气囊助产术在产程中的应用

目的:探讨气囊助产术在临床分娩中的作用。方法:选择300例初产妇,随机分为两组,观察组(气囊助产仪150例),对照组(未干预组150例)。结果:观察组(气囊助产仪150例)使用气囊助产仪术后均达到了明显缩短产程,明显降低剖宫产率,与对照组(未干预组150例)比较,有显著差异,具有可比性。结论:气囊助产术可缩短产程,减少产妇疼痛时间,降低软产道损伤,使阴道分娩率增加,降低剖产率,减少产后出血及产后尿潴留。     

产后血清C反应蛋白的影响因素研究

目的:研究产后血清C反应蛋白的影响因素。方法:选取2013年8月~2014年10月之间于我院分娩的产妇80例,40例经阴道分娩者设为对照组,40例剖宫产分娩者设为观察组,测量其不同时段的CRT浓度,比较手术与术后情况。结果:分娩前1d与分娩时两组产妇的CRP浓度无显著差异(P0.05),分娩后1d、2d、3d、4d时对照组的CRP浓度始终低于观察组,P0.05,差异具有统计学意义;产后48h WBC在两组产妇之间的对比无显著差异(P0.05),对照组的手术时间、术中出血量、术后感染率、产后48h体温、产后48h NEUT均明显低于观察组,P0.05,差异具有统计学意义。结论:影响产后血清C反应蛋白的一个重要因素就是分娩方式,分析其浓度值变化有助于选择合理的分娩方式,尽早发生术后感染,对治疗方案的调整有指导意义,可有效减少产后并发症。     

改变产妇体位加用地西泮和山莨菪碱在产程中的效果观察

目的 观察改变产妇体位加用地西泮和山莨菪碱在枕后位及枕横位分娩的效果.方法 对532例临产后分娩早期发现枕后位、枕横位,无头盆不称足月妊娠健康产妇,随机分为改变产妇体位加用地西泮和山莨菪碱组（A组）、常规体位组（B组）,观察两组的产程、分娩方式、出生时胎儿体重、产后出血及新生儿窒息情况.结果 A组的产程短,手术产率低,产后出血及新生儿窒息无增加;对照组的产程长,手术产率高.结论 临产后尽早发现枕后位、枕横位,及时改变产妇体位,加用安定和山莨菪碱可预防持续性枕后位、枕横位的发生,减少难产,提高阴道分娩质量.     

臀位分娩方式的选择对新生儿的影响

目的探讨单胎臀位分娩方式与新生儿窒息发生率、新生儿体重、新生儿死亡情况及产次之间的关系。方法将251例单胎臀位妊娠产妇按分娩方式分为阴道分娩组及剖宫产组,对其临床资料进行回顾性分析。结果新生儿体重剖宫产组显著高于阴道分娩组（P〈0．01）．新生儿窒息率剖宫产组显著低于阴道分娩组（P〈0．05）。新生儿死亡率剖宫产组显著低于阴道分娩组（P〈0．05）。结论正确选择单胎臀位妊娠分娩方式,将有助于降低新生儿窒息率、新生儿死亡率。     

自然分娩和剖宫产发生产后腰背痛的差异及相关因素分析

目的:比较自然分娩和剖宫产产妇术后发生腰背痛的情况差异及其相关影响因素。方法:选择2014年10月~2016年10月于我院就诊的400例产妇。按照分娩方式的不同分为自然分娩组和剖宫产组,每组各200例。比较两组产妇产后2、3、4个月腰背痛的发生率及疼痛(VAS)评分,并通过logistic回归分析探讨发生产后腰背痛的影响因素。结果:剖宫产组术后2、3、4个月产妇腰背痛的发生率均明显高于自然分娩组(P0.05);术后2个月,两组产妇腰背痛的VAS评分接近,术后3、4月剖宫产组产妇的VAS评分均显著高于自然分娩组(P0.05);生育超过3次、腰背痛史、剖宫产与产后腰背痛的发生密切相关(P0.05)。结论:剖宫产后腰背痛的发病率显著高于采取自然分娩方式的产妇,既往腰背痛史、分娩方式、生育次数、胎儿体重均与是产后腰背痛相关影响因素。     

