剖宫产率上升的原因及对策

近年来,剖宫产率日益上升,严重影响母婴利益,作为教学医院,也影响产科的临床教学质量.为提高产科质量,确保母婴安全,我们通过回顾性分析发现,胎儿窘迫,胎位异常,巨大儿,社会因素是剖宫产率上升的主要原因.相应对策可以通过加强孕产期宣教,实行镇痛分娩,建立待产、分娩、恢复及产后为一体(labor-delivery-recovery,LDR)分娩模式,提高医护人员助产技术水平,健全法制建设等措施,旨在降低剖宫产率.     

剖宫产率上升探析

剖宫产作为产科分娩的干预手段,既可以挽救孕妇和胎儿的生命,又会对孕妇和胎儿带来某些预料不到的危险。近年来,许多国家的剖宫产率随着剖宫产术的推广不断上升,引起了社会各界的广泛关注。本文概述了国内外剖宫产率变化的主要特征,综述了导致剖宫产率上升的主要因素及社会各界对剖宫产率上升的不同看法。     

剖宫产率上升探析

剖宫产作为产科分娩的干预手段,既可以挽救孕妇和胎儿的生命,又会对孕妇和胎儿带来某些预料不到的危险.近年来,许多国家的剖宫产率随着剖宫产术的推广不断上升,引起了社会各界的广泛关注.本文概述了国内外剖官产率变化的主要特征,综述了导致剖宫产率上升的主要因素及社会各界对剖宫产率上升的不同看法.     

从高危妊娠救治现状探讨三级综合医院产科发展模式

产科一直以来被大家公认为高危科室,三级综合医院产科收治的疑难危重孕产妇更多。自全面两孩政策实施以来,全国孕产妇死亡率出现升高趋势,比去年同期增长30.6%,母婴安全保障形势十分严峻。随着分娩人数的增加,各地妇幼服务机构工作量激增、工作压力加大,特别在高危妊娠的管理、救治等方面存在的问题日益突出。本文通过剖析高危妊娠救治现状,探讨三级综合医院产科发展模式,旨在为新形势下综合医院产科危重症救治方面提供新的思路。     

自然分娩与剖宫产的比较研究

剖宫产不是一种分娩方式,而是解决难产的手段。日益增高的剖宫产率成为人们关注的热点话题,自然分娩和剖宫产对母婴的健康和卫生资源的影响,有很多的研究和争议,对于没有医学指征要求剖宫产目前倾向于在知情同意的情况下尊重患者的自主权和选择权,但控制剖宫产率在一个理性的范围之内,是一个系统工程,值得全社会的关注。     

自然分娩与剖宫产的比较研究

剖宫产不是一种分娩方式,而是解决难产的手段.日益增高的剖宫产率成为人们关注的热点话题,自然分娩和剖宫产对母婴的健康和卫生资源的影响,有很多的研究和争议,对于没有医学指征要求剖宫产目前倾向于在知情同意的情况下尊重患者的自主权和选择权,但控制剖宫产率在一个理性的范围之内,是一个系统工程,值得全社会的关注.     

急症产科子宫切除36例临床分析

分析导致产科临床急症子宫切除的原因,探讨降低产科子宫切除的可能性方法.回顾分析我院产科2006年1月～2012年1月间36例急症子宫切除病例,胎盘因素占55.6％,子宫收缩乏力占27.8％,羊水栓塞占5.6％,子宫破裂占8.3％,晚期产后出血占2.8％.剖宫产术后行子宫切除31例,占剖宫产人数的0.39％;阴道分娩后5人行子宫切除,占阴道分娩总数的0.05％.为减少产后出血的发生,应严格掌握剖宫产指征,降低剖宫产率.     

