Factors Influencing Mode of Delivery: A Case-Control Study

The primary objective of this investigation was to scrutinize the prepregnancy conditions and lifestyles of 2046 women residing in Liuzhou City, with the aim of delineating the determinants of delivery methods. Evidently, the study unearthed substantial correlations between prepregnancy body mass index, educational attainment, exposure to passive smoking, medical history, and other variables with the mode of delivery. Furthermore, a predictive nomogram model was formulated to accurately forecast the likelihood of cesarean section. These discernments equip pertinent authorities with the means to institute targeted screening and supportive measures for women contemplating pregnancy based on these identified factors. Moreover, provision of services such as prepregnancy counseling and clinical risk assessments could be instrumental in curbing the incidence of cesarean section.

Impact of Delivery Mode on Morbidity in Preterm Infants with Very Low Birth Weights (<1500 Grams)

The mode of delivery and gestational age for very-low-birth-weight (VLBW) preterm infants are not yet well established and are constant topics of debate. Objective: To analyze the impact of delivery mode on morbidity in preterm infants weighing less than 1500 g. Results: Among 21,957 births, 81 were analyzed;53 were delivered vaginally, and 28 were delivered by cesarean section. The median maternal age, gestational age and body mass index among those delivered vaginally and by cesarean section were 20 years and 22.5 years, 27.6 weeks and 30.1 weeks, and 26.0 kg/m2 and 27.8 kg/m2, respectively. With respect to neonatal blood gas parameters, for those born vaginally and by cesarean section, the median pH was 7.32 and 7.24, the pCO2 was 41.5 mmHg and 51.1 mmHg, and the pO2 was 22.3 mmHg and 16 mmHg. The median fetal weight among those born by cesarean section and vaginally were 1180 g and 955 g, respectively. The median Apgar scores at the first and fifth minutes among those born by cesarean section and vaginally were 5.00 and 8.00 and 4.50 and 7.00, respectively. Conclusion: There was no significant difference between the results of vaginal and cesarean delivery for VLBW infants. Thus, further studies on this subject are needed.

Relationship between age of pregnant women with gestational diabetes mellitus and mode of delivery and neonatal Apgar score

BACKGROUND Gestational diabetes mellitus(GDM)refers to abnormal glucose tolerance during pregnancy,and it is often accompanied by obvious changes in glucose and lipid metabolism,and associated with adverse pregnancy outcomes.The incidence of fetal distress,polyhydramnios,puerperal infection,premature delivery,and macrosomia in pregnant women with GDM are higher than in those without GDM.AIM To analyze the relationship between age of pregnant women with GDM and mode of delivery and neonatal Apgar score.METHODS A total of 583 pregnant women with GDM who delivered in the Department of Obstetrics at our hospital between March 2019 and March 2022 were selected.Among them,377 aged<35 years were selected as the right age group and 206 aged>35 years were selected as the older group.The clinical data of the two groups were collected,and the relationship between age of the pregnant women with GDM and mode of delivery,maternal and neonatal outcomes,and neonatal Apgar score were compared.In the older group,159 women were classed as the adverse outcome group and 47 as the good outcome group according to whether they had adverse maternal and infant outcomes.The related factors of adverse maternal and infant outcomes were analyzed through logistic regression.RESULTS The number of women with assisted pregnancy,≤37 wk gestation,≥2 pregnancies,one or more deliveries,and no pre-pregnancy blood glucose screening in the older group were all higher than those in the right age group(P<0.05).The natural delivery rate in the right age group was 40.85%,which was higher than 22.33%in the older group(P<0.05).The cesarean section rate in the older group was 77.67%,which was higher than 59.15%in the right age group(P<0.05).The older group had a higher incidence of polyhydramnios and postpartum hemorrhage,and lower incidence of fetal distress than the right age group had(P<0.05).There was no significant difference in neonatal weight between the two groups(P>0.05).The right age group had higher Apgar scores at 1 and 5 min than the older group had(P<0.05).Significant differences existed between the poor and good outcome groups in age,education level,pregnancy mode,≤37 wk gestation,number of pregnancies,and premature rupture of membranes(P<0.05).Logistic regression showed that age,education level and premature rupture of membranes were all risk factors affecting the adverse outcomes of mothers and infants(P<0.05).CONCLUSION Delivery mode and Apgar score of pregnant women with GDM are related to age.Older age increases the adverse outcome of mothers and infants.

