Educational technology for primigravidae: a quasi-experimental study / Tecnología educacional para primigestas: estudio casi experimental / Tecnologia educacional para primigestas: estudo quase experimental

ABSTRACT Objective: To analyze the influence of an educational technology on the knowledge of primigravidae about the signs of labor and obstetric risk. Method: A quasi-experimental, before-and-after, non-randomized and non-concurrent study carried out with 90 primigravidae. For data analysis, descriptive statistics was applied,McNemarandStudent's t test. The project was submitted and approved by the Research Ethics Committee in 2020. Results: The profile of the pregnant women corresponded to women with an average age of 23 years, brown, living in a common-law marriage, and with an average of 10 years of education. Half of the pregnant women were in the third trimester of pregnancy and were undergoing usual-risk prenatal care. Only 12.22% of the participants reported having access to information on the subject. Data analysis showed a significant difference in the number of correct answers for the questions, before and after viewing the animated video, especially in questions related to signs of labor, bag of waters, and fetal movement test. Conclusion: Educational technology has a positive influence on primigravidae's knowledge about signs of labor and obstetric risk.

RESUMEN Objetivo: Analizar la influencia de una tecnología educacional sobre el conocimiento de primigestas acerca de las señales de trabajo de parto y de riesgo obstétrico. Método: Estudio casi experimental del tipo antes y después, no randomizado y no concurrente, realizado con 90 primigestas. Para análisis de los datos fue aplicada estadística descriptiva,McNemaryt Student. El proyecto fue sometido y aprobado por el Comité de Ética en 2020. Resultados: El perfil de las gestantes correspondió a mujeres con edad media de 23 años, pardas, que están en una unión estable y con media de 10 años de escolaridad. Mitad de las embarazadas estaban en el tercer trimestre gestacional y realizaban el preembarazo de riesgo habitual. Solamente el 12,22% de las participantes relataron tener acceso a informaciones sobre la temática. El análisis de los datos evidenció diferencia significativa en el número de aciertos de las cuestiones, antes y después de la visualización del vídeo animado, principalmente en las preguntas relacionadas a las señales del trabajo de parto, bolsa de aguas y conteo de movimientos fetales. Conclusión: La tecnología educacional tiene influencia positiva sobre el conocimiento de las primigestas acerca de las señales de parto y de riesgo obstétrico.

RESUMO Objetivo: Analisar a influência de uma tecnologia educacional sobre o conhecimento de primigestas acerca dos sinais de trabalho de parto e de risco obstétrico. Método: Estudo quase experimental do tipo antes e depois, não randomizado e não concorrente, realizado com 90 primigestas. Para análise dos dados foi aplicada estatística descritiva, McNemar e t Student. O projeto foi submetido e aprovado pelo Comitê de Ética em Pesquisa em 2020. Resultados: O perfil das gestantes correspondeu a mulheres com idade média de 23 anos, pardas, que vivenciam uma união estável e com média de 10 anos de escolaridade. Metade das gestantes estavam no terceiro trimestre gestacional e realizavam o pré-natal de risco habitual. Apenas 12,22% das participantes relataram ter acesso a informações sobre a temática. A análise dos dados evidenciou diferença significativa no número de acertos das questões, antes e depois da visualização do vídeo animado, principalmente nas perguntas relacionadas aos sinais de trabalho de parto, bolsa d'águas e mobilograma. Conclusão: A tecnologia educacional tem influência positiva sobre o conhecimento das primigestas acerca dos sinais de trabalho de parto e de risco obstétrico.