不同分娩方式对产妇产后心理和生理的影响

目的:探讨不同分娩方式对产妇产后心理和生理的影响.方法:随机选择2011年1月～2011年12月在苏大附一院分娩的初产妇400例,其中剖宫产、阴道自然分娩各200例,对两组产妇产后42天心理状况、恶露持续时间、泌乳情况进行调查.结果:两种分娩方式对产妇产后42天发生焦虑和抑郁心理的影响无明显差别(P＞0.05);阴道自然分娩组产后恶露持续时间短于剖宫产组,差异有显著意义(P＜0.01).有抑郁、焦虑情绪的产妇泌乳始动时间显著长于正常产妇,24h泌乳量显著少于正常产妇(P＜0.01).结论:剖宫产对产妇身体生理创伤大过阴道自然分娩,应严格控制剖宫产的适应症,鼓励阴道自然分娩.     

拉玛泽分娩法在初产妇分娩中的效果分析

目的:分析在初产妇分娩过程中应用拉玛泽分娩法的临床效果.方法:将245例初产孕妇分成两组,120例分娩全程采用常规方法助产(对照组),其余125例应用拉玛泽分娩法于分娩全过程中(观察组),比较两组孕妇总产程时间、产痛程度、产后2h出血量、并发症等相关指标.结果:观察组的产妇痛感较对照组的轻,其中轻度疼痛88例(70.4％),优于对照组26例(21.7％),观察组产妇总产程时间513.23分钟,产后2小时内出血量198.2 mL,产后出现并发症的产妇2例(1.6％),均优于对照组,P＜0.05,差异具有统计学意义.结论:拉玛泽分娩法在初产妇分娩过程中应用效果显著,助产士等人员均应熟练掌握,临床应提倡使用.     

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。     

产后出血296例临床分析

产后出血是指胎儿出生后24h内出血量超过400ml者,是分娩的严重并发症,多发生在产后2h,占我国产妇死亡的四大原因之首,其发病率占分娩总数的2%~3%。由于分娩时测量和收集失血量存在一定困难,估计失血量偏少,实际产后出血发病率更高。产后出血往往发病突然,而且来势凶猛,如抢救不及时,可直接危及生命。因此,防治产后出血是产科工作者的重要任务。本文对1995年1月至2005年12月入住我院的296例产后出血产妇的临床资料进行分析,并总结出预防、监测、抢救的方法,以供同行探讨。1临床资料1·1一般资料1995年1月~2005年12月在本院分娩的孕产妇8156例…     

产后出血临床抢救护理对策

目的:对产后出血临床抢救护理对策进行探讨。方法:选取从2011年1月到2012年2月到2014年2月收治的80位产后出血患者,采取急救处理以后给予护理干预。结果:产后出血主要是由凝血功能障碍、软产道损伤、胎盘因素以及宫缩乏力所引起的。阴道分娩发生产后出血的概率为5.26%,剖宫产发生产后出血概率为4.35%。结论:在产科中,比较常见的并发症就是产后出血,具有较高的发生概率,容易受到多种危险因素的影响。采取有效的抢救护理,能使产妇生命安全得到保障。     

Maternal and paternal contribution to intergenerational recurrence of breech delivery: population based cohort study

Objective To investigate intergenerational recurrence of breech delivery, with a hypothesis that both women and men delivered in breech presentation contribute to increased risk of breech delivery in their offspring.Design Population based cohort study for two generations.Setting Data from the medical birth registry of Norway, based on all births in Norway 1967-2004 (2.2 million births).Participants Generational data were provided through linkage by national identification numbers, forming 451 393 mother-offspring units and 295 253 father-offspring units. We included units where both parents and offspring were singletons and offspring were first born, forming 232 704 mother-offspring units and 154 851 father-offspring units for our analyses.Main outcome measure Breech delivery in the second generation.Results Men and women who themselves were delivered in breech presentation had more than twice the risk of breech delivery in their own first pregnancies compared with men and women who had been cephalic presentations (odds ratios 2.2, 95% confidence interval 1.8 to 2.7, and 2.2, 1.9 to 2.5, for men and women, respectively). The strongest risks of recurrence were found for vaginally delivered offspring and were equally strong for men and women. Increased risk of recurrence of breech delivery in offspring was present only for parents delivered at term.Conclusion Intergenerational recurrence risk of breech delivery in offspring was equally high when transmitted through fathers and mothers. It seems reasonable to attribute the observed pattern of familial predisposition to term breech delivery to genetic inheritance, predominantly through the fetus.     

