Postpartum Intrauterine Device: Use and Follow-Up of Users in the Maternity Ward of the Ratoma Communal Medical Center in Conakry, Guinea

Objective: The aim of this study was to describe the use of the postpartum intrauterine device in the maternity ward of the Ratoma communal medical center in Conakry. Methods: This was a descriptive cross-sectional study carried out between July 1st 2015 and June 30 2016, i.e. a duration of one year. Results: A total of 551 patients received advice on various contraceptive methods. Most of this advice was given in the post-partum period (40.2%) and during antenatal care (39.1%). Of the patients advised, 87 (15.8%) used the intrauterine device. The majority of users (93%) were married and uneducated (63.2%), and 39.1% were poor. The majority (56.3%) of intra-uterine devices were inserted in the immediate post-partum period. The majority of women had no adverse events either during the first six weeks (n = 57;65.5%) or at 3rd months (n = 75;86.2%) or 6th months (n = 76;87.4%) after IUD insertion. Most users remained complication-free throughout the follow-up period (n = 76;87.4% at 6th weeks and 3rd months, and n = 77;88.5% at 6th months). The continuation rate was 89.7% at 6 weeks and 3rd months, and 87.4% at 6th months after insertion. The majority of users (87.0%) were satisfied with the care they received. Conclusion: This study showed very few complications among intrauterine device users, and high continuation and satisfaction rates. The intrauterine device is a long-acting, effective, reversible and safe contraceptive that can be used by most women for birth spacing in Guinea, where women do not regularly visit health facilities.

Patient satisfaction and follow-up adherence to glaucoma case management clinic in China

AIM:To assess glaucoma patient satisfaction and follow-up adherence in case management and identify associated predictors to improve healthcare quality and patient outcomes.METHODS:In this cross-sectional study,a total of 119 patients completed a Patient Satisfaction Questionnaire-18 and a sociodemographic questionnaire.Clinical data was obtained from the case management system.Follow-up adherence was defined as completing each follow-up within±30d of the scheduled time set by ophthalmologists during the study period.RESULTS:Average satisfaction scored 78.65±7,with an average of 4.39±0.58 across the seven dimensions.Age negatively correlated with satisfaction(P=0.008),whilst patients with follow-up duration of 2 or more years reported higher satisfaction(P=0.045).Multivariate logistics regression analysis revealed that longer follow-up durations were associated with lower follow-up adherence(OR=0.97,95%CI,0.95-1.00,P=0.044).Additionally,patients with suspected glaucoma(OR=2.72,95%CI,1.03-7.20,P=0.044)and those with an annual income over 100000 Chinese yuan demonstrated higher adherence(OR=5.57,95%CI,1.00-30.89,P=0.049).CONCLUSION:The case management model proves effective for glaucoma patients,with positive adherence rates.The implementation of this model can be optimized in the future based on the identified factors and extended to glaucoma patients in more hospitals.

Pregnancy stressors and postpartum symptoms of depression and anxiety:the moderating role of a cognitivebehavioural therapy(CBT)intervention

Background Little is known about the association between stressors(especially positive stressors)during pregnancy and postpartum depression and anxiety.Aims We investigated the association between positive and negative stress events during different stages of pregnancy and postpartum mental health outcomes among low-income pregnant women with symptoms of anxiety in Pakistan and evaluated whether an intervention based on cognitive behavioural therapy(CBT)had a regulatory effect.Methods Participants were 621 pregnant Pakistani women with mild anxiety.Using the Pregnancy Experience Scale-Brief Version,six scores were created to assess positive and negative stressors.We performed a multivariate linear regression to examine whether these six scores,measured both at baseline and in the third trimester,were associated with postpartum anxiety and depressive symptoms.The effect of the intervention on this relationship was examined by adding an interaction term to the regression model.Results Hassles frequency measured in the third trimester was positively associated with depression(B=0.22,95%confidence interval(Cl):0.09 to 0.36)and anxiety(B=0.19,95%Cl:0.08to 0.30).At the same timepoint,uplifts intensity was negatively associated with symptoms of depression(B=-0.82,95%Cl:1.46 to-0.18)and anxiety(B=-0.70,95%Cl:-1.25 to-0.15),whereas hassles intensity was positively related to symptoms of depression(B=1.02,95%Cl:0.36 to 1.67)and anxiety(B=0.90,95%Cl:0.34 to 1.47).The intensity ratio of hassles to uplifts reported in the third trimester was positively related to both depression(B=1.40,95%Cl:0.59 to 2.20)and anxiety(B=1.26,95%Cl:0.57 to 1.96).The intervention strengthened the overall positive effects of uplfts and the negative effects of hassles.Pregnancy experiences at baseline during early pregnancy to mid-pregnancy were not associated with mental health outcomes.Conclusions Stressors in the third trimester but not earlier in pregnancy were associated with postpartum symptoms of anxiety and depression.The CBT intervention modified the association between pregnancy stressors and postpartum mental health outcomes.Programmes that promote positive experiences and reduce negative experiences,especially in late pregnancy,may mitigate postpartum mental health consequences.

