Epidemiological Aspects of Stillbirth and Neonatal Deaths in the Delivery Room at the Libreville Mother-Child University Hospital from 2019 to 2022

Introduction: Stillbirths are estimated at 2 million each year, of which more than 40% occur during labour. Our objective was to study the epidemiological aspects of stillbirth and neonatal deaths in the delivery room in our health facility. Patients and methods: Prospective, descriptive and analytical study, conducted at the Jeanne Ebori Foundation Mother-Child University Hospital over 4 years (January 2019-December 2022). All neonatal deaths in the delivery room or foetal death in utero, were included. Results: Among the 18,346 deliveries performed, 512 newborns were declared dead in the delivery room (27.9‰ live births), divided into in utero foetal death (19.0‰) and immediate neonatal death (8.9‰). The mean age was 34.3 weeks of amenorrhea. The rate of preterm birth was 60.4%. The sex ratio was 1.1. The average weight was 2186.6. The main causes were vascular (46.1%), foetal (20.2%), adnexal (17.1%) and asphyxia per partum (16.6%). Foetal causes were more likely to result in IUFD than other causes (OR = 6.4 [2.4 - 15.7], p < 0.001). After birth, partum asphyxia was more likely to lead to death before 15 minutes of life than other causes (OR = 11 [6.1 - 18.9], p Conclusion: The causes of stillbirth and early neonatal mortality are dominated by maternal vascular pathologies. However, the proportion of childbirth-related causes remains worrying. Better monitoring of pregnancy and labour will minimize this prevalence in our hospital.

The Outcome of Midwife-Mother Relationship in Delivery Room: A Qualitative Content Analysis

Effective communication and emotional support of parturient women improve the outcome of childbirth. Reduction in Duration of labor, cesarean rate, use of anesthesia, and 5 minute Apgar Score less than 7 can achieve. This study was a part of a large mixed method study during 2013-2014. In this qualitative study, in-depth interviews were conducted with 32 participants (16 mother and 16 midwife), using semi-structured interviews. Participants were recruited by pur-posive sampling with maximum diversity in terms of age, occupation, education and etc. Educational hospital of Arak University of Medical Sciences was considered as the setting. Each interview was conducted at a private and convenient location and took about 30 to 45 minutes. Interviews were audio taped and transcribed verbatim. Conventional content analysis was done for data analysis. Interviews continued until data saturation was obtained. Data were coded in MAXQDA software (version 11). The main category emerged as “outcome” of midwife-mother relationship. Facilitating childbirth, positive experience, mental health promotion and improvement in quality of life were derived as subcategories. Good midwife-mother relationship could promote positive outcome in labour. Results could assist midwives in providing holistic quality care to mothers during labour, thus providing positive consequence in child birth. Also, results could provide a framework and guidance for policymakers to create appropriate context for the midwife-mother relationship in maternity care.

Hospital Delivery Room versus Outdoor Birthing Place: Differences in Airborne Microorganisms and Their Impact on the Infant

The incidence of allergic airway diseases continues to increase in industrial countries while remaining much more stable in developing countries. Allergens inhaled are eventually also swallowed and evidently the gastrointestinal immune system has a role in regulating allergic responses in the pulmonary as well as the GI system. While some studies have pointed out the role of probiotic bacteria as a supplementary protection against the early development of various allergies, little attention has been paid to the composition of the airborne microflora first and continuosly inhaled by newborns and infants. This study compares the composition of two airborne microbial communities, one from hospital delivery rooms and the other from a nature reserve, evidently in use as a birthing place as early as 7500 B.C. around the air from the outdoor birthing place was marked by a far greater variation in microbial composition and a much higher representation of fungi than the air from the hospitals. The dominant bacterial species from the delivery rooms were Staphylococcus areus and Micrococcus luteus, originating from the staff and the hospital environment;the outdoor flora, however, was dominated by Pseudomonas spp. and Bacillus spp. In addition, 56% of all the bacterial isolates from the delivery rooms were most closely related to strains previously associated with clinical infections, whereas only 15% of isolates in the outdoor bacterial sample had such relationships. The role of airborne microorganisms could be important to infants with developing immune systems considering the microbial bias of hospital air presented in this study.

