Objectives: To evaluate the various scoring systems, APACHE II, SOFA, SAPS II and MPM for the prediction of prognosis of the obstetric critically ill patients admitted in a well supported ICU unit. Material and method...Objectives: To evaluate the various scoring systems, APACHE II, SOFA, SAPS II and MPM for the prediction of prognosis of the obstetric critically ill patients admitted in a well supported ICU unit. Material and methods: A prospective, observational study was conducted among all the obstetric patients admitted to the ICU between October 2011 and December 2012, during a period of 15 months. The data collected were of three categories: demographic, obstetric and ICU related. Results and Analysis: The patients admitted in the postpartum period (n = 28, 53.84%) were more than the antenatal admissions (n = 24, 46.16%). 32.69% of admissions were in the third trimester. The most common mode of delivery was emergency caesarean section (n = 27/40, 67.5%). Total caesarean deliveries were 35/40 = 87.5% in ICU patients. The mortality prediction scores were calculated for 41 patients only as acid blood gas analysis was not available for the rest. Patients required ventilation—51.92%, hemodialysis—19.23%, inotropic support—38.46%, blood transfusion—50%. Analysis of the statistical data for ICU parameters has shown that hospital stay (p = 0.011) and ventilation days (p = 0.014) are significant predictors of maternal outcome. Age (p = 0.789), ICU stay (p = 0.701) and RRT (p = 0.632) are not significant. Among the obstetric ICU admissions, hypertensive disorders of pregnancy (30.76%) was the predominant cause followed by obstetric haemorrhage (23.07%). Discussion: HELLP syndrome and eclampsia (n = 4, 57%) were the major causes of maternal deaths with anaesthetic mishaps accounting for 29% (n = 2). One (14%) death was due to Eisenmenger’s syndrome. In one case of H1N1 admitted with ARDS, caesarean section was done in MICU for worsening respiratory distress. The maternal mortality in this series of cases was 7/52 = 13.46%, excluding the unavoidable cases of maternal death (3 cases brain dead at admission and one cardiac arrest in emergency room), our maternal mortality rate is 3/48 = 6.25%. The predicted mortality as measured by all scoring systems (for 41 patients) was between 17% and 30%. The observed mortality was around 17%. Hence a reduction in mortality of 40% has been achieved due to intensive care. Conclusions: Leading cause of maternal mortality was HELLP syndrome. Hypertensive disorders of pregnancy were the most common cause of admission to ICU. In this study, all the scores were equally significant in predicting maternal mortality. Amongst the interventions done for these patients mechanical ventilation seems to have an influence on the overall outcome.展开更多
Systematic development of a patient safety culture is necessary because lack of quality care leads to human suffering. The aim of this review was to identify evidence of obstetric adverse events (AEs) and near-misses ...Systematic development of a patient safety culture is necessary because lack of quality care leads to human suffering. The aim of this review was to identify evidence of obstetric adverse events (AEs) and near-misses in the context of patient safety. We conducted a search of the published literature from Europe, Australia and the USA in the following databases: Cinahl, Cochrane, Maternity and Infant Care, Ovid, Pro-quest and PubMed, guided by PRISMA procedures. A total of 427 studies were screened, 15 full papers retrieved and nine studies included in the final thematic analysis. The selected papers address a broad spectrum of adverse patient safety events in obstetric care. The themes that emerged were: type of AEs, near-misses and their consequences, strategies to support and improve Patient Safety (PS) and domains related to the WHO Patient Safety competence outcomes. The findings of the first theme were grouped into the following categories: healthcare professionals’ perspectives on ethical conflicts, attributing blame and responsibility, and patients’ perspectives on lack of trust and involvement, as well as medication errors. The second theme, strategies to support interventions to improve PS, was based on two sub-themes: communicating effectively and gaining competence by learning from adverse events, while the third theme was domains related to the WHO Patient Safety competence outcomes. In conclusion, few studies have examined strategies for managing AEs despite the existence of programmes that target the implementation of changes, such as improved teamwork training. In addition to exploring strategies to make safety a priority for patients and healthcare professionals, it is of the utmost importance to improve communication with patients and between professionals in order to maintain and enhance safety. Efforts by organizations and individuals to continuously develop knowledge about the risk of AEs and the use of best practice guidelines are also essential.展开更多
Heart failure(HF)during pregnancy presents unique challenges due to the complex interplay between physiological changes and underlying cardiac conditions.Pregnancy-induced increases in blood volume,cardiac output,and ...Heart failure(HF)during pregnancy presents unique challenges due to the complex interplay between physiological changes and underlying cardiac conditions.Pregnancy-induced increases in blood volume,cardiac output,and heart rate can exacerbate pre-existing heart diseases or trigger new-onset HF,such as peripartum cardiomyopathy and preeclampsia-related HF.With pregnancy-related physiological changes altering pharmacokinetics,dosage adjustment becomes crucial,making its application limited to carefully selected cases where benefits outweigh the risks.Medication management for these patients requires a meticulous approach.Beta-blockers like metoprolol and bisoprolol are preferred despite limited evidence,and carvedilol may be cautiously used per clinical experience;atenolol is contraindicated for low-birth-weight risk.Diuretics(furosemide,bumetanide)are safe for congestion relief but warrant judicious dosing.Digoxin is generally safe but requires dose adjustment and regular monitoring due to pregnancy-induced pharmacokinetic alterations.Among positive inotropes,dobutamine exhibits favorable safety in pregnancy,whereas milrinone should be used cautiously for hypotension risk.Renin-angiotensin system inhibitors,mineralocorticoid receptor antagonists and sodium-glucose cotransporter 2 inhibitors are all contraindicated owing to risks of fetal malformations,male fetal feminization,and insufficient safety evidence,respectively.展开更多
Introduction: Obstetric Fistulas (OF) constitute a major public health problem in developing countries in general and in Central African Republic (CAR) in particular because of its numerous consequences. The objective...Introduction: Obstetric Fistulas (OF) constitute a major public health problem in developing countries in general and in Central African Republic (CAR) in particular because of its numerous consequences. The objective of this work is to contribute to the management of OF cases in CAR. Patients and Methods: This was a retrospective, descriptive and analytical study, including data from several OF care services. The study included 245 cases of OF, operated on from 2009 to 2018. The parameters studied were maternal and obstetrical data, sociodemographic data, the specific characteristics of the fistulas as well as the modalities and outcome of surgical treatment. The data collected came from six (6) OF surgical repair campaigns organized by the Ministry of Health and Population with the support of UNFPA. Results: We recorded 245 patients, representing a prevalence of 0.77% of OF per year. Among these patients, almost half (45.3%) were treated at the Sino-Central African Friendship University Hospital Center (CHUASC). The average age of the patients was 30 years (range 14 to 78 years). They were unschooled (53.9%) and primigravidas (35%). The fistulas had an average duration of evolution of 7.58 years. They were vesicovaginal in 25.3%. Types V and I dominated in 17.4% and 9.2%, respectively. In 85.9% of cases, fistulorrhaphy was performed, half of which (50.2%) via the upper route. The cure rate was 83.3%. Note that our study reveals statistically significant links between the evolution after surgery with age (p = 0.04 Conclusion: OF mainly affected women of childbearing age, uneducated, primiparous. Vesicovaginal fistula was the frequently encountered type and was manifested by urine loss clinically with a positive methylene blue test.展开更多
