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妇产科疾病健康宣教目录妇科疾病健康宣教1、妇科一般健康宣教…………………………………………………..32、外阴、阴道手术一般健康宣教………………………………………53、慢性盆腔炎健康宣教…………………………………………………84、子宫肌瘤健康宣教……………………………………………………95、异位妊娠健康宣教……………………………………………………96、功能失调性子宫出血一般健康宣教………………………………..127、葡萄胎健康宣教…………………………………………………….128、终止妊娠健康宣教………………………………………………….162012年6月新修订thepublictoparticipatein,inimperceptibleprovidedLpeople'sculturalquality.Tobuiltuse"Juxianissuedonthemicrochannel,"civilizedJuxian"microchannel,Ju,networksandothermainstreamnetworkmediacontinuedtopushsendonlineisenergyinformation,andcreateagoodnetworkenvironment.Deepentheactionofthebeautifulcountrysidecivilization,tocarryoutawiderangeof"newcountryside,newlife"training,givefullplaytothevillagepopulationculturecourtyard,ParkStreet,culturalsquareandotherpositionstheroleofpublicityandeducation,promoteruralwayoflifemorecivilized.Thisyeartheprovince'surbanandruralsanitationintegrationoftheruralmassessatisfactiontelephonesurvey,significantlyimprovedperformanceinourcounty,respectively,thantheendoflastyear,yearstoimprovethe5.2,17.5percentagepoints.Thetownshipstreets.Relevantdepartmentsofcountiesunitsshouldconscientiouslysumupexperience,adheretotheproblemoriented,peoplearenotsatisfiedwiththevillageasthefocusofthework,insistongraspingbothends,withthemiddle,toconsolidateandimprove,expandfurthereffort,intherealizationofthenormallong-termefforts,toensurethattheendofthisyeartoobtainbetterresults.Third,weneedtoacceleratethevoluntaryservicesystem.Toactivelypromotethepartymembersandmembersandcadresnormalizationofvolunteerservice,doagoodjobinpublicplaces,windowunitsandcommunityvolunteerservicestationconstruction,establishmentofcoveringthewhole49 产科疾病健康宣教1、孕妇入院健康宣教………………………………………………….172、正常产程健康宣教………………………………………………….193、分娩健康宣教……………………………………………………….254、产后出血健康宣教………………………………………………….275、剖宫产健康宣教…………………………………………………….286、正常足月新生儿健康宣教………………………………….............307、胎儿宫内窘迫健康宣教……………………………………..............318、胎膜早破护健康宣教….…………………………………………….329、前置胎盘健康宣教………………………………………………….3310、胎盘早剥的健康宣教………………………………………………3411、会阴切口术的健康宣教…………………………………………...3412、流产的健康宣教……………………………………………………3613、死胎的健康宣教…………………………………………………....3714、妊娠合并心脏病的健康宣教………………………………………4215、妊娠合并贫血的健康宣教…………………………………………4416、妊娠期高血压综合征的健康宣教…………………………………4517、妊娠合并性传播疾病的健康宣教…………………………………4618、新生儿窒息健康宣教………………………………………………492012年6月新修订thepublictoparticipatein,inimperceptibleprovidedLpeople'sculturalquality.Tobuiltuse"Juxianissuedonthemicrochannel,"civilizedJuxian"microchannel,Ju,networksandothermainstreamnetworkmediacontinuedtopushsendonlineisenergyinformation,andcreateagoodnetworkenvironment.Deepentheactionofthebeautifulcountrysidecivilization,tocarryoutawiderangeof"newcountryside,newlife"training,givefullplaytothevillagepopulationculturecourtyard,ParkStreet,culturalsquareandotherpositionstheroleofpublicityandeducation,promoteruralwayoflifemorecivilized.Thisyeartheprovince'surbanandruralsanitationintegrationoftheruralmassessatisfactiontelephonesurvey,significantlyimprovedperformanceinourcounty,respectively,thantheendoflastyear,yearstoimprovethe5.2,17.5percentagepoints.Thetownshipstreets.Relevantdepartmentsofcountiesunitsshouldconscientiouslysumupexperience,adheretotheproblemoriented,peoplearenotsatisfiedwiththevillageasthefocusofthework,insistongraspingbothends,withthemiddle,toconsolidateandimprove,expandfurthereffort,intherealizationofthenormallong-termefforts,toensurethattheendofthisyeartoobtainbetterresults.Third,weneedtoacceleratethevoluntaryservicesystem.Toactivelypromotethepartymembersandmembersandcadresnormalizationofvolunteerservice,doagoodjobinpublicplaces,windowunitsandcommunityvolunteerservicestationconstruction,establishmentofcoveringthewhole49 一、妇科一般健康宣教1、乳房疾病：非哺乳期学会自我诊断检查的方法并经常做字我检查是早发现、早诊断、早治疗乳房疾病的关键。自我检查方法：躺平，手指平放在乳房一侧，挨次摸整个乳房，正常乳房是软的，无肿块、结节或触痛，特别注意乳房的外上角伸向腋窝方向的部位不能遗漏，腋握也要检查，看有无肿大的淋巴结。检查是不抓捏乳房。如发现问题，即使到医院就诊。妇女乳头有液体流出或胸罩衬衣上渍斑，应来医院检查。月经前乳房胀痛不适，经后消失，或伴乳房肿块也应去医院检查。40岁以上妇女，家族中有乳房癌病史的更应多做自我检查，也可定期去医院检查。2、放宫内节育器：放置宫内节育器后，由于子宫收缩可有下腹轻微疼痛，一般不需服用止痛剂，忌用子宫收缩剂如益母膏之类。放器后休息2天，2周内不做重体力劳动，尤其是增加腹压的劳动及运动。放器后可有少量阴道流血，不必紧张，一般在2—3天后流血自止。若有持续出血或量似月经，应及时到医院就诊。术后两天内应禁盆浴、性生活，以免感染。3、孕期保健健康的孕妇可以照常工作或劳动，妊娠32周以后，应免值夜班及重体力劳动，保证足够睡眠时间。饮食要注意多样化，吃易消化的食物及蔬菜，少吃辛辣食物，妊娠后期适当增加含钙、铁类的thepublictoparticipatein,inimperceptibleprovidedLpeople'sculturalquality.Tobuiltuse"Juxianissuedonthemicrochannel,"civilizedJuxian"microchannel,Ju,networksandothermainstreamnetworkmediacontinuedtopushsendonlineisenergyinformation,andcreateagoodnetworkenvironment.Deepentheactionofthebeautifulcountrysidecivilization,tocarryoutawiderangeof"newcountryside,newlife"training,givefullplaytothevillagepopulationculturecourtyard,ParkStreet,culturalsquareandotherpositionstheroleofpublicityandeducation,promoteruralwayoflifemorecivilized.Thisyeartheprovince'surbanandruralsanitationintegrationoftheruralmassessatisfactiontelephonesurvey,significantlyimprovedperformanceinourcounty,respectively,thantheendoflastyear,yearstoimprovethe5.2,17.5percentagepoints.Thetownshipstreets.Relevantdepartmentsofcountiesunitsshouldconscientiouslysumupexperience,adheretotheproblemoriented,peoplearenotsatisfiedwiththevillageasthefocusofthework,insistongraspingbothends,withthemiddle,toconsolidateandimprove,expandfurthereffort,intherealizationofthenormallong-termefforts,toensurethattheendofthisyeartoobtainbetterresults.Third,weneedtoacceleratethevoluntaryservicesystem.Toactivelypromotethepartymembersandmembersandcadresnormalizationofvolunteerservice,doagoodjobinpublicplaces,windowunitsandcommunityvolunteerservicestationconstruction,establishmentofcoveringthewhole49 食物。孕妇衣服要宽松、柔软、胸部不宜束缚过紧，勤洗澡，勤换衣，妊娠最后一个月不宜盆浴，以淋浴为宜。妊娠早期三个月内以及末期，应避免性生活，以防流产、早产或感染。按时到医院进行产检。4、更年期综合征更年期综合征系绝经期前后，因卵巢功能减退，而出现的一系列症状和体征，是一个正常的生理过程。 患者应注意劳逸结合，保持情绪稳定，睡眠要充足，消除顾虑，以期缩短和减轻这些症状，使顺利地度过着一时期。适当限制脂类及糖类物质摄入，鼓励体育锻炼，以增加体质。症状严重者，应到医院就诊。5、性病必须及时到专业防治机构进行检查及接受规则治疗，不可讳疾忌医或乱投医，以免贻误病情。配偶或性伴侣应同时接受检查治疗，防止互相传染。衣裤床单、被单、浴巾等用物应进行消毒。建立社会主义的性道德观念和健康文明的性生活方式，洁身自爱，遵纪守法。thepublictoparticipatein,inimperceptibleprovidedLpeople'sculturalquality.Tobuiltuse"Juxianissuedonthemicrochannel,"civilizedJuxian"microchannel,Ju,networksandothermainstreamnetworkmediacontinuedtopushsendonlineisenergyinformation,andcreateagoodnetworkenvironment.Deepentheactionofthebeautifulcountrysidecivilization,tocarryoutawiderangeof"newcountryside,newlife"training,givefullplaytothevillagepopulationculturecourtyard,ParkStreet,culturalsquareandotherpositionstheroleofpublicityandeducation,promoteruralwayoflifemorecivilized.Thisyeartheprovince'surbanandruralsanitationintegrationoftheruralmassessatisfactiontelephonesurvey,significantlyimprovedperformanceinourcounty,respectively,thantheendoflastyear,yearstoimprovethe5.2,17.5percentagepoints.Thetownshipstreets.Relevantdepartmentsofcountiesunitsshouldconscientiouslysumupexperience,adheretotheproblemoriented,peoplearenotsatisfiedwiththevillageasthefocusofthework,insistongraspingbothends,withthemiddle,toconsolidateandimprove,expandfurthereffort,intherealizationofthenormallong-termefforts,toensurethattheendofthisyeartoobtainbetterresults.Third,weneedtoacceleratethevoluntaryservicesystem.Toactivelypromotethepartymembersandmembersandcadresnormalizationofvolunteerservice,doagoodjobinpublicplaces,windowunitsandcommunityvolunteerservicestationconstruction,establishmentofcoveringthewhole49 6、外阴瘙痒症注意经期卫生，行经期间勤换月经垫，擒清洗。保持外阴清洁干燥，不用热水烫洗，不用肥皂擦洗。忌乱用、滥用药物，忌抓瘙与局部摩擦。忌酒及辛辣，不吃海鲜等易引起过敏的食物。不穿紧身兜裤，内裤须宽松、透气，并以棉织品为宜。局部如有破损，感染，可用1：5000高锰酸钾（在温开水内假如微量高锰酸钾粉末，使呈淡红色不能过浓）浸洗，每日两次，每次20-3分钟。就医检查有无霉菌或滴虫，如有应及时治疗，而不要自己应用“止痒水”治疗。7、霉菌性阴道炎妇女如有外阴瘙痒，白带过多，应及时到医院就诊。发现霉菌性阴道眼炎时，不要到公共浴池或游泳池洗澡、游泳。及时治疗，可用2-4%小苏打溶液或洁尔阴等冲洗阴道或坐盆，清洁外阴后在医生指导下采用能用杀灭霉菌的药物治疗。切忌用热水烫洗，以免黏膜破损。治疗期间应禁房事，防止交叉感染。患者内裤、毛巾和浴盆必须用开水烫洗。如果反复发作久治不愈，应检查有无糖尿病，同时检查丈夫是否带菌者。8、滴虫性阴道炎滴虫性阴道炎患者，应严禁进入公共浴池洗澡或游泳池游泳，防止传播。患者衣物、毛巾、浴盆等用物要单独使用，内裤、毛巾用后应煮沸5-10分钟以消除病源。每日清洗外阴，用酸性药物浸洗或坐盆，（如1%乳酸，0.5%醋酸洁尔阴），然后用灭滴灵塞入阴道内或口服灭滴灵等治疗。患者丈夫应到医院泌尿科检查，如尿液中发现滴虫，应及时治疗。患者治疗期间应停止性生活。治疗后滴虫检查转为阴性时，仍应于下次月经干净后继续治疗一疗程固。二、外阴、阴道手术一般健康宣教1、做好家属的思想工作，对子宫切除的态度关系到日后婚姻生活的thepublictoparticipatein,inimperceptibleprovidedLpeople'sculturalquality.Tobuiltuse"Juxianissuedonthemicrochannel,"civilizedJuxian"microchannel,Ju,networksandothermainstreamnetworkmediacontinuedtopushsendonlineisenergyinformation,andcreateagoodnetworkenvironment.Deepentheactionofthebeautifulcountrysidecivilization,tocarryoutawiderangeof"newcountryside,newlife"training,givefullplaytothevillagepopulationculturecourtyard,ParkStreet,culturalsquareandotherpositionstheroleofpublicityandeducation,promoteruralwayoflifemorecivilized.Thisyeartheprovince'surbanandruralsanitationintegrationoftheruralmassessatisfactiontelephonesurvey,significantlyimprovedperformanceinourcounty,respectively,thantheendoflastyear,yearstoimprovethe5.2,17.5percentagepoints.Thetownshipstreets.Relevantdepartmentsofcountiesunitsshouldconscientiouslysumupexperience,adheretotheproblemoriented,peoplearenotsatisfiedwiththevillageasthefocusofthework,insistongraspingbothends,withthemiddle,toconsolidateandimprove,expandfurthereffort,intherealizationofthenormallong-termefforts,toensurethattheendofthisyeartoobtainbetterresults.Third,weneedtoacceleratethevoluntaryservicesystem.Toactivelypromotethepartymembersandmembersandcadresnormalizationofvolunteerservice,doagoodjobinpublicplaces,windowunitsandcommunityvolunteerservicestationconstruction,establishmentofcoveringthewhole49 重要因素，丈夫对妻子的理解和支持，是对患者最大的安慰，对减轻其思想压力至关重要，使患者及其丈夫了解子宫切除术有利于患者身体健康，术后有更充沛的精力从事工作及社会活动，让患者及其丈夫对手术持更积极的态度，向患者及其丈夫讲解一些卫生及性生理知识，使其了解人类最重要的性欲器官是大脑而非子宫，女性性敏感区主要在阴蒂及乳房，对于患者担心术后影响夫妻性生活的心理，有针对性地宣讲阴道、子宫及卵巢的主要生理功能，告诉患者阴道是性交器官，子宫全切除术并未损伤阴道，使患者解除忧虑，树立治疗信心。2、建立良好的护患关系，消除患者的焦虑心理，改善患者低落情绪树立战胜疾病的信心患者入院予以热情接待，介绍医院环境、科室情况，主管医生、护士，消除患者紧张、恐惧，陌生感。住院期间尊重患者，称呼亲切适当，态度和蔼，对人真诚，言行一致，多与患者交流沟通，了解其心理情况，耐心回答患者提出的各种问题，减轻其心理负担。护士在术前应根据患者具体情况，及时向患者及其家属介绍治疗的原理、方法、围手术期术前准备及注意事项、介绍麻醉方式、手术大致过程、手术后可能出现的症状、持续时间及应对方法等，同时告知患者术中如何配合，以取得患者及家属的信任，建立良好护患关系，消除患者紧张心理，使患者对手术充满信心，以最佳心理状态。3、满足患者的个体化需求：其主要护理thepublictoparticipatein,inimperceptibleprovidedLpeople'sculturalquality.Tobuiltuse"Juxianissuedonthemicrochannel,"civilizedJuxian"microchannel,Ju,networksandothermainstreamnetworkmediacontinuedtopushsendonlineisenergyinformation,andcreateagoodnetworkenvironment.Deepentheactionofthebeautifulcountrysidecivilization,tocarryoutawiderangeof"newcountryside,newlife"training,givefullplaytothevillagepopulationculturecourtyard,ParkStreet,culturalsquareandotherpositionstheroleofpublicityandeducation,promoteruralwayoflifemorecivilized.Thisyeartheprovince'surbanandruralsanitationintegrationoftheruralmassessatisfactiontelephonesurvey,significantlyimprovedperformanceinourcounty,respectively,thantheendoflastyear,yearstoimprovethe5.2,17.5percentagepoints.Thetownshipstreets.Relevantdepartmentsofcountiesunitsshouldconscientiouslysumupexperience,adheretotheproblemoriented,peoplearenotsatisfiedwiththevillageasthefocusofthework,insistongraspingbothends,withthemiddle,toconsolidateandimprove,expandfurthereffort,intherealizationofthenormallong-termefforts,toensurethattheendofthisyeartoobtainbetterresults.Third,weneedtoacceleratethevoluntaryservicesystem.Toactivelypromotethepartymembersandmembersandcadresnormalizationofvolunteerservice,doagoodjobinpublicplaces,windowunitsandcommunityvolunteerservicestationconstruction,establishmentofcoveringthewhole49 需求是住院环境安静、舒适，享受较高水平的医疗护理治疗，获得术后病情随访。在治疗护理时，争取为病人创造舒适的医疗环境，医护人员要文明有礼、动作轻柔、热情主动与患者沟通，尤其是实习同学进行操作时，必须与病人沟通好之后才能进行，及时告知病人的一些良性相关信息，如病理检验报告良性、血常规检验各参数恢复正常、生命体征正常等。4、以典型病例进行心理疏导：在护士做了大量心理工作的基础上，患者消除了紧张恐惧的心理，情绪稳定乐观，但还有少部分患者存有疑虑，此时护士应适时的利用患者身边的典型病例针对性的进行疾病知识的宣教，讲解科学健康知识，破除迷信提高患者对疾病的认识。5、鼓励患者尽早离床活动，促进机体康复：病人的术后恢复是病人、家属及医护人员共同参与的结果，鼓励患者尽早离床活动，可以防止静脉血栓形成，增加肺通气量，避免肺部并发症，促进肠道功能的恢复。