<strong>Aim</strong><strong>:</strong><span> Clinical audit is a tool to improve quality of care and to reduce maternal and perinatal morbidity and mortality. Auditing the CS according to...<strong>Aim</strong><strong>:</strong><span> Clinical audit is a tool to improve quality of care and to reduce maternal and perinatal morbidity and mortality. Auditing the CS according to a standard parameter will lead to strategies to avoid unnecessary intervention and to advice uniform practice. The aim was to evaluate the current practice and audit against international standards for various parameters relating to elective lower segment caesarean section and to assess compliance of physicians to audit standards.</span><span "=""> </span><b><span>Subject and methods: </span></b><span "=""><span>This is a cross-sectional study which was in a tertiary hospital in Kuwait from 1</span><sup><span>st</span></sup><span> October 2019 until 1</span><sup><span>st</span></sup><span> October 2020.</span><b> </b><span>The hospital medical, electronic records and case notes of three hundred and twenty-six </span><b><span>(326)</span></b><span> cases of elective caesarean sections were reviewed for study participants. Those women were booked under the care of internal and external physicians. Demographic data and primary outcomes were collected. </span><b><span>Results:</span></b><span> Outcome was measuring the compliance to the recognized Caesarean Section international standards: consent form, grade of LSCS, antacid and anti-emetics, type of anesthesia, uses of antibiotics, umbilical cord blood PH, and thromboprophylaxis.</span></span><span "=""> </span><span>The compliance for a signed consent form and cord blood PH was (100%), the use of preoperative antacid and antiemetic was (99.4%), combined regional anesthesia was given in (53.4%) of cases, preoperative antibiotics prophylaxis of second generation cephalosporin was</span><span "=""> </span><span>to (61.3%) of cases, post-operative thromboprophylaxis was given in (78.5%) of cases of which (33.6%) completed a 10 days duration.</span><span "=""> </span><span "=""><span>There was a statistically significant difference between internal and external physicians’ compliance regarding, type of anesthesia </span><b><span>2.3 (95%</span></b></span><b><span "=""> </span><span>CI, 1.3</span><span "=""> </span><span>-</span><span "=""> </span><span>4.1</span><span>, </span></b><span "=""><span>p = </span><b><span>0.004)</span></b><span>, type and timing of antibiotics </span><b><span>0.42 (95%</span></b></span><b><span "=""> </span><span>CI 0.22</span><span "=""> </span><span>-</span><span "=""> </span><span>0.79, </span></b><span "=""><span>p = </span><b><span>0.007) </span></b><span>and </span><b><span>0.33 (95%</span></b></span><b><span "=""> </span><span>CI 0.172</span><span "=""> </span><span>-</span><span "=""> </span><span>0.63,</span></b><span "=""><span> p = </span><b><span>0.0006) </span></b><span>and thromboprophylaxis </span><b><span>8.1 (95%</span></b></span><b><span "=""> </span><span>CI 2.80</span><span "=""> </span><span>-</span><span "=""> </span><span>23.23, </span></b><span "=""><span>p = </span><b><span>0.000)</span></b><span>.</span></span><span "=""> </span><b><span>Conclusion: </span></b><span "=""><span>The results are encouraging, but</span><b> </b><span>suboptimal compliance </span></span><span>i</span><span>s noticed mainly among external physicians.</span>展开更多
This study＇s objective was to investigate the Guguan-Xiangong Fault, which lies in the southern Liupanshan area, through satellite image interpretation and field observations. Guguan- Xiangong Fault is divided into f...This study＇s objective was to investigate the Guguan-Xiangong Fault, which lies in the southern Liupanshan area, through satellite image interpretation and field observations. Guguan- Xiangong Fault is divided into five subsegments; among these, the Badu-Longwei segment has been the most recently active. The geomorphic features of the Badu-Longwei segment are clearly displayed, including multiple high fault scarps with fresh bedrock free faces. There is significant evidence for Holocene activity of the three fault sections, located in Renhuashu, Tianjiagou, and Xinjiecun respectively. The three sections feature distinct episodic deposition and fault scratches. Based on 14C- dating and field observations on the three fault sections, two or more paleoearthquakes across the Badu-Longwei fault segment are ascertained, between 5874±116 and 5430±140 a BP, and after 2037±83 a BP respectively. The Badu-Longwei segment of the Guguan-Xiangong Fault is preliminarily extrapolated as the seismogenic structure of the 600 A.D. Qin-Long earthquake.展开更多