BACKGROUND Antenatal depression is a disabling mental disorder among pregnant women and may cause adverse outcomes for both the mother and the offspring.Early identification and intervention of antenatal depression ca...BACKGROUND Antenatal depression is a disabling mental disorder among pregnant women and may cause adverse outcomes for both the mother and the offspring.Early identification and intervention of antenatal depression can help to prevent adverse outcomes.However,there have been few population-based studies focusing on the association of social and obstetric risk factors with antenatal depression in China.AIM To assess the sociodemographic and obstetric factors of antenatal depression and compare the network structure of depressive symptoms across different risk levels based on a large Chinese population.METHODS The cross-sectional survey was conducted in Shenzhen,China from 2020 to 2024.Antenatal depression was assessed using the Chinese version of the Edinburgh Postnatal Depression Scale(EPDS),with a score of≥13 indicating the presence of probable antenatal depression.Theχ2 test and binary logistic regression were used to identify the factors associated with antenatal depression.Network analyses were conducted to investigate the structure of depressive symptoms across groups with different risk levels.RESULTS Among the 44220 pregnant women,the prevalence of probable antenatal depression was 4.4%.An age≤24 years,a lower level of education(≤12 years),low or moderate economic status,having a history of mental disorders,being in the first trimester,being a primipara,unplanned pregnancy,and pregnancy without pre-pregnancy screening were found to be associated with antenatal depression(all P<0.05).Depressive symptom networks across groups with different risk levels revealed robust interconnections between symptoms.EPDS8("sad or miserable")and EPDS4("anxious or worried")showed the highest nodal strength across groups with different risk levels.CONCLUSION This study suggested that the prevalence of antenatal depression was 4.4%.Several social and obstetric factors were identified as risk factors for antenatal depression.EPDS8("sad or miserable")and EPDS4("anxious or worried")are pivotal targets for clinical intervention to alleviate the burden of antenatal depression.Early identification of highrisk groups is crucial for the development and implementation of intervention strategies to improve the overall quality of life for pregnant women.展开更多
This study focuses on the relationship between job stress and intention to leave among obstetric(OB)nurses in the context of China's birth policy adjustment,and provides a scientific basis for policymakers and hea...This study focuses on the relationship between job stress and intention to leave among obstetric(OB)nurses in the context of China's birth policy adjustment,and provides a scientific basis for policymakers and healthcare administrators.This study used a non-experimental descriptive correlation design with a purposive sampling of 230 OB nurses from three tertiary hospitals in Jinan,Shandong Province.Participants were surveyed using three questionnaires and descriptive analysis;ANOVA and correlation analyses were used to analyze the relationship between participants'stressor levels and turnover intention.Pearson's correlation coefficient analysis showed that there was a positive correlation between nurses‘work stressors and turnover intention,with a correlation coefficient of r=0.53,a moderate positive correlation(P<0.001).Based on the survey data from three tertiary hospitals in Shandong Province,the obstetric nurses group has a medium level of work stressors,but a high turnover intention,highlighting the professional identity crisis.展开更多
This paper analyzes the current research status of job satisfaction among obstetric nurses at home and abroad,including research methods,influencing factors,correlation relationships,and countermeasures to improve job...This paper analyzes the current research status of job satisfaction among obstetric nurses at home and abroad,including research methods,influencing factors,correlation relationships,and countermeasures to improve job satisfaction of obstetric nurses.It aims to provide a reference for subsequent studies on job satisfaction of obstetric nurses.展开更多
Introduction: Access to the best quality of obstetrical care sometimes conceals acts and behaviors that fail to respect women’s physical, mental and social integrity. These negative experiences are referred to as obs...Introduction: Access to the best quality of obstetrical care sometimes conceals acts and behaviors that fail to respect women’s physical, mental and social integrity. These negative experiences are referred to as obstetrical violence. The aim of this study is to contribute to improving the quality of maternal health care. Patient and Method: This was a cross-sectional study with a quantitative component carried out in the obstetrics and gynecology department of the Maman Elisabeth Domitien University Hospital from November 1 to 30, 2024. All women in childbed seen for postnatal consultations within 42 days of delivery were included. Results: We included 109 women. Age ranged from 16 to 44 years with a mean of 26.9 (±6.02). The majority of women were living in common-law unions with 79.8% and 57.8% of mothers having a secondary education level. More than half of the participants (52.9%) said that they had not been prepared for childbirth during prenatal follow-up and 44.0% had not freely chosen their path of delivery. The vaginal route was the most observed route of delivery (97.3%). Of all vaginal deliveries, episiotomy was performed in 21.7% and uterine revision in 66.0%. For episiotomies, 26.1% of women in childbed were informed about its performance and 87.0% had had a bad experience with this event. For women who had undergone a uterine revision, 52.9% had been informed of its performance and 77.1% had a bad experience with the event. Women in childbed had been victims of inappropriate acts and verbal aggression in 18.4% and 14.7% respectively. Of all the participants, 45.0% said they had experienced the birth episode badly. Conclusion: This study has given us an idea of the subject. However, a large-scale study will enable us to understand the different facets of this subject.展开更多
Objective Great obstetrical syndrome(GOS)represents a group of pregnancy-related diseases that result in inadequate placentation.Most GOS cases end in preterm,either spontaneously or indicatively,and the use of antena...Objective Great obstetrical syndrome(GOS)represents a group of pregnancy-related diseases that result in inadequate placentation.Most GOS cases end in preterm,either spontaneously or indicatively,and the use of antenatal corticosteroids(ACS)is inevitably discussed.The placenta is an important,transient fetal-derived organ and is the embodiment of maternal or fetal well-being.However,few studies provide histological evidence of the placenta in GOS.This study aims to address these issues.Methods A total of 831 pregnant women were prospectively recruited.Placenta tissue was collected immediately and fixed with 4%paraformaldehyde solution for future H&E analysis.A novel checklist was devised to evaluate maternal vascular malperfusion sections on the basis of the commonly accepted Amsterdam placental workshop group consensus statement.Results A total of 131 patients were classified as having GOS.Comparisons between those with and without GOS revealed significant differences,including higher levels of distal villous hypoplasia,increased syncytial knots,accelerated villous maturation,and higher total scores in GOS.We found significant negative associations between GOS and neonatal weight,neonatal height,head circumference,placental surface area,placental volume,and placenta gross examination score.GOS neonates were 1.25 times more likely to have hyperbilirubinemia.Regarding the effect of ACS,a significant reduction in birthweight,height,and head circumference was observed,along with an increased risk of hyperbilirubinemia.Conclusion This study provides histological evidence of the GOS that supports the defective deep placentation hypothesis.Our research also contributes to benefit-risk consultation in the GOS,such as in cases of PE and FGR,where a balance between fetal lung maturation and short-term neonatal outcomes is crucial.展开更多