Process Modeling of Ferrofluids Flow for Magnetic Targeting Drug Delivery

Among the proposed techniques for delivering drugs to specific sites within the human body, magnetic targeting drug delivery surpasses due to its non-invasive character and its high targeting efficiency. Although there have been some analyses theoretically for magnetic drug targeting, very few researchers have addressed the hydrodynamic models of magnetic fluids in the blood vessel of human body. This paper presents a mathematical model to describe the hydrodynamics of ferrofluids as drug carriers flowing in a blood vessel under the applied magnetic field. A 3D flow field of magnetic particles in a blood vessel model is numerically simulated in order to further understand clinical application of magnetic targeting drug delivery. Simulation results show that magnetic nanoparticles can be enriched in a target region depending on the applied magnetic field intensity. Magnetic resonance imaging confirms the enrichment of ferrofluids in a desired body tissue of Sprague-Dawley rats. The simulation results coincide with those animal experiments. Results of the analysis provide the important information and can suggest strategies for improving delivery in favor of the clinical application.

Delivery room resuscitation intensity and associated neonatal outcomes of 24^(+0)-31^(+6) weeks'preterm infants in China:a retrospective cross-sectional study

Background The aim of this study was to review current delivery room(DR)resuscitation intensity in Chinese tertiary neonatal intensive care units and to investigate the association between DR resuscitation intensity and short-term outcomes in preterm infants born at 24+0_31+6 weeks gestation age(GA).Methods This was a retrospective cross-sectional study.The source population was infants born at 24+0_31+6 weeks'GA who were enrolled in the Chinese Neonatal Network 2019 cohort.Eligible infants were categorized into five groups:(1)regular care;(2)oxygen supplementation and/or continuous positive airway pressure(O2/CPAP);(3)mask ventilation;(4)endotracheal intubation;and(5)cardiopulmonary resuscitation(CPR).The association between DR resuscitation and shortterm outcomes was evaluated by inverse propensity score-weighted logistic regression.Results Of 7939 infants included in this cohort,2419(30.5%)received regular care,1994(25.1%)received O,/CPAP,1436(18.1%)received mask ventilation,1769(22.3%)received endotracheal intubation,and 321(4.0%)received CPR in the DR.Advanced maternal age and maternal hypertension correlated with a higher need for resuscitation,and antenatal steroid use tended to be associated with a lower need for resuscitation(P<0.001).Severe brain impairment increased significantly with increasing amounts of resuscitation in DR after adjusting for perinatal factors.Resuscitation strategies vary widely between centers,with over 50%of preterm infants in eight centers requiring higher intensity resuscitation.Conclusions Increased intensity of DR interventions was associated with increased mortality and morbidities in very preterm infants in China.There is wide variation in resuscitative approaches across delivery centers,and ongoing quality improvement to standardize resuscitation practices is needed.

Assembling structurally customizable synthetic carriers of si RNA through thermodynamically self-regulated process

This study demonstrates that our previously reported polywraplex, a synthetic siRNA carrier consisting of a uni-molecular polyplex core of customizable size and a self-assembled triblock copolymer envelop, may be constructed using dendrimers as the crosslinking junctions. Replacing the branched low molecular weight PEI with polyamidoamine(PAMAM) dendrimer in the zeta potential regulated polymerization resulted in the similar network structured cationic polymer with electron microscopically visible crosslinking junctions. This visibility may offer a convenient way to characterize the molecular structure of the rationally designed networked siRNA-packing cationic polymer without altering its chemical properties and biologic functions. A series of physical-chemical characterizations and biological assays, comprising size, zeta potential, pre-phagocytic siRNA leaking and degradation, and silencing of functional genes, confirmed that the advanced properties of polywraplexes remained with the dendrimer junctions. Although sixth generation PAMAM dendrimer was used as the crosslinking junctions in the size-customizable polymerization for electron microscopic observation, lower generation dendrimer should also work in case more practical and structurally defined cationic polymer is needed.

Screening in the Birth Room of Parturients with Unknown Human Immunodeficiency Virus (HIV) Serological Status at the Reference Health Center of Commune IV of the District of Bamako

Introduction: In order to prevent the vertical transmission of the Human Immunodeficiency Virus (HIV), it is essential that pregnant women must know their HIV serological status. Objective: To determine the proportion of parturients with unknown Human Immunodeficiency Virus (HIV) status in the delivery room and to identify the associated factors. Methods: We conducted a prospective descriptive study carried out at the Reference Health Center of Commune IV in the district of Bamako from July 1, 2017 to July 1, 2018. The sample size was 267 parturients. The word processing was carried out on World software from the 2016 office suite at the end of the data entry and analysis was carried out on the IBM software, SPSS version 22.0. Results: A total of 267 women were eligible for our study, among which 14 parturients were seropositive, i.e., a proportion of 5.2% of cases. The knowledge of parturients on HIV was 95.5% of cases, but more than half did not know the mode of mother-child transmission. Unschooled parturients were the most represented with 41.2%. Conclusion: In view of the large proportion (5.2%) of HIV-positive parturients in our study, voluntary screening activities in the delivery room remain necessary for the future of children born to HIV-positive mothers.

