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.

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.

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.

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。

早产儿产房内持续气道正压通气支持不同连接装置治疗效果比较

目的:比较极早产儿产房内复苏时使用双鼻孔鼻导管或面罩连接持续气道正压通气的治疗效果。方法:选择2021年6月至2023年1月在重庆市妇幼保健院出生的极早产儿共249例,依据出生后持续气道正压通气不同连接方式分为双鼻导管组(124例)和面罩组(125例),比较2组的复苏效果、住院情况及并发症发生情况。结果:在复苏时经双鼻导管连接持续气道正压通气提供持续气道正压的早产儿,生后1 h内血气分析pH值高于面罩组(P<0.05)、PaCO_(2)值低于面罩组(P<0.05),进入新生儿重症监护病房时的吸氧浓度低于面罩组(P<0.05),2组早产儿心率>100次/min的时间、经皮氧饱和度(SpO_(2))>80%的时间、复苏时气管插管率以及生后5 min的Apgar评分差异无统计学意义,2组早产儿Ⅲ~Ⅳ度早产儿脑室周围-脑室内出血发生率、Ⅱ期以上坏死性小肠结肠炎发生率、支气管肺发育不良发生率、早产儿视网膜病发生率差异无统计学意义。结论:产房内使用双鼻孔鼻导管连接持续气道正压通气提供持续气道正压在改善二氧化碳潴留、减轻酸中毒等方面优于面罩,且不增加早产儿严重并发症的发生,可用于极早产儿产房内稳定。

不同时机行硬膜外镇痛和家庭化产房对初产妇分娩方式及结局的影响

目的探讨不同时机实施硬膜外镇痛和家庭化产房对初产妇分娩方式及结局的影响。方法收集于2019年10月至2022年2月期间,在滨州医学院附属医院临产后自愿要求实施硬膜外镇痛分娩的初产妇402例为研究对象,其中根据初产妇选择产房的意愿及实施硬膜外镇痛时机进行分组,选择家庭化产房且宫颈口扩张<3 cm行硬膜外镇痛的初产妇107例、选择家庭化产房且宫口扩张≥3 cm行硬膜外镇痛的初产妇100例、选择普通产房且宫颈口扩张<3 cm行硬膜外镇痛的初产妇79例和选择普通产房且宫口扩张≥3 cm行硬膜外镇痛的初产妇116例。通过比较四组的一般临床资料、镇痛前后视觉模拟疼痛评分(VAS)、各产程时间、顺转剖宫产率、分娩出血量、侧切率、缩宫素使用率、人工破膜率及新生儿的各项指标情况等来研究不同时机实施硬膜外镇痛对选择家庭化产房和普通病房初产妇分娩方式及结局的影响。采用SPSS 26.0软件进行分析。结果家庭化产房+宫颈口扩张<3 cm组、普通产房+宫颈口扩张<3 cm组总产程均较家庭化产房+宫颈口扩张≥3 cm组延长,普通产房+宫颈口扩张<3 cm组总产程较普通产房+宫颈口扩张≥3 cm组延长,家庭化产房+宫颈口扩张<3 cm组、普通产房+宫颈口扩张<3 cm组第一产程较家庭化产房+宫颈口扩张≥3 cm组延长,普通产房+宫颈口扩张<3 cm组第一产程较普通产房+宫颈口扩张≥3 cm组延长,家庭化产房+宫颈口扩张≥3 cm组第二产程较普通产房+宫颈口扩张≥3 cm组缩短,P<0.05;家庭化产房+宫颈口扩张≥3 cm组侧切率低于普通产房+宫颈口扩张≥3 cm组,P<0.05,普通产房+宫颈口扩张<3 cm组缩宫素使用的百分率大于家庭化产房+宫颈口扩张≥3 cm组,P<0.05;家庭化产房+宫颈口扩张<3 cm组顺转剖宫产率大于家庭化产房+宫颈口扩张≥3 cm组,P<0.05。结论宫颈口扩张<3 cm行实施硬膜外分娩镇痛会一定程度上延长总产程、第一产程时间、同时增加顺转剖宫产率,家庭化产房的应用使第二产程时间相对缩短、侧切率相对降低,各组第三产程及新生儿结局无显著差异,对镇痛前后VAS、人工破膜率及分娩出血量等无影响,因此家庭化产房并且宫口扩张≥3 cm行硬膜外分娩镇痛为最佳分娩选择。

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。

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.

