ABSTRACT
Resumen ANTECEDENTES: La fascitis necrosante es una infección rara del tejido subcutáneo y la fascia que rápidamente puede complicarse y poner en riesgo la vida; por esto siempre debe tenerse en mente la posibilidad de este diagnóstico. OBJETIVO: Describir un caso raro de fascitis necrosante genital aparecida luego de un parto instrumentado. CASO CLÍNICO: Paciente primigesta, de 30 años, con antecedente de infección vaginal por Ureaplasma. El parto instrumentado tuvo lugar a las 39 semanas; se reparó la episiotomía medio-lateral derecha, sin complicaciones, y se dio de alta del hospital a las 48 horas. Al quinto día de puerperio acudió a Urgencias por dolor perineal intenso y fiebre. Durante la auscultación se encontró un hematoma perineal y glúteo derecho, con eritema alrededor, indurado y con crepitación vaginal, con secreción hematopurulenta fétida. Reportes de laboratorio: leucocitosis y anemia. Los cultivos de la herida reportaron infección polimicrobiana. El ultrasonido pélvico evidenció dos colecciones debidamente delimitadas en planos dérmicos y musculares. Se indicó tratamiento con antibióticos de amplio espectro, lavado quirúrgico y desbridamiento quirúrgico diario durante 5 días. Después, se inició la terapia de cierre asistido por vacío (VAC) durante 7 días hasta lograr la granulación. Se continuó con lavados quirúrgicos durante 5 días más. El día 18 posparto se cerró la herida sin complicaciones. A la sexta semana de seguimiento la herida había cicatrizado, sin dolor, ni incontinencia fecal o urinaria: solo hipoestesia de la cicatriz, pero con evolución satisfactoria. CONCLUSIÓN: Lo ideal es establecer el diagnóstico lo más temprano posible para disminuir la morbilidad y mortalidad, ofrecer inmediatamente atención multidisciplanaria que permita conseguir los mejores desenlaces quirúrgicos e incrementar la supervivencia.
Abstract BACKGROUND: Necrotizing fasciitis is a rare infection of the subcutaneous tissue and the fascia that is rapidly progressive and deadly, requiring early and aggressive surgical debridement to decrease mortality. The objective of this study was to describe a rare case of genital necrotizing fasciitis after operative vaginal delivery. CLINICAL CASE: A 30 years old primiparous woman with a history of vaginal infection by Ureaplasma. Instrumented delivery was attended at 39 weeks, repairing right mid-lateral episiotomy without complications and discharge after 48 hours. On the fifth day of the puerperium she went to the emergency department for severe perineal pain and fever, finding perineal hematoma and right gluteus with erythema around, indurated and with vaginal crepitation with fetid hemato-purulent secretion. The laboratories reported leukocytosis and anemia, wound cultures showed polymicrobial infection and pelvic ultrasound diagnosed 2 well-defined collections in dermal and muscular planes. Management was initiated with broad-spectrum antibiotics plus washing and daily surgical debridement for 5 days. Subsequently, it was placed with VAC therapy for 7 days until granulation was achieved; and then, surgical washes were continued for 5 more days. On the 18th day, the wound was closed without complications. In her sixth week of follow-up she has a scarred wound, without pain or fecal or urinary incontinence; only refers to hypoesthesia of the scar, but with satisfactory evolution. CONCLUSION: The ideal is to establish the diagnosis as early as possible to decrease morbidity and mortality, immediately offer multidisciplinary care that allows the best surgical outcomes to be achieved, and increases survival.
ABSTRACT
Objective To explore the effect of problem-based learning (PBL) health education and nursing mode on the occurrence of depression after primiparous women and its hormone levels. Methods A total of 468 primiparas who were delivered were selected. The number of singular numbers in the order of hospitalization was the control group, and the double number was the experimental group, 234 cases each. The control group used the traditional obstetric care model, and the experimental group used PBL health education model. The Edinburgh Postnatal Depression Scale (EPDS) and Self-rating Anxiety Scale (SAS) scores were compared between the two groups of prenatal women, 7 days, 42 days, and 3 months postpartum. Estrogen, progesterone, and 5-e were also tested. Serotonin levels. Postpartum depression rates were compared between the two groups according to EPDS and SAS scores. At the same time, the satisfaction rate of women on the quality of care in the two groups was investigated. ResuLts The EPDS scores (8.3 ± 2.5), ( 9.0 ± 3.8), and ( 8.1 ± 2.2) points at 7 days, 42 days, and 3 months after birth were significantly lower in the experimental group than in the control group (9.8 ± 2.5), (11.1 ± 3.7), and (9.2 ± 2.1) points. The difference between the two groups was statistically significant (t=2.35, 1.76, 0.26, P<0.01). The SAS scores (45.44±4.48), (49.28±3.59), and (38.16±4.45) points at 7 days, 42 days, and 3 months after birth were significantly lower in the experimental group than in the control group (51.69±4.93), (55.79±5.72), and (44.81±3.69) points. The difference was statistically significant (t=2.51, 3.65, 9.91, P < 0.01). There were 41 patients with post-production depression at 42 days postpartum, which was significantly higher than 13 patients in the experimental group. The difference was statistically significant (χ2=1.58, P<0.01). Maternal satisfaction in the experimental group was 96.15%(233/234), and in the control group was 89.32%(228/234), the difference was statistically significant (χ2=14.13, P<0.01). Estradiol levels (14 192.26±3 187.41), ( 2 954.44±326.16), ( 702.34±46.41) pmol/L at 7 days, 42 days and 3 months after birth were significantly higher in the experimental group than those in the control group (13 694.45 ± 3 212.18), (2 316.16 ± 391.22), (669.47 ± 53.25) pmol/L. The difference was statistically significant (t=5.16, 1.69, 4.26, P<0.05). The serotonin levels (434.25±8.41), (315.05±12.35) ng/L at 42 days and 3 months after delivery were significantly higher in the experimental group than those in the control group (415.96 ± 12.35), (308.15 ± 11.35) ng/L. The difference was statistically significant (t=1.58, 3.25, P < 0.05). Progesterone levels (28.19 ± 2.36), (8.25 ± 0.98) μg/L at 42 days and 3 months after delivery were significantly lower in the experimental group than those in the control group (34.25±2.44), (9.69 ± 1.25) μg/L. The difference was statistically significant (t =2.24, 5.16, P < 0.05). ConcLusions PBL health education model can significantly reduce the risk of postpartum depression in primipara, regulate estrogen, progesterone and serotonin levels, and can be applied in obstetrics.
