胎儿脐血流阻力增加与臀位的关系探讨

探讨臀位形成的影响因素。方法：用多普勒超声检测３９４例单胎臀位和１４０例正常足月单胎妊娠的脐动脉血流速度波型,分别测定了两组脐动脉血流指标ＰＩ,ＲＩ及Ｓ／Ｄ值,并测量了两组新生儿出生体重,同时对２０８例臀位的临床资料进行分析。结果：臀位组的脐动脉搏动指数（ＰＩ）、阻力指数（ＲＩ）及收缩期最大血流速度与舒张末期血流速度的比值（Ｓ／Ｄ值）均明显高于正常对照组（Ｐ〈０．０１）。结论：胎盘－胎儿循环阻力增     

492例臀位分娩临床分析

目的探讨臀位分娩的合理方式。方法回顾分析笔者所在医院2005年1月～2008年1月492例臀位分娩情况。结果 310例臀位阴道分娩与182例剖宫产新生儿窒息率和新生儿骨折率相比较差异无统计学意义（x2=0.23,P〉0.05）,两种分娩方式的产后出血率相比较差异有统计学意义（x2=4.73,P〈0.05）。结论臀位分娩有选择性的行阴道臀牵引助产分娩,并不会增加母儿的并发症,可以降低剖宫产率。     

针灸治疗臀先露的系统评价

目的系统评价针灸治疗臀先露的疗效。方法计算机检索Cochrane Library（Issue 1,2008）、PubMed（1980～2008．3）、MEDLINE（1966～2008）、Ovid循证医学数据库（1991～2008）,中国生物医学文献数据库（CBMdisc,1978-2008．3）、维普期刊全文数据库（VIP,1989～2008．3）、中国期刊全文数据库（CNKI,1979～2008．3）和万方数据资源系统（1983～2008．3）,手工检索7种中医杂志,检索时限均为1990～2008年3月,语种限制为中文和英文,按纳入排除标准收集针灸治疗臀先露的随机对照试验（RCT）,参照Cochrane系统评价员手册5．0．1推荐的对偏倚风险的评价工具进行文献质量评价,并采用RevMan 5．0软件进行Meta分析。结果最终纳入8个RCT,共1341例患者,其中5个研究质量较高,3个质量较低。6个研究的Meta分析结果显示,针灸治疗臀先露的胎头倒转成功率优于对照组,差异有统计学意义[RR=1．38,95％CI（1．20,1．58）]。结论针灸较之于常规护理或胸膝卧位疗法能提高臀先露的胎头倒转成功率。     

影响臀位妊娠结局的因素分析

目的 探讨臀位妊娠情况下．影响母儿结局的因素及合理分娩方式的选择原则。方法 对单胎臀位妊娠369例的临床资料进行单因素及多因素分析，找出影响单胎臀位妊娠结局的因素。结果 剖宫产组新生儿需转NICU率、新生儿并发症率、围产儿死亡率均较阴道分娩组低（P〈0．05）。剖宫产组产妇产后出血率及产后并发症发生率均较阴道分娩组高（P〈0．01），足月妊娠度剖宫产对臀住妊娠的新生儿有利．而剖宫产对母亲来说则是不利因素。结论 臀位妊娠分娩方式的选择应全面考虑围产儿及母亲因素，结合产妇及家属的意愿来决定。     

Risk factors and infant outcomes associated with umbilical cord prolapse.

OBJECTIVES: Our goal was to identify risk factors associated with umbilical cord prolapse and to review the perinatal outcome of cases of cord prolapse. METHODS: During the study years 77 cases were identified retrospectively. Associations between cord prolapse and potential risk factors were evaluated by means of the odds ratio. RESULTS: Of the 77 fetuses with umbilical cord prolapse 9.1% had a fetal weight of < 2500 gas compared with 9.4% for fetuses in control group (P > 0.05). The umbilical cord prolapse occurred in association with vertex presentation 66 times (85.7%), breech presentation nine times (11.7%) and transverse presentation two times (2.6%). The occurrence of breech presentation among the control cases was 2.6%, and that of transverse lie was 1.7% (P < 0.01). Case mothers were 1.6 times more likely to be multiparas compared with the control group (P < 0.01). The perinatal mortality rate was 39/1000. CONCLUSIONS: Our study showed that abnormal fetal presentation and multiparity are associated with an increased risk of umbilical cord prolapse. The association of risk of cord prolapse with low birth weight was statistically insignificant (P > 0.05). We suggest that the cesarean delivery decreased the risk of perinatal mortality among cases of cord prolapse.     