Correlation between Mode of Delivery and Newborn’s Cord Blood Composition

OBJECTIVE: The aim of this study is to find out the effect of delivery mode on newborn’s cord blood parameters particularly hemoglobin and hematocrite values. SETTING: Obstetrics and Gynecology Department, Qena Faculty of Medicine, South Valley University, Egypt. DURATION: From April 2015 to December 2017. STUDY DESIGN: A cross sectional study. METHODS: 900 live born neonates for healthy mothers were included in this study;all cases were delivered at full-term, with birth weight ranged from 2.5 to 3.5 Kg and had APGAR scores above 7 at 1 and 5 minutes. Newborns were divided into three groups (Group I included 300 newborns delivered by vaginal delivery without augmentation of labor, Group II included 300 newborns delivered vaginally with augmentation of labor and Group III included 300 newborns delivered by elective cesarean section). Blood sample was collected from the umbilical vein of each neonate for estimation of hemoglobin, hematocrit, RBCs count, platelets, WBCs count and reticulocytes. RESULTS: Cesarean section delivery had a statistically significant decrease in the level of iron-related hematologic indices including hemoglobin, hematocrit and RBCs count (p value < 0.001). There was a statistically significant difference among studied groups in reticulocyte count with (P value a positive correlation among newborns cord blood hemoglobin as regard to head circumference, length and gestational age and negative correlations as regard to maternal age, parity and birth weight with no statistically significance (P value > 0.05). CONCLUSIONS: Cesarean section delivery had a significant decrease in the level of iron-related hematologic indices including hemoglobin, hematocrit and RBCs count and has a non-significant decrease in WBCs and platelets counts in neonatal cord blood, which suggest high prevalence of newborn iron-deficiency anemia among cesarean births particularly in developing communities.

Facile Approach to Synthesize Gold Nanorod@Polyacrylic Acid/Calcium Phosphate Yolk–Shell Nanoparticles for Dual-Mode Imaging and pH/NIR-Responsive Drug Delivery

A facile strategy to fabricate gold nanorod@polyacrylic acid/calcium phosphate(Au NR@-PAA/Ca P) yolk–shell nanoparticles(NPs) composed with a PAA/Ca P shell and an Au NR yolk is reported. The asobtained Au NR@PAA/Ca P yolk–shell NPs possess ultrahigh doxorubicin(DOX) loading capability(1 mg DOX/mg NPs), superior photothermal conversion property(26%)and p H/near-infrared(NIR) dual-responsive drug delivery performance. The released DOX continuously increased due to the damage of the Ca P shell at low p H values. When the DOX-loaded Au NR@PAA/Ca P yolk–shell NPs wereexposed to NIR irradiation, a burst-like drug release occurs owing to the heat produced by the Au NRs. Furthermore,Au NR@PAA/Ca P yolk–shell NPs are successfully employed for synergic dual-mode X-ray computed tomography/photoacoustic imaging and chemo-photothermal cancer therapy. Therefore, this work brings new insights for the synthesis of multifunctional nanomaterials and extends theranostic applications.