产房风险评估运用于产房护理中对分娩与护理满意度影响分析

目的探析产房护理中产房风险评估的运用在分娩与护理满意度中的作用表现。方法整理2022年整年接收的产妇资料,从中选择1000例作为研究对象。以随机数字表法作为分组手段,将研究对象分成对照组和观察组,每组500例,对照组应用常规护理干预,观察组应用产房风险评估,对两组产程、母婴不良结局发生率、护理满意度等指标进行比较。结果对照组第一产程与第二产程时间长于观察组,组间差异有统计学意义(P<0.05),两组第三产程的时间大致相同,差异不明显无统计学意义(P>0.05)。观察组母婴不良结局发生率低于对照组,组间差异有统计学意义(P<0.05)。对照组护理满意度高于观察组,组间差异有统计学意义(P<0.05)。结论在产科护理过程中,采用产房风险评估进行护理,根据产妇具体状况进行分娩风险评估,进而实施针对性的护理干预措施,有助于缩短产程,促进自然分娩的顺利进行,确保产妇与婴儿的健康和安全,提升产妇对护理服务的满意度。

产科分娩手术室节能降耗管理探讨

分娩手术室是医院的重要医疗资源,手术室也是降低成本最有潜力的部门。其使用效率的提高,对医院的经济和社会效益起着重要作用。所以医院分娩室还需要充分认识到节能降耗管理的重要性,结合分娩室的特点,对工作流程进行优化,同时落实责任到人制度,更好地培养工作人员的责任意识和节约意识,保证管理质量。本文分析了加强医院分娩室节能降耗管理的必要性,然后探究具体的实施策略,以供参考。

分阶段目标教学法联合双向评价反馈机制在产房助产实习带教中应用的质性研究

目的探讨将分阶段目标教学法联合双向评价反馈机制在产房实习带教中的应用效果。方法选取本院产房实习的16名助产实习生和8名带教老师为研究对象,实习期间采用分阶段目标教学法联合双向评价反馈法,并进行分析。结果助产实习生普遍认为产房实习任务重,接生实操机会少,但是在实践过程中还是能收获成就感。带教老师认为目前实习生的自我意识强,个性差异大,需要因材施教,加强沟通和心理教育。结论分阶段目标教学法联合双向评价反馈机制在产房助产实习带教中应用是较为可行的,阶段性评估能在教与学之间建立互动关系,使带教老师及时掌握实习生的真实情况,进而调整教学计划,提高带教质量,是一种良好的临床教学管理模式。

产房风险评估在产妇护理中的应用效果

目的:分析产房风险评估在产妇护理中的应用效果。方法:选取2021年2月—2023年2月常德市妇幼保健院收治的72例产妇作为研究对象,按照随机数字表法分为对照组、研究组,各36例。对照组给予常规护理,研究组给予产房风险评估,比较两组产妇产程时间、分娩方式、不良分娩结局发生情况以及护理满意度。结果:研究组第一产程、第二产程、第三产程耗时均短于对照组,差异有统计学意义(P<0.001)。研究组剖宫产率低于对照组,自然分娩率高于对照组,差异有统计学意义(P<0.05);两组阴道助产率比较,差异无统计学意义(P>0.05)。研究组不良妊娠结局总发生率低于对照组,差异有统计学意义(P=0.045)。研究组护理总满意度高于对照组,差异有统计学意义(P=0.010)。结论:产房风险评估在产妇护理中的应用效果显著,能够缩短产程时间,降低不良分娩结局发生率,提高自然分娩率,产妇满意度高。

家庭化产房发生医院感染的相关危险因素

目的探讨家庭化产房发生医院感染的相关危险因素及防治措施。方法回顾性选取2020年1月至2023年5月入住郑州人民医院家庭化产房的孕妇6100例,根据是否发生医院感染分为感染组(85例)和非感染组(6015例),比较两组临床资料,通过单因素及多因素logistic回归方程分析医院感染的影响因素。结果感染率为1.39%(85/6100),其中呼吸系统感染42例,生殖道感染20例,手术切口感染16例,泌尿系统感染7例。感染组体重指数≥28 kg·m^(-2)、瘢痕子宫、胎膜早破、妊娠糖尿病、妊娠高血压、白蛋白<35 g·L^(-1)、侵入性检查次数≥3次患者占比高于非感染组,白蛋白≥35 g·L^(-1)、产房定期通风患者占比低于对照组(P<0.05)。体重指数≥28 kg·m^(-2)、胎膜早破、侵入性检查次数≥3次是医院感染的高危因素,白蛋白≥35 g·L^(-1)是医院感染的保护因素(P<0.05)。模型预测感染的曲线下面积(AUC)为0.762,模型预测效能良好。结论家庭化产房产妇发生医院感染主要与体重指数、胎膜早破、侵入性检查次数、白蛋白等有关,logistic预测模型可为临床预测医院感染发生风险提供可靠参考,建议临床提前采取相应干预措施,减少医院感染发生,进而保证产妇和新生儿安全。