患者及其家属的心理素质和认知程度不同，对术后早期离床活动的益处认识往往不足，指导并协助患者及早离床活动，增强了患者的信任和心理安全感，减轻了腹肌紧张产生的切口疼痛，防止了因术后体虚，下床后有头晕，恶心等情形，对于预防感染，提高机体抗病力起到了促进作用。6、thepublictoparticipatein,inimperceptibleprovidedLpeople'sculturalquality.Tobuiltuse"Juxianissuedonthemicrochannel,"civilizedJuxian"microchannel,Ju,networksandothermainstreamnetworkmediacontinuedtopushsendonlineisenergyinformation,andcreateagoodnetworkenvironment.Deepentheactionofthebeautifulcountrysidecivilization,tocarryoutawiderangeof"newcountryside,newlife"training,givefullplaytothevillagepopulationculturecourtyard,ParkStreet,culturalsquareandotherpositionstheroleofpublicityandeducation,promoteruralwayoflifemorecivilized.Thisyeartheprovince'surbanandruralsanitationintegrationoftheruralmassessatisfactiontelephonesurvey,significantlyimprovedperformanceinourcounty,respectively,thantheendoflastyear,yearstoimprovethe5.2,17.5percentagepoints.Thetownshipstreets.Relevantdepartmentsofcountiesunitsshouldconscientiouslysumupexperience,adheretotheproblemoriented,peoplearenotsatisfiedwiththevillageasthefocusofthework,insistongraspingbothends,withthemiddle,toconsolidateandimprove,expandfurthereffort,intherealizationofthenormallong-termefforts,toensurethattheendofthisyeartoobtainbetterresults.Third,weneedtoacceleratethevoluntaryservicesystem.Toactivelypromotethepartymembersandmembersandcadresnormalizationofvolunteerservice,doagoodjobinpublicplaces,windowunitsandcommunityvolunteerservicestationconstruction,establishmentofcoveringthewhole49 落实出院指导：出院患者发放书面“出院指导”以作健康教育指导。告知患者子宫切除会有暂时的不适，如腰痛、尿频、下腹坠胀等。出院后应适量活动，防治静脉栓塞等并发症发生。观察阴道有无出血现象，若出血多及时就诊。术后6周内禁止盆浴，保持会阴清洁，防逆行感染，3个月内禁性生活及体力劳动等增加腹压等活动，鼓励患者出院后定期同医院联系，以便随时对患者进行健康指导。7、遵医嘱饮食指导三、慢性盆腔炎健康宣教1、慢性盆腔炎常为急性盆腔炎未能恰当彻底治疗，或病人体质差，病程迁延而转来。也有的慢性盆腔炎没有急性盆腔炎病史。2、慢性盆腔炎的全身症状不明显。有时可有低烧，易感疲乏，精神不振、周身不适、失眠等。当病人抵抗力下降时，可急性发作。由于慢性炎症形成的疤痕、粘连、及盆腔充血，可引起下腹部坠胀、疼痛及腰能部酸痛。常在劳累、性交后、排便时及月经期前后加重。由于盆腔瘀血，病人出现月经和白带增多；卵巢功能受损害时可有月经失调；输卵管阻塞可造成不孕。检查子宫的位置后倾，活动受限或粘连固定，在子宫一侧或两侧可摸到条索状增粗的输卵管，并有轻度压痛。3、对病人应讲清慢性盆腔炎的有关知识，解除顾虑，增强治疗信心，增加营养，锻炼身体，注意劳逸结合，提高抵抗力。选用中药治疗慢性盆腔炎效果较好，湿热型多见，宜清热利湿、活血化瘀，遵医嘱做保留灌肠，有一定治疗效果。还可采用封闭疗法，能阻断恶性刺激，改善组织营养。使用微波thepublictoparticipatein,inimperceptibleprovidedLpeople'sculturalquality.Tobuiltuse"Juxianissuedonthemicrochannel,"civilizedJuxian"microchannel,Ju,networksandothermainstreamnetworkmediacontinuedtopushsendonlineisenergyinformation,andcreateagoodnetworkenvironment.Deepentheactionofthebeautifulcountrysidecivilization,tocarryoutawiderangeof"newcountryside,newlife"training,givefullplaytothevillagepopulationculturecourtyard,ParkStreet,culturalsquareandotherpositionstheroleofpublicityandeducation,promoteruralwayoflifemorecivilized.Thisyeartheprovince'surbanandruralsanitationintegrationoftheruralmassessatisfactiontelephonesurvey,significantlyimprovedperformanceinourcounty,respectively,thantheendoflastyear,yearstoimprovethe5.2,17.5percentagepoints.Thetownshipstreets.Relevantdepartmentsofcountiesunitsshouldconscientiouslysumupexperience,adheretotheproblemoriented,peoplearenotsatisfiedwiththevillageasthefocusofthework,insistongraspingbothends,withthemiddle,toconsolidateandimprove,expandfurthereffort,intherealizationofthenormallong-termefforts,toensurethattheendofthisyeartoobtainbetterresults.Third,weneedtoacceleratethevoluntaryservicesystem.Toactivelypromotethepartymembersandmembersandcadresnormalizationofvolunteerservice,doagoodjobinpublicplaces,windowunitsandcommunityvolunteerservicestationconstruction,establishmentofcoveringthewhole49 物理疗法，可促进盆腔血液循环，改善组织营养状态，提高新陈代谢以利炎症吸收和消退。各种抗菌药物也应根据细菌的敏感试验来选用。同时加用糜蛋白酶5毫克或透明质酸酶1500单位，肌肉注射，隔日1次，5-10次为一疗程，以利粘连和炎症的吸收。有明显肿块者可行手术切除。四、子宫肌瘤健康宣教1、子宫肌瘤患者在日常生活中应注意调节情绪，防止大怒大悲、多思多虑，应尽量做到知足常乐，性格开朗、豁达，避免过度劳累，这样五脏调和，气行疏畅，气行则血和，气血和则百病不生。另外，患者应注意节制房事，以防损伤肾气，加重病情。更应注意房事卫生、保持外阴清洁，以防止外邪内侵，入里化热，凝滞气血，加重病情。子宫肌瘤的形成与长期大量雌激素刺激有关，而动物实验表明，高脂肪食物促进了某些激素的生成和释放，故肥胖妇女子宫肌瘤的发生率明显升高。因此培养良好的饮食习惯，对子宫肌瘤有一定的抑制作用。2、饮食定时定量，不能暴饮暴食3、坚持低脂肪饮食，多吃瘦肉、鸡蛋、绿色蔬菜、水果等。4、多吃五谷杂粮如玉米、豆类等。5、常吃富有营养的干果类食物，如花生、芝麻、瓜子等。6、忌食辛辣、酒类、冰冻等食品。五、异位妊娠健康宣教thepublictoparticipatein,inimperceptibleprovidedLpeople'sculturalquality.Tobuiltuse"Juxianissuedonthemicrochannel,"civilizedJuxian"microchannel,Ju,networksandothermainstreamnetworkmediacontinuedtopushsendonlineisenergyinformation,andcreateagoodnetworkenvironment.Deepentheactionofthebeautifulcountrysidecivilization,tocarryoutawiderangeof"newcountryside,newlife"training,givefullplaytothevillagepopulationculturecourtyard,ParkStreet,culturalsquareandotherpositionstheroleofpublicityandeducation,promoteruralwayoflifemorecivilized.Thisyeartheprovince'surbanandruralsanitationintegrationoftheruralmassessatisfactiontelephonesurvey,significantlyimprovedperformanceinourcounty,respectively,thantheendoflastyear,yearstoimprovethe5.2,17.5percentagepoints.Thetownshipstreets.Relevantdepartmentsofcountiesunitsshouldconscientiouslysumupexperience,adheretotheproblemoriented,peoplearenotsatisfiedwiththevillageasthefocusofthework,insistongraspingbothends,withthemiddle,toconsolidateandimprove,expandfurthereffort,intherealizationofthenormallong-termefforts,toensurethattheendofthisyeartoobtainbetterresults.Third,weneedtoacceleratethevoluntaryservicesystem.Toactivelypromotethepartymembersandmembersandcadresnormalizationofvolunteerservice,doagoodjobinpublicplaces,windowunitsandcommunityvolunteerservicestationconstruction,establishmentofcoveringthewhole49 1、入院宣教：病人刚入院时因大出血精神较紧张，故先予以心理安慰，尽快使病人平静下来。并告知患者医生现予纱布紧压填塞宫颈创面、静滴止血药、输血的目的都是治疗大出血。虽然现在阴道出血少，但不能排除再次大出血可能，嘱病人卧床休息。并详细为病人及家属介绍病区环境、管床医生、护士及床头传呼器的使用等，使患者尽快消除陌生感，适应病房环境。2、心理指导：护士多巡视病房，多与患者交谈，护士态度要和蔼，操作熟练准确，以获得病人的信赖。通过交流及时了解病人情绪的变化，如患者初入院时，使用多种止血剂后，阴道仍有少量出血，故而情绪低落，有一种失望感，经过护士耐心、详细的讲解后，患者增强了治疗的信心。3、疾病宣教：因宫颈仅含少量肌纤维组织，收缩力差，血窦开放时多不能自动止血，对子宫收缩剂亦无效，故常出现难以控制的大出血。所以特别要向患者指出大出血的严重后果，向患者讲解宫颈妊娠发生的可能原因及主要临床症状，并将医生拟定的输血，阴道内纱布填塞压迫止血，液体中加入止血芳酸、止血敏、抑肽酶等止血药，静滴青霉素消炎，静推氨甲喋呤杀胚胎的各项治疗措施，及时告知患者，并详细解释各项治疗措施的目的、作用、注意事项，使患者对自己的疾病及治疗过程有初步了解，教会病人自己估计阴道出血量的方法。如发现阴道出血增多，及时告知医生或护士。因患者需动态观察B超、血HCG，故要向患者解释检查及抽血的方法、目的、意义，使患者能积极配合治疗。thepublictoparticipatein,inimperceptibleprovidedLpeople'sculturalquality.Tobuiltuse"Juxianissuedonthemicrochannel,"civilizedJuxian"microchannel,Ju,networksandothermainstreamnetworkmediacontinuedtopushsendonlineisenergyinformation,andcreateagoodnetworkenvironment.Deepentheactionofthebeautifulcountrysidecivilization,tocarryoutawiderangeof"newcountryside,newlife"training,givefullplaytothevillagepopulationculturecourtyard,ParkStreet,culturalsquareandotherpositionstheroleofpublicityandeducation,promoteruralwayoflifemorecivilized.Thisyeartheprovince'surbanandruralsanitationintegrationoftheruralmassessatisfactiontelephonesurvey,significantlyimprovedperformanceinourcounty,respectively,thantheendoflastyear,yearstoimprovethe5.2,17.5percentagepoints.Thetownshipstreets.Relevantdepartmentsofcountiesunitsshouldconscientiouslysumupexperience,adheretotheproblemoriented,peoplearenotsatisfiedwiththevillageasthefocusofthework,insistongraspingbothends,withthemiddle,toconsolidateandimprove,expandfurthereffort,intherealizationofthenormallong-termefforts,toensurethattheendofthisyeartoobtainbetterresults.Third,weneedtoacceleratethevoluntaryservicesystem.Toactivelypromotethepartymembersandmembersandcadresnormalizationofvolunteerservice,doagoodjobinpublicplaces,windowunitsandcommunityvolunteerservicestationconstruction,establishmentofcoveringthewhole49 4、用药宣教：对所用药物的作用及副作用、注意事项均及时告知患者。MTX化疗时，护士应耐心、详细地讲解化疗知识，要将可能出现的食欲不振、恶心呕吐、头晕、乏力、口腔溃疡等毒副反应告知患者，并向患者说明化疗后7～14天，血中的细胞将降到最低点，这段时间机体的抵抗力及免疫力也将下降，要严防感染。5、手术治疗宣教：宫颈妊娠治疗原则是立即终止妊娠，在方法上一般分为根治疗法和保守疗法。考虑到该患者已婚未曾生育，患者本人及家属强烈要求保住子宫，故对本例患者采取了止血、MTX化疗等保守治疗。同时清楚地告知患者，在保守治疗期间如出现意外或出血仍不止，即需要行子宫全切术，让患者对自己疾病的变化有充分的思想准备。6、饮食宣教：嘱患者补充营养，多进食含蛋白质、维生素丰富的食物，保持大便通畅。因患者贫血，故应多进食含铁丰富的波菜、木耳、红枣等食物。MTX化疗期间，宜吃无骨、无刺的软食，多漱口，严防口腔溃疡的发生。高热期间宜进食高热量、易消化食物，应少量多餐、多饮开水、注意漱口。7、出院宣教：告诫患者出院后仍需复查B超、血HCG，如出现异常随时复诊。MTX化疗后，短期内免疫功能下降，要防止再次感冒及继发感染。忌房事、盆浴2个月，保持外阴清洁卫生。注意休息，加强营养。thepublictoparticipatein,inimperceptibleprovidedLpeople'sculturalquality.Tobuiltuse"Juxianissuedonthemicrochannel,"civilizedJuxian"microchannel,Ju,networksandothermainstreamnetworkmediacontinuedtopushsendonlineisenergyinformation,andcreateagoodnetworkenvironment.Deepentheactionofthebeautifulcountrysidecivilization,tocarryoutawiderangeof"newcountryside,newlife"training,givefullplaytothevillagepopulationculturecourtyard,ParkStreet,culturalsquareandotherpositionstheroleofpublicityandeducation,promoteruralwayoflifemorecivilized.Thisyeartheprovince'surbanandruralsanitationintegrationoftheruralmassessatisfactiontelephonesurvey,significantlyimprovedperformanceinourcounty,respectively,thantheendoflastyear,yearstoimprovethe5.2,17.5percentagepoints.Thetownshipstreets.Relevantdepartmentsofcountiesunitsshouldconscientiouslysumupexperience,adheretotheproblemoriented,peoplearenotsatisfiedwiththevillageasthefocusofthework,insistongraspingbothends,withthemiddle,toconsolidateandimprove,expandfurthereffort,intherealizationofthenormallong-termefforts,toensurethattheendofthisyeartoobtainbetterresults.Third,weneedtoacceleratethevoluntaryservicesystem.Toactivelypromotethepartymembersandmembersandcadresnormalizationofvolunteerservice,doagoodjobinpublicplaces,windowunitsandcommunityvolunteerservicestationconstruction,establishmentofcoveringthewhole49 六、功能失调性子宫出血一般健康宣教1.注意调节情志，避免过度精神刺激。2.重视饮食调养，勿过食辛辣、生冷食品。3.注意经期卫生。4.搞好计划生育。5.早期治疗月经先期、月经量多、经期延长等月经失调疾病。6.出血期间避免重体力劳动，必要时卧床休息。禁性生活。七、葡萄胎健康宣教1、葡萄胎所有葡萄胎患者皆应嘱告定期随诊，最好长期与医院取得联系，更重要是在2内定期复查目的在于早期发现恶变，但有时也可能有残存的水泡状胎块。应劝告患者至少在2年内采取有效避孕措施最初半年应每月复查一次。如发生不规则阴道流血、咯血头痛或其他不适时，应立即到医院检查。复查时除询问月经是否正常外还应注意有无上述症状。检查时应注意子宫是否复理良好，阴道外阴有无紫蓝色结节，胸透（最好胸部拍片）有阴影存在。妊娠试验在随诊中非常重要葡萄胎完全清除后，约60%以上患者30天内妊娠试验转阴性。超过40天仍为阳性者应高度怀疑恶变或仍残存水泡状胎块thepublictoparticipatein,inimperceptibleprovidedLpeople'sculturalquality.Tobuiltuse"Juxianissuedonthemicrochannel,"civilizedJuxian"microchannel,Ju,networksandothermainstreamnetworkmediacontinuedtopushsendonlineisenergyinformation,andcreateagoodnetworkenvironment.Deepentheactionofthebeautifulcountrysidecivilization,tocarryoutawiderangeof"newcountryside,newlife"training,givefullplaytothevillagepopulationculturecourtyard,ParkStreet,culturalsquareandotherpositionstheroleofpublicityandeducation,promoteruralwayoflifemorecivilized.Thisyeartheprovince'surbanandruralsanitationintegrationoftheruralmassessatisfactiontelephonesurvey,significantlyimprovedperformanceinourcounty,respectively,thantheendoflastyear,yearstoimprovethe5.2,17.5percentagepoints.Thetownshipstreets.Relevantdepartmentsofcountiesunitsshouldconscientiouslysumupexperience,adheretotheproblemoriented,peoplearenotsatisfiedwiththevillageasthefocusofthework,insistongraspingbothends,withthemiddle,toconsolidateandimprove,expandfurthereffort,intherealizationofthenormallong-termefforts,toensurethattheendofthisyeartoobtainbetterresults.Third,weneedtoacceleratethevoluntaryservicesystem.Toactivelypromotethepartymembersandmembersandcadresnormalizationofvolunteerservice,doagoodjobinpublicplaces,windowunitsandcommunityvolunteerservicestationconstruction,establishmentofcoveringthewhole49 妊娠试验已转阴复诊中又转阳者，如非妊娠，应高度怀疑恶变如原尿阳性，稀释试验已转阴性，复诊中稀释试验又转阳性尤其是稀释度增高者，亦应高度怀疑恶变。2、葡萄胎术后须防恶变葡萄胎是一种因妊娠引起的疾病。正常妊娠子宫腔内应是胎儿与胎盘，而葡萄胎患者的子宫内却没有胎儿与胎盘，而是充满了无数大小不等的水泡状组织，因这些水泡累成串，酷似葡萄而得名。绝大多数的葡萄胎是良性的，治疗主要是通过刮宫术，清除宫腔内物。一些葡萄胎患者经刮宫治疗后，便以为一切已经过去，可以高枕无忧了。若有这种想法是很危险的，因为大约有10%~20%的患者术后有可能发生恶性变。葡萄胎易恶变易转移葡萄胎恶性变的结果有两种：侵蚀性葡萄胎（又称恶性葡萄胎）与绒毛膜癌，两者的临床表现和治疗相似，只是绒毛膜癌的恶性程度更高，更容易发生远处转移，且转移的发生既早又广泛。葡萄胎患者刮宫术后半个月中，阴道出血多可停止。若刮宫术后数月又出现不规则阴道出血，量多少不定，或刮宫术后半个多月阴道仍有出血，持续不止，在排除葡萄胎残留后，应怀疑恶性变的可能。刮宫术后1~2个月，妇科检查发现子宫仍未恢复正常大小，或子宫旁边有包块，且伴有腹痛者，应及时作血绒毛膜促性腺激素（HCG）和B超检查，以明确有无发生恶性变。