胎膜早破96例妊娠结局临床分析

目的:探讨胎膜早破(PROM)的临床处理及与妊娠结局的关系。方法:回顾性分析处理PROM96例的临床资料,及对母儿的影响,并并随机抽取同期110例胎膜未破产妇作对照,从分娩方式、产程时间及母儿并发症几方面进行分析。结果:观察组难产率、产后出血及产褥感染率,新生儿窒息发生率和新生儿死亡率均较对照组显著升高,差异均有统计学意义(P<0.05或<0.01)。结论:妇科炎症和引流产史是PROM的易发因素,胎膜早破的妊娠结局可导致难产及母婴并发症,应加强孕期保健:对未足月者以期素待疗法延长孕周可减少胎膜早破的发生;对足月PROM应引产或剖宫产结束妊娠,以改善新生儿预后及减少母婴并发症。     

胎膜早破120例临床分析及与妊娠结局的关系

目的:探讨120例胎膜早破(PROM)的临床特点及与妊娠结局的关系。方法:对2012年12月~2013年12月120例PROM的孕妇的临床资料进行回顾性分析,并以同期分娩的380例无PROM的孕妇作为对照组。分析不同分娩方式对产妇和儿童的影响。结果:PROM组的难产、剖宫产率分别为45.0%、43.3%,均明显高于对照组,差异有统计学意义(P0.05)。PROM组中的早产、新生儿窒息、新生儿肺炎的发病率分别为11.7%、7.5%、4.2%,与对照组相比均明显增高(P0.05);两组产褥感染的发病率差异无统计学意义(P0.05)。结论:PROM与难产、早产密切相关,对PROM的孕妇应加强临床观察,对不同孕周的PROM采取不同的治疗方案,一旦有难产发生应及时处理,以减少母婴并发症的发生。     

胎膜早破与分娩方式的关系及产程观察

目的:探讨胎膜早破对分娩方式与结果的影响,提高对产程观察的重视。方法:统计分析249例孕足月胎膜早破者的分娩方式、产程及母儿并发症,并与249例随机抽取同期孕足月无胎膜早破的产妇进行对照。结果:胎膜早破组自然分娩率明显低于对照组(P<0.05),产褥感染、新生儿窒息发生率明显高于对照组(P<0.05)。结论:胎膜早破易感染,并导致胎儿宫内窘迫和新生儿窒息,与难产、剖宫产有相关性,应合理选择分娩方式,积极处理产程,以确保母婴安全。     

剖腹产的临床治疗方法及临床治疗

目的 :探究剖腹产的临床治疗方法及临床治疗效果。方法:抽取2013年2月~2014年11月在我院就诊的98例孕产妇作为研究对象,所有患者都给与实施剖腹产手术,对手术患者的临床信息进行相关准确的统计与分析。结果:98例孕产妇使用剖腹产手术后,大部分产妇都获得良好的临床疗效,母婴均健康无恙,母婴在产期的死亡率极大的降低,大幅度增加了分娩的安全性。结论:如果产妇不能通过阴道分娩进行顺利的生产导致难产,可以选择实施剖腹产给予治疗,临床疗效显著,有很好的推广应用价值。     

浅谈分娩后产妇的心理护理

对于任何一位妇女而言,妊娠分娩是她们一生中最重要的阶段,在怀胎十月的这段时间内,其心理和生理上都会发生变化。在孕妇分娩过程中,除了产程中出现的产科合并症,如难产、胎位不正等生理原因造成的影响外,孕产妇的心理状态对产妇的影响也非常大。由于很多产妇缺乏相应的生育知识而产生烦躁、恐惧、精神失常等负面心理,不仅影响分娩过程,严重时甚至危及母婴的生命安全。因此,本文针对产妇分娩后的心理护理展开讨论,分析产妇分娩期间存在的心理表现,并结合实际情况,制定切实有效的心理护理措施,保证产妇身心健康。     

母婴同室护理对产妇并发症发生率及新生儿护理质量的影响分析

目的分析母婴同室护理对产妇并发症发生率及新生儿护理质量的影响。方法选择2014年4月~2016年3月在我院顺利分娩的产妇90例,随机分为对照组和研究组各45例,对照组给予产后常规护理,研究组实施母婴同室护理,比较两组新生儿状况和产妇并发症情况。结果研究组产妇并发症发生率为6.67%,明显低于对照组的24.44%,组间比较差异有统计学意义(P0.05)。两组新生儿每日哭闹次数3次的发生率比较,研究组为17.78%明显低于对照组的64.44%,组间比较差异有统计学意义(P0.05);而且新生儿腹泻、皮炎、上呼吸道感染等发生率比较,研究组为8.89%亦低于对照组的26.66%,组间差异有统计学意义(P0.05)。结论产妇分娩后实施母婴同室护理可明显降低产妇并发症发生率,提升新生儿护理质量,临床应用价值高。     