Simulação clínica no atendimento de enfermagem à mulher no terceiro trimestre gestacional: validação de cenário / Simulación clínica en la atención de enfermería a mujeres en el tercer trimestre gestacional: validación del escenario / Clinical simulation of nursing care to women in the third trimester of pregnancy: validation of a scenario

Objetivo: Elaborar e validar um cenário para simulação clínica e checklist para avaliação do ensino sobre consulta de enfermagem no terceiro trimestre gestacional. Método: Estudo metodológico em 5 etapas (Overview, Scenario, Scenario Desing Progression, Debriefing e Assessment), desenvolvido de novembro de 2019 a julho de 2020. A validação foi realizada pelos juízes de forma remota, com preenchimento de uma escala likert. Foi calculado o Índice de Validade de Conteúdo (IVC). Resultados: O cenário "Conduta do enfermeiro frente a uma gestante em fase latente do trabalho de parto na consulta de pré-natal" e seu checklist foram validados por 5 juízes, com IVC igual a 1,0. Conclusão: O processo de validação atesta o rigor científico com o qual o cenário e o ckecklist foram elaborados, assim permite que seja utilizado com segurança, no ensino de graduação em enfermagem. Espera-se que este estudo estimule novas pesquisas sobre a temática(AU)

Objective: To develop and validate a clinical simulation scenario and a checklist to evaluate teaching/learning aspects about nursing consultation to pregnant women in the third gestational trimester. Method: Methodological study in 5 stages (Overview, Scenario, Scenario Desing Progression, Debriefing and Assessment), developed from November 2019 to July 2020. The validation was performed remotely by the judges, with the completion of a Likert scale. The Content Validity Index (CVI) was calculated. Results: The scenario "Nurses' actions before a pregnant woman in the latent phase of labor during the prenatal consultation" and its checklist were validated by 5 judges, reaching a CVI equal to 1.0. Conclusion: The validation process attests to the scientific rigor with which the scenario and ckecklist were elaborated and can, therefore, be used safely in undergraduate nursing education. It is hoped that this study will stimulate further research on the subject(AU)

Objetivo: Desarrollar y validar un escenario para la simulación clínica y de un checklist para la evaluación de la enseñanza y el aprendizaje de una consulta de enfermería en el tercer trimestre del embarazo. Método: Estudio metodológico en 5 etapas (Overview, Scenario, Scenario Desing Progression, Debriefing e Assessment) desarrollado de noviembre de 2019 a julio de 2020. La validación fue realizada remotamente por los evaluadores, con la cumplimentación de una escala Likert. Se calculó el Índice de Validez de Contenido (IVC). Resultados: El escenario "Conducta de la enfermera hacia una mujer embarazada latente en el cuidado prenatal" y su checklist fueron validados por cinco evaluadores con un IVC de 1.0. Conclusión: La validación da fe del rigor científico con el que se desarrollaron el escenario y el checklist, lo que permite utilizarlo con seguridad en la educación en enfermería. Se espera que este estudio estimule más investigaciones sobre el tema(AU)

Ulcerative colitis in the postpartum period

We describe a scarcely reported case in which ulcerative colitis (UC) occurred in the postpartum period. The aims of this case report are to reinforce the recent assertion that a diet is a ubiquitous environmental factor in inflammatory bowel disease (IBD) and that a plant-based diet (PBD) is recommended for IBD. A 29-year-old woman normally delivered her first child. She first noticed bloody diarrhea 4.5 months after delivery. She was diagnosed with UC (left-sided colitis, moderate severity). Sulfasalazine induced remission. She then experienced and learned about PBD during an educational hospitalization. She resumed breast-feeding and stopped medication. An interview and questionnaire revealed a change in her diet 3 months after delivery, from a sound diet (plant-based diet score: 25) to an unhealthy diet (score: 9). It happened along with a change in residence, from her parent's home where her mother prepared traditional Japanese meals to her home where she prepared meals by herself. A feeling of release from childbirth prompted her to eat sweets and cheese despite being aware that the quality of the meals deteriorated. We described a scarcely reported case in which UC occurred in the postpartum period. It happened along with a change in her diet, from a sound diet to an unhealthy diet due to a feeling of release from childbirth. She replaced an omnivorous diet by PBD and stopped medication. The critical role of diet is largely ignored by healthcare professionals. We believe that greater appreciation of diet will change and improve management of IBD.

