Introduction: In spite of significant progress towards eliminating mother-to-child transmission (MCT) of HIV by 2025, trends in vertical mother-to-child transmission are still worrying in sub-Saharan African countries...Introduction: In spite of significant progress towards eliminating mother-to-child transmission (MCT) of HIV by 2025, trends in vertical mother-to-child transmission are still worrying in sub-Saharan African countries. This study aims to take stock of the factors associated with HIV MCT at the level of peripheral health training. Patients and Methods: This was a descriptive and analytical retrospective study, over a five-year period from January 1<sup>st</sup>, 2017 to December 31<sup>st</sup>, 2021. The study population was represented by HIV-positive women and their cared infants in the Parent-Child Transmission Prevention Unit (PCTP) of the Castors Urban Health Center (CUHC). Results: 288 medical records were selected out of a total of 347 HIV-positive mothers followed. HIV seroprevalence in the population of women who received PreNatal Consultation (PNC) during the study period was 8.2%. The HIV MCT rate was 3.7%. HIV+ mothers followed were mostly young (average age of 28), not living in a couple (96.9%), poorly educated (58.7%) and not engaged in income-generating activity (58.4%). They had all received triple therapy and the period of initiation of antiretroviral (ARV) therapy was in the majority of cases during the first trimester. Factors associated with MCT were: primiparity (OR = 18.4 [5.55 - 61.05];Khi<sup>2</sup> = 32.61;p < 0.001), late discovery of infection during large or after childbirth (OR = 0.03 [0.007 - 0.10];Khi<sup>2</sup> = 55.22;p < 0.001), WHO Clinical Stage 2 and 3 (OR = 0.007 [0.001 - 0.03];Khi<sup>2</sup> = 108.73;p < 0.001), CD4 count 200/mm<sup>3</sup> (OR = 14.12 [4.03 - 57.20];Khi<sup>2</sup> = 21.68;p < 0.001), viral load > 1000 copies/mm<sup>3</sup> (OR = 8.85 [2.33 - 43.20];Khi<sup>2</sup> = 10.46;p = 0.001), prolonged labor (OR = 12.33 [3.45 - 57.25];Khi<sup>2</sup> = 18.47;p < 0.001), premature rupture of membranes (OR = 24.03 [6.97 - 96.01];Khi<sup>2</sup> = 40.60;p <sup>2</sup> = 5.96;p = 0.014), and artificial or mixed breastfeeding (OR = 0.01 [0.002 - 0.043];Khi<sup>2</sup> = 97.65;p Conclusion: Taking into account the risk factors for PCTP is essential if we want to achieve the goal of “Zero New Infections in Children by the year 2025”.展开更多
Introduction: Innovations in surgical and anaesthetic techniques to provide a good maternal and child safety have made the cesarean section a routine intervention in obstetrics. However, its complications, especially ...Introduction: Innovations in surgical and anaesthetic techniques to provide a good maternal and child safety have made the cesarean section a routine intervention in obstetrics. However, its complications, especially the short or long term per and postoperative maternal ones, are not exceptional and can affect mothers’ vital prognosis. The objectives of this study were to describe the maternal per and postoperative complications encountered during the cesarean section. Patients and method: This is a prospective, descriptive and analytical study carried out at the maternity ward of Kankan Regional Hospital over a 6 month period from January 1, 2018 to June 30, 2018. Results: During this period, out of a total of 2229 deliveries, 319 caesarean sections were performed i.e. a rate of 12.51%. Complications concerned 111 patients (34.79%). The average age was 28 with extremes of 15 and 45. Non-medical transportation concerned 71.17% of our patients. The cesarean section was performed in emergency situations in 82.8% of cases. Indications were dominated by the fetopelvic disproportion. There was a statistically significant relationship between labour duration and the occurrence of complications. Intraoperative complications were dominated by bleeding (25.22% of all complications and 8.77% of total cesarean sections). Post-operative complications were dominated by parietal suppurations (94.49% of all complications and 34.79% of the total number of cesarean sections). In most cases, patients simultaneously developed several complications. Conclusion: The maternal complications of cesarean sections remain considerable. If the increase in the rate of caesarean sections has contributed to the improvement of the mother-fetal prognosis, the surgical procedure itself is not without complications, which encourages us to review its indications for a better management. Hemorrhagic and infectious complications were the most frequent. These results call for increased asepsis measures in our operation theaters to reduce infectious complications. The increase in Caesarean section rates over the years is faced with increased maternal morbidity in the short and long term. Its indications should be well thought out and should include the responsibility of an experienced obstetrician.展开更多
