who were delivered only once and by CS (87.7%) than in women who also had a history of vaginal delivery (79.2%). CONCLUSION: These findings indicate that women who have had a CS should strongly consider natural delivery for subsequent pregnancies.     

Oral misoprostol in the third stage of labor.

OBJECTIVE: To compare the efficacy of intravenous ergometrine, intramuscular oxytocin, and oral misoprostol in the control of postpartum hemorrhage. METHODS: Mean blood loss, rates of blood loss between 500 and 1000 ml, hematocrit fall greater than 10%, and need for additional oxytocic agents and nature and rates of adverse effects were assessed in this prospective, randomized, controlled study. RESULTS: All outcomes were similar in the 3 groups. The main adverse effects in the misoprostol group were temperatures higher than 99 degrees F, which normalized within 2 h and shivering, which was mild and self-limiting. CONCLUSIONS: Oral misoprostol is as effective as conventional oxytocic agents in preventing postpartum hemorrhage and can be recommended for use in low-resource settings.     

可行走分娩镇痛应用于潜伏期的临床研究

目的评价可行走分娩镇痛在潜伏期应用的临床效果。研究宫口开张不同大小应用分娩镇痛后的产程进展，对子宫收缩力的影响及新生儿Apgar评分情况。方法确认已临产无内科合并症的初产妇共75例，随机分为三组。Ⅰ组：宫口开张1cm左右；组：宫口开张2～3cm；Ⅲ组为正常对照组未采用分娩镇痛。观察镇痛起效时间、子宫收缩力的变化、总产程、产后出血量、分娩结局及新生儿Apgar评分。结果Ⅰ组与Ⅲ组比较总产程差异无统计学意义。Ⅰ组与Ⅱ组第一产程比较时间延长，差异有统计学意义（P〈0．05），Ⅱ组与Ⅲ组比较子宫收缩力无明显降低，第一产程中Ⅰ组与Ⅲ组比较子宫收缩力显著降低，P（0．05，Ⅰ组催产素使用率为100％。三组间产后出血、新生儿Apgar评分各组间差异无统计学意义。结论舒芬太尼合并低浓度的罗哌卡因引导下无痛分娩，从潜伏期应用，有明显的分娩镇痛作用，不增加产后出血量，对新生儿的Apgar评分无影响。     

检测宫颈阴道分泌物中胰岛素样生长因子结合蛋白-1预测早产的价值

目的:探讨检测胰岛素样生长因子结合蛋白-1(IGFBP-1)能否用于预测早产。方法:应用快速免疫法检测218例孕妇宫颈阴道分泌物中高磷酸化GFBP-1的含量。结果:先兆早产组IGFBP-1的阳性率是62.0%,正常妊娠组IGFBP-1的阳性率是9.1%,两组结果比较,差异有显著性。先兆早产IGFBP-1的阳性组发生早产率是83.6%。结论:检测IGFBP-1可以作为预测早产的客观指标。     

对男性海洛因依赖者康复训练效果的随访

目的:探索社区康复训练与劳动教养相结合的康复模式对男性海洛因依赖者的治疗效果。方法:以湖南省新开铺劳教大队的50名劳教吸毒人员为对照,对戒毒中心的50名劳教吸毒人员进行为期至少4个月的康复训练。康复训练以海洛因依赖者的需求、所处的康复阶段及接受能力为中心,包括强化戒毒治疗动机、减少吸毒造成的危害、复吸预防等各种技能训练。用成瘾严重度指数和应付方式问卷评估康复训练的疗效,并随访两组在解教后1 a的康复情况。结果:康复训练后海洛因依赖者幻想、退避、自责等不成熟型应付方式分值下降(P<0.01),求助的分值增加(P<0.01)。解教后1 a康复组与劳动教养组的戒断率差异无显著性,但康复训练组在海洛因滥用严重程度、违法犯罪行为和精神健康方面损害显著低于劳动教养组(P<0.05)。结论:劳动教养和社区康复训练都是对吸毒者有效的康复措施,康复训练的作用更大。