Effect of Resistance Training,Aerobic Exercise Before Doula-Assisted Delivery on the Psychological Well-Being and Labor Duration of Parturients

Objective:To investigate the impact of resistance training and aerobic exercise before doula-assisted delivery on the psychological well-being and labor duration of parturients.Methods:105 cases of parturients who gave birth in our hospital from February 2021 to April 2023 were included in this study.The patients were divided into a control group of 52 cases and an observation group of 53 cases.The patients in the control group received no particular intervention before delivery and only received doula assistance.The patients in the observation group received resistance training,aerobic exercise,and doula assistance prior to giving birth.After delivery,the mothers were observed for 2 hours in the delivery room and then returned to the maternal and infant ward.The observation indicators of the two groups were compared.Results:In comparison to the control group,the observation group exhibited shorter durations in the first,second,and third stages of labor,as well as the total delivery time.Additionally,the amount of postpartum blood loss at 2 hours was smaller in the observation group.The rate of cesarean section was lower,and the rate of vaginal natural delivery was higher in the observation group.Following the intervention,both groups of postpartum women showed decreased SAS and SDS scores compared to before the intervention.Moreover,the observation group had lower scores than the control group.These differences were all statistically significant(P<0.05).Conclusion:Resistance training and aerobic exercise before doula-assisted delivery can effectively improve the psychological state of parturients,shorten labor duration,increase the rate of natural vaginal delivery,and reduce pain and postpartum hemorrhage.

Maternal and Fetal Prognosis of Evacuated Parturients in N’Djamena Mother and Child Hospital (Chad)

Introduction: All pregnant women are at risk of obstetric complications leading to high fetal-maternal mortality and morbidity. The aim of this work was to evaluate the maternal and fetal prognosis of evacuated parturients. Patient and Method: we conducted a prospective analytical survey for four months, from April 1st to July 31st, 2018 in the Maternity of N’Djamena Mother and Child Hospital about the maternal and fetal prognosis of evacuated parturients. Any parturient evacuated or referred for obstetric complications was included. Study parameters were epidemiological, clinical, para-clinical, therapeutic and prognosis order. These parameters were analyzed in the SPSS 18 French version software. Results: Evacuated parturients represented 20% of maternity admissions. The average age was 23.9 years, with extremes ranging from 15 and 43 years. They were uneducated in 72.9%, primiparous in 46.8% of cases. The three delays were dominated by the 1st delay, which represented 34.1% of cases. In this series, 26.3% parturients had presented obstetric complications. Preruptive syndrome was the most common complication with 29.3% cases. Predisposing factors to maternal-fetal complications were low attendance antenatal care, late evacuation and distance travelled. The maternal mortality rate was 3%. Fetal complications were observed in 28.3% of cases and the neonatal mortality rate was 24.6%. Conclusion: The maternal and fetal complications of evacuated parturients are a real public health problem in our regions. The suppression of delays, capacity reinforcement of peripheral maternity and the periodic recycling peripheral centers to recognize obstetric emergencies will contribute to improve the maternal and fetal prognosis of evacuated parturients.

Screening in the Birth Room of Parturients with Unknown Human Immunodeficiency Virus (HIV) Serological Status at the Reference Health Center of Commune IV of the District of Bamako

Introduction: In order to prevent the vertical transmission of the Human Immunodeficiency Virus (HIV), it is essential that pregnant women must know their HIV serological status. Objective: To determine the proportion of parturients with unknown Human Immunodeficiency Virus (HIV) status in the delivery room and to identify the associated factors. Methods: We conducted a prospective descriptive study carried out at the Reference Health Center of Commune IV in the district of Bamako from July 1, 2017 to July 1, 2018. The sample size was 267 parturients. The word processing was carried out on World software from the 2016 office suite at the end of the data entry and analysis was carried out on the IBM software, SPSS version 22.0. Results: A total of 267 women were eligible for our study, among which 14 parturients were seropositive, i.e., a proportion of 5.2% of cases. The knowledge of parturients on HIV was 95.5% of cases, but more than half did not know the mode of mother-child transmission. Unschooled parturients were the most represented with 41.2%. Conclusion: In view of the large proportion (5.2%) of HIV-positive parturients in our study, voluntary screening activities in the delivery room remain necessary for the future of children born to HIV-positive mothers.