Obesity rates are increasing in Cameroon. Obstetric literature has recently focused on the rising incidence of complications with increases in weight gain in pregnancy. Some of these complications include gestational ...Obesity rates are increasing in Cameroon. Obstetric literature has recently focused on the rising incidence of complications with increases in weight gain in pregnancy. Some of these complications include gestational diabetes, hypertensive disorders, operative deliveries, genital tract lacerations and fetal birth trauma. Examining the effects of excess weight gain during the course of pregnancy could help identify weight gain limits. The Institute of Medicine (IOM) was recommended by the World Health Organization (WHO) to develop guidelines for weight gain during pregnancy and we designed this study in order to determine delivery outcomes when weight is gained above these guidelines. We also sought to know if these guidelines are applicable in our environment. In this cross-sectional analytic design, pre-pregnancy and intra-partum BMIs were calculated for all the parturients who consented. They were classified into normal weight gain and excessive weight gain based on IOM recommendations. Those in the normal weight gain group were women with BMIs that ranged between 18.5 kg/m2 and 30 kg/m2 and who gained 9 - 16 kgs. Those who gained weight above these range were considered as having gained excessive weight during pregnancy. They were all follow-up in labor using the partogram. We compared prepartum, intra-partum and post-partum outcomes in the two groups by calculating odds ratios (ORs), 95% confidence intervals and p values. One hundred and ten (110) overweight women were matched against the same number of women who had normal weight gain. There was no significant difference between social status, marital status as well as level of educational and weight gain in the two groups. Underweight (BMI p = 0.048). Women who gained weight above the recommended range suffered from preeclampsia 18.2% vs. 6.4% (OR 3.2, 95% CI 1.3 - 8.0, p = 0.014), higher cesarean section rates 27.3% vs. 10% (OR 3.3, 95% CI 1.5 - 7.1, p = 0.002), higher rates of induced labor 19.1% vs. 9.0% (OR 2.4, 95% CI 1.0 - 5.2, p = 0.05), prolonged labor 43.6% vs. 16.4% (OR 4.0, 95% CI 2.1 - 7.4, p = 0.000), postpartum hemorrhage 10% vs. 1.8% (OR 6.2, 95% CI 1.3 - 9.2, p = 0.002). There were also higher rates of fetal mal-presentation, 11.8% vs. 3.6% (OR 4.0, 95% CI 1.31 - 11.9, p = 0.004), macrosomia 30.9% vs. 6.4% (OR 7.0, 95% CI 2.7 - 15.6, p p = 0.0045) and birth trauma 10% vs. 1.8%. (OR 6.2, 95% CI 1.3 - 9.2, p = 0.023). Women who gained weight during pregnancy above the recommended range had increased risk of adverse obstetric and neonatal outcomes.展开更多
Preeclampsia(PE)is a pregnancy-specific syndrome,complicating 2%-8% of pregnancies.PE is a major cause of maternal mortality throughout the world with 60000 maternal deaths attributed to hypertensive disorders of preg...Preeclampsia(PE)is a pregnancy-specific syndrome,complicating 2%-8% of pregnancies.PE is a major cause of maternal mortality throughout the world with 60000 maternal deaths attributed to hypertensive disorders of pregnancy.PE also results in fetal morbidity due to prematurity and fetal growth restriction.The precise aetiology of PE remains an enigma with multiple theories including a combination of environmental,immunological and genetic factors.The conventional and leading hypotheses for the initial insult in PE is inadequate trophoblast invasion which is thought to result in incomplete remodelling of uterine spiral arteries leading to placental ischaemia,hypoxia and thus oxidative stress.The significant heterogeneity observed in pre-eclampsia cannot be solely explained by the placental model alone.Herein we critically evaluate the clinical(risk factors,placental blood flow and biomarkers)and pathological(genetic,molecular,histological)correlates for PE.Furthermore,we discuss the role played by the(dysfunctional)maternal cardiovascular system in the aetiology of PE.We review the evidence that demonstrates a role for both the placenta and the cardiovascular system in early-and late-onset PE and highlight some of the key differences between these two distinct disease entities.展开更多
The population plagued with the HIV/AIDS pandemic in Cameroon is young, a generation that may desire or control fertility. For those who may become pregnant, the desire to have children may not be there. We carried ou...The population plagued with the HIV/AIDS pandemic in Cameroon is young, a generation that may desire or control fertility. For those who may become pregnant, the desire to have children may not be there. We carried out this study to look at the picture of the reproductive health needs of women living with HIV/AIDS in our setting. In this cross-sectional non-analytic design that lasted for three years, we employed both qualitative and quantitative methods to collect data from them after receiving ethical clearance (N221/CM/2009) from the National Ethics Committee. Consenting HIV infected women who were attending the “HIV Day Care” clinics and those who delivered and were in the post partum wards in four of our major hospitals