In the new era,curriculum ideological and political education has become one of the core approaches for higher education to implement the fundamental task of moral education.Obstetrics and gynecology nursing is a prof...In the new era,curriculum ideological and political education has become one of the core approaches for higher education to implement the fundamental task of moral education.Obstetrics and gynecology nursing is a professional basic course for medical nursing majors,featuring professionalism,humanism,and sociality,which has a natural fit with the integration of curriculum ideological and political education.Based on the professional characteristics of obstetrics and gynecology nursing teaching,this paper constructs a“six-in-one”integration path from six dimensions:integration goals,element excavation,content penetration,method innovation,evaluation system,and teacher team construction.It provides a reference for cultivating obstetrics and gynecology nursing talents with both exquisite professional skills and noble professional literacy.展开更多
Clinical nursing in obstetrics and gynecology is far more than mere disease treatment and technical operations;it also carries profound humanistic care connotations.Through clinical practice analysis,this study system...Clinical nursing in obstetrics and gynecology is far more than mere disease treatment and technical operations;it also carries profound humanistic care connotations.Through clinical practice analysis,this study systematically elaborates on the risks existing in clinical obstetrics and gynecology nursing,analyzes the importance of humanized nursing,and proposes corresponding application countermeasures.It is found that the application of the humanized nursing model in clinical obstetrics and gynecology nursing can effectively meet the physical,psychological,and social needs of patients,establish a harmonious nurse-patient relationship,and have positive clinical value in promoting the physical and mental rehabilitation of patients.It is worthy of extensive promotion and application in clinical practice.展开更多
The burden of maternal mortality (MM) and morbidity is especially high in Asia.However,China has made significant progress in reducing MM over the past two decades,and hence maternal death rate has declined considerab...The burden of maternal mortality (MM) and morbidity is especially high in Asia.However,China has made significant progress in reducing MM over the past two decades,and hence maternal death rate has declined considerably in last decade,To analyze availability and quality of emergency obstetric care (EmOC) received by women at Tongji Hospital,Wuhan,China,this study retrospectively analyzed various pregnancy-related complications at the hospital from 2000 to 2009.Two baseline periods of equal length were used for the comparison of variables.A total of 11 223 obstetric complications leading to MM were identified on a total of 15 730 hospitalizations,either 71.35％ of all activities.No maternal death was recorded.Mean age of women was 29.31 years with a wide range of 14-52 years.About 96.26％ of women had higher levels of schooling,university degrees and above and received the education of secondary school or college.About 3.74％ received primary education at period two (P2) from 2005 to 2009,which was significantly higher than that of period one (P1) from 2000 to 2004 (P＜0.05) (OR:0.586; 95％ CI:0.442 to 0.776).About 65.69％ were employed as skilled or professional workers at P2,which was significantly higher than that of P1 (P＜0.05).About 34.31％ were unskilled workers at P2,which was significantly higher than that of P1 (P＜0.05).Caesarean section was performed for 9,930 women (88.48％) and the percentage of the procedure increased significantly from 19.25％ at P1 to 69.23％ at P2 (P＜0.05).We were led to conclude that,despite the progress,significant gaps in the performance of maternal health services between rural and urban areas remain.However,MM reduction can be achieved in China.Priorities must include,but not limited to the following:secondary healthcare development,health policy and management,strengthening primary healthcare services.展开更多
Vasopressors are routinely used to counteract hypotension after neuraxial anesthesia in Obstetrics. The understanding of the mechanism of hypotension and the choice of vasopressor has evolved over the years to a point...Vasopressors are routinely used to counteract hypotension after neuraxial anesthesia in Obstetrics. The understanding of the mechanism of hypotension and the choice of vasopressor has evolved over the years to a point where phenylephrine has become the preferred vasopressor. Due to the absence of definitive evidence showing absolute clinical benefit of one over the other, especially in emergency and high-risk Cesarean sections, our choice of phenylephrine over the other vasopressors like mephentermine, metaraminol, and ephedrine is guided by indirect evidence on fetalacid-base status. This review article evaluates the present day evidence on the various vasopressors used in obstetric anesthesia today.展开更多
Purpose: This study was conducted to audit prophylactic antibiotic use and to quantify the rate of wound infection. Methods: Across-sectional prospective study was conducted in the Obstetrics and Gynecology Department...Purpose: This study was conducted to audit prophylactic antibiotic use and to quantify the rate of wound infection. Methods: Across-sectional prospective study was conducted in the Obstetrics and Gynecology Department in Khartoum Teaching Hospital, Sudan during March 1st to 31st October 2010. All Patients (aged >18 years) were included. Results: Overall 725 patients were included. The performed surgical procedures were 751;of these 578 (76.9%) were Caesarean sections. Overall rate of wound infection was 7.8%. The rate of wound infection among patients operated on for caesarean section and abdominal hysterectomy was 8.3%, and 9.2%, respectively. Multivariate logistic analysis showed that body mass index [BMI] ≥ 30 kg/m2 OR 2.1, 95% CI (1.1 - 4.0), (P = 0.019) was the major independent risk factor for occurrence of wound infection. Evaluation of prescriptions’ parameters against the stated criteria showed that 113 (15.8%) patients were given antibiotics with adequate spectrum of activity, 611 (85.3%) given sub-dose/s, 83 (11.6%) received the first preoperative dose/s in a proper time window, and 716 (100%) had prophylaxis for extended duration. Overall conformity to the stated criteria for the evaluation of prescription’s parameters was not achieved in all prescriptions. Conclusions: In this setting, antibiotics were irrationally used and wound infection rate was high, and the situation calls for multiple interventions to correct the situation, through the activation of the infection control committee in the hospital and development of antimicrobial subcommittee to develop policies for the use and auditing of prophylactic antibiotics.展开更多
Objective: The aim of this study was to explore the correlation between psychological resilience and social support and anxiety in obstetric nurses and to provide theoretical basis for improving the mental health of o...Objective: The aim of this study was to explore the correlation between psychological resilience and social support and anxiety in obstetric nurses and to provide theoretical basis for improving the mental health of obstetric nurses.Methods: In this study, 190 obstetric nurses were included, using the general information questionnaire and The Connor-Davidson Resilience Scale(CD-RISC), Social Support Rating Scale, and survey of Self-evaluation of Anxiety Scale.Results: There are differences in the type of work and the score of psychological resilience(P<0.05), obstetric nurses’ resilience score was 65.58±10.65; self-rating anxiety score of obstetric nurses was 36.89±6.87; and social support score of obstetric nurses was44.3717.86. The psychological elasticity score and anxiety were negatively related(P<0.01), whereas the resilience score and total score of social support were positively related(P<0.01).Conclusions: Obstetric nurses have many responsibilities and stress. Nursing managers should focus on obstetric nurses’ mental health, lighten the obstetric nurses’ anxiety, and thus improve their mental flexibility and optimize the quality of nursing service better,with more passion into work.展开更多
