Prevalence, Maternal and Perinatal Prognosis of Breech Delivery Compared to That of the Vertex in 242 Cases for 484 Controls at Ségou Hospital in Malti

Introduction: Breech birth has always been a subject of great interest because of its risks of perinatal morbidity and mortality. Aim: The aim of our study was to compare the maternal and perinatal prognosis of breech delivery with that of vertex delivery. Patients and Method: This was a retrospective case-control analytical study carried out in the obstetrics and gynaecology department of Ségou hospital over a 2-year period from 1 January 2020 to 31 December 2021, involving 242 breech deliveries compared with 484 top deliveries with a live single foetus without foetal malformation of gestational age ≥ 35 SA. The statistical tests used were: chi² (p Results: The frequency of breech delivery was 3.3%, with a predominance of caesarean section for breech presentation (64.88%) compared with 32.85% for vertex (P: 0.00;CI: (0.191 - 0.367). The perinatal prognosis of fetuses with breech presentations was marked by a higher rate of neonatal asphyxia (Apgar score Conclusion: Breech birth is relatively rare in our department. It carries a higher risk of maternal morbidity and neonatal morbidity than breech delivery. However, the vital prognosis for the mother was identical in both groups.

Pull Breech out versus Push Impacted Head up in Emergency Cesarean Section: A Comparative Study

Objective: To compare maternal and fetal outcome associated with two methods Reverse breech extraction versus Head pushing to deliver the impacted fetal head in advanced labor requiring emergency Cesarean section. Method: A prospective comparative study was conducted on 80 pregnant women at term with cephalic presentation in advanced labour, requiring emergency Cesarean Section. Reverse breech extraction technique (pull method) was used in 40 cases (group I) and pushing the head up through the vagina (“push” method) was tried in (group II) 40 cases. The maternal outcome was assessed by extension of the uterine Incision, bladder injury, intra and postoperative blood transfusion, Postpartum hemorrhage, wound infection and duration of hospital stay. Fetal outcome was Apgar score and admission to neonatal intensive care unit. Results: Extension of the uterine incision was significantly lower in women undergoing reverse breech extraction compared to cephalic delivery (20% versus 50%;p = 0.001). The mean operative time (pull group) was lower than that in the (push group) 59.7 ± 4.2, versus 75.2 ± 6.1 p = 0.001 and blood loss was significantly lower in the (pull group) than that in the (push group) 878 ± 67 ml, versus 1321 ± 57 ml, p = 0.001. No significant difference between groups regarding maternal and neonatal outcome. Conclusion: Reverse breech extraction (pull) is safer than pushing head up through vagina (push) for delivery of a deeply impacted fetal head in advanced labour sensitizing emergency Cesarean Section and is associated with the least maternal complications.

Report of a New Case of Interlocking Heads in a Breech-Vertex Twin Delivery: A Conversation with My Residents

“Locked twins” is a rare event occurring in about 1 in every 1000 twin births. A 21-year-old primigravida with a 31-week twin pregnancy was admitted for delivery. The head of the first twin was locked to the chin of the second twin at the top of the symphysis pubis. Caesarean section was performed allowing the delivery of both dead twins. Twins gestations with first twin in the breech presentation raise index of suspicion of potential locked twin. However, management of such situation is controversial with most authors and colleges recommending caesarean section to avoid interlocking heads. We report another rare case of interlocking heads and bring up the topic about management of breech-first twin deliveries.

Breeches, Sword Play and Intriguing Ladies: Performing the Spanish Code of Honor as a Model for Social Formation in the Plays of the English Restoration

Over 10%of English Restoration drama engaged its audience through plays that were translated from or imitated the Spanish capa y espada form of theatre.English plays modeled on this form used Spanish locations and a constructed and rigid idea of honor as a proxy for English society.While dialogue was still important,it performed physical action of this form,including frequent use of breeches roles and female characters sword fighting,allowed for different and effective critiques and models of social behavior for women in England.Particularly important were concerns about women’s behavior and status in English society,and the presence of the actress for the first time on English stages heightened the effectiveness of these plays as an instrument of social discussion.

