目的 探讨孕期盆底肌锻炼联合产后盆底功能康复治疗对产后女性盆底功能障碍的防治效果。方法 选取2019年1月—2020年6月在我院产科门诊定期产检,B超确认为单胎足月顺产,剔除妊娠合并症及并发症,符合入组标准病例共316例,随机分成观察组和对照组,观察组131例,对照组185例,观察组在孕12周开始宣教孕期定期行盆底肌Kegel运动,并在产后42天开始行盆底康复治疗仪治疗6周,统计临床疗效,2组均在产后42天、3个月、6个月统计2组盆底功能检测、盆底器官脱垂(pelvic organ prolapse,POP)和压力性尿失禁(stress urinary incorrtinence,SUI)发生情况。结果 观察组和对照组一般资料,2组在年龄、分娩孕周、新生儿平均体重无统计学差异(P＞0.05),2组盆底功能进行检测比较,产后42天观察组阴道收缩持续时间、Ⅱ类肌纤维强度(85.24±22.19 cmH₂O)高于对照组(74.14±19.94 cmH₂O),差异具有统计学意义(P＜0.05),产后3月观察组I类肌纤维强度、阴道收缩持续时间、Ⅱ类肌纤维强度(76.41±16.42 cmH₂O;4.35±1.78 s;94.15±18.25 cmH₂O)高于对照组(62.45±17.55 cmH₂O;3.89±1.52 s;88.55±18.36 cmH₂O),差异具有统计学意义(P＜0.05),产后6月观察组I类肌纤维强度、阴道收缩持续时间、Ⅱ类肌纤维强度(79.56±15.78 cmH₂O;5.46±2.01 s;99.78±23.47 cmH₂O)明显高于对照组(67.63±14.45 cmH₂O;4.13±1.45 s;90.16±18.75 cmH₂O),差异具有统计学意义(P＜0.05)。对比2组POP和SUI发生率情况,产后42天观察组SUI发生率(28.24%)低于对照组(35.14%),差异具有统计学意义(P＜0.05);产后3月观察组POP和SUI发生率(18.32%;13.74%)低于对照组(22.70%;17.83%),差异具有统计学意义(P＜0.05),产后6月观察组POP和SUI发生率(0.00%;0.07%)明显低于对照组(8.10%;11.89%),差异具有统计学意义(P＜0.05)。 结论 孕期行盆底肌锻炼联合产后盆底功能康复治疗能明显改善产后盆底功能状态,显著降低产后盆底功能障碍性疾病的发生率。

Objective To explore the prevention and treatment effect of pelvic floor muscle exercise during pregnancy combined with postpartum pelvic floor function rehabilitation therapy on postpartum pelvic floor dysfunction in women. Methods From January 2019 to June 2020, women in our hospital's obstetrics outpatient department for regular obstetric checkups were selected, which ultrasound confirmed it was a singleton full-term delivery. The cases of stillbirth, fetal malformation and placenta previa were excluded. A total of 316 cases met the inclusion criteria and were randomly divided into the observation group and the control group, with 131 cases in the observation group and 185 cases in the control group. Observation group started regular pelvic floor muscle Kegel exercises from 12 weeks of gestation,and accepted pelvic floor rehabilitation therapeutic treatment from 42 days to six weeks postpartum. We summerized the pelvic floor function tests results, pelvic organ prolapse (POP) and stress urinary incontinence (SUI) situation of both groups in 42 days, 3 months and 6 months postpartum. Results The general information of the observation group and the control group showed that there were no statistical differences in age, gestational age of delivery and average weight of newborn (P>0.05). The pelvic floor function 42 days after delivery of the two groups was tested and compared, duration of vaginal contraction and class Ⅱ muscle fiber strength of the observation group [(85.24±22.19) cmH₂O] was significantly higher than that of the control group [(74.14±19.94) cmH₂O], and the difference was statistically significant (P＜0.05). Class I muscle fiber strength, duration of vaginal contraction and class Ⅱ muscle fiber strength were observed at 3 months postpartum, those of observation group[(76.41±16.42) cmH₂O; (4.35±1.78) s; (94.15±18.25) cmH₂O] were significantly higher than that in the control group [(62.45± 17.55) cmH₂O; (3.89±1.52) s; (88.55±18.36) cmH₂O], and the difference were statistically significant (P<0.05). At 6 months postpartum, class I muscle fiber strength, vaginal contraction duration and class Ⅱ muscle fiber strength in observation group [(79.56±15.78) cmH₂O; (5.46±2.01) s; (99.78±23.47) cmH₂O] were significantly higher than that of the control group [(67.63±14.45) cmH₂O; (4.13± 1.45) s; (90.16±18.75) cmH₂O], and the difference were statistically significant (P<0.05). Comparison of the incidence of POP and SUI between the two groups showed that the incidence of SUI in the observation group at 42 days postpartum (28.24%) was significantly lower than that in the control group (35.14%), the difference was statistically significant (P＜0.05). The incidences of POP and SUI in the observation group at 3 months postpartum (18.32%; 13.74%) were significantly lower than that of the control group (22.70%; 17.83%), the difference were statistically significant (P＜0.05). The incidences of POP and SUI in the observation group at 6 months postpartum (0.00%; 0.07%) were significantly lower than that of the control group (8.10%; 11.89%), the difference were statistically significant (P＜0.05). Conclusion Pelvic floor muscle exercise during pregnancy combined with postpartum pelvic floor function rehabilitation therapy can significantly improve postpartum pelvic floor function and significantly reduce the incidence of postpartum pelvic floor dysfunction diseases.