Effect of intrathecal analgesia on labor / 中华围产医学杂志

As an effective analgesic method,intrathecal analgesia has been widely accepted.Though labor analgesia could relieve the labor pain,it remains controversial about its adverse effects on labor progress and delivery outcomes.With the development of labor analgesia technique,a large number of clinical studies have suggested that the protocol,dosage and analgesic methods of local anesthesia may also affect the labor and delivery outcomes.There is a growing need to explore more optimized anesthetics and analgesic methods for clinical and scientific research.

Analysis of labor progression characteristics of 1089 nulliparas managed by the new partogram / 中华妇产科杂志

Objective To analyze labor progression characteristics among nulliparas and provide reference to labor progress management. Methods A retrospective study was conducted on 1089 women who went for vaginal delivery at the First Affiliated Hospital, Sun Yet-San University from January 1st, 2015 to May 31th, 2016. The duration of cervical dilation from 1.0 cm to the next and the process of initial cervical dilation (2.0 cm or 3.0 cm) to full cervical dilation of nulliparas were analyzed. Results The cervical dilation speed was accelerating with the progress of labor. The rate of cervical dilation changed fastest between 5.0-6.0 cm dilation, which was more than 3.0 cm/hour. With regard to labor curves, at admission of 2.0 cm cervical dilation, it rose dramatically from 5.0 cm dilation. At admission of 3.0 cm dilation, it presented approximately linear rising before 5.5 cm dilation, then became steeper. Conclusions The cervical dilation speed is fast. Both labor curves of initial cervical dilation (2.0 cm or 3.0 cm) to full cervical dilation show obvious acceleration stage with steep slope.

March of the partogram / 中华围产医学杂志

In 1930s, Wolf created the first partogram. In 1950s, Friedman proposed the classical model of partogram that has been applied in clinical labor assessment ever since. Over the past ten years, Zhang has made great improvement in this field. Here, we reviewed the three different stages in partogram research (the first proposed stage, Friedman's classical stage and Zhang's stage) in terms of its background, demographic characteristics and clinical application. Moreover, this article also emphasized the necessity of partogram research and discussed the prospects for future research and clinical application based on the recent progress in China.

Correlation of Expression of Secretory Phospholipase A2 in Peripheral Blood and Infection of Amniotic Cavity in Preterm Premature Rupture of Membranes / 中国医科大学学报

Objective To explore the role and significance of secretory phospholipase A2(sPLA2)in peripheral blood in preterm premature rup?ture of membranes(pPROM)and infection of amniotic cavity. Methods RT-PCR was used to detect the expression levels of sPLA2 mRNA in pe?ripheral blood of 30 patients with pPROM (experimental group),30 non-full term normal pregnant patients without pPROM (normal control group)and 30 full term patients with PROM(full-term control group)before and after delivery. Fetal membranes were collected at the time of deliv?ery of patients with pPROM for pathologic examination to determine histological chorioamnionitis(HCA). Results The expression levels of sPLA2 mRNA in peripheral blood were 1.079±0.746 and 0.651±0.481 in the experimental group and the normal control group before delivery,respectively, indicating that the expression of sPLA2 mRNA was increased in the experimental group compared with the normal control group(P=0.011). The expression levels of sPLA2 mRNA in peripheral blood were 2.439±0.086 and 2.575±0.036 in the experimental group and the full-term control group at labor onset,respectively,indicating that there was no statistically significant difference in the level of sPLA2 mRNA in peripheral blood between the experimental group and the full-term control group at labor onset(P=0.787). The level of sPLA2 was related to chorioamnionitis in the experi?mental group at labor onset. Conclusion The increase of sPLA2 may participate in the pathogenesis of preterm premature rupture of membranes and is related with the infection of chorioamnionitis.