What to do when it is breech? A state-of-the-art review on management of breech presentation

Any non-cephalic presentation in a fetus is regarded as malpresentation.The most common malpresentation,breech,contributes to 3%-5%of term pregnancies and is a leading indication for cesarean delivery.Identification of risk factors and a proper physical examination are beneficial;however,ultrasound is the gold standard for the diagnosis of malpresentations.External cephalic version(ECV)refers to a procedure aimed to convert a non-cephalic presenting fetus to cephalic presentation.This procedure is performed manually through the mother’s abdomen by a trained health care provider,to reduce the likelihood of a cesarean section.Studies have reported a version success rate of above 50%by ECV.The main objective of this review is to present a broad perspective on fetal malpresentation,ECV,and delivery of a breech fetus.The focus is to elaborate all clinical scenarios of breech and to provide an evidence-based clinical approach for them.After discussing breech prevalence,risk factors,diagnosis,and management,an updated review of ECV is presented.Moreover,ECV indications/contraindications,alternatives,clinical techniques on how to perform ECV and breech vaginal delivery,and obstetrical considerations for the delivery of malpresentations are thoroughly discussed.

Effect of Stimulating the BL67 Point on Fetal Correction from Breech to Cephalic Presentation and Natural Delivery after the 36 Weeks of Pregnancy: A Randomized Clinical Trial

Objective:Various techniques are proposed for changing fetal presentation.We aimed to assess the effect of BL67 point stimulation on correcting breech presentation and natural delivery in women at 36-38 gestational weeks.Methods:A parallel single blinded randomized clinical trial was conducted on 72 eligible pregnant women with breech presentation at the 36 weeks of pregnancy.The subjects were divided into two groups-intervention(n=36)and control groups(n=36)by block randomization method.The intervention group stimulated the BL67 point by self-administration for 20 min once a day for 2 weeks.Finally,the appearance of cephalic presentation and rate of vaginal delivery was compared between the groups(n1=n2=32)using the Chi-square test and multivariate logistic regression.Results:The correction of breech to cephalic presentation occurred in 53.1% of patients in the intervention group.The adjusted relative risk(RR)for fetal correction from breech to cephalic was 1.80(RR=1.80,95%confidence interval[CI],1.13-5.17).It was shown that the stimulation of the BL67 point increased the correction of breech to cephalic presentation.In addition,the rate of vaginal delivery increased by>4-fold(RR=4.16,95%CI,2.54-6.82)by correction to cephalic presentation.Moreover,65.6%of mothers in intervention group and 90.6%in the control group underwent cesarean section.Conclusions:The stimulation of the BL67 point is a safe,inexpensive,and effective method that can be self-administered at home for fetal correction from breech to cephalic presentation in women with breech presentations during 36-38 gestational weeks.This promotes uncomplicated natural childbirth.

Constitutive model of viscoelastic dynamic damage for the material of gas obturator in modular-charge howitzer

In order to investigate the mechanical response behavior of the gas obturator of the breech mechanism,made of polychloroprene rubber(PCR), uniaxial compression experiments were carried out by using a universal testing machine and a split Hopkinson pressure bar(SHPB), obtaining stress-strain responses at different temperatures and strain rates. The results revealed that, in comparison to other polymers, the gas obturator material exhibited inconspicuous strain softening and hardening effects;meanwhile, the mechanical response was more affected by the strain rate than by temperature. Subsequently, a succinct viscoelastic damage constitutive model was developed based on the ZWT model, including ten undetermined parameters, formulated with incorporating three parallel components to capture the viscoelastic response at high strain rate and further enhanced by integrating a three-parameter Weibull function to describe the damage. Compared to the ZWT model, the modified model could effectively describe the mechanical response behavior of the gas obturator material at high strain rates. This research laid a theoretical foundation for further investigation into the influence of chamber sealing issues on artillery firing.

Study of relationship between motion of mechanisms in gas operated weapon and its shock absorber

The article deals with the motion of the breech block carrier and the weapon casing of an automatic weapon mounted on a flexible carriage and the base of the weapon.Earlier works,which did not consider the dynamic properties of the base of the weapon,did not allow to reconcile the calculated and experimental results of the weapon casing displacement when shooting from firing rests.For the analysis of the motion of individual parts,the methods of mathematical modelling and firing experiments using a high-speed camera were chosen.Calculations show the best accord with experiment when modelling the system with 4 degrees of freedom.The oscillation of the system regarding the movement of the breech block carrier and the weapon casing was investigated under changed conditions of rate of fire,the use of a muzzle brake and different types of shock absorbers.The velocities and displacements of the weapon casing and the breech block carrier at different values of the impulse of the gases to the breech block carrier were determined.

