Cesarean Sections according to the Robson’s Classification in Two University Hospitals of Yaoundé: Indications and Maternofetal Outcome

Introduction: Cesarean section is a surgical intervention which consists in the extraction of a fetus from the uterus after its incision. The rate of cesarean section varies depending on the country and the health facility. For this reason, in 2015, the World Health Organization (WHO) recommended the use of Robson’s classification to evaluate the practice of cesarean sections in order to identify the groups of women who had abnormally high rates. The objective of our study was to evaluate cesarean sections using the Robson’s classification in CHRACERH and in the Yaoundé Central Hospital (YCH). Methodology: We carried out a retrospective cross sectional and descriptive study in two (02) university hospitals in Yaoundé which took place from December 2017 to May 2018. We included in our study all women who gave birth over a period of two (02) years from January 2016 to December 2017 in these two health facilities. Our sampling was exhaustive over the study period. The parturients’ information was collected using an anonymous and pretested questionnaire. The Robson’s group of every parturient was determined. Descriptive parameters like mean and proportions were calculated. We compared the rates and indications of cesarean sections between the both hospitals using Chi2 test. Results: Out of 330 deliveries realized in CHRACERH, we had 90 cesarean sections;hence, a rate of 27.2%. Out of 1863 deliveries carried out at the YCH, 462 were by cesarean section, hence a rate of 24.8%. The women who belonged to groups 1, 3 and 5 contributed to the highest rates of cesarean sections in both hospitals: in CHRACERH, group 5 (31.1%), group 3 (20%) and group 1 (15.6%), at YCH: group 3 (22.5%), group 1 (21.6%) and group 5 (17.3%). The indications of the cesarean sections varied depending on the Robson’s group and the hospital, the principal indication in group 1 was acute fetal distress (28.6%) in CHRACERH and cephalopelvic disproportion (36.7%) at YCH. Cephalopelvic disproportion was the predominant indication in groups 3 of CHRACERH (44.4%) and YCH (39.2%). In groups 5, CHRACERH and of YCH, a scarred uterus was the principal indication for the cesarean section at 82.4% and 78.4% respectively. At CHRACERH, the maternofetal complications were more frequent in groups 1 and 2 at the YCH, this was the case mostly in groups 1 and 3. Conclusion: The Robson’s classification is an adequate tool for the evaluation and comparison of the rates of cesarean sections. The rates of cesarean section in CHRACERH (27.2%) and at YCH (24.8%) were higher than the rates recommended by WHO. Robson’s groups 1, 3 and 5 were identified as the groups most at risk for cesarean sections in the both hospitals.

Analysis of the Effect of Midwives’ Psychological Care Intervention on the Progress of Labor and Cesarean Rate of Elderly Women in Labor

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.

Study on the Indications for and Factors Related to Cesarean Section at Three District Hospitals in Shanghai

Objective To understand the indications for and factors related to cesarean section （CS）. Methods Pregnant women who attended health examination at three selected district hospitals were investigated from May 2001 to February 2003. Results Among 933 puerperas, the CS rate was 37. 62%. The top four indications for CS were fetal distress （36. 5%）, social factors （35.9%）, relative cephalopelvic disproportion （18.5%） and pregnancy complications （6.3%） respectively, The result of regression analysis showed that puerperas who were overweight before pregnancy, had no confidence in vaginal delivery and had macrosomia were more likely to have CS. Conclusion At present, the CS rate in Shanghai was rather high, The main indications for CS were fetal distress and social factors. The high CS rate was associated with the psychological factor and some demographic factors such as birth weight and puerperas＇ weight before pregnancy.

Effect of Cesarean Section on the Severity of Postpartum Hemorrhage in Chinese Women： The Shanxi Study

