Intrapartum fetal monitoring has been criticized for the lack of evidence of improvement in fetal outcome despite causing increased operative intervention. Paradoxically, cardiotocography （CTG） has been a major driv...Intrapartum fetal monitoring has been criticized for the lack of evidence of improvement in fetal outcome despite causing increased operative intervention. Paradoxically, cardiotocography （CTG） has been a major driver for litigation for neonatal neurological injury. This analytical review tries to explore why extensive clinical studies and trials over 50 years have failed to demonstrate or bring about signifcant improvement in intrapartum fetal monitoring. There seems a need for significant reform. International congruence on most aspects of CTG interpretation [defnitions of fetal heart rate （FHR） parameters, CTG recording speed, 3-tier systems, etc .] is highly desirable to facilitate future meaningful clinical studies, evaluation and progress in this field. The FHR changes are non-specific and poor surrogate for fetal well-being. As a compromise for maintaining low false-negative results for fetal acidemia, a high false-positive value may have to be accepted. The need for redefning the place of adjuvant tests of fetal well-being like fetal blood sampling or fetal electrocardiography （ECG） is discussed. The FHR decelerations are often deterministic （center-stage） in CTG interpretation and 3-tier categorization. It is discussed if their scientifc and physiological classifcation （avoiding framing and confirmation biases） may be best based on time relationship to uterine contractions alone. This may provide a more sound foundation which could improve the reliability and further evolution of 3-tier systems. Results of several trials of fetal ECG （STAN） have been inconclusive and a need for a fresh approach or strategy is considered. It is hoped that the long anticipated Computer-aided analysis of CTG will be more objective and reliable （overcome human factors） and will offer valuable support or may eventually replace visual CTG interpretation. In any case, the recording and archiving all CTGs digitally and testing cord blood gases routinely in every delivery would be highly desirable for future research. This would facilitate well designed retrospective studies which can be very informative especially when prospective randomised controlled trials are often diffcult and resource-intensive.展开更多
Intrapartum maternal normoglycemia seems to play an important role in the prevention of adverse perinatal, maternal and neonatal outcomes. Several glucose monitoring protocols have been developed, aiming to achieve a ...Intrapartum maternal normoglycemia seems to play an important role in the prevention of adverse perinatal, maternal and neonatal outcomes. Several glucose monitoring protocols have been developed, aiming to achieve a tight glucose monitoring and control. Depending on the type of diabetes and the optimal or suboptimal glycemic control, the treatment options include fasting status of the parturient, frequent monitoring of capillary blood glucose, intravenous dextrose infusion and subcutaneous or intravenous use of insulin. Continuous glucose monitoring system(CGMS) is a relatively new technology that measures interstitial glucose at very short time intervals over a specifi c period of time. The resulting profi le provides a more comprehensive measure of glycemic excursions than intermittent home blood glucose monitoring. Results of studies applying the CGMS technology in patients with or without diabetes mellitus(DM) have revealed new insights in glucose metabolism. Moreover, CGMS have a potential role in the improvement of glycemic control during pregnancy and labor, which may lead to a decrease in perinatal morbidity and mortality. In conclusion, the use of CGMS, with its important technical advantages compared to the conventional way of monitoring, may lead into a more etiological intrapartum management of both the mother and her fetus/infant in pregnancies complicated with DM.展开更多