走出胎膜早破病因学研究的误区

1　胎膜早破的概况胎膜早破 (ｐｒｅｍａｔｕｒｅｒｕｐｔｕｒｅｏｆｍｅｍｂｒａｎｅｓ,ＰＲＯＭ)为产科的一个常见并发症 ,是指在临产前胎膜破裂。其发生率国内报道为 2 7～ 1 7% [1] ,且发病率正逐年升高。其中约 3 0 %～ 40 %的胎膜早破并发早产 ,为新生儿发病率和病死率上升的一个重要原因。发生胎膜早破后 ,90 %的孕妇将在 2 4小时内分娩 ;如果是早产并发胎膜早破 ,则 90 %的孕妇将在 1周内分娩。若处理不当 ,并发绒毛膜羊膜炎、子宫内膜炎、剖宫产率、产后出血、新生儿感染及围产儿病死率均较无胎膜早破者明显增高。因目前对胎膜早…     

剖宫产泛滥的原因及解决对策

剖宫产术经过几代产科医生们的不懈努力得到了不断的发展,成为产科学中一种常见而十分重要的手术,用于帮助不能或不宜经阴道分娩的产妇娩出胎儿,挽救了无数产妇和胎儿的生命.但近20～30年来,世界各地及我国的许多大、中、小城市出现了剖宫产率不断升高的现象.欧美国家的剖宫产率已达20%～30%,南美国家则更高,如巴西在1986年全国的剖宫产率已达36.4%,一些地区超过了50%[1].在亚洲国家中,韩国妇女迷信生辰八字,有40%的妇女剖宫产.近年来,我国的剖宫产率升高迅速[2],国内资料报道,北京协和医院在林巧稚大夫工作期间即20世纪50～60年代,该院产科剖宫产率才2%左右.70年代的剖宫产率为5%～11%,80年代为20%～22%,90年代为40%左右[3].据<健康报>载,国内Ⅲ级医院平均剖宫产率高达32%以上,最多的达到63%,甚至达到70%以上.剖宫产过多过滥,不但是目前产科界的突出问题,而且也是严重的社会健康问题,已成为一种"社会流行时尚".     

剖宫产泛滥的原因及解决对策

剖宫产术经过几代产科医生们的不懈努力得到了不断的发展,成为产科学中一种常见而十分重要的手术,用于帮助不能或不宜经阴道分娩的产妇娩出胎儿,挽救了无数产妇和胎儿的生命。但近20~30年来,世界各地及我国的许多大、中、小城市出现了剖宫产率不断升高的现象。欧美国家的剖宫产     

Infant irritability: The impact of fetal alcohol exposure,maternal depressive symptoms,and low emotional support from the husband

Objectives: The aim of this study was to investigate the impact of fetal alcohol exposure, maternal depressive symptoms, and low emotional support from the husband on infant irritability in the first one and a half years of life. Four models describing the interplay of these factors were assessed: A direct effect model, an interaction or threshold model, a mediational model and a transactional model. Method: A sample of initially 458 women was assessed in a prospective 3‐wave study across the first 17 months after childbirth. Fetal alcohol exposure was questioned retrospectively six weeks after birth. Infant irritability was reported by the mothers and fathers. Results: Support for the direct effect model and the interaction model could be found: Fetal alcohol exposure and low emotional support from the husband were associated with increased infant irritability at 5 months. The impact of fetal alcohol exposure was moderated by postnatal depressive symptoms. More irritability was reported if both risk factors, prenatal alcohol exposure and maternal depressive symptoms, were present. Infant irritability and maternal depressive symptoms were associated cross‐sectionally. At the age of 17 months only a main effect of prenatal alcohol exposure on irritability could be found. Conclusion: Direct effects of fetal alcohol exposure, maternal depressive symptoms, and low emotional support from the husband on infant irritability as well as an interaction between fetal alcohol exposure and maternal depressive symptoms were revealed. The interaction can be understood in terms of a diathesis‐stress model. However, no longitudinal associations between maternal depressive symptoms and infant irritability could be found.     

