持续性枕后位180例临床分析

目的为了减少母婴并发症,及时处理产程。方法选择我院2002年5月～2006年1月分娩的产妇3205例,对发生持续性枕后位180例产妇进行观察。结果180例中,自然分娩12例(6.67%),胎吸助产10例(50.56%),产钳助产23例(12.76%),剖宫产135例(75.00%)。180例中无围生儿死亡,发生新生儿窒息32例,新生儿窒息率17.78%。结论持续性枕后位应适当放宽剖宫产指征,避免过度试产,以减少母儿并发症。     

197例臀位产临床分析

目的 探讨臀位不同分娩方式及围产儿愈后。方法 对1998年1月至2003年7月臀位产197例分娩的方式及臀产儿愈后进行回顾性分析。结果 臀位发生率为2．34％．围产儿死亡率为55．84‰；臀位牵引围产儿死亡率较高，而剖宫产术无一例围产儿死亡。结论 对于臀位应根据产妇及胎儿的具体情况选择合适的分娩方式．以确保母要安全。     

剖宫产与围产期母儿死亡分析

<正>本文就我院1983年4月至1993年5月10年中剖宫产与围产期母儿死亡情况分析讨论如下。 资料分析 从1983年4月至1993年5月,在我院分娩的孕周>28周的产妇共26596例,其中双胎249例,共分娩围产儿26845例,死亡410例,围产儿死亡率15.27‰。产妇死亡6例,死亡率为2.26/万。共施行剖宫产手术6024例,剖宫产率为22.65％,其中双胎58例,剖宫产围产儿67082例,死亡71例,死亡率为11.67‰,剖宫产围产儿死亡率略低于总围产儿死亡率。剔除死胎、新生儿畸形者,剖宫产与阴道分娩的围产儿死亡率无明显差异(见下表)。     

197例臀位产临床分析

目的　探讨臀位不同分娩方式及围产儿愈后。方法　对 1998年 1月至 2 0 0 3年 7月臀位产 197例分娩的方式及臀产儿愈后进行回顾性分析。结果　臀位发生率为 2 .34% ,围产儿死亡率为 5 5 .84‰ ;臀位牵引围产儿死亡率较高 ,而剖宫产术无一例围产儿死亡。结论　对于臀位应根据产     

臀位分娩方式326例临床分析

目的 分析臀位产的三种分娩方式与围产儿死亡率、新生儿并发症的关系，对降低臀位围产儿的死亡率进行探讨。方法 对四年来在我院分娩的326例臀位产孕妇的围产儿死亡率、Apgar评分及新生儿并发症与三种分娩方式的关系进行分析。结果 三种分娩方式中，臀牵引的围产儿死亡率为261％，臀助产为4.68％，剖宫产为1．92％。结论 臀牵引的主要死亡原因为后出胎头困难。臀位剖宫产的主要死亡原因为剖宫产时机把握不正确。     

宫内发育迟缓儿的分娩方式与围产儿转归

对１５７例足月体重≤２５００ｇ宫内发育迟缓儿的分娩方式与围产儿转归进行了临床分析。结果表明，新生儿生出体重愈低，围产儿死亡率、新生儿窒息率和新生儿并发症的发生率愈高。剖宫产组围产儿死亡率不仅没有下降，反而增加了新生儿窒息率和并发症的发生率。胎吸和产钳助娩组新生儿并发症的发生率明显升高。臀位助娩和臀位牵引的亲手儿窒息率，并发症发生率及围产儿死亡率显著高于自然分娩组，故对宫内发育迟缓儿应加强围产保健和     

妊娠高血压综合征产妇的分娩观察与临床体会

目的 探讨妊娠高血压综合征产妇合理的分娩方式,保证母婴安全.方法 对我院2009～2011年间收治的59例妊娠高血压综合征产妇的临床资料进行回顾性分析,包括分娩时机、分娩方式及分娩结局.结果 18例孕周＜33周者中,新生儿窒息6例(33.3%),围产儿死亡4例(22.2%),41例孕周≥33周者中,新生儿窒息8例(19.5%),围产儿死亡3例(7.3%).产妇无1例死亡,且无严重的并发症.17例顺产产妇中,新生儿窒息6例(35.3%),围产儿死亡5例(29.4%),孕产妇并发症发生3例(17,6%).行胎头吸引或会阴侧切产钳助娩20例产妇中,新生儿窒息4例(20.0%),围产儿死亡4例(20.0%),孕产妇并发症发生2例(10.0%).行剖宫产终止妊娠的22例产妇中,新生儿窒息3例(13.6%),围产儿死亡2例(9.1%),孕产妇并发症发生2例(9.1%).结论 产妇孕33周后选择终止妊娠,以及行剖宫产终止妊娠能够有效降低新生儿窒息率、死亡率以及产妇并发症的发生率,较大程度上保证了母婴安全.     

