Facilitators to Immediate Post Partum Intra Uterine Contraceptive Device Uptake among Mothers Delivering in Meru Hospital

Family planning allows people to attain their desired number of children and determine the spacing of pregnancies. It is important to promote uptake of family planning services because it is one of the four pillars of the Safe Motherhood Initiative to reduce maternal death in developing countries. It is also enshrined in health related Sustainable Development Goals. Post Partum Intra Uterine Contraceptive Device (PPIUCD) is the oldest methods of family planning. During the ancient times, foreign bodies like stones were introduced into the woman’s uterus for prevention of pregnancy. Post partum method of contraception is highly recommended because it is long acting, convenient, safe and highly effective with minimal side effects compared to the hormonal methods. Despite these advantages, the method is the lowest in use globally, regionally and locally. According to the Meru Hospital records for the year 2017, the immediate PPIUCD uptake was very low at 3.4%. The broad objective of this study was to assess the factors that facilitate uptake of PPIUCD at Meru Hospital. The study site was post natal ward maternity department of Meru Hospital for a period of two months that is September and October in the year 2018. A descriptive research design was used and the study population was the mothers who were admitted in the ward during the study period. A sample size of 74 respondents was used as the representative to the target population of 289 mothers. Simple random sampling was used to get the sample for the facilitators. Data were collected using structured questionnaires and interview schedules. The data collection instruments were pretested at Embu Level five Hospital and split half reliability test technique used. Validity was ensured through review of literature from similar studies and by consulting supervisors in the department. Permission to conduct the study was sought from National Commission for Science, Technology and Innovation through Chuka University Ethics and Research Committee. Descriptive analysis was done to get percentages using Statistical Package for Social Science (SPSS) for windows version 23.0. Qualitative data were analyzed by grouping data into themes according to the study objectives. The analyzed data were presented in tables, charts and narratives. The findings of the study revealed that;the main client related facilitators to PPIUCD uptake were older age above 30 years, employment, tertiary level of education and knowledge on the method as a result of the providers’ effort to share information. That is 70% of older aged mothers, 60% of the employed and 40% with tertiary education had the insertion. The main provider facilitator to PPIUCD uptake was timely counseling and insertion services. 20% of those who had the insertion said that timely counseling was done during antenatal period. The main method related facilitator to PPIUCD uptake was past experience and preference to alternative methods of contraception. 50% of those who accepted the insertion had previous bad experience and side effects of other alternative methods. Some 30% of users perceived that the method was effective and convenient because once inserted no need for frequent visits to the clinic. The study concluded that clients, providers and method factors facilitated uptake of immediate PPIUCD. The study recommends putting in place strategies to improve the uptake of the method by considering the client, provider and method related facilitators.

Experimental Trypanosoma brucei infection at immediate post partum period:effects on dam and the offspring

Objective:To investigate the effects of immediate post-partum infection with Trypanosoma brucei（T.brucei） on dam and offspring.Methods:Sixty female Albino rats（Rattus norvegicus） weighing between 130-170 g were used as animal model.The animals were divided as follows: 25 infected between 1-5 days post partum;10 infected unbred as positive controls;and 25 uninfected as negative controls.The following parameters were evaluated:packed cell volume （PCV）,level of parasitaemia,survival time,litter size and litter weight at birth and on days 7, 14 and 21 post delivery,using conventional methods.Possible trans-mammary transmission of infection to litter through milk was also assessed.Results:The results showed a comparatively （P【0.05） higher mean PCV value for the uninfected negative control on the 8 day post infection compared with the infected groups which corresponded with the increasing level of parasitaemia in the two infected groups.Mean litter size and litter weights were higher（P【0.05） in the uninfected controls on the 21st day.Survival time in the infected groups were similar.No evidence of trans-mammary transfer of infection was recorded.Conclusion:T.brucei infection during immediate post partum period is detrimental to the dam and impairs growth of the offspring.