Loss to Specialized Cardiology Follow-Up in Adults Living with Congenital Heart Disease

Background:Much has been written about the loss to follow-up in the transition between pediatric and adult Congenital Heart Disease(CHD)care centers.Much less is understood about the loss to follow-up(LTF)after a successful transition.This is critical too,as patients lost to specialised care are more likely to experience mor-bidity and premature mortality.Aims:To understand the prevalence and reasons for loss to follow-up(LTF)at a large Australian Adult Congenital Heart Disease(ACHD)centre.Methods:Patients with moderate or highly complex CHD and gaps in care of>3 years(defined as LTF)were identified from a comprehensive ACHD data-base.Structured telephone interviews examined current care and barriers to clinic attendance.Results:Overall,407(22%)of ACHD patients(n=1842)were LTF.The mean age at LTF was 31(SD 11.5)years and 54%were male;311(76%)were uncontactable.Compared to adults seen regularly,lost patients were younger,with a greater socio-economic disadvantage,and had less complex CHD(p<0.05 for all).We interviewed 59 patients(14%).The top 3 responses for care absences were“feeling well”(61%),losing track of time(36%),and not needing fol-low-up care(25%).Conclusions:A large proportion of the ACHD population becomes lost to specialised cardiac care,even after a successful transition.This Australian study reports younger age,moderate complexity defects,and socio-economic disadvantage as predictive of loss to follow-up.This study highlights the need for novel approaches to patient-centered service delivery even beyond the age of transition and resources to maintain patient engagement within the ACHD service.

Therapeutic effect of manual massage on early postpartum rectus abdominis separation and postpartum depression

BACKGROUND Rectus abdominis separation(DRA)affects pelvic stability and body image.No studies have explored the effects of manual massage on early postpartum DRA and postpartum depression.AIM To analyze the curative effect of massage on early postpartum DRA and its impact on postpartum depression and thus its ability promote the overall psychosomatic rehabilitation of postpartum women.METHODS Data were retrospectively collected on 70 primiparous women with postpartum DRA who underwent rehabilitation at the Postpartum Rehabilitation Center of Huzhou Maternal and Child Health Hospital from October 2022 to September 2023.The patients were divided into the Group S(35 cases,biomimetic electrical stimulation treatment)and Group L(35 cases,biomimetic electrical stimulation combined with manual massage treatment).Baseline data,the edinburgh postpartum depression scale(EPDS)score,and the visual analog scale(VAS)scores for rectus abdominis distance,waist circumference,and lower back pain before and after treatment were compared.RESULTS No significant differences were found in the baseline data,rectus abdominis distance,waist circumference,and VAS and EPDS scores between the two groups before treatment(P>0.05).After treatment,the distance between rectus abdominis and waist circumference in Group L were significantly smaller than those in Group S(P<0.05).Furthermore,lower back pain(VAS score)and the EPDS score in Group L were significantly lower than those in Group S(P<0.05).CONCLUSION Manual massage can significantly reduce early postpartum DRA,waist circumference,and back pain and improve the patient’s mental state and postpartum depression.