Change of labor duration:a systematic analysis / 中华妇产科杂志

Objective To evaluate the labor duration of healthy primiparas in the past 20 years compared with Friedman labor curve.Methods Published observational studies about labor duration in primiparas with singleton vertex presentation were searched in PubMed,EMBase,Cochrane library,CNKI,VIP and Wanfang database.The Cochrane Collaborafion' s RevMan 5.1 software was used for reta-analysis.Results Eleven literatures involving 4534 primiparas were included,which were eligible for the criteria to investigate the labor duration.Meta-analysis showed that the length of active phase was significantly different between what was showed in primiparas in the past 20 years and Friedman labor curve[ P =0.01,weighted mean difference ( WMD ) =1.61,95％ CI:0.38 to 2.83 ],and significant differences were also found in the second stage duration (P =0.0006,WMD =-0.20,95％ CI:-0.31 to -0.09 ).Conclusions Compared with Friedman labor curve,active phase length of healthy primiparas in the past 20 years was significantly longer and second stage length was shorter.Reassessing labor curve of healthy primiparas is required for more scientific guidance and less unnecessary interventions.

Correlation between expression of RhoA and Rho kinase in uterine smooth muscle and the onset of labor / 中华妇产科杂志

Objective To investigate the role of RhoA and Rho kinase system in the onset of labor. Methods Forty term pregnant women, who delivered through cesarean section at the Xiangya Second Hospital of Central South University from February 2007 to November 2007, were selected and divided into 2 groups: 20 in labor group and 20 in non-labor group. Another 20 non-pregnant women undergoing hysterectomy due to cervical intraepithelial neoplasia were chosen as the control. Real-time fluorescence quantitative RT-PCR and western blot were applied to detect the expression RhoA and ROCKⅠ mRNA and protein in uterine smooth muscle tissue and the correlation between the mRNA and protein expression of RhoA and ROCKⅠ were analyzed. Results (1) The mRNA expressions of both RhoA and ROCKⅠ were detected in all groups, and higher levels were found in the labor group than in the non-labor group and the control [RhoA mRNA: (3.51±0.56)×10-3 vs. (2.75±0.52)×10-3 and (2.11±0.54)×10-3; ROCKⅠ mRNA: (4.07±0.66)×10-3 vs. (2.71±0.52)×10-3 and(2.01±0.23)×10-3, P<0.01]. (2) RhoA and ROCKⅠ proteins were also identified in all three groups, and the expressions in the labor and non-labor group were higher than those of the control (RhoA protein: 0.72±0.23 and 0.64±0.17 vs. 0.46±0.15; ROCKⅠ protein: 0.56±0.14 and 0.42±0.16 vs. 0.29±0.08, P<0.01). (3) The expression of RhoA mRNA and ROCKⅠ mRNA were positively correlated in each of the three groups (r=0.73,P<0.01), and the same was found in the expression of RhoA protein and ROCKⅠ protein (r=0.37,P<0.01). Conclusion The increased expression of RhoA and Rho kinase may play an important role in the initiation of labor.

Correlation between the expression of activator protein-1 and connexin 43 in uterine smooth muscle during pregnancy and the onset of labor and preterm delivery / 中华围产医学杂志

Objective To study the expression of activator protein-1(AP-1)and connexin 43(Cx43)in uterine smooth muscle of term pregnancy and its relationship with preterm delivery.Methods Immuno-histochemistry was applied for 15 uterine smooth muscle samples of term pregnancy without labor(Group Ⅰ),15 of term pregnancy in labor(group Ⅱ)and 10 of preterm delivery in labor(group Ⅲ)to investigate the expression of two subunits of AP-1(c-Jun and c-Fos)and Cx 43. Results (1)The expression of Cx43 in group Ⅰ and Ⅱ(4.33±0.51 and 4.20±0.42)were significantly higher than that in group Ⅲ(3.15±0.41,P<0.01).Lable index of c-Jun protein in group Ⅲ,Ⅱ and Ⅰ was(52.34±4.18)%,(45.25±5.24)%and(34.14±4.26)%,respectively (P<0.01),and the lable index of c-Fos protein was(53.48±4.36)%,(43.32±6.21)%and(31.29±3.34)%,respectively(P<0.01).Positive correlation was found between the expression of Cx43and c-Jun,c-Fos in pregnancy uterine smooth muscle(r=0.65,0.63,P<0.01). ConclusionsThe Cx43 plays an important role in the onset of labor.The expressions of Cx43 is positively related with the expression of AP-1 in pregnancy uterine smooth muscle.