Uterotonic drugs use for post partum hemorrhage: An audit of the third stage of labor management

Objectives: Worldwide the use of uterotonic drugs has significantly reduced maternal mortality from postpartum hemorrhage. The objective is to audit the use of uterotonics in the active management of the third and fourth stages of labor. Methods: Personal data, diagnostic clinical information, blood loss and uterotonics administered were extracted from a cohort of 634 consecutive parturient. Trend in Shock Index (Pulse Rate/Systolic Blood Pressure) and 48 hours hematocrit changes were computed and analyzed. Results: There were 422 vagina deliveries and 212 caesarean sections. Primiparous mothers were 141 (34.2%), while grand multiparous mothers were 14 (3.4%). The mean visually estimated postpartum blood loss 165.9 ± 80 ml. There was no significant difference in the mean blood loss between the three parity groups of parturient [P = 0.09]. Fourteen parturient (3.44%) had blood loss ≥500 ml. The value of Shock Index (Pulse Rate/Systolic Blood Pressure) in the study ranged between 0.43 and 1.38. Logistic regression analysis of the variables associated with the switch between the three regimens of uterotonic drugs, showed a significant positive correlation between VEBL and uterotonic drugs administered [Pearson correlation = 0.130, P-value = 0.008]. In addition, there was a significant negative correlation between uterotonic drugs administered and Shock Index at 30 minutes and 2 hours postpartum. The correlation coefficient between VEBL and regimens of uterotonic drugs used was positive and significant (P = 0.019). Conclusion: Visually estimated blood loss, with shock are the main Triggers involved in switching between uterotonic drugs regimens used in active management of PPH. Shock index calculation is vital in management decision. We advocate training of all birth attendants on VEBL.

Factors Influencing the Resumption of Postpartum Female Sexuality in Women Who Have Given Birth Once or Several Times at the Ignace Deen Maternity Hospital of the Conakry University Hospital Centre (Guinea)

Introduction: Sexuality in the postpartum period is a taboo subject that raises many questions, especially among women. The aim of this study was to evaluate the influence of factors such as mode of delivery, parity, type of household and level of education on the resumption of sexuality, by comparing our results with those in the literature. Methods: This is a prospective descriptive and analytical study, which took place from 3 April to 2 June 2023 in the maternity ward of the Ignace Deen National Hospital of the University Hospital Centre of Conakry. The sample included married women who had given birth once or several times. Results: Of 118 married women who had given birth once or several times and who were questioned about their sexuality in the postpartum period, 75.42% (89 cases) stated that they had resumed sexual activity in the postpartum period. (The majority were aged 20 - 29 years (46.61%), pauci pares (51.69%), living in a monogamous household (88.14%), with secondary education (44.92%) and self-employed (38.98%). More than half (58.47%) of these women had a normal vaginal delivery with vulvo-perineal tear (5.80%), episiotomy (15.94%) and instrumental extraction (8.69%). The main reasons for resuming sexual activity were the desire to satisfy their partner (50.56%) and to maintain the harmony of the couple (29.21%). Resumption of sexual activity was more common in patients who had given birth by caesarean section (p = 0.007) and in patients with a higher level of education (p = 0.03). However, it was not influenced by parity or household type. Conclusion: Sexuality remains a taboo subject, and its resurgence in the postpartum period is influenced by the mode of delivery and the level of education and perception of women. Certain practices and complications related to childbirth can also influence the resumption of sexuality in the postpartum period.

Abdominal Pain and Fever Indicative Postpartum Ovarian Vein Thrombosis: A Case Report

Introduction: OVT is rare, with an incidence of 0.05% to 0.18% and occurring preferentially in postpartum period. Any delay in management may compromise the patient’s vital prognosis. Observation: We report a case of a 34-year-old patient, G2P3, who delivered twins by cesarean section at 39 weeks of amenorrhea. She presented abdominal pain and fever on the 4th day of postpartum. Biological tests showed a biological inflammatory syndrome and a positive blood culture with gram-positive Staphylococcus. After 72 hours of antibiotics with no clinical or biological improvement, a CT scan revealed a 12 mm thrombus in the lumen of the right ovarian vein’s connection to the inferior vena cava. Antibiotic treatment was continued, associated with an anticoagulant. The evolution was been favorable. Conclusion: Rare and serious pathology, the diagnosis is made using medical imaging. The outcome is generally favorable with antibiotic therapy and anticoagulant therapy.

