摘要：目的：探讨晚期产后大出血的发生原因，提出防治措施。方法：对我院1992年1月至2000年1月收治的晚期产后大出血36例病例进行回顾性分析。结果：晚期产后出血的原因依次为胎盘残留、子宫复旧不全、切口裂开。结论：重视第三产程的处理，特别是对产时出血米索前列醇的应用，可有效预防大出血的发生。采用宫缩素及抗感染、清宫术等对症治疗可获得满意的治疗效果，对严重急性出血者可行子宫切除术。
Objective To evaluate the effect of music therapy for childbirth. Methods Such databases as The Cochrane Library, PubMed, EMbase, EBSCO host, SpringerLINK Online Journals, CBM and WanFang Data were searched from January of 2000 to December of 2010 to collect randomized controlled trials (RCTs) of music therapy for childbirth. The quality of RCTs was appraised and the data were extracted. Meta-analyses were conducted with RevMan5.02 software for the standarded RCTs. Results A total of nine RCTs were included. Five RCTs indicated the music therapy could alleviate the labor pain; five RCTs indicated the music therapy could reduce the event risk of cesarean section due to the failure of transvaginal trial labor; three RCTs indicated the music therapy could shorten the first stage of labor; two RCTs indicated the music therapy could stabilize the systolic pressure and heart rate when complete cervical dilation was done, and three RCTs indicated the music therapy could relieve anxiety. In addition, music therapy had no influence on neonate Apgar’s score; and the result of meta-analyses on postpartum hemorrhage was not reliable through sensitivity analyses. Conclusion The music therapy applied during childbirth can relieve the labor pain and anxiety, stabilize the heart rate and systolic pressure when complete cervical dilation is done, reduce the event risk of cesarean section due to the failure of transvaginal trial labor, shorten the first stage of labor, and is beneficial to the mind and body of parturient.
Objective To compare maternal and obstetrical outcomes of water birth and land birth. Methods We searched PubMed, EMbase, SCI, The Cochrane Library, Chinese Biomedical Literature Database, China Journal Full Text Database, Chinese Scientific Journals Full Text Database, conference proceedings, and references of the included studies to identify randomized controlled trials (RCTs) comparing water birth and land birth. The methodological quality was evaluated and the data was extracted by two reviewers independently using a designed extraction form. The Cochrane Collaboration’s RevMan 5.0 software was used to carry out meta-analyses. Results Eleven RCTs involving 3963 lying-in women were included. The results of meta-analysis showed that the rate of episiotomy (OR=0.09, 95%CI 0.01 to -0.59) and estimated blood loss (MD= -36.02, 95% -55.24 to -16.79) in the immersion group were significantly lower than those in the non-immersion group. There were no significant differences between the two groups on the other sides of the study. Conclusion Water birth can reduce the rate of episiotomy and estimated blood loss during the duration of labor. And there is no more risk of maternal and neonatal infection. More high-quality randomized controlled trials are required.
Objective To investigate and analyze the cognition of intraspinal labor analgesia (ILA) of women in labor and its influencing factors. Methods A total of 322 women in labor in West China Second University Hospital of Sichuan University between May and September 2015 were investigated by questionnaire, which included the general situation, the pregnancy status, the understanding for labor pain, and the cognition of ILA. Investigator introduced the knowledge of ILA to them after the investigation, and then they were re-investigated for the choice of ILA. Results Only 22.67% of these women in labor knowed ILA clearly, 53.42% heared it but did not understand, and 49.38% liked to use it. The proportion of women in labor who liked to use it increased to 81.89% after introduction, and the difference was significant (P<0.001). Among all factors, the acknowledgement level of ILA and the choice to use it were mainly related to the family awareness concept for labor pain. Conclusions The cognition of ILA of women in labor is not enough, and their using desire is not strong. The family awareness concept is one of the important factors. The education and advertise to the women in labor and their family members after admiting to labor room can increase the choice rate of ILA significantly.
OBJECTIVE: To search for the operation timing and methods for obstetrical brachial plexus injury (OBPI). METHODS: Thirty-two children with upper OBPI were treated by microsurgical procedure from October 1997 to April 2001. The average age of patients was 10 months, ranged from 3 months to 24 months; of them, 19 were below 6 months while 13 were over 6 months. Surgical procedure included neurolysis(n = 12), coaptation after resection of the neuroma without function (n = 7), phrenic nerve transfer to anterior cord of upper trunk or musculocutaneous nerve (n = 7) and intercostal nerves transfer to musculocutaneous nerve(n = 6). The children underwent operation with microsurgical technique and 7/0 or 9/0 nylon was used for nerve suture. RESULTS: Thirty cases were followed up for 21 months postoperatively; the excellent and good rate was 76.7% (23/30). The results of the children under 6 months were better than those over 6 months. CONCLUSION: The microsurgical operation might be considered at the age of 3-6 month infants who had shown little or no improvement in elbow flexion. Neurolysis and nerve coaptation are superior to neurotization. The appropriate procedure should be selected according to the findings of exploration.
