Objectives:This study aimed to explore the perceptions and recommendations of multiparas and health-related professionals regarding appropriate birth intervals(Bis)and key determinants.Methods:In-depth semi-structured...Objectives:This study aimed to explore the perceptions and recommendations of multiparas and health-related professionals regarding appropriate birth intervals(Bis)and key determinants.Methods:In-depth semi-structured interviews were conducted between April 1 and June 30,2022.Nine multiparas and thirteen health-related professionals were purposefully sampled until data saturation was reached.A thematic analysis approach was applied to the interview transcripts,utilizing dual independent coding and consensus validation in NVivo 12.0.Results:The data generated two overarching categories:1)balanced decision-making on the appropriate birth intervals and 2)internal and external determinants integrated with health and societal considerations.Four key themes emerged following the two categories:1)consistency and discrepancy between the actual and recommended birth intervals of multiparas;2)health-and developmentoriented professional recommendations;3)internal determinants related to individual-level factors;and 4)external determinants related to child-related factors,family support,and social security.Weighing women's reproductive health and career development,multiparas and health-related professionals perceived a length between 18 and 36 months as the appropriate Bl.Conclusion:Multiparas and health-related professionals shaped their balanced recommendations on a relatively appropriate birth interval ranging from 18 to 36 months,which was influenced by women's individual-level factors,child-related factors,family support,and social security.Targeted social and healthcare services should be offered to women and their families during the Bls.展开更多
Introduction: Grand multiparity is a known risk factor for maternal and fetal complications. Materials and Methods: We carried out a cross-sectional descriptive study on the delivery of grand multiparas at the materni...Introduction: Grand multiparity is a known risk factor for maternal and fetal complications. Materials and Methods: We carried out a cross-sectional descriptive study on the delivery of grand multiparas at the maternity of the regional hospital annex of Ayos, a semi-rural locality in the Center region of Cameroon. The study covered the period from January 2012 through December 2020, and the objective was to assess the frequency, the determinants and the outcome of delivery in grand multiparas. Results: We recorded 1384 deliveries and enrolled 137 cases of delivery of grand multiparas. This gives a frequency of grand multipara delivery of 9.89%. The mean age of the women was 34.96 ± 4.45 years. Married parturients accounted for 65% of the cases and 16.8% were HIV positive. Delivery occurred at term in 89.9%. In 35.8%, no antenatal consultation was