Post-partum reactivation of chronic hepatitis B virus infection among hepatitis B e-antigen-negative women

AIM: To investigate the frequency and timing of post-partum chronic hepatitis B virus(HBV) reactivation and identify its pre-partum predictors. METHODS: Forty-one hepatitis B e antigen(HBe Ag)-negative chronic HBV infected pregnant women were prospectively evaluated between the 28 th and the 32 nd week of gestation. Subjects were re-evaluated at 3-mo intervals during the first post-partum year and every 6 mo during the following years. HBV DNA was determined using real-time reverse transcription polymerase chain reaction(Cobas Taq Man HBV Test) with a lower detection limit of 8 IU/m L. Post-partum reactivation(PPR) was defined as abnormal alanine aminotransaminase(ALT) levels and HBV DNA above 2000 IU/m L. RESULTS: Fourteen out of 41 women(34.1%) had prepartum HBV DNA levels > 2000 IU/m L, 18(43.9%) had levels < 2000 IU/m L and 9(21.9%) had undetectable levels. Fourteen women were lost to follow-up(failure to return). PPR occurred in 8 of the 27(29.6%) women evaluated, all within the first 6 mo after delivery(5 at month 3; 3 at month 6). Five of the 6(83.3%) women with pre-partum HBV DNA > 10000 IU/m L exhibited PPR compared with 3 of the 21(14.3%) women with HBV DNA < 10000 IU/m L(two with HBV DNA > 2000 and the third with HBV DNA of 1850IU/m L), P = 0.004. An HBV DNA level ≥ 10000 IU/m L independently predicted post-partum HBV infection reactivation(OR = 57.02, P = 0.033). Mean pre-partum ALT levels presented a non-significant increase in PPR cases(47.3 IU/L vs 22.2 IU/L, respectively, P = 0.094).CONCLUSION: In the present study, PPR occurred in approximately 30% of HBe Ag-negative pregnant women; all events were observed during the first semester after delivery. Pre-partum HBV DNA level > 10000 IU/m L predicted PPR.

Barriers to Immediate Post-Partum Intra-Uterine Contraceptive Device Uptake among Mothers Delivering at Meru Hospital

Global contraceptive use is at 64%, Africa lagging behind at 33.4%. Kenya has an unmet need for family planning at 23%. Hormonal injections are the most used in Africa at 9.8% and Intra-Uterine Contraceptive Devices at 3.8%. Low uptake of 3.4% was reported in Meru Hospital and lack of literature on immediate Post Partum Intra Uterine Contraceptive Device (PPIUCD) uptake. Immediate Post Partum Intra Uterine Contraceptive Device is a long acting reversible contraceptive device inserted into the uterus immediately within 48 hours after delivery. The objective was to assess Barriers to Immediate Post-Partum Intra-Uterine Contraceptive Device uptake among Mothers delivering in Meru Hospital. Descriptive research design was used and a population of 289 mothers was targeted. Sample size of 74 respondents was selected using simple random sampling. Questionnaires and interview schedules were used to collect data. The collected data were entered and analyzed using Statistical Package for Social Science windows version 23.0. Descriptive analysis was used to obtain frequencies and percentages. Chi-square was used to test the relationship of study variables and presented in tables. The qualitative data were analyzed thematically. The findings revealed that provider related barriers such as none provision of the services and untimely counseling for the insertion had the highest impact to low uptake (57%). Clients lacked information where 68% reported that they were not counseled. Demographic and reproductive characteristics also played a role in low uptake. Using the chi square test, there was a significant relationship, P = 0.001 between young age of the mothers, unemployment (53%), low parity (56%) and low uptake. Preference for other alternative contraceptives (25.8%) such as hormonal methods was a barrier to the uptake. Therefore, barriers to PPIUCD uptake are provider related, alternative methods of contraception and client related such as lack of information, unemployment, young age and low parity. The findings will inform Meru hospital management on barriers to immediate PPIUCD uptake. The study recommends an investigation on why providers hinder PPIUCD uptake and create awareness on PPIUCD services to the community.