thepublictoparticipatein,inimperceptibleprovidedLpeople'sculturalquality.Tobuiltuse"Juxianissuedonthemicrochannel,"civilizedJuxian"microchannel,Ju,networksandothermainstreamnetworkmediacontinuedtopushsendonlineisenergyinformation,andcreateagoodnetworkenvironment.Deepentheactionofthebeautifulcountrysidecivilization,tocarryoutawiderangeof"newcountryside,newlife"training,givefullplaytothevillagepopulationculturecourtyard,ParkStreet,culturalsquareandotherpositionstheroleofpublicityandeducation,promoteruralwayoflifemorecivilized.Thisyeartheprovince'surbanandruralsanitationintegrationoftheruralmassessatisfactiontelephonesurvey,significantlyimprovedperformanceinourcounty,respectively,thantheendoflastyear,yearstoimprovethe5.2,17.5percentagepoints.Thetownshipstreets.Relevantdepartmentsofcountiesunitsshouldconscientiouslysumupexperience,adheretotheproblemoriented,peoplearenotsatisfiedwiththevillageasthefocusofthework,insistongraspingbothends,withthemiddle,toconsolidateandimprove,expandfurthereffort,intherealizationofthenormallong-termefforts,toensurethattheendofthisyeartoobtainbetterresults.Third,weneedtoacceleratethevoluntaryservicesystem.Toactivelypromotethepartymembersandmembersandcadresnormalizationofvolunteerservice,doagoodjobinpublicplaces,windowunitsandcommunityvolunteerservicestationconstruction,establishmentofcoveringthewhole49 葡萄胎恶变后容易转移，最常见的转移器官为肺，其次为阴道，脑转移又次之。肺转移者主要症状为咳嗽、血痰、咯血及胸痛等。胸部X线摄片是最简便易行的诊断方法，可在胸片上发现小结节状阴影；稍晚，症灶可呈棉絮状阴道转移者，阴道壁上可发现紫蓝色隆起的结节，转移结节一旦破溃可发生大出血。脑转移多继发于肺转移后，是致死的主要原因。早期瘤检阶段多表现为一过性的失误、失明等症状；以后进入脑瘤期，可出现头痛、呕吐、偏瘫及昏迷等症状，若未能及时控制病情，颅内压持续升高，可引起脑疝而死亡。3、刮宫术后的随访要坚持2年葡萄胎刮宫治疗后需随访的原因有：一是因葡萄胎术后发生恶性变的机会较大，二是一旦发生恶性变后，容易通过血液循环向远处转移，常常子宫病变的症状尚未出现，却已有远处器官的转移了。因此，葡萄胎刮宫术后定期随访，对早期发现恶变，及时接受治疗，争取较好的治疗效果，有着极为重要的意义。葡萄胎刮宫术后，应每周作一次HCG定量测量，直到降到正常水平。开始3个月应每周复查一次，此后3个月中，每半个月一次，以后每月一次应持续半年，每二年起改为每半年一次，共随访二年。随访中，除监测HCG外，还须注意有无阴道异常出血、咳嗽、咯血及转移器官的相应症状，进行妇科检查、盆腔B超以及X线胸片检查等。在随访的二年内，应坚持采取安全套或阴道融膜避孕，宫内节育器会引起子宫异常出血，易与术后恶性变引起的阴道出血相混淆；含有雌激素的避孕有促进滋养细胞生长的作用，故都不能采用。4、高危患者预防性化疗或减少恶变发生thepublictoparticipatein,inimperceptibleprovidedLpeople'sculturalquality.Tobuiltuse"Juxianissuedonthemicrochannel,"civilizedJuxian"microchannel,Ju,networksandothermainstreamnetworkmediacontinuedtopushsendonlineisenergyinformation,andcreateagoodnetworkenvironment.Deepentheactionofthebeautifulcountrysidecivilization,tocarryoutawiderangeof"newcountryside,newlife"training,givefullplaytothevillagepopulationculturecourtyard,ParkStreet,culturalsquareandotherpositionstheroleofpublicityandeducation,promoteruralwayoflifemorecivilized.Thisyeartheprovince'surbanandruralsanitationintegrationoftheruralmassessatisfactiontelephonesurvey,significantlyimprovedperformanceinourcounty,respectively,thantheendoflastyear,yearstoimprovethe5.2,17.5percentagepoints.Thetownshipstreets.Relevantdepartmentsofcountiesunitsshouldconscientiouslysumupexperience,adheretotheproblemoriented,peoplearenotsatisfiedwiththevillageasthefocusofthework,insistongraspingbothends,withthemiddle,toconsolidateandimprove,expandfurthereffort,intherealizationofthenormallong-termefforts,toensurethattheendofthisyeartoobtainbetterresults.Third,weneedtoacceleratethevoluntaryservicesystem.Toactivelypromotethepartymembersandmembersandcadresnormalizationofvolunteerservice,doagoodjobinpublicplaces,windowunitsandcommunityvolunteerservicestationconstruction,establishmentofcoveringthewhole49 由于葡萄胎是一种因妊娠引起的疾病，只要做好计划生育，落实避孕措施，减少妊娠次数就可免患葡萄胎，尤其是40岁以上妇女尽可能不再妊娠，因为高龄妊娠不仅葡萄胎的发生率高，而且容易发生恶性变。发生葡萄胎后要提防术后恶变。葡萄胎刮宫术后严密观察HCG的变化是提防恶变的最主要的措施。刮宫术后12周以上，HCG持续高于正常水平，或曾一度降至正常水平后又迅速升高，在排除残余葡萄胎与再妊娠后，提示患者已处于恶性葡萄胎的早期阶段，应及时给予化疗。预防葡萄胎术后恶性变，迄今尚无理想的办法，但对有恶变倾向的高危患者预防性化疗有可能减少恶变的发生。年龄大于40岁、子宫明显大于经月份达到或超过5个月大小、HCG值异常升高大于105IU/L及家庭偏远难以随访者，可采取预防性化疗。预防性化疗应于刮宫前2~3天开始。对刮宫术中发现葡萄胎以小水泡为主，或病理检查发现滋养细胞高度增生，或伴有不典型增生者，或刮宫术后HCG下降到一定高值后，不再继续下降者，可采取选择性化疗，也有减少恶变的作用。5、随访 （1）HCG定量测定，葡萄胎排空后每周一次，直至降低至正常水平。随后3个月内仍每周一次，此后3个月每2周一次，然后每个月一次持续至少半年。如第二年未怀孕，可每半年一次，共随访2年。thepublictoparticipatein,inimperceptibleprovidedLpeople'sculturalquality.Tobuiltuse"Juxianissuedonthemicrochannel,"civilizedJuxian"microchannel,Ju,networksandothermainstreamnetworkmediacontinuedtopushsendonlineisenergyinformation,andcreateagoodnetworkenvironment.Deepentheactionofthebeautifulcountrysidecivilization,tocarryoutawiderangeof"newcountryside,newlife"training,givefullplaytothevillagepopulationculturecourtyard,ParkStreet,culturalsquareandotherpositionstheroleofpublicityandeducation,promoteruralwayoflifemorecivilized.Thisyeartheprovince'surbanandruralsanitationintegrationoftheruralmassessatisfactiontelephonesurvey,significantlyimprovedperformanceinourcounty,respectively,thantheendoflastyear,yearstoimprovethe5.2,17.5percentagepoints.Thetownshipstreets.Relevantdepartmentsofcountiesunitsshouldconscientiouslysumupexperience,adheretotheproblemoriented,peoplearenotsatisfiedwiththevillageasthefocusofthework,insistongraspingbothends,withthemiddle,toconsolidateandimprove,expandfurthereffort,intherealizationofthenormallong-termefforts,toensurethattheendofthisyeartoobtainbetterresults.Third,weneedtoacceleratethevoluntaryservicesystem.Toactivelypromotethepartymembersandmembersandcadresnormalizationofvolunteerservice,doagoodjobinpublicplaces,windowunitsandcommunityvolunteerservicestationconstruction,establishmentofcoveringthewhole49 （2）注意月经是否规则，有无异常阴道流血、咳嗽、咯血及其他转移灶症状，并作妇科检查。选择一定间隔作盆腔B型超声，必要时X线胸片检查也可重复进行。葡萄胎随访期间必须严格避孕一年，首选避孕套，不宜使用宫内节育器，以免穿孔或混淆子宫出血原因。八、终止妊娠健康宣教1 、入院的宣教：1.建立良好的护患关系 患者进入病房后，建立良好的护患关系是有效完成健康教育的基础，护士热情接待患者，告知患者住院环境，在护理过程中用征询的口吻和关心的态度与患者沟通，使他们以轻松、愉快、可信赖的态度接受治疗和护理。2.通过患者自由选择终止妊娠的方式 护士执行医嘱给药时与患者建立友好关系，护士亲切的态度会使患者愉快信任护士，配合服药。3.服药宣教 以亲切友善的态度交代患者，服药米非司酮前后需空腹2h，用凉开水送服，第三天口服米索前列醇前测生命体征，服药前后空腹2h，服药后有不规则的腹痛和少许阴道流血以及注意观察阴道排出物，并保留标本留待护士查看，只有把服药的各项注意事项交代清楚，患者才能配合。服药期间给予饮食上的指导，进食有营养及易消化的食物。2 、心理指导： 1 .对未婚先孕患者 thepublictoparticipatein,inimperceptibleprovidedLpeople'sculturalquality.Tobuiltuse"Juxianissuedonthemicrochannel,"civilizedJuxian"microchannel,Ju,networksandothermainstreamnetworkmediacontinuedtopushsendonlineisenergyinformation,andcreateagoodnetworkenvironment.Deepentheactionofthebeautifulcountrysidecivilization,tocarryoutawiderangeof"newcountryside,newlife"training,givefullplaytothevillagepopulationculturecourtyard,ParkStreet,culturalsquareandotherpositionstheroleofpublicityandeducation,promoteruralwayoflifemorecivilized.Thisyeartheprovince'surbanandruralsanitationintegrationoftheruralmassessatisfactiontelephonesurvey,significantlyimprovedperformanceinourcounty,respectively,thantheendoflastyear,yearstoimprovethe5.2,17.5percentagepoints.Thetownshipstreets.Relevantdepartmentsofcountiesunitsshouldconscientiouslysumupexperience,adheretotheproblemoriented,peoplearenotsatisfiedwiththevillageasthefocusofthework,insistongraspingbothends,withthemiddle,toconsolidateandimprove,expandfurthereffort,intherealizationofthenormallong-termefforts,toensurethattheendofthisyeartoobtainbetterresults.Third,weneedtoacceleratethevoluntaryservicesystem.Toactivelypromotethepartymembersandmembersandcadresnormalizationofvolunteerservice,doagoodjobinpublicplaces,windowunitsandcommunityvolunteerservicestationconstruction,establishmentofcoveringthewhole49 由于是不正常性行为而导致未婚先孕，故多有胆怯、羞愧、自责等心理，护士可以在温馨的环境下以尊重人、和蔼、注意保护隐私的方式开展心理辅导，帮助她们解决心理问题。 2 .对稽留流产和避孕失败的患者 护士通过关心和以热情的态度对待患者，给予耐心解释，安慰和疏导，关注患者情绪，及时告知治疗护理情况，让患者充分享受知情权，使患者感受到精神上、心理上的支持。3 .排胎后的指导:（1）指导患者进食多样化，富含营养，忌辛辣、生冷的食物.（2）避免奶胀，按医嘱用药，告知回奶的方法。（3）鼓励患者尽早下床活动，促进恶露排出。（4）指导排胎后的卫生保健及生殖健康的有关知识，帮助患者了解健康的性行为及指导正确的避孕方法，禁性生活1个月。 一、孕妇入院健康宣教1、 入院宣教：产妇入院后，应先领其熟悉病房环境，介绍作息时间，陪护制度等。并进行饮食指导，使其消除陌生感，增加对医护人员的信任。2 、住院教育thepublictoparticipatein,inimperceptibleprovidedLpeople'sculturalquality.Tobuiltuse"Juxianissuedonthemicrochannel,"civilizedJuxian"microchannel,Ju,networksandothermainstreamnetworkmediacontinuedtopushsendonlineisenergyinformation,andcreateagoodnetworkenvironment.Deepentheactionofthebeautifulcountrysidecivilization,tocarryoutawiderangeof"newcountryside,newlife"training,givefullplaytothevillagepopulationculturecourtyard,ParkStreet,culturalsquareandotherpositionstheroleofpublicityandeducation,promoteruralwayoflifemorecivilized.Thisyeartheprovince'surbanandruralsanitationintegrationoftheruralmassessatisfactiontelephonesurvey,significantlyimprovedperformanceinourcounty,respectively,thantheendoflastyear,yearstoimprovethe5.2,17.5percentagepoints.Thetownshipstreets.Relevantdepartmentsofcountiesunitsshouldconscientiouslysumupexperience,adheretotheproblemoriented,peoplearenotsatisfiedwiththevillageasthefocusofthework,insistongraspingbothends,withthemiddle,toconsolidateandimprove,expandfurthereffort,intherealizationofthenormallong-termefforts,toensurethattheendofthisyeartoobtainbetterresults.Third,weneedtoacceleratethevoluntaryservicesystem.Toactivelypromotethepartymembersandmembersandcadresnormalizationofvolunteerservice,doagoodjobinpublicplaces,windowunitsandcommunityvolunteerservicestationconstruction,establishmentofcoveringthewhole49 1.产前宣教 要根据孕妇的不同情况进行心理咨询与指导，使她们了解妊娠及分娩的全过程与相关知识和技能，解除其在自然分娩过程中的不必要心理负担，减少剖宫产。作好医学知识宣教，如讲解如何识别分娩先兆，正常的分娩过程，产后进行母乳喂养的重要性。解除不良临产心理，增加对分娩的信心，做好充分的自然分娩准备。2 .产时宣教 护士应热情地向产妇讲解待产过程中每一项检查的目的。通过交谈、握手、抚摸等方式使其转移宫缩痛时的注意力，同时不断给予精神上的安慰与解释，给予产妇鼓励与表扬，指导其如何正确用力，以便配合医护工作，使其缩短产程尽快结束分娩。3 .产后宣教 告诉产妇应尽早解小便，排空膀胱，一般为4～6h内，以免影响子宫收缩；24h后应下床活动；保持会阴部清洁，以防产褥期感染；多食半流质、清淡易消化食物，促进乳汁尽早分泌；指导母乳喂养方法与技巧等。3 、出院指导：（1）饮食：宜多样化，要富含蛋白质、矿物质和维生素。（2）产褥期禁房事，一般49天后子宫创面恢复。禁盆浴，避免逆行感染。（3）注意避孕，哺乳期一般不来月经，但有可能排卵，所以要做好避孕措施。thepublictoparticipatein,inimperceptibleprovidedLpeople'sculturalquality.Tobuiltuse"Juxianissuedonthemicrochannel,"civilizedJuxian"microchannel,Ju,networksandothermainstreamnetworkmediacontinuedtopushsendonlineisenergyinformation,andcreateagoodnetworkenvironment.Deepentheactionofthebeautifulcountrysidecivilization,tocarryoutawiderangeof"newcountryside,newlife"training,givefullplaytothevillagepopulationculturecourtyard,ParkStreet,culturalsquareandotherpositionstheroleofpublicityandeducation,promoteruralwayoflifemorecivilized.Thisyeartheprovince'surbanandruralsanitationintegrationoftheruralmassessatisfactiontelephonesurvey,significantlyimprovedperformanceinourcounty,respectively,thantheendoflastyear,yearstoimprovethe5.2,17.5percentagepoints.Thetownshipstreets.Relevantdepartmentsofcountiesunitsshouldconscientiouslysumupexperience,adheretotheproblemoriented,peoplearenotsatisfiedwiththevillageasthefocusofthework,insistongraspingbothends,withthemiddle,toconsolidateandimprove,expandfurthereffort,intherealizationofthenormallong-termefforts,toensurethattheendofthisyeartoobtainbetterresults.Third,weneedtoacceleratethevoluntaryservicesystem.Toactivelypromotethepartymembersandmembersandcadresnormalizationofvolunteerservice,doagoodjobinpublicplaces,windowunitsandcommunityvolunteerservicestationconstruction,establishmentofcoveringthewhole49 （4）如阴道流血时间较长，应及时到医院就诊。通过对孕产妇实施心理健康教育，改变了她们传统的观念，增长了医学知识。了解到有关产褥保健方面的知识，同时改善了护患关系，加强了护患交流。护理人员的自身价值得以体现，激发了学习热情，拓宽了知识面，使其在工作中不断提高自身素质。 二、正常产程健康宣教1、第一产程：又称宫颈扩张期。从开始出现间歇5～6分钟的规律宫缩，到宫口开全。初产妇需11～12小时，经产妇需6～8小时。2、第二产程：又称胎儿娩出期。从宫口开全到胎儿娩出。初产妇需1～2小时，经产妇通常数分钟即可完成，但也有长达1小时者。3、第三产程：又称胎盘娩出期。从胎儿娩出到胎盘娩出，需5～15分钟，不超过30分钟。（一）第一产程的临床经过及处理1.临床表现：（1）规律宫缩：产程开始时，宫缩持续时间约30秒，间歇期5～6分钟。随着产程进展，持续时间延长至50～60秒，间歇期2～3分钟。当宫口近开全时，宫缩持续时间长达1分钟或1分钟以上，间歇期仅1分钟或稍长。