Dural puncture epidural technique provides better anesthesia quality in repeat cesarean delivery than epidural technique:Randomized controlled study

BACKGROUND Repeat cesarean deliverys involve a longer surgery and more severe visceral traction than primary cesarean deliverys.The dural puncture epidural(DPE)technique provides faster and more effective analgesia for labor,but there is no sufficient evidence to indicate whether it is suitable for parturients undergoing repeat cesarean delivery.AIM To determine the efficacy and safety of the DPE anesthesia technique in patients undergoing repeat cesarean delivery.METHODS Patients undergoing repeat cesarean delivery were randomly divided into the DPE and epidural anesthesia(EA)groups.A 25-G spinal needle was used for dural puncture via a 19-G epidural needle.The patients in the two groups were injected with 5 mL of 2%lidocaine followed by 15 mL of a mixture of 1%lidocaine+0.5%ropivacaine as the epidural dosage.The primary outcome was the onset time of sensory block to the T6 dermatome level and the sensory and motor block degree.RESULTS A total of 115 women were included(EA:57,DPE:58).The mean time to sensory block to the T6 Level was significantly shorter in the DPE group than in the EA group(14.7 min vs 16.6 min;95%confidence interval,13.9 to 15.4 vs 15.8 to 17.4;P=0.001).The cranial sensory block level was significantly higher at 5,10,and 15 min after the initial dose in the DPE group than in the EA group(P<0.05).The sacral sensory block level was significantly higher and the modified bromage score was significantly lower in the DPE group at each time point(P<0.05).Adverse effects and neonatal outcomes were comparable between the two groups(P>0.05).CONCLUSION The DPE technique provided higher-quality anesthesia than the EA technique,with a rapid onset of surgical anesthesia,better cranial and sacral sensory block spread and a higher motor block degree,without increasing the incidence of maternal or fetal side effects in patients undergoing repeat cesarean delivery.

Manual removal of the placenta: Evaluation of some risk factors and management outcome in a tertiary maternity unit. A case controlled study

Objective: Lack of consensus on when to diagnose and manage retained placenta in the absence of hemorrhage in the 3rd stage of labor, has often subjected Manual removal of placenta (MROP) to the discretion of the accoucher. This study aimed to appraise the practice of manual removal of placenta in a tertiary institution in Nigeria with a view to evaluating risk factors for the procedure and advance probable guidelines to enhance standardization of diagnosis of retained placenta. Design: Case controlled study. Setting: Tertiary maternity center in South west Nigeria. Participants: Data from the hospital records of 92 parturients who had MROP from January to December 2009 were compared with 91 immediate next parturients without MROP matched for age and parity. Variables such as the past obstetric and gynecological history, status of accoucher, gestational age at delivery, duration of 3rd stage, estimated blood loss, quantum of blood transfused and length of hospitalization were extracted and subjected to statistical analysis using the SPSS package. Results: There were 4613 deliveries of which 92 parturients had MROP, an incidence of 1.99%. The mean duration of 3rd stage in the study group was 35.6 ± 18.8 minutes compared to 21.6 ± 6.28 minutes in the control. Doctors were the accoucher in 96.8% of cases while midwives took the deliveries in 84.4% in the control group. Previous scarring of the pregnant uterus such as dilatation and curettage and caesarean section predisposed to MROP compared to the control group (P rd stage of labor with definite criteria for diagnosis of retained placenta to reduce the probable risk of unnecessary MROP.

HIV/AIDS Screening in the African Birthplace (Hospital in Kayes, Mali)

Purpose: The purpose of this study was to determine HIV prevalence among participants admitted to the delivery room and recent birth attendants. Materials and Methods: This was a descriptive, cross-sectional, analytical study, with a prospective collection from February 1, 2018 to January 31, 2019 at fousseyni Daou Hospital in Kayes, Mali. Results: During our study period, we recorded 4269 deliveries. HIV-positive patients known before labour accounted for 0.21%. Four hundred and six participants received counselling/testing in the delivery room;of which 36 refused the test: 8.87% and 370 accepted or 91.13%. Thirteen patients tested positive or 3.51%. The 20 - 35 age group was the most represented at 76.92%. Positive patients tested received ARV treatment in the delivery room in 92.31% of cases;and 1 patient or 7.69% did not receive treatment for refusal. Vaginal delivery was the most common at 77%, with caesarean section 23%. Newborns had a good prognosis in their first weeks of life in 85%;fetal lethality was observed in 15% of newborns including 1 case of fresh stillbirth and 1 case of pediatric deaths for neonatal suffering. Conclusion: Counselling and voluntary HIV/AIDS testing during labour and immediate postpartum can detect many pregnant women who escape screening during antenatal consultations.

Uneventful Spinal Anesthesia in a Patient with Precipitous Drop of Platelet Secondary to HELLP Syndrome: A Case Report and Review of Literatures

Thrombocytopenia caused by Hemolysis, Elevated Liver enzymes and Low Platelet count (HELLP) syndrome in pre-eclampsia parturients can be associated with substantial maternal and neonatal morbidity. Data on the issue of the safety of neuraxial anesthesia with thrombocytopenia in HELLP syndrome is limited. A lower limit of 100,000 per microliter for platelet count was suggested as “safe” for performing neuraxial anesthesia, however there is no supporting data. This lower limit is challenged lately. We present a case of uneventful spinal anesthesia for urgent Cesarean section in a patient with severe pre-eclamsia, HELLP syndrome and precipitous platelet drop from 230,000 to 42,000 per microliter.