产房助产护理在产妇产后出血中的应用效果

目的:探讨产房助产护理在产妇产后出血中的应用效果。方法:选取2022年1月—2023年12月于北京市大兴区人民医院妇产科分娩的产妇1000例作为研究对象,随机分为常规组(n=400)与干预组(n=600)。常规组予以常规护理,干预组予以产房助产护理。比较两组产妇产后出血情况、临床分娩时间、产后出血控制效果。结果:干预组产后出血发生率,产后2、24 h出血量低于常规组,差异有统计学意义(P<0.001)。干预组第一、二、三产程及总产程时间短于常规组,差异有统计学意义(P<0.001)。干预组产后出血控制总有效率高于常规组,差异有统计学意义(P=0.003)。结论:产房助产护理在产妇产后出血中的应用效果良好,能够缩短分娩时间,减少产后出血率和出血量,且对出血控制效果较好,临床应用价值显著。

家庭产房一体化护理模式对产妇产后心理状态的影响分析

目的:探讨对产妇产后进行家庭产房一体化护理模式对心理状态的影响。方法:选取2021年5月至2023年5月本院收治的产妇80例作为研究对象,将其随机分为观察组与对照组,各40例,对照组采用常规护理干预,观察组采用家庭产房一体化护理模式干预。比较两组负面情绪、分娩方式及母婴结局、生活质量、角色适应优良情况。结果:护理前,两组SAS、SDS各项评分比较,差异无统计学意义(P>0.05);护理后,两组SAS、SDS评分均显著降低,且观察组对应评分低于对照组(P<0.05)。观察组自然分娩率高于对照组,产后出血率、新生儿窒息率低于对照组(P<0.05)。护理前,两组WHOQOL-BREF评分比较,差异无统计学意义(P>0.05);护理后,两组WHOQOL-BREF与护理前相比均上升,且观察组WHOQOL-BREF评分高于对照组(P<0.05)。观察组角色适应优良率高于对照组(P<0.05)。结论:家庭产房一体化护理模式能够帮助产妇减轻因生产带来的焦虑抑郁负面情绪,提高自然分娩率,减少母婴不良结局,从而提高产妇的生活质量,并且能够帮助产妇快速适应母亲的角色,临床应用价值较高。

在产房质量控制中应用助产士分级授权管理模式的效果分析

目的:探讨助产士分级授权管理模式在产房质量控制中的应用效果。方法:将临沂市妇幼保健院2021年1月—2022年12收治的产房产妇80例作为研究对象,抽签法分为两组。对照组给予常规护理,试验组给予助产士分级授权管理模式。比较两组护理前后产妇负面情绪积分、产妇护理满意度、自然分娩率、会阴侧切率、纠纷发生率。结果:试验组产妇负面情绪积分低于对照组,产妇护理满意度高于对照组,自然分娩率高于对照组,会阴侧切率、纠纷发生率低于对照组(P<0.05)。结论:产房产妇实施助产士分级授权管理模式效果确切,可以有效提高自然分娩率,降低会阴侧切率、纠纷发生率,减轻产妇的焦虑和抑郁情绪,提高产妇对助产护理服务的满意度。

产房护理中实施助产士分层管理模式对产房质量控制的影响分析

目的分析在产房护理中实施助产士分层管理模式对产房质量控制造成的影响。方法选取分娩的100例产妇,根据随机数字表法将其分为观察组与对照组,每组50例。对照组产妇给予常规的产房护理,观察组产妇在对照组基础上给予助产士分层管理模式的相关产房护理,比较两组产妇的护理质量及产后2h出血量、总产程时间。结果护理后观察组产妇的护理质量评分高于对照组,差异有统计学意义(P<0.05)。观察组产妇产后2h出血量为(156.67±13.21)ml,对照组产妇产后2h出血量为(207.45±17.48)ml,观察组产妇产后2h出血量少于对照组(P<0.05)。观察组总产程时间为(9.45±1.24)h,对照组总产程时间为(12.48±2.77)h,观察组总产程时间短于对照组(P<0.05)。结论在产房护理中实施助产士分层管理模式,不仅可以提高产妇的护理质量,还可减少产后出血量,缩短产程时间,提升产妇分娩的安全性,值得临床应用。

产房助产士在镇痛分娩中的护理配合及护理价值探究

针对产房助产士在镇痛分娩中的护理配合及护理价值进行研究分析。选取2023年3月—2023年9月北京市密云区妇幼保健院妇产科收治的15例产妇为研究对象,由助产士指导产妇完成分娩,评估产房助产士对帮助产妇顺利分娩的作用以及镇痛分娩护理时产妇的相关需求。结果显示,15例产妇均认为在助产士的帮助和指导下能够顺利分娩,可减轻其在分娩过程中的疼痛感;产妇在分娩过程中对于产房助产士镇痛分娩护理配合存在较高的需求。研究发现,产房助产士为产妇分娩提供护理支持与配合,可以减轻产妇分娩过程中的疼痛感,提升分娩成功率。