Increasing rates of cesarean section, as high as 50% in some countries in Latin America, compared with the US and the rest of the world, demand a closer analysis of its causes and implications. The significant morbidi...Increasing rates of cesarean section, as high as 50% in some countries in Latin America, compared with the US and the rest of the world, demand a closer analysis of its causes and implications. The significant morbidity for both mother and baby associated with cesarean section requires immediate action from national and international societies to confront the situation with specific solutions, including patient education. We recommend a consensus meeting of Latin American ACOG (American College of Obstetricians and Gynecologists) section members to address the issue and to consider adopting guidelines based on evidence and reflecting the realities of the countries involved.展开更多
Objective:To analyze the effect of midwife psychological nursing intervention in the clinical care of elderly women in labor.Methods:According to the order of admission,74 elderly women were divided into the control g...Objective:To analyze the effect of midwife psychological nursing intervention in the clinical care of elderly women in labor.Methods:According to the order of admission,74 elderly women were divided into the control group and the observation group.In addition to the routine perinatal nursing interventions,the observation group strengthened the implementation of midwives’psychological nursing interventions.The duration of labor,mode of delivery,psychological state,and stress response indexes of the two groups were analyzed and compared.Results:The observation group had a shorter duration of all labor stages and total duration of labor than the control group,a lower cesarean section rate than the control group,and a higher degree of improvement in anxiety,depression,and stress response indexes in the 3-day postpartum period as compared to the control group(P<0.05).Conclusion:The implementation of midwife psychological care intervention in perinatal care of elderly women can further shorten the duration of labor,reduce the cesarean section rate,and improve the psychological state and stress indicators,which is worth promoting.展开更多
Background: Accidental urinary tract particularly bladder injury during cesarean delivery has a significant maternal morbidity, as it may lead to extended operative time, infection of urinary tract and sometimes devel...Background: Accidental urinary tract particularly bladder injury during cesarean delivery has a significant maternal morbidity, as it may lead to extended operative time, infection of urinary tract and sometimes development of urinary tract fistulae. Objective: To find out the efficacy of urinary bladder inflation immediately prior to cesarean section (CS) procedure in minimizing incidence of accidently urinary tract injury in high risk patients. Setting: Obstetrics and Gynecology Department, Faculty of Medicine, South Valley University, Qena, Egypt. Duration: From August 2017 to November 2018. Study Design: A prospective randomized controlled trial. Methods: Seventy six pregnant women recruited from attendants of outpatient antenatal care unit of obstetrics and gynecology department who planned for cesarean delivery and carried one or more risk factors for urinary tract injury. Patients randomly were classified into 2 groups (group I included 38 cases, underwent bladder inflation using triple way Foley’s catheter immediately before CS and group II included 38 cases, and underwent bladder deflation with 2 ways Foley’s catheter immediately before CS. Results: The overall incidence of urinary tract injury was significantly