Approximately 303,000 women die annually while giving birth, worldwide, and more than 99% of the deaths occur in developing countries. In Zambia, a developing country situated in sub-Saharan Africa, most of the matern...Approximately 303,000 women die annually while giving birth, worldwide, and more than 99% of the deaths occur in developing countries. In Zambia, a developing country situated in sub-Saharan Africa, most of the maternal mortalities occur during the intrapartum and immediate postpartum periods, arising from postpartum hemorrhage, sepsis, obstructed labor, and hypertensive disorders. <span style="font-family:Verdana;">Aim:<span style="font-family:Verdana;"> The aim of this study was to assess the quality of intrapartum services provided in health facilities in the country. <span style="font-family:Verdana;">Methodology:<span style="font-family:Verdana;"> Guided by a descriptive <span style="font-family:Verdana;">cross sectional<span style="font-family:Verdana;"> design, data were collected from 264 women in labor using a World Health Organization validated observation checklist. Convenience sampling was used to recruit the women, while multistage sampling was used to select four health facilities. The Social Package for Social Sciences, version 23 was used to analyze the data. <span style="font-family:Verdana;">Results:<span style="font-family:Verdana;"> One health facility met the World Health Organization 80% minimum standard in four out of the five categories used to measure quality in intrapartum care, while the other three met the minimum standard in one category each. <span style="font-family:Verdana;">Conclusion:<span style="font-family:Verdana;"> Low numbers of midwives, inadequate supplies <span style="font-family:Verdana;">and<span style="font-family:Verdana;"> equipment were major obstacles to following national and international agreed standards for providing optimal care during <span style="font-family:Verdana;">intrapartum<span style="font-family:Verdana;"> period. <span style="font-family:Verdana;">Recommendations:<span style="font-family:Verdana;"> There is <span style="font-family:Verdana;">need<span style="font-family:Verdana;"> for local and national stakeholders in Zambia to urgently address the structural barriers that were observed, as well as invest in sufficient numbers of adequately trained and motivated midwives.展开更多
The anesthesia ex utero intrapartum treatment (EXIT) procedure is a specialized surgical procedure used to deliver babies who have airway compression due to cystic adenomatoid malformation, bronchopulmonary sequestrat...The anesthesia ex utero intrapartum treatment (EXIT) procedure is a specialized surgical procedure used to deliver babies who have airway compression due to cystic adenomatoid malformation, bronchopulmonary sequestration, cervical teratomas, or other congenital conditions. EXIT is erroneously known as a routine cesarean section (CS), but is rather an extension of CS with discernible differences. The procedure creates an opening in the anesthetized abdomen of the mother and uterus. Once EXIT is complete, the remainder of the CS proceeds. EXIT is much more complex than a routine CS, as it requires coordination between the mother and a multidisciplinary team of surgical and neonatal personnel. This review highlights current anesthetic concepts during the EXIT procedure.展开更多
Purpose: We propose that using remifentanil in ex utero intrapartum treatment (EXIT) procedures reduces the need for maternal exposure to general anesthesia. Using remifentanil along with spinal anesthesia eliminates ...Purpose: We propose that using remifentanil in ex utero intrapartum treatment (EXIT) procedures reduces the need for maternal exposure to general anesthesia. Using remifentanil along with spinal anesthesia eliminates the fetal and maternal risks associated with inhalational general anesthesia, allows the mother to be awake, and obviates the need for and costs associated with general anesthesia and a second anesthesia team. Materials and Methods: We performed a retrospective review of all sequential patients undergoing ex utero intrapartum treatment procedure at our hospital from 1/1/2009 to 11/1/2010. All procedures were performed under regional neuraxial analgesia, using nitroglycerine as a tocolytic agent and remifentanil for analgesia. Variables included indication, time to secured fetal airway, complications, estimated blood loss, need for additional anesthetics, participating personnel, and survival. Results: All five of our ex utero intrapartum treatment procedures were successfully completed with combined spinal epidural remifentanil anesthetic. No patient was required additional alternative anesthetic. There were no complications with mother or fetus. Indications for procedure were arthyrogryposis (n = 3), fetal goiter, and micrognathia. Average time to secured airway was 10.25 minutes. Average estimated blood loss was 1010 ml. All five mothers were conscious during their procedure. Conclusions: We report the largest series of ex utero intrapartum treatment procedures performed with remifentanil regional anesthesia. We found that the combined use of nitroglycerin and regional remifentanil anesthesia is a safe alternative to the pediatric otolaryngologist for performing ex utero intrapartum treatment procedures without the risks of general anesthesia, allowing the mother to be awake for the delivery, and reducing the cost of providing care.展开更多