FROM A HAY HOUSE TO AN ADVANCED DELIVERY ROOM

When I interviewed Droma,she had already retired and was staying at home to look after her grandson.This was on June 3rd,2017.At the Apple Orchard in Lhoka City,Tibet Autonomous Region,the sun was hanging in sky with sparkling light."I was born in the winter of 1956.

HIV/AIDS Screening in the African Birthplace (Hospital in Kayes, Mali)

Purpose: The purpose of this study was to determine HIV prevalence among participants admitted to the delivery room and recent birth attendants. Materials and Methods: This was a descriptive, cross-sectional, analytical study, with a prospective collection from February 1, 2018 to January 31, 2019 at fousseyni Daou Hospital in Kayes, Mali. Results: During our study period, we recorded 4269 deliveries. HIV-positive patients known before labour accounted for 0.21%. Four hundred and six participants received counselling/testing in the delivery room;of which 36 refused the test: 8.87% and 370 accepted or 91.13%. Thirteen patients tested positive or 3.51%. The 20 - 35 age group was the most represented at 76.92%. Positive patients tested received ARV treatment in the delivery room in 92.31% of cases;and 1 patient or 7.69% did not receive treatment for refusal. Vaginal delivery was the most common at 77%, with caesarean section 23%. Newborns had a good prognosis in their first weeks of life in 85%;fetal lethality was observed in 15% of newborns including 1 case of fresh stillbirth and 1 case of pediatric deaths for neonatal suffering. Conclusion: Counselling and voluntary HIV/AIDS testing during labour and immediate postpartum can detect many pregnant women who escape screening during antenatal consultations.

Exploiting Virtual Elasticity of Manufacturing Systems to Respect OTD—Part 2: Post-Optimality Conditions for the Cases of Ergodic and Non-Ergodic Order Rate with Deterministic Product-Mix

Respecting the on-time delivery (OTD) for manufacturing orders is mandatory. However, for non-JIT Batch & Queue Push-manufacturing systems, the compliance of OTD is not intrinsically guaranteed. As an OTD related manufacturing theory is largely missing it is crucial to understand and formalize the necessary conditions of OTD compliance for complex production environments for maximum exploitation of the production capacity. This paper evaluates the conditions of post-optimality while being OTD compliant for production systems, which are characterized by stochastic order rate and a deterministic product-mix. Instead of applying discrete event simulation to explore the real case-by-case order scheduling optimization for OTD compliance, a Cartesian approach is followed. This enables to define theoretically the solution space of order backlog for OTD, which contributes to developing further manufacturing theory. At the base stands the recently defined new concept of virtual manufacturing elasticity by reducing lead-time to increase virtually production capacity. The result has led to defining additional two corollaries to the OTD theorem, which sets up basic OTD theory. Apart from defining the post-optimal requirements to guarantee for orders at least a weak solution for OTD compliance, this paper reveals that for a deterministic product-mix a non-ergodic order arrival rate can be rescheduled into an ergodic order input rate to the shopfloor if the virtual elasticity T is large enough, hence the importance of having fast and flexible production lines.