高原(西宁地区)臀位产围产儿死亡的临床分析

本文就我院自1980～1982年三年内93例臀位产并就臀位产中剖宫产术的应用问题进行了分析。三年内分娩总数为3670例,臀产发生率为2.54％,与省内,国内外文献报导为3％—4％相比略有降低。但臀位产围产儿死亡率较高(9.89％)故对围产儿死亡与妊娠,胎儿等诸因素的关系如产妇年龄,产次,产程、孕周,分娩方式,胎儿体重以及合并症等逐项比较分析。认为当前围产医学发展,我国提倡少生优生,第一胎分娩相对上升,做好孕期检查,纠正胎位异常且对临产时臀位产的正确处理,减少围产儿死亡甚为重要。并认为剖宫产术可以降低围产儿死亡率,所以恰当放宽应用。     

异常分娩

940447“例份位分娩的临床分析/孙玉霞t’’//哈尔滨医药一1993,13(1)一33~34 作者对哈尔滨道里区妇产医院臀位分娩的“例(占么59纬)进行了回彝性分析,其中阴道分娩39例(6。.94%),剖宫产25例(39.06%),阴道分娩组围产儿死亡4例6.25%,剖宫产组为。,但两组无明显差别P>。.05,比同期枕前位围产儿死亡率高约17倍。阴道分娩组新生儿皇息率(54.84沁,25.。。%)明显高于剖宫产组(12%)两组有极显著差异,作者认为本组4例围产儿死亡均为脐带脱垂而不是分娩方式决定的,因此不应把降低件产儿死亡率寄希望于剖宫产上,根本的是应作好孕期管理,早期发现及纠…     

臀位分娩方式的分析

目的：分析臀位产的3种分娩方式与围产儿死亡率、胎儿宫内窘迫、新生儿并发症的关系，对降低臀位产的死亡率进行探索。方法：对5年间在我院住院分娩的244例臀位产患的围产儿死亡率、Apgar评分及新生儿并发症与3种分娩方式的关系进行分析。结果：3种分娩方式中，臀牵引的围产儿死亡率为151‰，臀助产为46．5‰，剖宫产为32．0‰。结论：臀牵引的主要死亡原因为后出头困难，臀位剖宫产的主要死亡原因为早产。     

焦虑和抑郁对分娩方式的影响和分析

目的研究产妇精神状态（焦虑和抑郁）与分娩方式的关系，探讨焦虑和抑郁发生的社会相关因素，经上述研究为产前、产时实施心理护理提供依据。方法对392例健康产妇以焦虑自评量表和抑郁自评量表评定精神状态。所有产妇以产科常规、家属陪伴进行分娩而不进行干预，观察其分娩方式；按分娩方式分为顺产组、产钳助产组和剖宫产组。采用SPSS软件进行统计学分析，方差分析和q检验、卡方检验及卡方趋势检验。结果392例产妇中存在心理障碍的占57．40％，其中焦虑发生率为19．89％，抑郁发生率为21．56％，焦虑并抑郁发生率为14．03％。剖宫产组、产钳助产组的焦虑评分及抑郁评分明显高于正常产组，而且焦虑和抑郁的发生随年龄增大、学历增高而增加。结论焦虑和抑郁状态是增加手术助产率的一个显著因素，焦虑和抑郁的发生与年龄、文化程度等社会因素相关。     

Impact of increased rate of caesarean section on perinatal outcome: sociolegal evaluation

Sharp rise in the caesarean section rate, over the past years has been causing lot of concerns. It is to be evaluated whether the decrease in perinatal mortality rate is due to the rising rate of caesarean section. Five hundred consecutive patients were selected on whom caesarean section had been performed. Both mother and baby were followed till they are discharged from the hospital. Foetal distress was the commonest indication in primigravidae who underwent caesarean section. The other indications of caesarean section in this study were breech, severe pre-eclampsia, eclampsia, cord prolapse, elderly primi, postdated, premature rupture of membrane, twin, compound presentation, meconium stained liquor. The occurrence of perinatal morbidity in caesarean section was 10% compared to 12% in vaginal delivery. Common causes of perinatal morbidity were asphyxia, prematurity, diarrhoea, septicaemia, jaundice, conjunctivitis and scalp injury. The occurrence of perinatal mortality in caesarean section was 3.8% compared to 3% in vaginal delivery. Causes of perinatal mortality were stillbirth, meconium aspiration syndrome, hypoxic ischaemic encephalopathy, prematurity and congenital malformation. In spite of safety of vaginal birth after caesarean section it continues to be underutilised. Good perinatal care proper screening and use of newer effective pharmacological agents improve the maternal progress as well as perinatal outcome without increasing the caesarean section rate.     