Aim&objective The diagnosis of foetal distress in a clinical setting is based on foetal cardiotocography findings during labour.This study aims to analyse the total deceleration area(TDA)on intrapartum cardiotocog...Aim&objective The diagnosis of foetal distress in a clinical setting is based on foetal cardiotocography findings during labour.This study aims to analyse the total deceleration area(TDA)on intrapartum cardiotocogram which will predict neonatal acidemia at bith.Materials&methods The study participants included women in labour having intrapartum foetal distress(National Institute of Child Halth and Human Development criteria category II and persistent category II on cardiotocogram),who had the 30-min traces(prior to delivery/decision to delivery)and foetal umbilical cord blood gas analysis at delivery.The TDA was calculated and analysed against the cord blood pH obtained at delivery.The deceleration area is calculated as the width of the widest aspect of deceleration(below baseline)measured in minutes which is multiplied by the maximum depth below the baseline and divided by two.TDA is the summation of all the deceleration areas in the last 30 min before delivery.Results A total of 168 participants were analysed.There were 42 cases and 146 controls in the study.The mean TDA in the case and control group was 254.62 missed beats and 165 missed beats,respectively.It was observed that an intrapartum TDA of 2195 missed beats was associated with neonatal acidemia at birth and with an area under curve of 0.6576(95%CI 0.5305 to 0.7847)with a positive predictive value of 83.78%.Conclusion In this study,an intrapartum TDA of≥195 missed beats was significantly associated with neonatal acidemia at birth.The calculation of TDA has simplified intrapartum foetal monitoring.展开更多
INTRODUCTION The incidence of fetal cardiac tumor was about 0.14% as determined by fetal echocardiography. It was extremely difficult to deal with the fetus when the severe circulatory instability was induced by a car...INTRODUCTION The incidence of fetal cardiac tumor was about 0.14% as determined by fetal echocardiography. It was extremely difficult to deal with the fetus when the severe circulatory instability was induced by a cardiac tumor in the womb. It was reported that ex utero intrapartum treatment （EXIT） procedure solved the problems of fetal airway or pulmonary lesion during delivery to avoid hypoxia after birth. The goal of EXIT is to maintain placental circulation while steps are taken to optimize the transition of the baby from fetal to neonatal life. This study introduced the experience of EXIT procedure to solve the problems of fetal circulation induced by a fetal cardiac tumor.展开更多
Background To determine whether ex utero intrapartum treatment (EXIT) is an appropriate approach for managing fetuses antenatally diagnosed with giant congenital omphaloceles. Methods We retrospectively reviewed patie...Background To determine whether ex utero intrapartum treatment (EXIT) is an appropriate approach for managing fetuses antenatally diagnosed with giant congenital omphaloceles. Methods We retrospectively reviewed patients with omphaloceles who underwent either an EXIT procedure or a traditional repair surgery. Basic and clinical parameters including gender, gestational age, birth weight, maternal blood loss, operative times and operative complications were analyzed. During the 6–12-month follow-ups, postoperative complications including bowel obstruction, abdominal infections, postoperative abdominal distension were monitored, and survival rate was analyzed. Results A total of seven patients underwent the EXIT procedure and 11 patients underwent the traditional postnatal surgery. We found no differences in maternal age, gestational age at