Subsequent pregnancy outcomes and fertility rates in the case series that underwent bilateral hypogastric artery ligation(BHGAL)due to severe postpartum hemorrhage

Objective:To evaluate the effect of bilateral hypogastric artery ligation(BHGAL)on women's pregnancy outcomes and fertility rates in cases with severe postpartum hemorrhage.Methods:Patients hospitalized in a tertiary care center between 2007 and 2018 were included in the study.The records of cases were obtained from the hospital database,retrospectively.Maternal demographic data,morbidities or complications associated with BHGAL surgery,any additional haemostatic interventional or surgical procedures,preoperative admission and lowest postoperative haematocrit-hemoglobin values,blood products given,type of anaesthesia,intensive care unit(ICU)and length of hospital stay were recorded.In cases without surgical sterilization,future fertility and subsequent pregnancy outcomes were assessed for at least two years after operation.Information was obtained through face-to-face or telephone interviews with patients whose long-term fertility and subsequent pregnancy outcomes were assessed.Results:Sixty-eight patients with BHGAL surgery history were included in the study.26 Of 37 cases(70%)that did not undergo surgical sterilization had a desire for pregnancy after the surgery.Six of these cases(23%)were diagnosed with secondary infertility.The fertility rate of these cases was 77%,and subsequent pregnancy was detected in 20 women.A total of 25 pregnancies,including first and second pregnancies,developed,and 15 of these pregnancies resulted in term delivery,six preterm births,one stillbirth,and three abortions.Conclusions:The postoperative pregnancy rate was found to be higher than the rate of women with infertility problems,and this surgery does not seem to adversely affect pregnancy outcomes.This is a tertiary center experience and cohort studies with large patient series are needed.

Iodine Nutrition, Thyroid-stimulating Hormone, and Related Factors of Postpartum Women from three Different Areas in China: A Cross-sectional Survey

Objective Studies on the relationship between iodine,vitamin A(VA),and vitamin D(VD)and thyroid function are limited.This study aimed to analyze iodine and thyroid-stimulating hormone(TSH)status and their possible relationships with VA,VD,and other factors in postpartum women.Methods A total of 1,311 mothers(896 lactating and 415 non-lactating)from Hebei,Zhejiang,and Guangxi provinces were included in this study.The urinary iodine concentration(UIC),TSH,VA,and VD were measured.Results The median UIC of total and lactating participants were 142.00µg/L and 139.95µg/L,respectively.The median TSH,VA,and VD levels in all the participants were 1.89 mIU/L,0.44μg/mL,and 24.04 ng/mL,respectively.No differences in the UIC were found between lactating and non-lactating mothers.UIC and TSH levels were significantly different among the three provinces.The rural UIC was higher than the urban UIC.Obese mothers had a higher UIC and a higher prevalence of excessive TSH.Higher UICs and TSHs levels were observed in both the VD deficiency and insufficiency groups than in the VD-sufficient group.After adjustment,no linear correlation was observed between UIC and VA/VD.No interaction was found between vitamins A/D and UIC on TSH levels.Conclusion The mothers in the present study had no iodine deficiency.Region,area type,BMI,and VD may be related to the iodine status or TSH levels.

D-Dimer: Predictor of Postpartum Hemorrhage among Pre-Eclampsia at Kilimanjaro Christian Medical Centre

Background: Postpartum hemorrhage (PPH) is the major contributor to maternal mortality and morbidity worldwide as well as in Tanzania. Studies have shown Pre-eclampsia as a risk indicator for Postpartum hemorrhage and D-dimer tends to rise in women with pre-eclampsia. Few studies that have shown the association between D-dimer and PPH have been controversial and differ according to ethnicity and lifestyle. Hence there is no suitable reference interval for D-dimer in predicting Postpartum hemorrhage among women with pre-eclampsia. Broad Objective: This study aimed to assess the association, sensitivity, and specificity of D-dimer as a laboratory predictor of postpartum hemorrhage among women with pre-eclampsia at KCMC hospital. Methodology: This was a hospital-based analytical cross-sectional study conducted at KCMC Hospital in Northern Tanzania from September 2022 to March 2023. A total of 195 women with pre-eclampsia were included in this study. Plasma D-dimer levels were taken from women with pre-eclampsia pre-delivery. Haematocrit was compared before and after delivery, and a fall of 10% was considered as Postpartum hemorrhage together with clinical assessment of the patient. Participants were divided among those who had severe features and those who did not have severe features and were further categorized into those who had PPH and those who did not have PPH. Logistic regression was used to determine the association between D-dimer and PPH adjusting for other factors. The Receiver Operating Curve (ROC) was used to evaluate the predictive value. Results: Higher median D-dimer levels were seen among women who had PPH compared to those who had no PPH. D-dimer was seen to be associated with PPH, thus for every unit increase of µg/ml of D-dimer among women who had pre-eclampsia without severe features there was a 14% significant increase in the odds of having postpartum hemorrhage and a 45% significant increase of having postpartum hemorrhage among those who had pre-eclampsia with severe features. Furthermore, the cut-off point of a D-dimer level of 0.66 µg/ml significantly predicts postpartum hemorrhage with a sensitivity of 75% and specificity of 55%. For those who had no severe features the cut-off point was 0.53 µg/ml with a sensitivity of 95% and specificity of 53%, and for those who had severe features the cut-off point was 3.58 µg/ml with a sensitivity of 50% and specificity of 96%. Conclusion: D-dimer can be used to predict postpartum hemorrhage among pre-eclampsia, especially among those who have severe features. This shows that D-dimer has specificity in predicting PPH in women with pre-eclampsia and can be applied in clinical services to save women from maternal morbidity and mortality. Blood products such as fresh frozen plasma, platelets, and whole blood together with tranexamic acid should be readily available in women with pre-eclampsia especially those with severe features with a D-dimer level of 3.58 µg/ml and above during delivery as they are at high risk of developing PPH.