in Yaounde were enrolled. Interviews were individualized. We used both CSPro version 4.1 and Statistical Package for Social Sciences (SPSS) version 19.0 softwares for data analysis. Four hundred and fifteen (415) women were enrolled;the mean age was 29 ± 7.8 years;the most represented age group was 24 -29 years. They were single (36.14%), well educated (5 out of 10 had attained university level of education), 61.20% revealed that their partners knew their HIV status, 82.4% believed that screening for cancer of the cervix was necessary for their status and 47.70% would want to be screened for some or all STIs. About 36.86% had the desire to have children, 57.1% of those who delivered did not plan to have the pregnancies out of which 82% would have wanted a modern method of contraception but did not have (82% unmet needs). Modern contraceptive use was associated with age and individual characteristics such as level of education. It was 64.34% among women who had secondary level of education and below as against 35.66% among those who had high school level of education and above. Contraceptive use was also high among women who were unmarried as against those who were married (89.64% vs 10.36%). The desire to have children decreased as age increased (43.85% vs 18.79%) and was lower among married women compared to those who were single (13.01% versus 49.64%). These women were found to have high unmet needs for modern contraception and showed interest in STIs and cervical cancer screening.展开更多
Induction of labor has been in practice for several decades but the decision to induce labor in multifetal gestations has not been accepted by many practitioners in contemporary obstetrics. The aim of this study was t...Induction of labor has been in practice for several decades but the decision to induce labor in multifetal gestations has not been accepted by many practitioners in contemporary obstetrics. The aim of this study was to compare maternal and fetal outcomes among women with uncomplicated twin gestations who were induced at term and those who were not. It was a cross-sectional analytic study that lasted ten years, (1st January 2000 to 31st December 2009 inclusive) at the maternity of the central hospital, Yaounde, Cameroon. 158 women were enrolled, 79 were induced and 79 went into labor spontaneously. Maternal and fetal outcomes, duration of labor, the prevalence of caesarean section were compared in the two groups. The average age of the women in the groups was 26, 75 ± 3.65 years (range 15 - 41 years). For those who were induced, indication was premature rupture of membranes in 44 (56%) of cases. The characteristics of induced and none induced women were similar, except for the number of antenatal consultations (P ≤ 0.001). There was a significant difference in the duration of labor in the two groups (6 hrs versus 9, 75 hrs;P ≤ 0.001). The overall rate of vaginal delivery in the two groups was 87, 97% (n = 139), 88.87% in the group that was induced versus 86.07% in the group that labor was spontaneous (OR 1, 22;95% IC 0, 51-2, 92;p ≤ 0.90). With respect to primary outcomes, there were no statistically significant differences between the group that labor was induced and that which labor was spontaneous. The prevalence of caesarean delivery was similar in the two groups (10%, 12% vs 13%, 92%;OR 0%, 7%;95% IC 0, 27-1, 85;P ≤ 0.50). The main indications for caesarean section were acute fetal distress and failed induction. The first and fifth minute APGAR scores less than 7 in the first twins delivered in the two groups were similar. The 312 children delivered in both arms did not show any complications at birth. However, there were 3 neonatal deaths (1 vs 2). There were no cases of uterine rupture or maternal deaths among the 156 women. Induction of labor may be proposed to women with uncomplicated term twin gestations with specific indications. Induction in these highly selected cases does not impute any additional risks but close monitoring of labor is very necessary.展开更多
Aims:To assess what proportion of all cardiac abnormality can be suspected at birth when all clinical examination before discharge is undertaken by a small stable team of clinicians.Methods:A prospective audit of all ...Aims:To assess what proportion of all cardiac abnormality can be suspected at birth when all clinical examination before discharge is undertaken by a small stable team of clinicians.Methods:A prospective audit of all the 14 572 births in a maternity unit only staffed by nurse practitioners between 1996 and 2003. Results:1.2%of all babies born in the unit were found to have a structural defect (as confirmed by echocardiography)within a year of birth. The number not suspected before discharge declined over time,and only 6%were first suspected after discharge in the last four years of this eight year study. Four potentially life threatening conditions initially went unsuspected in 1996-8,but none after that. A policy of referring every term baby with a murmur at 1 day of age that was still present at 7-10 days resulted in 4.2%requiring cardiac referral; 54%of these babies still had a murmur when assesse done to two weeks later,and 33%had a structural defect. Parents said in independent,retrospectively conducted,interviews that they found it confidence building to have any possible heart defect identified early and the cause of any murmur clearly and authoritatively explained. Conclusions:Effective screening requires experience and a clear,structured,referral pathway,but can work much better than most previous reports suggest.Whether staff bring a medical or nursing background to the task may well be of less importance.展开更多