diagnosis, gestational age at delivery and birth weight between the two groups. In the EXIT group, the average operation time for mother was 68.3 ± 17.5 minutes and the average maternal blood loss was 233.0 ± 57.7 mL. The operation time in the EXIT group (22.0 ± 4.5 minutes) was shorter than that in the traditional group (35 ± 8.7 minutes), but the length of hospital stay in the EXIT group (20.5 ± 3.1 days) was longer than that in the traditional group (15.7 ± 2.5 days,P < 0.05). During the follow-up, one patient in the EXIT group had an intestinal obstruction, one developed abdominal compartment syndrome and one died in the traditional group. Conclusions In our experience, EXIT is a safe and effective procedure for the treatment of giant congenital omphaloceles. However, more experience is needed before this procedure can be widely recommended.展开更多
目的探讨产时超声管理妊娠期糖尿病产妇产程的应用价值。方法选择2022年1月1日—2023年12月31日在佛山市高明区人民医院妇产科分娩的妊娠期糖尿病初产妇共100例。患者签署知情同意书后,按照1∶1比例采用随机数字表法分为对照组和研究组...目的探讨产时超声管理妊娠期糖尿病产妇产程的应用价值。方法选择2022年1月1日—2023年12月31日在佛山市高明区人民医院妇产科分娩的妊娠期糖尿病初产妇共100例。患者签署知情同意书后,按照1∶1比例采用随机数字表法分为对照组和研究组各50例。对照组采用阴道指诊检查判断产程和分娩方式。研究组采用经腹联合会阴超声测量检查判断产程及分娩方式。收集两组初产妇血糖、血常规、分娩方式、产后24 h出血量以及切口情况,新生儿Apgar评分。结果研究组阴道分娩率高于对照组(88.0%vs 72.0%,P<0.05),而阴道检查次数(4.18±0.8 vs 6.82±0.8,P<0.05)少于对照组、不良事件发生率(4%vs 16%,P<0.05)低于对照组。相对于对照组,研究组血红蛋白水平较高(104.10±5.25 vs 100.30±4.78,P<0.05)、而白细胞计数(11.40±1.49 vs 12.04±1.66,P<0.05)以及中性粒细胞百分比较低(72.79±4.04 vs 75.01±5.53,P<0.05)。结论通过产时超声监测判断妊娠期糖尿病初产妇产程,能够降低阴道操作引起的感染等风险,提高阴道分娩率,有效降低产妇感染,提高产妇分娩满意度以及舒适度,改善母婴结局。展开更多
目的:探讨产时超声在改善第二产程异常产妇妊娠结局中的应用效果。方法:选取2023年1月—2024年9月江西省妇幼保健院产科收治的200例第二产程异常的产妇,根据信封编号后奇偶数法分为对照组、观察组,每组100例。对照组根据阴道指检情况决...目的:探讨产时超声在改善第二产程异常产妇妊娠结局中的应用效果。方法:选取2023年1月—2024年9月江西省妇幼保健院产科收治的200例第二产程异常的产妇,根据信封编号后奇偶数法分为对照组、观察组,每组100例。对照组根据阴道指检情况决定分娩方式,观察组根据阴道指检结合经腹及经会阴超声检查决定分娩方式。统计两组分娩方式、产时胎位不正情况,比较两组经阴道分娩产妇的产程、产程出血量、产后出血量、分娩相关并发症及新生儿情况。结果:观察组阴道分娩率高于对照组,产时胎位不正率低于对照组(P<0.05)。两组阴道分娩产妇第二产程、第三产程、总产程均短于对照组(P<0.05)。观察组阴道分娩产妇产程出血量、产后出血量少于对照组(P<0.05)。观察组分娩相关并发症发生率低于对照组(P<0.05);两组经阴道分娩新生儿体重、血气指标(pH值、氧分压、二氧化碳分压、乳酸)、出生后10 min Apgar评分比较,差异无统计学意义(P>0.05);观察组经阴道分娩新生儿出生后1、5 min Apgar评分高于对照组(P<0.05);观察组经阴道分娩新生儿不良结局发生率低于对照组(P<0.05)。结论:阴道指检联合产时超声可提高第二产程异常产妇阴道分娩成功率,辅助胎位判断,缩短产程,减少产后出血与分娩相关并发症风险,同时改善新生儿不良结局。展开更多
文摘Intrapartum fetal monitoring has been criticized for the lack of evidence of improvement in fetal outcome despite causing increased operative intervention. Paradoxically, cardiotocography （CTG） has been a major driver for litigation for neonatal neurological injury. This analytical review tries to explore why extensive clinical studies and trials over 50 years have failed to demonstrate or bring about signifcant improvement in intrapartum fetal monitoring. There seems a need for significant reform. International congruence on most aspects of CTG interpretation [defnitions of fetal heart rate （FHR） parameters, CTG recording speed, 3-tier systems, etc .] is highly desirable to facilitate future meaningful clinical studies, evaluation and progress in this field. The FHR changes are non-specific and poor surrogate for fetal well-being. As a compromise for maintaining low false-negative results for fetal acidemia, a high false-positive value may have to be accepted. The need for redefning the place of adjuvant tests of fetal well-being like fetal blood sampling or fetal electrocardiography （ECG） is discussed. The FHR decelerations are often deterministic （center-stage） in CTG interpretation and 3-tier categorization. It is discussed if their scientifc and physiological classifcation （avoiding framing and confirmation biases） may be best based on time relationship to uterine contractions alone. This may provide a more sound foundation which could improve the reliability and further evolution of 3-tier systems. Results of several trials of fetal ECG （STAN） have been inconclusive and a need for a fresh approach or strategy is considered. It is hoped that the long anticipated Computer-aided analysis of CTG will be more objective and reliable （overcome human factors） and will offer valuable support or may eventually replace visual CTG interpretation. In any case, the recording and archiving all CTGs digitally and testing cord blood gases routinely in every delivery would be highly desirable for future research. This would facilitate well designed retrospective studies which can be very informative especially when prospective randomised controlled trials are often diffcult and resource-intensive.
