导乐陪伴分娩对初产妇心理影响的临床观察

目的 :观察导乐陪伴分娩对初产妇心理的影响。方法 :2 16例接受导乐陪伴分娩的初产妇为观察组 ,2 16例由丈夫或家人陪伴分娩的初产妇为对照组 ,采用症状自评量表 (SCL -90 )测定两组产妇分娩前后的总因子分 ,并分析两组产妇的SCL -90评分的差异。结果 :分娩前两组产妇总因子分差异无显著性( 8 4± 2 1/ 8 7± 2 4,t=1 2 5 ,P >0 0 5 ) ,而分娩后观察组SCL -90总因子分明显低于对照组 (阴道自娩组 :13 3± 3 4/ 18 6± 5 3,t=10 6 3,P <0 0 5 ;手术助产组 :15 2± 3 8/ 19 8± 6 3,t =4 41,P <0 0 5 )。结论 :导乐陪伴分娩对产妇的心理会产生有利的影响 ,应加以倡导     

超导可视联合米索前列醇用于初孕妇无痛人工流产术的临床观察

目的探讨超导可视联合米索前列醇用于初孕妇无痛人工流产术的临床效果。方法选取扎兰屯市人民医院2010年9月至2011年9月自愿实行人工流产术的孕6~10周初孕妇160例,采用完全随机分组方式,将受术者分为超导可视联合米索前列醇无痛人工流产组(观察组)和只进行超导可视无痛人工流产组(对照组),每组各80例。观察宫颈扩张效果、手术时间、术中出血量及手术并发症等指标。结果观察组宫颈完全松弛有效率高于对照组(P0.05);观察组出血量少于对照组(P0.05)。结论超导可视联合米索前列醇用于初孕妇无痛人工流产术有助于扩张宫颈及减少术中术后出血量,预防并减少手术并发症的发生,安全有效,值得推广。     

Spontaneous Uterine Rupture in a Primigravida at 35 Weeks of Gestation. A Case Report and Review of the Literature

Spontaneous uterine rupture is a rare but life-threatening event. Usually, this complication is associated with such risk factors as previous injury of the uterine wall. We report a case of spontaneous rupture of an unscarred uterus in the absence of classical risk factors, and review the literature with respect to the possible aetiologies of this condition. We conclude that the differential diagnosis of atypical abdominal pain in pregnancy should include spontaneous uterine rupture, even in the absence of classical risk factors.     

The incidence and impact of increased body mass index on maternal and fetal morbidity in the low-risk primigravid population

Objective. To determine the incidence and impact of increased body mass index (BMI) on maternal and fetal morbidity in the low-risk primigravid population.

Methods. This was a prospective study with retrospective analysis of delivery outcome data. All low-risk primigravida who met the inclusion criteria during the recruitment period were approached. BMI was calculated using the formula weight/height squared. The participants were divided into five categories: ‘underweight’ (BMI <20 kg/m²), ‘normal’ (BMI 20.01–25 kg/m²), ‘overweight’ (BMI 25.01–30 kg/m²), ‘obese’ (BMI 30.01–40 kg/m²), and ‘morbidly obese’ (BMI >40 kg/m²). Maternal outcomes evaluated included gestation at delivery, onset of labor (spontaneous/induced/elective cesarean section), length of labor, use of oxytocin and epidural, mode of delivery, and estimated blood loss. Perinatal outcome measures included infant birth weight (kg) and centile, gestational age, ponderal index, Apgar score <7 at 5 minutes, cord pH <7.1, presence of meconium grade 3 at delivery, degree of resuscitation required, admission to neonatal intensive care unit (NICU), and duration of stay.

Results. One thousand and eleven women participated in the study. Complete outcome data were available for 833 women (82%). A significant difference was identified in gestation at delivery between the subgroups (p < 0.004). A significant positive correlation was identified between cesarean section rates with increasing BMI, even when gestation was controlled for (p = 0.004). Similarly, women in the normal BMI group remained significantly less likely to have an infant requiring NICU admission than obese women (2.2% vs. 8.6%; p = 0.011).

Conclusion. High BMI is associated with longer gestations, higher operative delivery rates, and an increased rate of neonatal intensive care admission.     

First Australian trial of the birth-training device Epi-No: a highly significantly increased chance of an intact perineum

BACKGROUND: A German report suggested significantly better outcomes in terms of perineal care, second stage length and neonatal outcome for users of Epi-No. OBJECTIVE: To carry out a pilot study of the first use of the Epi-No birth training device in Australia for women having their first baby. STUDY POPULATION AND METHODS: Forty-eight primigravidae having their confinement at Birralee Birthing Unit who used the device compared to all other primigravida who delivered during the same period. RESULTS: The study shows a highly significantly improved outcome for the perineum when users are compared to primigravid non-user controls. We could not demonstrate decreased instrumental delivery rates nor a better outcome in term of Apgar scores. DISCUSSION: The Epi-No device should be offered as an option to all primigravidae to use during the late third trimester.     

Pruritic urticarial papules and plaques of pregnancy: current status

Pruritic urticarial papules and plaques of pregnancy is a common benign dermatosis of pregnancy that was described in 1979 as an intensely pruritic urticarial cutaneous eruption. This is a well-defined clinical entity that mainly occurs in primigravidas in the third trimester, which resolves spontaneously or with delivery and is usually responsive to topical treatments. The aetiology of PUPPP is obscure. Histology is non-specific, but consistently shows mild lymphohistiocytic perivascular inflammatory infiltrate with a variable number of eosinophils. Immunofluorescent studies are negative. The maternal and fetal prognosis are generally unaffected, and the condition is usually responsive to topical corticosteroids and oral antihistamines.