A study of prolonged labour.

Two hundred and three consecutive cases of prolonged labour have been retrospectively reviewed from January 1984 to December 1986. The incidence of prolonged labour was 4.39%. It was noted that 66.5% of the patients with prolonged labour were unbooked emergency admissions, and 73.3% were primipara. The causes of prolonged labour were the occipitoposterior position (10.8%), relative cephalopelvie disproportion (18.2%), uterine dysfunction (44.5%), and in 26.1% an obstructive cause was present. A spontaneous vaginal delivery occurred in 34.4%, a forceps delivery in 22.6% and the caesarean section rate was 29%. The maternal mortality, febrile and non-febrile morbidity were 9.7 per 1000 total births, 42.8% and 17.2% respectively, which showed a direct relation to the duration of labour, and a significant increase in the patients with obstructed labour, and after an abdominal delivery. The corrected perinatal mortality was 165 per 1000 total births, which was also directly related to the duration of labour, and 74.3% of the perinatal deaths occurred in the patients with obstructed labour. The perinatal mortality in the study group was nearly three times higher than the overall hospital group. Neonatal morbidity occurred in 48.8% of the newborns.     

应用阴道表面电极研究不同分娩方式对产后妇女盆底肌力的影响

目的 研究经阴道分娩及剖宫产分娩对产后妇女盆底肌力的影响.方法 将184例产妇根据分娩方式分为剖宫产分娩组(n=59)、阴道自然分娩组(n=117)及产钳分娩组(n=8);于产后6～8周进行问卷调查,并应用Femiscan生物反馈治疗仪检测产后盆底肌力.同期选择20例年龄相当的已婚未育女性作为对照组.结果 对照组妇女盆底肌力的各项指标均高于产后妇女,差异有统计学意义(P＜0.05).剖宫产分娩组产妇产后盆底肌力最强,产钳分娩组产妇产后盆底肌力最差,两组盆底肌肉活力值的差异有统计学意义(P＜0.05).剖宫产分娩组及阴道自然分娩组产后左右两侧盆底肌肉活力值的差异无统计学意义(P＞0.05).产钳分娩组产妇左右两侧盆底肌肉活力值比较,差异有统计学意义(P＜0.05).阴道自然分娩组产妇第一产程时间与产钳分娩组比较,差异无统计学意义(P＞0.05);两组第二产程时间比较,差异有统计学意义(P＜0.05).结论 阴道自然分娩产妇产后早期的盆底肌力与选择性剖宫产分娩产妇相当;产钳分娩产妇盆底肌力最差,可能与其第二产程时间过长有关.     

Rotational delivery with Kielland's forceps

A retrospective study over 15 months showed that 10.7% of primigravid women and 1.6% of multigravid women were delivered by Kielland's forceps: a total of 145 babies. The successful vaginal delivery rate for attempted Kielland's forceps was 96.7%. The neonatal outcome was good and there were no perinatal deaths. Traumatic injuries were present in 7.6% of babies and were minor. The data show that even in the presence of fetal distress, Kielland's forceps can be safely employed for rotational delivery from the mid-pelvic cavity. This approach can avoid some caesarean sections without undue risk to the baby, the caesarean rate being 9.5%. As 10.7% of primigravid women required rotational delivery with Kielland's forceps, it is desirable that primigravid women should be cared for by obstetricians who are skilled in the use of the instrument, in order to maintain a low caesarean section rate in this group, with a good neonatal outcome.     

Changing trends in the management of eclampsia from a teaching hospital

Eclampsia is a major source of both maternal and perinatal mortality. In the management of eclampsia, the role of magnesium sulphate as anticonvulsant and early delivery are well established. The present study is an analysis of maternal and perinatal outcomes after the introduction of magnesium sulphate and liberalisation of caesarean section over a period from August 2002 to September 2004. The observations were compared with statistics from the same hospital from 1995-1997. The incidenceof eclampsia has remained relatively constant but postpartum cases of eclampsia have increased. The case fatality rate of eclampsia has fallen from 11.3% to 5.3%. The perinatal mortality has also fallen from 54.8% to 24.3%. The caesarean section rate for eclampsia has increased from near 10% to 49.7%. Both maternal mortality and perinatal mortality are lowest in the caesaean section group. But the improved perinatal salvage in caesarean section babies may partially reflect the tendency to avoid caesarean section in gross prematurity. The ideal anaesthesia for eclampsia remains unknown but the results with use of general anaesthesia in all cases with precautions produced favourable results.     