Background: The success rate of vaginal birth after cesarean section with a single cesarean scar is greater than 50%, the lack of the information about the safety of vaginal birth after cesarean delivery pushes most o...Background: The success rate of vaginal birth after cesarean section with a single cesarean scar is greater than 50%, the lack of the information about the safety of vaginal birth after cesarean delivery pushes most of obstetricians to increase the num ber of cesarean sections following a previous cesarean section. Guidelines for Vaginal birth after cesarean (VBAC) indicate that TOLAC offers women with no contraindications and one previous transverse low-segment cesarean. The objective of the current study was to study the outcome of trial of labour after caesarean section (TOLAC), the indications for emergency repeat cesarean section and to determine the maternal and fetal prognosis in vaginal birth after caesarian section (VBAC) at Tshikaji Mission Hospital. Patients, Material and Methods: This is a retrospective study of the records of 126 women were selected to undergo the TOLAC in the department of gynecology and obstetrics at the Tshikaji Mission Hospital over the period from January 1<sup>st</sup> to December 31<sup>st</sup>, 2021. The data on demography, antenatal care, labour and delivery and outcomes were collected from the maternity unit of this hospital. The data were analyzed using SPSS version 2.0. Results: The TOLAC in 126 studied women. The course of work allowed vaginal delivery 107 parturient women, a success rate of successful VBAC of 85% after the TOLAC. The repeat emergency cesarean section was necessary for delivery in 15% of cases for failed TOLAC. There was no maternal mortality, but we recorded one fetal death or 0.8% of perinatal mortality, 2 cases of cicatricial dehiscence, the incidence of 1.6%. Maternal morbidity after delivery on cicatricial uterus was dominated by postpartum hemorrhages, with 19 cases or 15.1% of cases. Cervical dilatation of more than 3 cm at the time of admission, the parity more than 3 and were the significant factors in favor of a successful VBAC. Birth weight of more than 3500 g, fetal distress and malpresentation were associated with a lower success rate of VBAC. The TOLAC in selected cases has great importance in the present era of the rising rate of primary CS especially in rural areas. Conclusion: Pregnancy on a cicatricial uterus represents a high-risk pregnancy. Trial of VBAC in selected cases has great importance in the present era of the rising rate of primary CS especially in rural areas. There is a significantly high vaginal birth after caesarian section (VBAC) success rate among selected women undergoing trial of scar in Tshikaji Hospital. TOLAC remains the option for childbirth in low resource settings as Kasai region in DRC. Adequate patient education and counselling in addition to appropriate patient selection for TOLAC remain the cornerstone to achieving high VBAC success rate.展开更多
Background: This study aims to evaluate the effects of omission of the bladder flap formation at primary and repeat lower segment CS. Patients and Methods: The current study was randomized controlled trial conducted i...Background: This study aims to evaluate the effects of omission of the bladder flap formation at primary and repeat lower segment CS. Patients and Methods: The current study was randomized controlled trial conducted in Women Health Hospital, Assiut University, Egypt between March 2017 and May 2018 (ClinicalTrial.gov NCT03016273). Patients were divided into: Non bladder flap group: Uterine incision made 1 cm above the vesico-uterine reflection without incision and dissection of the bladder peritoneum and bladder flap group: Standard cesarean section technique with incision and dissection of a bladder flap prior to uterine incision. Results: The study included 150 patients (75 in each arm). The most common indication for CS in both groups was repeated CS. Non-bladder flap group, compared with flap group, showed shorter skin-incision to delivery time and total operative time, and significantly lower mean estimated blood loss and postoperative pain score. Non-bladder flap group, compared with flap group, was more likely to show postoperative microhematuria. The two groups required approximately the same time for post-operative defecation. Conclusion: Omission of bladder flap formation during CS is associated with shorter operative time, less blood loss, less postoperative pain and lower incidence of postoperative hematuria.展开更多
The principle and method of flexible multibody system dynamics is presented. The dynamic equation have been developed by means of Huston's method based on Kane's equation. In which the flexible members with g...The principle and method of flexible multibody system dynamics is presented. The dynamic equation have been developed by means of Huston's method based on Kane's equation. In which the flexible members with general cross-section characters were divided into finite segment models under the assumption of small strain. In order to decrease the degrees of freedom of the system and increase the efficiency of numerical calculation. the mode transformation has been introduced. A typical example is presented. and the foregoing method has been perfectly verified.展开更多