Incongruence between the Preferred Mode of Delivery and Risk of Childbirth Complications among Antepartum Women in Mulago Hospital, Uganda

Objective: Women’s preferences for the mode of delivery provide clues on their knowledge and perceptions of anticipated risk of childbirth complications.?The objective was toinvestigate?incongruence between preferred mode of delivery and risk of adverse pregnancy outcomes. Methods: Through a cross-sectional study, data were?collected from 327?women admitted to Mulago hospital. Data included socio-demographic?characteristics, past medical, gynaecological and obstetric history, pregnancy complications, knowledge of pregnancy complications and preferred mode of delivery. The preferred mode of delivery and knowledge of related risks for adverse pregnancy outcomes were compared. Results: The mean age of participants was 24.7 years (±5.9), ranging?14?-?43 years, of whom 41.4% were nulliparous. The preferred mode of delivery was vaginal (84.1%). Incongruence?(preference for a mode of delivery that did not correspond to expected or anticipated risks) occurred in 88 (26.9%) of the women, and was associated with having secondary school or higher level of education (OR 2.49, CI 1.52?-?4.08) and history of previous vaginal delivery (OR 3.82,?CI 1.94?-?7.49). Conclusion: One in four women had incongruence between preferred mode of delivery and risks of adverse pregnancy outcomes, which called?for urgent interventions to improve decision-making about intrapartum care.

Fetal Outcome and Mode of Delivery in a Patient with Meconium-Stained Amniotic Fluid

Background: Meconium stained amniotic fluid (MSAF), especially observed before term, is considered a sign of fetal jeopardy. Although many studies characterized this condition and associated it with delivery mode, data is lacking in this area, Saudi Arabia. Thus, we attempted to study it. Methods: All data were retrieved from pregnant patients with MSAF who delivered at King Abdul, Saudi Arabia, from January 2015 to December 2018. Results: 758 showed MSAF, of which 83% had vaginal delivery, whereas remaining 17% had an emergency caesarean section. Of them, 32 (4.2%) infants developed meconium aspiration syndrome, and 7 (21.8%) were admitted to the NICU. Conclusion: It was reconfirmed that MSAF is associated with a newborn risk, especially meconium aspiration syndrome. Patients had a higher rate for emergent caesarean section and baby admission to NICU. These data may be useful to make health/reproductive-health poly-making in this area.

ERROR COUNTER-BASED NEGATIVE ACKNOWLEDGEMENT MODE IN CCSDS FILE DELIVERY PROTOCOL

Deep space communication has its own features such as long propagation delays,heavy noise,asymmetric link rates,and intermittent connectivity in space,therefore TCP/IP protocol cannot perform as well as it does in terrestrial communications.Accordingly,the Consultative Committee for Space Data Systems(CCSDS) developed CCSDS File Delivery Protocol(CFDP),which sets standards of efficient file delivery service capable of transferring files to and from mass memory located in the space segment.In CFDP,four optional acknowledge modes are supported to make the communication more reliable.In this paper,we gave a general introduction of typical communication process in CFDP and analysis of its four Negative Acknowledgement(NAK) modes on the respect of file delivery delay and times of retransmission.We found out that despite the shortest file delivery delay,immediate NAK mode suffers from the problem that frequent retransmission may probably lead to network congestion.Thus,we proposed a new mode,the error counter-based NAK mode.By simulation of the case focused on the link between a deep space probe on Mars and a ter-restrial station on Earth,we concluded that error counter-based NAK mode has successfully reduced the retransmission times at negligible cost of certain amount of file delivery delay.

Research on the Novel Empty Core Needle Transdermal Drug Delivery Mode and the Corresponding Advantages

In this paper, we conduct research on novel empty core needle transdermal drug delivery mode and the corresponding advantages.Compared with the traditional mode of drug delivery, transdermal drug delivery system advantages obvious drug absorbed from the digestivetract, intestinal factors such as interference, “the first effect” can avoid liver can maintain the stability of the human body blood drugconcentration to increase effectiveness. This paper analyzes the issues from the two aspects. （1） Transdermal Therapeutie System Analysis; （2）Microneedles in Transdermal Drug Delivery. By considering the experimental analysis, we conduct the numerical simulation on the mentionedissues. The experiment result verifi es and refl ects the general properties of the designed methodology that will enhance the overall researchperformance of the related topics.