新疆吐鲁番加依墓地的母婴合葬现象

新疆吐鲁番加依墓地位于吐鲁番市亚尔乡加依村南3公里的戈壁台地上,其年代大致在青铜-早期铁器时代。本文结合人类骨骼考古学、死亡考古学与临床医学的方法,对其中4例疑似的母婴合葬墓（M31、M70、M222、M224）进行了研究。通过对墓葬中遗骸的生物学信息以及埋藏位置信息的采集与分析,判断这4座墓葬中的个体关系应当为母亲和其婴儿。其中,3座墓葬中的母婴个体为分娩后死亡,1座墓葬中的母亲和胎儿个体死于孕期或者分娩过程中。造成这些个体死亡的直接原因可能是难产和产褥期疾病,营养不良和感染性疾病等因素也增加了他们的死亡风险。这4座墓葬一方面体现了古代女性生育所面临的困难,一方面体现了加依先民们对于母婴联结以及“灵魂”的认识,将母婴葬于一室不仅是对死者的关怀,更是对生者的告慰。本文的研究旨在为解读古代遗址中的母婴合葬墓提供一个新视角。     

单胎头位初产妇产程图分析

目的：探讨存在难产因素初产妇产程图的临床意义。方法：对2009年6月至2010年6月在济南军区总医院住院分娩的326例单胎头位初产妇的产程图进行回顾性分析。结果：产程图异常组中难产因素的构成比和剖宫产率均高于产程图正常组;存在难产因素的组别（胎方位异常组、宫缩乏力组、巨大儿组）产程中各阶段时限均较正常产妇组长,宫颈扩张速度均较正常组慢,胎头位置均高于正常组,以上差异均有统计学意义（P〈0．05）。结论：在产程中对产程图中各阶段时限、宫颈扩张速度及胎头位置等指标进行监测,来预测和及时发现头位难产因素的存在,及时给予处理,改善母儿预后。     

单胎头位初产妇产程图分析

目的:探讨存在难产因素初产妇产程图的临床意义。方法:对2009年6月至2010年6月在济南军区总医院住院分娩的326例单胎头位初产妇的产程图进行回顾性分析。结果:产程图异常组中难产因素的构成比和剖宫产率均高于产程图正常组;存在难产因素的组别(胎方位异常组、宫缩乏力组、巨大儿组)产程中各阶段时限均较正常产妇组长,宫颈扩张速度均较正常组慢,胎头位置均高于正常组,以上差异均有统计学意义(P<0.05)。结论:在产程中对产程图中各阶段时限、宫颈扩张速度及胎头位置等指标进行监测,来预测和及时发现头位难产因素的存在,及时给予处理,改善母儿预后。     

羊水栓塞9例临床分析

羊水栓塞是指分娩过程中。羊水物质进入母体血循环引起肺栓塞,休克,DIC等一系列严重症状综合征。是比较少见的,严重威胁母婴安全的产科并发症。也是孕产妇死亡的重要原因之一,死亡率在70-80％。     

Teratology Public Affairs Committee position paper: maternal obesity and pregnancy

Compared to normal-weight women, obese women have an increased risk of infertility and pregnancy complications. The most consistently described pregnancy complications are hypertensive disorders, gestational diabetes mellitus, thromboembolic events, and cesarean section. Fetal and neonatal complications may include congenital malformations, macrosomia, and shoulder dystocia. The literature suggests that women with a body mass index (BMI) >or=30 have approximately double the risk of having a child with a neural tube defect (NTD) compared to normal-weight women, and the increased risk associated with higher maternal body weight does not appear to be modified by folic acid supplementation. The Public Affairs Committee of the Teratology Society supports the public health initiatives identified by the U.S. Food and Drug Administration in 2004 and the research initiatives identified by the National Institutes of Health in 2004. The Public Affairs Committee recommends that clinicians counsel women about appropriate caloric intake and exercise and that health-care providers educate parents about appropriate childhood nutrition. Breast-feeding should be encouraged based on evidence of a protective effect against childhood obesity, as well as other health advantages.     