Causes of Birth Asphyxia and Trauma

Causes of birth asphyxia and trauma were determined in the 208 most severely affected infants of 10,995 consecutive live births; 159 infants had cerebral disturbances, 39 had fractures and palsies, and 10 had fractures or palsies in addition to cerebral disturbances. Most frequent causes of birth asphyxia and trauma were: prolonged labour, midforceps or breech delivery in full-term infants; abruption placentae, difficult breech delivery, and maternal sedation in premature infants; and unattended precipitate deliveries in immature infants. Asphyxia following normal labour and delivery usually occurred in infants with fetal malnutrition.Improved obstetrical management with more frequent use of Cesarean section delivery might have been of value in preventing much of this fetal injury.Asphyxia and trauma due to complications of delivery were twice as frequent on the ward as on the private service. This may have been due in part to a lower Cesarean section rate on the ward service. A monthly review of birth asphyxia and trauma is recommended to help maintain a high standard of obstetrical practice.     

Temporal Variation in Japanese Macaque Bodily Mass

We investigated the bodily mass of infants and postpartum adult females longitudinally in provisioned free-ranging Japanese macaque (Macaca fuscata) troops of the Takasakiyama Natural Zoo, Oita, Japan. We investigated whether the rate of mass change in postpartum adult females and infants is more strongly associated with season (or calendar date) as opposed to the length of time since delivery/birth. Focal adult females' postpartum mass ranged between 7 and 10 kg for a year after delivery. For postpartum adult females, calender date (season) influenced the rate of mass change more than the length of time since delivery did. Rate of mass change in postpartum adult females was high in October (autumn) and April and May (spring) and low between December and February (winter). This may reflect seasonality in energy and protein intake from natural foods. Infant mass increased steadily from birth. Mass of infants varied between individuals, some infants reached 2 kg by about 240 days of age, and others by about 400 days of age. It was unclear, however, whether the rate of mass change in infants was influenced more by age or calendar date (season). Differences in trends between adult females and infants may reflect, to some degree, differences in sources of energy intake, i.e. solid foods for adult females and suckling and solid foods for infants.     

Mode of delivery and survival in babies weighing less than 2000 g at birth.

A retrospective study of babies weighing less than 2000 g at birth admitted over a four-year period to Nottingham City Hospital Neonatal Unit showed a higher incidence of lower Apgar scores and the need for intubation in babies born by caesarean section and breech deliveries. Mortality in those delivered by the breech (35%) was statistically higher than those by caesarean section (10%) or vertex (14%). It is concluded that small babies born by breech delivery have a higher mortality than when delivered vaginally and should have the benefit of caesarean section.     

Breech delivery and birth-related behaviors in wild mantled howling monkeys

The breech birth of an infant mantled howling monkey was observed on February 12, 1990. The mother assisted the successful delivery by pulling on the infant's tail and hindleg. No other members of the social group attended the mother or demonstrated any interest in the birth process.     

Hypopituitarism and stalk agenesis: a congenital syndrome worsened by breech delivery?

Thirty-seven patients with idiopathic hypopituitarism, of whom 12 had multiple pituitary hormone deficiencies (MPHD) and 25 isolated growth hormone deficiency (IGHD), were evaluated by magnetic resonance imaging (MRI). Twenty-two of the 37 showed congenital anterior pituitary hypoplasia, stalk agenesis and ectopic posterior pituitary gland at the infundibular recess (group A), while the remaining 15 presented isolated anterior pituitary hypoplasia (group B). Perinatal histories obtained from all patients demonstrated that 18/22 children of group A (81.81%) had histories of adverse perinatal events, with breech presentation in 15 (68.18%). Twelve of 12 children of group A born by breech delivery developed MPHD; 3 born by cesarean section for breech presentation had only IGHD. Patients of group B had also a high incidence of perinatal insults (12/15, 80%), but breech delivery was markedly less frequent (13.33 vs. 68.18% of group A) and responsible for only IGHD. Group B had also higher percentages of maternal spontaneous abortion and low birth weight. Our study suggests that several factors may play a role in the development of growth hormone deficiency. Some patients had severe perinatal insults apparently leading to hypopituitarism. We were able to define by MRI a group of patients with congenital abnormalities, such as anterior pituitary hypoplasia, stalk agenesis and posterior pituitary ectopia, among whom breech presentation was very common. In this group, breech delivery was always followed by MPHD while cesarean or normal delivery in such patients was followed by IGHD only.     

