ABSTRACT
<p><b>INTRODUCTION</b>This study aimed to identify predictors of the outcome and clinical efficacy of emergency pelvic artery embolisation (PAE) for primary postpartum haemorrhage (PPH) and to assess the post-embolisation fertility of PAE patients in a regional hospital setting.</p><p><b>METHODS</b>A 12-year retrospective study of patients undergoing emergency PAE was conducted at a regional acute general hospital. Clinical and procedural parameters, clinical outcomes and post-embolisation pregnancy success rates were analysed.</p><p><b>RESULTS</b>There were 47,221 deliveries at the hospital during the study period, of which 33 patients required urgent PAE for primary PPH. The technical success rate of embolisation was 97.0% (n = 32). Clinically adequate haemostasis was achieved by a single embolisation procedure in 24 (72.7%) patients; the remaining eight eventually required surgery to achieve cessation of bleeding. Among the parameters studied, multivariate logistic regression analysis showed that pre-embolisation platelet count (p = 0.036) and maternal age (p = 0.019) were the only significant independent predictors of embolisation failure. Only two patients successfully conceived after PAE, although one of them had an ectopic pregnancy.</p><p><b>CONCLUSION</b>Emergency PAE is an effective measure to arrest life-threatening bleeding in patients with primary PPH. As low pre-embolisation platelet count and advanced maternal age are associated with higher odds of embolisation failure, careful post-embolisation monitoring may be required for such patients. Embolisation also allows subsequent pregnancy. However, further studies are required to assess the outcomes of post-embolisation pregnancies.</p>
ABSTRACT
PURPOSE: The objectives of this study were to identify the prevalence and rationales of traditional Chinese pregnancy restrictions and to investigate the relationship between pregnancy restriction, health-related quality of life, and perceived stress level at a two-stage design. METHODS: Stage I consisted of exploring the traditional Chinese pregnancy restrictions and their underlying beliefs based on extensive literature review followed by in-depth interviews with 30 pregnant women. Stage II investigated the relationship between pregnancy restrictions, health-related quality of life, and perceived stress among 1,151 women. Self-developed traditional Chinese pregnancy restrictions lists were measured on adherence towards the traditional Chinese pregnancy restriction. Perceived stress and health-related quality of life were measured by the Perceived Stress Scale and the Short Form-12 (SF-12) Health Survey, respectively. RESULTS: The majority of the women adhered to traditional Chinese pregnancy restrictions in order to protect the unborn child from danger and to avoid the problems associated pregnancy and birth, such as miscarriage, stillbirth, death of the mother, and imperfections in the newborn. Pregnant women who adhered to behavioral restrictions were more likely to associate with poor physical component of healthrelated quality of life. However, there was no significant difference between pregnancy restrictions and Perceived Stress Scale scores. CONCLUSION: The findings provided cultural rationales of pregnancy restrictions within a Macao context that may assist health professionals to better understand women from different cultures. It is essential in the development of culturally appropriate healthcare to support women in making a healthy transition to motherhood.
Subject(s)
Child , Female , Humans , Infant, Newborn , Pregnancy , Abortion, Spontaneous , Asian People , China , Delivery of Health Care , Health Occupations , Health Surveys , Macau , Mothers , Parturition , Pregnant Women , Prevalence , Quality of Life , Stillbirth , Stress, PsychologicalABSTRACT
<p><b>BACKGROUND</b>The rise of the production of CTX-M class extended spectrum β-lactamases (ESBLs) has been well documented in traveling countries but no data are found for Macao, an international travel city. The objectives of this study were to identify the antimicrobial resistance pattern, and determine the prevalence, genotype and clonal relationship of ESBLs in 209 clinical Escherichia coli strains from Macao, China.</p><p><b>METHODS</b>Antimicrobial susceptibility test was performed to determine the resistance patterns of the isolates using the disk diffusion method with 17 antimicrobial agents. Phenotypic detection was screened and confirmed according to the Clinical and Laboratory Standards Institute. Genotypic characterization was detected by isoelectric focusing analysis, polymerase chain reaction and sequencing. The clonal relationship between the different ESBL isolates was studied by pulsed-field gel electrophoresis (PFGE).</p><p><b>RESULTS</b>Imipenem and meropenem exhibited 100% susceptible among 209 strains. Overall, 82.3%, 67.3%, 52.9%, 51.2% and 51.0% of the isolates displayed resistance to ampicillin, tetracycline, ciprofloxacin, sulfamethoxazole trimethoprim and gentamycin. The prevalence rate of ESBLs was 30.1%. Antibiotic resistances were found to be significantly higher among the ESBL producing group compared to non-ESBL producing group. We detected CTX-M-14 to be the major genotypic characterization of ESBLs (76.2%). Two strains showed indistinguishable patterns by PFGE.</p><p><b>CONCLUSIONS</b>The prevalence of antimicrobial resistance is alarming high in Macao. Antimicrobial resistance is significantly higher among the ESBL producing group. This study documented CTX-M-14 as the predominant ESBL type. Although indistinguishable pattern was found between two strains, it was too small to decide whether any of the investigated strains was epidemic. Our findings may be also pertinent for other geographic areas undergoing similar travel characteristics to understand the corresponding effects on bacterial populations.</p>