The time window for repair of the lower trunk is shorter than that of the upper trunk in patients with obstetric brachial plexus palsy. The denervated intrinsic muscles of the hand become irreversibly atrophic much fa...The time window for repair of the lower trunk is shorter than that of the upper trunk in patients with obstetric brachial plexus palsy. The denervated intrinsic muscles of the hand become irreversibly atrophic much faster than the denervated biceps. However, it is unclear whether the motor endplates of the denervated interosseous muscles degenerate more rapidly than those of the denervated biceps. In this study, we used a rat model of obstetric brachial plexus palsy of the right upper limb. C5–6 was lacerated distal to the intervertebral foramina, with concurrent avulsion of C7–8 and T1, with the left upper limb used as the control. Bilateral interossei and biceps were collected at 5 and 7 weeks. Immunofluorescence was used to assess the morphology of the motor endplates. Real-time quantitative polymerase chain reaction and western blot assay were used to assess mRNA and protein expression levels of acetylcholine receptor subunits(α, β and δ), rapsyn and β-catenin. Immunofluorescence microscopy showed that motor endplates in the denervated interossei were fragmented, while those in the denervated biceps were morphologically intact with little fragmentation. The number and area of motor endplates, relative to the control side, were significantly lower in the denervated interossei compared with the denervated biceps. mRNA and protein expression levels of acetylcholine receptor subunits(α, β and δ) were significantly lower, whereas β-catenin protein expression was higher, in the denervated interossei compared with the denervated biceps. The protein expression of rapsyn was higher in the denervated biceps than in the denervated interossei at 7 weeks. Our findings demonstrate that motor endplates of interossei are destabilized, whereas those of the biceps remain stable, in the rat model of obstetric brachial plexus palsy. All procedures were approved by the Experimental Animal Ethics Committee of Fudan University, China(approval No. DF-187) in January 2016.展开更多
Introduction: Obstetric Fistula (OF) is a tragedy and a public health problem (physical, social, moral and psychological). Objective: To determine the clinical, therapeutic and prognostic aspects of obstetric fistula ...Introduction: Obstetric Fistula (OF) is a tragedy and a public health problem (physical, social, moral and psychological). Objective: To determine the clinical, therapeutic and prognostic aspects of obstetric fistula at CHUD/B-A maternity ward in 2016. Study Method: This is a descriptive, analytic study with prospective data collection from March 07 to December 31, 2016. Patients with obstetric fistula were the study population. Results: A total of 37 patients were treated including 35 operated, the other two not operated for pyuria and bladder calculus after examination under spinal anesthesia. The average age was 36.6 ± 10.5 years with the extremes of 21 years and 65 years. The mean age of onset of Obstetric Fistula (OF) was 28.9 ± 6.5 years. Patients came from southern Benin (51.4%), were married (67.6%), peasant (35.1%) and out of school (81.1%). The types of OF were vesico-vaginal fistula (VVF) (62.2%), urethro-vaginal fistula (24.3%), vesico-uterine fistula (VUF) (5.4%), and uretero-vaginal fistula (2.7%). The fistula site was supra trigonal (54.1%), urethral (18.9%), trigonal (10.8%), vesico-uterine (10.8%), cervical urethral (2.7%), ureteroid vaginal (2.7%). Fistulas were complex (70.3%), complicated (24.3%) and simple (5.4%). The vaginal route was one of the first routes (64.9%). The operative techniques used were CHASSAR MOIR hysterorrhaphy (74.3%). The cure with continence was 68.6%. Conclusion: OF is observed in young women of childbearing age. VVF is the most common. The management is surgical with several operating techniques. Healing is possible. Hence the importance of paying special attention to these patients for their care.展开更多
Background: Anemia is one of the most widely prevalent disorders, affecting the lives of almost half a billion women of reproductive age, contributing to over 100,000 maternal and almost 600,000 perinatal deaths (most...Background: Anemia is one of the most widely prevalent disorders, affecting the lives of almost half a billion women of reproductive age, contributing to over 100,000 maternal and almost 600,000 perinatal deaths (mostly through pre-term delivery, low birth weight) each year. Increased risk of infant mortality and reduced cognitive development and reduced energy levels which affect productivity in adults are cited. During pregnancy increased requirements, inadequate intake of iron and other micronutrients and parasitic (malaria, hookworm) as wells as bacterial (mostly urinary tract) infections are the main causes. In order to reduce such maternal and neonatal burden, it has been worldwide admitted to adopt cost-effective preventive interventions during pregnancy, including iron-folic acid supplementation, de-hookworming medication and anti-malarial prevention or treatment. Intestinal absorption of iron is limited by a lot of factors including bioavailability, iron status of the woman, substances accompanying or contained in diet, chelating agents such as diet fibers or calcium salts. Any supplementation put additional constraint in terms of absorption. Unabsorbed iron is known to have pro-oxidant properties likely to induce production of free radicals. These in turn might induce oxidative stress accountable for in generation of many obstetrical outcomes. This potential link between oxidative stress resulting from free radicals hyperproduction induced by non absorbed iron and harmful maternal/perinatal conditions is rarely questioned by searchers. Objectives: To determine overall (food and supplemented) iron consumption, iron and oxidative status in a cohort of pregnant women and to seek associations between findings and adverse obstetrical outcomes. Methods: At the University Clinics of Kinshasa, we designed a protocol for a prospective cohort study dealing with clinical and biochemical parameters of oxidative stress among pregnant women iron supplemented. Women with a single pregnancy not exceeding 19 weeks without obvious pathology, regardless of age and parity, were eligible for inclusion in the study. Conclusion: This study is expected to assess consequences of oral iron supplementation during pregnancy in terms of obstetrical outcomes associated with oxidative stress linked to unabsorbed iron.展开更多
AIM: To analyze safety and efficacy of pelvic arterial embolization(PAE) in preventing and treating obstetrical hemorrhage.METHODS: A consecutive study of eight cases undergoing pelvic artery embolization from January...AIM: To analyze safety and efficacy of pelvic arterial embolization(PAE) in preventing and treating obstetrical hemorrhage.METHODS: A consecutive study of eight cases undergoing pelvic artery embolization from January 2010 to October 2012 in Department of Obstetric and Gynecology of Maulana Azad Medical College for intractable obstetric hemorrhage was done. All embolization were carried out in cath lab of cardiology Department at associated GB Pant Hospital.RESULTS: Clinical success was defined as arrest of bleeding after PAE without need for repeat PAE or additional surgery which was 75% in our series. PAE was successful in controlling obstetrical hemorrhage in all except one who had mortality. Other had hysterectomy due to secondary hemorrhage. Five resumed menstruation. None of the women intended to conceive, hence are practicing contraception. CONCLUSION: PAE is minimally invasive procedure which should be offered early for hemostasis in intractable obstetrical haemorrhage unresponsive to uterotonic. It is a fertility sparing option with minor complications.展开更多