Women’s Perception Concerning Health Care in the Post-Partum Period: A Meta-Synthesis

This meta-synthesis presents the results of qualitative studies on puerperal perception concerning woman’s care in the post-partum period. Four databases were researched using keywords such as “postnatal care” (or) “postpartum period”, (and) “care”, “women”, “perception”, “qualitative research”, “women’s health services”, “community health services”, “allied health personnel”, “primary health care”, resulting in 9 articles for analysis. Six themes were identified: interpersonal relationship, information, communication, attending the necessities, service organization and other supports. Results report mainly on the unsatisfactory professional care for women, appreciating the form of dealing with promptness and the timing to be attended;trust;content, coherence and the way to inform;clarification of doubts;friendly conversation and clinical assistance. The professional workload was restricted on postpartum period care quality. There were gaps found in clinical practice and in dialogical communication and information on women’s health necessities.

High prevalence of post-partum depression in women with coeliac disease

AIM: To explore the prevalence of post-partumdepression(PPD) in coeliac disease(CD). METHODS: we performed a case-control study evaluating the prevalence of PPD in CD patients on gluten-free diet(GFD) compared to that of healthy subjects experiencing a recent delivery. All participants were interviewed about menstrual features, modality and outcome of delivery and were evaluated for PPD by Edinburgh Postnatal Depression Scale(EPDS). RESULTS: The study included 70 CD patients on GFD(group A) and 70 controls(group B). PPD was present in 47.1% of CD women and in 14.3% of controls(P < 0.01; OR = 3.3). Mean EPDS score was higher in CD compared to the controls(mean score: group A 9.9 ± 5.9; group B 6.7 ± 3.7; P < 0.01). A significant association was observed between PPD and menstrual disorders in CD(69.7% vs 18.9%; P < 0.001; OR = 3.6). CONCLUSION: PPD is frequent in CD women on GFD, particularly in those with previous menstrual disorders. we suggest screening for PPD in CD for early detection and treatment of this condition.

GDM患者产后出血危险因素分析及预防

目的:分析妊娠期糖尿病(GDM)患者产后出血(PPH)发生PPH的危险因素,提出对策建议.方法:整群抽样法抽取2021年1月-2023年2月本地区3所医院接收的2984例GDM患者临床资料,根据患者产后24h出血量分为PPH组与非PPH组.收集患者临床资料,采用logistic回归分析模型筛选导致GDM患者PPH的危险因素.结果:2984例GDM患者中539例发生PPH,PPH发生率18.1%.PPH组年龄≥35岁、孕前体质指数(BMI)≥24kg/m^(2)、有刮宫史、有剖宫产史、孕次≥2次、经产、合并妇科炎症、空腹血糖(FBG)≥7mmol/L、胎膜早破、胎盘早剥、胎盘前置、胎盘残留、羊水过多、产程延长、糖化血红蛋白(HbA1c)≥6.5%患者占比均高于非PPH组;多因素logistic回归分析表明,年龄≥35岁、孕前BMI≥24kg/m^(2)、刮宫史、剖宫产史、经产、合并妇科炎症、胎盘早剥、胎盘残留、羊水过多、HbA1c≥6.5%均是导致GDM患者并发PPH的危险因素(均P<0.05).结论:建议临床对年龄≥35岁、孕前BMI≥24kg/m^(2)、有刮宫史、剖宫产史、经产、合并妇科炎症、胎盘早剥、羊水过多GDM患者的加强关注,及时、彻底清除胎盘残留.也提示孕妇控制饮食以控制胎儿体重,降低PPH发生率.