Postpartum hemorrhage （PPH） is one of the most adverse obstetric outcomes. Our aim is to detect the risks of multilevel PPH in different cesarean section （CS） groups [including nulliparous CS with indications, nulliparous CS without indications, repeat cesarean （RC）, vaginal birth after cesarean （VBAC）, cesarean after vaginal birth （CAVB）]. We conducted a retrospective cohort study, and the data on 127 145 women collected from January 2014 to May 2016 and from 35 tertiary hospitals in Shanxi province, China, were reviewed. Based on the measuring results of PPH, an ordered logistic regression model was used to analyze the adjusted PPH risks for each of the CS groups, and comparisons were drawn between them. Finally, a total of 99 066 nulliparous （77.92%） and 28 079 multiparous （22.08%） women were observed. The number of CS cases was 61 117, and the rate for CS was 48.07%. A total of 10 029 women did not show indications for CS and accounted for 16.41% of the CS parturient, whereas 9103 women underwent a repeated cesarean, with a CS frequency of 14.89%. The number of VBAC cases was 989, whose rate was 9.88% in prior CS women. The number （proportions） of PPH was 3658 （2.88%） in L1 （PPH volume： ≥900 and 〈1500 mL）, 520 （0.41%） in L2 （PPH volume： ≥1500 and〈2100 mL）, and 201 （0.16%） in L3 （PPH volume： ≥2100 mL）. The Ln （n= 1, 2, 3, etc.） represented the increasing order of PPH severity. In the adjusted results, compared with spontaneous vaginal delivery （SVD） as the reference group, in the adjusted result for nulliparous, there was a decreased PPH risk in CS with indications （OR： 2.32; CI： 2.04-2.62）, which was lower than that of CS without indications （OR： 2.50; CI： 2.01-2.96）. The highest PPH risk in all subgroups （i.e. nulliparous and multiparous groups） was observed in the RC （OR： 3.61; CI： 3.16-4.17）, which was nearly twice higher than that of the VBAC （OR： 1.82; CI： 1.33-2.52）. CAVB （OR： 1.03; CI： 0.65-1.62） showed no significant difference with the reference group. Thus, we deemed that CS should be avoided in nulliparous pregnancies unless indicated, to prevent or reduce the rates for the use of RC or VBAC which are high risks of severe PPH to the parturient women.

Understanding Midwives’ Perspective on Care of Post Cesarean Section Women at the University Teaching Hospital—Women and Newborn, Lusaka

Background: A cesarean section is a major obstetric surgical procedure performed for the purpose of delivering a live baby when vaginal delivery would put the mother and the baby at risk due to complications of pregnancy, labour and delivery. Although caesarean section is a life saving procedure, it is associated with a number of risks or problems in the postoperative period. The aim of the study was to understand the Midwives’ perspective on the care of postpartum mothers who had cesarean section at the University Teaching Hospital—Women and Newborn in Lusaka District. Methods: A descriptive cross sectional survey was conducted at the University Teaching Hospital—Women and Newborn in Lusaka. 51 Midwives working in postnatal wards were consecutively selected to participate in the study. Data was collected using a self administered questionnaire with a 4 point Likert scale and also some closed and open ended questions. SPSS version 20 statistical package was used to analyse data, expressed as descriptive summary measures. Results: All the 51 Midwives were female and they scored themselves highly on a 4 point Likert scale as always performing all the immediate post-operative care on the postpartum mothers who had a caesarean section while the score was much lower during the subsequent post-operative period. Staffing levels and medical-surgical materials were found to be low and affect care of Postpartum mothers (P-0.050). The majority (94.2%) of the Midwives also indicated that C-section mothers were not given any form of written materials or standardized instructions to take home as reference material during the Information, Education Communication sessions on discharge (P-0.001) and home/domiciliary visits to postpartum mothers who had C-sections on postpartum were not being undertaken. Conclusion: There was need to improve the care rendered to the postpartum women who had complicated labour and delivery including caesarean sections in order to promote good health and to prevent postpartum complications.

Comparison of Sexual Function in Primiparous Women Pre-Pregnancy and Postpartum: Difference of the Sexual Function after the Normal Vaginal Delivery and the Cesarean Section