thepublictoparticipatein,inimperceptibleprovidedLpeople'sculturalquality.Tobuiltuse"Juxianissuedonthemicrochannel,"civilizedJuxian"microchannel,Ju,networksandothermainstreamnetworkmediacontinuedtopushsendonlineisenergyinformation,andcreateagoodnetworkenvironment.Deepentheactionofthebeautifulcountrysidecivilization,tocarryoutawiderangeof"newcountryside,newlife"training,givefullplaytothevillagepopulationculturecourtyard,ParkStreet,culturalsquareandotherpositionstheroleofpublicityandeducation,promoteruralwayoflifemorecivilized.Thisyeartheprovince'surbanandruralsanitationintegrationoftheruralmassessatisfactiontelephonesurvey,significantlyimprovedperformanceinourcounty,respectively,thantheendoflastyear,yearstoimprovethe5.2,17.5percentagepoints.Thetownshipstreets.Relevantdepartmentsofcountiesunitsshouldconscientiouslysumupexperience,adheretotheproblemoriented,peoplearenotsatisfiedwiththevillageasthefocusofthework,insistongraspingbothends,withthemiddle,toconsolidateandimprove,expandfurthereffort,intherealizationofthenormallong-termefforts,toensurethattheendofthisyeartoobtainbetterresults.Third,weneedtoacceleratethevoluntaryservicesystem.Toactivelypromotethepartymembersandmembersandcadresnormalizationofvolunteerservice,doagoodjobinpublicplaces,windowunitsandcommunityvolunteerservicestationconstruction,establishmentofcoveringthewhole49 （2）宫口扩张：当宫缩渐频且不断增强时，宫颈管逐渐短缩直至消失，宫口逐渐扩张。宫口扩张于潜伏期速度较慢，进入活跃期后扩张速度加快。当宫口开全时，子宫下段及阴道形成宽阔的筒腔。（3）胎头下降程度：定时行肛门检查，以明确胎头颅骨最低点的位置，并能协助判断胎位。（4）胎膜破裂：在胎先露部前面的羊水量不多约1OOml，称为前羊水，形成的前羊水囊称为胎胞，它有助于扩张宫口。宫缩继续增强，当羊膜腔压力增加到一定程度时自然破膜。破膜多发生在宫口近开全时。2.观察产程进展及处理（1）子宫收缩：最简单的方法是由助产人员以一手手掌放于产妇腹壁上，定时连续观察宫缩持续时间、强度、规律性以及间歇期时间，并予以记录。用胎儿监护仪描记的宫缩曲线，可以看出宫缩强度、频率和每次宫缩持续时间，是较全面反映宫缩的客观指标。监护仪有外监护与内监护两种类型，外监护临床上最常用。（2）胎心：用听诊器于潜伏期在宫缩间歇时每隔1～2小时听胎心一次。进入活跃期后，宫缩频繁时应每15～30分钟听胎心一次，每次听诊1分钟。thepublictoparticipatein,inimperceptibleprovidedLpeople'sculturalquality.Tobuiltuse"Juxianissuedonthemicrochannel,"civilizedJuxian"microchannel,Ju,networksandothermainstreamnetworkmediacontinuedtopushsendonlineisenergyinformation,andcreateagoodnetworkenvironment.Deepentheactionofthebeautifulcountrysidecivilization,tocarryoutawiderangeof"newcountryside,newlife"training,givefullplaytothevillagepopulationculturecourtyard,ParkStreet,culturalsquareandotherpositionstheroleofpublicityandeducation,promoteruralwayoflifemorecivilized.Thisyeartheprovince'surbanandruralsanitationintegrationoftheruralmassessatisfactiontelephonesurvey,significantlyimprovedperformanceinourcounty,respectively,thantheendoflastyear,yearstoimprovethe5.2,17.5percentagepoints.Thetownshipstreets.Relevantdepartmentsofcountiesunitsshouldconscientiouslysumupexperience,adheretotheproblemoriented,peoplearenotsatisfiedwiththevillageasthefocusofthework,insistongraspingbothends,withthemiddle,toconsolidateandimprove,expandfurthereffort,intherealizationofthenormallong-termefforts,toensurethattheendofthisyeartoobtainbetterresults.Third,weneedtoacceleratethevoluntaryservicesystem.Toactivelypromotethepartymembersandmembersandcadresnormalizationofvolunteerservice,doagoodjobinpublicplaces,windowunitsandcommunityvolunteerservicestationconstruction,establishmentofcoveringthewhole49 （3）宫口扩张及胎头下降：产程图中宫口扩张曲线将第一产程分为潜伏期和活跃期。潜伏期是指从临产出现规律宫缩开始至宫口扩张3cm.此期间扩张速度较慢，平均每2～3小时扩张1cm，约需8小时，最大时限为16小时，超过16小时称为潜伏期延长。活跃期是指宫口扩张3～1Ocm.此期间扩张速度明显加快，约需4小时，最大时限为8小时，超过8小时称为活跃期延长，可疑有难产因素存在。活跃期划分3期，最初是加速期，是指宫口扩张3～4cm，约需1.5小时；接着是最大加速期，是指宫口扩张4～9cm，约需2小时；最后是减速期，是指宫口扩张9～1Ocm，约需30分钟，然后进入第二产程。胎头下降曲线是以胎头颅骨最低点与坐骨棘平面的关系标明。坐骨棘平面是判断胎头高低的标志。胎头颅骨最低点平坐骨棘时，以"0"表达；在坐骨棘平面上1cm时，以"-1"表达；在坐骨棘平面下1cm时，以"+1"表达，余依此类推。（4）胎膜破裂：胎膜多在宫口近开全时自然破裂，前羊水流出。若先露为胎头，羊水呈黄绿色混有胎粪，应立即行阴道检查，注意有无脐带脱垂，并给予紧急处理。若羊水清而胎头浮未入盆时需卧床，以防脐带脱垂。若破膜超过12小时尚未分娩者，酌情给予抗炎药物预防感染。（5）精神安慰。（6）血压：应每隔4～6小时测量一次。thepublictoparticipatein,inimperceptibleprovidedLpeople'sculturalquality.Tobuiltuse"Juxianissuedonthemicrochannel,"civilizedJuxian"microchannel,Ju,networksandothermainstreamnetworkmediacontinuedtopushsendonlineisenergyinformation,andcreateagoodnetworkenvironment.Deepentheactionofthebeautifulcountrysidecivilization,tocarryoutawiderangeof"newcountryside,newlife"training,givefullplaytothevillagepopulationculturecourtyard,ParkStreet,culturalsquareandotherpositionstheroleofpublicityandeducation,promoteruralwayoflifemorecivilized.Thisyeartheprovince'surbanandruralsanitationintegrationoftheruralmassessatisfactiontelephonesurvey,significantlyimprovedperformanceinourcounty,respectively,thantheendoflastyear,yearstoimprovethe5.2,17.5percentagepoints.Thetownshipstreets.Relevantdepartmentsofcountiesunitsshouldconscientiouslysumupexperience,adheretotheproblemoriented,peoplearenotsatisfiedwiththevillageasthefocusofthework,insistongraspingbothends,withthemiddle,toconsolidateandimprove,expandfurthereffort,intherealizationofthenormallong-termefforts,toensurethattheendofthisyeartoobtainbetterresults.Third,weneedtoacceleratethevoluntaryservicesystem.Toactivelypromotethepartymembersandmembersandcadresnormalizationofvolunteerservice,doagoodjobinpublicplaces,windowunitsandcommunityvolunteerservicestationconstruction,establishmentofcoveringthewhole49 （7）饮食：鼓励产妇少量多次进食，以保证精力和体力充沛。（8）活动与休息：临产后，可在病房内适当活动。若初产妇宫口近开全，或经产妇宫口已扩张4cm时，应卧床并行左侧卧位。（9）排尿与排便：临产后，应鼓励产妇每2～4小时排尿一次。若初产妇宫口扩张＜4cm、经产妇＜2cm时，应行温肥皂水灌肠，加速产程进展。但胎膜早破、阴道流血、胎头未衔接、胎位异常、有剖宫产史、宫缩很强估计一小时内即将分娩以及患严重心脏病等，均不宜灌肠。（10）肛门检查：临产后，应适时在宫缩时行肛门检查（简称肛查）。临产初期隔4小时查一次，经产妇或宫缩频者的间隔应缩短。肛查可以了解宫颈软硬程度、厚薄，宫口扩张程度，是否已破膜，骨盆腔大小，确定胎位以及胎头下降程度。（11）阴道检查：应在严密消毒后进行。阴道检查能直接摸清胎头，并能触清矢状缝及囟门确定胎位、宫口扩张程度，以决定其分娩方式。适用于肛查胎先露部不明、宫口扩张及胎头下降程度不明、疑有脐带先露或脱垂、轻度头盆不称经试产4小时产程进展缓慢者。严密消毒后进行的阴道检查并不增加感染机会。（12）其他：外阴部应剃除阴毛，并用肥皂水和温开水清洗；初产妇及有难产史的经产妇，应再次行骨盆外测量。（二）第二产程的临床经过及处理thepublictoparticipatein,inimperceptibleprovidedLpeople'sculturalquality.Tobuiltuse"Juxianissuedonthemicrochannel,"civilizedJuxian"microchannel,Ju,networksandothermainstreamnetworkmediacontinuedtopushsendonlineisenergyinformation,andcreateagoodnetworkenvironment.Deepentheactionofthebeautifulcountrysidecivilization,tocarryoutawiderangeof"newcountryside,newlife"training,givefullplaytothevillagepopulationculturecourtyard,ParkStreet,culturalsquareandotherpositionstheroleofpublicityandeducation,promoteruralwayoflifemorecivilized.Thisyeartheprovince'surbanandruralsanitationintegrationoftheruralmassessatisfactiontelephonesurvey,significantlyimprovedperformanceinourcounty,respectively,thantheendoflastyear,yearstoimprovethe5.2,17.5percentagepoints.Thetownshipstreets.Relevantdepartmentsofcountiesunitsshouldconscientiouslysumupexperience,adheretotheproblemoriented,peoplearenotsatisfiedwiththevillageasthefocusofthework,insistongraspingbothends,withthemiddle,toconsolidateandimprove,expandfurthereffort,intherealizationofthenormallong-termefforts,toensurethattheendofthisyeartoobtainbetterresults.Third,weneedtoacceleratethevoluntaryservicesystem.Toactivelypromotethepartymembersandmembersandcadresnormalizationofvolunteerservice,doagoodjobinpublicplaces,windowunitsandcommunityvolunteerservicestationconstruction,establishmentofcoveringthewhole49 1.临床表现：宫口开全后，若仍未破膜，常影响胎头下降，应行人工破膜。于宫缩时胎头露出于阴道口，露出部分不断增大，在宫缩间歇期，胎头又缩回阴道内，称为胎头拨露，直至胎头双顶径越过骨盆出口，宫缩间歇时胎头也不再缩回，称为胎头着冠，然后娩出胎头。接着出现胎头复位及外旋转后，前肩和后肩相继娩出，胎体很快娩出，后羊水随之涌出。2.观察产程进展及处理（1）密切监测胎心：应勤听胎心，通常应每5～10分钟听一次，要时用胎儿监护仪观察胎心率及其基线变异。（2）指导产妇屏气：宫口开全后，指导产妇正确运用腹压。（3）接产准备：初产妇宫口开全、经产妇宫口扩张4cm且宫缩规律有力时，作好接产准备工作。（4）接产（1）会阴撕裂的诱因：会阴炎症水肿、会阴过紧缺乏弹性、耻骨弓过低、胎儿过大、胎儿娩出过速等，均容易造成会阴撕裂。（2）接产要领：协助胎头俯屈，让胎头以最小径线在宫缩间歇时缓慢地通过阴道口，是预防会阴撕裂的关键，还必须正确娩出胎肩，胎肩娩出时也要注意保护好会阴。（3）接产步骤：接产者站在产妇右侧。当胎头拨露使阴唇后联合紧张时，应开始保护会阴。thepublictoparticipatein,inimperceptibleprovidedLpeople'sculturalquality.Tobuiltuse"Juxianissuedonthemicrochannel,"civilizedJuxian"microchannel,Ju,networksandothermainstreamnetworkmediacontinuedtopushsendonlineisenergyinformation,andcreateagoodnetworkenvironment.Deepentheactionofthebeautifulcountrysidecivilization,tocarryoutawiderangeof"newcountryside,newlife"training,givefullplaytothevillagepopulationculturecourtyard,ParkStreet,culturalsquareandotherpositionstheroleofpublicityandeducation,promoteruralwayoflifemorecivilized.Thisyeartheprovince'surbanandruralsanitationintegrationoftheruralmassessatisfactiontelephonesurvey,significantlyimprovedperformanceinourcounty,respectively,thantheendoflastyear,yearstoimprovethe5.2,17.5percentagepoints.Thetownshipstreets.Relevantdepartmentsofcountiesunitsshouldconscientiouslysumupexperience,adheretotheproblemoriented,peoplearenotsatisfiedwiththevillageasthefocusofthework,insistongraspingbothends,withthemiddle,toconsolidateandimprove,expandfurthereffort,intherealizationofthenormallong-termefforts,toensurethattheendofthisyeartoobtainbetterresults.Third,weneedtoacceleratethevoluntaryservicesystem.Toactivelypromotethepartymembersandmembersandcadresnormalizationofvolunteerservice,doagoodjobinpublicplaces,windowunitsandcommunityvolunteerservicestationconstruction,establishmentofcoveringthewhole49 （4）会阴切开指征：会阴过紧或胎儿过大，估计分娩时会阴撕裂不可避免者，或母儿有病理情况急需结束分娩者。 （5）会阴切开术：包括会阴后-侧切开术及会阴正中切开术。（三）第三产程的临床经过及处理1.胎盘剥离征象（1）子宫体变硬呈球形，胎盘剥离后降至子宫下段，下段被扩张，子宫体呈狭长形被推向上，子宫底升高达脐上。（2）剥离的胎盘降至子宫下段，阴道口外露的一段脐带自行延长。（3）阴道少量流血。（4）用手掌尺侧在产妇耻骨联合上方轻压子宫下段时，子宫体上升而外露的脐带不再回缩。2.胎盘剥离及排出方式有两种：胎儿面娩出式和母体面娩出式。3.新生儿处理（1）清理呼吸道：新生儿大声啼哭，表示呼吸道已通畅。（2）处理脐带。thepublictoparticipatein,inimperceptibleprovidedLpeople'sculturalquality.Tobuiltuse"Juxianissuedonthemicrochannel,"civilizedJuxian"microchannel,Ju,networksandothermainstreamnetworkmediacontinuedtopushsendonlineisenergyinformation,andcreateagoodnetworkenvironment.Deepentheactionofthebeautifulcountrysidecivilization,tocarryoutawiderangeof"newcountryside,newlife"training,givefullplaytothevillagepopulationculturecourtyard,ParkStreet,culturalsquareandotherpositionstheroleofpublicityandeducation,promoteruralwayoflifemorecivilized.Thisyeartheprovince'surbanandruralsanitationintegrationoftheruralmassessatisfactiontelephonesurvey,significantlyimprovedperformanceinourcounty,respectively,thantheendoflastyear,yearstoimprovethe5.2,17.5percentagepoints.Thetownshipstreets.Relevantdepartmentsofcountiesunitsshouldconscientiouslysumupexperience,adheretotheproblemoriented,peoplearenotsatisfiedwiththevillageasthefocusofthework,insistongraspingbothends,withthemiddle,toconsolidateandimprove,expandfurthereffort,intherealizationofthenormallong-termefforts,toensurethattheendofthisyeartoobtainbetterresults.Third,weneedtoacceleratethevoluntaryservicesystem.Toactivelypromotethepartymembersandmembersandcadresnormalizationofvolunteerservice,doagoodjobinpublicplaces,windowunitsandcommunityvolunteerservicestationconstruction,establishmentofcoveringthewhole49 （3）Apgar评分及其意义：根据新生儿出生后的心率、呼吸、肌张力、喉反射及皮肤颜色5项体征对新生儿进行评分，满分为10分，属正常新生儿；7分以上只需进行一般处理；4～7分缺氧较严重，需清理呼吸道、人工呼吸、吸氧、用药等措施才能恢复；3分以下缺氧严重，需紧急抢救，行喉镜在直视下气管内插管并给氧。应在出生后5分钟、10分钟时再次评分。1分钟评分反映在宫内的情况，而5分钟及以后评分则反映复苏效果，与预后关系密切4、协助胎盘娩出：当确认胎盘已完全剥离时，协助娩出胎盘。检查胎盘胎膜将胎盘辅平，先检查胎盘母体面的胎盘小叶有无缺损。5、检查胎膜是否完整，再检查胎盘胎儿面边缘有无血管断裂，能及时发现副胎盘。还应检查胎盘、胎膜有无其他异常。6、检查软产道：仔细检查会阴、小阴唇内侧、尿道口周围、阴道及宫颈有无裂伤。若有裂伤，应立即缝合。7、预防产后出血：正常分娩出血量多数不足300ml.遇既往有产后出血史或易发生宫缩乏力的产妇，可在胎头或胎肩娩出时，缩宫素10U加于25％葡萄糖液20ml内静注，能加强宫缩，减少出血。若胎儿已娩出30分钟，轻轻按压子宫及静注子宫收缩剂后仍不能使胎盘排出时，再行手取胎盘术。若胎盘娩出后出血多时，可经下腹部直接注入宫体肌壁内或肌注麦角新碱0.2～0.4mg，并将缩宫素20U加于5％葡萄糖液500ml内静脉滴注。8、观察产后一般情况：应在分娩室观察产妇2小时，测量血压、脉搏。注意子宫收缩、子宫底高度、膀胱充盈否、阴道流血量、会阴阴道有无血肿等，发现异常及时处理。产后2小时后，将产妇和新生儿送回病房。thepublictoparticipatein,inimperceptibleprovidedLpeople'sculturalquality.Tobuiltuse"Juxianissuedonthemicrochannel,"civilizedJuxian"microchannel,Ju,networksandothermainstreamnetworkmediacontinuedtopushsendonlineisenergyinformation,andcreateagoodnetworkenvironment.Deepentheactionofthebeautifulcountrysidecivilization,tocarryoutawiderangeof"newcountryside,newlife"training,givefullplaytothevillagepopulationculturecourtyard,ParkStreet,culturalsquareandotherpositionstheroleofpublicityandeducation,promoteruralwayoflifemorecivilized.Thisyeartheprovince'surbanandruralsanitationintegrationoftheruralmassessatisfactiontelephonesurvey,significantlyimprovedperformanceinourcounty,respectively,thantheendoflastyear,yearstoimprovethe5.2,17.5percentagepoints.Thetownshipstreets.Relevantdepartmentsofcountiesunitsshouldconscientiouslysumupexperience,adheretotheproblemoriented,peoplearenotsatisfiedwiththevillageasthefocusofthework,insistongraspingbothends,withthemiddle,toconsolidateandimprove,expandfurthereffort,intherealizationofthenormallong-termefforts,toensurethattheendofthisyeartoobtainbetterresults.Third,weneedtoacceleratethevoluntaryservicesystem.Toactivelypromotethepartymembersandmembersandcadresnormalizationofvolunteerservice,doagoodjobinpublicplaces,windowunitsandcommunityvolunteerservicestationconstruction,establishmentofcoveringthewhole49 三、分娩健康宣教1、护理人员要以热情、亲切、和蔼的态度接待产妇，介绍入院须知和住院环境及注意事项。