ABSTRACT
Objective@#To explore the effect of problem-based learning (PBL) health education and nursing mode on the occurrence of depression after primiparous women and its hormone levels.@*Methods@#A total of 468 primiparas who were delivered were selected. The number of singular numbers in the order of hospitalization was the control group, and the double number was the experimental group, 234 cases each. The control group used the traditional obstetric care model, and the experimental group used PBL health education model. The Edinburgh Postnatal Depression Scale (EPDS) and Self-rating Anxiety Scale (SAS) scores were compared between the two groups of prenatal women, 7 days, 42 days, and 3 months postpartum. Estrogen, progesterone, and 5-e were also tested. Serotonin levels. Postpartum depression rates were compared between the two groups according to EPDS and SAS scores. At the same time, the satisfaction rate of women on the quality of care in the two groups was investigated.@*Results@#The EPDS scores (8.3 ± 2.5), (9.0 ± 3.8), and (8.1 ± 2.2) points at 7 days, 42 days, and 3 months after birth were significantly lower in the experimental group than in the control group (9.8 ± 2.5), (11.1 ± 3.7), and (9.2 ± 2.1) points. The difference between the two groups was statistically significant (t =2.35, 1.76, 0.26, P < 0.01). The SAS scores (45.44±4.48), (49.28±3.59), and (38.16±4.45) points at 7 days, 42 days, and 3 months after birth were significantly lower in the experimental group than in the control group (51.69±4.93), (55.79±5.72), and (44.81±3.69) points. The difference was statistically significant (t =2.51, 3.65, 9.91, P < 0.01). There were 41 patients with post-production depression at 42 days postpartum, which was significantly higher than 13 patients in the experimental group. The difference was statistically significant (χ2=1.58, P<0.01). Maternal satisfaction in the experimental group was 96.15%(233/234), and in the control group was 89.32%(228/234), the difference was statistically significant (χ2=14.13, P<0.01). Estradiol levels (14 192.26±3 187.41), (2 954.44±326.16), (702.34±46.41) pmol/L at 7 days, 42 days and 3 months after birth were significantly higher in the experimental group than those in the control group (13 694.45±3 212.18), (2 316.16±391.22), (669.47 ± 53.25) pmol/L. The difference was statistically significant (t =5.16, 1.69, 4.26, P < 0.05). The serotonin levels (434.25±8.41), (315.05±12.35) ng/L at 42 days and 3 months after delivery were significantly higher in the experimental group than those in the control group (415.96±12.35), (308.15±11.35) ng/L. The difference was statistically significant (t=1.58, 3.25, P < 0.05). Progesterone levels (28.19±2.36), (8.25±0.98) µg/L at 42 days and 3 months after delivery were significantly lower in the experimental group than those in the control group (34.25±2.44), (9.69±1.25) µg/L. The difference was statistically significant (t =2.24, 5.16, P < 0.05).@*Conclusions@#PBL health education model can significantly reduce the risk of postpartum depression in primipara, regulate estrogen, progesterone and serotonin levels, and can be applied in obstetrics.
ABSTRACT
Objective To explore the successful breastfeeding experience of primiparous women with natural childbirth during the first 6 months postpartum. Methods A phenomenological methodology was used. Semi-structured in depth interviews were conducted among 11 primiparous women of natural childbirth. The data were transcribed, collated, summarized and analyzed using Colaizzi′s method. Results The primiparous women who sustained exclusive breastfeeding for six months after natural delivery experienced three stages which were:anxiety of breastfeeding,gradual adaption of breastfeeding, and coexistence of puzzles and insistence. The first stage was anxiety of breastfeeding including three themes: lack of experience in breastfeeding, conflict of breastfeeding, and noticeable fatigue during feeding.The second stage was gradual adaption of breastfeeding including four themes:family and social support, presenting regular feeding schedules, identification of mother role, and establishing a good mother-child relationship.The last stage was coexistence of puzzles and insistence which containing three themes: coexistence of confusion and perseverance, fear of returning back to work, suffering of maternal separation,and commitment of breastfeed. Conclusions In order to release the anxiety and improve the confidence of breastfeeding of primiparous women, it is vital to rely on the conjoint efforts of the family members,healthcare institutions,communities,enterprises,society and other aspects to improve the rate and duration of exclusive breastfeeding.