文摘<strong>Aim</strong><strong>:</strong><span> Clinical audit is a tool to improve quality of care and to reduce maternal and perinatal morbidity and mortality. Auditing the CS according to a standard parameter will lead to strategies to avoid unnecessary intervention and to advice uniform practice. The aim was to evaluate the current practice and audit against international standards for various parameters relating to elective lower segment caesarean section and to assess compliance of physicians to audit standards.</span><span "=""> </span><b><span>Subject and methods: </span></b><span "=""><span>This is a cross-sectional study which was in a tertiary hospital in Kuwait from 1</span><sup><span>st</span></sup><span> October 2019 until 1</span><sup><span>st</span></sup><span> October 2020.</span><b> </b><span>The hospital medical, electronic records and case notes of three hundred and twenty-six </span><b><span>(326)</span></b><span> cases of elective caesarean sections were reviewed for study participants. Those women were booked under the care of internal and external physicians. Demographic data and primary outcomes were collected. </span><b><span>Results:</span></b><span> Outcome was measuring the compliance to the recognized Caesarean Section international standards: consent form, grade of LSCS, antacid and anti-emetics, type of anesthesia, uses of antibiotics, umbilical cord blood PH, and thromboprophylaxis.</span></span><span "=""> </span><span>The compliance for a signed consent form and cord blood PH was (100%), the use of preoperative antacid and antiemetic was (99.4%), combined regional anesthesia was given in (53.4%) of cases, preoperative antibiotics prophylaxis of second generation cephalosporin was</span><span "=""> </span><span>to (61.3%) of cases, post-operative thromboprophylaxis was given in (78.5%) of cases of which (33.6%) completed a 10 days duration.</span><span "=""> </span><span "=""><span>There was a statistically significant difference between internal and external physicians’ compliance regarding, type of anesthesia </span><b><span>2.3 (95%</span></b></span><b><span "=""> </span><span>CI, 1.3</span><span "=""> </span><span>-</span><span "=""> </span><span>4.1</span><span>, </span></b><span "=""><span>p = </span><b><span>0.004)</span></b><span>, type and timing of antibiotics </span><b><span>0.42 (95%</span></b></span><b><span "=""> </span><span>CI 0.22</span><span "=""> </span><span>-</span><span "=""> </span><span>0.79, </span></b><span "=""><span>p = </span><b><span>0.007) </span></b><span>and </span><b><span>0.33 (95%</span></b></span><b><span "=""> </span><span>CI 0.172</span><span "=""> </span><span>-</span><span "=""> </span><span>0.63,</span></b><span "=""><span> p = </span><b><span>0.0006) </span></b><span>and thromboprophylaxis </span><b><span>8.1 (95%</span></b></span><b><span "=""> </span><span>CI 2.80</span><span "=""> </span><span>-</span><span "=""> </span><span>23.23, </span></b><span "=""><span>p = </span><b><span>0.000)</span></b><span>.</span></span><span "=""> </span><b><span>Conclusion: </span></b><span "=""><span>The results are encouraging, but</span><b> </b><span>suboptimal compliance </span></span><span>i</span><span>s noticed mainly among external physicians.</span>
基金supported by the Chinese Geological Survey (CGS) (Grant No.1212011120181 & Grant No.1212011120115)a key project of the Natural Science Foundation of China (Grant No.41030317)
文摘This study＇s objective was to investigate the Guguan-Xiangong Fault, which lies in the southern Liupanshan area, through satellite image interpretation and field observations. Guguan- Xiangong Fault is divided into five subsegments; among these, the Badu-Longwei segment has been the most recently active. The geomorphic features of the Badu-Longwei segment are clearly displayed, including multiple high fault scarps with fresh bedrock free faces. There is significant evidence for Holocene activity of the three fault sections, located in Renhuashu, Tianjiagou, and Xinjiecun respectively. The three sections feature distinct episodic deposition and fault scratches. Based on 14C- dating and field observations on the three fault sections, two or more paleoearthquakes across the Badu-Longwei fault segment are ascertained, between 5874±116 and 5430±140 a BP, and after 2037±83 a BP respectively. The Badu-Longwei segment of the Guguan-Xiangong Fault is preliminarily extrapolated as the seismogenic structure of the 600 A.D. Qin-Long earthquake.