形式追随功能:敌楼核心功能与建筑形制的关联探析

作为明长城的标志性建筑,敌楼功能与形制间的关系尚未厘清,导致类型多样化的成因和设计原则存疑、长城遗产价值揭示受阻。以明代火器为视角,史料与实物互证,分析历史上“敌楼”改名“铳楼”的原因,探索西洋火器佛郎机对敌楼核心功能的影响,通过敌楼的断代研究和“明长城全线图像与三维数据库”抽样调查,从历时性和共时性角度比较敌楼的结构与平面、箭窗与吐水嘴的位置、“悬眼”有无等形制特点,验证佛郎机与敌楼的共生关系,得出围绕核心功能的敌楼形制设计原则,拓展建筑遗产与可移动文物多元互证的研究方法,为相关遗产的价值揭示和利用提供参考。

臀位外倒转术在足月臀位妊娠产妇中的应用及矫正成功影响因素分析

目的探讨臀位外倒转术在足月臀位妊娠产妇中的应用,并分析其矫正成功影响因素。方法选取2020年1月至2023年1月收治的足月单胎臀位妊娠产妇162例,根据干预情况将其分为研究组(n=69例)和对照组(n=93例)2组。统计比较2组分娩方式、臀位矫正成功情况及治疗过程中并发症发生情况;采用单因素和多因素Logistic回归分析探讨足月臀位妊娠产妇臀位外倒转术矫正成功影响因素。结果研究组阴道分娩率和臀位矫正成功率[57/69,82.61%;47/69,68.12%]均高于对照组[2/93,2.15%;28/93,30.11%](P<0.01)。治疗过程中,研究组胎盘早剥、脐带绕颈、头盆不称发生率和围产期新生儿住院率[1/69,1.45%;2/69,2.90%;1/69,1.45%;1/69,1.45%]低于对照组[9/93,9.68%;12/93,12.90%;10/93,10.75%;11/93,11.83%](P<0.05)。多因素Logistic回归分析结果显示,新生儿体质量和产次是足月臀位妊娠产妇臀位外倒转术矫正成功的独立影响因素(P<0.05,P<0.01)。结论足月臀位妊娠产妇应用臀位外倒转术可提高阴道分娩率,降低并发症发生率,而新生儿体质量和产次是影响该技术矫正成功的主要因素。

足月臀位外倒转术成功预测模型的建立与验证

目的:建立单胎足月臀位外倒转术成功的预测模型并进行内部验证。方法:回顾分析2015年1月至2021年9月在首都医科大学附属北京妇产医院行臀位外倒转术的485例单胎臀位孕妇的临床资料,按手术结局分为成功组和失败组。采用logistic回归模型进行多因素分析,筛选出外倒术成功的影响因素作为预测因子建立预测模型,应用R软件构建预测模型的列线图。绘制受试者工作特征(ROC)曲线对模型预测性能进行评估,并运用Bootstrap法进行内部验证。结果:经产、宫缩抑制剂使用、胎儿体重<2960g、羊水指数≥11.3cm、非前壁胎盘、脐绕颈<2周是外倒转术成功的独立有利因素,纳入上述6个因素作为预测因子,建立外倒转术成功的预测模型及列线图。该预测模型的ROC曲线下面积为0.74(95%CI为0.70~0.79),此时灵敏度为71.43%,特异度为67.38%。模型的内部验证结果提示其预测曲线与临床实际曲线一致性良好。结论:基于上述预测因子建立的足月臀位外倒转术成功的预测模型具有较好的预测效能,可为临床医生进行临床咨询和选择外倒转术的适宜人群提供参考。

基于深度学习的弹底窝痕特征点比对方法

针对3D弹底窝痕(BFI)表面粗糙度成分中峰点、谷点、鞍点和脊点等特征点,由于击打偏心或不完全接触产生无效区域,传统的特征点检测与匹配方法比对精度低,且不适用于条纹状纹理的BFI.综合考虑,采用自监督学习模型检测特征点以及注意力机制图神经网络匹配特征点.对于特征点检测模型,首先对虚拟图像数据集有监督训练然后通过多尺度变换产生伪标签并进行自监督学习;对于特征点匹配模型,采用注意力机制图神经网络建立特征点间匹配关系,为减少无效区域干扰,添加垃圾箱通道用于表示没有对应匹配关系的特征点.采用共聚焦显微镜采集BFI表面形貌并滤波提取其中表面粗糙度成分,分别对颗粒状和条纹状纹理特征的BFI数据进行验证.与传统方法对比,以已知不匹配BFI的特征点匹配率最大值为阈值,该方法能够完全区分已知匹配和已知不匹配BFI,适用于颗粒状和条纹状纹理特征的BFI,具有抗无效区域干扰能力.