Introduction: Sexual function is undoubtedly an important dimension of adult life. Due to all the conflicting results with regard to sexual function after the normal vaginal delivery (NVD) or the Cesarean Section (CS), in the present study, we aimed to compare the sexual function in women pre-pregnancy and postpartum and also after the NVD and CS. Materials and Methods: In this cohort study, two groups of healthy women, with antenatal normal pregnancies, who underwent NVD (n = 90) and CS (n = 113), were prospectively studied. The sexual function of the participants was assessed through a Female Sexual Function Index (FSFI) questionnaire in two stages: once before pregnancy and then within 3 to 6 months after delivery, which lasted from June 2011 to September 2012. The data were analyzed by descriptive and inferential statistics. Data were analyzed using chi-square test, Mann-Whitney test, and T Test. Results: Based on the data gathered from 206 women who completed the FSFI questionnaire in two stages, the mean (±SD) self-reported timing of the resumption of sexual activity was 8.9 ± 1.3. There was no significant statistical difference found between the two groups by timing of the resumption of sexual activity in NVD and CS groups. There was also no statistically significant difference found in the overall sexual function scores between the two groups (NVD vs. CS). The average score for female sexual function in desire, arousal, orgasm, and satisfaction within 3 to 6 months after delivery was significantly lower than that of their pre-pregnancy period (p < 0.004). The mean coitus in postpartum period was 1.84 ± 1.20 per week. Conclusion: Based on the findings of this study, there was no significant relationship between the mode of delivery and changes in sexual function. Therefore, it can be claimed that CS is not preferred to NVD with regard to preserving normal sexual functioning.

Cesarean Section Indications and Prognosis in Adolescents Girls at the Mother-Child Pool of the Teaching Hospital of Tengandogo (CHU-T) in Burkina Faso

Objective: Conduct a study on cesarean sections in adolescent girls at the mother-child pool of the CHU-T in order to reduce maternal-fetal morbidity and mortality. Patients and Methods: This was a descriptive and cross-sectional study with a retrospective data collection method from January 1st, 2018 to December 31st, 2019. Results: The frequency of caesarean sections in our series was estimated at 59.9% in adolescent girls. 68.7% of adolescent girls were married, the average age was estimated at 18.3 ± 1 years, primiparous women were the most represented group with a rate of 88%. Adolescent girls were housewives in 73.5% of cases, with 37.4% of them living in rural areas. The main indications for cesarean section were: pre-rupture syndrome (22.9%), fetal distress (19.3%), pre-eclampsia/eclampsia (18.1%) and bony dystocia (21.6%). The following results derive from the classification of the cesarean section indications into 2 groups according to one or the other member of the “mother-child” couple: maternal indications accounted for 57.8% while fetal adnexal indications were estimated at 36.1%. As for perinatal mortality, it reached 24.1%. Conclusion: Improving the maternal-fetal prognosis of cesarean section in adolescent girls necessarily requires the strengthening of pregnancies follow-ups among this population group where pregnancy is most often unplanned.

Prediction of Success Rates of Vaginal Birth after Cesarean Delivery According to the Previous Indication for Cesarean Delivery

Background: Trial of labor after cesarean delivery (TOLAC) has long been accepted as a safe option for women with previous cesarean delivery. Previous efforts have been exerted in trials to predict the success rates of TOLAC according to specific parameters related to previous cesarean section and before TOLAC. We aimed to investigate the different indications of previous cesarean delivery as independent predictors for successful vaginal birth. Methods: A retrospective study was conducted in Armed Forces Hospitals of the Southern Region between December 15, 2019, and July 1, 2020. The included 566 patients with previous cesarean section who were willing to undergo a trial of labor were divided into two groups according to the success of vaginal birth (VBAC). Results: The nonrecurring indications for previous cesarean delivery were higher in the successful group (fetal distress 54.7% vs 41.1%, malpresentation 26% vs 21.4%, multifetal pregnancy 3.8% vs 2.7%). Additionally, the successful VBAC group had a significantly higher percentage of previous successful VBAC (47.7% vs 21.9%) and prior vaginal deliveries (58.5% vs 44.2%) and less coincidence of medical disorders and meconium-stained liquor (18.1% vs 26.3% and 3.2% vs 8.2%, respectively) than the unsuccessful group. Conclusion: During counseling regarding trial of labor after cesarean section, indications for previous cesarean section not related to arrest of labor can predict higher success of VBAC. Moreover, previous successful vaginal delivery or VBAC improves the success rates.

