ABSTRACT
AIM: To evaluation the effects of esketamine and butorphanol on postoperative pruritus induced by epidural morphine injection in cesarean delivery parturients. METHODS: A total of 162 parturients who underwent elective cesarean section under continuous epidural anesthesia in Taizhou Central Hospital (Taizhou University Hospital), were selected and randomly divided into esketamine group (group K), butorphanol group (group B) and blank control group (group C). 5min after umbilicus amputation, parturients in group K was injected with 3 mg morphine diluent through epidural catheter, and esketamine 0.2 mg/kg intravenously. Parturients in groups B and C were given the same dose of morphine,and butorphanol 10 μg/kg or the same volume of normal saline, respectively. The incidence of postoperative pruritus at different times, the degree of pruritus and incidence of other adverse reactions were compared among three groups. RESULTS: The highest incidence of pruritus occurred within 4 hours after operation. The incidence of postoperative pruritus at 4 hours in group K and B was significantly lower than that in group C (3.7% vs. 3.7% vs. 29.6%, P 0.05). There were no significant differences in the incidence of postoperative nausea, vomiting, dizziness and postoperative pain scores among three groups (P > 0.05). CONCLUSION: Both esketamine and butorphanol can reduce the incidence and degree of pruritus caused by epidural morphine injection in parturients, without affecting the analgesic effect of morphine and without increasing the incidence of adverse reactions. Esketamine is as effective and safe as butorphanol in preventing pruritus after cesarean section.
ABSTRACT
Objective To establish a clinical nursing pathway for elderly parturients. Methods The clinical nursing pathway draft for elderly parturients were designed though the method of case analysis and literature review. Delphi method was used by 10 experts engaged in clinical medical or nursing with 2 rounds. Results The recovery rates of the two Delphi method were 100%, the experts who put forward the proposal on the 2 rounds of expert conclusion were 60.00% (6/10) and 20.00% (2/10) respectively. The expert's familiarity with the correspondence is 0.90, the coefficient of judgment is 0.80 and the coefficient of authority is 0.85.The mean value and standard deviation of the 2 rounds of correspondence were 3.60～5.05 (standard deviation 0.34～0.94) and 3.91～4.13 (standard deviation 0.26～0.60)respectively. The coordination coefficients of the 2 rounds of experts consultation were 0.441 and 0.592 (all P＜0.001). The clinical nursing pathway for elderly parturients with pregnancy management were three stages: confirmed pregnancy to 13+6weeks, 14 weeks to 27+6days pregnant and 28 weeks pregnant to childbirth, including a total of 74 projects for 4 modules such as medical history collection, physical examination, clinical laboratory and other examination and nursing measures. Conclusions The practicable clinical nursing pathway for elderly parturients was constructed because its high degree of familiarity,authority,coordination and concentration. The statistical analysis results are reliable,it is beneficial to standardize the pregnancy management for elderly parturients and improve the quality of clinical nursing.
ABSTRACT
Background: The use of routine episiotomy is now less favoured among obstetricians. Given considerable evidence, it use increases maternal morbidity without evidence to support maternal or neonatal benefit. Objectives: To determine the current rate of episiotomy among parturients delivering at Federal Medical Centre, Owo, Ondo State, Nigeria and to identify factors associated with episiotomy. Methods: The retrospective study was conducted using the delivery records between 1st January 2012 and 31st December 2012. Information was obtained from the delivery register and medical records. There were 802 booked patients who had singleton vaginal deliveries between the studied periods. A total of 728 of these patients’ case records were obtained for analysis using SPSS 17. Results: The incidence of episiotomy was 9.3%. Those age <20 years, nulliparous, those who had assisted breech and instrumental deliveries had more episiotomy (P <0.0001). All the instrumental deliveries and most assisted breech deliveries (67%) were taken by the doctors. Episiotomies were more common when doctors took deliveries (Doctor vs. Nurses: 28.6% vs. 5.8%) (P <0.0001). Conclusion: While this study has identified factors associated with episiotomy, the episiotomy rate remain within normal rate at the studied centre. It is pertinent that health care providers always bear in mind the standard indications for episiotomy. This will go a long way in reducing the episiotomy rate and maintaining the recommended WHO rate of 10%.