文摘Introduction: In spite of significant progress towards eliminating mother-to-child transmission (MCT) of HIV by 2025, trends in vertical mother-to-child transmission are still worrying in sub-Saharan African countries. This study aims to take stock of the factors associated with HIV MCT at the level of peripheral health training. Patients and Methods: This was a descriptive and analytical retrospective study, over a five-year period from January 1<sup>st</sup>, 2017 to December 31<sup>st</sup>, 2021. The study population was represented by HIV-positive women and their cared infants in the Parent-Child Transmission Prevention Unit (PCTP) of the Castors Urban Health Center (CUHC). Results: 288 medical records were selected out of a total of 347 HIV-positive mothers followed. HIV seroprevalence in the population of women who received PreNatal Consultation (PNC) during the study period was 8.2%. The HIV MCT rate was 3.7%. HIV+ mothers followed were mostly young (average age of 28), not living in a couple (96.9%), poorly educated (58.7%) and not engaged in income-generating activity (58.4%). They had all received triple therapy and the period of initiation of antiretroviral (ARV) therapy was in the majority of cases during the first trimester. Factors associated with MCT were: primiparity (OR = 18.4 [5.55 - 61.05];Khi<sup>2</sup> = 32.61;p < 0.001), late discovery of infection during large or after childbirth (OR = 0.03 [0.007 - 0.10];Khi<sup>2</sup> = 55.22;p < 0.001), WHO Clinical Stage 2 and 3 (OR = 0.007 [0.001 - 0.03];Khi<sup>2</sup> = 108.73;p < 0.001), CD4 count 200/mm<sup>3</sup> (OR = 14.12 [4.03 - 57.20];Khi<sup>2</sup> = 21.68;p < 0.001), viral load > 1000 copies/mm<sup>3</sup> (OR = 8.85 [2.33 - 43.20];Khi<sup>2</sup> = 10.46;p = 0.001), prolonged labor (OR = 12.33 [3.45 - 57.25];Khi<sup>2</sup> = 18.47;p < 0.001), premature rupture of membranes (OR = 24.03 [6.97 - 96.01];Khi<sup>2</sup> = 40.60;p <sup>2</sup> = 5.96;p = 0.014), and artificial or mixed breastfeeding (OR = 0.01 [0.002 - 0.043];Khi<sup>2</sup> = 97.65;p Conclusion: Taking into account the risk factors for PCTP is essential if we want to achieve the goal of “Zero New Infections in Children by the year 2025”.
文摘Introduction: Innovations in surgical and anaesthetic techniques to provide a good maternal and child safety have made the cesarean section a routine intervention in obstetrics. However, its complications, especially the short or long term per and postoperative maternal ones, are not exceptional and can affect mothers’ vital prognosis. The objectives of this study were to describe the maternal per and postoperative complications encountered during the cesarean section. Patients and method: This is a prospective, descriptive and analytical study carried out at the maternity ward of Kankan Regional Hospital over a 6 month period from January 1, 2018 to June 30, 2018. Results: During this period, out of a total of 2229 deliveries, 319 caesarean sections were performed i.e. a rate of 12.51%. Complications concerned 111 patients (34.79%). The average age was 28 with extremes of 15 and 45. Non-medical transportation concerned 71.17% of our patients. The cesarean section was performed in emergency situations in 82.8% of cases. Indications were dominated by the fetopelvic disproportion. There was a statistically significant relationship between labour duration and the occurrence of complications. Intraoperative complications were dominated by bleeding (25.22% of all complications and 8.77% of total cesarean sections). Post-operative complications were dominated by parietal suppurations (94.49% of all complications and 34.79% of the total number of cesarean sections). In most cases, patients simultaneously developed several complications. Conclusion: The maternal complications of cesarean sections remain considerable. If the increase in the rate of caesarean sections has contributed to the improvement of the mother-fetal prognosis, the surgical procedure itself is not without complications, which encourages us to review its indications for a better management. Hemorrhagic and infectious complications were the most frequent. These results call for increased asepsis measures in our operation theaters to reduce infectious complications. The increase in Caesarean section rates over the years is faced with increased maternal morbidity in the short and long term. Its indications should be well thought out and should include the responsibility of an experienced obstetrician.