Neonatal Injury at Cephalic Vaginal Delivery: A Retrospective Analysis of Extent of Association with Shoulder Dystocia

Purpose

To describe the risk factors and labor characteristics of Clavicular fracture (CF) and brachial plexus injury (BPI); and compare antenatal and labor characteristics and prognosis of obstetrical BPI associated with shoulder dystocia with obstetrical BPI not associated with shoulder dystocia.

Methods

This retrospective study consisted of women who gave birth to an infant with a fractured clavicle or BPI between January 2009 and June 2013. Antenatal and neonatal data were compared between groups. The control group (1300) was composed of the four singleton vaginal deliveries that immediately followed each birth injury. A multivariable logistic regression model, with backward elimination, was constructed in order to find independent risk factors associated with BPI and CF. A subgroup analysis involved comparison of features of BPI cases with or without associated shoulder dystocia.

Results

During the study period, the total number of vaginal deliveries was 44092. The rates of CF, BPI and shoulder dystocia during the study period were 0,6%, 0,16% and 0,29%, respectively. In the logistic regression model, shoulder dystocia, GDM, multiparity, gestational age >42 weeks, protracted labor, short second stage of labor and fetal birth weight greater than 4250 grams increased the risk of CF independently. Shoulder dystocia and protracted labor were independently associated with BPI when controlled for other factors. Among neonates with BPI whose injury was not associated with shoulder dystocia, five (12.2%) sustained permanent injury, whereas one neonate (4.5%) with BPI following shoulder dystocia sustained permanent injury (p = 0.34).

Conclusion

BPI not associated with shoulder dystocia might have a higher rate of concomitant CF and permanent sequelae.     

Risk factors for dystocia in pigtailed macaques (Macaca nemestrina)

Dystocia (difficult labor) is an important component of the management of nonhuman primates and results in significant fetal and maternal morbidity and increased use of veterinary resources. Dystocias can arise from abnormalities of the maternal pelvis or fetus or uncoordinated uterine activity. Although risk factors for stillbirths have been established in nonhuman primates, risk factors for dystocias have not. The objective of this study was to determine maternal and fetal risk factors for dystocia in macaques. Retrospective data were collected from 83 pigtailed macaques (Macaca nemestrina) diagnosed with dystocia. The diagnosis of dystocia was made based on clinical or pathologic evidence. Maternal records of age, reproductive history, experimental history, clinical records, and fetal birth weight and any applicable fetal necropsy reports were reviewed. The gestational age of the fetus, the infant's birth weight, total previous births by the dam, and the proportions of both viable delivery (inverse effect) and surgical pregnancy interventions (direct effect) in the dam's history generated a model that maximized the experimental variance for predicting dystocia in the current pregnancy and explained 24% of the dystocia deliveries. The number of total previous births and proportion of previous cesarean sections accounted for the greatest effect. This model can identify individual dams within a colony that are at risk for dystocias and allow for changes in breeding colony management, more intense monitoring of dams at risk, or allocation of additional resources.     

Increased incidence of pregnancy complications in women who later develop scleroderma: a case control study

Introduction  

Studies have shown that fetal progenitor cells persist in maternal blood or bone marrow for more than 30 years after delivery. Increased trafficking of fetal cells occurs during pregnancy complications, such as hypertension, preeclampsia, miscarriage and intra-uterine growth restriction (IUGR). Women with these pregnancy complications are significantly more often HLA-class II compatible with their spouses. Women who later develop scleroderma also give birth to an HLA-class II child more often. From these prior studies we hypothesized that preeclampsia and other pregnancy complications could be associated with increased levels of fetal cell trafficking, and later be involved in the development of scleroderma.     

Prenatal diagnosis by amniocentesis in 800 pregnancies

Prenatal diagnoses by amniocentesis have been made in 800 pregnancies at the Genetics Division of the Los Angeles County-University of Southern California Medical Center. This experience has indicated that the amniocentesis procedure is safe and highly accurate. Amniocentesis was not associated with significant morbidity or mortality for either infant or mother. The observed complications are assumed to be related to the high-risk nature of these pregnancies, the patients having been selected primarily on the basis of advanced maternal age or a previous abnormal child. The needle puncture marks, which occurred in 2.4 percent of the live births, resulted in no serious developmental or cosmetic effects to the infants. No errors in cytogenetic diagnosis are known to have occurred in this series.     