Clinical study on acupoint-injection combined with epidural analgesia for labour / 中国基层医药

Objective To discuss whether the separating block of sensory nerve with acupoint-injection and epidural analgesia by ropivacaine during labour.Methods Ninty full term primigravidae with ASAⅠ～Ⅱwere randomly divided into 3 groups:group E(n = 30),group C(n = 30)and group A(n = 30).When the external cervi- cal os was dilated to 3cm,group A:acupiont-injection to Ci Liao;group E:epidural analgesia with 0.075% ropiva- caine and fentanyel 2?g/ml;group C:combining group A and group E except fentanyel 2?g/ml.Level of pain(VAS scores),degree of sensory and motor block,the mode of delivery,the progress of labour and side effects were recorded and compared.Results The level of pain(VAS scores)in group A was higher than that of group C and group E,and there were no significant differences in group C and group E,Bur there were some side effects discovered in group E. There was no significant differences of the mode of delivery in the groups.Conclusion The method that acupoint- rejection combined with epidural analgesia by 0.075% ropivacaine is effective and has no side effects for labour.

Effects of routine early amniotomy on labor and health status of foetus and neonate: a meta-analysis / 中华妇产科杂志

Objective To analyze the effects of routine early amniotomy on labor and health status of foetus and neonate. Methods The results of “Early amniotomy increases the frequency of fetal heart rate abnormalities, A randomized controlled trial of early amniotomy, Effect of early amniotomy on the risk of dystocia in nulliparous women, The influence of elective amniotomy on fetal heart rate patterns and the course of labor in term patients: A randomized study, Randomised trial comparing a policy of early with selective amniotomy in uncomplicated labour at term and A randomized controlled trial and meta-analysis of active management of labour were analyzed using Mantel-Haenszel method (fixed effect model) in meta-analysis. Results (1) The routine early amniotomy can shorten 94.90 min of the first stage of labor, 95% CI (-119.17,-70.52). (2) The OR for cesarean section was 1.25,95%CI (0.99-1.57),for instrumental vaginal delivery was 1.05, 95% CI (0.90-1.24). (3) There was no difference in abnormal fetal heart rate at first stage (OR=0.95, 95% CI: 0.75-1.21), but there was increased abnormal fetal heart rate at second stage(OR=1.28, 95% CI: 1.02-1.61). (4) The frequency of stained amniotic fluid and abnormal Apgar scores at 1 minute was not different significantly [ OR=1.17,95% CI (0.78-1.73);OR=0.71,95%CI: (0.49-1.03)]. Conclusions Routine early amniotomy appears to be associated with both benefits and risks. Beneficial effects include reductions in labor duration and possible decrease in frequency of abnormal Apgar score at one minute. Risks include increase in abnormal fetal heart rate at second stage and possible rise in cesarean section rate.

Effects of epidural ropivacaine labor analgesia on duration of labor and mode of delivery / 中华妇产科杂志