done. The use of the partograph during labor was reported in 11.7%. Per vaginal delivery was noted in 88.3%, emergency cesarean in 10.2% and elective cesarean in 1.5%. The most frequent maternal complications included post-partum hemorrhage (19.9%), genital tract tears (12.4%), endometritis (9.5%) and surgical wound infection (8.7%). No maternal death was recorded. The mean birth weight of the newborns was 3336.8 ± 550 g. Fetal complications were mostly represented by neonatal infection (20.1%), perinatal death (7.9%) and neonatal asphyxia (9.5%). Conclusion: The frequency of grand multiparous delivery in the semi-rural locality of Ayos, Cameroon, was 9.89%. The mean age of parturients was 38.96 years and the proportion of vaginal delivery was 88.3%.展开更多
目的探讨不同程度小于胎龄儿(small for gestational age,SGA)发生的影响因素,为早期识别重度SGA的发生提供依据。方法回顾性收集2018年1月—2022年12月北京大学人民医院产科出生的新生儿及其母亲围产期资料。新生儿分为重度SGA组(出生...目的探讨不同程度小于胎龄儿(small for gestational age,SGA)发生的影响因素,为早期识别重度SGA的发生提供依据。方法回顾性收集2018年1月—2022年12月北京大学人民医院产科出生的新生儿及其母亲围产期资料。新生儿分为重度SGA组(出生体重低于同胎龄同性别婴儿的第3百分位数)、轻度SGA组(出生体重≥第3百分位数且<第10百分位数)和非SGA组(出生体重≥第10百分位数)。采用有序多分类logistic回归模型分析不同程度SGA发生的影响因素。结果共纳入14821例新生儿,其中重度SGA组258例(1.74%),轻度SGA组902例(6.09%),非SGA组13661例(92.17%)。早产儿比例和死产比例均为重度SGA组>轻度SGA组>非SGA组(P<0.0125);重度SGA组与轻度SGA组新生儿窒息比例均大于非SGA组(P<0.0125)。有序多分类logistic回归分析显示:母孕前消瘦(OR=1.838)、母孕前肥胖(OR=3.024)、体外受精-胚胎移植(OR=2.649)、妊娠合并子痫前期(OR=1.743)、妊娠合并结缔组织病(OR=1.795)、脐带绕颈(OR=1.213)、羊水少(OR=1.848)、宫内生长受限(OR=27.691)等均与发生更严重的SGA有关(P<0.05);孕母为经产妇(OR=0.457)更倾向于不发生严重的SGA(P<0.05)。结论母孕前消瘦、母孕前肥胖、体外受精-胚胎移植、妊娠合并子痫前期、妊娠合并结缔组织病、羊水少、脐带绕颈、宫内生长受限与更严重的SGA发生密切相关;孕母为经产妇是发生严重SGA的保护因素。展开更多
背景自“全面二孩”政策实施后,经产妇为主要分娩人群,高龄、慢性合并症、产科并发症、剖宫产术后再次妊娠等问题日渐突出,给产科工作者带来新的挑战。目的基于修正版Robson分类系统对新生育政策下经产妇的剖宫产现状进行分析,为合理控...背景自“全面二孩”政策实施后,经产妇为主要分娩人群,高龄、慢性合并症、产科并发症、剖宫产术后再次妊娠等问题日渐突出,给产科工作者带来新的挑战。目的基于修正版Robson分类系统对新生育政策下经产妇的剖宫产现状进行分析,为合理控制剖宫产率、提高产科医疗质量提供数据支持。方法纳入2017—2020年在南方医科大学第十附属医院剖宫产分娩的产妇共19170例,分为初产妇组(n=5630)和经产妇组(n=13540)。通过电子病历系统收集产妇信息,包括年龄、孕产次、既往分娩情况、胎方位、妊娠合并症及并发症、产妇结局及新生儿结局等,并对两组产妇的一般资料、产妇结局及新生儿结局进行比较。采用修正版Robson分类系统,根据产科特征(产次、胎位、胎儿数量、分娩孕周)对产妇进行分类,对比两组在修正版Robson分类系统中的分布及各组占比随年度变化情况。结果经产妇中剖宫产后再次妊娠的比例高达81.4%(11026/13540);经产妇组的年龄、孕次、产次及年龄≥35岁、妊娠合并糖尿病比例均高于初产妇组(P<0.05)。修正版Robson分类在所有剖宫产产妇中,以R3类(妊娠≥37周单胎头位,至少有1次剖宫产史)为主(50.4%,9668/19170),其次为R1类(妊娠≥37周单胎头位初产,自然临产、诱导临产或临产前剖宫产)(20.8%,3993/19170);经产妇中,R3类的占比最高达71.4%(9668/13540)。分析经产妇人群特征发现,2017—2020年,占比最高的R3类产妇从73.5%下降至67.1%,而R2类[妊娠≥37周单胎头位经产(无剖宫产史),自然临产、诱导临产或临产前剖宫产]、R8类[所有妊娠<37周单胎头位(包括有剖宫产史)]的占比均有所升高。经产妇组产后24 h出血量、输血比例高于初产妇组,而术后住院天数低于初产妇组(P<0.05)。19170例产妇共分娩新生儿20026名例,其中初产妇分娩6077例,经产妇分娩13949例;经产妇组新生儿出生体质量、1 min Apgar评分高于初产妇组新生儿,而1 min Apgar评分≤7分、转新生儿科比例低于初产妇组新生儿(P<0.05);两组产妇剖宫产新生儿5 min Apgar评分比较,差异无统计学意义(P>0.05)。结论高龄和剖宫产术后再次妊娠是经产妇的突出特征。R3类的占比虽然逐年下降,但仍是剖宫产经产妇的主要人群,为降低剖宫产率,需有效控制初次分娩剖宫产,并在安全的前提下积极推广R3类产妇经阴道试产。同时,经产妇中R2类和R8类的占比有所升高,对产科临床实践提出了新的要求。展开更多
基金supported by the Key Discipline Program of the Fifth Round of the Three-Year Public Health Action Plan(2020-2022 Year)of Shanghai,China(GWV-10.1-XK08).