Determinants of Home Birth in the Community of Dagbati in Togo

Introduction: Home birth or unassisted birth means for a woman to make the decision to give birth at home, not alone in absolute terms, but without professional assistance, be it that of a midwife, a doctor or any other person with midwifery qualifications. Methods: This was a descriptive cross-sectional study conducted from November 04th to December 21st, 2019 and from August 17th to August 21st, 2020, in the community of Dagbati, in 33 women who gave birth at home, received at the USP of Dagbati and during advanced strategies;who were registered or not in the delivery register of USP Dagbati and who agreed to participate in the survey freely and in an informed manner. Results: Of the 48 deliveries that took place in the locality during our study period, 33 took place at home, with a rate of 68.7%. The average age of the women giving birth was 26.33 years with extremes of 15 and 47 years. In 42.4% of cases, they were farmers. Twenty-seven women who gave birth had farmer spouses (81.9%). The distance between their house and the health center was greater than 2 km in 78.8% of cases. Among the reasons for giving birth at home, the lack of financial means was mentioned in 60.6%. In 63.6%, the family had assisted the women in giving birth. Conclusion: Home birth is still a reality in our communities, despite the increased number of health facilities. The sensitization of the population, the improvement of the conditions of accessibility to the health center, the quality of obstetric care, and also, the improvement of the living conditions of women will surely allow a total abandonment of home births.

Application Effect of Midwifery Nursing in the Prevention of Neonatal Asphyxia

Objective:To explore the role of midwifery care in the prevention of neonatal asphyxia.Method:The 100 cases of parturient received in our hospital from January 2018 to January 2021 were divided into two groups,respectively,the control group and the experimental group with 50 cases in each group.The control group received routine care,and the experimental group received midwifery care.The psychological status of the mothers and the occurrence of neonatal asphyxia were compared between the two groups.Results:Before nursing,there was no significant difference in the mental state of the two groups of parturient(P>0.05).After the nursing,the mental state of the parturient in the experimental group was significantly better than that of the control group(P<0.05);After different ways of nursing,the incidence of asphyxia in neonates in the control group was significantly higher than that in the experimental group(P<0.05),and the comparison between the groups was statistically significant.Conclusion:The timely delivery of midwifery care for parturient can improve the mental state of the parturient and help reduce the incidence of neonatal asphyxia.It is worthy of clinical attention and promotion.

Goal-directed Fluid Therapy May Improve Hemodynamic Stability of Parturient with Hypertensive Disorders of Pregnancy Under Combined Spinal Epidural Anesthesia for Cesarean Delivery and the Well-being of Newborns

Background： Hypotension induced by combined spinal epidural anesthesia in parturient with hypertensive disorders of pregnancy （HDP） can easily compromise blood supply to vital organs including uteroplacental perfusion and result in fetal distress. The aim of this study was to investigate whether the goal-directed fluid therapy （GDFT） with LiDCOrapid system can improve well-being of both HDP parturient and their babies. Methods： Fifty-two stable HDP parturient scheduled for elective cesarean delivery were recruited. After loading with 10 ml/kg lactated Ringer＇s solution （LR）, parturient were randomized to the GDFT and control group. In the GDFT group, individualized fluid therapy was guided by increase in stroke volume （ASV） provided via LiDCO rapid system. The control group received the routine fluid therapy. The primary endpoints included maternal hypotension and the doses of vasopressors administered prior to fetal delivery. The secondary endpoints included umbilical blood gas abnormalities and neonatal adverse events. Results： The severity of HDP was similar between two groups. The total LR infusion （P 〈 0.01） and urine output （P 〈 0.05） were higher in the GDFT group than in the control group. Following twice fluid challenge tests, the systolic blood pressure, mean blood pressure, cardiac output and SV in the GDFT group were significantly higher, and the heart rate was lower than in the control group. The incidence of maternal hypotension and doses of phenylephrine used prior to fetal delivery were significantly higher in the control group than in the GDFT group （P 〈 0.01）. There were no differences in the Apgar scores between two groups. In the control group, the mean values of pH in umbilical artery/vein were remarkably decreased （P 〈 0.05）, and the incidences of neonatal hypercapnia and hypoxemia were statistically increased （P 〈 0.05） than in the GDFT group. Conclusions： Dynamic responsiveness guided fluid therapy with the LiDCOrapid system may provide potential benefits to stable HDP parturient and their babies.