目的 研究妊娠早期低血压对子宫动脉血流的影响。方法 前瞻性连续收集2020年9月—2021年3月在广州市妇女儿童医疗中心行产前检查的早孕期正常单胎妊娠孕妇,分为两组:低血压组(43人)及正常血压组(73人),分别监测两组孕妇的双侧子宫动脉血流搏动指数 (pulse index,PI)及收缩期峰值 (peak systolic velocity,PSV),并比较两组间PI及PSV是否有统计学差异。结果 双侧子宫动脉血流PI与平均动脉压呈线性正相关关系(P＜0.05)。低血压组双侧子宫动脉PI低于正常血压组,差异有统计学意义(P＜0.05),低血压组右侧子宫动脉PSV低于正常血压组,差异有统计学意义(P＜0.05),左侧子宫动脉PSV两组间无差异(P＞0.05)。结论 低血压孕妇子宫动脉血流动力学参数异常降低,临床应重视妊娠期低血压孕妇子宫动脉血流动力学异常者的围产期管理。

Objective To study the relationship between early pregnancy hypotension and uterine artery blood flow. Methods We prospectively and consecutively selected pregnant women with normal singleton pregnancy in early pregnancy for this study from September 2020 to March 2021 in Guangzhou Women and Children's Medical Center. According to the blood pressure, they were divided into hypotension group (n=43) and normal blood pressure group (n=73). We monitored the pulse index (PI) and peak systolic velocity (PSV) of bilateral uterine artery blood flow, then compared the PI and PSV between the two groups. Results There was a positive linear correlation between PI and mean arterial pressure (P＜0.05). The PI of bilateral uterine arteries in hypotension group was lower than that in normal blood pressure group (P＜0.05). PSV of right uterine artery in hypotension group was lower than that in normal blood pressure group (P＜0.05). PSV of left uterine artery in hypotension group was not different from that in normal blood pressure group (P＞0.05). Conclusion Uterine artery hemodynamic parameters of hypotensive pregnant women decreased abnormally, so attention should be paid to the perinatal management of pregnant women with abnormal uterine artery hemodynamics.

目的 探讨影响孕晚期死胎伴胎动减少延迟就诊的临床因素,加强围产期宣教。方法 回顾性分析2017年1月—2019年10月广州市妇女儿童医疗中心住院分娩的孕晚期(孕周≥28周)单胎死胎病例的相关临床资料。结果 在79例死胎中,有59例(74.68%)孕妇感知胎动减少,但只有27人(45.76%)在感知胎动减少后24小时内就诊。妊娠未合并胎儿生长受限可能会导致延迟就诊(P=0.03<0.1)。结论 胎动减少和死胎发生密切相关,但大部分孕妇可能会出现延迟就诊。加强孕期产检,规范孕期宣教,尤其是合并胎儿生长受限等高危妊娠时的孕期严密监测,强调胎动的重要性,在感知胎动减少后强调早期就诊,有助于减少孕晚期死胎风险。

Objective To explore the clinical factors that affect the consultation time of stillbirth after perceptive reduction of fetal movement in the third trimester of pregnancy, and to strengthen the perinatal education. Methods A retrospective analysis of single stillbirth in late pregnancy (gestational weeks≥ 28 weeks) in Guangzhou Women and Children's Medical Center from January 2017 to October 2019 was taken, and the relevant clinical data were summarized and evaluated. Results Out of 79 stillbirth cases, 59 (74.68%) cases had decreased fetal motility. Only 27 pregnant women (45.76%) visited the doctor in 24 hours after they perceived the reduction of fetal movement. Pregnancy without fetal growth restriction may lead to delayed consultation (P=0.03<0.1). Conclusion Perception of decreased fetal movement is closely related to the occurrence of stillbirth, but most pregnant women may have delayed visits. To strengthen the prenatal examination, standardize the propaganda and education during pregnancy, especially the close monitoring of high-risk pregnancy such as fetal growth restriction, emphasize the importance of fetal movement, and emphasize the early consultation after perceiving the reduction of fetal movement, are helpful to reduce the risk of stillbirth in late pregnancy.