B超引导下行单胎臀位外倒转的有效性及安全性探讨

目的探讨B超引导下行单胎臀位外倒转的有效性及安全性。方法选取60例单胎臀位外倒转孕妇,根据臀位外倒转方法不同将孕妇分为观察组(实行B超引导下臀位外倒转)与对照组(不进行特殊处理),每组30例,比较两组胎位矫正成功率、分娩结局及胎儿不良结局情况。结果观察组胎位矫正成功率高于对照组(P<0.05)。观察组阴道分娩率73.33%高于对照组的10.00%(P<0.05)。观察组新生儿窒息、胎儿迫、脐带脱垂总发生率低于对照组,但比较差异无统计学意义(P>0.05)。结论在单胎臀位外倒转中引入B超引导下操作,能够提升臀位外倒转有效性,保证安全性,具有积极影响。

至阴穴艾灸联合超声下臀位倒转术对妊娠临床结局影响的护理研究

目的探究至阴穴艾灸联合超声下臀位倒转术对妊娠临床结局的影响。方法选取2022年1月至2023年8月在赣州市妇幼保健院定期产前检查、分娩的60例妊娠晚期单胎产妇作为研究对象,采用随机数字表法将其分为对照组(30例)和联合组(30例)。对照组采用常规护理结合超声下臀位倒转术,联合组在对照组方法的基础上加用至阴穴艾灸。比较两组的臀位矫正成功率、分娩情况、护理服务满意度、新生儿的相关情况。结果联合组产妇的臀位矫正成功率(76.67%)高于对照组(50.00%),差异有统计学意义(P<0.05);两组的分娩情况比较,差异有统计学意义(P<0.05)。两组新生儿的体重、脐动脉血糖比较,差异无统计学意义(P>0.05)。联合组新生儿的血氧分压、新生儿1 min Apgar评分高于对照组,差异有统计学意义(P<0.05)。对照组、联合组的护理服务总满意度分别为63.33%、83.33%,两组护理服务总满意度比较,差异无统计学意义(P>0.05)。结论至阴穴艾灸联合超声下臀位倒转术可提高臀位矫正成功率以及阴道分娩率,临床应用价值显著,值得推广。

改良臀位外倒转术在纠治足月单胎臀位中的临床应用

目的探讨改良臀位外倒转术在纠治足月单胎臀位中的临床应用。方法选取80例单胎妊娠且胎位为臀位孕妇,根据臀位外倒转术不同分为观察组(改良臀位外倒转术)与对照组(传统臀位外倒转术),各40例。比较两组一般资料、臀位外倒转术情况、并发症发生情况及妊娠结局。结果观察组新生儿体质量(3372.50±144.09)g重于对照组(3255.00±189.39)g,差异有统计学意义(P<0.05)。观察组臀位外倒转术(ECV)次数少于对照组,ECV总成功率(82.5%)高于对照组(62.5%),椎管内麻醉发生率(20.0%)低于对照组(47.5%),差异有统计学意义(P<0.05)。两组并发症发生率比较差异无统计学意义(P>0.05)。观察组分娩孕周、阴道分娩率高于对照组,行ECV术与分娩的时间间隔长于对照组,新生儿出生时的Apgar评分≤7分、出生后48 h内收入院的发生率低于对照组,差异有统计学意义(P<0.05)。结论改良臀位外倒转术在纠治足月单胎臀位的总成功率高于传统臀位外倒转术,且椎管内麻醉术使用更低、妊娠结局更好,值得临床进一步推广与应用。

妊娠晚期臀位倒转术围手术期的护理效果观察

目的:分析妊娠晚期臀位倒转手术患者应用围手术期护理的临床效果。方法:研究于2021年1月至2023年6月选取上犹县妇幼保健院80例妊娠晚期胎儿臀位为观察对象,均行臀位倒转手术,随机均分为对照组与观察组,各40例。对照组患者实施常规护理,观察组患者予以围手术期护理,评价两组患者的手术应激状态与生活质量。结果:术后,两组患者的收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)、心率(HR)、血氧饱和度(SPO2)均升高,且相比对照组,观察组患者的SBP、DBP、MAP、HR均较低,SPO2较高,差异具有统计学意义(P<0.05)。术后,两组患者的生理机能、生理职能、精力、社会功能、情感职能、精神健康评分均升高,且相比对照组,观察组患者的生理机能、生理职能、精力、社会功能、情感职能、精神健康评分较高,差异具有统计学意义(P<0.05)。结论:妊娠晚期臀位倒转手术患者应用围手术期护理可在一定程度上降低患者的手术应激,提升患者的生活质量。