ABSTRACT
Purposes: To evaluate analgesic effect and adverse effects of intrathecal morphine and fentanyl in parturients undergoing cesarean section. Methods: This is a retrospective, descriptive study from anesthetic and recovery room records from January 2001 to August 2011. Results: From this 11-year retrospective, descriptive analysis in 10,061 patients undergoing cesarean section who received intrathecal opioids, it had been found that their pain scores both at rest and with movement were mild and moderate, respectively. Nausea / vomiting and pruritus were common complications but no patient experienced respiratory depression. Conclusions: Intrathecal morphine is effective for controlling postcesarean pain with minor adverse effects.
ABSTRACT
Background: The best mode of delivery of breech presentation for optimum neonatal outcome has been a subject of controversy over the years. Aim of current study was to determine the pattern of distribution, incidence, mode of delivery and outcome of singleton breech presentations at term among parturients at this centre. Methods: This was a retrospective study of singleton breech term delivery at the federal medical centre, Owerri between January 1, 2007 and December 31, 2011. Singleton breech term deliveries were identified from the labor ward register and the hospital numbers extracted to retrieve the case notes from the medical records department of the hospital. Some data were collected and analysed. Results: There were a total of 9624 deliveries during the study period, out of which 328 (3.4%) were singleton breech presentation at term. Term singleton breech was commoner in multiparous 200 (61%) than in primiparous 128 (39%) women. Extended (Frank) breech was the commonest type of breech presentation (60.4%) followed by flexed (complete) breech (36.0%) and footling breech (3.6%) was the least common. Assisted vaginal breech delivery was conducted in 66.2% of cases while 27.4% were delivered by emergency caesarean section and 6.4% of cases were delivered through elective caesarean section. There were one maternal and 24 perinatal death. Twenty one (87.5%) of perinatal deaths those occurred in unbooked mothers. Conclusion: Although assisted vaginal breech delivery for singleton breech term delivery was commonly performed in our centre, elective caesarean delivery gives the better neonatal outcome for fetuses presenting breech.
ABSTRACT
Objective To observe the influence of combined spinal and epidural anesthesia( CSEA) of different po-sitions on the anesthesia effect, anesthesia operation and hemodynamic index during cesarean section of obese par-turients. Methods Eighty obese parturients[BMI≥30] undergoing cesarean section were randomly divided into two groups, that was group A and B, with 40 cases each. In group A, the parturients were required to undergo lat-eral decubitus position with 0.5% ropivacaine hydrochloride of 2. 4 ml. In group B, the parturients were required to undergo sitting position with the same ropivacaine hydrochloride as group A. The following data was recorded, which were the percentage of one-attempt's successful epidural needle placement, the anesthesia level,the anesthe-sia effect and the hemodynamic change. All the complications were also observed,such as the supine hypotension syndrome during operation,headache after spinal anesthesia and postoperative spinal nerve stimulation. ResultsThe difference of anesthetic effect between the two groups was insignificant in statistics while group B's rate of one-attempt successful puncture was higher than gruop A ( P <0.05 ) . The difference of hemodynamic index between them was significant in statistics ( P<0.05 ) with group B's rate of supine hypotension syndrome lower than group A. Conclusion Both body positions have the same anesthtic effect for obese parturients during cesarean section while the puncture operation of sitting positon is easier than lateral decubitus position and the hemodynamic change is also more stable.
ABSTRACT
Objective To study the effect of evidence-based nursing combined with KAP model on health education to the parturients from suburbs.Methods According to problems in 200 pregnant women from suburban areas, health education was performed to them using evidence-based nursing and KAP model. The rate of access to knowledge, confidence about laboring, spontaneous participation in action to promote delivery, natural birth rate, episiotomy rate, breastfeeding rate and rate for satisfaction with midwives were compared between pre-and post-health education.Results After intervention, their access to knowledge, confidence about laboring, spontaneous participation in action to promote delivery were obviously improved than those before intervention(P<0.05). The rate of natural birth, cesarean delivery, forceps delivery and satisfaction with midwives were 66.0 %, 30.0 %, 1.0% and 94.4 %, respectively.Conclusion Evidence-based nursing and KAP model is effective in the health education to pregnant women from suburbs.