The Caesarean Section in Dakar: Indications and Analysis Prognosis

The objective of this study was to analyze the indications of cesarean sections performed in a Level II clinic and to evaluate early maternal and neonatal outcome in the context of decentralization of obstetric and emergency newborn care. Material and Method: This was a retrospective descriptive and analytical study conducted at the maternity CSNC over a period of 12 months from 1 July 2010 to 30 June 2011. It included all women in childbirth by caesarean section and excluded patients admitted for management of complications of cesarean section performed in another structure. Results: During the study period, 595 caesarean sections were performed on a total of 4410 births, a rate of 13.5%. The average age of patients was 27 years. The mean parity was 2. The patients came from them even 55%. They were admitted with a single uterine scar in 28.40% of cases and bi-scar in 25.4% of cases. A pathology was associated with pregnancy in 31.6% of cases. These pathologies were dominated by vascular and renal syndromes (75.5%), anemia (13.8%) and the obstacles previa (10.1%). Caesarean sections were performed in 517 patients in emergency. The technique of Misgav Ladach was the most common 75.1%. The average hospital stay was 4.2 days with extremes of 0 and 15 days. Postoperative maternal mortality was 0.34%. Operative follow-up was simple in 98.3% of patients. Two patients (0.34%) died after surgery. In 92.4% of the cases, the newborns were alive. The Apgar score in the first minute was favorable (greater than or equal to 7/10) in 503 newborns (95.1%) and unfavorable (less than 7/10) in 47 cases (8.55%). At the fifth minute, he was favorable in 98.5% of the cases. Overall stillbirth was 72.26‰ with a total of 43 stillbirths including 3 macerated stillbirths. Conclusion: Cesarean section is by far the most accomplished action in gynecology and obstetrics. Its ease of implementation and low cost, and of course his results in terms of reduction of maternal-fetal morbidity and mortality make a key intervention and allowed its extension.

Obstetricians and pregnant women from Formiga’s town, in Minas Gerais State, Brazil. Deciding what kind of labor to be held

The decision of what kind of labor that should be held is intermittently generating a great debate in Brazil. The growth in the number of cesarean sections has raised worries in some of the involved sectors of the society. It was proposed to investigate the factors which lead the women to take this decision, trying to understand the principle involved. A bibliographic review about the subject was made. The research happened in the town of Formiga, where some data were collected in two hospitals—public and private —about the number of labors during two months. Subsequently, the obstetricians and a group of pregnant women were submitted to a questionnaire, the answers were compiled and transformed into graphs which were analyzed. Finally, the data were compared with the related literature. The number of cesarean sections in the town was above the standard recommended. According to the obstetricians, the main reason would be the preference of the pregnant women, fact which was not confirmed by them, that discrepancy was confirmed by the literature. The level of information about the clinical indications for the type of labor was considered satisfactory by the doctors and the pregnant women, data contestable by the academics. The fear and the pain were identified by obstetricians and pregnant women as a predominant factor for the preference of cesarean sections, provided that, according to the literature, shows the precariousness of information for pregnant women about the normal birth. Another important data is that the doctors can have an important role in the kind of labor to be made. According to the obstetricians, their role would be very limited, but according to some pregnant women, they did trust in the doctors which should be the ideal labor for them. The analysis of most of the data collected shows a discrepancy between the information of pregnant women and obstetricians. Both sides involved in the issue do not admit as responsible for the elevate number of cesarean sections, so, some new approaches are needed for analysis. This analysis and diagnosis indicate the next step of the research: the supervision of the pregnant women, since the beginning of the gestation until the birth, trying to figure out the real factors which lead them to decide what kind of delivery should be taken.

2014-2020年东莞市某三级医院流动人口产妇剖宫产率及剖宫产指征分析

目的分析东莞市某三级医院2014-2020年流动人口产妇剖宫产率及剖宫产指征变化情况。方法收集2014-2020年东莞市某三级甲等医院住院分娩流动人口产妇的临床资料,剖宫产指征以第一指征为主,对其剖宫产指征构成及其变化进行回顾性分析。结果该组孕产妇32401例,剖宫产8721例,剖宫产率为26.9%。2014-2020年各年份的剖宫产率分别为29.8%、25.2%、26.6%、26.3%、25.1%、28.0%、27.1%。剖宫产指征以瘢痕子宫居首位,其他依次为胎位异常、胎儿宫内窘迫和社会因素。在高龄、非高龄产妇剖宫产指征中,瘢痕子宫和胎位异常均分别位居第1、2位,第3位剖宫产指征分别为产妇要求和胎儿宫内窘迫;高龄产妇的瘢痕子宫、前置胎盘、妊娠合并症、妊娠合并肿瘤构成比等均高于非高龄产妇,胎位异常、胎儿宫内窘迫、羊水过少、产程异常的比例则低于非高龄产妇(P<0.05)。结论该研究的剖宫产率仍高于WHO标准,剖宫产指征中以瘢痕子宫和胎位异常为主。