E-Cervix弹性成像评估不同分娩史孕妇妊娠期宫颈组织差异的研究

目的探讨不同分娩方式生育史孕妇宫颈E-Cervix参数随孕周的变化规律,以及不同分娩方式对再次妊娠时的宫颈软硬度和长度的影响。方法前瞻性收集2022年6月—2023年6月在我院定期产检的单胎妊娠孕妇,分别于11~14周、20~24周、28~32周经阴道超声测量孕妇宫颈的E-Cervix弹性参数。根据既往有无生育史及分娩方式,将研究对象分为初产妇组(A组)、经产妇无剖宫产史组(B组)和经产妇合并剖宫产史组(C组)。采用Friedman检验比较各组孕妇3个孕周段各宫颈参数值的差异,Mann-Whitney U检验比较初产妇与经产妇无剖宫产史及经产妇合并剖宫产史的宫颈各参数值差异。结果共纳入191例孕妇,其中A组101例,B组49例,C组41例。A组宫颈弹性值3个孕周段的差异均具有统计学意义(P<0.05);B组除应变比值(Ratio)外,余宫颈弹性值在3个孕周段的差异均具有统计学意义(P<0.05);C组除弹性对比指数(ECI)及Ratio外,余宫颈弹性值在3个孕周段的差异均具有统计学意义(P<0.05)。随着孕周段的增加,3组硬度比值(HR)逐渐减小,宫颈内口平均应变值(IOS)、宫颈外口平均应变值(EOS)逐渐增大。A组3个孕周段宫颈长度(CL)值中位数分别为3.36、3.51、3.49(P<0.05);B组3个孕周段CL值中位数分别为3.27、3.58、3.50(P<0.05);C组3个孕周段CL值中位数分别为3.38、3.73、3.63(P=0.057)。3组孕妇宫颈长度呈现出先增长再缩短的发展趋势。中孕期A组ECI值中位数小于B组(2.34比2.63),HR值中位数大于B组(89.81%比87.20%),CL值中位数小于C组(3.51比3.73),且差异均有统计学意义(P=0.008、P=0.024、P=0.034)。早孕期及晚孕期各项宫颈参数值在A组与B组及A组与C组间的差异均无明显统计学意义(P>0.05)。结论E-Cervix技术客观地反映出不同分娩方式生育史孕妇妊娠期宫颈组织随孕周增加均产生一系列生理变化。不同分娩方式会影响再次妊娠时的宫颈弹性和宫颈长度的变化,中孕期经产妇无剖宫产史孕妇宫颈组织较初产妇软且均质性差,经产妇合并剖宫产史孕妇宫颈长度明显长于初产妇。

家属陪护下温馨助产模式对初产妇分娩结局及产后恢复影响

目的:观察家属陪护下温馨助产模式对初产妇分娩结局及产后恢复的影响.方法:纳入2022年4月-2023年5月本院产科收治的115例初产妇,随机数字表法分为对照组(58例)与观察组(57例),对照组行常规分娩护理,观察组开展家属陪护下温馨助产模式护理干预,对照组脱落2例,观察组脱落1例,比较各组分娩结局、新生儿结局、产妇产后出血量以及分娩疼痛(改良面部表情疼痛评估工具,FPS-R)、产后焦虑(SAS)与抑郁(SDS)自评量表评分、总产程与住院时间、产妇护理满意率.结果:两组顺利阴道分娩率均为100.0%,观察组分娩后并发症率(0)低于对照组(7.1%),新生儿不良事件发生率(0)低于对照组(8.9%),产妇产后出血量(216.2±10.8ml)少于对照组(289.7±15.2 ml),FPS-R评分(7.9±0.4分)低于对照组(8.9±0.5分),SAS(36.5±3.0分)与SDS(34.8±5.2分)评分低于对照组(42.4±3.8分、41.8±4.8分),总产程(516.23±9.76min)与住院时间(2.14±0.22d)均短于对照组(612.34±10.65 min、2.95±0.26d),产妇护理满意率(96.4%)高于对照组(85.7%)(均P<0.05).结论:家属陪护下温馨助产模式可较好缓解产妇心理不良状态,改善分娩结局,促进产后恢复,降低不良分娩结局,产妇较为满意.