higher in group II (7 cases = 18.4%) than in group I (2 cases = 5.2%) with p value < 0.001. The incidence of urinary bladder injury was moderately significantly higher in group II (5 cases = 13.1%) than group I (2 cases = 5.2%) with p value 0.01;ureteric or combined vesico-ureteric injuries had been reported only in group II (1 case = 2.6% and 1 case = 2.6%) respectively with no case reported in group I (p There was a highly statistically significant difference between group I and group II as regard to hospital stay (p < 0.001) but mildly significant differences in operative time and remote urinary tract fistulae (p Conclusions: There was significant reduction in urinary bladder injury, ureteric injury, operative time and hospital stay. Urinary bladder inflation immediately before cesarean section should be applied in patients who have any risk factor of dense bladder adhesion as a protective procedure against urinary tract injuries.展开更多
The water quality of Dianchi Lake declines quickly and the eutrophication is getting serious. To identify the internal pollution load of Dianchi Lake it is necessary to evaluate its sediment accumulation. Sedimentatio...The water quality of Dianchi Lake declines quickly and the eutrophication is getting serious. To identify the internal pollution load of Dianchi Lake it is necessary to evaluate its sediment accumulation. Sedimentation rates of Dianchi Lake are determined by ^137Cs dating. However, ^137Cs vertical distribution in sediment cores of Dianchi Lake has special characteristics because Dianchi Lake is located on the southeast of the Qinghai-Tibet Plateau, the Kunming quasi-stationary front is over the borders of Yunnan and Guizhou where the specific precipitation is distributed. Besides 1954, 1963 and 1986 ^137Cs marks can be determined in sediment cores, a ^137Cs mark of 1976 representing the major period of ^137Cs released from China unclear test can be determined and used for an auxiliary dating mark. Meanwhile Dianchi Lake is divided into seven sections based on the water depth, basin topography, hydrological features and supplies of silt and the lakebed area of each section is calculated. The mean annual sedimentation rates for seven sections are 0.0810, 0.1352, 0.1457, 0.1333, 0.0904, 0.1267 and 0.1023 g/cm^2 a in 1963-2003, respectively. The gross sediment accumulation of the lake is 26.18×10^4 t/a in recent 17 years and 39.86×10^4t/a in recent 50 years.展开更多
背景自“全面二孩”政策实施后,经产妇为主要分娩人群,高龄、慢性合并症、产科并发症、剖宫产术后再次妊娠等问题日渐突出,给产科工作者带来新的挑战。目的基于修正版Robson分类系统对新生育政策下经产妇的剖宫产现状进行分析,为合理控...背景自“全面二孩”政策实施后,经产妇为主要分娩人群,高龄、慢性合并症、产科并发症、剖宫产术后再次妊娠等问题日渐突出,给产科工作者带来新的挑战。目的基于修正版Robson分类系统对新生育政策下经产妇的剖宫产现状进行分析,为合理控制剖宫产率、提高产科医疗质量提供数据支持。方法纳入2017—2020年在南方医科大学第十附属医院剖宫产分娩的产妇共19170例,分为初产妇组(n=5630)和经产妇组(n=13540)。通过电子病历系统收集产妇信息,包括年龄、孕产次、既往分娩情况、胎方位、妊娠合并症及并发症、产妇结局及新生儿结局等,并对两组产妇的一般资料、产妇结局及新生儿结局进行比较。采用修正版Robson分类系统,根据产科特征(产次、胎位、胎儿数量、分娩孕周)对产妇进行分类,对比两组在修正版Robson分类系统中的分布及各组占比随年度变化情况。结果经产妇中剖宫产后再次妊娠的比例高达81.4%(11026/13540);经产妇组的年龄、孕次、产次及年龄≥35岁、妊娠合并糖尿病比例均高于初产妇组(P<0.05)。修正版Robson分类在所有剖宫产产妇中,以R3类(妊娠≥37周单胎头位,至少有1次剖宫产史)为主(50.4%,9668/19170),其次为R1类(妊娠≥37周单胎头位初产,自然临产、诱导临产或临产前剖宫产)(20.8%,3993/19170);经产妇中,R3类的占比最高达71.4%(9668/13540)。分析经产妇人群特征发现,2017—2020年,占比最高的R3类产妇从73.5%下降至67.1%,而R2类[妊娠≥37周单胎头位经产(无剖宫产史),自然临产、诱导临产或临产前剖宫产]、R8类[所有妊娠<37周单胎头位(包括有剖宫产史)]的占比均有所升高。经产妇组产后24 h出血量、输血比例高于初产妇组,而术后住院天数低于初产妇组(P<0.05)。19170例产妇共分娩新生儿20026名例,其中初产妇分娩6077例,经产妇分娩13949例;经产妇组新生儿出生体质量、1 min Apgar评分高于初产妇组新生儿,而1 min Apgar评分≤7分、转新生儿科比例低于初产妇组新生儿(P<0.05);两组产妇剖宫产新生儿5 min Apgar评分比较,差异无统计学意义(P>0.05)。结论高龄和剖宫产术后再次妊娠是经产妇的突出特征。R3类的占比虽然逐年下降,但仍是剖宫产经产妇的主要人群,为降低剖宫产率,需有效控制初次分娩剖宫产,并在安全的前提下积极推广R3类产妇经阴道试产。同时,经产妇中R2类和R8类的占比有所升高,对产科临床实践提出了新的要求。展开更多