Prevalence and Associated Factors of Postpartum Depression: A Study Conducted in Health Centres in Dakar (Senegal)

Introduction: Postpartum depression is the most common psychiatric disorder affecting women in the perinatal period. According to the WHO, it affects 10% - 15% of women who have just given birth. In Africa, and particularly in Senegal, epidemiological studies focusing exclusively on postpartum depression are rare or non-existent. For this reason, we conducted this screening study on postpartum depression to assess the socio-demographic characteristics and associated factors. Methods: This was a prospective cross- sectional study with descriptive and analytical aims. It was carried out in the twelve Dakar referral health centres during the period August 2021 to June 2022. Results: At the end of our survey we had recruited one hundred and twenty-two (122) participants with a PPD prevalence rate of 25.41%. The most common age group was 24 - 29 years. 40% of the participants were of Fulani ethnicity, followed by Wolof. Married women made up 93% of the sample. The school enrolment rate was 89%. Most participants were not in paid employment. Domestic violence was present in 14% of couples. 28% of mothers reported experiencing a stressful life event during their pregnancy. 22% of the women had a chronic medical condition, of which 55% had high blood pressure. 1% of the women reported a personal psychiatric history and 5% a family psychiatric history. Most women had between two and four healthy living children. The pregnancy was unwanted in 17% of cases and 12% of participants had a complication. 6% were dissatisfied with the quality of their antenatal care. The caesarean section rate was 18%. In terms of associated factors, eight factors were identified in a bivariate analysis: single marital status, lack of support from partner, domestic violence, conflict with in-laws, and the occurrence of a stressful life event during pregnancy, the presence of a personal medical history, lack of satisfaction with pregnancy follow-up, and mode of delivery by caesarean section. Conclusion: Our study showed the high prevalence of PPD (25.41%) and identified associated risk factors. Among these factors, two were strongly associated with postpartum depression: lack of satisfaction with pregnancy care and experiencing a stressful life event during pregnancy. Systematic screening or identification of risk factors during pregnancy is necessary for comprehensive treatment based on a biopsychosocial approach.

Postpartum Family Planning at the Timbuktu Hospital in Mali

Introduction: Postpartum family planning is the prevention of pregnancies during the 12 months following childbirth. Few studies have been devoted to postpartum family planning in Mali. Our work will contribute to reducing unmet need for family planning. Objective: To study the use of contraceptive methods in the postpartum period in the obstetrics and gynecology unit of Timbuktu hospital. Materials and Methods: This was a descriptive and analytical cross-sectional study with prospective collection of data from January 1, 2022 to December 31, 2023. All women who gave birth having chosen and benefited from a contraceptive method were included. The statistical test used was the Fisher test with a significance threshold fixed at 5%. Results: The frequency of contraception in the postpartum period was 17.03%. The average age of clients was 26.14% with extremes of 14 and 45 years. They were paupiparous at 56.4% with an inter-birth interval of less than 12 months at 12.3%. More than half of the counseling (58.5%) was done during postnatal visits. The methods chosen were implants at 48.1%, injectable progestins at 21.3%, intrauterine device at 14.7%, miro-progestin pills at 13.5%, tubal ligation at 1 .4% and condoms at 1%. The regular follow-up rate was 51.1% of cases and 25.6% had no follow-up. Conclusion: The overall rate of postpartum family planning of 17.08% remains low. Improving FP staff skills will reduce unmet needs and contribute to increasing contraceptive prevalence in Timbuktu.