2、医护人员的某些言谈举止往往会加重产妇的紧张和恐惧，这就要求我们要严格遵守保护性医疗制度，注意自己的言行举动，针对产妇的社会角色、性格、文化素质等特点，正确运用艺术性语言，建立融洽的护患关系，对产妇提出的问题要耐心听取，适当讲究策略地给予回答。忠于产妇的利益，主动关心产妇的需求，以获取她们的信任，从而使产妇产生安全和信赖感。3、做好知识宣教工作，向产妇讲解有关正常的分娩知识，临产后可出现的征象，宫缩与分娩的关系，告诉产妇宫缩时应配合呼吸及轻按摩腹部或腰骶部以减轻疼痛，宫缩好可促进产程的进展，以及分娩时如何配合，使她们知道分娩是正常的生活过程。妊高征患者要注意异常情况的发生，如眼花、头痛等出现时要及时告诉医护人员。4、产妇对产痛的耐受力与各人的痛阈有关外，还与心理状态有关，并且占很重要的位置。当产妇的心理状态不佳时，常表现为一有宫缩就呻吟不止，大喊大叫，不能自我控制，甚至拒绝饮食，使体力和精力消耗很大，导致宫缩无力，造成难产。助产人员应根据产妇的不同情况尽量给予鼓励、安抚与陪伴，经常巡视，以交谈的方式减轻产妇的疼痛。2.5thepublictoparticipatein,inimperceptibleprovidedLpeople'sculturalquality.Tobuiltuse"Juxianissuedonthemicrochannel,"civilizedJuxian"microchannel,Ju,networksandothermainstreamnetworkmediacontinuedtopushsendonlineisenergyinformation,andcreateagoodnetworkenvironment.Deepentheactionofthebeautifulcountrysidecivilization,tocarryoutawiderangeof"newcountryside,newlife"training,givefullplaytothevillagepopulationculturecourtyard,ParkStreet,culturalsquareandotherpositionstheroleofpublicityandeducation,promoteruralwayoflifemorecivilized.Thisyeartheprovince'surbanandruralsanitationintegrationoftheruralmassessatisfactiontelephonesurvey,significantlyimprovedperformanceinourcounty,respectively,thantheendoflastyear,yearstoimprovethe5.2,17.5percentagepoints.Thetownshipstreets.Relevantdepartmentsofcountiesunitsshouldconscientiouslysumupexperience,adheretotheproblemoriented,peoplearenotsatisfiedwiththevillageasthefocusofthework,insistongraspingbothends,withthemiddle,toconsolidateandimprove,expandfurthereffort,intherealizationofthenormallong-termefforts,toensurethattheendofthisyeartoobtainbetterresults.Third,weneedtoacceleratethevoluntaryservicesystem.Toactivelypromotethepartymembersandmembersandcadresnormalizationofvolunteerservice,doagoodjobinpublicplaces,windowunitsandcommunityvolunteerservicestationconstruction,establishmentofcoveringthewhole49 严密细心观察产妇的进展。在进行检查操作过程中，要注意态度认真，手法准确、轻柔、熟练，观察细致，记录及时，必要时将检查结果主动告诉产妇，使她们感到自己受尊重，受重视，以增加她们的信心，把顾虑、恐惧的心情转移到积极的行为中，以最佳的心理迎接分娩的到来。四、产后出血健康宣教1、做好孕前及孕期的保健工作，孕早期开始产前检查监护，不宜妊娠者及时在早孕时终止妊娠。2、对具有较高产后出血危险的产妇做好及早处理的准备工作，这类产妇包括：①多孕、多产及曾有多次宫腔手术者；②高龄初产妇或低龄孕妇；③有子宫肌瘤剔除史；④生殖器发育不全或畸形；⑤妊高征；⑥合并糖尿病、血液病等；⑦宫缩乏力产程延长；⑧行胎头吸引、产钳等助产手术助产，特别是并用宫缩剂更需注意；⑨死胎等。3、第一产程密切观察产妇情况，注意水分及营养的补充，避免产妇过度疲劳，必要时可酌情肌注度冷丁，使产妇有休息机会。4、重视第二产程处理，指导产妇适时及正确使用腹压。对有可能发生产后出血者，应安排有较高业务水平的医师在场守候。有指征者适时适度作会阴侧切或会阴正中切开。接产技术操作要规范，正确引导胎头、胎肩及胎头顺利娩出。对已有thepublictoparticipatein,inimperceptibleprovidedLpeople'sculturalquality.Tobuiltuse"Juxianissuedonthemicrochannel,"civilizedJuxian"microchannel,Ju,networksandothermainstreamnetworkmediacontinuedtopushsendonlineisenergyinformation,andcreateagoodnetworkenvironment.Deepentheactionofthebeautifulcountrysidecivilization,tocarryoutawiderangeof"newcountryside,newlife"training,givefullplaytothevillagepopulationculturecourtyard,ParkStreet,culturalsquareandotherpositionstheroleofpublicityandeducation,promoteruralwayoflifemorecivilized.Thisyeartheprovince'surbanandruralsanitationintegrationoftheruralmassessatisfactiontelephonesurvey,significantlyimprovedperformanceinourcounty,respectively,thantheendoflastyear,yearstoimprovethe5.2,17.5percentagepoints.Thetownshipstreets.Relevantdepartmentsofcountiesunitsshouldconscientiouslysumupexperience,adheretotheproblemoriented,peoplearenotsatisfiedwiththevillageasthefocusofthework,insistongraspingbothends,withthemiddle,toconsolidateandimprove,expandfurthereffort,intherealizationofthenormallong-termefforts,toensurethattheendofthisyeartoobtainbetterresults.Third,weneedtoacceleratethevoluntaryservicesystem.Toactivelypromotethepartymembersandmembersandcadresnormalizationofvolunteerservice,doagoodjobinpublicplaces,windowunitsandcommunityvolunteerservicestationconstruction,establishmentofcoveringthewhole49 宫缩乏力者，当胎肩娩出后，即肌注催产素10U，并继以静脉滴注催产素，以增强子宫收缩，减少出血。5、正确处理第三产程，准确收集并测量产后出血量。待胎盘自然剥离征象出现后，轻压子宫下段及轻轻牵引脐带帮助胎盘、胎膜完整排出，并仔细检查胎盘、胎膜是否完整。检查软产道有无撕裂或血肿。检查子宫收缩情况，按摩子宫以促进子宫收缩。6、胎盘娩出后，产妇应继续留在产房观察2小时，因产后出血约80%发生在产后2小时内，故应重点监护，密切观察一般情况、生命指征、阴道流血和宫缩情况。但也不能忽视12小时以后的出血情况，应向产妇交代注意事项，医护人员定期巡视，发现问题及早处理。7、失血较多尚未有休克征象者，应及早补充血容量，其效果远较发生休克后再补同等血量为好。8、早期哺乳可刺激子宫收缩，减少阴道流血量。五、剖宫产健康宣教1、少用止痛药物：剖宫术后，麻醉药作用逐渐消退，下腹部伤口痛觉开始恢复，一般术后数小时伤口开始剧烈疼痛。此时，为了让产妇能很好地休息，医生在手术当天或当天夜里给用一些止痛药物。在此之后不要再用止痛药物，因为它会影响身体的健康，尤其是引起肠蠕动功能的恢复，所以需要产妇对疼痛做些忍耐。thepublictoparticipatein,inimperceptibleprovidedLpeople'sculturalquality.Tobuiltuse"Juxianissuedonthemicrochannel,"civilizedJuxian"microchannel,Ju,networksandothermainstreamnetworkmediacontinuedtopushsendonlineisenergyinformation,andcreateagoodnetworkenvironment.Deepentheactionofthebeautifulcountrysidecivilization,tocarryoutawiderangeof"newcountryside,newlife"training,givefullplaytothevillagepopulationculturecourtyard,ParkStreet,culturalsquareandotherpositionstheroleofpublicityandeducation,promoteruralwayoflifemorecivilized.Thisyeartheprovince'surbanandruralsanitationintegrationoftheruralmassessatisfactiontelephonesurvey,significantlyimprovedperformanceinourcounty,respectively,thantheendoflastyear,yearstoimprovethe5.2,17.5percentagepoints.Thetownshipstreets.Relevantdepartmentsofcountiesunitsshouldconscientiouslysumupexperience,adheretotheproblemoriented,peoplearenotsatisfiedwiththevillageasthefocusofthework,insistongraspingbothends,withthemiddle,toconsolidateandimprove,expandfurthereffort,intherealizationofthenormallong-termefforts,toensurethattheendofthisyeartoobtainbetterresults.Third,weneedtoacceleratethevoluntaryservicesystem.Toactivelypromotethepartymembersandmembersandcadresnormalizationofvolunteerservice,doagoodjobinpublicplaces,windowunitsandcommunityvolunteerservicestationconstruction,establishmentofcoveringthewhole49 2、术后多翻身：由于手术对肠道的刺激及受麻醉药的影响，剖宫产术后产妇都有不同程度的肠胀气，因而发生腹胀。如果多做翻身动作则会使麻痹的肠肌蠕动功能恢复得更快，肠道内的气体就会尽早排出而解除腹胀。3、宜取半卧位:因为剖宫术的产妇不能与正常阴道分娩的产妇一样，即在产后24小时就可起床活动，因此恶露不易排出。如果采取半卧位。同时配合多翻身，就会促使恶露排出，以防发生恶露淤积子宫腔内而引起感染，影响子宫复旧功能。4、产后尽力排尿:剖宫产前给产妇放置导尿管，一般在术后24～48小时、待膀胱肌肉恢复收缩排尿功能后拔掉。拔管后，只要一有尿意就努力去自解，否则，再保留导尿管容易引起尿路细菌感染。只要体力允许，尽早下床活动并逐渐增加活动量，这样不仅可促进肠蠕动和子宫腹复原。还可避免术后肠粘连，血栓性静脉炎形成。5、饮食照料要点术后第二天可以吃清淡流质食物，如蛋汤、米汤，切忌进牛奶、豆浆、大量蔗糖等胀气食品。等肠道气体排通后，则可进半流质食物，如稀粥、汤面、馄饨等。6、做健身恢复操：术后10天左右，如果一切都正常即可做如下运动：1、仰卧，两腿交替举起，先与身体垂直，然后慢慢放下来。两腿分别各做5次。thepublictoparticipatein,inimperceptibleprovidedLpeople'sculturalquality.Tobuiltuse"Juxianissuedonthemicrochannel,"civilizedJuxian"microchannel,Ju,networksandothermainstreamnetworkmediacontinuedtopushsendonlineisenergyinformation,andcreateagoodnetworkenvironment.Deepentheactionofthebeautifulcountrysidecivilization,tocarryoutawiderangeof"newcountryside,newlife"training,givefullplaytothevillagepopulationculturecourtyard,ParkStreet,culturalsquareandotherpositionstheroleofpublicityandeducation,promoteruralwayoflifemorecivilized.Thisyeartheprovince'surbanandruralsanitationintegrationoftheruralmassessatisfactiontelephonesurvey,significantlyimprovedperformanceinourcounty,respectively,thantheendoflastyear,yearstoimprovethe5.2,17.5percentagepoints.Thetownshipstreets.Relevantdepartmentsofcountiesunitsshouldconscientiouslysumupexperience,adheretotheproblemoriented,peoplearenotsatisfiedwiththevillageasthefocusofthework,insistongraspingbothends,withthemiddle,toconsolidateandimprove,expandfurthereffort,intherealizationofthenormallong-termefforts,toensurethattheendofthisyeartoobtainbetterresults.Third,weneedtoacceleratethevoluntaryservicesystem.Toactivelypromotethepartymembersandmembersandcadresnormalizationofvolunteerservice,doagoodjobinpublicplaces,windowunitsandcommunityvolunteerservicestationconstruction,establishmentofcoveringthewhole49 2、仰卧，两管自然放在身体两侧。屈曲抬起右腿并使其大腿尽力靠近腹部而使腿跟尽力靠近臀部。左右腿交替做，各做5次。3、仰卧，双膝屈曲，双管交台抱在胸前，然后慢慢起成半坐位，再恢复仰卧位。4、仰卧，双膝屈曲，双臂上举伸直，做仰卧起坐医学，教育网收集整理。5、俯位，两腿屈向胸部，大腿与床垂直，臀抬起，胸部与床紧贴。应早晚各做一次，每次持续时间一开始2-3分钟，逐渐延长到10分钟。6、保持外阴和腹部切口的清洁，每天冲洗外阴1-2次，要注意别让水污染切口。六、正常足月新生儿健康宣教1、促进母婴感情建立目前国内外均大力提倡母婴同室和母乳喂养。因此，在母婴的情况允许下，婴儿出生后，应尽早（30分钟内）将新生儿安放在母亲身旁，进行皮肤接触、鼓励早吸吮，促进感情交流，有利于婴儿身心发育。2、宣传育儿保健常识向家长介绍喂养（包括添加辅食）、保暖、防感染、预防接种等有关知识。thepublictoparticipatein,inimperceptibleprovidedLpeople'sculturalquality.Tobuiltuse"Juxianissuedonthemicrochannel,"civilizedJuxian"microchannel,Ju,networksandothermainstreamnetworkmediacontinuedtopushsendonlineisenergyinformation,andcreateagoodnetworkenvironment.Deepentheactionofthebeautifulcountrysidecivilization,tocarryoutawiderangeof"newcountryside,newlife"training,givefullplaytothevillagepopulationculturecourtyard,ParkStreet,culturalsquareandotherpositionstheroleofpublicityandeducation,promoteruralwayoflifemorecivilized.Thisyeartheprovince'surbanandruralsanitationintegrationoftheruralmassessatisfactiontelephonesurvey,significantlyimprovedperformanceinourcounty,respectively,thantheendoflastyear,yearstoimprovethe5.2,17.5percentagepoints.Thetownshipstreets.Relevantdepartmentsofcountiesunitsshouldconscientiouslysumupexperience,adheretotheproblemoriented,peoplearenotsatisfiedwiththevillageasthefocusofthework,insistongraspingbothends,withthemiddle,toconsolidateandimprove,expandfurthereffort,intherealizationofthenormallong-termefforts,toensurethattheendofthisyeartoobtainbetterresults.Third,weneedtoacceleratethevoluntaryservicesystem.Toactivelypromotethepartymembersandmembersandcadresnormalizationofvolunteerservice,doagoodjobinpublicplaces,windowunitsandcommunityvolunteerservicestationconstruction,establishmentofcoveringthewhole49 3、新生儿筛查护理人员应了解有条件对新生儿进行筛查的单位及项目，如先天性甲状腺功能减低症、苯丙酮尿症和半乳糖症等，以便对可疑者建议去进行筛查。七、胎儿宫内窘迫健康宣教1、胎动监测：胎动是表明胎儿存活的良好标志，也是对宫内缺氧最为敏感的指标。胎动计数是妊娠期监测胎儿宫内状况的一种简便方法，可长期使用。一般准妈妈20周左右能感到胎动。28周后应学会自数胎动：如胎儿连续运动完后算1次胎动，间隔再动又算1次，以此类推。孕妇每天早、中、晚各取左侧静卧1小时，由孕妇凭主观感觉分别记录这3小时的胎动次数，将早、中、晚3次胎动数相加乘4，则作为12小时胎动数。胎动计数12小时≥30次为正常，若12小时＜10次为异常。逐日记录胎动计数。若发现胎动与往日比较过频或过少，都可能提示胎儿有宫内缺氧，应及时到医院检查。2、胎心监测：丈夫可在医生指导下学会用听诊器直接听取胎心率。正常胎心率应是120～160次/分。胎动时胎心率应增快＞10次/分，或胎心率不规则。若胎心率减慢少于或多于这个数，则提示胎儿缺氧应及时到医院就诊。thepublictoparticipatein,inimperceptibleprovidedLpeople'sculturalquality.Tobuiltuse"Juxianissuedonthemicrochannel,"civilizedJuxian"microchannel,Ju,networksandothermainstreamnetworkmediacontinuedtopushsendonlineisenergyinformation,andcreateagoodnetworkenvironment.Deepentheactionofthebeautifulcountrysidecivilization,tocarryoutawiderangeof"newcountryside,newlife"training,givefullplaytothevillagepopulationculturecourtyard,ParkStreet,culturalsquareandotherpositionstheroleofpublicityandeducation,promoteruralwayoflifemorecivilized.Thisyeartheprovince'surbanandruralsanitationintegrationoftheruralmassessatisfactiontelephonesurvey,significantlyimprovedperformanceinourcounty,respectively,thantheendoflastyear,yearstoimprovethe5.2,17.5percentagepoints.Thetownshipstreets.Relevantdepartmentsofcountiesunitsshouldconscientiouslysumupexperience,adheretotheproblemoriented,peoplearenotsatisfiedwiththevillageasthefocusofthework,insistongraspingbothends,withthemiddle,toconsolidateandimprove,expandfurthereffort,intherealizationofthenormallong-termefforts,toensurethattheendofthisyeartoobtainbetterresults.Third,weneedtoacceleratethevoluntaryservicesystem.Toactivelypromotethepartymembersandmembersandcadresnormalizationofvolunteerservice,doagoodjobinpublicplaces,windowunitsandcommunityvolunteerservicestationconstruction,establishmentofcoveringthewhole49 3、定期产检：及时发现可能引起胎儿宫内缺氧的各种母源性因素，并得到及时的诊治。医生还可通过胎儿心电图检查、胎心率电子监护、B超生物物理评分、多普勒超声脐血流检查等，及时发现胎心率异常变化，及时采取应变措施。八、胎膜早破护健康宣教1、孕育宣传教育营养不良的孕妇易发生胎膜早破，应指导孕妇合理膳食进富含微量元素和维生素的食物，如：鱼、蛋、瘦肉、动物肝脏、豆制品及新鲜蔬菜和水果等。2、定期产前检查、纠正胎位不正对于臀先露者于孕30周左右采取膝胸卧位、针灸纠正胎位可减少胎膜早破的发生。双胎、羊水过多除避免重体力劳动，多卧床休息外，可采用中药治疗羊水过多。3、防止腹部外伤避免阴道检查，医学教|育网搜集整理孕晚期禁止性交，注意产前卫生保健，可减少胎膜早破的发生。4、宫颈松弛换者，可在非孕期修补或在孕14～16周左右进行宫颈环扎术。5、预防性应用抗生素，文献报道，胎膜早破>24小时，绒毛膜羊膜炎的发生率为3.0%～25.0%，破膜后6小时内使用青霉素等抗生素预防感染可减少母儿感染等并发症的发生。