482例产褥期阴道微生态调查

目的了解产褥期妇女阴道微生态状况,为临床保健提供循证依据。方法选择长兴县妇幼保健院产后门诊复查的产褥期妇女482例及来院体检的健康妇女86例,采集阴道分泌物作pH、病原体、清洁度和阴道微生态功能检查,进行阴道微生态学评价、比较。结果 482例产褥期阴道pH为(4.62±0.62);阴道清洁度Ⅲ~Ⅳ127例;微生态正常者75例,占15.56%;微生态失调者407例,占84.43%。86例健康妇女阴道pH(4.38±0.65);阴道清洁度Ⅲ~Ⅳ14例;微生态正常者34例,占39.53%;微生态失调者52例,占60.47%。差异有统计学意义。结论产褥期妇女阴道微生态发生改变,表现为pH升高,清洁度下降,微生态失调比例明显升高,应引起临床保健工作者关注。     

马来酸麦角新碱联合米索前列醇对剖宫产产后出血患者凝血功能、血流动力学及血清NO、NOS水平的影响

摘要 目的：探讨马来酸麦角新碱联合米索前列醇对剖宫产产后出血患者凝血功能、血流动力学及血清一氧化氮（NO）、一氧化氮合酶（NOS）水平的影响。方法：选取2017年6月~2019年10月期间我院收治的剖宫产产后出血患者98例,根据信封抽签法分为对照组（n=49）和研究组（n=49）,对照组患者给予米索前列醇,研究组在对照组基础上联合马来酸麦角新碱治疗,比较两组患者凝血功能、血流动力学、临床指标、血清NO、NOS水平及不良反应。结果：研究组治疗后的产后恶露持续时间、住院时间短于对照组,产后2 h内出血、产后2～24 h出血少于对照组（P<0.05）。两组不良反应发生率比较无差异（P>0.05）。两组治疗后凝血酶原时间（PT）、凝血活酶时间（APTT）,纤维蛋白原（FIB）、D-二聚体（D-D）水平均下降,且研究组低于对照组（P<0.05）。两组治疗后收缩压（SBP）、舒张压（DBP）均下降,但研究组高于对照组（P<0.05）,两组治疗后心率（HR）升高,但研究组低于对照组（P<0.05）。两组治疗后血清NO、NOS水平均下降,且研究组低于对照组（P<0.05）。结论：剖宫产产后出血患者给予马来酸麦角新碱联合米索前列醇治疗,可有效维持血流动力学平稳,降低血清NO、NOS水平,改善患者凝血功能及临床指标。     

Mental health problems and influencing factors in Japanese women 4?months after delivery

Background

Postpartum mental health problems are a major public health issue; however, studies on the mental health status of mothers and its influencing factors between 8 weeks and 1 year postpartum are scarce. Furthermore, it would be necessary to examine the factors influencing mothers’ mental health in order to evaluate their physiological adaptations to the nursing environment.

Methods

We examined the mental health status of postpartum women and the factors influencing poor mental health at 4 months after delivery. A cross-sectional study of 584 postpartum women was conducted. Information on mental health status, delivery, and other factors was collected using a self-administered questionnaire. Women were asked about their age, height, weight, gestational or marital status, whether they were eating regular meals, appetite, frequency of going out, financial difficulty, stressful life events, and history of depression. The Japanese version of the 12-item General Health Questionnaire (GHQ-12) was used to identify potential poor mental health status. Participants with GHQ-12 scores of ≥4 were classified as the high GHQ-12 score group (poor mental health status) and participants with GHQ-12 scores of ≤3 were classified as the low GHQ-12 score group (good mental health status).

Results

Forty-five women (7.7%) were classified as having high GHQ-12 scores. Multiple logistic regression analysis revealed that older age, not eating meals regularly, and history of depression were significantly associated with poor mental health. Financial difficulty had a borderline association with poor mental health in this model.

Conclusions

These risk factors might help practitioners identify women at high risk of poor mental health after delivery.     

团体辅导对产妇产后抑郁的影响

目的：团体辅导对产妇产后抑郁情绪的影响。方法：选择唐山莱医院产科住院足月分娩、无精神病史、无产前、产中及产后合并症者,且婴儿健康的产妇240例,随机分成两组,实验组产妇在产后进行4—6次的团体心理辅导;对照组产妇实施常规护理。在产后第7、42天利用爱丁堡产后抑郁量表（EPDS）进行两次抑郁情绪评定。结果：两组产妇产后7天（t-=-7．798,P=0．000）、42天（t=：3．147,P=-0．002）的抑郁评分差异有统计学意义,且初产妇的干预效果要好于经产妇（t7th产3．393,t42nd=4．284,P〈0．005）。结论：团体辅导对改善产妇产后抑郁状态有明显效果。     