文摘Obesity rates are increasing in Cameroon. Obstetric literature has recently focused on the rising incidence of complications with increases in weight gain in pregnancy. Some of these complications include gestational diabetes, hypertensive disorders, operative deliveries, genital tract lacerations and fetal birth trauma. Examining the effects of excess weight gain during the course of pregnancy could help identify weight gain limits. The Institute of Medicine (IOM) was recommended by the World Health Organization (WHO) to develop guidelines for weight gain during pregnancy and we designed this study in order to determine delivery outcomes when weight is gained above these guidelines. We also sought to know if these guidelines are applicable in our environment. In this cross-sectional analytic design, pre-pregnancy and intra-partum BMIs were calculated for all the parturients who consented. They were classified into normal weight gain and excessive weight gain based on IOM recommendations. Those in the normal weight gain group were women with BMIs that ranged between 18.5 kg/m2 and 30 kg/m2 and who gained 9 - 16 kgs. Those who gained weight above these range were considered as having gained excessive weight during pregnancy. They were all follow-up in labor using the partogram. We compared prepartum, intra-partum and post-partum outcomes in the two groups by calculating odds ratios (ORs), 95% confidence intervals and p values. One hundred and ten (110) overweight women were matched against the same number of women who had normal weight gain. There was no significant difference between social status, marital status as well as level of educational and weight gain in the two groups. Underweight (BMI p = 0.048). Women who gained weight above the recommended range suffered from preeclampsia 18.2% vs. 6.4% (OR 3.2, 95% CI 1.3 - 8.0, p = 0.014), higher cesarean section rates 27.3% vs. 10% (OR 3.3, 95% CI 1.5 - 7.1, p = 0.002), higher rates of induced labor 19.1% vs. 9.0% (OR 2.4, 95% CI 1.0 - 5.2, p = 0.05), prolonged labor 43.6% vs. 16.4% (OR 4.0, 95% CI 2.1 - 7.4, p = 0.000), postpartum hemorrhage 10% vs. 1.8% (OR 6.2, 95% CI 1.3 - 9.2, p = 0.002). There were also higher rates of fetal mal-presentation, 11.8% vs. 3.6% (OR 4.0, 95% CI 1.31 - 11.9, p = 0.004), macrosomia 30.9% vs. 6.4% (OR 7.0, 95% CI 2.7 - 15.6, p p = 0.0045) and birth trauma 10% vs. 1.8%. (OR 6.2, 95% CI 1.3 - 9.2, p = 0.023). Women who gained weight during pregnancy above the recommended range had increased risk of adverse obstetric and neonatal outcomes.
文摘Preeclampsia(PE)is a pregnancy-specific syndrome,complicating 2%-8% of pregnancies.PE is a major cause of maternal mortality throughout the world with 60000 maternal deaths attributed to hypertensive disorders of pregnancy.PE also results in fetal morbidity due to prematurity and fetal growth restriction.The precise aetiology of PE remains an enigma with multiple theories including a combination of environmental,immunological and genetic factors.The conventional and leading hypotheses for the initial insult in PE is inadequate trophoblast invasion which is thought to result in incomplete remodelling of uterine spiral arteries leading to placental ischaemia,hypoxia and thus oxidative stress.The significant heterogeneity observed in pre-eclampsia cannot be solely explained by the placental model alone.Herein we critically evaluate the clinical(risk factors,placental blood flow and biomarkers)and pathological(genetic,molecular,histological)correlates for PE.Furthermore,we discuss the role played by the(dysfunctional)maternal cardiovascular system in the aetiology of PE.We review the evidence that demonstrates a role for both the placenta and the cardiovascular system in early-and late-onset PE and highlight some of the key differences between these two distinct disease entities.