Modified Xiaoyao powder for postpartum depression:A systematic review and meta-analysis

Objective:To evaluate the effectiveness and safety of modified Xiaoyao powder for postpartum depression(PPD)by conducting a systematic review of randomized controlled trials(RCTs).Methods:The Chinese National Knowledge Infrastructure Databases(CNKI),the Chinese Scientific Journals Database(VIP),Wanfang,Google Scholar,the SinoMed,Embase,Cochrane Library,and PubMed databases were searched from their inception to April 25,2023.The Cochrane Risk of Bias tool was used to assess the quality of the trials.We applied the risk ratio to present dichotomous data and the mean difference to present continuous data.Data with similar characteristics were pooled for meta-analysis and heterogeneity was assessed using I2.Results:This review included 35 trials involving 2848 participants.The quality of the included studies was low(unclear randomization processes and insufficient reporting of blinding).Participants treated with modified Xiaoyao powder plus Western medicine showed lower Hamilton Depression Scale(HAMD)depression score than those who used Western medicine alone(mean difference=-2.15;95%confidence interval:-2.52 to 1.78;P<.00001),and higher effective rate(relative risk=1.19;95%confidence interval:1.15 to 1.24;P<.00001),When comparing modified Xiaoyao alone with Western medicine,the HAMD depression score remained low,however,the efficacy rate was higher in the modified Xiaoyao group.Regarding adverse events,the modified Xiaoyao group reported weight gain,nausea,and diarrhea,but no severe adverse events were reported.Conclusion:Modified Xiaoyao may help relieve depression in PPD when used alone or in combination with Western medicine,with minor side effects.Therefore,future high-quality,large-sample size RCTs are warranted.

Postpartum depression and partner support during the period of lactation:Correlation research and its influencing factors

BACKGROUND Postpartum depression(PPD)not only affects the psychological and physiological aspects of maternal health but can also affect neonatal growth and development.Partners who are in close contact with parturient women play a key role in communication and emotional support.This study explores the PPD support relationship with partners and its influencing factors,which is believed to establish psychological well-being and improve maternal partner support.AIM To explore the correlation between PPD and partner support during breastfeeding and its influencing factors.METHODS Convenience sampling was used to select lactating women(200 women)who underwent postpartum examinations at the Huzhou Maternity and Child Health Care Hospital from July 2022 to December 2022.A cross-sectional survey was conducted on the basic information(general information questionnaire),depression level[edinburgh postnatal depression scale(EPDS)],and partner support score[dyadic coping inventory(DCI)]of the selected subjects.Pearson’s correlation analysis was used to analyze the correlation between PPD and DCI in lactating women.Factors affecting PPD levels during lactation were analyzed using multiple linear regression.RESULTS The total average score of EPDS in 200 lactating women was(9.52±1.53),and the total average score of DCI was(115.78±14.90).Dividing the EPDS,the dimension scores were:emotional loss(1.91±0.52),anxiety(3.84±1.05),and depression(3.76±0.96).Each dimension of the DCI was subdivided into:Pressure communication(26.79±6.71),mutual support(39.76±9.63),negative support(24.97±6.68),agent support(6.87±1.92),and joint support(17.39±4.19).Pearson’s correlation analysis demonstrated that the total mean score and individual dimension scores of EPDS during breastfeeding were inversely correlated with the total score of partner support,stress communication,mutual support,and cosupport(P<0.05).The total mean score of the EPDS and its dimensions were positively correlated with negative support(P<0.05).Multiple linear regression analysis showed that the main factors affecting PPD during breastfeeding were marital harmony,newborn health,stress communication,mutual support,negative support,cosupport,and the total score of partner support(P<0.05).CONCLUSION PPD during breastfeeding was associated with marital harmony,newborn health,stress communication,mutual support,negative support,joint support,and the total DCI score.