Background： The cesarean section rate （CSR） bas been a main concern worldwide. The present study aimed to investigate the CSR in Beijing, China, and to analyze the related lactors of CS delivery. Methods： An obser...Background： The cesarean section rate （CSR） bas been a main concern worldwide. The present study aimed to investigate the CSR in Beijing, China, and to analyze the related lactors of CS delivery. Methods： An observational study was conducted in 15 medical centers in Beijing using a systemic cluster sampling naethod. In total, 15, 194 pregnancies were enrolled in the study between ,lune 20, 2013 and November 30, 2013. Independent t-tests and Pearson＇s Chi-square test were nsed to examine differences between two groups, and related factors of the CSR were examined by multivariable logistic regression. Results： The CSR was 41.9% （4471/10,671） in singleton primiparae. Women who were more than 35 years old had a 7.4-fold increased risk of CS delivery compared with women 〈25 years old （odd ratio [OR] 7.388, 95% confidence interval [Cl] = 5.561-9.816, P 〈 0.001 ）. Prepregnancy obese women had a 2-1bid increased risk of CS delivery compared with prepregnancy normal weight women （OR = 2.058. 95% CI = 1.640-2.584, P〈 0.001 ）. The excessive weight gain group had a 1.4-fold increased risk of CS delivery compared with the adequate weight gain group （OR 1.422, 95% CI = 1.289 1.568, P〈 0.001 ）. Gestational diabetes mellitus （GDM） women and DM women had an increased risk of CS delivery （ 1.2- and 1.7-fold, respectively） compared with normal blood glucose women. Women who were born in rural areas had a lower risk of CS delivery than did those who were born in urban areas （OR 0.696, 95% CI = 0.625-0.775, P 〈 0.001 ）. The risk of CS delivery gradually increased with a decreasing education level. Neonates weighing 3000-3499 g had the lowest CSR （36.2%）. Neonates weighing 〈2500 g had a 2-fold increased risk of CS delivery compared with neonates weighing 3000 3499 g （OR - 2.020, 95% CI=1.537 2.656, P 〈 0.001 ）. Neonates weighing ≥4500 g had an 8.3-fold increased risk of CS delivery compared with neonates weighing 3000-3499 g （OR = 8.313.95% CI= 4.436-15.579, P 〈 0.001）. Conclusions： Maternal age, prepregnancy body mass index, geslational weight gain, blood glncose levels, residence, education level, and singleton fetal birth weight arc all factors that might significantly affect the CSR.展开更多
目的:探究间羟胺联合腰硬联合麻醉对剖宫产产妇的影响。方法:选取2021年1月—2022年10月泉州市第一医院收治的100例待剖宫产产妇。根据随机数表法将其分为腰硬联合麻醉组和联合治疗组,各50例。腰硬联合麻醉组给予腰硬联合麻醉,联合治疗...目的:探究间羟胺联合腰硬联合麻醉对剖宫产产妇的影响。方法:选取2021年1月—2022年10月泉州市第一医院收治的100例待剖宫产产妇。根据随机数表法将其分为腰硬联合麻醉组和联合治疗组,各50例。腰硬联合麻醉组给予腰硬联合麻醉,联合治疗组给予间羟胺联合腰硬联合麻醉。比较两组麻醉前、术后收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)、心输出量(CO)、心率(HR)、心脏指数(CI),手术指标,新生儿缺氧情况及不良反应。结果:术后,两组DBP、SBP、MAP下降,但联合治疗组DBP、SBP、MAP均高于腰硬联合麻醉组,差异有统计学意义(P<0.05)。术后,两组HR、CO、CI均降低,但联合治疗组HR、CO、CI均高于腰硬联合麻醉组,差异有统计学意义(P<0.05)。两组手术时间、术中失血量、术中液体输注量比较,差异无统计学意义(P>0.05)。两组新生儿1 min和5 min Apgar评分比较,差异无统计学意义(P>0.05)。联合治疗组不良反应发生率低于腰硬联合麻醉组,差异有统计学意义(P<0.05)。结论:间羟胺联合腰硬联合麻醉对剖宫产产妇进行干预,能较好地维护产妇血压、心率水平,调节产妇血流动力学,对新生儿Apgar评分有较小的影响,效果显著。展开更多
文摘Increasing rates of cesarean section, as high as 50% in some countries in Latin America, compared with the US and the rest of the world, demand a closer analysis of its causes and implications. The significant morbidity for both mother and baby associated with cesarean section requires immediate action from national and international societies to confront the situation with specific solutions, including patient education. We recommend a consensus meeting of Latin American ACOG (American College of Obstetricians and Gynecologists) section members to address the issue and to consider adopting guidelines based on evidence and reflecting the realities of the countries involved.
