Profile of Pregnant Women and Success of the Uterine Test on a Uni or Bi-Scar Uterus at the Maternity Ward of Panzi Hospital, in the Democratic Republic of the Congo

Introduction: Trial of labor after a previous cesarean section (TOLAC) is a method that requires strict monitoring to decrease the cesarean section (CS) rate and improve the maternal and neonatal prognosis. The objective is to determine the profile and outcome of patients with one and two previous CSs who performed TOLAC at Panzi General Referral Hospital. Methodology: This is a cross-sectional study with a prospective collection of data of 111 patients with one and two previous CSs at Panzi Hospital from January 2021 to August 2022. Statistical Package for the Social Sciences SPSS version 23 software was used to analyze the collected data. The percentages of categorical variables were summarized in a frequency table. The mean or median with standard deviation was used to summarize quantitative variables. Results: The overall success rate of the TOLAC was 64%, with 63.8% following one previous CS and 64.3% following two CSs. The mean age of the patients was 27.09 years, with an age range of 25 - 34 years. They were mostly pauciparous (52.2%), married (88.3%), with a high school education (60.4%). The inter-delivery interval > 18 months was noted (64.1%) and overweight in 63.9%. More than three antenatal consultations were performed (58.6%). We found a mean gestational age of 38 (34 - 41) weeks. The perinatal mortality rate was 0.9%. However, we did not record any cases of maternal mortality during the study period. Conclusion: TOLAC after one and two previous CS is implemented in the maternity Unit of Panzi Hospital for well-selected patients. In addition, the success rate is similar after TOLAC with an acceptable maternal-neonatal prognosis.

Vaginal Birth after One Caesarean Section—Ten Years Experience in a South Eastern Nigerian Hospital

Background: The rising caesarean section rate worldwide is an increasing source of concern to all. A significant contributor to this is a previous caesarean delivery. One strategy in the armamentarium of obstetricians for reducing this is vaginal birth after one caesarean section (VBAC). The safety, outcome and complications of this procedure in our Center which is in a developing country had never been studied hence the need for this work. Aim: To find out the outcome and complications of vaginal births after one caesarean delivery in our Center. Method: A retrospective study involving a ten-year review of all cases of trials of labour after one caesarean delivery in our Center was done. Result: Of the 305 trials of labour after one caesarean delivery, 221 women had vaginal birth giving a vaginal birth after one caesarean section rate of 72.5%. Majority of the babies 303 (99.2%) were alive and had good Apgar scores while 2 (0.7%) died giving a perinatal mortality rate of 7 per 1000 babies. There were complications in 21 (6.7%) of the women with retained placenta, in 7 (2.3%) of the women as the commonest, followed by postpartum haemorrhage in 6 (1.96%). Five (1.62%) women had scar dehiscence while 3 (0.98%) had uterine rupture. Conclusion: Vaginal birth after one caesarean section is safe in well selected cases even in our resource poor settings. It offers our women a culturally-acceptable option of fulfilling long-held dreams of vaginal delivery even after one caesarean section and should be offered to our women whenever possible.

玛瑙山原生锰矿半工业脱硫试验

针对高硫锰矿块状物(10～40 mm),3家合作在玛瑙山矿采用GTO脱硫为剂在1.26 m3试验炉进行了半工业脱硫试验.结果表明,脱硫效果明显,矿石残存硫量为0.98%,GTO脱硫率67.66%,达到了高炉冶炼富锰渣的入炉要求.

脐血锰浓度和1岁婴儿体重的关系:基于山东莱州湾出生队列研究

[背景]大量研究表明锰可以对人体的生长发育产生影响。婴幼儿阶段是生长发育的关键期,更易受锰暴露的毒性影响。[目的]探讨脐血锰浓度与1岁婴儿体重的关系。[方法]基于山东莱州湾出生队列,将183例同时完成问卷调查及脐带血检测的母子对纳入研究。通过问卷调查一般人口学特征和1岁婴儿膳食信息,测量其身高、体重,并测定脐血锰、铅、砷和铁的质量浓度(后称浓度)。按锰暴露水平对数值的四分位数将研究对象分为四组(Q1~Q4),描述不同组间的一般人口学特征。采用单因素回归分析研究1岁婴儿体重的影响因素。在校正孕前体质量指数(BMI)、家庭月收入、产次、出生体重、婴儿性别、1岁婴儿主食摄入频次及脐血铅、铁和砷元素后,采用广义线性模型分析脐血锰浓度对1岁婴儿体重的影响,并进一步研究了不同性别间该影响的差异。[结果]183例孕妇年龄为(27.90±4.61)岁,孕前BMI为(21.72±3.04)kg·m-2。其中132例为初产妇(72.1%),136例孕妇无主动或被动吸烟情况(74.3%)。大多数1岁婴儿经常摄入主食(83.6%)。1岁婴儿体重为(10.55±1.15)kg,身高为(76.97±2.71)cm。孕妇人口学特征在脐血锰浓度Q1~Q4组间差异均无统计学意义(P>0.05),1岁婴儿体重和身高在脐血锰浓度Q1~Q4组间差异具有统计学意义(F=4.111,P=0.008;F=2.717,P=0.046)。锰、铅、铁和砷在脐血的检出率分别为82.5%(151/183)、85.8%(157/183)、99.5%(182/183)和79.8%(146/183)。脐血锰、脐血铅、脐血铁和脐血砷中位数浓度分别为106.1μg·L-1、36.3μg·L-1、462.7 mg·L-1、6.4μg·L-1。1岁婴儿体重与脐血锰浓度(P=0.005)、脐血铅浓度(P=0.030)、1岁婴儿主食摄入频次(P<0.05)以及婴儿性别(P<0.001)的关联具有统计学意义。脐血锰浓度每增加一个对数浓度,1岁婴儿体重平均减少0.10 kg(95%CI:-0.12^-0.07,P=0.021),Q2组1岁婴儿体重平均减少0.68 kg(95%CI:-1.11^-0.26,P=0.002),Q3和Q4组未出现此关联。按性别分层后,脐血锰浓度每增加一个对数浓度,1岁男婴体重平均减少0.28 kg(95%CI:-0.42^-0.14,P<0.001),Q2、Q3、Q4组1岁男婴体重分别减少0.81、0.87、0.83 kg(95%CI:-1.42^-0.21,P=0.009;95%CI:-1.49^-0.25,P=0.006;95%CI:-1.46^-0.19,P=0.011),1岁女婴中未出现此关联。[结论]随着脐血锰浓度的升高,1岁婴儿体重有下降的趋势,对男婴的影响可能比女婴更明显。