Cesarean section in Iraqi Awassi ewes: A case study

We describe criteria for choosing Cesarean section to treat dystocia, and identify factors that appeared to influence the success of Cesarean section in Iraqi Awassi ewes under clinical condition. The study was conducted on 276 ewes presented for dystocia during the lambing seasons from 1985 to 1990. Out of 130 (47%) ewes assigned to undergo Cesarean section, 65 (50%) had ringwomb, while oversized fetus, emphysematous fetus, fetal monsters and hydroallantois accounted for 37 (28%), 16 (13%), 10 (7%) and 2 (1%) of the ewes, respectively. Primiparous and 2-year old ewes (54%) as well as ewes carrying singletons (53%) were assigned to surgery more frequently than multiparous ewes over 2 Y of age carrying twins. Ewes that delivered male lambs underwent surgery more frequently than those with female lambs (63 vs 37%). The maternal survival rate was 95% while after 86% of the surgeries the ewes had an uncomplicated recovery and conceived in the following estrus. Based on this case study, Cesarean section appears to be a safe and successful procedure for management of dystocia in Iraqi Awassi ewes.     

A case of Cushing's syndrome in pregnancy

Cushing's syndrome (also known as hypercortisolemia) is rare in pregnant women due to the menstrual disturbances and infertility in women with hypercortisolism. A diagnosis of pathological hypercortisolism in pregnant women is often difficult as some symptoms of the disease may be associated with a complicated pregnancy. Hypercortisolemia leads to serious complications for mother and foetus, and is associated with premature labour and high foetal mortality. Hormonal and radiological diagnostics in pregnancy are limited. The results of hormonal measurements and dynamic tests are difficult to interpret due to the physiological changes in the hypothalamo-pituitaryadrenal axis connected with pregnancy. The optimal time and method of treatment should be chosen cautiously case by case because of the possibility of maternal and foetal complications. In this paper, we present a case of Cushing's syndrome secondary to adrenal adenoma in which the diagnosis was made in the 22(nd) week of pregnancy. Due to the advanced gestational status and mild symptoms of hypercortisolism, only symptomatic treatment was introduced. The patient was under continuous obstetric and endocrinological care. At 35 weeks of gestation, the pregnancy was terminated by emergency caesarean section because of premature detachment of the placenta. A male infant weighing 2,450 g was delivered; neither adrenal insufficiency in the child nor hypercortisolemia complications in the mother were observed.     

Obstetrics in elephants

Obstetrics, one of the oldest fields in veterinary medicine, is well described and practiced in domestic and exotic animals. However, when providing care during elephant birth or dystocia, veterinary intervention options differ greatly from any domestic species, and are far more limited due to the dimensions and specific anatomy of the elephant reproductive tract. In addition, aging of captive elephant populations and advanced age of primiparous females make active birth management increasingly important. Intrauterine infection, uterine inertia and urogenital tract pathologies are emerging as major causes for dystocia, often leading to foetal and dam death. This paper reviews the current knowledge on elephant birth and the factors associated with dystocia. It then summarises recommendations for birth and dystocia management. As Caesarean section, the most common ultima ratio in domestic animal obstetrics, is lethal and therefore not an option in the elephant, non-invasive medical treatment, induction of the Fergusson reflex or the conscious decision to leave a retained foetus until it is expelled voluntarily, are key elements in elephant obstetrics. Surgical strategies such as episiotomy and foetotomy are sometimes inevitable in order to try to save the life of the dam, however, these interventions result in chronic post-surgical complications or even fatal outcome. Limited reliable data on serum calcium concentrations, and pharmacokinetics and effect of exogenous oestrogen, oxytocin, and prostaglandins during birth provide the scope of future research, necessary to advance scientific knowledge on obstetrics in elephants.     

Idiopathic thrombocytopenic purpura in pregnancy and neonatal period

In pregnancy and neonatal period both mother and child are endangered by bleeding complications due to maternal idiopathic thrombocytopenic purpura. Obstetrical and perinatal management therefore must aim at increasing maternal and fetal platelet count. In our paper six patients in nine pregnancies are reported. Two of them (five pregnancies) were treated with corticosteroids, four of the patients were successfully treated with i.v. immunoglobulins (IgG). Longterm steroid application and splenectomy during pregnancy may be hazardous for mother and fetus. IgG i.v. administration in contrast offers a new and safe way to control maternal and fetal platelet counts during pregnancy, delivery and the neonatal period.