文摘Objective:To analyze the effect of midwife psychological nursing intervention in the clinical care of elderly women in labor.Methods:According to the order of admission,74 elderly women were divided into the control group and the observation group.In addition to the routine perinatal nursing interventions,the observation group strengthened the implementation of midwives’psychological nursing interventions.The duration of labor,mode of delivery,psychological state,and stress response indexes of the two groups were analyzed and compared.Results:The observation group had a shorter duration of all labor stages and total duration of labor than the control group,a lower cesarean section rate than the control group,and a higher degree of improvement in anxiety,depression,and stress response indexes in the 3-day postpartum period as compared to the control group(P<0.05).Conclusion:The implementation of midwife psychological care intervention in perinatal care of elderly women can further shorten the duration of labor,reduce the cesarean section rate,and improve the psychological state and stress indicators,which is worth promoting.
文摘Background: Accidental urinary tract particularly bladder injury during cesarean delivery has a significant maternal morbidity, as it may lead to extended operative time, infection of urinary tract and sometimes development of urinary tract fistulae. Objective: To find out the efficacy of urinary bladder inflation immediately prior to cesarean section (CS) procedure in minimizing incidence of accidently urinary tract injury in high risk patients. Setting: Obstetrics and Gynecology Department, Faculty of Medicine, South Valley University, Qena, Egypt. Duration: From August 2017 to November 2018. Study Design: A prospective randomized controlled trial. Methods: Seventy six pregnant women recruited from attendants of outpatient antenatal care unit of obstetrics and gynecology department who planned for cesarean delivery and carried one or more risk factors for urinary tract injury. Patients randomly were classified into 2 groups (group I included 38 cases, underwent bladder inflation using triple way Foley’s catheter immediately before CS and group II included 38 cases, and underwent bladder deflation with 2 ways Foley’s catheter immediately before CS. Results: The overall incidence of urinary tract injury was significantly higher in group II (7 cases = 18.4%) than in group I (2 cases = 5.2%) with p value < 0.001. The incidence of urinary bladder injury was moderately significantly higher in group II (5 cases = 13.1%) than group I (2 cases = 5.2%) with p value 0.01;ureteric or combined vesico-ureteric injuries had been reported only in group II (1 case = 2.6% and 1 case = 2.6%) respectively with no case reported in group I (p There was a highly statistically significant difference between group I and group II as regard to hospital stay (p < 0.001) but mildly significant differences in operative time and remote urinary tract fistulae (p Conclusions: There was significant reduction in urinary bladder injury, ureteric injury, operative time and hospital stay. Urinary bladder inflation immediately before cesarean section should be applied in patients who have any risk factor of dense bladder adhesion as a protective procedure against urinary tract injuries.