Postpartum quality of life and mental health in women with heart disease:Integrated clinical communication and treatment

BACKGROUND Postpartum quality of life(QoL)in women with heart disease has been neglected.AIM To improve clinical communication and treatment,we integrated medical data and subjective characteristics to study postpartum QoL concerns.METHODS The study assessed QoL 6 wk after birth using the 12-Item Short-Form Health Survey.The Edinburgh Postnatal Depression Scale,Cardiac Anxiety Questionnaire,European Heart Failure Self-Care Behavior Scale,and a self-designed questionnaire based on earlier research were also used to assess patient characteristics.Patient data were collected.Prediction models were created using multiple linear regression.RESULTS This retrospective study examined postpartum QoL in 105 cardiac patients.Postpartum QoL scores were lower(90.69±13.82)than those of women without heart disease,with physical component scores(41.09±9.91)lower than mental component scores(49.60±14.87).Postpartum depression(33.3%),moderate anxiety(37.14%),pregnancy concerns(57.14%),offspring heart problems(57.14%),and life expectancy worries(48.6%)were all prevalent.No previous cardiac surgery,multiparity,higher sadness and cardiac anxiety,and fear of unfavorable pregnancy outcomes were strongly related to lower QoL(R^(2)=0.525).CONCLUSION Postpartum QoL is linked to physical and mental health in women with heart disease.Our study emphasizes the need for healthcare workers to recognize the unique characteristics of these women while developing and implementing comprehensive management approaches during their maternity care.

Long-term assessment of collagenase treatment for Dupuytren’s contracture:A 10-year follow-up study

BACKGROUND Enzymatic fasciotomy with collagenase clostridium histolyticum(CCH)has revolutionized the treatment for Dupuytren’s contracture(DC).Despite its benefits,the long-term outcomes remain unclear.This study presented a comprehensive 10-year follow-up assessment of the enduring effects of CCH on patients with DC.AIM To compare the short-term(12 wk)and long-term(10 years)outcomes on CCH treatment in patients with DC.METHODS A cohort of 45 patients was treated with CCH at the metacarpophalangeal(MCP)joint and the proximal interphalangeal(PIP)joint and underwent systematic reevaluation.The study adhered to multicenter trial protocols,and assessments were conducted at 12 wk,7 years,and 10 years post-surgery.RESULTS Thirty-seven patients completed the 10-year follow-up.At 10 years,patients treated at the PIP joint exhibited a 100%recurrence.However,patients treated at the MCP joint only showed a 50%recurrence.Patient satisfaction varied,with a lower satisfaction reported in PIP joint cases.Recurrence exceeding 20 degrees on the total passive extension deficit was observed,indicating a challenge for sustained efficacy.Significant differences were noted between outcomes at the 7-year and 10-year intervals.CONCLUSION CCH demonstrated sustained efficacy when applied to the MCP joint.However,caution is warranted for CCH treatment at the PIP joint due to a high level of recurrence and low patient satisfaction.Re-intervention is needed within a decade of treatment.

Clinical risk factors for preterm birth and evaluating maternal psychology in the postpartum period

BACKGROUND Although the specific pathogenesis of preterm birth(PTB)has not been thoroughly clarified,it is known to be related to various factors,such as pregnancy complications,maternal socioeconomic factors,lifestyle habits,reproductive history,environmental and psychological factors,prenatal care,and nutritional status.PTB has serious implications for newborns and families and is associated with high mortality and complications.Therefore,the prediction of PTB risk can facilitate early intervention and reduce its resultant adverse consequences.AIM To analyze the risk factors for PTB to establish a PTB risk prediction model and to assess postpartum anxiety and depression in mothers.METHODS A retrospective analysis of 648 consecutive parturients who delivered at Shenzhen Bao’an District Songgang People’s Hospital between January 2019 and January 2022 was performed.According to the diagnostic criteria for premature infants,the parturients were divided into a PTB group(n=60)and a full-term(FT)group(n=588).Puerperae were assessed by the Self-rating Anxiety Scale(SAS)and Self rating Depression Scale(SDS),based on which the mothers with anxiety and depression symptoms were screened for further analysis.The factors affecting PTB were analyzed by univariate analysis,and the related risk factors were identified by logistic regression.RESULTS According to univariate analysis,the PTB group was older than the FT group,with a smaller weight change and greater proportions of women who underwent artificial insemination and had gestational diabetes mellitus(P<0.05).In addition,greater proportions of women with reproductive tract infections and greater white blood cell(WBC)counts(P<0.05),shorter cervical lengths in the second trimester and lower neutrophil percentages(P<0.001)were detected in the PTB group than in the FT group.The PTB group exhibited higher postpartum SAS and SDS scores than did the FT group(P<0.0001),with a higher number of mothers experiencing anxiety and depression(P<0.001).Multivariate logistic regression analysis revealed that a greater maternal weight change,the presence of gestational diabetes mellitus,a shorter cervical length in the second trimester,a greater WBC count,and the presence of maternal anxiety and depression were risk factors for PTB(P<0.01).Moreover,the risk score of the FT group was lower than that of the PTB group,and the area under the curve of the risk score for predicting PTB was greater than 0.9.CONCLUSION This study highlights the complex interplay between postpartum anxiety and PTB,where maternal anxiety may be a potential risk factor for PTB,with PTB potentially increasing the incidence of postpartum anxiety in mothers.In addition,a greater maternal weight change,the presence of gestational diabetes mellitus,a shorter cervical length,a greater WBC count,and postpartum anxiety and depression were identified as risk factors for PTB.