小剂量氯胺酮复合右美托咪定对剖宫产术后疼痛、抑郁评分的影响

目的:观察小剂量氯胺酮复合右美托咪定对剖宫产者术后疼痛、抑郁评分的影响.方法:选取2020年10月-2022年10月本院接收的拟行腰硬联合麻醉(CSEA)下剖宫产产妇80例,以随机数表法分为单一组和联合组各40例,两组均于麻醉前泵注0.5μg/kg右美托咪定,联合组在取出胎儿后静注0.25mg/kg氯胺酮.比较两组术后视觉模拟评分法(VAS)评分,术前及术后应激反应指标[肾上腺素(E)、去甲肾上腺素(NE)、皮质醇(Cor)]水平,术后40项恢复质量评分量表(QoR-40)评分,术前术后爱丁堡产后抑郁量表(EPDS)评分;统计两组不良反应.结果:术后2h、6 h、12h、24hVAS评分联合组均低于单一组,术后6h、24h的E、NE、Cor水平两组均较术前提高但联合组低于单一组,术后24h、48hQoR-40评分联合组(189.74±2.82分、194.15±3.14分)均高于单一组(176.13±3.27分、183.06±3.59分),术后24h、5dEPDS评分两组均高于术前但联合组(6.18±2.24分、5.47±2.06分)均低于单一组(7.64±2.65分、6.50±2.31分)(均P<0.05);两组不良反应发生无差异(P>0.05).结论:小剂量氯胺酮复合右美托咪定可减轻剖宫产产妇术后疼痛,减轻应激反应及抑郁情绪,改善产后恢复质量,且安全可靠.

Symphyseal Disjunction after Dystocic Vaginal Delivery: About Two Cases at the SourôSanou University Hospital of Bobo-Dioulasso (CHUSS)

Diastasis of the symphysis pubis is a rare postpartum complication. We report two cases of symphysis diastasis after dystocic delivery, in two patients who presented in the postpartum period with functional impotence, pubalgia and acute urine retention. A frontal radiograph of the pelvis confirmed the diagnosis, showing a symphyseal separation of 12 mm and 18 mm. In our case, management was mainly medical, with a favorable clinical outcome.

Short Communication: Effect of Timing of Introduction to Pasture Post Calving and Supplementation with <i>Saccharomyces cerevisiae</i>on Milk Fatty Acid Profiles in Early Lactation Dairy Cows

There is increased public awareness of the effect of dietary fatty acid (FA) profile on human health. Therefore, when devising nutritional management strategies for dairy cows it is important to evaluate the effects of said strategies on the FA profile of the milk. This experiment investigates the effects of two early PP nutritional management strategies (NM);abrupt introduction to pasture (AP) or a total mixed ration for 21 d followed by a gradual introduction to pasture over 7 d (GP), with (Y) or without (C) live yeast (YS) on milk fatty acid (FA) profile. Forty multiparous dairy cows were assigned to one of four dietary treatments in a two (AP vs. GP) by two (Y vs. C) factorial, randomized block design. The experiment was conducted from d 1 to 70 PP. Pasture, TMR and concentrate samples were taken weekly to assess the chemical and FA composition. Milk yield was recorded daily and individual milk samples were collected weekly to determine milk FA composition. There was no interaction between NM strategy and YS supplementation on milk FA. Similarly, YS supplementation did not affect milk FA profile. However, GP had higher concentrations of C10 (P = 0.04), C12 (P = 0.01), C14 (P = 0.02) and medium chain FA (P = 0.02) vs. AP. Whereas AP had higher concentrations of the FA cis-9, C18:1 (P < 0.01), long chain FA (P = 0.1) and unsaturated FA (P = 0.01) and lower concentrations of saturated FA (P = 0.01) vs. GP. These results suggest that abruptly introducing the early lactation dairy cow to a pasture based diets positively alters the FA composition of the milk produced when compared to the milk from a dairy cow gradually introduced to pasture.