基金National Natural Science Foundation of China, No.40771186The Key Project of the State Key Laboratory of Soil Sustainable Agriculture,Nanjing Institute of Soil Sciences,Chinese Academy of Sciences,No.5022505
文摘The water quality of Dianchi Lake declines quickly and the eutrophication is getting serious. To identify the internal pollution load of Dianchi Lake it is necessary to evaluate its sediment accumulation. Sedimentation rates of Dianchi Lake are determined by ^137Cs dating. However, ^137Cs vertical distribution in sediment cores of Dianchi Lake has special characteristics because Dianchi Lake is located on the southeast of the Qinghai-Tibet Plateau, the Kunming quasi-stationary front is over the borders of Yunnan and Guizhou where the specific precipitation is distributed. Besides 1954, 1963 and 1986 ^137Cs marks can be determined in sediment cores, a ^137Cs mark of 1976 representing the major period of ^137Cs released from China unclear test can be determined and used for an auxiliary dating mark. Meanwhile Dianchi Lake is divided into seven sections based on the water depth, basin topography, hydrological features and supplies of silt and the lakebed area of each section is calculated. The mean annual sedimentation rates for seven sections are 0.0810, 0.1352, 0.1457, 0.1333, 0.0904, 0.1267 and 0.1023 g/cm^2 a in 1963-2003, respectively. The gross sediment accumulation of the lake is 26.18×10^4 t/a in recent 17 years and 39.86×10^4t/a in recent 50 years.
文摘背景自“全面二孩”政策实施后,经产妇为主要分娩人群,高龄、慢性合并症、产科并发症、剖宫产术后再次妊娠等问题日渐突出,给产科工作者带来新的挑战。目的基于修正版Robson分类系统对新生育政策下经产妇的剖宫产现状进行分析,为合理控制剖宫产率、提高产科医疗质量提供数据支持。方法纳入2017—2020年在南方医科大学第十附属医院剖宫产分娩的产妇共19170例,分为初产妇组(n=5630)和经产妇组(n=13540)。通过电子病历系统收集产妇信息,包括年龄、孕产次、既往分娩情况、胎方位、妊娠合并症及并发症、产妇结局及新生儿结局等,并对两组产妇的一般资料、产妇结局及新生儿结局进行比较。采用修正版Robson分类系统,根据产科特征(产次、胎位、胎儿数量、分娩孕周)对产妇进行分类,对比两组在修正版Robson分类系统中的分布及各组占比随年度变化情况。结果经产妇中剖宫产后再次妊娠的比例高达81.4%(11026/13540);经产妇组的年龄、孕次、产次及年龄≥35岁、妊娠合并糖尿病比例均高于初产妇组(P<0.05)。修正版Robson分类在所有剖宫产产妇中,以R3类(妊娠≥37周单胎头位,至少有1次剖宫产史)为主(50.4%,9668/19170),其次为R1类(妊娠≥37周单胎头位初产,自然临产、诱导临产或临产前剖宫产)(20.8%,3993/19170);经产妇中,R3类的占比最高达71.4%(9668/13540)。分析经产妇人群特征发现,2017—2020年,占比最高的R3类产妇从73.5%下降至67.1%,而R2类[妊娠≥37周单胎头位经产(无剖宫产史),自然临产、诱导临产或临产前剖宫产]、R8类[所有妊娠<37周单胎头位(包括有剖宫产史)]的占比均有所升高。经产妇组产后24 h出血量、输血比例高于初产妇组,而术后住院天数低于初产妇组(P<0.05)。19170例产妇共分娩新生儿20026名例,其中初产妇分娩6077例,经产妇分娩13949例;经产妇组新生儿出生体质量、1 min Apgar评分高于初产妇组新生儿,而1 min Apgar评分≤7分、转新生儿科比例低于初产妇组新生儿(P<0.05);两组产妇剖宫产新生儿5 min Apgar评分比较,差异无统计学意义(P>0.05)。结论高龄和剖宫产术后再次妊娠是经产妇的突出特征。R3类的占比虽然逐年下降,但仍是剖宫产经产妇的主要人群,为降低剖宫产率,需有效控制初次分娩剖宫产,并在安全的前提下积极推广R3类产妇经阴道试产。同时,经产妇中R2类和R8类的占比有所升高,对产科临床实践提出了新的要求。