文摘Background: The success rate of vaginal birth after cesarean section with a single cesarean scar is greater than 50%, the lack of the information about the safety of vaginal birth after cesarean delivery pushes most of obstetricians to increase the num ber of cesarean sections following a previous cesarean section. Guidelines for Vaginal birth after cesarean (VBAC) indicate that TOLAC offers women with no contraindications and one previous transverse low-segment cesarean. The objective of the current study was to study the outcome of trial of labour after caesarean section (TOLAC), the indications for emergency repeat cesarean section and to determine the maternal and fetal prognosis in vaginal birth after caesarian section (VBAC) at Tshikaji Mission Hospital. Patients, Material and Methods: This is a retrospective study of the records of 126 women were selected to undergo the TOLAC in the department of gynecology and obstetrics at the Tshikaji Mission Hospital over the period from January 1<sup>st</sup> to December 31<sup>st</sup>, 2021. The data on demography, antenatal care, labour and delivery and outcomes were collected from the maternity unit of this hospital. The data were analyzed using SPSS version 2.0. Results: The TOLAC in 126 studied women. The course of work allowed vaginal delivery 107 parturient women, a success rate of successful VBAC of 85% after the TOLAC. The repeat emergency cesarean section was necessary for delivery in 15% of cases for failed TOLAC. There was no maternal mortality, but we recorded one fetal death or 0.8% of perinatal mortality, 2 cases of cicatricial dehiscence, the incidence of 1.6%. Maternal morbidity after delivery on cicatricial uterus was dominated by postpartum hemorrhages, with 19 cases or 15.1% of cases. Cervical dilatation of more than 3 cm at the time of admission, the parity more than 3 and were the significant factors in favor of a successful VBAC. Birth weight of more than 3500 g, fetal distress and malpresentation were associated with a lower success rate of VBAC. The TOLAC in selected cases has great importance in the present era of the rising rate of primary CS especially in rural areas. Conclusion: Pregnancy on a cicatricial uterus represents a high-risk pregnancy. Trial of VBAC in selected cases has great importance in the present era of the rising rate of primary CS especially in rural areas. There is a significantly high vaginal birth after caesarian section (VBAC) success rate among selected women undergoing trial of scar in Tshikaji Hospital. TOLAC remains the option for childbirth in low resource settings as Kasai region in DRC. Adequate patient education and counselling in addition to appropriate patient selection for TOLAC remain the cornerstone to achieving high VBAC success rate.
文摘Background: This study aims to evaluate the effects of omission of the bladder flap formation at primary and repeat lower segment CS. Patients and Methods: The current study was randomized controlled trial conducted in Women Health Hospital, Assiut University, Egypt between March 2017 and May 2018 (ClinicalTrial.gov NCT03016273). Patients were divided into: Non bladder flap group: Uterine incision made 1 cm above the vesico-uterine reflection without incision and dissection of the bladder peritoneum and bladder flap group: Standard cesarean section technique with incision and dissection of a bladder flap prior to uterine incision. Results: The study included 150 patients (75 in each arm). The most common indication for CS in both groups was repeated CS. Non-bladder flap group, compared with flap group, showed shorter skin-incision to delivery time and total operative time, and significantly lower mean estimated blood loss and postoperative pain score. Non-bladder flap group, compared with flap group, was more likely to show postoperative microhematuria. The two groups required approximately the same time for post-operative defecation. Conclusion: Omission of bladder flap formation during CS is associated with shorter operative time, less blood loss, less postoperative pain and lower incidence of postoperative hematuria.
文摘The principle and method of flexible multibody system dynamics is presented. The dynamic equation have been developed by means of Huston's method based on Kane's equation. In which the flexible members with general cross-section characters were divided into finite segment models under the assumption of small strain. In order to decrease the degrees of freedom of the system and increase the efficiency of numerical calculation. the mode transformation has been introduced. A typical example is presented. and the foregoing method has been perfectly verified.