至2002年4月,分娩期会阴保护的证据如下: ①合成的可吸收材料在分娩期外阴1、2度撕伤修补和外阴切开中的应用(可以减少疼痛时间):1个系统评价发现,使用合成的可吸收缝合线相对于普通肠线明显减少了分娩后10天内镇痛药的使用剂量.对于分娩期的疼痛和分娩3个月后的性交痛,合成的可吸收材料与普通肠线无显著差别.系统评价中的一个大规模RCT发现,合成的可吸收材料在分娩后12个月显著降低性交痛. ②皮下连续缝合材料在外阴1、2度撕伤修补和外阴切开中的应用(减少疼痛时间):1个系统评价发现,皮下连续缝合相对间断缝合明显减轻了分娩后10天以内的疼痛.③分娩期对病人持续的支持(减少助产器械的使用):1个系统评价发现,分娩期对产妇持续的支持(注释:分娩过程中有护士、助产士等专业人士陪伴,并提供咨询)明显减少了助产器械的使用及会阴切开,但不能防止分娩期损伤的发生.④各种方法和材料在3、4度撕伤修补中的应用: 我们没有找到评论外阴3、4度撕伤修补最好的材料和方法的RCT.⑤硬膜外麻醉(增加了助产的机率,从而增加了会阴损伤的机率):1个系统评价没有找到直接的证据来比较硬膜外麻醉和其他麻醉对会阴损伤的影响.但是,一些RCT发现,仅在第一产程使用硬膜外麻醉和在第一产程及二、三产程都使用硬膜外麻醉相比,后者的器械助产及会阴损伤风险显著升高.⑥不协助孕妇分娩和协助分娩的比较( 增加了孕妇疼痛,无证据显示会阴损伤风险及会阴切开机率减少):1个RCT发现,不协助孕妇分娩(不接触胎儿头部或者保护产妇会阴)与协助产妇分娩(分娩期在胎头上施压及保护产妇会阴)相比,显著增加了产后10天的疼痛但却减少了会阴切开的机率.但无证据显示前者增加了会阴损伤风险或3、4度外阴撕伤风险.⑦会阴正中切开(相比会阴侧切增加了3、4度会阴撕伤机率):无证据显示会阴正中切开能比会阴侧切减少会阴疼痛或者伤口裂开的机率.一项来自半随机试验的有限证据表明,会阴正中切开可能增加3、4度会阴撕伤的机率.⑧会阴2度撕伤及会阴切开后不缝合会阴肌肉: 1个小样本RCT发现,在皮肤烧灼感和痛觉上,缝合与不缝合肌肉在产后2～3天,愈合后2～3天或产后8周没有差别.⑨会阴1、2度撕伤和切开后不缝合会阴皮肤(减少了性交痛): 1个大样本RCT发现,不缝合皮肤与常规缝合相比,产后10天疼痛没有显著差异,但却显著减少了分娩3个月后的性交痛.⑩第二产程胎头被动下降: 1个RCT比较了胎头被动下降和主动推动胎头快速下降,结果发现二者对会阴损伤没有差别.(11)限制性的会阴切开 (减少了后壁的损伤): 1个系统评价发现,对有胎儿或母亲指征的产妇限制性使用会阴切开能显著减少会阴后壁的撕伤,但却增加了阴道前壁及阴唇的损伤风险.(12)持续性的屏气向下用力:1篇来自2个质量不高的临床对照试验的系统评价发现,第二产程向下用力时,屏气与不屏气对会阴撕伤的发生率及程度没有影响.1篇RCT比较胎头被动下降与屏气用力推动胎头下降,二者对会阴撕伤率也没有影响.(13)分娩期体位:1个系统评价比较了直立位、仰卧位和侧卧位,结果发现分娩期直立位显著降低了会阴切开机率,却明显增加了会阴2度撕伤的风险.(14)胎头吸引(相比产钳减少了会阴损伤,但增加了新生儿脑出血风险):1个系统评价发现,胎头吸引器与产钳相比,显著降低了会阴损伤机率,但增加了新生儿脑出血和视网膜出血的风险.