Introduction: Healthcare-associated infections (HAIs) are a public health issue. An infection is said to be associated with the care if it occurs during or after the care of a patient, and if it was neither present no...Introduction: Healthcare-associated infections (HAIs) are a public health issue. An infection is said to be associated with the care if it occurs during or after the care of a patient, and if it was neither present nor incubation at the beginning of the care. Objective: The purpose of this work was to study the bacteriology of infections associated with obstetric care in the gynecology-obstetrics department of CHU Gabriel Touré. Patients and Methods: This is an epidemiological, descriptive, analytical study conducted in the gynecology-obstetrics department of the CHU Gabriel Touré, from April 11th, 2016 to August 29th, 2016 (5 months). Data collection focused on the clinical and laboratory characteristics of healthcare-associated infections in patients during their hospitalization. Included in the study were any patients hospitalized in the Gynecology and Obstetrics Department who agreed to participate in the study. The criteria used to diagnose the associated infection were those of the Atlanta CDC. Operative wound monitoring was done up to the 30th postoperative day. Results: We have recorded 200 patients, out of whom 138 were operated on and 23 cases of bacterial infection associated with care (11.50%). The average age of the patients was 32.52 years ± 13.36 years against 29.36 years ± 10.28 years for the patients who did not present the infection. Seven point five percent of the evacuated patients had an infection associated with care. The most common types of infection were surgical site infection (60.86%), urinary tract infection (26.08%), endometritis and sepsis with 13.04% each. The isolated organisms were all resistant to Amoxicillin, to Amoxicillin + Clavulanic acid (88.88%) and to Ciprofloxacin (77.77%). The average duration of hospitalization for patients who developed the infection was 14.70 days. The lethality was 1.50%. The average cost of management of patients who developed the surgical site infection was 119,837 FCFA. Conclusion: The bacterial infections associated with the care remain frequent in our service and dominated by the infections of the operating site. Isolated organisms were all resistant to amoxicillin in 88.88% case ciprofloxacin.展开更多
文摘Objectives: To evaluate the various scoring systems, APACHE II, SOFA, SAPS II and MPM for the prediction of prognosis of the obstetric critically ill patients admitted in a well supported ICU unit. Material and methods: A prospective, observational study was conducted among all the obstetric patients admitted to the ICU between October 2011 and December 2012, during a period of 15 months. The data collected were of three categories: demographic, obstetric and ICU related. Results and Analysis: The patients admitted in the postpartum period (n = 28, 53.84%) were more than the antenatal admissions (n = 24, 46.16%). 32.69% of admissions were in the third trimester. The most common mode of delivery was emergency caesarean section (n = 27/40, 67.5%). Total caesarean deliveries were 35/40 = 87.5% in ICU patients. The mortality prediction scores were calculated for 41 patients only as acid blood gas analysis was not available for the rest. Patients required ventilation—51.92%, hemodialysis—19.23%, inotropic support—38.46%, blood transfusion—50%. Analysis of the statistical data for ICU parameters has shown that hospital stay (p = 0.011) and ventilation days (p = 0.014) are significant predictors of maternal outcome. Age (p = 0.789), ICU stay (p = 0.701) and RRT (p = 0.632) are not significant. Among the obstetric ICU admissions, hypertensive disorders of pregnancy (30.76%) was the predominant cause followed by obstetric haemorrhage (23.07%). Discussion: HELLP syndrome and eclampsia (n = 4, 57%) were the major causes of maternal deaths with anaesthetic mishaps accounting for 29% (n = 2). One (14%) death was due to Eisenmenger’s syndrome. In one case of H1N1 admitted with ARDS, caesarean section was done in MICU for worsening respiratory distress. The maternal mortality in this series of cases was 7/52 = 13.46%, excluding the unavoidable cases of maternal death (3 cases brain dead at admission and one cardiac arrest in emergency room), our maternal mortality rate is 3/48 = 6.25%. The predicted mortality as measured by all scoring systems (for 41 patients) was between 17% and 30%. The observed mortality was around 17%. Hence a reduction in mortality of 40% has been achieved due to intensive care. Conclusions: Leading cause of maternal mortality was HELLP syndrome. Hypertensive disorders of pregnancy were the most common cause of admission to ICU. In this study, all the scores were equally significant in predicting maternal mortality. Amongst the interventions done for these patients mechanical ventilation seems to have an influence on the overall outcome.
基金supported by The Japan Society for Promotion of Science(ID No.S15190)and awards to Professor Elisabeth Severinsson for her work at the Department of Midwifery and Women’s Health at the University of Tokyo.
文摘Systematic development of a patient safety culture is necessary because lack of quality care leads to human suffering. The aim of this review was to identify evidence of obstetric adverse events (AEs) and near-misses in the context of patient safety. We conducted a search of the published literature from Europe, Australia and the USA in the following databases: Cinahl, Cochrane, Maternity and Infant Care, Ovid, Pro-quest and PubMed, guided by PRISMA procedures. A total of 427 studies were screened, 15 full papers retrieved and nine studies included in the final thematic analysis. The selected papers address a broad spectrum of adverse patient safety events in obstetric care. The themes that emerged were: type of AEs, near-misses and their consequences, strategies to support and improve Patient Safety (PS) and domains related to the WHO Patient Safety competence outcomes. The findings of the first theme were grouped into the following categories: healthcare professionals’ perspectives on ethical conflicts, attributing blame and responsibility, and patients’ perspectives on lack of trust and involvement, as well as medication errors. The second theme, strategies to support interventions to improve PS, was based on two sub-themes: communicating effectively and gaining competence by learning from adverse events, while the third theme was domains related to the WHO Patient Safety competence outcomes. In conclusion, few studies have examined strategies for managing AEs despite the existence of programmes that target the implementation of changes, such as improved teamwork training. In addition to exploring strategies to make safety a priority for patients and healthcare professionals, it is of the utmost importance to improve communication with patients and between professionals in order to maintain and enhance safety. Efforts by organizations and individuals to continuously develop knowledge about the risk of AEs and the use of best practice guidelines are also essential.
基金Supported by National Key R and D Program of China,No.2022YFC3500704National Natural Science Foundation of China,No.82305376+1 种基金Project of Supporting Young Scientific and Technological Talents in Jiangsu Province in 2024,No.JSTJ-2024-380College Students'Innovative Entrepreneurial Training Plan Program,No.202310315029Z.
文摘Heart failure(HF)during pregnancy presents unique challenges due to the complex interplay between physiological changes and underlying cardiac conditions.Pregnancy-induced increases in blood volume,cardiac output,and heart rate can exacerbate pre-existing heart diseases or trigger new-onset HF,such as peripartum cardiomyopathy and preeclampsia-related HF.With pregnancy-related physiological changes altering pharmacokinetics,dosage adjustment becomes crucial,making its application limited to carefully selected cases where benefits outweigh the risks.Medication management for these patients requires a meticulous approach.Beta-blockers like metoprolol and bisoprolol are preferred despite limited evidence,and carvedilol may be cautiously used per clinical experience;atenolol is contraindicated for low-birth-weight risk.Diuretics(furosemide,bumetanide)are safe for congestion relief but warrant judicious dosing.Digoxin is generally safe but requires dose adjustment and regular monitoring due to pregnancy-induced pharmacokinetic alterations.Among positive inotropes,dobutamine exhibits favorable safety in pregnancy,whereas milrinone should be used cautiously for hypotension risk.Renin-angiotensin system inhibitors,mineralocorticoid receptor antagonists and sodium-glucose cotransporter 2 inhibitors are all contraindicated owing to risks of fetal malformations,male fetal feminization,and insufficient safety evidence,respectively.