Clinical Features of Post-Parturient Hemoglobinuriain Dairy Cattle and Buffaloes: A Review

Postpartum hemoglobinuria (PPH) is a sporadic noninfectious syndrome which normally seen in bovine around the world. PPH is most commonly affecting high-productive cows and buffaloes during the early pregnancy and early lactation period. PPH stands as a serious threat to the dairy cattle and buffaloes in Afghanistan, Pakistan, and India, affecting a considerable number of animals every year. It is characterized by hemoglobinuria, intravenous hemolysis, severe anemia, and death due to anemia and hypoxia. However, the exact mechanism of the mentioned illness is not completely understood. Lots of comprehensive studies have been done and/or still are in progress in order to find the exact causes of intravascular hemolysis that is responsible for hemoglobinuria in the mentioned disease. But, hypophosphatemia in the high productive milking cows during the early stage of milk production is widely confident to be associated with PPH. In different parts of the world, many risk factors had been reported to be associated with PPH. Decreasing the level of phosphorous in blood serum, interrupted the phospholipid layers of red blood cells resulting in hemoglobinuria, a decrease in milk production, anorexia, and the death of animals in the cause if remained untreated. Urinalysis and hematology findings are the most commonly suitable diagnostic tools for this disease. Lots of studies have been suggesting that injection of sodium acid phosphate along with important minerals and supportive therapy with anti-oxidants can be used as the therapeutic protocol for the management of PPH.

血清TIMP-1、TGF-β1水平对瘢痕子宫再次妊娠产后出血的预测价值

目的探讨瘢痕子宫再次妊娠产妇血清基质金属蛋白酶组织抑制因子-1(TIMP-1)、转化生长因子-β1(TGF-β1)水平及其对产后出血的预测价值。方法选取2019年3月至2021年12月在本院分娩的瘢痕子宫再次妊娠产妇217例,根据是否并发产后出血分为观察组(137例,发生产后出血)和对照组(80例,未发生产后出血)。同时收集产妇分娩孕周、孕次、子宫瘢痕厚度等临床资料。采用酶联免疫吸附法测定瘢痕子宫再次妊娠产妇血清TIMP-1、TGF-β1水平;Pearson法分析血清TGF-β1和TIMP-1表达水平的相关性;采用Logistic多因素回归分析影响瘢痕子宫再次妊娠产妇发生产后出血的相关因素;采用受试者工作特征(ROC)曲线分析血清TGF-β1和TIMP-1表达水平对瘢痕子宫再次妊娠产妇发生产后出血的预测效能。结果观察组血清TIMP-1水平高于对照组(P<0.05),血清TGF-β1水平低于对照组(P<0.05);观察组患者血清TIMP-1与TGF-β1表达呈负相关(r=-0.935,P<0.05)。观察组分娩孕周<40周、子宫瘢痕厚度<4 mm、刮宫次数≥2次的患者比例均高于对照组(P<0.05)。分娩孕周<40周、子宫瘢痕厚度<4 mm、刮宫次数≥2次、TIMP-1均为瘢痕子宫再次妊娠产妇发生产后出血的危险因素(P<0.05),TGF-β1为保护因素(P<0.05)。血清TIMP-1、TGF-β1预测瘢痕子宫再次妊娠产妇发生产后出血的曲线下面积(AUC)分别为0.881、0.901,而二者联合预测的AUC为0.959,优于血清TIMP-1、TGF-β1单独预测(Z=2.139、2.227,P=0.036、0.024)。结论瘢痕子宫再次妊娠产妇血清TIMP-1、TGF-β1水平与产后出血的发生密切相关,二者联合检测对其产后出血具有较好的预测价值。