The problem of relating fetal outcome with breech presentation to mode of delivery

We retrospectively analyzed 546 consecutive singleton pregnancies with breech presentations that ended at ≧36 weeks of gestation for the relationship between the intended mode of delivery and fetal outcome. Twelve patients were excluded from the analysis because these infants had major malformations. Of the 534 remaining patients, 124 (23%) were delivered by elective cesarean section. The other 410 women (77%) went into spontaneous labor. Intrapartum emergency cesarean section was required in 112 (27%) of these 410 women; the other 298 (73%) were delivered vaginally. There were 5 poor neonatal outcomes: 3 perinatal deaths and 2 cases of cerebral palsy probably due to intrapartum asphyxia. The risk of poor outcome was thus 1.2% (5/410), in the intended vaginal delivery group vs. no such outcome in the group of 124 patients that had an elective cesarean section. Three of 5 infants with poor outcome were actually born by emergency cesarean section and comparisons of results according to ultimate method of delivery rather than according to intended method of delivery may be misleading and in our case would have been biased against cesarean section. Received: 4 July 1995 / Accepted: 21 December 1995     

Cesarean delivery after successful external cephalic version of breech presentation at term: a comparative study

OBJECTIVE: The purpose of this study was to evaluate the rate and indications of cesarean delivery after a successful external cephalic version. STUDY DESIGN: A case-control study was performed from patients who were delivered in a tertiary care center between 1987 and 2000. Each patient who underwent a successful external cephalic version (study group) was compared with the next woman with the same parity, who was delivered at term (control group). Nulliparous and multiparous women were analyzed separately. Chi-squared, Mann-Whitney, and Student t tests were used for statistical analysis. Multivariate logistic regression analysis was performed where appropriate. RESULTS: A total of 602 patients were included in this study. The rates of cesarean delivery in nulliparous women (29.8% vs 15.9%; P<.001) and in multiparous women (15.9% vs 4.7%; P<.001) were significantly higher when compared with the control group. Patients with successful external cephalic version were more likely to have a cesarean delivery for dystocia (nulliparous, 22.5% vs 11.9%; P=.01; multiparous, 10.9% vs 1.3%; P<.01). After an adjustment for confounding variables, a successful external cephalic version was associated with an increased rate of cesarean delivery at term (nulliparous: odds ratio, 2.04; 95% CI, 1.13-3.68; multiparous: odds ratio, 4.30; 95% CI, 1.76-10.54). CONCLUSION: The rate of cesarean delivery for dystocia is increased after a successful trial of external cephalic version in both nulliparous and multiparous women.     

The breech presentation and the vertex presentation following an external version represent risk factors for neonatal hip instability

The aim of this study was to evaluate the frequency and type of hip-joint instability and the frequency of hip dislocation requiring treatment in neonates who had been lying in the breech presentation and were delivered vaginally after an external version or by caesarean section, and to compare them with neonates who were naturally in the vertex presentation. Breech presentations without ongoing labour were subjected to an attempted external version and, in cases where this proved unsuccessful or where labour had started, to deliver by caesarean section. None of the breech presentations was vaginally delivered. The anterior-dynamic ultrasound method was used to assess the hip-joint status of the neonates. Out of 6571 foetuses, 257 were in breech presentation after 36 wk of pregnancy. Sixty-two were vaginally delivered following an external version to vertex presentation and 195 were delivered by caesarean section, 75 of these following unsuccessful attempts to perform a version. Treatment for congenital hip-joint dislocation was performed on 0.2%. Out of the breech presentations, 1.0% of those delivered by caesarean section were treated, while in those with vaginal delivery following an external version the treatment frequency was 3.2%. No case of late diagnosed hip dislocation was recorded. Significant differences in frequency of hip-joint instability and treatment were found between (i) neonates delivered in breech presentation and those delivered with vertex presentation, (ii) infants delivered in vertex presentation, naturally or after successful version, and (iii) those delivered by caesarean section with or without attempted external version and those delivered with vortex presentation.     

新生儿窒息58例相关因素分析

目的探讨新生儿窒息发生的相关因素,提出干预措施。方法对2005年1月至2005年12月在我院发生的58例新生儿窒息的原因进行回顾性分析。结果新生儿窒息为综合因素所致,胎盘功能异常占31.03%,脐带异常占25.86%,早产儿占18.97%,臀位产占42.86%。结论做好孕期保健,加强高危妊娠的产前检查和产时胎儿监护,适时选择适当的分娩方式是降低新生儿窒息率和死亡率的关键。