妊娠期糖尿病与妊娠结局的分析

目的 探讨妊娠期糖尿病对妊娠结局的影响。方法 回顾性分析2004年1月～2005年12月住院分娩的妊娠期糖尿病及健康孕妇各62例的妊娠结局。结果 妊娠期糖尿病组中病理妊娠、妊娠期高血压、羊水异常、胎膜早破、胎儿窘迫、早产儿、巨大儿、妊娠胆汁淤积症（ICP）、剖官产的发生率分别为85．48％、30．65％、14．52％、4．84％、12．90％、19．35％、17．74％、14．52％、98．39％。均明显高于对照组。分别为51．61％、6．45％、1．61％、0、3．23％、3．23％、4．84％、1．61％、51．61％。差异有统计学意义（P〈0.05）。结论 妊娠期糖尿病对母婴危害大。及早诊断和治疗妊娠期糖尿病，可减少母婴并发症，降低围产儿死亡率。     

Clinical Analysis of Placenta Previa Complicated with Previous Caesarean Section

Objective To investigate the clinical features and treatment of placenta previa complicated with previous caesarean section. Methods The clinical data of 29 patients with placenta previa complicated with a previous caesarean section (RCS group) admitted in Peking Union Medical College Hospital during a period from 2003 to 2011 were retrospectively reviewed and compared with those of 243 patients with placenta previa without a previous caesarean section (FCS group) during the same period. Results There was no difference in the mean age (28.9±3.6 vs. 28.1±4.5 years) and the average gravidity (2.35±1.48 vs. 2.21±1.53) between RCS group and FCS group (all P>0.05). The RCS group had more preterm births (24.1% vs. 13.2%), complete placenta previa (55.2% vs. 4.9%), placenta accreta (34.5% vs. 2.5%), more blood loss during caesarean section (1412±602 vs. 648±265 mL), blood transfusion (51.7% vs. 4.9%), disseminated intravascular coagulation (13.8% vs. 2.1%), and obstetric hysterectomy (13.8% vs. 0.8%) than the FCS group (all P<0.05). The preterm infant rate (30.0% vs. 13.0%), neonatal asphyxia rate (10.0% vs. 4.9%), and perinatal mortality rate (6.7% vs. 0.4%) of the RCS group were higher than those of the FCS group (all P<0.05). Conclusions More patients had complete placenta previa and placenta accreta, postpartum hemorrhage, transfusion, uterine packing, obstetric hysterectomy, and perinatal morbidity in the placenta previa patients with previous caesarean section. The patient should be informed of the risk and unnecessary first cesarean sections should be avoided.     

A study of caesarean section cases with special reference to maternal and neonatal outcome.

Two hundred cases of lower uterine segment caesarean section were studied in SSKM Hospital and IPGME&R, Calcutta (a referral hospital) during the period 1986-1987. All were unselected cases of which 192 were booked and 8 were unbooked. The maximum number of caesarean sections were done in the age group of 21-30 years ie, in 154 cases (77.00%). Of total number of cases 53.5% were primigravida, and rest were multipara. Postoperative complications were noted in 42 cases (21%). Complications were more in unbooked and emergency cases ie, 7 (87.5%) and also in cases of antepartum haemorrhage (3 out of 8 cases) and where foetal distress (12 out of 51 cases) ie, prolonged labour, difficult labour was present. Neonatal mortality and morbidity (8 and 26 out of 154 total births respectively) were high in the age group of 21-30 years. Neonatal complications following caesarean section were found in 21.8% patients in emergency caesarean section and 15.5% in elective caesarean section. Neonatal morbidity was 15% and perinatal mortality was 4% in this study. Asphyxia (11 cases) and respiratory distress syndrome (10 cases) were more dangerous complications in caesarean section. There was no maternal mortality in this series.     

新生儿窒息与产科高危因素的临床分析

目的探讨新生儿窒息的产科高危因素及防治措施,降低新生儿窒息的发生率,提高产科医疗质量。方法回顾性分析2001年1月至2005年5月在宣武医院分娩的6 568例新生儿中182例新生儿窒息的临床资料,探讨与新生儿窒息相关的产科因素,分析分娩方式的选择对新生儿窒息的影响。结果脐带因素、羊水异常、早产等是引起新生儿窒息的主要产科因素。自然分娩与剖宫产引起新生儿窒息的发生率差异无统计学意义,阴道助产引起新生儿窒息的发生率较前两者明显增加,差异有统计学意义(P<0.01)。结论加强围生期保健,加强产前及产时胎儿监护,早期发现与新生儿窒息有关的产科高危因素,并予以防治。把握分娩时机,恰当选择分娩方式,正确处理妊娠并发症与合并症。同时熟练掌握新生儿抢救复苏技术,可降低产科因素引起新生儿窒息及围生儿死亡的发生率。