thepublictoparticipatein,inimperceptibleprovidedLpeople'sculturalquality.Tobuiltuse"Juxianissuedonthemicrochannel,"civilizedJuxian"microchannel,Ju,networksandothermainstreamnetworkmediacontinuedtopushsendonlineisenergyinformation,andcreateagoodnetworkenvironment.Deepentheactionofthebeautifulcountrysidecivilization,tocarryoutawiderangeof"newcountryside,newlife"training,givefullplaytothevillagepopulationculturecourtyard,ParkStreet,culturalsquareandotherpositionstheroleofpublicityandeducation,promoteruralwayoflifemorecivilized.Thisyeartheprovince'surbanandruralsanitationintegrationoftheruralmassessatisfactiontelephonesurvey,significantlyimprovedperformanceinourcounty,respectively,thantheendoflastyear,yearstoimprovethe5.2,17.5percentagepoints.Thetownshipstreets.Relevantdepartmentsofcountiesunitsshouldconscientiouslysumupexperience,adheretotheproblemoriented,peoplearenotsatisfiedwiththevillageasthefocusofthework,insistongraspingbothends,withthemiddle,toconsolidateandimprove,expandfurthereffort,intherealizationofthenormallong-termefforts,toensurethattheendofthisyeartoobtainbetterresults.Third,weneedtoacceleratethevoluntaryservicesystem.Toactivelypromotethepartymembersandmembersandcadresnormalizationofvolunteerservice,doagoodjobinpublicplaces,windowunitsandcommunityvolunteerservicestationconstruction,establishmentofcoveringthewhole49 6、胎膜早破终止妊娠的时间足月胎膜早破（>36周）原则上应尽快终止妊娠。破膜后观察24小时，如未自然临产，应引进。对于未足月胎膜早破者，因母儿感染率远远超过早产儿的并发症，建议取阴道后穹窿羊水测定磷脂酰甘油，若胎肺成熟应终止妊娠。孕32～35周胎膜早破者，胎儿出生后存活力较强，以引产为宜。胎龄在32孕周以下，如无宫内感染，无胎儿宫内窘迫，可预防性应用抗生素，肌注地塞米松10mg，每日二次持续2天以促胎肺成熟。如能期待48小时以上加之由于胎膜破裂对胎儿的应激作用，可促进胎肺表面活性物质的产生，从而降低新生儿呼吸窘迫综合征的发生率。孕2.8周以下胎膜早破，由于胎龄过小，胎儿存活率很低，除有个别期待疗法得到活婴的报道外，一般应以终止妊娠为宜。医学教|育网搜集整理如出现感染象征，则不论胎龄大小，均应终止妊娠，尽早结束分娩。7、胎膜早破孕妇临产后应加强胎心率的监护，使用产程图监护产程，胎膜早破易发生胎儿宫内窘迫。临产后应常规吸氧，卧床待产，以防止宫缩时脐带脱垂，出现胎儿宫内窘迫象征。如胎儿出生后能存活，应立即剖宫产结束分娩。九、前置胎盘健康宣教thepublictoparticipatein,inimperceptibleprovidedLpeople'sculturalquality.Tobuiltuse"Juxianissuedonthemicrochannel,"civilizedJuxian"microchannel,Ju,networksandothermainstreamnetworkmediacontinuedtopushsendonlineisenergyinformation,andcreateagoodnetworkenvironment.Deepentheactionofthebeautifulcountrysidecivilization,tocarryoutawiderangeof"newcountryside,newlife"training,givefullplaytothevillagepopulationculturecourtyard,ParkStreet,culturalsquareandotherpositionstheroleofpublicityandeducation,promoteruralwayoflifemorecivilized.Thisyeartheprovince'surbanandruralsanitationintegrationoftheruralmassessatisfactiontelephonesurvey,significantlyimprovedperformanceinourcounty,respectively,thantheendoflastyear,yearstoimprovethe5.2,17.5percentagepoints.Thetownshipstreets.Relevantdepartmentsofcountiesunitsshouldconscientiouslysumupexperience,adheretotheproblemoriented,peoplearenotsatisfiedwiththevillageasthefocusofthework,insistongraspingbothends,withthemiddle,toconsolidateandimprove,expandfurthereffort,intherealizationofthenormallong-termefforts,toensurethattheendofthisyeartoobtainbetterresults.Third,weneedtoacceleratethevoluntaryservicesystem.Toactivelypromotethepartymembersandmembersandcadresnormalizationofvolunteerservice,doagoodjobinpublicplaces,windowunitsandcommunityvolunteerservicestationconstruction,establishmentofcoveringthewhole49 1、前置胎盘的发生往往与多产及子宫内膜炎有关，因此做好计划生育，医学教|育网搜集整理严格执行人流或分娩等手术时的无菌操作技术，防止产后感染，可以减少前置胎盘的发病。2、做好产前检查和孕期卫生宣传工作。一旦发现晚期妊娠阴道流血，即应检查，有前置胎盘可疑者宜住院观察，无条件时应转院治疗，不宜在家分娩。十、胎盘早剥的健康宣教加强产前检查，积极预防及治疗妊高征：对合并慢性高血压、慢性肾炎等高危妊娠应加强管理；妊娠晚期避免仰卧及腹部外伤；胎位异常作外倒转术纠正胎位时，操作必须轻柔；处理羊水过多或双胎分娩时避免宫腔压力骤然降低。十一、会阴切口术的健康宣教1、加强围产期保健知识宣教产前患有阴道炎、外阴炎的产妇要及时诊治；给产妇讲解分娩知识，在第二产程指导产妇正确运用腹压及如何与助产人员配合，避免会阴严重裂伤；教会产妇产后观察伤口和自我护理的方法。2、严格掌握会阴切开指征除对会阴体高度水肿或有疤痕、巨大儿、早产儿等有明确适应证的产妇实施会阴切开术，一般不轻易行会阴切开术。thepublictoparticipatein,inimperceptibleprovidedLpeople'sculturalquality.Tobuiltuse"Juxianissuedonthemicrochannel,"civilizedJuxian"microchannel,Ju,networksandothermainstreamnetworkmediacontinuedtopushsendonlineisenergyinformation,andcreateagoodnetworkenvironment.Deepentheactionofthebeautifulcountrysidecivilization,tocarryoutawiderangeof"newcountryside,newlife"training,givefullplaytothevillagepopulationculturecourtyard,ParkStreet,culturalsquareandotherpositionstheroleofpublicityandeducation,promoteruralwayoflifemorecivilized.Thisyeartheprovince'surbanandruralsanitationintegrationoftheruralmassessatisfactiontelephonesurvey,significantlyimprovedperformanceinourcounty,respectively,thantheendoflastyear,yearstoimprovethe5.2,17.5percentagepoints.Thetownshipstreets.Relevantdepartmentsofcountiesunitsshouldconscientiouslysumupexperience,adheretotheproblemoriented,peoplearenotsatisfiedwiththevillageasthefocusofthework,insistongraspingbothends,withthemiddle,toconsolidateandimprove,expandfurthereffort,intherealizationofthenormallong-termefforts,toensurethattheendofthisyeartoobtainbetterresults.Third,weneedtoacceleratethevoluntaryservicesystem.Toactivelypromotethepartymembersandmembersandcadresnormalizationofvolunteerservice,doagoodjobinpublicplaces,windowunitsandcommunityvolunteerservicestationconstruction,establishmentofcoveringthewhole49 3、提高整体操作技术水平本组中1例复杂裂伤继发感染、1例切口渗血、1例缝合时阴道遗留纱布继发感染、2例切口对合不良致切口裂开的产妇均是由工作3年以下助产士接产。因此，加强对低年资助产士操作技术的培训和考核以及责任心的培养尤为重要。将选择会阴切口大小、控制胎头胎肩娩出速度、缝合时彻底止血、严格恢复解剖结构和正确对合皮肤切口等作为重点考核内容。4、产后会阴护理不容忽视重视产后会阴护理，尤其是患有妊高征、产后出血、原发宫缩乏力致产程较长或复杂裂伤缝合时间较长的产妇，在注意给予营养饮食增加机体抵抗力的同时，更要保持会阴部的清洁干燥，坚持每日消毒护理外阴2次，但产后42天内一般不清洗阴道。5、产后便秘的预防和处理产后要指导产妇进食适量蔬菜、水果以保持大便通畅，便秘者要及时通便。6、产后尿潴留的预防和处理待产期间要及时协助产妇排尿，产后嘱产妇多饮水，于2～4小时内自行排尿，必要时可用各种方法诱导排尿或导尿。7、期待疗法和定期家访thepublictoparticipatein,inimperceptibleprovidedLpeople'sculturalquality.Tobuiltuse"Juxianissuedonthemicrochannel,"civilizedJuxian"microchannel,Ju,networksandothermainstreamnetworkmediacontinuedtopushsendonlineisenergyinformation,andcreateagoodnetworkenvironment.Deepentheactionofthebeautifulcountrysidecivilization,tocarryoutawiderangeof"newcountryside,newlife"training,givefullplaytothevillagepopulationculturecourtyard,ParkStreet,culturalsquareandotherpositionstheroleofpublicityandeducation,promoteruralwayoflifemorecivilized.Thisyeartheprovince'surbanandruralsanitationintegrationoftheruralmassessatisfactiontelephonesurvey,significantlyimprovedperformanceinourcounty,respectively,thantheendoflastyear,yearstoimprovethe5.2,17.5percentagepoints.Thetownshipstreets.Relevantdepartmentsofcountiesunitsshouldconscientiouslysumupexperience,adheretotheproblemoriented,peoplearenotsatisfiedwiththevillageasthefocusofthework,insistongraspingbothends,withthemiddle,toconsolidateandimprove,expandfurthereffort,intherealizationofthenormallong-termefforts,toensurethattheendofthisyeartoobtainbetterresults.Third,weneedtoacceleratethevoluntaryservicesystem.Toactivelypromotethepartymembersandmembersandcadresnormalizationofvolunteerservice,doagoodjobinpublicplaces,windowunitsandcommunityvolunteerservicestationconstruction,establishmentofcoveringthewhole49 相结合的可行性和必要性一般来说，顺产的产妇对第2次行会阴缝合难以接受，如等待切口完全愈合再出院，会增加产妇的经济负担，医.学教育网搜集整理同时给生活带来许多不便。对切口已度过急性炎症期的产妇来说，最主要的处理措施是伤口的局部护理，会阴部有较强的抗感染和再愈合能力，所有的护理措施可以在家中落实。医护人员多次上门免费服务、宣传保健知识、讲解红外线照射的作用原理、高锰酸钾溶液坐浴的药理作用和注意事项等，产妇和家属都非常愿意接受，可以缩小医患之间的距离，有的甚至成为朋友。所以，笔者认为，期待疗法和定期家访相结合用于会阴切口愈合不良的产妇是一种行之有效的方法。十二、流产的健康宣教1术前宣教护理：对于前来行人工流产的孕妇，医护人员从受术者的利益出发，围绕每个受术者的不同心态，做好相应的心理护理。满足她们的心理需要，保守她们的隐私，减轻心理负担和压力，从而建立良好的护患关系，取得受术者的信任与合作。术前宣教以消除恐惧、紧张心理，安定孕妇情绪为主。将准备行人工流产的孕妇置于清洁、明亮的侯诊室等候，必要时允许其丈夫陪伴。并向她们介绍人工流产的大致步骤，回答孕妇的疑问，使她们明白人工流产是小手术，受术者如配合好，避免紧张，手术完全可以顺利而安全地进行。2宫颈松弛护理：thepublictoparticipatein,inimperceptibleprovidedLpeople'sculturalquality.Tobuiltuse"Juxianissuedonthemicrochannel,"civilizedJuxian"microchannel,Ju,networksandothermainstreamnetworkmediacontinuedtopushsendonlineisenergyinformation,andcreateagoodnetworkenvironment.Deepentheactionofthebeautifulcountrysidecivilization,tocarryoutawiderangeof"newcountryside,newlife"training,givefullplaytothevillagepopulationculturecourtyard,ParkStreet,culturalsquareandotherpositionstheroleofpublicityandeducation,promoteruralwayoflifemorecivilized.Thisyeartheprovince'surbanandruralsanitationintegrationoftheruralmassessatisfactiontelephonesurvey,significantlyimprovedperformanceinourcounty,respectively,thantheendoflastyear,yearstoimprovethe5.2,17.5percentagepoints.Thetownshipstreets.Relevantdepartmentsofcountiesunitsshouldconscientiouslysumupexperience,adheretotheproblemoriented,peoplearenotsatisfiedwiththevillageasthefocusofthework,insistongraspingbothends,withthemiddle,toconsolidateandimprove,expandfurthereffort,intherealizationofthenormallong-termefforts,toensurethattheendofthisyeartoobtainbetterresults.Third,weneedtoacceleratethevoluntaryservicesystem.Toactivelypromotethepartymembersandmembersandcadresnormalizationofvolunteerservice,doagoodjobinpublicplaces,windowunitsandcommunityvolunteerservicestationconstruction,establishmentofcoveringthewhole49 人工流产综合征发生的机理是由于术中对宫颈的牵拉、扩张及对宫壁的负压吸引等机械刺激引起内脏迷走神经反射所致。因此，减轻对宫颈与宫壁的刺激是减少人工流产综合征发生的关键环节。对8-10周以上大月份妊娠及初孕妇，或距前次妊娠8年以上，以及精神、神经过度紧张的孕妇我们分别选用下列护理措施。 1、导尿管置入松弛法：术前12h在常规消毒下，取16号导尿管置入宫颈内口，次日手术时宫颈内口松弛。 2、宫颈口麻醉松弛法：人工流产扩宫前用无菌棉签蘸透2%利多卡因，插入宫颈内口，放置1-2min，可使粘膜下的感觉细胞麻醉，同样可使宫颈松弛。3、宫内麻醉松弛法：用探针探查宫腔深度后，将一根无菌导尿管缓缓置入宫腔，注入1%利多卡因10-15ml后取出导尿管，2-3min后宫口开始松弛。3、术中护理：减少手术创伤，缩短扩宫及吸宫时间。根据孕周选用合适的吸管及负压。术中操作轻柔而迅速。妥善有序地摆置好手术台上的器械，避免手术器械的碰撞，勿让受术者看到血染的器械与纱布。吸引器吸管进入宫腔后旋转抽吸2周即可抽出，降低负压，再行进入，宫壁由光滑变为粗糙即可结束手术。术中以减轻受术者的心理负担为主，提高其痛阈值，采用暗示、转移、分散注意力的方法，与其谈一些轻松话题，如“孩子多大了？”“在哪工作呀？”或做一些分散痛觉的动作，如擦汗、按摩腹部，指压内关、合谷等。十三、死胎的健康宣教thepublictoparticipatein,inimperceptibleprovidedLpeople'sculturalquality.Tobuiltuse"Juxianissuedonthemicrochannel,"civilizedJuxian"microchannel,Ju,networksandothermainstreamnetworkmediacontinuedtopushsendonlineisenergyinformation,andcreateagoodnetworkenvironment.Deepentheactionofthebeautifulcountrysidecivilization,tocarryoutawiderangeof"newcountryside,newlife"training,givefullplaytothevillagepopulationculturecourtyard,ParkStreet,culturalsquareandotherpositionstheroleofpublicityandeducation,promoteruralwayoflifemorecivilized.Thisyeartheprovince'surbanandruralsanitationintegrationoftheruralmassessatisfactiontelephonesurvey,significantlyimprovedperformanceinourcounty,respectively,thantheendoflastyear,yearstoimprovethe5.2,17.5percentagepoints.Thetownshipstreets.Relevantdepartmentsofcountiesunitsshouldconscientiouslysumupexperience,adheretotheproblemoriented,peoplearenotsatisfiedwiththevillageasthefocusofthework,insistongraspingbothends,withthemiddle,toconsolidateandimprove,expandfurthereffort,intherealizationofthenormallong-termefforts,toensurethattheendofthisyeartoobtainbetterresults.Third,weneedtoacceleratethevoluntaryservicesystem.Toactivelypromotethepartymembersandmembersandcadresnormalizationofvolunteerservice,doagoodjobinpublicplaces,windowunitsandcommunityvolunteerservicestationconstruction,establishmentofcoveringthewhole49 1、在打算怀孕的时候就开始补充叶酸：根据大规模的医学研究，从怀孕前三个月到怀孕三个月，每天补充0.4毫克的叶酸，可以使胎儿神经管缺陷(包括无脑症、脑膨出和脊柱裂)的机会降低40%-80%，这是少数可以预防的先天性畸形，包括胎死腹中的一个办法。2、治疗母体的疾病：许多母体的慢性疾病，例如高血压、糖尿病或甲状腺异常，都会增加胎死腹中的机会，所以在怀孕之前应该进行相关的检查，如果发现这一类问题，应该先治疗以后再怀孕。3、调整作息：许多研究发现，过重的工作负担，会增加早产、流产、死产以及他而生长迟缓的机会，所以孕妇应该调整作息，要有充分的休息。4、按时产检：孕妇应该按规定的时间产检，可以及早发现问题，例如妊娠糖尿病或是妊娠高血压，并且及时处理，不但可以减少胎死腹中的机会，也能确保母体的安全。5、注意性生活：有些性传染病，会造成胎儿死亡或重大畸形，如梅毒。避免多个性伴侣，或是使用保险套，可以避免性病的传染。若是发现有感染的现象，应该及早治疗。6、避免环境中的毒物：环境中的读物都会增加胎儿死亡的机会，过去有一篇报告指出，美国每年由于孕妇抽烟，导致超过4000个胎儿死亡。孕妇也切忌没有经过医生处方擅自服用药物。至于毒品如海洛因，也会导致胎儿死亡。环境中的污染物质或是毒物，例如多氯联苯和戴奥辛也可能引起胎儿死亡。这些状况都应该尽量避免。