Effect of percutaneous electrical stimulation at the Baliao point on preventing postpartum urinary retention after labor analgesia

BACKGROUND Anesthetic drugs used in labor analgesia also paralyze the bladder muscle by blocking the sacral plexus,thereby affecting maternal postpartum spontaneous urination and increasing the risk of postpartum urinary retention(PUR).AIM To analyze the effect of percutaneous electrical stimulation at the Baliao point combined with biofeedback therapy for PUR prevention.METHODS We selected 182 pregnant women who received labor analgesia in obstetrics between June 2022 and December 2023.They were divided into the combined therapy group(transcutaneous electrical stimulation of the Baliao point combined with biofeedback therapy)and the control group(biofeedback therapy alone).The first spontaneous urination time,first postpartum urine volume,bladder residual urine volume,postpartum hemorrhage volume,pre-urination waiting time,PUR incidence,adverse reactions,and the intervention’s clinical efficacy were compared between the two groups.RESULTS The first spontaneous urination time after delivery was more delayed(2.92±1.04 h vs 3.61±1.13 h,P<0.001),with fewer initial postpartum urine(163.54±24.67 mL vs 143.72±23.95 mL,P<0.001),more residual bladder urine(54.81±10.78 mL vs 65.25±13.52 mL,P<0.001),more postpartum bleeding(323.15±46.95 mL vs 348.12±45.03 mL,P=0.001),and longer waiting time for urination(0.94±0.31 min vs 1.29±0.42 min,P<0.001),in the control group than in the combined therapy group.The control group also had higher PUR incidence(4.65%vs 15.85%,P=0.016).Both groups had no adverse reactions,but the clinical total efficacy rate of the intervention was significantly higher in the combined therapy group than in the control group(95.35%vs 84.15%,P=0.016).CONCLUSION Percutaneous electrical stimulation of the Baliao point combined with biofeedback can significantly promote postpartum micturition of parturients with labor analgesia,thereby effectively preventing PUR occurrence.

Oketani massage with jasmine oil improves breast milk production on postpartum days 1-3

Objective:This study aimed to determine the effect of Oketani massage with jasmine oil on improving breast milk production on days 1-3.Materials and Methods:This preexperimental one-group pretest-posttest design was conducted with 44 eligible respondents,selected using an incidental sampling technique.Oketani massage with jasmine oil was conducted once a day for 3 consecutive days.A total of 44 respondents were selected with incidental sampling.Sufficient breast milk production was observed through the frequency of baby urination in 24 h,the frequency of baby defecation in 24 h,the baby’s weight,and the length of time the baby slept or remained calm after breastfeeding.Results:Results showed that Oketani massage using jasmine oil impacted on increasing breast milk production in postpartum on days 1-3(Z=6.633,P=0.000).The baby’s weight in 3 days was increased after intervention compared with intervention before(2858.25±180.62 g vs.2881.66±180.96 g,t=55.33,P=0.000),the baby’s urination frequency was increased after intervention(4.55±0.50 vs.7.20±0.70,t=17.87,P=0.000),the breastfeeding frequency has decreased(10.27±1.42 vs.8.82±0.82,t=6.94,P=0.000),and the time of baby’s sleeping or calming state has increased(5.14±6.46 h vs.8.48±10.24 h,t=2.11,P=0.041).Conclusion:Oketani massage combined with jasmine oil has been shown to be effective on improving breast milk production on days 1-3.