团体辅导对产妇产后抑郁的影响

目的:团体辅导对产妇产后抑郁情绪的影响。方法:选择唐山某医院产科住院足月分娩、无精神病史、无产前、产中及产后合并症者,且婴儿健康的产妇240例,随机分成两组,实验组产妇在产后进行4-6次的团体心理辅导;对照组产妇实施常规护理。在产后第7、42天利用爱丁堡产后抑郁量表（EPDS）进行两次抑郁情绪评定。结果:两组产妇产后7天（t=7.798,P=0.000）、42天（t=3.147,P=0.002）的抑郁评分差异有统计学意义,且初产妇的干预效果要好于经产妇(t_7th=3.393,t_42nd=4.284,P<0.005)。结论:团体辅导对改善产妇产后抑郁状态有明显效果。     

Effect of length of progesterone exposure during ovulatory wave development on pregnancy rate

The objective was to determine the effects of the duration of progesterone exposure during the ovulatory wave on fertility (pregnancy rate) in beef cattle. We tested the hypothesis that short-progesterone exposure during the growing and early-static phase of the ovulatory follicle (analogous to the ovulatory wave of 3-wave cycles) is associated with higher fertility than a longer duration of exposure (analogous to the ovulatory wave of 2-wave cycles). Three to 5 days after ovulation, beef heifers (n = 172) and suckled beef cows (n = 193) were given an intravaginal progesterone-releasing device (CIDR) and 2.5 mg estradiol - 17β +50 mg progesterone im to induce a new follicular wave. Cattle were allocated to short- or long-progesterone exposure groups (for 3 and 6 d after wave emergence, respectively) after which prostaglandin F_2α was administered and CIDR were removed. Forty-eight hours later, all cattle were given 12.5 mg pLH and artificially inseminated (AI) with frozen-thawed semen. The diameter of the two largest follicles and the corpus luteum were measured by transrectal ultrasonography at CIDR removal, insemination, and 36 h after insemination. Pregnancy diagnosis was done ultrasonically 38 and 65 d post-AI. There was no difference in pregnancy rates in short- vs long-progesterone exposure in heifers (53 vs 47%, P = 0.44) or cows (63 vs 58%, P = 0.51). However, the diameter of the ovulatory follicle at CIDR removal and AI was smaller in short- than in long-progesterone groups (P < 0.02), and larger in cows than in heifers (P < 0.006). In conclusion, short-progesterone exposure during the growing and early-static phase of the ovulatory follicle (similar to 3-wave cycles) was not associated with higher fertility than a longer progesterone exposure (similar to 2-wave cycles).     

Factors affecting the occurrence of postpartum prolonged luteal activity in clinically healthy high-producing dairy cows

The objective was to characterize risk factors affecting the occurrence of prolonged luteal phase (PLP) in postpartum, clinically healthy, high-producing dairy cows. Transrectal ultrasound examinations of the reproductive tract were performed twice weekly, from the 1st to 8th wk after calving in 151 multiparous clinically healthy lactating Holstein cows (mean ± SD of peak milk yield = 56.7 ± 7.4 kg). Serum samples were collected twice weekly to measure progesterone and every 2 wk to detect β-hydroxybutyrate (βHB), and α1-acid glycoprotein (AGP). Body condition score (BCS) was recorded weekly after calving. Based on the serum progesterone profile, 52 (34.4%) cows had normal ovarian activity (NLA), whereas 36 (23.8%) cows had a prolonged luteal phase (PLP), the most prevalent type of abnormal pattern of luteal activity. Furthermore, 63 cows with short luteal activity, delayed first ovulation, or cystic ovaries were excluded from this study. Serum AGP concentrations, as an indication of postpartum chronic endometritis, were not different (P > 0.05) between cows with NLA and PLP. Categories of peak milk yields (kg) were positively correlated with the incidence (%) of cows with PLP (r = 0.87, P = 0.02). Furthermore, milk yield peak, day of milk yield peak, mean milk yield (8 wk in milk), and milk yield on the expected day of luteolysis were higher (P < 0.05) in cows with PLP than NLA, and cows with PLP had greater loss of BCS (P = 0.007) than those with NLA. The likelihood of cows with PLP decreased by 0.9-fold for every 1 d delay of commencement of luteal activity (C-LA). Moreover, the likelihood of cows with PLP increased by 1.8-fold for each 1 mmol/L increase in the 1st wk serum βHB concentrations. In conclusion, higher mean of milk yield, greater BCS loss, earlier C-LA, and later peak milk yield were the major risk factors affecting the occurrence of postpartum PLP in clinically healthy, high-producing dairy cows.     