thepublictoparticipatein,inimperceptibleprovidedLpeople'sculturalquality.Tobuiltuse"Juxianissuedonthemicrochannel,"civilizedJuxian"microchannel,Ju,networksandothermainstreamnetworkmediacontinuedtopushsendonlineisenergyinformation,andcreateagoodnetworkenvironment.Deepentheactionofthebeautifulcountrysidecivilization,tocarryoutawiderangeof"newcountryside,newlife"training,givefullplaytothevillagepopulationculturecourtyard,ParkStreet,culturalsquareandotherpositionstheroleofpublicityandeducation,promoteruralwayoflifemorecivilized.Thisyeartheprovince'surbanandruralsanitationintegrationoftheruralmassessatisfactiontelephonesurvey,significantlyimprovedperformanceinourcounty,respectively,thantheendoflastyear,yearstoimprovethe5.2,17.5percentagepoints.Thetownshipstreets.Relevantdepartmentsofcountiesunitsshouldconscientiouslysumupexperience,adheretotheproblemoriented,peoplearenotsatisfiedwiththevillageasthefocusofthework,insistongraspingbothends,withthemiddle,toconsolidateandimprove,expandfurthereffort,intherealizationofthenormallong-termefforts,toensurethattheendofthisyeartoobtainbetterresults.Third,weneedtoacceleratethevoluntaryservicesystem.Toactivelypromotethepartymembersandmembersandcadresnormalizationofvolunteerservice,doagoodjobinpublicplaces,windowunitsandcommunityvolunteerservicestationconstruction,establishmentofcoveringthewhole49 7、重视产前教育：产前教育可以提供资讯，让孕妇了解怀孕的生理变化以及应该注意事项。无知会导致风险，例如许多孕妇本身不了解抽烟或是乱服成药对宝宝所造成的伤害，也不知道怀孕危险的征兆。参加医院的各种产前教育，可以获得各种资讯，降低风险。8、注意流行疾病：有一些传染疾病，不但会造成胎死腹中，而且即使胎儿存活，也会留下严重的后遗症，例如德国麻疹。所以如果怀孕前发现没有德国麻疹抗体，应该先注射疫苗再怀孕。如果是怀孕期间，才发现没有抗体，则在疾病流行期间，尽量避免到公共场所，以避免被传染。小课题：死thepublictoparticipatein,inimperceptibleprovidedLpeople'sculturalquality.Tobuiltuse"Juxianissuedonthemicrochannel,"civilizedJuxian"microchannel,Ju,networksandothermainstreamnetworkmediacontinuedtopushsendonlineisenergyinformation,andcreateagoodnetworkenvironment.Deepentheactionofthebeautifulcountrysidecivilization,tocarryoutawiderangeof"newcountryside,newlife"training,givefullplaytothevillagepopulationculturecourtyard,ParkStreet,culturalsquareandotherpositionstheroleofpublicityandeducation,promoteruralwayoflifemorecivilized.Thisyeartheprovince'surbanandruralsanitationintegrationoftheruralmassessatisfactiontelephonesurvey,significantlyimprovedperformanceinourcounty,respectively,thantheendoflastyear,yearstoimprovethe5.2,17.5percentagepoints.Thetownshipstreets.Relevantdepartmentsofcountiesunitsshouldconscientiouslysumupexperience,adheretotheproblemoriented,peoplearenotsatisfiedwiththevillageasthefocusofthework,insistongraspingbothends,withthemiddle,toconsolidateandimprove,expandfurthereffort,intherealizationofthenormallong-termefforts,toensurethattheendofthisyeartoobtainbetterresults.Third,weneedtoacceleratethevoluntaryservicesystem.Toactivelypromotethepartymembersandmembersandcadresnormalizationofvolunteerservice,doagoodjobinpublicplaces,windowunitsandcommunityvolunteerservicestationconstruction,establishmentofcoveringthewhole49 咖啡对西方人而言是生活中不可或缺的饮料，不管是晨起唤醒沉睡中的灵魂、工作中的提神或是午茶的优闲，都离不开咖啡。台湾咖啡族人口这几年增长的速度快，许多计画怀孕的女性也是咖啡的爱好者，但咖啡对于怀孕或胎儿健康是否有影响？是每个准妈妈都想了解的问题。“咖啡因”为存在于60种以上植物叶子、种子或果肉中的天然成份，例如：咖啡豆、可可豆、可乐豆和茶叶等，而最通常之食物来源为咖啡、茶、巧克力和清凉饮料（如：可乐、含茶饮料），咖啡因具轻度的中枢神经刺激作用，可减轻疲劳感、增强记性、推理能力和智力的灵活度，只要少少的32毫克（约1杯可乐的含量），就可以增进听觉和视觉的反应时间，但每个人对咖啡因的敏感性有很大的不同，有些人觉得增加灵活度的咖啡因量，可能某些人就会觉得不舒服，老年人可能对咖啡因的效用更敏感。 喝咖啡会不会少钙 一般人常会问喝咖啡会不会骨质疏松？这可能与美国早期一个研究报告有关。此报告指出，平均每天喝两杯咖啡的妇女，更年期后骨质密度比不喝咖啡的妇女低。但依据美国一个近期的研究显示，当排除抽烟、喝酒、体重及荷尔蒙治疗等因子后，发现停经后的女性长期摄取咖啡因与骨质流失并无关联。至于钙质的吸收代谢方面，1杯冲煮式的咖啡中所含的咖啡因量，可降低4毫克钙质的吸收，而此量可由1~2茶匙的牛奶轻易的补足。所以，喝咖啡的族群骨质密度会较低，可能与其每日饮食中钙质的摄取量本来就较低较有关系。高血压的老年人，摄取咖啡因会引起血压轻微的上升，但通常不会持续数小时以上，且此短暂微幅的血压上升，比每日正常活动（如：爬楼梯等）引起的血压上升还要来得低。 怀孕初期可能增加自发性流产thepublictoparticipatein,inimperceptibleprovidedLpeople'sculturalquality.Tobuiltuse"Juxianissuedonthemicrochannel,"civilizedJuxian"microchannel,Ju,networksandothermainstreamnetworkmediacontinuedtopushsendonlineisenergyinformation,andcreateagoodnetworkenvironment.Deepentheactionofthebeautifulcountrysidecivilization,tocarryoutawiderangeof"newcountryside,newlife"training,givefullplaytothevillagepopulationculturecourtyard,ParkStreet,culturalsquareandotherpositionstheroleofpublicityandeducation,promoteruralwayoflifemorecivilized.Thisyeartheprovince'surbanandruralsanitationintegrationoftheruralmassessatisfactiontelephonesurvey,significantlyimprovedperformanceinourcounty,respectively,thantheendoflastyear,yearstoimprovethe5.2,17.5percentagepoints.Thetownshipstreets.Relevantdepartmentsofcountiesunitsshouldconscientiouslysumupexperience,adheretotheproblemoriented,peoplearenotsatisfiedwiththevillageasthefocusofthework,insistongraspingbothends,withthemiddle,toconsolidateandimprove,expandfurthereffort,intherealizationofthenormallong-termefforts,toensurethattheendofthisyeartoobtainbetterresults.Third,weneedtoacceleratethevoluntaryservicesystem.Toactivelypromotethepartymembersandmembersandcadresnormalizationofvolunteerservice,doagoodjobinpublicplaces,windowunitsandcommunityvolunteerservicestationconstruction,establishmentofcoveringthewhole49 计画怀孕的女性常质疑是否应戒咖啡，研究结果显示，即使每天咖啡因摄取大于500毫克，也不会造成延迟怀孕，且并无证据显示孕妇咖啡因的摄取与畸型胎、早产和出生体重不足等有关。虽然如此，仁爱医院营养室仍劝告怀孕的妇女应适度的节制，因为在怀孕的第一期大量咖啡因的摄取可能会轻微增加自发性流产之危险，且怀孕的第二期以后咖啡因的代谢亦较为缓慢。据美国学者的调查分析，美国成年人平均每天咖啡因摄取量约2毫克/公斤体重（70公斤体重的人约140毫克/天），其中80%来自咖啡；5~18岁的孩子每天摄取约38毫克，而孩子们咖啡因的主要来源是清凉饮料（如：可乐、含茶饮料）。尽管孩子们的体型较成人小，但对咖啡因的敏感度较低，大部份的孩子在小量咖啡因的摄取下，不会有不良的影响，且孩子们的代谢和排除咖啡因的速度比成人快得多，即使有影响，时间亦很短。无论如何，建议家长们仍应注意孩子们含咖啡因食品和饮料的摄取量，以免孩子们以此取代了健康食物的选择，增加空热量食物的摄取，造成肥胖及营养不均衡。 孕妇大量喝咖啡会死胎 丹麦科学家于本周五宣布，如果孕妇每天喝咖啡的量超过八杯，那么发生死胎的危险性会增加三倍。来自丹麦Aarhus大学的Kirstenthepublictoparticipatein,inimperceptibleprovidedLpeople'sculturalquality.Tobuiltuse"Juxianissuedonthemicrochannel,"civilizedJuxian"microchannel,Ju,networksandothermainstreamnetworkmediacontinuedtopushsendonlineisenergyinformation,andcreateagoodnetworkenvironment.Deepentheactionofthebeautifulcountrysidecivilization,tocarryoutawiderangeof"newcountryside,newlife"training,givefullplaytothevillagepopulationculturecourtyard,ParkStreet,culturalsquareandotherpositionstheroleofpublicityandeducation,promoteruralwayoflifemorecivilized.Thisyeartheprovince'surbanandruralsanitationintegrationoftheruralmassessatisfactiontelephonesurvey,significantlyimprovedperformanceinourcounty,respectively,thantheendoflastyear,yearstoimprovethe5.2,17.5percentagepoints.Thetownshipstreets.Relevantdepartmentsofcountiesunitsshouldconscientiouslysumupexperience,adheretotheproblemoriented,peoplearenotsatisfiedwiththevillageasthefocusofthework,insistongraspingbothends,withthemiddle,toconsolidateandimprove,expandfurthereffort,intherealizationofthenormallong-termefforts,toensurethattheendofthisyeartoobtainbetterresults.Third,weneedtoacceleratethevoluntaryservicesystem.Toactivelypromotethepartymembersandmembersandcadresnormalizationofvolunteerservice,doagoodjobinpublicplaces,windowunitsandcommunityvolunteerservicestationconstruction,establishmentofcoveringthewhole49 Wisborg告诉路透社记者说：“我们发现死胎的危险性会随着孕妇每天所喝的咖啡的杯数的增加而增长。与那些从不喝咖啡的妇女相比，每天喝4到7杯咖啡的孕妇死胎发生的危险性增加80％。每天喝咖啡超过八杯的妇女发生死胎的危险性增加三倍以上。”研究人员对于孕妇喝咖啡的影响的研究结果各不相同，有些科学家发现，咖啡的确会对胎儿产生影响，但是另一部分研究却认为并不存在这种影响。一般认为适量喝咖啡，比如每天一到两倍，还是安全的。为了弄清这一点，Wisborg等人对18000余名生活在丹麦的孕妇喝咖啡的情况、死胎发生的情况进行了调查。 研究结果发表于今年2月22日出版的《英国医学杂志》上。Wisborg发现，喝咖啡较多的妇女往往同时也是吸烟者及喝酒较多。他说：“但是在对这些影响因素进行校正之后，喝咖啡与死胎之间的相关性只发生了很轻微的变化。”但是在考虑吸烟习惯之后，研究人员发现孕妇喝咖啡的量与胎儿死亡之间没有相关性。Wisborg指出，以往的研究已经证实，怀孕期间喝咖啡会增加流产和低出生体重儿发病的危险性。Wisborg总结认为：“尽管如何对怀孕妇女或者那些将要怀孕的妇女提出建议还十分困难，但是根据本研究的结果，至少应该告诉孕妇每天喝咖啡的量不应超过四杯。 咖啡因的安全摄取量 至于成年人每天咖啡因的安全摄取量，专家们建议约300毫克/天是适量的，相当于约3杯咖啡的含量，且每次的频率间隔应大于3~4小时。然而每个人对咖啡因之感受性皆不相同，其影响因素包括喝的量、频率、个人代谢率、体重和生理状况等，所以，所谓的适量应依个人对咖啡因的反应而定。适量的饮用咖啡是安全的，但应注意摄取足量的钙质及均衡的营养，避免摄取过多含糖之空热量食品，才是保健之道。十四、妊娠合并心脏病的健康宣thepublictoparticipatein,inimperceptibleprovidedLpeople'sculturalquality.Tobuiltuse"Juxianissuedonthemicrochannel,"civilizedJuxian"microchannel,Ju,networksandothermainstreamnetworkmediacontinuedtopushsendonlineisenergyinformation,andcreateagoodnetworkenvironment.Deepentheactionofthebeautifulcountrysidecivilization,tocarryoutawiderangeof"newcountryside,newlife"training,givefullplaytothevillagepopulationculturecourtyard,ParkStreet,culturalsquareandotherpositionstheroleofpublicityandeducation,promoteruralwayoflifemorecivilized.Thisyeartheprovince'surbanandruralsanitationintegrationoftheruralmassessatisfactiontelephonesurvey,significantlyimprovedperformanceinourcounty,respectively,thantheendoflastyear,yearstoimprovethe5.2,17.5percentagepoints.Thetownshipstreets.Relevantdepartmentsofcountiesunitsshouldconscientiouslysumupexperience,adheretotheproblemoriented,peoplearenotsatisfiedwiththevillageasthefocusofthework,insistongraspingbothends,withthemiddle,toconsolidateandimprove,expandfurthereffort,intherealizationofthenormallong-termefforts,toensurethattheendofthisyeartoobtainbetterresults.Third,weneedtoacceleratethevoluntaryservicesystem.Toactivelypromotethepartymembersandmembersandcadresnormalizationofvolunteerservice,doagoodjobinpublicplaces,windowunitsandcommunityvolunteerservicestationconstruction,establishmentofcoveringthewhole49 1.妊娠前:根据心脏代偿功能、病因、病变范围等考虑能否妊娠。心功能Ⅰ、Ⅱ级者，一般可以妊娠；心功能Ⅲ级及以上，或有心衰史者，均不宜妊娠。2.妊娠期:（1）终止妊娠。不宜妊娠者，妊娠12周前行人工流产；妊娠中期则行引产加绝育术。有心衰者应先控制心衰再终止妊娠，如果妊娠已达28周以上，一般不宜终止妊娠，应在严密监护下待其分娩。（2）加强产前检查。允许妊娠者，加强产前检查，增加检查次数。应由产科医生和心内科医生分别检查，相互配合。发现问题者提早住院待产。（3）预防心衰。①注意休息，避免过度劳累；②注意营养，进高蛋白、高维生素、低盐饮食；③积极防治各种并发症和合并症；④预产期前2周入院待产；⑤严密观察，早期发现并控制心衰。3.分娩期（1）预防感染：应用抗生素直至产后1周。（2）选择分娩方式：主要根据心功能而定。心功能Ⅰ～Ⅱ级，又无产科指征者，可考虑经阴道分娩；如心功能Ⅲ～Ⅳ级，或有产科指征者，应以剖宫产术结束分娩。thepublictoparticipatein,inimperceptibleprovidedLpeople'sculturalquality.Tobuiltuse"Juxianissuedonthemicrochannel,"civilizedJuxian"microchannel,Ju,networksandothermainstreamnetworkmediacontinuedtopushsendonlineisenergyinformation,andcreateagoodnetworkenvironment.Deepentheactionofthebeautifulcountrysidecivilization,tocarryoutawiderangeof"newcountryside,newlife"training,givefullplaytothevillagepopulationculturecourtyard,ParkStreet,culturalsquareandotherpositionstheroleofpublicityandeducation,promoteruralwayoflifemorecivilized.Thisyeartheprovince'surbanandruralsanitationintegrationoftheruralmassessatisfactiontelephonesurvey,significantlyimprovedperformanceinourcounty,respectively,thantheendoflastyear,yearstoimprovethe5.2,17.5percentagepoints.Thetownshipstreets.Relevantdepartmentsofcountiesunitsshouldconscientiouslysumupexperience,adheretotheproblemoriented,peoplearenotsatisfiedwiththevillageasthefocusofthework,insistongraspingbothends,withthemiddle,toconsolidateandimprove,expandfurthereffort,intherealizationofthenormallong-termefforts,toensurethattheendofthisyeartoobtainbetterresults.Third,weneedtoacceleratethevoluntaryservicesystem.Toactivelypromotethepartymembersandmembersandcadresnormalizationofvolunteerservice,doagoodjobinpublicplaces,windowunitsandcommunityvolunteerservicestationconstruction,establishmentofcoveringthewhole49 （3）产程处理特点：第一产程避免紧张恐惧，保证休息和营养，吸氧，应用镇静剂，左侧卧位或半卧位，严密观察心率、呼吸等，严格控制输液速度和输液量，若有早期心衰征象，应给快速洋地黄制剂。第二产程避免产妇屏气用力，用会阴切开术、胎吸术或产钳术，及早结束分娩。第三产程防止腹压骤降，腹部放置沙袋并用腹带加压包扎，以防腹压骤降而诱发心力衰竭。宫缩不好，可肌内注射缩宫素，但禁用麦角新碱，以防静脉压增高，引起心力衰竭、产后立即注射吗啡10mg或哌替啶100mg。4.产褥期 产后1周内仍需卧床休息，除继续严密观察心脏情况外，还应严密观察宫缩和阴道出血等。心功能T-W级者不宜授乳。凡属不宜妊娠者应避孕，如需绝育者，应待产后1周左右且病情稳定时施行绝育术。十五、合并贫血的健康宣教首先应加强预防措施。孕妇应适当注意营养，特别是蛋白质及新鲜蔬菜的补充。已贫血者更应注意，应同时服用铁制剂。胃酸缺乏时可给稀盐酸0.5～2ml及维生素C100mg，3/日，有助于铁的吸收和利用。thepublictoparticipatein,inimperceptibleprovidedLpeople'sculturalquality.Tobuiltuse"Juxianissuedonthemicrochannel,"civilizedJuxian"microchannel,Ju,networksandothermainstreamnetworkmediacontinuedtopushsendonlineisenergyinformation,andcreateagoodnetworkenvironment.Deepentheactionofthebeautifulcountrysidecivilization,tocarryoutawiderangeof"newcountryside,newlife"training,givefullplaytothevillagepopulationculturecourtyard,ParkStreet,culturalsquareandotherpositionstheroleofpublicityandeducation,promoteruralwayoflifemorecivilized.Thisyeartheprovince'surbanandruralsanitationintegrationoftheruralmassessatisfactiontelephonesurvey,significantlyimprovedperformanceinourcounty,respectively,thantheendoflastyear,yearstoimprovethe5.2,17.5percentagepoints.Thetownshipstreets.Relevantdepartmentsofcountiesunitsshouldconscientiouslysumupexperience,adheretotheproblemoriented,peoplearenotsatisfiedwiththevillageasthefocusofthework,insistongraspingbothends,withthemiddle,toconsolidateandimprove,expandfurthereffort,intherealizationofthenormallong-termefforts,toensurethattheendofthisyeartoobtainbetterresults.Third,weneedtoacceleratethevoluntaryservicesystem.Toactivelypromotethepartymembersandmembersandcadresnormalizationofvolunteerservice,doagoodjobinpublicplaces,windowunitsandcommunityvolunteerservicestationconstruction,establishmentofcoveringthewhole49 一般血红蛋白在6g%以上者，都采用口服铁剂疗法，选用副作用小、利用率高的铁制剂，如硫酸亚铁、琥珀酸亚铁、富马酸亚铁、硫酸甘油及葡萄酸亚铁等。