文摘Intrapartum maternal normoglycemia seems to play an important role in the prevention of adverse perinatal, maternal and neonatal outcomes. Several glucose monitoring protocols have been developed, aiming to achieve a tight glucose monitoring and control. Depending on the type of diabetes and the optimal or suboptimal glycemic control, the treatment options include fasting status of the parturient, frequent monitoring of capillary blood glucose, intravenous dextrose infusion and subcutaneous or intravenous use of insulin. Continuous glucose monitoring system(CGMS) is a relatively new technology that measures interstitial glucose at very short time intervals over a specifi c period of time. The resulting profi le provides a more comprehensive measure of glycemic excursions than intermittent home blood glucose monitoring. Results of studies applying the CGMS technology in patients with or without diabetes mellitus(DM) have revealed new insights in glucose metabolism. Moreover, CGMS have a potential role in the improvement of glycemic control during pregnancy and labor, which may lead to a decrease in perinatal morbidity and mortality. In conclusion, the use of CGMS, with its important technical advantages compared to the conventional way of monitoring, may lead into a more etiological intrapartum management of both the mother and her fetus/infant in pregnancies complicated with DM.
文摘Approximately 303,000 women die annually while giving birth, worldwide, and more than 99% of the deaths occur in developing countries. In Zambia, a developing country situated in sub-Saharan Africa, most of the maternal mortalities occur during the intrapartum and immediate postpartum periods, arising from postpartum hemorrhage, sepsis, obstructed labor, and hypertensive disorders. <span style="font-family:Verdana;">Aim:<span style="font-family:Verdana;"> The aim of this study was to assess the quality of intrapartum services provided in health facilities in the country. <span style="font-family:Verdana;">Methodology:<span style="font-family:Verdana;"> Guided by a descriptive <span style="font-family:Verdana;">cross sectional<span style="font-family:Verdana;"> design, data were collected from 264 women in labor using a World Health Organization validated observation checklist. Convenience sampling was used to recruit the women, while multistage sampling was used to select four health facilities. The Social Package for Social Sciences, version 23 was used to analyze the data. <span style="font-family:Verdana;">Results:<span style="font-family:Verdana;"> One health facility met the World Health Organization 80% minimum standard in four out of the five categories used to measure quality in intrapartum care, while the other three met the minimum standard in one category each. <span style="font-family:Verdana;">Conclusion:<span style="font-family:Verdana;"> Low numbers of midwives, inadequate supplies <span style="font-family:Verdana;">and<span style="font-family:Verdana;"> equipment were major obstacles to following national and international agreed standards for providing optimal care during <span style="font-family:Verdana;">intrapartum<span style="font-family:Verdana;"> period. <span style="font-family:Verdana;">Recommendations:<span style="font-family:Verdana;"> There is <span style="font-family:Verdana;">need<span style="font-family:Verdana;"> for local and national stakeholders in Zambia to urgently address the structural barriers that were observed, as well as invest in sufficient numbers of adequately trained and motivated midwives.
文摘The anesthesia ex utero intrapartum treatment (EXIT) procedure is a specialized surgical procedure used to deliver babies who have airway compression due to cystic adenomatoid malformation, bronchopulmonary sequestration, cervical teratomas, or other congenital conditions. EXIT is erroneously known as a routine cesarean section (CS), but is rather an extension of CS with discernible differences. The procedure creates an opening in the anesthetized abdomen of the mother and uterus. Once EXIT is complete, the remainder of the CS proceeds. EXIT is much more complex than a routine CS, as it requires coordination between the mother and a multidisciplinary team of surgical and neonatal personnel. This review highlights current anesthetic concepts during the EXIT procedure.