文摘Objectives:This study aimed to explore the perceptions and recommendations of multiparas and health-related professionals regarding appropriate birth intervals(Bis)and key determinants.Methods:In-depth semi-structured interviews were conducted between April 1 and June 30,2022.Nine multiparas and thirteen health-related professionals were purposefully sampled until data saturation was reached.A thematic analysis approach was applied to the interview transcripts,utilizing dual independent coding and consensus validation in NVivo 12.0.Results:The data generated two overarching categories:1)balanced decision-making on the appropriate birth intervals and 2)internal and external determinants integrated with health and societal considerations.Four key themes emerged following the two categories:1)consistency and discrepancy between the actual and recommended birth intervals of multiparas;2)health-and developmentoriented professional recommendations;3)internal determinants related to individual-level factors;and 4)external determinants related to child-related factors,family support,and social security.Weighing women's reproductive health and career development,multiparas and health-related professionals perceived a length between 18 and 36 months as the appropriate Bl.Conclusion:Multiparas and health-related professionals shaped their balanced recommendations on a relatively appropriate birth interval ranging from 18 to 36 months,which was influenced by women's individual-level factors,child-related factors,family support,and social security.Targeted social and healthcare services should be offered to women and their families during the Bls.
文摘Introduction: Grand multiparity is a known risk factor for maternal and fetal complications. Materials and Methods: We carried out a cross-sectional descriptive study on the delivery of grand multiparas at the maternity of the regional hospital annex of Ayos, a semi-rural locality in the Center region of Cameroon. The study covered the period from January 2012 through December 2020, and the objective was to assess the frequency, the determinants and the outcome of delivery in grand multiparas. Results: We recorded 1384 deliveries and enrolled 137 cases of delivery of grand multiparas. This gives a frequency of grand multipara delivery of 9.89%. The mean age of the women was 34.96 ± 4.45 years. Married parturients accounted for 65% of the cases and 16.8% were HIV positive. Delivery occurred at term in 89.9%. In 35.8%, no antenatal consultation was done. The use of the partograph during labor was reported in 11.7%. Per vaginal delivery was noted in 88.3%, emergency cesarean in 10.2% and elective cesarean in 1.5%. The most frequent maternal complications included post-partum hemorrhage (19.9%), genital tract tears (12.4%), endometritis (9.5%) and surgical wound infection (8.7%). No maternal death was recorded. The mean birth weight of the newborns was 3336.8 ± 550 g. Fetal complications were mostly represented by neonatal infection (20.1%), perinatal death (7.9%) and neonatal asphyxia (9.5%). Conclusion: The frequency of grand multiparous delivery in the semi-rural locality of Ayos, Cameroon, was 9.89%. The mean age of parturients was 38.96 years and the proportion of vaginal delivery was 88.3%.