Objective To study the effects of ropivacaine on the duration of labor and mode of delivery in the primigravidas using patient-controlled epidural analgesia (PCEA). Methods Retrospective analysis was performed. The 190 healthy, full-term, and single-fetus parturient primigravidas who received PCEA with 0.1% ropivacaine+fentanyl (1 ?g/ml ) were in the epidural analgesia group. Another 222 primigravidas who didnot receive PCEA were in the control group. The duration of labor and modes of delivery, and the neonatal Apgar scores in both two groups were recorded and evaluated. Results Those in the epidural analgesia group experienced a significantly longer first stage [(426?161) minutes], longer second stage [(54?27) minutes] and longer full duration of delivery [(489?166) minutes] than those in the control one [(409?170) minutes, (364?167) minutes and (37?22) minutes]. The rate of using pitocin in the epidural analgesia group (30.2 %) was significantly higher than that in the control group (4.1%). The cesarean section rate in epidural analgesia group (20.0 %) was lower than that in the control one (28.4%); while the rate of instrumental delivery in the epidural analgesia group (20.0%) was significantly higher than that in the control one (6.3%). In summary, there were significant differences between two groups in the duration of labor, the rate of using pitocin, the rate of instrumental delivery and the rate of cesarean section. But there were no differences found for those newborn who had Apgar scores less than 7 at the point of both one and five minutes (7.9% and 4.5%, 2.6% and 0.5% respectively). Conclusion Epidural ropivacaine labor analgesia lengthens the duration of labor and increases the rate of instrumental delivery, but it has no significant negative effects on the neonates.

Concentrations of cortisol and dehydroepiandrosterone sulfate in fetal umbilical cord blood for term labor / 中华妇产科杂志

Objective To study the effect of cortisol and dehydroepiandrosterone sulfate(DHEA S)in fetal umbilical cord blood on term labor. Methods Cortisol and DHEA S concentrations were measured By radioimmunoassay in 100 term fetal umbilical cord blood. They were divided into four groups. Group A selective cesarean section without any birth pain ( n =18),Group B cesarean section in latent phase( n =10),Group C cesarean section in active phase( n =12),Group D spontaneous vaginal deliver( n =60). Results The concentrations of fetal umbilical cord cortisol in spontaneous vaginal deliver group was gradually increased with gestational week. The peak level was in the 39th gestation week,by the 42th gestation week,the concentration of cortisol declined to the 37th gestation week. DHEA S changed paralleled with cortisol ( r =0.46, P

Clinical study on labor pain relief using the combined spinal-epidural analgesia and inhaling nitrous oxide / 中华妇产科杂志

Objective To study the pain relief effectiveness of the combined spinal epidural analgesia(CSEA) and the inhalation of nitrous oxide, and the influences on the mothers and infants Methods The 300 cases of pregnant women were randomly divided into 3 groups: CSEA group,nitrous oxide group and control group The nitrous oxide group was that pregnant women inhaled nitrous oxide premixed with oxygen (50%∶50%),the pregnant women of the CSEA group were injected fentanyl and bupivacaine in the subarachnoid and epidural space,analgesic was not used in the control group The degree of labor pain, duration of the labor,way of delivery, bleeding volume, rate of anoxia of newborn,blood gas analysis to maternal radius artery and fetal umbilical blood among 3 groups were observed Results The effect for analgesia labor of the CSEA group was much better than that of the nitrous oxide group ( P 0 05) In the second stage of labor,the 3 groups were alike to each other The bleeding volume of caesarean section (373?77) ml in the nitrous oxide group was much more than the other 2 groups, there was no difference between the CSEA group (259?78) ml and the control group (239?89) ml The rate of obstetric forceps of CSEA group was higher than the control group ( P

Clinical study: the effects of inhaling nitrous oxide for analgesia labor on pregnant women and fetus / 中华妇产科杂志

Objective To investigate the effect of the inhalation of nitrous oxide premixed with oxygen (50%∶50%) for analgesia labor on maternal and fetus. Methods A total of 100 cases of pregnant women were provided with nitrous oxide premixed with oxygen (50%∶50%) (control group); Another 100 cases were provided only with oxygen (comparison group). Recording duration of the Labor, way of delivery, bleeding volume, Apgars score, blood gas analysis to maternal radius artery and fetal umbilical blood among all patients. Results The effect for analgesia labor of the premixed gas was much better than that of control group, but there were no significant differences in time of labor, bleeding volume, Apgars score between the two groups. Conclusions The inhalation of nitrous oxide premixed with oxygen (50%∶50%) for analgesia labor benefits pregnant women because of keeping them being a good mental and physical condition. The inhalation of nitrous oxide for analgesia labor is a safe, effective and easy method.