文摘The population plagued with the HIV/AIDS pandemic in Cameroon is young, a generation that may desire or control fertility. For those who may become pregnant, the desire to have children may not be there. We carried out this study to look at the picture of the reproductive health needs of women living with HIV/AIDS in our setting. In this cross-sectional non-analytic design that lasted for three years, we employed both qualitative and quantitative methods to collect data from them after receiving ethical clearance (N221/CM/2009) from the National Ethics Committee. Consenting HIV infected women who were attending the “HIV Day Care” clinics and those who delivered and were in the post partum wards in four of our major hospitals in Yaounde were enrolled. Interviews were individualized. We used both CSPro version 4.1 and Statistical Package for Social Sciences (SPSS) version 19.0 softwares for data analysis. Four hundred and fifteen (415) women were enrolled;the mean age was 29 ± 7.8 years;the most represented age group was 24 -29 years. They were single (36.14%), well educated (5 out of 10 had attained university level of education), 61.20% revealed that their partners knew their HIV status, 82.4% believed that screening for cancer of the cervix was necessary for their status and 47.70% would want to be screened for some or all STIs. About 36.86% had the desire to have children, 57.1% of those who delivered did not plan to have the pregnancies out of which 82% would have wanted a modern method of contraception but did not have (82% unmet needs). Modern contraceptive use was associated with age and individual characteristics such as level of education. It was 64.34% among women who had secondary level of education and below as against 35.66% among those who had high school level of education and above. Contraceptive use was also high among women who were unmarried as against those who were married (89.64% vs 10.36%). The desire to have children decreased as age increased (43.85% vs 18.79%) and was lower among married women compared to those who were single (13.01% versus 49.64%). These women were found to have high unmet needs for modern contraception and showed interest in STIs and cervical cancer screening.
文摘Induction of labor has been in practice for several decades but the decision to induce labor in multifetal gestations has not been accepted by many practitioners in contemporary obstetrics. The aim of this study was to compare maternal and fetal outcomes among women with uncomplicated twin gestations who were induced at term and those who were not. It was a cross-sectional analytic study that lasted ten years, (1st January 2000 to 31st December 2009 inclusive) at the maternity of the central hospital, Yaounde, Cameroon. 158 women were enrolled, 79 were induced and 79 went into labor spontaneously. Maternal and fetal outcomes, duration of labor, the prevalence of caesarean section were compared in the two groups. The average age of the women in the groups was 26, 75 ± 3.65 years (range 15 - 41 years). For those who were induced, indication was premature rupture of membranes in 44 (56%) of cases. The characteristics of induced and none induced women were similar, except for the number of antenatal consultations (P ≤ 0.001). There was a significant difference in the duration of labor in the two groups (6 hrs versus 9, 75 hrs;P ≤ 0.001). The overall rate of vaginal delivery in the two groups was 87, 97% (n = 139), 88.87% in the group that was induced versus 86.07% in the group that labor was spontaneous (OR 1, 22;95% IC 0, 51-2, 92;p ≤ 0.90). With respect to primary outcomes, there were no statistically significant differences between the group that labor was induced and that which labor was spontaneous. The prevalence of caesarean delivery was similar in the two groups (10%, 12% vs 13%, 92%;OR 0%, 7%;95% IC 0, 27-1, 85;P ≤ 0.50). The main indications for caesarean section were acute fetal distress and failed induction. The first and fifth minute APGAR scores less than 7 in the first twins delivered in the two groups were similar. The 312 children delivered in both arms did not show any complications at birth. However, there were 3 neonatal deaths (1 vs 2). There were no cases of uterine rupture or maternal deaths among the 156 women. Induction of labor may be proposed to women with uncomplicated term twin gestations with specific indications. Induction in these highly selected cases does not impute any additional risks but close monitoring of labor is very necessary.
文摘Aims:To assess what proportion of all cardiac abnormality can be suspected at birth when all clinical examination before discharge is undertaken by a small stable team of clinicians.Methods:A prospective audit of all the 14 572 births in a maternity unit only staffed by nurse practitioners between 1996 and 2003. Results:1.2%of all babies born in the unit were found to have a structural defect (as confirmed by echocardiography)within a year of birth. The number not suspected before discharge declined over time,and only 6%were first suspected after discharge in the last four years of this eight year study. Four potentially life threatening conditions initially went unsuspected in 1996-8,but none after that. A policy of referring every term baby with a murmur at 1 day of age that was still present at 7-10 days resulted in 4.2%requiring cardiac referral; 54%of these babies still had a murmur when assesse done to two weeks later,and 33%had a structural defect. Parents said in independent,retrospectively conducted,interviews that they found it confidence building to have any possible heart defect identified early and the cause of any murmur clearly and authoritatively explained. Conclusions:Effective screening requires experience and a clear,structured,referral pathway,but can work much better than most previous reports suggest.Whether staff bring a medical or nursing background to the task may well be of less importance.