文摘Introduction: Obstetric Fistulas (OF) constitute a major public health problem in developing countries in general and in Central African Republic (CAR) in particular because of its numerous consequences. The objective of this work is to contribute to the management of OF cases in CAR. Patients and Methods: This was a retrospective, descriptive and analytical study, including data from several OF care services. The study included 245 cases of OF, operated on from 2009 to 2018. The parameters studied were maternal and obstetrical data, sociodemographic data, the specific characteristics of the fistulas as well as the modalities and outcome of surgical treatment. The data collected came from six (6) OF surgical repair campaigns organized by the Ministry of Health and Population with the support of UNFPA. Results: We recorded 245 patients, representing a prevalence of 0.77% of OF per year. Among these patients, almost half (45.3%) were treated at the Sino-Central African Friendship University Hospital Center (CHUASC). The average age of the patients was 30 years (range 14 to 78 years). They were unschooled (53.9%) and primigravidas (35%). The fistulas had an average duration of evolution of 7.58 years. They were vesicovaginal in 25.3%. Types V and I dominated in 17.4% and 9.2%, respectively. In 85.9% of cases, fistulorrhaphy was performed, half of which (50.2%) via the upper route. The cure rate was 83.3%. Note that our study reveals statistically significant links between the evolution after surgery with age (p = 0.04 Conclusion: OF mainly affected women of childbearing age, uneducated, primiparous. Vesicovaginal fistula was the frequently encountered type and was manifested by urine loss clinically with a positive methylene blue test.
基金Supported by the Joint Funds of the National Natural Science Foundation of China,No.U23A20434National Natural Science Foundation of China,No.82301738,No.82371535,and No.82171518+1 种基金the National Key Research and Development Program of China,No.2021YFF1201204the Science and Technology Innovation Program of Hunan Province,No.2023RC3083.
文摘BACKGROUND Antenatal depression is a disabling mental disorder among pregnant women and may cause adverse outcomes for both the mother and the offspring.Early identification and intervention of antenatal depression can help to prevent adverse outcomes.However,there have been few population-based studies focusing on the association of social and obstetric risk factors with antenatal depression in China.AIM To assess the sociodemographic and obstetric factors of antenatal depression and compare the network structure of depressive symptoms across different risk levels based on a large Chinese population.METHODS The cross-sectional survey was conducted in Shenzhen,China from 2020 to 2024.Antenatal depression was assessed using the Chinese version of the Edinburgh Postnatal Depression Scale(EPDS),with a score of≥13 indicating the presence of probable antenatal depression.Theχ2 test and binary logistic regression were used to identify the factors associated with antenatal depression.Network analyses were conducted to investigate the structure of depressive symptoms across groups with different risk levels.RESULTS Among the 44220 pregnant women,the prevalence of probable antenatal depression was 4.4%.An age≤24 years,a lower level of education(≤12 years),low or moderate economic status,having a history of mental disorders,being in the first trimester,being a primipara,unplanned pregnancy,and pregnancy without pre-pregnancy screening were found to be associated with antenatal depression(all P<0.05).Depressive symptom networks across groups with different risk levels revealed robust interconnections between symptoms.EPDS8("sad or miserable")and EPDS4("anxious or worried")showed the highest nodal strength across groups with different risk levels.CONCLUSION This study suggested that the prevalence of antenatal depression was 4.4%.Several social and obstetric factors were identified as risk factors for antenatal depression.EPDS8("sad or miserable")and EPDS4("anxious or worried")are pivotal targets for clinical intervention to alleviate the burden of antenatal depression.Early identification of highrisk groups is crucial for the development and implementation of intervention strategies to improve the overall quality of life for pregnant women.
文摘This study focuses on the relationship between job stress and intention to leave among obstetric(OB)nurses in the context of China's birth policy adjustment,and provides a scientific basis for policymakers and healthcare administrators.This study used a non-experimental descriptive correlation design with a purposive sampling of 230 OB nurses from three tertiary hospitals in Jinan,Shandong Province.Participants were surveyed using three questionnaires and descriptive analysis;ANOVA and correlation analyses were used to analyze the relationship between participants'stressor levels and turnover intention.Pearson's correlation coefficient analysis showed that there was a positive correlation between nurses‘work stressors and turnover intention,with a correlation coefficient of r=0.53,a moderate positive correlation(P<0.001).Based on the survey data from three tertiary hospitals in Shandong Province,the obstetric nurses group has a medium level of work stressors,but a high turnover intention,highlighting the professional identity crisis.
文摘This paper analyzes the current research status of job satisfaction among obstetric nurses at home and abroad,including research methods,influencing factors,correlation relationships,and countermeasures to improve job satisfaction of obstetric nurses.It aims to provide a reference for subsequent studies on job satisfaction of obstetric nurses.
文摘Introduction: Access to the best quality of obstetrical care sometimes conceals acts and behaviors that fail to respect women’s physical, mental and social integrity. These negative experiences are referred to as obstetrical violence. The aim of this study is to contribute to improving the quality of maternal health care. Patient and Method: This was a cross-sectional study with a quantitative component carried out in the obstetrics and gynecology department of the Maman Elisabeth Domitien University Hospital from November 1 to 30, 2024. All women in childbed seen for postnatal consultations within 42 days of delivery were included. Results: We included 109 women. Age ranged from 16 to 44 years with a mean of 26.9 (±6.02). The majority of women were living in common-law unions with 79.8% and 57.8% of mothers having a secondary education level. More than half of the participants (52.9%) said that they had not been prepared for childbirth during prenatal follow-up and 44.0% had not freely chosen their path of delivery. The vaginal route was the most observed route of delivery (97.3%). Of all vaginal deliveries, episiotomy was performed in 21.7% and uterine revision in 66.0%. For episiotomies, 26.1% of women in childbed were informed about its performance and 87.0% had had a bad experience with this event. For women who had undergone a uterine revision, 52.9% had been informed of its performance and 77.1% had a bad experience with the event. Women in childbed had been victims of inappropriate acts and verbal aggression in 18.4% and 14.7% respectively. Of all the participants, 45.0% said they had experienced the birth episode badly. Conclusion: This study has given us an idea of the subject. However, a large-scale study will enable us to understand the different facets of this subject.
基金supported by the National Science Foundation of China(No.81873843)the National Science and Technology Pillar Program of China during the Twelfth Five-Year Plan Period(No.2014BA105B05)the Fundamental Research Funds for the Central Universities(No.2017 KFYXJJ102 and No.2019 KFYXKJC053).
文摘Objective Great obstetrical syndrome(GOS)represents a group of pregnancy-related diseases that result in inadequate placentation.Most GOS cases end in preterm,either spontaneously or indicatively,and the use of antenatal corticosteroids(ACS)is inevitably discussed.The placenta is an important,transient fetal-derived organ and is the embodiment of maternal or fetal well-being.However,few studies provide histological evidence of the placenta in GOS.This study aims to address these issues.Methods A total of 831 pregnant women were prospectively recruited.Placenta tissue was collected immediately and fixed with 4%paraformaldehyde solution for future H&E analysis.A novel checklist was devised to evaluate maternal vascular malperfusion sections on the basis of the commonly accepted Amsterdam placental workshop group consensus statement.Results A total of 131 patients were classified as having GOS.Comparisons between those with and without GOS revealed significant differences,including higher levels of distal villous hypoplasia,increased syncytial knots,accelerated villous maturation,and higher total scores in GOS.We found significant negative associations between GOS and neonatal weight,neonatal height,head circumference,placental surface area,placental volume,and placenta gross examination score.GOS neonates were 1.25 times more likely to have hyperbilirubinemia.Regarding the effect of ACS,a significant reduction in birthweight,height,and head circumference was observed,along with an increased risk of hyperbilirubinemia.Conclusion This study provides histological evidence of the GOS that supports the defective deep placentation hypothesis.Our research also contributes to benefit-risk consultation in the GOS,such as in cases of PE and FGR,where a balance between fetal lung maturation and short-term neonatal outcomes is crucial.