产程三维导航系统在高龄产妇中的应用及对产程和妊娠结局的影响研究

目的:探讨产程三维导航系统在高龄产妇中的应用及对产程和妊娠结局的影响。方法:选择2020年4月—2021年6月广州市花都区人民医院产科收治的高龄产妇60例为研究对象,按随机数字表法将其分为两组,各30例。所有产妇均拟行阴道分娩,对照组采用传统方法监测,观察组采用产程三维导航系统监测。比较两组产妇胎先露下降情况、产时出血量、产后2 h出血量、阴道分娩者产程时间、新生儿Apgar评分、妊娠结局。结果:观察组胎先露下降情况优于对照组,产时出血量、产后2 h出血量均少于对照组,差异均有统计学意义(P<0.05);两组产钳助产率、新生儿出生1 min Apgar评分比较,差异均无统计学意义(P>0.05);观察组阴道分娩率高于对照组,剖宫产率、新生儿胎儿窘迫和新生儿窒息发生率均低于对照组,差异均有统计学意义(P<0.05);观察组阴道分娩者第一、二产程均短于对照组阴道分娩者,差异均有统计学意义(P<0.05)。结论:产程三维导航系统用于高龄产妇中,能减少产时出血量、产后2 h出血量及动态监测胎先露下降的水平,提高新生儿Apgar评分,能有效提高高龄产妇阴道分娩率,缩短阴道分娩产程,降低剖宫产率、新生儿胎儿窘迫和新生儿窒息发生率。

NICU早产儿母乳喂养链式管理效果评价

目的观察链式管理对NICU早产儿母乳喂养及喂养并发症的影响。方法将180例NICU早产儿按入院时间分为对照组和试验组各90例。对照组实施常规NICU母乳喂养策略,试验组在对照组基础上进行链式管理,构建并实施产房、产科和NICU间横向管理和各科室内部纵向管理。结果最终对照组82例、试验组81例早产儿完成研究。干预后,试验组纯母乳喂养率显著高于对照组,试验组早产儿喂养不耐受、坏死性小肠结肠炎、宫外发育迟缓和新生儿高胆红素血症发生率显著低于对照组(均P<0.05),试验组恢复至出生体质量日龄显著短于对照组,出院体质量显著大于对照组(均P<0.05)。结论链式管理有利于提高NICU早产儿的纯母乳喂养率,降低喂养并发症发生率,促进新生儿生长发育。

我国医保谈判药品“双通道”管理政策执行困境及推进策略

目的为我国医保谈判药品“双通道”管理政策的顺利实施落地提供参考。方法基于史密斯政策执行过程模型,从实施细则与监管体系、药品遴选、药品配备和质量控制、医保基金运行状况和信息化能力4个方面对医保谈判药品“双通道”政策的执行困境进行分析,并提出相应推进策略。结果与结论我国医保谈判药品“双通道”政策可能存在政策实施细则和全流程监管体系不够明确,部分医保谈判药品纳入“双通道”管理的适宜性和可操作性有待斟酌,药品配备和质量控制方面存在难点,各地医保基金管理和运行状况存在差异以及信息化能力不足等执行困境。对此,本研究认为可通过完善“双通道”政策实施细则、提高“双通道”药品目录合理性、建立“双通道”药店动态退出机制、推行专业化配送服务、完善电子处方流转平台等措施来推动“双通道”政策的实施落地。

分娩镇痛初产妇产程中入量管理研究

目的 探讨饮食方式对分娩镇痛足月初产妇分娩结局的影响。方法 单胎足月初产妇400例随机分为观察组和对照组,观察组行入量管理及个体化的饮食指导。对照组根据孕妇的意愿进食水,比较2组分娩质量,初产妇呕吐,发生率、因宫缩乏力使用缩宫素率、产时发热率、会阴侧切率、转剖宫产率、阴道助产率、产后出血率;比较2组第一产程时间、第二产程时间、分娩镇痛时长及产后2 h出血量;比较2组新生儿Apgar评分、随机血糖、脐动脉血pH值、脐动脉血乳酸(Lac)值、新生儿窒息发生率、新生儿发热率、新生儿血糖异常发生率。结果 观察组产妇呕吐的发生率、因宫缩乏力使用缩宫素率、产时发热率、会阴侧切率、转剖宫产率、阴道助产率均低于对照组;观察组产后出血率、第一产程时间、第二产程时间、分娩镇痛时长及产后2 h出血量小于对照组,观察组新生儿高血糖的发生率和新生儿低血糖发生率低于对照组,差异均有统计学意义(P<0.05)。2组脐动脉血pH值、Lac值、新生儿Apgar评分、新生儿随机血糖、新生儿窒息率、新生儿发热率比较,差异无统计学意义(P>0.05)。结论 产程中对产妇进行入量管理及个体化的饮食指导可以减少宫缩乏力发生率,缩短产程持续时间,降低难产发生率,减少产后2 h出血量及降低新生儿血糖异常的发生率。