孕前BMI及孕期BMI变化对产妇分娩方式及围产期结局的影响分析

目的分析孕前体质指数(BMI)及孕期BMI变化对产妇分娩方式、围产期结局的影响,为备孕期及孕期女性的体重管理提供依据。方法选取2022年8月至2023年8月在昆明市妇幼保健院住院分娩的98例孕妇作为研究对象,按孕前BMI将研究对象分为消瘦组(n=16)、正常组(n=54)、超重或肥胖组(n=28);按孕期BMI变化分为增重不足组(n=19)、增重正常组(n=27)、增重过多组(n=52),分析组间孕妇分娩方式及围产期结局的差异。结果98例孕妇中,69例行阴道分娩,29例行剖宫产。消瘦组、正常组、超重或肥胖组孕妇分娩方式比较差异具有统计学意义(χ^(2)值为11.068,P<0.05);增重不足组、增重正常组及增重过多组的孕妇分娩方式比较差异具有统计学意义(χ^(2)值为9.126,P<0.05)。消瘦组、正常组、超重或肥胖组的妊娠并发症、胎儿不良事件、新生儿不良事件比例比较差异具有统计学意义(χ^(2)值分别为13.411、21.977、23.885,P<0.05),而产后并发症比例的差异无统计学意义(P>0.05);不同孕期BMI变化组别的妊娠并发症、胎儿不良事件、新生儿不良事件及产后并发症比例比较差异均具有统计学意义(χ^(2)值分别为11.651、10.825、16.534、11.159,P<0.05)。结论孕前超重或肥胖、孕期增重过多均可能增加产妇剖宫产及不良围产期结局的发生风险。建议孕前超重或肥胖的妇女在备孕期间进行减重管理,孕期仍需科学管理体重,避免孕期增重过多或增重不足。

基于配送服务模式及路径策略的物流无人机调度模型

针对远距离城市空间物流无人机配送问题,提出基于两级多中心场景的无人机(Unmanned Aerial Vehicle, UAV)配送服务模式.综合考虑客户时间、无人机充电和配送路径策略等内容,建立以最小配送总成本为目标的两级多中心物流无人机城市配送调度模型,通过比较标准算例下Cplex优化软件与鲸鱼优化算法(Whale Optimization Algorithm, WOA)、遗传算法(Genetic Algorithm,GA)和灰狼优化算法(Grey Wolf Optimization, GWO)3种启发式算法的实验结果,确定求解算法以设计两阶段算法进行求解.以天津市中心城区为例进行模型求解,并从需求点规模、机型和时间窗3方面进行敏感度分析.研究结果表明:与闭合式路径相比,半开放式路径策略分别节省约11.09%、60.45%的配送总成本和时间窗惩罚成本,成本节省随配送规模增大而增加;提出的固定路径班次模式相比现有按需模式,其可变成本和总成本降幅均高于18%,使用无人机数量减少近28%,生成的班次时刻表和飞行路径时空图可显现不同模式优劣.本文提出的模型对优化远距离城市物流无人机调度方案及配送模式有一定实用价值,可为企业在物流无人机的配送规划方面提供参考.

