2017-09-08 17:39
来源:
徐州市妇幼保健院
8月31日晚8点左右，陕西省榆林市第一医院绥德院区住院部5楼，一名待产孕妇从楼上坠下身亡。近日，这则新闻不断引发热议。网传，起因竟是剖宫产与顺产之争。那么，孕妇分娩该选哪种方式？又有什么方式能够降低分娩疼痛呢？徐州市妇幼保健院产科副主任朱锦明来告诉您。
到底什么情况下要剖宫产？
NO.01
朱锦明主任说：“作为三级甲等妇幼专科医院，每年接诊的孕产妇数量居全市之首。我们按照国家要求，对于无指证剖宫产手术管理的比较严格，所以临床上对于选择剖宫产还是顺产我们非常谨慎。除非是具备剖宫产的绝对指征，才会行剖宫产术。不需要的则尽量鼓励孕妇自然分娩。” 选择顺产还是剖宫产，关键是要专业医生来判断和评估，哪些有剖宫产的指征，医生会根据具体情况，选择适合孕产妇的分娩方式。
知识点
剖宫产指征分为绝对性指征和相对性指征。
绝对性指征是指一定不能经阴道分娩的。比如，有的孕妇曾经患过脊髓炎后遗症的、中央型前置胎盘、胎儿横位就属于剖腹产绝对性指征，必须剖宫产手术。
相对性指征是指经阴道分娩有一定风险，但不是完全不能顺产，可以试产。例如，孕妇患有中等程度的高血压、部分前置胎盘、胎儿脐带绕颈两周就就属于相对指征，可以试产，也可以行剖宫产手术。
“
如果经医生评估，认为待产妇有自然分娩的条件，那经过合理的干预，通过医生、家属、待产妇共同的配合和努力，一般都是可以顺利分娩的。但是，如果已经明确孕产妇的条件不适合顺产，却还要一味追求顺产，反而会让孕产妇和宝宝都造成伤害。
生孩子究竟有多痛？
NO.02
“产痛”是绝大多数女性一生中经历的最激烈的疼痛，在医学疼痛指数上，产痛仅次于烧灼痛，排在第二位。产痛实际上是分娩过程中的生理现象，是由于子宫收缩，宫颈扩张造成的，正常人是具备承受这种疼痛的能力的。但是产妇的精神状态处于紧张、恐惧、焦虑、信心不足之中，会增加产妇对疼痛的敏感度，长时间的过度疼痛对于母亲和胎儿可能产生一系列不良的生理和心理影响。
为什么世界各国都鼓励顺产？
NO.03
1．相对于自然分娩，剖宫产存在着较多风险，术中可能有麻醉意外，长远来说，剖腹手术的妈妈容易导致肠粘连等合并症，再怀孕风险更大，有些疤痕体质较严重的妈妈，手术疤痕触目惊心。
2.自然分娩时腹部的阵痛使产妇的垂体还会分泌一种催产素的激素，这种激素不但能促进产程的进展，还能促进母亲产后乳汁的分泌，由于顺产后恢复快，也容易早下奶。
3.免疫球蛋白G（1gG）在自然分娩过程中可由母体传给胎儿，自然分娩的新生儿具有更强的抵抗力。
4.自然分娩的胎儿在产道内受到触、味、痛觉及本位感的锻炼，促进大脑及前庭功能发育，对今后运动及性格均有好处。
5.分娩的过程中子宫有规律的收缩，经过产道时，胎儿头部受到挤压、头部充血、可提高脑部呼吸中枢的兴奋性，有利于新生儿出生后迅速建立正常呼吸。
6.自然分娩过程中，有规律的子宫收缩能让胎儿肺部得到锻炼，让肺泡表面活性物质增加，促进胎儿肺成熟，出生后肺泡易于扩张，很少发生肺透明膜病；同时，经过产道的挤压作用，还可以将胎儿呼吸道内的羊水和粘液排挤出来，新生儿的并发症湿肺、吸入性肺炎的发生可大大地减少。
怎么缓解疼痛？
NO.04
“无痛分娩”是一种通俗的说法，医学上称为分娩镇痛，目前国际医学界应用最广泛的方式为“硬膜外麻醉”。在今天的中国，只有1%的妈妈选择采用无痛分娩，而在国外已经很普遍了。这是一项简单易行、安全成熟的技术。大约在给药10分钟后，分娩的妈妈就感觉不到宫缩的强烈阵痛了，能感觉到的疼痛就像月经时轻微的腹痛。医生打一次药，药效大约持续一个半小时或更长，待有了疼痛感觉后继续打药，如此往复，直至分娩结束。
这一技术与剖宫产麻醉的操作方法完全相同，都是由专业的麻醉医师从脊柱外层的硬膜注射麻醉药，无痛分娩的麻醉药物剂量只有剖宫产手术麻醉剂量的1/10或更少，因此它的风险比剖宫产还要小。并可根据产程的进展调节药量和用药时间，使产妇在骨盆肌肉放松、产痛减少八九成的情况下，头脑清醒，活动正常，较为松弛的完成分娩过程。
如何管理产妇情绪？
NO.05
孕妇的精神心理在怀孕分娩期间是非常敏感和脆弱的。当遇到生产困难或耐受不了宫缩疼痛时，得不到家人的理解，或者家庭不和睦，往往会暗自伤心，从而导致精神抑郁。人们都知道产后抑郁症，事实上这种抑郁不仅会发生在产后，产前和产时同样存在。因此，孕产妇的精神心理因素对分娩的影响也是至关重要的。徐州市妇幼保健院的助产士门诊，就是为了孕妈妈们特别设立的，助产士会科学引导孕妇产程中该怎么做以减少紧张恐惧，理性面对分娩方式。如果在分娩过程中出现紧张恐慌等情况，医护人员也会在床边指导，安抚孕妇。返回搜狐，查看更多
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　　UNITED NATIONS, April 14 (Xinhua) -- Representatives from UN Security Council members and other countries on Wednesday sent their deep condolences to the Chinese government and people for a strong earthquake that hit the northwestern part of the country and killed at least 589 people.The diplomats from nearly 40 countries and the European Union offered their condolences to China when they were taking the floor at an open Council debate on the situation in the Middle East, which kicked off here Wednesday morning. The representatives were from the only countries which inscribed to speak at the open debate.Representatives from Austria, Bosnia, Brazil, Britain, France, Gabon, Japan, Lebanon, Nigeria, Russia and the United States offered their condolences to the Chinese delegation for the 7.1-magnitude earthquake, which struck northwest China's Qinghai Province early Wednesday.Condolences were also from such countries as Afghanistan, Argentina, Botswana, Cuba, Egypt, Iran, Kenya, Kuwait, Nicaragua, Pakistan, Sri Lanka, Syria, Tunisia and Venezuela.Earlier, UN Secretary-General Ban Ki-moon and president of the UN General Assembly Ali Treki also sent their deep condolences to China over the strong earthquake.At least 589 people have reportedly died and 10,000 others were injured in the wake of the deadly earthquake, local authorities said.