Effects of Spasfon on course of labor / 中华妇产科杂志

0.05). Conclusion Spasfon can effectively improve cervical dilatation during labor and it is well tolerated by both mother and newborn.

Study on controlling the blood glucose level of gestational diabetes mellitus sufferer regularly during labor / 中华妇产科杂志

Objective To study the maternal blood glucose management of gestational diabetes mellitus during the labor and relationship of maternal blood glucose in labor and neonatal blood sugar. Methods A prospective study on maternal blood glucose monitoring and control during labor was carried in 40 pregnant women with abnormal glucose metabolism. We adjusted maternal blood glucose by low-dosage constant insulin drop during labor. Results Maternal blood glucose in labor arranged between 3.8 ～ 11.2 mmol/L,and low-dosage constant insulin drop was used in 17 cases (42.5%). The neonatal blood glucose was (4.0?1.5)mmol/L following delivery and (3.9?1.0)mmol/L at 24-hour postpartum. There were 2 cases with neonatal hypoglycemia. The neonatal blood glucose of the rest 23 cases was (4.2?1.5)mmol/L,and (3.9?1.0)mmol/L at 24-hour postpartum,and 1 case with neonatal hypoglycemia. There was no the difference of the blood glucose level of newborns between mothers with abnormal glucose metabolism and the normal pregnant women. Conclusion It is necessary to monitor and control the blood glucose level by low dose constant insulin during labor in pregnant women with abnormal glucose metabolism.

The effect of the variation of cesarean sections during labor and their indications on total cesarean section rate / 中华围产医学杂志

Objective To investigate the effect of variation of cesarean sections during labour and their indications on the total cesarean section rate. Methods A total of 458 cases of cesarean section was selected from January to June of 1990,1996,2002. They were divided as indication group and no indication group. The change of the indication and cesarean section rate was compared. Results The ratio of cesarean section during labour in total cesarean sections rised. The ratio was 22.0%, 20.8% and 39.4% in 1990, 1996 and 2002 respectively. The proportion of no indication surgery in 2002(63.37%) showed significant growth as compared with that of 1990 (33.84) and 1996 (32.58). Of all cases of cesarean section having indications, the rate of trial produce failure increased in 2002 (25.81%) while it was 11.45% and 16.67% in 1990 and 1996 respectively. The rate of fetal distress decreased from 25.19% (1990), 21.67% (1996) to 12.90% (2002). Conclusion Ascen ding of cesarean section rates during labour was an important factor that increased cesarean section rate in recent years. To decrease the total rates of cesarean section, many important measures should be done such as paying more attention to social factors, reinforcing propaganda and maternal health care , encouraging spontaneous vaginal delivery, emphasizing company during labour and analgesia or pain free delivery, laying stress on the management and monitoring during first stage of labour as well as psychological care.

Relationship between Psychological Factors and Mode or Duration of Labor / 中华围产医学杂志

Objective To observe the relationship between psychological factor(anxiety and depression) and postpartum hemorrhage?mode and duration of labor. Methods Ninety two healthy nulliparas who had no gist of cesarean section were involved in our study. Their psychosis were evaluated with Self-rating Anxiety Scale(SAS) and Self-rating Depression Scale(SDS),according to which they were divided into two groups:high-score group and low-score group.All women were not interfered during the courses of delivery. Mode, duration of labor and postpartum hemorrhage were observed. Results Among the 92 nulliparas observed, the spontaneous delivery rate was 86.96% (80 cases) and the postpartum hemorrhage rate was 10% (8 cases). The scores of SAS and SDS of the low educational level group, the spontaneous group or the non-hemorrhage group were significantly lower than those of the high educational level group, the dystocia group or the hemorrhage group respectively. Moreover, the duration of first and the second stage of the high SAS score group or the high SDS score group was significantly longer than that of the low SAS score group or the low SDS score group,P