ABSTRACT
Objective To investigate the effect of clinical health education path on maternity patients carrying the hepatitis B virus.Methods Two hundred and ten maternity patients carrying hepatitis B virus were randomly divided into two groups equally:In the control group the routine health education method for the parturients was used and in the experiment group the clinical health education path was used.Before discharge,the two groups were compared in terms of the qualification rate for health education and the satisfaction degree among the parturients.Result The qualification rate for health education in the experiment group was significantly higher than that of the control group(P<0.05)and the satisfaction degree of the experiment group was significantly higher as well than that of the control group(P<0.05).Conclusion The clinical health education path is effective in enhancing the effect of health education,increasing the satisfaction with nursing service,improving the quality of nursing and thus improve the holistic nursing.
ABSTRACT
Objective To study the influence of Orem self-care theory on postpartum quality of life and role change of parturients with natural labor. Methods 100 parturients with natural labor in our hospital from May 2010 to July 2011 were selected as research object,and they were randomly divided into the control group and the observation group with 50 cases in each group,the control group was taken care with routine nursing methods,the observation group was given with nursing according to Orem self-care theory.Then the SCL-90 score,situation of role change and satisfaction degree of two groups before nursing and on the second and fifth days after nursing were analyzed and compared. Results The SCL-90 score of the observation group after the nursing on second and fifth days was all lower than those of the control group,the better rate of role change was higher than that of the control group,patients'satisfaction degree was higher than that of the control group. Conclusions The Orem self-care theory plays an important role in improving the quality of life and role change of parturients with natural labor after delivery,and it can significantly improve satisfaction degree of parturients.
ABSTRACT
0.05).Breast feeding of the neonates as well as color of skin and lip,sleeping,movement response and regurgitation had no significant difference in both groups.Conclusions: PCIA using xafon after cesarean delivery can provide excellent analgesic effect but few side effects At the same time,it has no adverse effect on neonates.Xafon may be safely administered intravenously with other narcotics in parturients undergoing cesarean section.
ABSTRACT
The percentage of first-time cesarean section at Hanoi Obstetric and Gynecology Hospital in 2000 was 28.94%. Among the patients with a history of cesarean section, 88.25% have undergone cesarean section and 8.30% had a forceps delivery. The most common reason for repeated cesarean section is premature rupture of the membranes, non-progressive cervix (36%), and interval between this cesarean section and previous cesarean section was less than 2 years (5%). There were 3 uterine ruptures (0.5%), and subtotal hysterectomy rate was 1.7%.
Subject(s)
Cesarean Section , ParturitionABSTRACT
This study was attempted to observe the rate of oxygen desaturation after full oxygenation in six parturients scheduled for Cesarean sections and six patients scheduled for transabdominal hysterectomies. We calculated the mean rate of fall of arterial saturation (slope of desaturation: less than SaO2 (t2)-SaO2(t1) greater than/t2-t1) and changes in arterial blood gases were observed. All subjects were denitrogenated then a single isolated apnea was carried out. The mean time to obtain 90% saturation was longer in the nonpregnant group (7.5 min vs 3.6 min in parturients). The mean slope of desaturation was steeper in the parturients (-3.34) than the nonpregnant group (-1.52). As far as the oxygen reserve is concerned, the parturients had a lesser margin of safety than the nonpregnant women. It was concluded that the lower the thoracic gas volume (parturients), the lower the alveolar O2 stores and, the more rapidly these stores are depleted.
Subject(s)
Adult , Female , Humans , Pregnancy , Arteries , Blood , Blood Gas Analysis , Obstetric Labor Complications/blood , Oxygen/blood , Sleep Apnea Syndromes/bloodABSTRACT
0.10), but more significant after the causes of DIC were corrected( P