文摘Purpose: We propose that using remifentanil in ex utero intrapartum treatment (EXIT) procedures reduces the need for maternal exposure to general anesthesia. Using remifentanil along with spinal anesthesia eliminates the fetal and maternal risks associated with inhalational general anesthesia, allows the mother to be awake, and obviates the need for and costs associated with general anesthesia and a second anesthesia team. Materials and Methods: We performed a retrospective review of all sequential patients undergoing ex utero intrapartum treatment procedure at our hospital from 1/1/2009 to 11/1/2010. All procedures were performed under regional neuraxial analgesia, using nitroglycerine as a tocolytic agent and remifentanil for analgesia. Variables included indication, time to secured fetal airway, complications, estimated blood loss, need for additional anesthetics, participating personnel, and survival. Results: All five of our ex utero intrapartum treatment procedures were successfully completed with combined spinal epidural remifentanil anesthetic. No patient was required additional alternative anesthetic. There were no complications with mother or fetus. Indications for procedure were arthyrogryposis (n = 3), fetal goiter, and micrognathia. Average time to secured airway was 10.25 minutes. Average estimated blood loss was 1010 ml. All five mothers were conscious during their procedure. Conclusions: We report the largest series of ex utero intrapartum treatment procedures performed with remifentanil regional anesthesia. We found that the combined use of nitroglycerin and regional remifentanil anesthesia is a safe alternative to the pediatric otolaryngologist for performing ex utero intrapartum treatment procedures without the risks of general anesthesia, allowing the mother to be awake for the delivery, and reducing the cost of providing care.
文摘Aim&objective The diagnosis of foetal distress in a clinical setting is based on foetal cardiotocography findings during labour.This study aims to analyse the total deceleration area(TDA)on intrapartum cardiotocogram which will predict neonatal acidemia at bith.Materials&methods The study participants included women in labour having intrapartum foetal distress(National Institute of Child Halth and Human Development criteria category II and persistent category II on cardiotocogram),who had the 30-min traces(prior to delivery/decision to delivery)and foetal umbilical cord blood gas analysis at delivery.The TDA was calculated and analysed against the cord blood pH obtained at delivery.The deceleration area is calculated as the width of the widest aspect of deceleration(below baseline)measured in minutes which is multiplied by the maximum depth below the baseline and divided by two.TDA is the summation of all the deceleration areas in the last 30 min before delivery.Results A total of 168 participants were analysed.There were 42 cases and 146 controls in the study.The mean TDA in the case and control group was 254.62 missed beats and 165 missed beats,respectively.It was observed that an intrapartum TDA of 2195 missed beats was associated with neonatal acidemia at birth and with an area under curve of 0.6576(95%CI 0.5305 to 0.7847)with a positive predictive value of 83.78%.Conclusion In this study,an intrapartum TDA of≥195 missed beats was significantly associated with neonatal acidemia at birth.The calculation of TDA has simplified intrapartum foetal monitoring.
文摘INTRODUCTION The incidence of fetal cardiac tumor was about 0.14% as determined by fetal echocardiography. It was extremely difficult to deal with the fetus when the severe circulatory instability was induced by a cardiac tumor in the womb. It was reported that ex utero intrapartum treatment （EXIT） procedure solved the problems of fetal airway or pulmonary lesion during delivery to avoid hypoxia after birth. The goal of EXIT is to maintain placental circulation while steps are taken to optimize the transition of the baby from fetal to neonatal life. This study introduced the experience of EXIT procedure to solve the problems of fetal circulation induced by a fetal cardiac tumor.