文摘In the new era,curriculum ideological and political education has become one of the core approaches for higher education to implement the fundamental task of moral education.Obstetrics and gynecology nursing is a professional basic course for medical nursing majors,featuring professionalism,humanism,and sociality,which has a natural fit with the integration of curriculum ideological and political education.Based on the professional characteristics of obstetrics and gynecology nursing teaching,this paper constructs a“six-in-one”integration path from six dimensions:integration goals,element excavation,content penetration,method innovation,evaluation system,and teacher team construction.It provides a reference for cultivating obstetrics and gynecology nursing talents with both exquisite professional skills and noble professional literacy.
文摘Clinical nursing in obstetrics and gynecology is far more than mere disease treatment and technical operations;it also carries profound humanistic care connotations.Through clinical practice analysis,this study systematically elaborates on the risks existing in clinical obstetrics and gynecology nursing,analyzes the importance of humanized nursing,and proposes corresponding application countermeasures.It is found that the application of the humanized nursing model in clinical obstetrics and gynecology nursing can effectively meet the physical,psychological,and social needs of patients,establish a harmonious nurse-patient relationship,and have positive clinical value in promoting the physical and mental rehabilitation of patients.It is worthy of extensive promotion and application in clinical practice.
基金supported by agrant of Key Research Center for Humanities and Social Sciences in Hubei Province
文摘The burden of maternal mortality (MM) and morbidity is especially high in Asia.However,China has made significant progress in reducing MM over the past two decades,and hence maternal death rate has declined considerably in last decade,To analyze availability and quality of emergency obstetric care (EmOC) received by women at Tongji Hospital,Wuhan,China,this study retrospectively analyzed various pregnancy-related complications at the hospital from 2000 to 2009.Two baseline periods of equal length were used for the comparison of variables.A total of 11 223 obstetric complications leading to MM were identified on a total of 15 730 hospitalizations,either 71.35％ of all activities.No maternal death was recorded.Mean age of women was 29.31 years with a wide range of 14-52 years.About 96.26％ of women had higher levels of schooling,university degrees and above and received the education of secondary school or college.About 3.74％ received primary education at period two (P2) from 2005 to 2009,which was significantly higher than that of period one (P1) from 2000 to 2004 (P＜0.05) (OR:0.586; 95％ CI:0.442 to 0.776).About 65.69％ were employed as skilled or professional workers at P2,which was significantly higher than that of P1 (P＜0.05).About 34.31％ were unskilled workers at P2,which was significantly higher than that of P1 (P＜0.05).Caesarean section was performed for 9,930 women (88.48％) and the percentage of the procedure increased significantly from 19.25％ at P1 to 69.23％ at P2 (P＜0.05).We were led to conclude that,despite the progress,significant gaps in the performance of maternal health services between rural and urban areas remain.However,MM reduction can be achieved in China.Priorities must include,but not limited to the following:secondary healthcare development,health policy and management,strengthening primary healthcare services.
文摘Vasopressors are routinely used to counteract hypotension after neuraxial anesthesia in Obstetrics. The understanding of the mechanism of hypotension and the choice of vasopressor has evolved over the years to a point where phenylephrine has become the preferred vasopressor. Due to the absence of definitive evidence showing absolute clinical benefit of one over the other, especially in emergency and high-risk Cesarean sections, our choice of phenylephrine over the other vasopressors like mephentermine, metaraminol, and ephedrine is guided by indirect evidence on fetalacid-base status. This review article evaluates the present day evidence on the various vasopressors used in obstetric anesthesia today.
文摘Purpose: This study was conducted to audit prophylactic antibiotic use and to quantify the rate of wound infection. Methods: Across-sectional prospective study was conducted in the Obstetrics and Gynecology Department in Khartoum Teaching Hospital, Sudan during March 1st to 31st October 2010. All Patients (aged >18 years) were included. Results: Overall 725 patients were included. The performed surgical procedures were 751;of these 578 (76.9%) were Caesarean sections. Overall rate of wound infection was 7.8%. The rate of wound infection among patients operated on for caesarean section and abdominal hysterectomy was 8.3%, and 9.2%, respectively. Multivariate logistic analysis showed that body mass index [BMI] ≥ 30 kg/m2 OR 2.1, 95% CI (1.1 - 4.0), (P = 0.019) was the major independent risk factor for occurrence of wound infection. Evaluation of prescriptions’ parameters against the stated criteria showed that 113 (15.8%) patients were given antibiotics with adequate spectrum of activity, 611 (85.3%) given sub-dose/s, 83 (11.6%) received the first preoperative dose/s in a proper time window, and 716 (100%) had prophylaxis for extended duration. Overall conformity to the stated criteria for the evaluation of prescription’s parameters was not achieved in all prescriptions. Conclusions: In this setting, antibiotics were irrationally used and wound infection rate was high, and the situation calls for multiple interventions to correct the situation, through the activation of the infection control committee in the hospital and development of antimicrobial subcommittee to develop policies for the use and auditing of prophylactic antibiotics.
基金supported by The National Social Science Fund of China(No.15BRK023)
文摘Objective: The aim of this study was to explore the correlation between psychological resilience and social support and anxiety in obstetric nurses and to provide theoretical basis for improving the mental health of obstetric nurses.Methods: In this study, 190 obstetric nurses were included, using the general information questionnaire and The Connor-Davidson Resilience Scale(CD-RISC), Social Support Rating Scale, and survey of Self-evaluation of Anxiety Scale.Results: There are differences in the type of work and the score of psychological resilience(P<0.05), obstetric nurses’ resilience score was 65.58±10.65; self-rating anxiety score of obstetric nurses was 36.89±6.87; and social support score of obstetric nurses was44.3717.86. The psychological elasticity score and anxiety were negatively related(P<0.01), whereas the resilience score and total score of social support were positively related(P<0.01).Conclusions: Obstetric nurses have many responsibilities and stress. Nursing managers should focus on obstetric nurses’ mental health, lighten the obstetric nurses’ anxiety, and thus improve their mental flexibility and optimize the quality of nursing service better,with more passion into work.