保留胎膜剖宫产在早产孕妇中的应用效果分析

目的:分析保留胎膜剖宫产在早产孕妇中的应用效果。方法:选取2022年1月—2023年8月于东莞市长安医院行剖宫产的早产孕妇80例作为研究对象,随机分为观察组和对照组,各40例。对照组实施常规剖宫产,观察组实施保留胎膜剖宫产。比较两组治疗效果。结果:观察组术中出血量、产后24 h出血量少于对照组,差异有统计学意义(P<0.001)。术前,两组红细胞计数、血细胞比容、血红蛋白水平比较,差异无统计学意义(P>0.05);术后3 d,两组红细胞计数、血细胞比容、血红蛋白水平低于术前,但观察组高于对照组,差异有统计学意义(P<0.05)。观察组脐动脉pH、脐静脉血红蛋白水平高于对照组,肿瘤坏死因子-α水平低于对照组,差异有统计学意义(P<0.05)。观察组新生儿出生后1、5 min阿普加评分高于对照组,差异有统计学意义(P<0.05)。结论:保留胎膜剖宫产在早产孕妇中的应用效果显著,可减少孕妇术中及产后24 h出血量,减轻早产儿机体损伤。

手术室静默疗法与肌肉放松疗法联用对剖宫产初产妇心理弹性、医学应对的影响分析

目的 探讨剖宫产初产妇应用手术室静默疗法联合肌肉放松疗法对其心理弹性和医学应对的影响。方法 选取1230例2021年1月~2022年12月我院收治的剖宫产初产妇,按信封随机法分成试验组(615例)、对照组(615例)。对照组施行肌肉放松疗法,试验组在此基础上施行手术室静默疗法,对比两组负面情绪、医学应对、疼痛变化和心理弹性得分等。结果 干预后,两组SDS得分、SAS得分、回避与屈服等医学应对得分均降低,面对得分提高,且试验组SDS得分、SAS得分、回避与屈服等医学应对得分低于对照组,面对得分高于对照组(P<0.05)。干预后1d、3d、5d两组VAS得分下降,且试验组干预后3d、5d VAS得分低于对照组(P<0.05)。两组干预后,自强、乐观和坚韧等心理弹性得分升高,且试验组自强、乐观和坚韧得分高于对照组(P<0.05)。结论 在剖宫产初产妇护理中,手术室静默疗法与肌肉放松疗法联用的效果显著,有助于改善其医学应对方式,减轻术后疼痛感,并促进心理弹性提高。

中西医结合护理干预应用于初产妇剖宫产术后护理的效果研究

分析中西医结合护理干预应用于初产妇剖宫产术后护理的效果。选取2022年6月—2023年6月青岛大学附属威海市立第二医院收治的90例行剖宫产的初产妇为研究对象,随机将其分为常规组和试验组两组,每组各45例。常规组采用常规护理,试验组采用中西医结合护理,比较两组的护理效果。结果显示,试验组整体护理效果优于常规组(P<0.05)。研究发现,在初产妇剖宫产术后护理中应用中西医结合护理干预,可缩短产妇泌乳始动时间,增加产妇泌乳量,加速产妇产后恢复,提高产妇满意度,值得推广。