基于DLP 3D打印的高给药效率微针制备工艺

载药微针可以实现一次性快速药物递送,无需二次药物涂敷与输送过程,但其不佳的载药量与刺入率造成了给药效率差的问题。研发了一种基于数字光处理(DLP)3D打印技术的高给药效率微针(HDMN)制备工艺。通过在载药微针上构建锯齿状针体结构与阶梯状载药结构来提高载药微针的刺入率与载药量,进而提高给药效率。实验结果表明使用环氧丙烯酸酯(EA)打印微针时,当曝光时间为700 ms、打印层厚为30μm时,打印出的微针实际尺寸与理论尺寸平均误差最小为9.2%。利用旋涂法在微针表面交联聚乙二醇二丙烯酸酯(PEGDA)以改善微针生物相容性。显微镜观察发现,当交联层数为1层时,PEGDA均匀地覆盖在微针表面。石蜡膜穿刺实验结果表明,HDMN穿透了2层石蜡膜,而相同实验条件下的传统载药微针仅穿透了1层。药物释放实验结果表明,HDMN相对于传统载药微针在猪皮内留下的模拟药物浓度提升了61%。该研究为后续通过改善微针结构来优化微针性能研究提供了有益借鉴。

穿心莲内酯自微乳给药系统制备

目的制备穿心莲内酯自微乳给药系统。方法根据平衡溶解度、辅料配伍、伪三元相图确定辅料比例范围。以广藿香油占比、Labrasol ALF与Tween 80比例、Km为影响因素,平衡溶解度为评价指标,星点设计-响应面法优化处方,再进行体外评价。结果最优处方为广藿香油、Labrasol ALF、Tween 80、Transcutol HP占比10.45%、13.28%、9.82%、66.44%,平衡溶解度为(11.95±0.04)mg/g。质量参数分别为乳化时间(20.22±0.38)s,粒径(51.70±2.91)nm,多分散指数0.27±0.02,透光率(91.21±1.58)%。自微乳给药系统冻融稳定性良好,稀释倍数、分散介质对其粒径无明显影响,在磷酸盐缓冲液(pH 6.8)中溶出迅速。结论自微乳给药系统可提高穿心莲内酯溶解度、溶出速率。

自由体位联合无痛暗示对足月无痛分娩产妇的效果及睡眠质量的影响

目的:探究足月无痛分娩产妇于护理期间联合应用自由体位、无痛暗示护理的干预价值。方法:选取2022年6月至2023年1月福建省立医院南院收治的足月无痛分娩产妇86例作为研究对象,按照随机数字表法分为对照组和观察组,每组43例。对照组实施常规护理,观察组予以自由体位联合无痛暗示护理,对比2组护理效果,评估指标包含产程时间、顺转剖宫产率及睡眠质量。结果:测定2组产妇产程,所得结果均显示为观察组第一、二、三产程以及总产程时间偏短,与对照组比较,差异均有统计学意义(均P<0.05);相较于对照组,观察组顺转剖宫产等风险事件发生率较低,差异有统计学意义(P<0.05);术后,评估2组产妇睡眠质量,观察组各项指标数值均偏低于对照组,差异均有统计学意义(均P<0.05)。结论:足月无痛分娩的产妇予以其自由体位、无痛暗示护理在缩短产程的同时可以提高产妇睡眠质量,降低了顺转剖宫产率以及风险事件发生率。

乳化溶剂蒸发法在递送体系中的应用

将生物活性物质载入递送体系可以改善其水溶性、稳定性和生物利用度,便于在食品、药品和化妆品等领域应用。乳化溶剂蒸发法是一种常见的制备活性物质递送载体的方法,具有使用条件温和,易于操作和放大,溶剂残留较低等优点。本文简要介绍乳化溶剂蒸发法,综述材料的选择和制备过程对所制载体的影响以及该法在制备活性物质递送体系中的应用研究进展,旨在推动乳化溶剂蒸发法的深入研究和实际应用。

产房助产士职业暴露标准化防护策略

目的:分析产房助产士职业暴露危险因素及标准化防护策略。方法:随机选取2021年1月至2023年5月无锡市锡山人民医院的30名助产士,选取其中未采取标准化防护措施的15名助产士为对照组,选取采取标准化防护措施的15名助产士为观察组。将两组的职业暴露情况进行比较,并分析暴露发生原因,提出相应的标准化防护策略。结果:观察组职业暴露发生情况、暴露后处理均优于对照组,差异有统计学意义(P<0.05)。结论:应用标准化防护策略可有效降低助产士工作中职业暴露的发生率,对保护助产士健康有积极意义,具有推广价值。