　　
　　BEIJING, April 1 (Xinhua) -- Two Chinese vaccine makers Thursday confirmed they have shut down operations after their rabies vaccines were found to be substandard.The State Food and Drug Administration (SFDA) announced in December that a total of 215,800 units of rabies vaccines made by Jiangsu Ealong Biotech Co. and Hebei Bioforwell Co. from July to October 2008 had quality problems.The agency had ordered the two companies to halt production and sales.The confirmation came after media reports saying Ealong Biotech had resumed production and seven executives had been detained. Reports said the company had mixed an additive with the vaccine to reduce costs, leaving as many as 1 million people affected nationwide.Some local newspapers even reported that deaths or illness were likely caused by the faulty vaccines.Yan Jiangying, the SFDA spokesman, said the SFDA was yet to release investigation results as the probe was still underway.But Yan said people needed several injections to build up immunity as the 180,000 units of vaccines made by Ealong Biotech were not as effective as required by the drug watchdog.Liu Wu, general manager of Ealong Biotech, said the faulty vaccines may not provide protection against rabies as they were not up to national standards.But Liu said "We have not received any reports on adverse reactions in people receiving rabies vaccine shots."Liu also denied there were 1 million people affected, saying each person should receive five injections, or one unit, rather than receive one injection of each unit.The company had not produced or sold even one dose of rabies vaccine since Nov. 30, Liu told Xinhua.It also halted production of the A/H1N1 flu vaccine in February when the quality permit expired, he said.Liu also denied that seven company executives had been arrested and that they had put an additive in the vaccines.Ealong Biotech is the nation's fourth-largest rabies vaccine maker with a market share of 11 percent. It took orders from the Chinese government for 6.3 million doses of A/H1N1 flu vaccines in 2009, ranking third nationwide.Wang Kejing, deputy director of the food and drug administration in Sanhe city, where Hebei Bioforwell Co. is located, said the company had not sold even one dose of vaccine since April last year.Hebei Bioforwell Co., which only produced rabies vaccines, had been shut down for rectification. It said earlier that all the faulty rabies vaccines had been used, but they had received no reports of adverse reactions.In the northern Shanxi province, almost 100 children had died or fell ill after taking shots of vaccines for encephalitis, hepatitis B and rabies, the Beijing-based China Economic Times reported on March 17.The Ministry of Health has launched an investigation into the case after media exposure.
　　
　　BEIJING, June 2 (Xinhua) -- China opposes the U.S. decision to set final duties of up to more than 200 percent on imports of steel gratings from China, the Ministry of Commerce (MOC) said in a statement Wednesday.This came after the U.S. Commerce Department Tuesday announced final anti-dumping duties of 136.76 to 145.18 percent on the gratings to "offset below-market pricing." It also set a countervailing duty of 62.46 percent.MOC said the United States had acted "discriminatorily" in the anti-dumping and anti-subsidy investigation and made the wrong conclusion, and China is dissatisfied and is opposed to this.Such move could hurt the interests of China, which both Chinese government and enterprises would not accept, the ministry said.China urged the U.S. to take effective measures to correct the mistake, it said.According to the U.S. trade remedy procedure, the U.S. International Trade Commission (ITC) will also make its final injury determination about the product soon.If the ITC makes affirmative final determinations that imports of steel gratings from China materially injure, or threaten material injury to, the domestic industry, the Commerce Department will issue anti-dumping duties and countervailing duties orders.In 2009, the United States imposed a series of trade remedy measures on Chinese products, and the value involved was eight times more than that in 2008, the MOC statement said."Such action not only hurts the interests of China, but also has an adverse impact on bilateral economic and trade ties," it said.China hoped the United States could show restraint in using trade remedy measures and act to fight trade protectionism, it said.
　　
　　BEIJING, April 18 (Xinhua) -- China encourages foreign experts to help upgrade its technological innovation and the quality of economic growth, Chinese Vice Premier Zhang Dejiang said here Sunday."China welcomes foreign experts to offer suggestions on the country's industry development and technological innovation and to help Chinese enterprises solve technological difficulties," Zhang said when meeting a group of Chinese and U.S. engineering experts.More than 270 experts from both countries attended the Eighth Sino-American Technology and Engineering Conference on April 11-18, at which they conducted academic exchanges in fields of advanced manufacturing, information technology, biomedicine and environmental protection.Stressing that China was at a crucial stage of transforming the economic growth pattern, Zhang said China will continue to boost international cooperation and attract foreign expertise in science and technology.
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