Outcome of breech delivery at term.

OBJECTIVE--To compare neonatal mortality and morbidity in term infants presenting by the breech and delivered vaginally or by caesarean section. DESIGN--Population based comparison of outcomes. Data derived from the St Mary''s maternity information system. SETTING--North West Thames Regional Health Authority, 1988-90. SUBJECTS--3447 singleton fetuses presenting by the breech at term. MAIN OUTCOME MEASURES--Intrapartum and neonatal mortality, low Apgar scores, intubation at birth, and admission to special care baby units. RESULTS--After the exclusion of babies with congenital anomalies the incidence of intrapartum and neonatal death associated with vaginal birth was 8/961 (0.83%) compared with 1/2486 (0.03%) in babies born by caesarean section (relative risk 20, 95% confidence interval 2.5 to 163). The numbers of low Apgar scores and neonatal intubation were doubled in babies born vaginally or by emergency caesarean section compared with those delivered by elective operation. CONCLUSIONS--The good neonatal outcome associated with elective caesarean delivery of the term breech fetus may influence the decision of women and their obstetricians about mode of delivery.     

Neurological follow-up of 281 children born in breech presentation: a controlled study.

A study was conducted of all children delivered in breech presentation from 1969 to 1977 in the university''s department of obstetrics. One-fifth of the deliveries were by caesarean section. Perinatal mortality was high (13.2%) but was due almost exclusively to causes other than the birth itself. The 256 surviving children and their matched controls were neurologically examined at 18 months or at ages varying between 3 and 10 years. The attrition rate was 5.7%, but in most cases data on development were available. Significant differences between the study and control groups existed for only minor neurological dysfunctions. It is concluded that the main danger of breech presentation is in the associated complications of pregnancy and that there is no reason to advocate a higher frequency of abdominal delivery than the 20% found in this study.     

External cephalic version of the term breech baboon (Papio sp.) fetus

BACKGROUND: Breech presentation in baboons may be associated with head entrapment and stillbirth during vaginal delivery. For this reason, pregnant dams at our institution typically undergo cesarean delivery for known breech presentation, leading to problems with maternal-infant bonding and increased nursery utilization. METHODS: This paper describes a simple, non-invasive technique called external cephalic version (ECV) that effectively converts the baboon breech fetus into a cephalic presentation. RESULTS: ECV was successful in each of seven attempted cases, with the consistent development of contractions and vaginal bleeding leading to the delivery of a healthy liveborn infant within 72 hours. CONCLUSIONS: ECV may offer a safe and effective alternative to cesarean section for delivery of the breech baboon fetus.     

Twin and singleton births in Ghana--a case-control study.

A retrospective study involving 623 twin and 1246 singleton births was conducted to compare the two groups with regard to selected maternal, fetal and labor and delivery characteristics and outcomes. Maternal age and parity were significantly higher for twins. The risks of preterm delivery, arrival in the labor ward in second stage of labor, cesarean births and postpartum haemorrhage were significantly higher in twin than in singleton births. In vaginal deliveries twin mothers were significantly less likely to have had episiotomies or perineal lacerations. There was no difference in the duration of the third stage of labor or in the incidence of retained placentae. Antepartum haemorrhage was a less likely indication for cesarean delivery among twins, while there was no significant difference in the likelihood of severe pre-eclampsia/eclampsia being an indication. Singleton babies were significantly heavier than twins. The incidences of malpresentation, low birth weight, stillbirths and of admission of live births to the neonatal intensive care unit were significantly higher in twins. There was no difference in the rate of instrumental vaginal delivery, or in the route of delivery of fetuses presenting by the breech. There is the need for detailed study of the incidences of antepartum haemorrhage and hypertensive diseases in twin and singleton pregnancies and of the factors determining the mode of delivery when such complications arise. Labor and delivery should also be examined to determine any differences between the two groups, especially in the first and second stages.