文摘Background： The cesarean section rate （CSR） bas been a main concern worldwide. The present study aimed to investigate the CSR in Beijing, China, and to analyze the related lactors of CS delivery. Methods： An observational study was conducted in 15 medical centers in Beijing using a systemic cluster sampling naethod. In total, 15, 194 pregnancies were enrolled in the study between ,lune 20, 2013 and November 30, 2013. Independent t-tests and Pearson＇s Chi-square test were nsed to examine differences between two groups, and related factors of the CSR were examined by multivariable logistic regression. Results： The CSR was 41.9% （4471/10,671） in singleton primiparae. Women who were more than 35 years old had a 7.4-fold increased risk of CS delivery compared with women 〈25 years old （odd ratio [OR] 7.388, 95% confidence interval [Cl] = 5.561-9.816, P 〈 0.001 ）. Prepregnancy obese women had a 2-1bid increased risk of CS delivery compared with prepregnancy normal weight women （OR = 2.058. 95% CI = 1.640-2.584, P〈 0.001 ）. The excessive weight gain group had a 1.4-fold increased risk of CS delivery compared with the adequate weight gain group （OR 1.422, 95% CI = 1.289 1.568, P〈 0.001 ）. Gestational diabetes mellitus （GDM） women and DM women had an increased risk of CS delivery （ 1.2- and 1.7-fold, respectively） compared with normal blood glucose women. Women who were born in rural areas had a lower risk of CS delivery than did those who were born in urban areas （OR 0.696, 95% CI = 0.625-0.775, P 〈 0.001 ）. The risk of CS delivery gradually increased with a decreasing education level. Neonates weighing 3000-3499 g had the lowest CSR （36.2%）. Neonates weighing 〈2500 g had a 2-fold increased risk of CS delivery compared with neonates weighing 3000 3499 g （OR - 2.020, 95% CI=1.537 2.656, P 〈 0.001 ）. Neonates weighing ≥4500 g had an 8.3-fold increased risk of CS delivery compared with neonates weighing 3000-3499 g （OR = 8.313.95% CI= 4.436-15.579, P 〈 0.001）. Conclusions： Maternal age, prepregnancy body mass index, geslational weight gain, blood glncose levels, residence, education level, and singleton fetal birth weight arc all factors that might significantly affect the CSR.
文摘目的:探究间羟胺联合腰硬联合麻醉对剖宫产产妇的影响。方法:选取2021年1月—2022年10月泉州市第一医院收治的100例待剖宫产产妇。根据随机数表法将其分为腰硬联合麻醉组和联合治疗组,各50例。腰硬联合麻醉组给予腰硬联合麻醉,联合治疗组给予间羟胺联合腰硬联合麻醉。比较两组麻醉前、术后收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)、心输出量(CO)、心率(HR)、心脏指数(CI),手术指标,新生儿缺氧情况及不良反应。结果:术后,两组DBP、SBP、MAP下降,但联合治疗组DBP、SBP、MAP均高于腰硬联合麻醉组,差异有统计学意义(P<0.05)。术后,两组HR、CO、CI均降低,但联合治疗组HR、CO、CI均高于腰硬联合麻醉组,差异有统计学意义(P<0.05)。两组手术时间、术中失血量、术中液体输注量比较,差异无统计学意义(P>0.05)。两组新生儿1 min和5 min Apgar评分比较,差异无统计学意义(P>0.05)。联合治疗组不良反应发生率低于腰硬联合麻醉组,差异有统计学意义(P<0.05)。结论:间羟胺联合腰硬联合麻醉对剖宫产产妇进行干预,能较好地维护产妇血压、心率水平,调节产妇血流动力学,对新生儿Apgar评分有较小的影响,效果显著。