腰硬联合麻醉分娩镇痛后发热对母婴分娩结局的影响

目的探讨腰硬联合麻醉分娩镇痛后发热对分娩结局的影响,以期改善母婴结局。方法选取2020年1月至2022年6月进行腰硬联合麻醉分娩镇痛的300例产妇作为研究对象,根据镇痛后是否出现发热将产妇分为两组。对照组为未出现发热的产妇,共150例;观察组为出现发热的产妇,共150例。比较两组产妇的阴道操作次数、破膜时间、总产程时间、缩宫素使用比例、分娩方式、产妇不良结局发生率以及新生儿不良结局发生率。结果观察组阴道操作次数(7.56±1.12)次,破膜时间为(11.86±2.03)h,总产程时间为(17.08±2.34)h,使用缩宫素加强宫缩为51例(34.00%),对照组阴道操作次数(5.41±1.04)次,破膜时间为(8.69±1.75)h,总产程时间为(15.04±1.84)h,使用缩宫素加强宫缩为20例(13.33%),两组产妇的阴道操作次数、破膜时间、总产程时间、缩宫素使用比例等指标比较差异均有统计学意义(P<0.001)。观察组产妇自然分娩82例(54.67%),剖宫产45例(30.00%),器械助产23例(15.33%),对照组产妇自然分娩121例(80.67%),剖宫产19例(12.67%),器械助产10例(6.67%),两组产妇的分娩方式比较差异有统计学意义(P<0.05或0.001)。观察组产妇出现低血压、头痛、产后出血、产褥感染等总不良结局发生率为60.67%(91/150),对照组产妇出现低血压、头痛、产后出血、产褥感染等总不良结局发生率为31.33%(47/150),两组产妇总不良结局发生率差异有统计学意义(P<0.001)。观察组出现胎儿窘迫、新生儿窒息、新生儿败血症、新生儿高胆红素血症等总不良结局发生率为40.67%(61/150),对照组出现胎儿窘迫、新生儿窒息、新生儿败血症、新生儿高胆红素血症等总不良结局发生率为22.67%(34/150),两组新生儿总不良结局发生率差异有统计学意义(P<0.001)。结论产时发热是一种临床表现,早发现早预防非常重要。对于产科医生而言,应加强产程管理,掌握阴道操作指征,严格遵循无菌操作,以预防感染性产时发热。同时,要避免产时发热相关因素的叠加,防止非感染性发热的发生。此外,还需综合分析产时发热的原因,动态监测各项指标,仔细鉴别,并采取适宜的产程处理措施。

基于天然多糖的刺激响应型药物控释系统研究进展

刺激响应型药物控释系统一般以天然多糖生物大分子或其衍生物作为载体,通过化学结合或物理吸附等方式负载药物分子。具有刺激响应功能的天然多糖生物大分子或其衍生物能够感知其所处环境的变化,并由于其物理或化学性质的变化而做出应激响应,因此可在不同环境或条件的刺激下,通过药物与载体之间化学键断裂或载体自身降解等方式将药物从载体中释放,从而实现药物的控制释放。结合课题组的研究工作,介绍了常用的刺激方式,包括单一刺激和多重刺激、外源性刺激和内源性刺激,为开发新型刺激响应型药物控释系统提供了思路。

孕早期及孕中期血清PP-13和ADMA对子痫前期孕妇分娩方式的预测价值

目的分析孕早期、孕中期血清半乳糖凝集素-13(PP-13)、非对称性二甲基精氨酸(ADMA)对子痫前期孕妇分娩方式的预测价值。方法回顾性收集2020年1月至2022年12月在该院产科分娩的120例孕妇的临床资料,其中子痫前期孕妇76例,按照子痫前期严重程度分为轻度组52例、重度组24例,另选取同期正常孕妇44例作为对照组,采用酶联免疫吸附试验(ELISA)检测PP-13和ADMA水平。比较3组研究对象PP-13、ADMA水平,比较不同分娩方式孕妇PP-13、ADMA水平,绘制受试者工作特征(ROC)曲线分析PP-13、ADMA预测子痫前期孕妇分娩方式的效能。结果孕早期及孕中期PP-13水平均为重度组<轻度组<对照组,且任意两组间比较,差异均有统计学意义(P<0.05);而孕早期及孕中期ADMA水平均为重度组>轻度组>对照组,且任意两组间比较,差异有统计学意义(P<0.05)。剖宫产比例为重度组>轻度组>对照组,自然分娩比例及阴道助产比例为重度组<轻度组<对照组,且任意两组间比较,差异均有统计学意义(P<0.05)。自然分娩孕妇孕早期、孕中期PP-13水平均高于其他分娩方式孕妇,ADMA水平均低于其他分娩方式孕妇,差异均有统计学意义(P<0.05)。ROC曲线分析显示,孕早期PP-13、孕早期ADMA、孕中期PP-13、孕中期ADMA预测子痫前期孕妇自然分娩的曲线下面积(AUC)分别为0.806、0.963、0.781、0.673。结论孕早期PP-13、孕早期ADMA、孕中期PP-13可能可以用于子痫前期孕妇分娩方式的预测。