Environmental Impact Assessment Follow-Up of Seismic Survey Offshore Activities in Brazil

Follow-up of environmental impacts is an integral part of the Environmental Impact Assessment (EIA) process, closely related to the effectiveness of the instrument. EIA follow-up has been receiving a lot of interest from scientists and practitioners, though it is recognized as one of the weakest points of EIA systems globally. Also, EIA follow-up is influenced by the context, mainly in terms of the types of projects or activities and their related impacts on the environment. Therefore, the present paper is focused on the investigation of the follow-up stage applied to the activity of seismic survey coupled with offshore oil & gas exploitation in Brazil. Research was based on a qualitative approach that included document analysis and semi-structured interviews with analysts involved in EIA processes, and sought to generate evidence of effectiveness of the EIA follow-up as conducted by the Federal Environment Agency (Ibama) in order to situate the practice of follow-up in the broader context of international best practice principles. Based on the findings, it was concluded that, due to the peculiarities of offshore seismic survey, it is necessary to promote adaptations in the procedures for monitoring impacts in order to ensure proper alignment with the principles and conceptual foundations that guide EIA practice. Specifically, the timing of the execution of the activity imposes challenges for its integration into the “conventional” cycle that has guided the monitoring of the impacts in the EIA of projects.

Study on the Application Effect of Flexible Nursing Care in Patients with Postpartum Urinary Retention and its Effect on Lactation

Objective: To study the application effect of flexible nursing in patients with postpartum urinary retention and its effect on lactation. Methods: A total of 200 cases of postpartum urinary retention patients admitted between January 2021 and January 2022 were selected and randomly grouped into two groups, a control group (conventional nursing) and an observation group (flexible nursing), of 100 cases each. The time of onset of lactation, the lactation volume score, urinary indicators, the amount of post-partum hemorrhage, and the quality of life score of the two groups were compared. Results: The observation group’s lactation initiation time (21.41 ± 1.52) h and lactation volume score (2.11 ± 0.52) were better than that of the control group (P < 0.05). The observation group’s first urination time (2.11 ± 0.51) min was lower than the control group, while the urinary retention completely relieved time (33.12 ± 8.61) h, and first urinary volume (262.17 ± 52.41) mL was higher than that of the control group (P < 0.05). The amount of postpartum hemorrhage in the observation group (151.21 ± 22.12) mL was less than that in the control group (P < 0.05). The scores of somatic functioning (86.25 ± 2.20), psychological functioning (91.56 ± 1.45), social functioning (89.25 ± 2.45), and material life (89.75 ± 1.45) of the observation group were higher than those of the control group after nursing (P < 0.05). Conclusion: Flexible nursing care in patients with postpartum urinary retention exhibited significant nursing effects and lactation function was effectively improved.

Treatment of postpartum depression with integrated traditional Chinese and Western medicine nursing and electrical stimulation

BACKGROUND Postpartum depression(PPD)is a common psychological disease among puerperal women,and postpartum pelvic floor dysfunction is a common disease among pregnant women.The occurrence of postpartum pelvic floor dysfunction will increase the incidence of PPD.AIM To explore the therapeutic effect of integrated traditional Chinese and Western medicine nursing combined with electrical stimulation of pelvic floor muscles and the rectus abdominis on PPD.METHODS From April 2020 to January 2022,100 parturients with a rectus abdominis muscle separation distance>2.0 cm who underwent reexamination 6 wk after delivery at our hospital were selected as the research subjects.According to the random number table method,the patients were divided into either an observation group(n=50)or a control group(n=50).There was no significant difference in the general data between the two groups(P>0.05).Both groups were treated by electrical stimulation.The observation group was additionally treated by integrated traditional Chinese and Western medicine nursing.A self-designed Depression Knowledge Questionnaire was used to evaluate the awareness of knowledge on depression in all patients 3 wk after intervention.The Hamilton Depression Scale(HAMD)was used to evaluate the depression before intervention and 1 wk and 3 wk after intervention,and the Morisky Medication Adherence Scale(MMAS-8)was used to evaluate the medication compliance.SPSS19.0 was used for statistical analyses.RESULTS The rate of awareness of knowledge on depression in the observation group was significantly higher than that of the control group(P<0.05).The scores of MMAS-8 were comparable between the two groups before intervention(P>0.05),but were significantly higher in the observation group than in the control group at 1 wk and 3 wk after intervention(P<0.05).The HAMD scores were comparable between the two groups before intervention(P>0.05),but were significantly lower in the observation group than in the control group at 1 wk and 3 wk after intervention(P<0.05).CONCLUSION Integrated traditional Chinese and Western medicine nursing combined with electrical stimulation of pelvic floor muscles and the rectus abdominis is effective in the treatment of postpartum depression and worthy of clinical promotion.