IMPACT OF MATERNAL DEPRESSION ON PREGNANCIES AND ON EARLY ATTACHMENT

The relatively high prevalence and duration of depression in the prenatal and postpartum periods reinforce the need for better understanding of maternal depression. The purpose of this article is to explore the main effects of depression to pregnancies’ outcome and to early attachment reviewing research from the last decade and to find the best way to prevent the negative effects of maternal depression to infants. Recent studies have reported significant associations between maternal depression and several adverse obstetric, fetal, and neonatal outcomes. Antenatal depression has been associated with shorter gestation and lower birth weight, with consequences for infant development. A number of studies have demonstrated an association between prenatal depression and attachment difficulties, which seems to play an important mediating role in the development of further adverse outcomes for children. This review reveals some potential risks of untreated depression during the antenatal and postnatal periods, with possibly significant implications for practice and further research. Considering the high prevalence of depression, antenatal detection of depressive symptoms and intervention before childbirth has huge importance in prevention. Early interventions also may need to focus on mother–infant interactions as a key factor of later child development.     

Stress and reproduction: introduction to the special section.

This special section on stress and reproduction is devoted to an emerging frontier in interdisciplinary research that merits the attention of health psychologists. The majority of the studies concern the role of stress and emotion on birth outcomes such as low birth weight, fetal growth and preterm delivery, or mechanisms underlying these findings. The implications of this research extend from maternal and infant health to life-span development and adult health and mortality.     

Posttraumatic stress symptoms following childbirth and mothers' perceptions of their infants

Postpartum psychological distress can adversely affect the early mother–infant relationship; however, this has not been investigated in relation to posttraumatic stress disorder (PTSD) following childbirth. This article explores whether PTSD symptoms relating to labor and delivery are associated with mothers' early perceptions of their infant. Using labor and childbirth as the stressor criterion, 211 women were assessed at 6 weeks' postpartum for symptoms of intrusions, avoidance, and hyperarousal. Their perceptions of their infants, of mother‐to‐infant attachment, and infant behavioral characteristics also were evaluated. In sum, 3.8% of the women fulfilled full diagnostic criteria, and a further 21.3% reported clinically significant symptoms on at least one dimension of PTSD. Those meeting full or partial criteria perceived their attachment relationships to be significantly less optimal and reported more negative maternal representations in terms of their infants being less warm and more invasive. They also rated them as being temperamentally more difficult, prone to distress, and less easy to soothe. However, when the effects of depression were partialled, only the effect for perceived warmth remained. Posttraumatic stress symptoms relating to labor and delivery may adversely influence maternal perceptions of infants, with potentially adverse implications for the developing mother–infant relationship. The overlap with depressive symptoms requires further exploration.     

Mothers speak differently to infants at‐risk for dyslexia

Dyslexia is a neurodevelopmental disorder manifested in deficits in reading and spelling skills that is consistently associated with difficulties in phonological processing. Dyslexia is genetically transmitted, but its manifestation in a particular individual is thought to depend on the interaction of epigenetic and environmental factors. We adopt a novel interactional perspective on early linguistic environment and dyslexia by simultaneously studying two pre‐existing factors, one maternal and one infant, that may contribute to these interactions; and two behaviours, one maternal and one infant, to index the effect of these factors. The maternal factor is whether mothers are themselves dyslexic or not (with/without dyslexia) and the infant factor is whether infants are at‐/not‐at family risk for dyslexia (due to their mother or father being dyslexic). The maternal behaviour is mothers’ infant‐directed speech (IDS), which typically involves vowel hyperarticulation, thought to benefit speech perception and language acquisition. The infant behaviour is auditory perception measured by infant sensitivity to amplitude envelope rise time, which has been found to be reduced in dyslexic children. Here, at‐risk infants showed significantly poorer acoustic sensitivity than not‐at‐risk infants and mothers only hyperarticulated vowels to infants who were not at‐risk for dyslexia. Mothers’ own dyslexia status had no effect on IDS quality. Parental speech input is thus affected by infant risk status, with likely consequences for later linguistic development.     