Endometrial biopsy: a valuable clinical and research tool in bovine reproduction

Studies of postpartum endometrial physiologic and immune mechanisms in cows are compromised by the difficulty in acquiring tissue of suitable quality and in sufficient quantity (Bos taurus). Endometrial biopsy sampling has attracted concern regarding potential animal ill-health and perturbed subsequent fertility. Here, we describe a method of endometrial biopsy that obtains high-quality tissue samples and does not compromise fertility. Using a Hauptner instrument, endometrial biopsies were taken at 15, 30, and 60 d postpartum from 13 mixed-breed beef cows. The effects of repeat biopsy on health (heart rate, respiration rate, color of mucous membranes, rectal temperature), onset of estrous cyclicity, and first service conception rate were monitored. Extensive daily clinical examinations revealed no signs of ill-health. All cows had resumed estrous cyclicity at 60 d postpartum. A conception rate of 77% was achieved after estrus synchronization and artificial insemination. Each biopsy yielded intact endometrial tissue and nucleic acid suitable for extensive histologic and molecular analysis, respectively. We conclude that when carried out appropriately, bovine endometrial biopsy is a safe and reliable technique for assessing postpartum uterine function or health.     

妊娠期高血压患者产后抑郁的影响因素探讨及其生命质量调查

摘要 目的：探讨妊娠期高血压患者产后抑郁的影响因素,调查其生命质量。方法：选择2016年6月至2021年6月于我院产科分娩的312例妊娠期高血压患者,采用爱丁堡产后抑郁量表（EPDS）评估患者产后抑郁发生率。收集临床资料,采用多因素Logistic回归分析影响妊娠期高血压患者发生产后抑郁的危险因素。采用中文版36项简明健康状况调查表（SF-36）评估患者生命质量。结果：312例妊娠期高血压患者中有66例发生产后抑郁,发生率为21.15%。单因素分析结果显示,抑郁组年龄≥35岁、受教育程度在高中（中专）及以下、无经济收入、婚姻状况为未婚/离异/丧偶、有妊娠并发症、分娩孕周＜36周、无导乐陪产、新生儿疾病、伤口剧烈疼痛、产后出血、产褥感染、产后血压控制差的比例高于无抑郁组（P＜0.05）。多因素Logistic回归分析显示,新生儿疾病、分娩孕周＜36周、产后血压控制差、无经济收入、受教育程度低是妊娠期高血压患者发生产后抑郁的危险因素（P＜0.05）。抑郁组SF-36躯体功能、生理职能、躯体疼痛、总体健康、生命活力、社会功能、情感功能、精神健康评分均低于无抑郁组（P＜0.05）。结论：新生儿疾病、分娩孕周＜36周、产后血压控制差、无经济收入、受教育程度低是妊娠期高血压患者产后抑郁的危险因素,产后抑郁患者生命质量较低,临床应加强产后心理干预,改善患者生命质量。     

腹动脉球囊置入联合宫颈提拉缝合治疗凶险性前置胎盘产后大出血临床效果

摘要 目的：探讨腹动脉球囊置入联合宫颈提拉缝合治疗凶险性前置胎盘产后大出血的临床效果。方法：选取我院2019年1月到2021年12月收治的178例凶险性前置胎盘患者作为研究对象,所有患者均采取剖宫产手术,且术后出现产后大出血现象,将所有患者依照术中胎盘位置及植入情况治疗方式分为观察组（n=73）与对照组（n=105）。其中对照组产妇采取腹动脉球囊置入联合宫腔纱条填塞术,观察组采取腹动脉球囊置入联合宫颈提拉缝合治疗,对比两组产妇的剖宫产时间、术后24 h失血量、术中失血量以及总手术时间,相关临床指标,产后泌乳时间和产后1 d、2 d的泌乳量评分以及住院时间,并发症发生情况。结果：两组产妇剖宫产时间、球囊预置术时间对比无明显差异（P＞0.05）,观察组产妇术后24 h失血量、术中失血量、总手术时间明显低于对照组（P＜0.05）。手术前两组产妇凝血酶原时间（PT）、凝血活酶时间（APTT）、血小板（PLT）、纤维蛋白原（FIB）、一氧化氮（NO）、一氧化氮合酶（NOS）、D-二聚体（D-Dimer）无明显差异（P＞0.05）,治疗后两组产妇PT均升高,观察组高于对照组,PLT、NO、NOS均降低,观察组低于对照组;对照组APTT、FIB无明显变化,但观察组APTT高于对照组,FIB低于对照组;观察组D-Dimer无明显变化,但对照组升高（P＜0.05）。观察组产妇的产后1、2 d泌乳量评分明显高于对照组,泌乳时间、术后住院时间明显低于对照组（P＜0.05）。观察组产妇术后并发症发生率明显低于对照组（P＜0.05）。结论：对凶险性前置胎盘产后大出血患者采取腹动脉球囊置入联合宫颈提拉缝合治疗能够进一步减轻患者术后出血量,且改善患者凝血因子、一氧化氮、一氧化氮合酶、纤维蛋白原、D-二聚体水平,提升泌乳量,减少术后并发症发生率,值得临床应用推广。