基金supported by Grants from the National Natural Science Foundation of China(Nos.81270441,81401240)
文摘Background To determine whether ex utero intrapartum treatment (EXIT) is an appropriate approach for managing fetuses antenatally diagnosed with giant congenital omphaloceles. Methods We retrospectively reviewed patients with omphaloceles who underwent either an EXIT procedure or a traditional repair surgery. Basic and clinical parameters including gender, gestational age, birth weight, maternal blood loss, operative times and operative complications were analyzed. During the 6–12-month follow-ups, postoperative complications including bowel obstruction, abdominal infections, postoperative abdominal distension were monitored, and survival rate was analyzed. Results A total of seven patients underwent the EXIT procedure and 11 patients underwent the traditional postnatal surgery. We found no differences in maternal age, gestational age at diagnosis, gestational age at delivery and birth weight between the two groups. In the EXIT group, the average operation time for mother was 68.3 ± 17.5 minutes and the average maternal blood loss was 233.0 ± 57.7 mL. The operation time in the EXIT group (22.0 ± 4.5 minutes) was shorter than that in the traditional group (35 ± 8.7 minutes), but the length of hospital stay in the EXIT group (20.5 ± 3.1 days) was longer than that in the traditional group (15.7 ± 2.5 days,P < 0.05). During the follow-up, one patient in the EXIT group had an intestinal obstruction, one developed abdominal compartment syndrome and one died in the traditional group. Conclusions In our experience, EXIT is a safe and effective procedure for the treatment of giant congenital omphaloceles. However, more experience is needed before this procedure can be widely recommended.
文摘目的探讨产时超声管理妊娠期糖尿病产妇产程的应用价值。方法选择2022年1月1日—2023年12月31日在佛山市高明区人民医院妇产科分娩的妊娠期糖尿病初产妇共100例。患者签署知情同意书后,按照1∶1比例采用随机数字表法分为对照组和研究组各50例。对照组采用阴道指诊检查判断产程和分娩方式。研究组采用经腹联合会阴超声测量检查判断产程及分娩方式。收集两组初产妇血糖、血常规、分娩方式、产后24 h出血量以及切口情况,新生儿Apgar评分。结果研究组阴道分娩率高于对照组(88.0%vs 72.0%,P<0.05),而阴道检查次数(4.18±0.8 vs 6.82±0.8,P<0.05)少于对照组、不良事件发生率(4%vs 16%,P<0.05)低于对照组。相对于对照组,研究组血红蛋白水平较高(104.10±5.25 vs 100.30±4.78,P<0.05)、而白细胞计数(11.40±1.49 vs 12.04±1.66,P<0.05)以及中性粒细胞百分比较低(72.79±4.04 vs 75.01±5.53,P<0.05)。结论通过产时超声监测判断妊娠期糖尿病初产妇产程,能够降低阴道操作引起的感染等风险,提高阴道分娩率,有效降低产妇感染,提高产妇分娩满意度以及舒适度,改善母婴结局。
文摘目的:探讨产时超声在改善第二产程异常产妇妊娠结局中的应用效果。方法:选取2023年1月—2024年9月江西省妇幼保健院产科收治的200例第二产程异常的产妇,根据信封编号后奇偶数法分为对照组、观察组,每组100例。对照组根据阴道指检情况决定分娩方式,观察组根据阴道指检结合经腹及经会阴超声检查决定分娩方式。统计两组分娩方式、产时胎位不正情况,比较两组经阴道分娩产妇的产程、产程出血量、产后出血量、分娩相关并发症及新生儿情况。结果:观察组阴道分娩率高于对照组,产时胎位不正率低于对照组(P<0.05)。两组阴道分娩产妇第二产程、第三产程、总产程均短于对照组(P<0.05)。观察组阴道分娩产妇产程出血量、产后出血量少于对照组(P<0.05)。观察组分娩相关并发症发生率低于对照组(P<0.05);两组经阴道分娩新生儿体重、血气指标(pH值、氧分压、二氧化碳分压、乳酸)、出生后10 min Apgar评分比较,差异无统计学意义(P>0.05);观察组经阴道分娩新生儿出生后1、5 min Apgar评分高于对照组(P<0.05);观察组经阴道分娩新生儿不良结局发生率低于对照组(P<0.05)。结论:阴道指检联合产时超声可提高第二产程异常产妇阴道分娩成功率,辅助胎位判断,缩短产程,减少产后出血与分娩相关并发症风险,同时改善新生儿不良结局。