The impact of prenatal serotonin reuptake inhibitor (SRI) antidepressant exposure and maternal mood on mother–infant interactions at 3 months of age

Exposure to maternal depression increases risks for altered mother–infant interactions. Serotonin reuptake inhibitor (SRI) antidepressants are increasingly prescribed to manage antenatal maternal illness. The impact of SRIs on early mother–infant interactions was unknown. Three-month-old infants of 32 depressed mothers treated with SRI medications during pregnancy and 43 non-medicated mothers were studied. Using an established face-to-face mother–infant interaction paradigm, dyad interactions were studied with and without a toy. Videotaped sessions yielded 4 measures: maternal sensitivity, dyadic organization, infant readiness to interact, and maternal interruptive behaviors. Even with prenatal SRI treatment, depressed mothers interrupted their infants more during toy play. In the absence of prenatal SRI treatment, maternal postnatal depression adversely influenced infant behavior. Higher levels of maternal depression symptoms at 3 months predicted poorer infant readiness to interact during the toy session. Conversely, in the SRI-exposed group, higher prenatal depression scores predicted greater infant readiness to interact at 3 months. Increased infant readiness with SRI exposure suggests a “fetal programming effect” whereby prenatal maternal mood disturbances shaped a future response to a postnatal depressed maternal environment.     

Near-term fetal response to maternal spoken voice

Knowledge about prenatal learning has been largely predicated on the observation that newborns appear to recognize the maternal voice. Few studies have examined the process underlying this phenomenon; that is, whether and how the fetus responds to maternal voice in situ. Fetal heart rate and motor activity were recorded at 36 weeks gestation (n = 69) while pregnant women read aloud from a neutral passage. Compared to a baseline period, fetuses responded with a decrease in motor activity in the 10 s following onset of maternal speech and a trend level decelerative heart rate response, consistent with an orienting response. Subsequent analyses revealed that the fetal response was modified by both maternal and fetal factors. Fetuses of women who were previously awake and talking (n = 40) showed an orienting response to onset of maternal reading aloud, while fetuses of mothers who had previously been resting and silent (n = 29) responded with elevated heart rate and increased movement. The magnitude of the fetal response was further dependent on baseline fetal heart rate variability such that largest response was demonstrated by fetuses with low variability of mothers who were previously resting and silent. Results indicate that fetal responsivity is affected by both maternal and fetal state and have implications for understanding fetal learning of the maternal voice under naturalistic conditions.     

Maternal sensitivity moderates the impact of prenatal anxiety disorder on infant responses to the still-face procedure

Animal studies have demonstrated the interactive effects of prenatal stress exposure and postnatal rearing style on offspring capacity to manage stress. However, little is known about how parenting quality impacts the association between maternal prenatal anxiety and stress reactivity in human infants. This prospective study examined the impact of prenatal anxiety disorder and maternal caregiving sensitivity on infants’ responses to a standardised interactive stressor (still-face procedure). Eighty-four women completed a clinical interview during pregnancy to assess anxiety symptoms meeting DSM-IV diagnostic criteria. At infant age 7 months, maternal sensitivity to infant distress and infant negative affect were observed and coded during the still-face procedure. Maternal postnatal (concurrent) anxiety and depression were also assessed at this time. Results indicated a negative association between maternal sensitivity to infant distress and infant negative affect responses to the still-face procedure. An unexpected finding was a positive association between parity and infant reactivity. The main effect for sensitivity was qualified by a significant interaction, p < .05, suggesting that the impact of sensitivity was particularly marked among infants of women who experienced an anxiety disorder during pregnancy. This finding is consistent with a cumulative risk model suggesting that maternal prenatal anxiety and quality of maternal care act in concert to shape infant outcomes.     

Advances in prevention and treatment of cerebral palsy

In recent years there have been a number of advances in understanding of predisposing and protective factors in the development of cerebral palsy in infants. Multiple gestation births, maternal infection, and maternal and fetal thrombophilic conditions all predispose to the development of CP in the infant. Opportunities for prevention of CP may develop from an improved understanding of these factors and their mechanisms of operation. Similar progress has been made in the evaluation of treatments for CP and the effects of these treatments on the individual's impairment, function, and disability. Selective posterior rhizotomy and Botulinum toxin A are now widely used in the treatment of spasticity. The challenge remains to determine how effectively these promising interventions can alter long-term function and quality of life outcomes in children and adults with CP.