目的 对出生缺陷知信行健康教育模式效果进行策略分析与探讨,为进一步完善围产期保健服务及健康教育工作提供合理化建议。方法 采用《孕期妇女出生缺陷基本知识知晓率专题测评问卷》并结合实际情况设定有关信念、行为方面的7个问题,对2011年1月—2013年6月期间在中心孕妇学校参加健康教育活动课堂的孕妇进行调查,并应用决策树模型对中心现有的出生缺陷知信行健康教育模式效果进行探讨。结果 预防出生缺陷知识方面,对初高中及中专文化程度的孕期妇女加强出生缺陷预防知识健康教育的预期收益合计达到51.2%,可作为重点目标人群;预防出生缺陷信念方面,主要决定因素是户籍类型和年龄,加大对本地户籍及25岁以上流动妇女人群的健康教育,促进孕期妇女树立预防出生缺陷信念的预期收益累计达95.9%;预防出生缺陷行为方面,主要影响因素是产检医生的嘱咐,受到嘱咐的孕期妇女预期收益为62.3%。结论 为了达到出生缺陷防治目标与健康教育整体效果的提高,应将预防出生缺陷的健康教育工作重点放在初高中及中专文化程度人群,本地户籍孕期妇女和25岁以上流动性孕期妇女又是需要树立预防出生缺陷信念的重点人群,强化产检医生的嘱托义务是提高孕期妇女出生缺陷知信行健康教育模式效果的有力保证。

Objective To identify factors related to the knowledge, attitude and practice KAP of birth defects prevention among pregnant women, and provide reasonable suggestions to improve perinatal health services and health education. Methods Using cluster sampling method, 5500 participants from pregnant women school were enrolled. Information on “awareness of basic knowledge of birth defects” and 7 questions about attitudes and practice to participant actual situation was gathered through personal interviews using a structured questionnaire. The related factors were analyzed by classification tree model of SPSS 19.0. Results As to birth defects related knowledge, prospective return was more than 50% in the pregnant women with junior, senior high school and technical secondary school education level. As to birth defects prevention faith, the main determinant was census register types; prospective return of pregnant women who were local permanent residents and floating population aged ≥25 years was 95.9%. The main influencing factor of practice was prenatal doctor's education; prospected return was 62.3% after strengthening the health education of prenatal doctor. Conclusion In order to improve birth defects education effect, pregnant women who have junior, senior high school and technical secondary school education level and are local permanent residents or floating population aged ≥25 years should be key targeted population. Prenatal doctor's health education will be a powerful guarantee.

目的 探讨GDM孕早、中期脂肪细胞因子Chemerin、RBP4水平的变化。方法 采用前瞻性研究,测定38例GDM及40例正常孕妇孕早、中期血清Chemerin、RBP4水平,分析其与胰岛素抵抗的相关性。结果 GDM组孕妇孕早、中期血清Chemerin、RBP4水平及HOMA-IR均较对照组升高,差异有统计学意义(P<0.05);两组孕妇孕中期血清Chemerin、RBP4水平均较孕早期升高,差异有统计学意义 (P<0.05);Chemerin、RBP4水平与IR成正相关,差异有统计学意义(P<0.05)。结论 GDM孕妇孕早、中期脂肪细胞因子Chemerin、RBP4水平升高,Chemerin、RBP4水平的升高与IR有一定相关性。

Objective To discuss the serum levels of the Adipokine Chemerin、RBP4 of Gestational Diabetes Mellitus(GDM) in early pregnancy and middle pregnancy. Methods In prospective study, pregnant women, venous blood was collected from 40 controls and 38 GDM during early pregnancy (9-12weeks)and middle pregnancy (22-26weeks). Serum insulin, Chemerin, RBP4 were measured by enzyme-linked immunosorbent assay (ELISA). Results Mean serum levelsof Chemerin and RBP4 were significantly higher among GDM cases compared with controls during early pregnancy and middle pregnancy(P<0.05). In two groups, Mean serum levels of Chemerin and RBP4 in middle pregnancy were significantly higher than those in early pregnancy (P<0.05).During early pregnancy and middle pregnancy, the Chemerin and RBP4 levels were positively related with HOMA-IR (P＜0.05). Conclusion There is evidence of a positive association elevated Chemerin and RBP4 concentration of early pregnancy and middle pregnancy with increased GDM risk.