粤北地区社会心理因素对妊娠期妇女分娩方式选择及生存质量的影响

目的探究粤北地区社会心理因素对妊娠期妇女分娩方式选择及生存质量的影响。方法选取2022年1月—2023年5月在粤北人民医院住院的1000例单胎头位产妇为研究对象,根据选择的分娩方式将其分为镇痛阴道分娩组(412例)、普通阴道分娩组(286例)、剖宫产组(302例)。对比三组的社会-心理学特征,包括焦虑自评表(SAS)、抑郁自评量表(SDS)、艾森克问卷调查表(EPQ-RSC)、日常生活活动能力评定表(ADL)、生存质量评定量表(WHOQOL-BREF)的评分;对比三组的VAS评分以判定疼痛效应;对比三组的产程时间、产后2h内出血量以及住院天数。结果镇痛阴道分娩组的SAS、SDS与EPQ-ESC评分最低,剖宫产组的SAS、SDS与EPQ-ESC评分最高,组间差异有统计学意义(P<0.05);镇痛阴道分娩组的WHOQOL-BREF评分明显高于普通阴道分娩组与剖宫产组,差异有统计学意义(P<0.05);普通阴道分娩组与剖宫产组的WHOQOL-BREF评分差异无统计学意义(P>0.05);三组的ADL评分差异无统计学意义(P>0.05);镇痛阴道分娩组与普通阴道分娩组的宫缩间歇期与产后的VAS评分差异无统计学意义(P>0.05);镇痛阴道分娩组在宫口开3cm、宫口开7~8cm以及宫口开全时期的VAS评分均明显低于普通阴道分娩组,差异有统计学意义(P<0.05);镇痛阴道分娩组与普通阴道分娩组的住院时间差异无统计学意义(P>0.05);镇痛阴道分娩组的产程时间与产后2h出血量均明显小于普通阴道分娩组,差异有统计学意义(P<0.05)。结论粤北地区的社会心理因素对妊娠期妇女的分娩方式选择和生存质量有显著影响,没有精神心理因素(如焦虑抑郁)影响的更愿意选择镇痛阴道分娩;而受精神心理因素(如焦虑抑郁)影响较大的,易选用剖宫产,且镇痛阴道分娩孕妇的生存质量明显高于常规阴道分娩与剖宫产孕妇。