文摘目的探讨高龄妊娠期糖尿病(GDM)产妇糖耐量的特点及其与妊娠结局的关系。方法选择2020年1月1日—2024年12月31日在广州市第一人民医院规律产检并分娩的高龄产妇727例,包括高龄初产妇226例(GDM 78例)和高龄经产妇501例(GDM 131例),按照75 g OGTT血糖异常项数进行分组:一项血糖异常产妇为GDM I组(高龄初产妇38例,高龄经产妇68例);两项血糖异常产妇为GDMⅡ组(高龄初产妇26例,高龄经产妇51例);三项血糖异常产妇为GDMⅢ组(高龄初产妇14例,高龄经产妇12例);75 g OGTT正常高龄产妇为对照组。收集研究对象一般资料、75g OGTT血糖及相关妊娠结局进行分析比较。结果高龄初产妇GDM发生率(34.51%)较高龄经产妇GDM发生率(26.15%)高,差异具有统计学意义(P=0.021);高龄初产妇GDMⅢ型宫内感染(28.57%)、产后出血(14.29%)发生率最高,差异具有统计学意义(P=0.037、0.039);高龄初产妇GDM I型早产(23.68%)发生率最高,差异具有统计学意义(P=0.013)。高龄初产妇及经产妇GDMⅡ型的羊水过多、甲状腺功能减退、宫内感染、早产发生率均呈上升趋势。结论高龄妊娠糖尿病产妇随OGTT血糖异常项增多出现不良妊娠结局风险升高,其中高龄初产妇的早产、宫内感染及产后出血的发生率更高,因此,针对高龄初产妇,应更加注重孕期血糖及健康管理,以减少不良妊娠结局的发生。
文摘目的探讨不同程度小于胎龄儿(small for gestational age,SGA)发生的影响因素,为早期识别重度SGA的发生提供依据。方法回顾性收集2018年1月—2022年12月北京大学人民医院产科出生的新生儿及其母亲围产期资料。新生儿分为重度SGA组(出生体重低于同胎龄同性别婴儿的第3百分位数)、轻度SGA组(出生体重≥第3百分位数且<第10百分位数)和非SGA组(出生体重≥第10百分位数)。采用有序多分类logistic回归模型分析不同程度SGA发生的影响因素。结果共纳入14821例新生儿,其中重度SGA组258例(1.74%),轻度SGA组902例(6.09%),非SGA组13661例(92.17%)。早产儿比例和死产比例均为重度SGA组>轻度SGA组>非SGA组(P<0.0125);重度SGA组与轻度SGA组新生儿窒息比例均大于非SGA组(P<0.0125)。有序多分类logistic回归分析显示:母孕前消瘦(OR=1.838)、母孕前肥胖(OR=3.024)、体外受精-胚胎移植(OR=2.649)、妊娠合并子痫前期(OR=1.743)、妊娠合并结缔组织病(OR=1.795)、脐带绕颈(OR=1.213)、羊水少(OR=1.848)、宫内生长受限(OR=27.691)等均与发生更严重的SGA有关(P<0.05);孕母为经产妇(OR=0.457)更倾向于不发生严重的SGA(P<0.05)。结论母孕前消瘦、母孕前肥胖、体外受精-胚胎移植、妊娠合并子痫前期、妊娠合并结缔组织病、羊水少、脐带绕颈、宫内生长受限与更严重的SGA发生密切相关;孕母为经产妇是发生严重SGA的保护因素。
文摘背景自“全面二孩”政策实施后,经产妇为主要分娩人群,高龄、慢性合并症、产科并发症、剖宫产术后再次妊娠等问题日渐突出,给产科工作者带来新的挑战。目的基于修正版Robson分类系统对新生育政策下经产妇的剖宫产现状进行分析,为合理控制剖宫产率、提高产科医疗质量提供数据支持。方法纳入2017—2020年在南方医科大学第十附属医院剖宫产分娩的产妇共19170例,分为初产妇组(n=5630)和经产妇组(n=13540)。通过电子病历系统收集产妇信息,包括年龄、孕产次、既往分娩情况、胎方位、妊娠合并症及并发症、产妇结局及新生儿结局等,并对两组产妇的一般资料、产妇结局及新生儿结局进行比较。采用修正版Robson分类系统,根据产科特征(产次、胎位、胎儿数量、分娩孕周)对产妇进行分类,对比两组在修正版Robson分类系统中的分布及各组占比随年度变化情况。结果经产妇中剖宫产后再次妊娠的比例高达81.4%(11026/13540);经产妇组的年龄、孕次、产次及年龄≥35岁、妊娠合并糖尿病比例均高于初产妇组(P<0.05)。修正版Robson分类在所有剖宫产产妇中,以R3类(妊娠≥37周单胎头位,至少有1次剖宫产史)为主(50.4%,9668/19170),其次为R1类(妊娠≥37周单胎头位初产,自然临产、诱导临产或临产前剖宫产)(20.8%,3993/19170);经产妇中,R3类的占比最高达71.4%(9668/13540)。分析经产妇人群特征发现,2017—2020年,占比最高的R3类产妇从73.5%下降至67.1%,而R2类[妊娠≥37周单胎头位经产(无剖宫产史),自然临产、诱导临产或临产前剖宫产]、R8类[所有妊娠<37周单胎头位(包括有剖宫产史)]的占比均有所升高。经产妇组产后24 h出血量、输血比例高于初产妇组,而术后住院天数低于初产妇组(P<0.05)。19170例产妇共分娩新生儿20026名例,其中初产妇分娩6077例,经产妇分娩13949例;经产妇组新生儿出生体质量、1 min Apgar评分高于初产妇组新生儿,而1 min Apgar评分≤7分、转新生儿科比例低于初产妇组新生儿(P<0.05);两组产妇剖宫产新生儿5 min Apgar评分比较,差异无统计学意义(P>0.05)。结论高龄和剖宫产术后再次妊娠是经产妇的突出特征。R3类的占比虽然逐年下降,但仍是剖宫产经产妇的主要人群,为降低剖宫产率,需有效控制初次分娩剖宫产,并在安全的前提下积极推广R3类产妇经阴道试产。同时,经产妇中R2类和R8类的占比有所升高,对产科临床实践提出了新的要求。