北京市区域严重产后出血分级诊疗及转诊管理的现况调查

目的:探讨转诊中心与非转诊中心严重产后出血(SPPH)的救治现况,为区域内SPPH的预防和处理提供改进策略。方法:回顾性分析2021年1月至2023年6月北京市两区SPPH(产后出血量≥1500 ml或输血制品≥1000 ml)病例的临床资料,共纳入SPPH 201例,根据其是否为市级转诊中心分为转诊中心组(125例)和非转诊中心组(76例)。比较两组间的临床特征。进一步分层分析,采用Logistic回归模型分析大量产后出血,即产后出血量≥4000 ml,和(或)输注悬浮红细胞(RBC)>10 U和(或)输注血浆>1000 ml的危险因素。结果:对两组SPPH病例分析,转诊中心组较非转诊中心组患者的年龄大,分娩孕周小,伴有孕期产后出血高危因素的比例高,差异有统计学意义(P<0.05);转诊中心组SPPH的首要原因为胎盘因素,而非转诊中心组的首要因素为子宫收缩乏力,差异有统计学意义(P<0.05);非转诊中心组在剖宫产术中出血量高,采用B-Lynch缝合/血管缝扎的比例低,宫腔填塞比例高(P<0.05);非转诊中心组血浆输注量、重返手术室、剖腹探查、各种产后出血并发症的发生率均显著高于转诊中心组(P<0.05);非转诊中心组大量产后出血病例数显著多于转诊中心组(P<0.05)。在大量产后出血病例中,转诊中心组具有孕期产后出血高危因素者多于非转诊中心组(71.4%vs.33.3%,P<0.05),转诊中心组胎盘因素是主要出血原因(57.1%),非转诊中心组子宫收缩乏力和胎盘因素是主要出血原因(42.9%,28.6%)。多因素Logistic回归分析发现,非转诊中心分娩(aOR 3.47,95%CI 1.40~9.18)、多次宫腔操作史(aOR 12.63,95%CI 1.24~131.30)是大量产后出血的高危因素。结论:区域内高危孕产妇转诊管理效果较好,加强非转诊助产机构的高危因素识别、手术缝合技术和SPPH综合管理培训,预防SPPH、大量产后出血和输血的发生。

中心群组化孕期保健模式联合循证护理对高龄孕妇剖宫产率、妊娠结局及母乳喂养情况的影响

目的探讨中心群组化孕期保健模式联合循证护理对高龄孕妇剖宫产率、妊娠结局及母乳喂养情况的影响。方法选择2021年12月至2023年8月东莞市人民医院产科收治的90例高龄孕妇作为研究对象,按照随机数字分配法分为观察组和对照组各45例。对照组孕妇接受传统孕期保健模式,观察组孕妇给予中心群组化孕期保健模式联合循证护理,孕期保健及护理从孕妇入组开始直至孕妇分娩。自制调查问卷调查两组孕妇的孕期相关知识了解程度,所有孕妇于孕32周前完成第一次问卷调查,包括孕期活动、产前检查、孕期饮食三个维度;所有孕妇于孕35周前完成第二次问卷调查,包括胎儿保健和分娩知识两个维度。采用焦虑自评量表(SAS)、抑郁自评量表(SDS)分别于孕妇入组时、分娩后2 h评价两组孕妇的负面情绪。比较两组孕妇的第一产程、第二产程、第三产程及总产程时间以及分娩方式、产后出血量、新生儿Apgar评分和母乳喂养技能量表(LATCHES)评分。结果观察组孕妇的孕期活动、产前检查、孕期饮食、胎儿保健和分娩知识得分分别为(18.86±1.19)分、(18.21±1.03)分、(18.06±0.94)分、(19.11±1.13)分、(18.23±0.98)分,明显高于对照组的(17.51±0.86)分、(17.34±0.91)分、(17.02±0.75)分、(17.89±0.85)分、(17.42±0.81)分,差异均有统计学意义(P<0.05);观察组孕妇分娩后2 h的SAS、SDS评分分别为(44.23±5.38)分、(43.19±5.03)分,明显低于对照组的(48.71±6.43)分、(47.34±6.19)分,差异均有统计学意义(P<0.05);观察组孕妇的第一产程、第二产程、第三产程和总产程时间分别为(198.75±51.92)min、(38.61±10.02)min、(6.23±1.14)min、(239.06±62.41)min,明显短于对照组的(241.26±62.37)min、(53.46±14.71)min、(7.86±1.82)min、(312.23±78.09)min,差异均有统计学意义(P<0.05);观察组孕妇的剖宫产率为11.11%,明显低于对照组的31.11%,观察组的产后出血量为(264.48±31.23)mL,明显低于对照组的(311.65±46.74)mL,新生儿Apgar评分和LATCHES量表评分分别为(9.26±0.51)分、(31.27±3.23)分,明显高于对照组的(8.74±0.37)分、(28.03±2.16)分,差异均有统计学意义(P<0.05)。结论中心群组化孕期保健模式联合循证护理能够有效提高高龄孕妇对孕期相关知识的了解程度和自我管理能力,孕妇孕期的负面情绪得到有效缓解,产程明显缩短,剖宫产率明显降低,孕妇的母乳喂养状况得到显著改善。