经会阴二维超声参数评估初产妇分娩方式及产程

目的探讨经会阴二维超声参数对初产妇分娩方式及产程的评估价值。方法回顾性分析2021年2月至2023年8月在郑州市妇幼保健院经阴道试产的162例初产妇资料,根据分娩结局分为自然分娩组和剖宫产组。比较两组宫口扩张6 cm时的经会阴二维超声参数[产程进展角(AOP)、胎头-会阴距离(HPD)],绘制受试者工作特征(ROC)曲线检验AOP、HPD对初产妇分娩方式的预测价值。以AOP、HPD中位数进行分组,比较不同AOP、HPD的初产妇分娩方式及产程时间的差异,采用Pearson相关性分析,检验AOP、HPD与自然分娩初产妇产程时间的关系。结果162例初产妇中127例为自然分娩,35例为剖宫产。自然分娩组初产妇AOP、HPD大于剖宫产组(P<0.05)。ROC曲线结果显示,AOP、HPD预测初产妇自然分娩的曲线下面积(AUC)均>0.7,有一定预测价值,且以二者联合预测价值最高。162例初产妇AOP、HPD中位数分别为132°、4.1 cm,AOP≥132°、HPD≥4.1 cm组初产妇的自然分娩率分别高于AOP<132°组、HPD<4.1 cm组(P<0.05)。127例自然分娩初产妇的AOP、HPD中位数分别为133°、4.3 cm,AOP≥133°组、HPD≥4.3 cm组自然分娩初产妇的第一产程、第二产程及总产程时间均分别短于AOP<133°组、HPD<4.3 cm组(P<0.05)。经Pearson相关性检验,AOP、HPD与自然分娩初产妇第一产程、第二产程、总产程均呈负相关(r<0,P<0.05)。结论经会阴二维超声参数AOP、HPD可用于指导初产妇分娩方式的合理选择,二者与产程有关,能够为分娩管理提供参考。

产前AIDET沟通模式联合体验式分娩对产妇产程及应对方式的影响

目的:探讨产前AIDET沟通模式联合体验式分娩对产妇产程及应对方式的影响。方法:选取2020年7月-2022年7月某院产科住院的80例孕晚期孕妇为研究对象,根据入院先后将其分为对照组(n=40,体验式分娩)和观察组(n=40,产前AIDET沟通模式+体验式分娩);比较两组干预前后应对方式[医学应对方式问卷中文版(MCMQ)],产程进展及分娩结局,产后并发症发生情况,新生儿健康状况[Apgar评分]及满意度。结果:干预前,两组MCMQ各维度评分均无显著差异(P>0.05);干预后,观察组面对评分高于对照组(t=4.367,P<0.05),屈服、回避评分低于对照组(t=-7.402,0.297,-4.162;P<0.05)。观察组第一产程、第二产程、第三产程及总产程均较对照组短(t=-6.717,-12.332,-5.314,-7.788;P<0.05);且观察组自然分娩占比高于对照组(67.50%vs 40.00%),剖宫产占比低于对照组(10.00%vs 30.00%)(χ^(2)=7.243,P<0.05)。观察组产后出血、尿潴留、会阴损伤发生率均低于对照组(χ^(2)=3.914,3.914,4.588;P<0.05),两组产后抑郁情况比较,观察组95.00%产妇正常,对照组70.00%正常,30.00%出现不同程度产后抑郁(χ^(2)=8.815,P<0.05)。两组新生儿出生1min、出生5min、出生10min后Apgar评分均无显著差异(P>0.05)。两组满意度比较,观察组为95.00%,高于对照组的77.50%(χ^(2)=5.165,P<0.05)。结论:产前AIDET沟通模式联合体验式分娩效果显著,可使产妇积极应对分娩,缩短各产程及总产程,提高自然分娩率,降低产后并发症及产后抑郁发生率,提升满意度。

公共数据有偿服务的正当性与实践路径研究

公共数据有偿服务是公共数据价值化和要素化的必由之路,但是目前对于公共数据有偿服务的正当性、有效路径和风险防范都还缺乏充分的研究和切实可行的方案。本文研究为持续健康推动公共数据有偿服务提供参考。本文剖析了公共数据的概念,分析了公共数据有偿服务的范围,从社会经济价值、数据权属和收费的合理性与必要性三个方面切入,论证了公共数据有偿服务的正当性。通过深入分析开展公共数据有偿服务的有效路径,本文明确建议在授权和运营模式、服务交付方式、定价策略、利益补偿机制这四个关键环节应当采取的策略和方案。通过讨论公共数据有偿服务中可能的风险和防范措施,本文总结提炼了六条具体建议。