Objective To explore the effect of different pre-labor position for premature rupture of membrane (PROM) after 37 weeks with vertex and engaged presentation on the maternal and neonatal outcomes. Methods A total of 120 women over 37 weeks PROM with single fetus in vertex presentation and engaged head were randomly allocated into two groups. The trial group (60 women) received no limit of movement after hospitalization and before labor while the control group (60 women) adapted lateral and supine position alternatively with hip-up. Labor process and neonatal outcomes were observed and recorded. SPSS 13.0 software was adopted to analyze the data. Results Compared with the control group, the trial group had higher rate of normal birth (70% vs. 46.7%, χ2=6.72, P=0.01), shorter first and second stage of labor (t=2.11, P=0.039; t=2.75, P=0.007), fewer incidence of dysuria during labor (χ2=8.11, P=0.0041), and less amount of amniotic fluid (107±55 mL vs. 248±42 mL, t=4.188, P=0.000 1). Conclusion For PROM over 37 weeks pregnancy with single vertex presentation and engaged head, no limit on the position before labor is safe and feasible, and it can improvie spontaneous delivery rate, shorten labor process, decrease amount of amniotic fluid, and eliminate the incidence of dysuria. It is worth to be popularized in the clinic.
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 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.
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 study the special traits of primiparae’s compliance with labor analgesia, so as to offer individualized analgesia solutions during spontaneous labor. Methods The uniparous primiparae with cephalic presentation between gestational weeks 38 and 40 were divided into two groups based on their educational background (college education or above, and high school education or below), each group with 20 cases. The demographical statistics of the two groups including their State-Trait Anxiety Inventory (STAI) grading, PCA results, and delivery situation were recorded and analyzed. Results Differences in age, height, and weight were not statisticallysignificant (Pgt;0.05); differences in T-AI were not statistically significant (Pgt;0.05); differences in S-AI were statistically significant (Plt;0.05); differences in anxiety and numbers of adding anesthetics were not statistically significant (Pgt;0.05); differences in failure to tolerate labor pains and requiring caesarean section were statistically significant (Plt;0.05). Conclusion Primiparae with higher educational degree tend to have higher S-AI grading and perform poorly in compliance with labor analgesia.
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 assess the effectiveness and safety of local versus systemic application of opioids for labor analgesia. Methods We searched PubMed (1966 to January 2008), EMBASE (1980 to January 2008), The Cochrane Library (Issue 1, 2008), CBM (1978 to January 2008), CNKI (1979 to January 2008) for randomized controlled trials (RCTs) involving local versus systemic application of opioids for labor analgesia. Quality assessment and data extraction were conducted by two reviewers independently. Meta-analyses were conducted with The Cochrane Collaboration’s RevMan 4.2.10 software. Results A total of 12 trials involving 5909 participants met the inclusion criteria. Meta-analyses showed that local application of opioids was superior to systemic application in terms of maternal satisfaction with pain relief during labor (RR 1.63, 95% CI 1.27 to 2.09). No significant difference was found between the two groups in the incidence of low neonatal Apgar score at 5 minutes (RR 0.63, 95% CI 0.40 to 1.01). Conclusion Local application of opioids for labor analgesia appears to be more effective than systematic use in reducing pain during labor. But as for safety concerns, maternal and neonatal adverse effects are observed in both groups. Thus, more high-quality and large-scale RCTs are needed.
Objective To assess the effects on labour, maternal, and neonatal outcomes of different techniques and drugs for analgesia during labour. Methods We searched The Cochrane Library (Issue 4, 2006) , MEDLINE (Jan. 1978 to Oct. 2006) and CBMdisc (Jan. 1980 to Oct. 2006) to collect the current best evidence of labor analgesia. Results We included eight Cochrane systematic reviews and six other meta-analyses. The evidence showed that epidural analgesia was associated with a longer second stage of labour, more frequent oxytocin augmentation, higher incidence of instrumental vaginal delivery and maternal fever. But it was unlikely to increase the risk of caesarean section. Conclusion Epidural analgesia is superior to other approaches.
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.