基金supported by the National Natural Science Foundation of China,No.81672240(to LC)
文摘The time window for repair of the lower trunk is shorter than that of the upper trunk in patients with obstetric brachial plexus palsy. The denervated intrinsic muscles of the hand become irreversibly atrophic much faster than the denervated biceps. However, it is unclear whether the motor endplates of the denervated interosseous muscles degenerate more rapidly than those of the denervated biceps. In this study, we used a rat model of obstetric brachial plexus palsy of the right upper limb. C5–6 was lacerated distal to the intervertebral foramina, with concurrent avulsion of C7–8 and T1, with the left upper limb used as the control. Bilateral interossei and biceps were collected at 5 and 7 weeks. Immunofluorescence was used to assess the morphology of the motor endplates. Real-time quantitative polymerase chain reaction and western blot assay were used to assess mRNA and protein expression levels of acetylcholine receptor subunits(α, β and δ), rapsyn and β-catenin. Immunofluorescence microscopy showed that motor endplates in the denervated interossei were fragmented, while those in the denervated biceps were morphologically intact with little fragmentation. The number and area of motor endplates, relative to the control side, were significantly lower in the denervated interossei compared with the denervated biceps. mRNA and protein expression levels of acetylcholine receptor subunits(α, β and δ) were significantly lower, whereas β-catenin protein expression was higher, in the denervated interossei compared with the denervated biceps. The protein expression of rapsyn was higher in the denervated biceps than in the denervated interossei at 7 weeks. Our findings demonstrate that motor endplates of interossei are destabilized, whereas those of the biceps remain stable, in the rat model of obstetric brachial plexus palsy. All procedures were approved by the Experimental Animal Ethics Committee of Fudan University, China(approval No. DF-187) in January 2016.
文摘Introduction: Obstetric Fistula (OF) is a tragedy and a public health problem (physical, social, moral and psychological). Objective: To determine the clinical, therapeutic and prognostic aspects of obstetric fistula at CHUD/B-A maternity ward in 2016. Study Method: This is a descriptive, analytic study with prospective data collection from March 07 to December 31, 2016. Patients with obstetric fistula were the study population. Results: A total of 37 patients were treated including 35 operated, the other two not operated for pyuria and bladder calculus after examination under spinal anesthesia. The average age was 36.6 ± 10.5 years with the extremes of 21 years and 65 years. The mean age of onset of Obstetric Fistula (OF) was 28.9 ± 6.5 years. Patients came from southern Benin (51.4%), were married (67.6%), peasant (35.1%) and out of school (81.1%). The types of OF were vesico-vaginal fistula (VVF) (62.2%), urethro-vaginal fistula (24.3%), vesico-uterine fistula (VUF) (5.4%), and uretero-vaginal fistula (2.7%). The fistula site was supra trigonal (54.1%), urethral (18.9%), trigonal (10.8%), vesico-uterine (10.8%), cervical urethral (2.7%), ureteroid vaginal (2.7%). Fistulas were complex (70.3%), complicated (24.3%) and simple (5.4%). The vaginal route was one of the first routes (64.9%). The operative techniques used were CHASSAR MOIR hysterorrhaphy (74.3%). The cure with continence was 68.6%. Conclusion: OF is observed in young women of childbearing age. VVF is the most common. The management is surgical with several operating techniques. Healing is possible. Hence the importance of paying special attention to these patients for their care.
文摘Background: Anemia is one of the most widely prevalent disorders, affecting the lives of almost half a billion women of reproductive age, contributing to over 100,000 maternal and almost 600,000 perinatal deaths (mostly through pre-term delivery, low birth weight) each year. Increased risk of infant mortality and reduced cognitive development and reduced energy levels which affect productivity in adults are cited. During pregnancy increased requirements, inadequate intake of iron and other micronutrients and parasitic (malaria, hookworm) as wells as bacterial (mostly urinary tract) infections are the main causes. In order to reduce such maternal and neonatal burden, it has been worldwide admitted to adopt cost-effective preventive interventions during pregnancy, including iron-folic acid supplementation, de-hookworming medication and anti-malarial prevention or treatment. Intestinal absorption of iron is limited by a lot of factors including bioavailability, iron status of the woman, substances accompanying or contained in diet, chelating agents such as diet fibers or calcium salts. Any supplementation put additional constraint in terms of absorption. Unabsorbed iron is known to have pro-oxidant properties likely to induce production of free radicals. These in turn might induce oxidative stress accountable for in generation of many obstetrical outcomes. This potential link between oxidative stress resulting from free radicals hyperproduction induced by non absorbed iron and harmful maternal/perinatal conditions is rarely questioned by searchers. Objectives: To determine overall (food and supplemented) iron consumption, iron and oxidative status in a cohort of pregnant women and to seek associations between findings and adverse obstetrical outcomes. Methods: At the University Clinics of Kinshasa, we designed a protocol for a prospective cohort study dealing with clinical and biochemical parameters of oxidative stress among pregnant women iron supplemented. Women with a single pregnancy not exceeding 19 weeks without obvious pathology, regardless of age and parity, were eligible for inclusion in the study. Conclusion: This study is expected to assess consequences of oral iron supplementation during pregnancy in terms of obstetrical outcomes associated with oxidative stress linked to unabsorbed iron.
文摘AIM: To analyze safety and efficacy of pelvic arterial embolization(PAE) in preventing and treating obstetrical hemorrhage.METHODS: A consecutive study of eight cases undergoing pelvic artery embolization from January 2010 to October 2012 in Department of Obstetric and Gynecology of Maulana Azad Medical College for intractable obstetric hemorrhage was done. All embolization were carried out in cath lab of cardiology Department at associated GB Pant Hospital.RESULTS: Clinical success was defined as arrest of bleeding after PAE without need for repeat PAE or additional surgery which was 75% in our series. PAE was successful in controlling obstetrical hemorrhage in all except one who had mortality. Other had hysterectomy due to secondary hemorrhage. Five resumed menstruation. None of the women intended to conceive, hence are practicing contraception. CONCLUSION: PAE is minimally invasive procedure which should be offered early for hemostasis in intractable obstetrical haemorrhage unresponsive to uterotonic. It is a fertility sparing option with minor complications.
文摘Introduction: Healthcare-associated infections (HAIs) are a public health issue. An infection is said to be associated with the care if it occurs during or after the care of a patient, and if it was neither present nor incubation at the beginning of the care. Objective: The purpose of this work was to study the bacteriology of infections associated with obstetric care in the gynecology-obstetrics department of CHU Gabriel Touré. Patients and Methods: This is an epidemiological, descriptive, analytical study conducted in the gynecology-obstetrics department of the CHU Gabriel Touré, from April 11th, 2016 to August 29th, 2016 (5 months). Data collection focused on the clinical and laboratory characteristics of healthcare-associated infections in patients during their hospitalization. Included in the study were any patients hospitalized in the Gynecology and Obstetrics Department who agreed to participate in the study. The criteria used to diagnose the associated infection were those of the Atlanta CDC. Operative wound monitoring was done up to the 30th postoperative day. Results: We have recorded 200 patients, out of whom 138 were operated on and 23 cases of bacterial infection associated with care (11.50%). The average age of the patients was 32.52 years ± 13.36 years against 29.36 years ± 10.28 years for the patients who did not present the infection. Seven point five percent of the evacuated patients had an infection associated with care. The most common types of infection were surgical site infection (60.86%), urinary tract infection (26.08%), endometritis and sepsis with 13.04% each. The isolated organisms were all resistant to Amoxicillin, to Amoxicillin + Clavulanic acid (88.88%) and to Ciprofloxacin (77.77%). The average duration of hospitalization for patients who developed the infection was 14.70 days. The lethality was 1.50%. The average cost of management of patients who developed the surgical site infection was 119,837 FCFA. Conclusion: The bacterial infections associated with the care remain frequent in our service and dominated by the infections of the operating site. Isolated organisms were all resistant to amoxicillin in 88.88% case ciprofloxacin.