循证理念支持下多维可视化健康教育对剖宫产初产妇母乳喂养认知度及成功率的影响

目的探讨循证理念支持下多维可视化健康教育对剖宫产初产妇母乳喂养认知度及成功率的影响。方法选取2021年6月至2022年12月期间于郑州大学第五附属医院产科进行剖宫产手术的120例初产产妇作为研究对象,根据所行护理时间不同,将2021年6月至2022年4月期间予以剖宫产术后常规干预的60例产妇纳为对照组,将2021年4月至2022年12月期间予以循证理念支持下多维可视化健康教育干预的60例产妇纳为循证组,两组均干预至出院。比较两组产妇喂养认知度、术后24 h以内喂养成功率、产后泌乳始动时间、喂养意愿以及护理满意度。结果干预后,循证组医院自制母乳喂养知识问卷总分、术后24 h以内喂养成功率均高于对照组(P<0.05),产后泌乳始动时间短于对照组(P<0.05);循证组母乳喂养动机量表下各维度评分、中文版母乳喂养自我效能简式量表评分均高于对照组(P<0.05);循证组护理满意度量表下各维度评分及总分均高于对照组(P<0.05)。结论循证理念支持下多维可视化健康教育可明显提升剖宫产初产妇母乳喂养认知度与喂养成功率,缩短产后泌乳始动时间,提高产妇喂养意愿和护理满意度。

共享决策在剖宫产术后再次妊娠分娩方式中的应用进展

就再次妊娠妇女面临的分娩方式决策挑战以及共享决策在再次妊娠分娩方式中的实施过程、应用效果、阻碍因素和发展策略进行综述,以期为剖宫产术后再次妊娠妇女的分娩管理提供依据。

阴道试产中转剖宫产术前Ⅲ型安尔碘阴道灌洗预防产褥感染效果

目的:分析阴道试产中转剖宫产术前Ⅲ型安尔碘阴道灌洗预防产褥感染效果。方法:回顾性分析2022年1月-2023年12月本院产科阴道试产失败中转剖宫产产妇400例临床资料,其中2022年1-12月术前作外阴备皮、冲洗的200例纳入对照组,2023年1-12月术前作外阴备皮、Ⅲ型安尔碘阴道灌洗、冲洗的200例产妇纳入观察组,对比两组术后体温、24h出血量、产褥感染率、切口感染率及白细胞计数(WBC)、C反应蛋白(CRP)和降钙素原(PCT)水平变化情况。结果:观察组术后24h(36.90±0.17℃)、48h(36.70±0.15℃)、72h体温(36.50±0.12℃)均低于对照组(37.00±0.21℃、36.80±0.16℃、36.60±0.13℃),术后24h出血量(287.3±21.5ml)少于对照组(296.2±23.7ml),产褥感染率(0.5%)低于对照组(3.5%)(均P<0.05),两组切口感染率(0.5%、1.0%)无差异(P>0.05)。观察组术后72h WBC(10.07±2.28×10^(9)/L)、CRP(2.23±0.39mg/L)、PCT(4.05±0.62ng/ml)水平均低于对照组[(12.77±3.59)×10^(9)/L、5.06±1.28mg/L、7.33±1.51ng/ml](均P<0.05)。结论:阴道试产中转剖宫产术前Ⅲ型安尔碘阴道灌洗可有效控制术后产妇体温和WBC、CRP、PCT水平,减少产褥感染发生。

快速康复护理用于妊娠期糖尿病患者剖宫产围术期的效果评价

目的 评估妊娠期糖尿病患者剖宫产围术期护理中,快速康复护理的实施效果。方法 选取2021年1月—2023年10月庆阳市人民医院产科收治的68例妊娠期糖尿病患者为研究对象,所有患者均实施剖宫产,经抽签法分成研究组、对照组,各34例,分别实施快速康复护理、常规护理。比较两组患者血糖指标、术后切口感染率及满意度。结果 护理后,两组患者的血糖指标均低于护理前,且研究组低于对照组,差异有统计学意义(P<0.05);研究组的术后切口感染率(2.94%)低于对照组(20.59%),差异有统计学意义(χ^(2)=5.100,P=0.024);研究组满意度高于对照组,差异有统计学意义(P<0.05)。结论 快速康复护理对降低术后切口感染率有积极意义,可以帮助患者改善血糖指标情况,可以满足患者合理护理需求。