产后压力性尿失禁发生风险的列线图预测模型建立与验证

目的:探讨产后压力性尿失禁(SUI)发生风险因素以及构建列线图预测模型。方法:回顾性分析本院2020年6月-2021年9月收治的360例接受盆底功能筛查的产妇临床资料。采用logistic回归分析预测SUI的独立影响因素,筛选有意义的指标构建预测产后SUI的列线图。采用受试者工作特征曲线(ROC)分析列线图的预测效能。结果:SUI发生率25.0%。单因素分析表明妊娠次数、居住地、妊娠期间职业、受教育程度、人均月收入、分娩方式、孕期SUI以及流产史与SUI的发生有关,多因素分析显示妊娠数≥2次、居住乡村、职业体力劳动、阴道分娩、孕期发生SUI以及有流产史是SUI的独立危险因素。基于多因素分析结果,生成了产后压力性尿失禁发生风险的列线图预测模型,ROC曲线下面积为0.887(95%CI 0.821~0.915)(P<0.01),采用具有500个重采样的BOOTSTRAP方法进行验证,列线图模型的拟合曲线与理想曲线无明显差异,有较好一致性。结论:妊娠≥2次、居住地乡村、职业体力劳动、阴道分娩、孕期发生SUI以及有流产史是产后SUI发生的独立危险因素,临床应予以关注,提早进行干预。

Complications of Twin Delivery and Associated Factors: A Hospital-Based Cross-Sectional Analytical Study in Yaoundé

Background: Twin birth is considered a high-risk obstetrical situation. Despite the progress in obstetrical and pediatric care that has occurred in recent years, twin delivery is still associated with high maternal morbidity and perinatal mortality. Few recent studies have focused on the complications and risk factors associated with complications of twin birth in our environment. The objective of our study was to identify the complications of twin birth and the factors associated with them. Methodology: We carried out a cross-sectional analytical study. Data collection was prospective, over a period of 4 months (January 1, 2022 to April 30, 2022), at the maternity units of the Gyneco-Obstetric and Pediatric Hospital of Yaoundé and the Central Hospital of Yaoundé. The study population included all pregnant women who gave birth to twins during our study period at these hospitals. Data analysis was done using the SPSS software (Statistical Package for the Social Sciences) version 23.0. The Chi-square test was used to compare proportions and the student’s t test to compare means. A p-value of less than 0.05 was considered statistically significant. Results: In total, we recorded 37 complicated twin deliveries out of a total of 66 twin deliveries. This corresponded to a complication rate of 56%. Maternal complications occurred in 11.38% of cases, the majority being soft tissue lesions (4.54%), and postpartum hemorrhage (4.54%). Perinatal complications at the time of delivery were dominated by early neonatal infections (12.12%), non-reassuring fetal condition (10.6%) and intrauterine fetal death (6.06%). Factors associated with complications of twin births after univariate analysis were: maternal age ≤ 30 years (OR = 8.15;CI = 9.78 - 71.06;P = 0.03), being a student, (OR = 5.09;CI = 3.65 - 7.10;P = 0.00), primary level of education (OR = 1.48;CI = 3.30 - 6.63;P = 0.00), having less than four prenatal contacts (OR = 5.76;CI = 12.2 - 27, 24;P = 0.02), lack of ultrasound assessments (OR = 2.65;CI = 1.08 - 4.65, P = 0.04), diagnosis of twinning at labor (P = 0.03), admission for preeclampsia and eclampsia (OR = 2.01;CI = 1.24 - 5.9;P = 0.04), qualification of birth attendant as midwife (OR = 2.33;CI = 6, 38 - 8.50;P = 0.00), delivery time greater than 15 minutes for the second twin (OR = 2.45;CI = 1.14 - 5.26;P = 0.019). Conclusion: twin birth remains associated with high maternal and neonatal morbidity in our environment. The rate of maternal-fetal complications is 56% in our series. Post-partum hemorrhage, soft tissue injury and early neonatal infections are the main complications. These are closely linked to a number of factors whose control would improve the prognosis of twin birth.