另有一种复合铁制剂，含有少量铜、钴、锰、维生素，则更有利于血红蛋白的合成及促进红细胞的成熟。巨幼红细胞性贫血可用叶酸及维生素B12等，同时给铁剂。血红蛋白<5g%或红细胞<150万时，应输血，以少量多次为宜。十六、期高血压综合征的健康宣教1、血压综合征是妊娠晚期常见的病理性情况，是妊娠期最危险的疾病。由于采取了早期预防、早期治疗的措施，母子的死亡率和过去相比已大大减少了。妊娠高血压综合征在临床上简称妊高征。2、征虽然是危险性高的疾病，但其原因现在还不清楚，可能与子宫胎盘缺血、免疫功能异常、高血压体质以及孕妇的营养状况有关。3、thepublictoparticipatein,inimperceptibleprovidedLpeople'sculturalquality.Tobuiltuse"Juxianissuedonthemicrochannel,"civilizedJuxian"microchannel,Ju,networksandothermainstreamnetworkmediacontinuedtopushsendonlineisenergyinformation,andcreateagoodnetworkenvironment.Deepentheactionofthebeautifulcountrysidecivilization,tocarryoutawiderangeof"newcountryside,newlife"training,givefullplaytothevillagepopulationculturecourtyard,ParkStreet,culturalsquareandotherpositionstheroleofpublicityandeducation,promoteruralwayoflifemorecivilized.Thisyeartheprovince'surbanandruralsanitationintegrationoftheruralmassessatisfactiontelephonesurvey,significantlyimprovedperformanceinourcounty,respectively,thantheendoflastyear,yearstoimprovethe5.2,17.5percentagepoints.Thetownshipstreets.Relevantdepartmentsofcountiesunitsshouldconscientiouslysumupexperience,adheretotheproblemoriented,peoplearenotsatisfiedwiththevillageasthefocusofthework,insistongraspingbothends,withthemiddle,toconsolidateandimprove,expandfurthereffort,intherealizationofthenormallong-termefforts,toensurethattheendofthisyeartoobtainbetterresults.Third,weneedtoacceleratethevoluntaryservicesystem.Toactivelypromotethepartymembersandmembersandcadresnormalizationofvolunteerservice,doagoodjobinpublicplaces,windowunitsandcommunityvolunteerservicestationconstruction,establishmentofcoveringthewhole49 征发生在妊娠24周以后，主要伴有高血压、浮肿、蛋白尿三个症状。症状的表现因人而异，有的人三个症状同时出现，也有的人只出现一个症状。其基本的病理变化是全身小动脉的痉挛。由于血管痉挛导致血压升高，当收缩压超过130mmHg、舒张压超过90mmHg就属于高血压了。如患高血压，胎盘的血管容易破裂，会成为引起胎盘早期剥离。由于血管痉挛，毛细血管通透性增加，血液中的水分从血管漏出，积存于皮下组织而发生。浮肿易出现于下肢。如果是正常状态，夜里睡眠时即可消失。但如果在早晨起床时并不消失，而且不只是下肢，连手、脸、腹部都看得出有浮肿，就应注意了。血管痉挛导致肾脏缺血而不能充分发挥作用，尿中出现蛋白质而发生蛋白尿，根据验尿就可以做出清楚的判断。由于胎盘供血不足影响胎儿的发育，会发生胎儿宫内生长迟缓，生后体弱，死亡率高，脑瘫等后遗症发生的比率也高。如果症状进一步发展，在妊娠中、分娩中或产后有时会引起子痫，这是由于脑缺血水肿而引起的全身弥漫性血管内凝血而出血不止，易发生产后大出血。4、征尚无确实可以治愈的治疗方法。其基本治疗措施是保持安静状态，必要时用镇静剂，使用解除血管痉挛的药物、降压药，必要时用利尿剂，适时终止妊娠。症状轻时可以在家中治疗，注意休息，睡眠时采取侧卧位，不要吃得太咸，以免加重水肿，适当服用降压药。如进一步发展为重症，就要住院治疗。住院可以在医院的严格管理下进行治疗，医生会用一些作用较强的降压药，静脉点滴硫酸镁解除血管痉挛，水肿严重时用利尿剂。如进行这些治疗症状好转，胎儿发育基本正常，可以等到37周分娩，但不能超过预产期；如果治疗后无好转或加重，那么在什么时期、采用什么方法分娩要根据医生慎重地判断而进行。十七、妊娠合并性传播疾病的健康宣教1.饮食护理：1、thepublictoparticipatein,inimperceptibleprovidedLpeople'sculturalquality.Tobuiltuse"Juxianissuedonthemicrochannel,"civilizedJuxian"microchannel,Ju,networksandothermainstreamnetworkmediacontinuedtopushsendonlineisenergyinformation,andcreateagoodnetworkenvironment.Deepentheactionofthebeautifulcountrysidecivilization,tocarryoutawiderangeof"newcountryside,newlife"training,givefullplaytothevillagepopulationculturecourtyard,ParkStreet,culturalsquareandotherpositionstheroleofpublicityandeducation,promoteruralwayoflifemorecivilized.Thisyeartheprovince'surbanandruralsanitationintegrationoftheruralmassessatisfactiontelephonesurvey,significantlyimprovedperformanceinourcounty,respectively,thantheendoflastyear,yearstoimprovethe5.2,17.5percentagepoints.Thetownshipstreets.Relevantdepartmentsofcountiesunitsshouldconscientiouslysumupexperience,adheretotheproblemoriented,peoplearenotsatisfiedwiththevillageasthefocusofthework,insistongraspingbothends,withthemiddle,toconsolidateandimprove,expandfurthereffort,intherealizationofthenormallong-termefforts,toensurethattheendofthisyeartoobtainbetterresults.Third,weneedtoacceleratethevoluntaryservicesystem.Toactivelypromotethepartymembersandmembersandcadresnormalizationofvolunteerservice,doagoodjobinpublicplaces,windowunitsandcommunityvolunteerservicestationconstruction,establishmentofcoveringthewhole49 在营养的摄入方面，肝脏是人体新陈代谢的重要器官，妊娠合并乙肝的患者因为肝脏功能发生障碍而影响物质代谢，如果不提前预防，对胎儿影响很大，所以合理的营养饮食对肝功能的恢复十分重要。既要重视蛋白质和糖的摄取，又要考虑维生素和无机盐的补充。所以，既要吃些肉、蛋、乳、豆制品、糖果和粮食等。又要吃些新鲜的蔬菜和水果。既要重视蛋白质和糖的充足，又要结合病情考虑病人的消化吸收能力和体重增长情况。饮食过量会加重肝脏的负担。2、在食物选择方面，在妊娠早期，病人食欲不佳，食物以少油质清淡为主，适当增加糖量，以保证热量的充足。妊娠晚期仍以清淡为宜。但需增添易消化的蛋白质食品并力求做到美味可口，多样化，以促进食欲。若妊娠后期体重有明显增长趋势应及时控制油脂和糖量，防止脂肪肝。3、在餐次安排方面最好采用少食多餐的方法。因为肝炎病人的消化吸收功能较弱，少食多餐既可减轻肝脏负担防止消化不良，又可增加进食量，有利于肝细胞的恢复。2切断传播途径一般来说乙型肝炎的传播途径是尿液、汗液、唾液、乳汁及血液制品感染。妊娠期，应注意个人卫生，养成良好的卫生习惯，饭前便后洗手，实行分餐制，生活用品与家人的用品分开放置经常清洗外阴，会阴纸垫焚烧。同时要加强锻炼，每天散步，增强机体免疫力，提高防病能力，预防感冒。如妊娠期患病需治疗输液、打针，严格执行针管、针头、采血针、牙科手术器械的消毒工作、医疗注射及预防接种时应做到一人一针一管制度。2.用药指导thepublictoparticipatein,inimperceptibleprovidedLpeople'sculturalquality.Tobuiltuse"Juxianissuedonthemicrochannel,"civilizedJuxian"microchannel,Ju,networksandothermainstreamnetworkmediacontinuedtopushsendonlineisenergyinformation,andcreateagoodnetworkenvironment.Deepentheactionofthebeautifulcountrysidecivilization,tocarryoutawiderangeof"newcountryside,newlife"training,givefullplaytothevillagepopulationculturecourtyard,ParkStreet,culturalsquareandotherpositionstheroleofpublicityandeducation,promoteruralwayoflifemorecivilized.Thisyeartheprovince'surbanandruralsanitationintegrationoftheruralmassessatisfactiontelephonesurvey,significantlyimprovedperformanceinourcounty,respectively,thantheendoflastyear,yearstoimprovethe5.2,17.5percentagepoints.Thetownshipstreets.Relevantdepartmentsofcountiesunitsshouldconscientiouslysumupexperience,adheretotheproblemoriented,peoplearenotsatisfiedwiththevillageasthefocusofthework,insistongraspingbothends,withthemiddle,toconsolidateandimprove,expandfurthereffort,intherealizationofthenormallong-termefforts,toensurethattheendofthisyeartoobtainbetterresults.Third,weneedtoacceleratethevoluntaryservicesystem.Toactivelypromotethepartymembersandmembersandcadresnormalizationofvolunteerservice,doagoodjobinpublicplaces,windowunitsandcommunityvolunteerservicestationconstruction,establishmentofcoveringthewhole49 如病人乙型肝炎e抗原阳性，还需检查其爱人的血液中的乙型肝炎病毒指标，如其爱人血液中乙型肝炎表面抗原为阴性，可在医生指导下注射乙型肝炎疫苗，方可受孕。在婴儿娩出后24小时内注射第一针乙型肝炎疫苗，剂量为30微克，到出生后第一个月和第六个月再分别注射第二针和第三针，后两针剂量为10微克。也可在婴儿出生后24小时内注射高价免疫球蛋白。分娩后应检验乳汁DNA，检验结果无碍方可母乳喂养，检验结果不能喂养时，遵医嘱用回奶药。 3.心理护理与社会影响1、心理护理热情接待孕妇并与其亲切交谈，向患者及家属讲述乙肝的一些基本知识，提高自身对疾病的认识，以便更好地护理病人，并指导病人自我调节，使其正视疾病，消除心理压力，增强战胜疾病的信心。讲述乙肝知识的同时讲解分娩知识，分散其注意力，使其保持愉快的心情去迎接自己的小宝宝，懂得如何呵护小宝宝，呵护自己。 2、社会因素乙肝患者在日常工作中不同程度的因此而受到影响，同事会因此避而远之，严重的甚至性格改变、忧虑、抑郁等。妊娠期的患者更会因此而加重心理负担，担心自己的宝宝受到影响。我们应给予患者更多的关心和保护，让她们树立信心，相信自己，相信医院。thepublictoparticipatein,inimperceptibleprovidedLpeople'sculturalquality.Tobuiltuse"Juxianissuedonthemicrochannel,"civilizedJuxian"microchannel,Ju,networksandothermainstreamnetworkmediacontinuedtopushsendonlineisenergyinformation,andcreateagoodnetworkenvironment.Deepentheactionofthebeautifulcountrysidecivilization,tocarryoutawiderangeof"newcountryside,newlife"training,givefullplaytothevillagepopulationculturecourtyard,ParkStreet,culturalsquareandotherpositionstheroleofpublicityandeducation,promoteruralwayoflifemorecivilized.Thisyeartheprovince'surbanandruralsanitationintegrationoftheruralmassessatisfactiontelephonesurvey,significantlyimprovedperformanceinourcounty,respectively,thantheendoflastyear,yearstoimprovethe5.2,17.5percentagepoints.Thetownshipstreets.Relevantdepartmentsofcountiesunitsshouldconscientiouslysumupexperience,adheretotheproblemoriented,peoplearenotsatisfiedwiththevillageasthefocusofthework,insistongraspingbothends,withthemiddle,toconsolidateandimprove,expandfurthereffort,intherealizationofthenormallong-termefforts,toensurethattheendofthisyeartoobtainbetterresults.Third,weneedtoacceleratethevoluntaryservicesystem.Toactivelypromotethepartymembersandmembersandcadresnormalizationofvolunteerservice,doagoodjobinpublicplaces,windowunitsandcommunityvolunteerservicestationconstruction,establishmentofcoveringthewhole49 3、5病人出院后的生活护理病人出院后，如果生活调理得当，将有利于巩固治疗效果，促进肝功能的进一步恢复，所以康复期间病人的生活调整至关重要。4保持饮食平衡。食物中充足的蛋白质对肝细胞的再生和维护有利，碳水化合对肝脏有保护作用，各种维生素有益于肝脏功能的恢复，但进食量必须恰当。在食物的质量、品种上要合理搭配，且要养成杂食细嚼的好习惯。这样的平衡饮食有利于肝脏对营养物质的加工、利用和吸收，同时促进肝功能的恢复。5、适当服用保肝药物。尽管保肝药物对肝有营养保护的作用，但是如果乱服，仍可能增加肝脏的负担。必须纠正保肝药多服无妨的观点。6、婴儿用品应严格消毒，避免和妈妈的生活用品接触，以防感染。7、必须保护充足的睡眠和必要的卧床休息，勤换会阴纸垫，保持会阴部清洁干燥，换下的会阴纸垫应严格消毒处理。早睡早起，呼吸新鲜空气，适量散步和活动对于肝功能进一步恢复也极为重要。十八、新生儿窒息健康宣教1、因家长护理不当，健康的新生儿，有时也会突然脸色青紫，哭不出声，甚至呼吸受阻而发生窒息。这种现象往往使家长手足无措，如果抢救不及时还会造成严重后果。那么应怎样预防呢？thepublictoparticipatein,inimperceptibleprovidedLpeople'sculturalquality.Tobuiltuse"Juxianissuedonthemicrochannel,"civilizedJuxian"microchannel,Ju,networksandothermainstreamnetworkmediacontinuedtopushsendonlineisenergyinformation,andcreateagoodnetworkenvironment.Deepentheactionofthebeautifulcountrysidecivilization,tocarryoutawiderangeof"newcountryside,newlife"training,givefullplaytothevillagepopulationculturecourtyard,ParkStreet,culturalsquareandotherpositionstheroleofpublicityandeducation,promoteruralwayoflifemorecivilized.Thisyeartheprovince'surbanandruralsanitationintegrationoftheruralmassessatisfactiontelephonesurvey,significantlyimprovedperformanceinourcounty,respectively,thantheendoflastyear,yearstoimprovethe5.2,17.5percentagepoints.Thetownshipstreets.Relevantdepartmentsofcountiesunitsshouldconscientiouslysumupexperience,adheretotheproblemoriented,peoplearenotsatisfiedwiththevillageasthefocusofthework,insistongraspingbothends,withthemiddle,toconsolidateandimprove,expandfurthereffort,intherealizationofthenormallong-termefforts,toensurethattheendofthisyeartoobtainbetterresults.Third,weneedtoacceleratethevoluntaryservicesystem.Toactivelypromotethepartymembersandmembersandcadresnormalizationofvolunteerservice,doagoodjobinpublicplaces,windowunitsandcommunityvolunteerservicestationconstruction,establishmentofcoveringthewhole49 2、要预防窒息并不难，平时最好养成孩子独自睡觉的习惯，不要含着奶头睡觉。如果大人让孩子和自己睡在一个被窝里给孩子为奶，待疲劳的妈妈熟睡后，充盈的乳房会堵住孩子的口鼻，枕头和棉被也会阻塞孩子的呼吸，造成窒息事故。3、喂奶的姿势要正确，最好抱起喂，使头部略抬高，不致使奶液返溢入气管。橡皮奶头孔不宜过大，奶瓶的倾斜度以吸不进空气为宜。喂完后应将孩子竖抱起，轻拍其背部，待打嗝后再放回床上，并要向右侧卧，以免溢奶时奶液吸入气管。thepublictoparticipatein,inimperceptibleprovidedLpeople'sculturalquality.Tobuiltuse"Juxianissuedonthemicrochannel,"civilizedJuxian"microchannel,Ju,networksandothermainstreamnetworkmediacontinuedtopushsendonlineisenergyinformation,andcreateagoodnetworkenvironment.Deepentheactionofthebeautifulcountrysidecivilization,tocarryoutawiderangeof"newcountryside,newlife"training,givefullplaytothevillagepopulationculturecourtyard,ParkStreet,culturalsquareandotherpositionstheroleofpublicityandeducation,promoteruralwayoflifemorecivilized.Thisyeartheprovince'surbanandruralsanitationintegrationoftheruralmassessatisfactiontelephonesurvey,significantlyimprovedperformanceinourcounty,respectively,thantheendoflastyear,yearstoimprovethe5.2,17.5percentagepoints.Thetownshipstreets.Relevantdepartmentsofcountiesunitsshouldconscientiouslysumupexperience,adheretotheproblemoriented,peoplearenotsatisfiedwiththevillageasthefocusofthework,insistongraspingbothends,withthemiddle,toconsolidateandimprove,expandfurthereffort,intherealizationofthenormallong-termefforts,toensurethattheendofthisyeartoobtainbetterresults.Third,weneedtoacceleratethevoluntaryservicesystem.Toactivelypromotethepartymembersandmembersandcadresnormalizationofvolunteerservice,doagoodjobinpublicplaces,windowunitsandcommunityvolunteerservicestationconstruction,establishmentofcoveringthewhole49
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