椎管内镇痛对孕妇臀位外倒转术的辅助疗效

目的探讨椎管内镇痛下对臀位单胎妊娠孕妇实施外倒转术的成功率,并分析外倒转术的并发症发生情况。方法将60例定期产前检查并分娩的孕妇随机分为硬膜外麻醉组(EA组)和腰硬联合阻滞麻醉组(CSEA组),每组30例;另设无任何镇痛的30例孕妇为对照组。采用视觉模拟评分法比较3组行外倒转术时孕妇疼痛评分;比较3组转为头位的比例、剖宫产率、不良反应的发生率。结果实施椎管内镇痛后,EA组和CSEA组孕妇疼痛评分分别为1.87±2.94和1.73±2.71,明显优于对照组的6.84±3.08(P=0.031和P=0.027)。EA组瞬时外倒转成头位的比例为78.3%,高于CSEA组的51.7%和对照组的48.3%(P=0.023和P=0.041);CSEA组与对照组比较,差异无统计学意义。与CSEA组和对照组比较,EA组剖宫产率、臂位为第一指征剖宫产率均较低,差异均有统计学意义(P=0.037和P=0.029)。CSEA组孕妇低血压、恶心呕吐、胎心率减慢的发生率均明显高于对照组,差异均有统计学意义(P=0.021,P=0.042,P=0.033)。3组孕妇在外倒转术期间均无胎盘早剥发生。3组孕妇在外倒转术后早产和脐带绕颈的发生率比较,差异均无统计学意义。结论对于臀位单胎妊娠孕妇,经硬膜外镇痛后实施的外倒转术可有效矫正胎位,降低剖宫产率;经腰硬联合镇痛是否能提高瞬时外倒转术的成功率尚不明确。

膛炸模式及其机理分析

通过国内外大量膛炸事故的破坏状况与膛炸原因的统计分析 ,本文将膛炸模式归纳为五种类型 :(1)装药设计不当引起火药破碎 ;(2 )冲击载荷引起弹内炸药引爆 ;(3)引信失灵引起弹内炸药引爆 ;(4 )外界激励引起弹内炸药半爆 ;(5 )炮膛不净引起胀膛或炸膛。在此基础上 ,对各种膛炸模式的膛炸原因与机理作了详细分析。

孕晚期臀位外倒转术的安全性和影响因素的临床分析

【目的】探讨孕晚期臀位外倒转术的安全性和影响外倒转术成功的相关因素。【方法】收集2015年9月至2017年7月在中山大学附属第三医院孕晚期实施外倒转术的80例孕妇患者作为研究对象,按照外倒转成功与否分为成功组和失败组,对两组的相关因素(年龄、产次、BMI、羊水量、胎盘位置、脐带绕颈和胎儿估重等)及妊娠结局进行单因素统计学分析。【结果】80例患者中,外倒转手术成功48例(60.0%),失败32例(40.0%);成功组与失败组间,患者产次,BMI,羊水深度的差异具有有统计学意义(P<0.05);成功组中有3例(6.2%)行剖宫产术,失败组中均择期剖宫产(100.0%)。实施外倒转术的80例患者,无外倒转术中急诊剖宫产,无新生儿窒息,胎膜早破发生11例(13.8%)。外倒转失败原因包括患者腹部肌肉紧张合并疼痛不能耐受12例(37.5%),腹部肌肉紧张合并疼痛可耐受9例(28.0%),操作过程中出现宫缩2例(6.3%),先露已入盆难以上推出骨盆5例(15.6%),复位至臀位2例(6.3%),操作过程中胎心短期减慢2例(6.3%)。【结论】患者产次、BMI和羊水深度是外倒转成功率的影响因素;外倒转术操作安全性高,选择合适的病例,改善腹肌紧张、疼痛、宫缩等因素,可增加外倒转成功率。

应用分娩球运动纠正胎儿臀先露及改善分娩结局

目的探讨应用分娩球运动纠正胎儿臀位的临床效果及对分娩结局的影响。方法随机将我院产科门诊产检的单胎臀位160例初产妇分为观察组和对照组,每组80例,对照组选择膝胸卧位,孕妇俯卧在瑜伽垫上,胸部着地,臀部翘起。观察组采用分娩球运动,孕妇跪式和趴式伏在分娩球上,做前后,左右摆动和转圈运动,观察两组患者胎儿臀先露纠正效果、分娩方式。结果对照组的纠正成功率为55.0%,观察组的纠正成功率为83.8%,两组比较有统计学差异(P<0.01)。两组产妇胎位纠正成功后,对照组顺产率为59.1%,观察组顺产率为89.6%,两组比较差异有统计学意义(P<0.01)。结论与传统的膝胸卧位相比,应用分娩球运动纠正臀先露具有更高的舒适性、成功率、顺产率。