认知行为治疗联合系统性家庭治疗改善轻中度产后抑郁

目的:探讨认知行为疗法联合系统性家庭疗法对轻中度产后抑郁的改善作用。方法:将249例产后42天的轻中度产后抑郁患者随机分为两组,一组接受常规的产后护理(对照组,n=128),一组在此基础上接受为期3个月的认知行为治疗联合系统性家庭治疗(心理治疗组,n=121)。在产后6、12、18和24个月时对两组患者进行随访。使用爱丁堡产后抑郁问卷(EPDS)和匹兹堡睡眠质量指数问卷(PSQI)在干预前、干预结束时和产后6、12、18、24个月时分别对两组进行评定。结果:共213例患者(心理治疗组104例、对照组109例)完成试验。干预结束时,心理治疗组的EPDS总分[(11.3±2.9)vs.(13.6±3.5)]、PSQI总分[(9.5±3.7)vs.(12.1±4.1)]及睡眠质量、入睡时间、睡眠时间、睡眠效率、睡眠障碍和日间功能障碍因子分均低于对照组(均P<0.01);与干预前相比,在研究的各阶段,两组的EPDS和PSQI总分均有所下降,心理治疗组的降分率高于对照组的同期降分率(均P<0.01)。干预后,与同一阶段的对照组相比,心理治疗组的入睡时间更短(P<0.01)、睡眠时间更长(P<0.05)、夜间觉醒次数更少(P<0.05)。结论:本研究提示,认知行为疗法联合系统性家庭疗法可以减轻轻中度产后抑郁患者的抑郁情绪,改善其睡眠质量。

产前心理护理对产科应激事件及产后抑郁症的预防作用

目的探讨产前心理护理对产科应激事件及产后抑郁症(post-partum depression,PPD)的预防作用。方法将2008年1月至2009年6月在我院行产前检查并住院分娩的初产妇3120例随机分为两组,对照组孕妇(1428例)接受常规的产前检查和护理;研究组孕妇(1452例)除接受常规的产前检查和护理外,还接受产前心理护理干预。结果两组孕妇产前对分娩痛苦、胎儿异常和胎儿性别等均有不同程度的担心;对照组和研究组产科应激事件的发生率分别为32.2%(460/1428)和20.5%(297/1452),差异具有统计学意义(P<0.01);对照组和研究组发生产科应激事件的孕妇中PPD的发生率分别15.71%和8.39%,差异具有统计学意义(P<0.05);随着产科应激事件频次的增加,两组孕妇PPD的发生率均呈现增高趋势(P<0.01)。结论产前心理护理能有效降低孕产妇产科应激事件及PPD的发生率,对PPD具有积极的预防作用。

生活事件、社会支持、个性因素及产前心理状态对产后抑郁症的影响

目的探讨心理社会因素对产后抑郁的影响,为干预产后抑郁的发生提供理论支持。方法采用围产期孕妇一般情况调查表、爱丁堡产后抑郁量表(EPDS)、生活事件量表、A型行为问卷、艾森克个性问卷(EPQ)、社会支持评定量表(SSRS)、症状自评量表(SCL-90)、特质焦虑量表、状态焦虑量表对45名产后抑郁妇女、84名正常产妇进行分析。结果产后抑郁组受教育年限[(9.8±3.0)a]低于正常组[(11.6±3.5)a],差别有统计学意义(P<0.01);产后抑郁组社会支持总分、客观支持分、主观支持分及社会利用度均低于正常组,差别有统计学意义(P<0.05);产后抑郁组负性生活事件分、神经质分、时间紧迫感分、竞争与敌意分均高于正常组,差别有统计学意义(P<0.01);产前SCL-90抑郁分[产后抑郁组(19.02±3.66),正常组(16.25±3.39)]、焦虑分[产后抑郁组(14.24±3.53),正常组(12.51±2.50)]、强迫分[产后抑郁组(15.09±3.15),正常组(13.08±2.64)]等分值产后抑郁组均高于正常组,差别有统计学意义(P<0.01);EPDS总分与产妇受教育年限、SSRS总分、主观支持分、社会支持利用度呈负相关(P<0.05),与EPQ神经质原始分呈正相关(P<0.01);神经质与社会支持、利用度呈负相关,差别有统计学意义(P<0.01)。结论产后抑郁产前心理已经发生变化,低社会支持、高生活事件及神经质等不良个性因素影响产后抑郁的发生,应加强产前心理社会因素干预。