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Background: Morbidity of caesarean section still persist in terms of pain, infection and adhesion. This study will focus on different morbidities associated with ECS.Methods: A retrospective analysis of 29 ECS were included from June to September 2018, done at Midnapore Medical college, West Bengal, India.Results: Contracted pelvis (12/29, 41.37%) and cephalopelvic disproportion (10/29,34.48%) were common indications for ECS. Mean gestational age was 39.65±1.31 weeks and birth weight were 3.01±0.40 kg. Time taken for ECS was 33.06±10.85 minutes. Extension of uterine incision and mild distension of abdomen occurred in 3.44% each. Post-operative period was uneventful and all discharged after 72 hours of operation.Conclusions: ECS can be performed safely by experienced hands with less feto-maternal morbidity and early discharge of mother and baby.
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Resumo Estudos sobre a efetividade das compras públicas frequentemente enfatizam o preço de aquisição. Pouco se sabe, contudo, sobre outras dimensões de desempenho das contratações realizadas pelo governo, incluindo as relações de interdependência entre custo de aquisição e qualidade. Usando a celeridade na entrega como dimensão alternativa de desempenho, este estudo investigou quais são os mecanismos que ajudam a compreender a redução dos preços contratados e dos prazos de entrega dos objetos adquiridos por meio de compras públicas eletrônicas, bem como a influência da economia obtida na fase de licitação sobre a celeridade da entrega. Analisando uma base de dados única, com informações detalhadas de 3.755 processos de compras realizadas por um órgão do governo federal, constatou-se que, embora as licitações eletrônicas sejam eficazes para reduzir preços contratados nos certames de intensa competição, não há relação significativa entre o acirramento da concorrência entre os participantes e a celeridade na entrega. Ademais, os resultados indicam que fornecedores com histórico de desempenho insatisfatório são exatamente aqueles que continuam comprometendo o resultado das compras públicas.
Resumen Estudios sobre la efectividad de las compras públicas frecuentemente enfatizan sobre el precio de adquisición. Sin embargo, se sabe poco sobre otras dimensiones de desempeño de las contrataciones realizadas por los gobiernos. Usando la rapidez en la entrega como una segunda dimensión de desempeño, este estudio investigó cuáles son los mecanismos que ayudan a comprender la reducción de los precios contratados y de los plazos de entrega de los objetos adquiridos en un portal electrónico de compras públicas, así como la influencia del ahorro obtenido en la fase de licitación sobre la rapidez en la entrega. Analizando una base de datos única, con informaciones detalladas de 3.755 procesos de compras realizadas por un órgano del gobierno federal, se comprobó que, aun cuando las licitaciones electrónicas sean eficaces para reducir los precios contratados en concursos de intensa competición, no existe una relación significativa entre la agresiva competencia entre los participantes y la rapidez en la entrega. Además, los resultados indican que proveedores con histórico de desempeño insatisfactorio son exactamente aquellos que continúan comprometiendo el resultado de las compras públicas.
Abstract Studies on the effectiveness of government procurement have a prominent focus on contracted prices. However, not much is known about other dimensions of the performance of contracts awarded by the government such as the relation of interdependence between contracted prices and quality. Using delivery time as a dimension for quality, this study explores the mechanisms that influence contracted prices and delivery time. It also discusses how price reduction influences ex-post quality in the context of government electronic procurement. Analysis using a data base with detailed information of 3,755 procurement processes executed by a Brazilian organization of the Federal Public Administration shows that, despite procurement processes being effective to reduce prices in competitive bids, there is no evidence that this price reduction negatively affects delivery time. In addition, results show that suppliers with a history of poor performance are those that keep harming government procurement performance.
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Public Administration , Competitive Bidding , Public Sector , Health GovernanceABSTRACT
Background: To study maternal outcome in eclampsia in relation to respiratory complications, fever, DIC, renal system affection and electrolyte imbalance. (2) To study the fetal outcome in eclampsia in relation to small for gestational age, intrauterine death, neonatal mortality, perinatal mortality and need for NICU admission. Methods: It was a cross-sectional prospective study conducted at Department of Obstetrics and Gynaecology at Department of Gynaecology, Adesh Institute of Medical Sciences and Research, Bathinda, Punjab, India. All patients admitted with eclampsia was enrolled for the study as per the criteria given. It was a a cross-sectional prospective study conducted on women admitted with eclampsia after the gestational age of 20 weeks and presented with convulsions. The outcome in relation to maternal and neonatal morbidity and mortality was studied on the basis of various complications and defined parameters. Results: A total of 50 patients were enrolled in the study. The most common age group of patients who had eclampsia after 20 weeks of gestation belonged to age group of 31-35 years followed by 26-30 years and the least common age group was between 41- 45 years of age. The mean age was found to be 28.23 years. The most common indication of LSCS in patients with eclampsia was fetal distress followed by Unfavourable cervix, failure of induction and contracted pelvis. The most common complications seen in patients with eclampsia included Respiratory complications like aspiration pneumonia, pleural effusion and pulmonary edema. Conclusions: Less ANC visits were associated with more threat and complications. Eclampsia was found to be associated with preterm delivery. Increase in convulsion to delivery interval lead to increase severity of complications.
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Objective To figure out the optimal parameters of a volumetric modulated arc therapy ( VMAT) plan for cervical and upper esophageal cancer by quality evaluation of VMAT plans with different parameters, and to provide a reference for the design of clinical VMAT treatment plan. Methods Ten patients with cervical esophageal cancer and ten patients with upper esophageal cancer were enrolled as subjects. The Nucletron Oncentra 4. 3 treatment planning system was used to generate plans for Elekta Synergy VMAT accelerator. Six VMAT plans were made with variation in the gantry angle ( 2°, 3°, and 4°), the maximum delivery time (80 s, 110 s, and 150 s), and the collimator angle (0° and 45°). The doses to the planning target volume and organs at risk were analyzed by paired t test. Results For cervical and upper esophageal cancer, the quality of VMAT plans with a collimator angle of 45° was better than those with a collimator angle of 0°(P=0. 003?0. 007). For cervical esophageal cancer, there was no significant difference in quality between VMAT plans with a maximum delivery time of 110 s or 150 s and those with a maximum delivery time of 80 s ( P>0. 05 );for upper esophageal cancer, there was also no significant difference in quality between VMAT plans with three different maximum delivery times ( P>0. 05 ) . For cervical esophageal cancer, the VMAT plans with a gantry angle of 3° had a better quality than those with a gantry angle of 2° or 4°(P=0. 010?0. 048). For upper esophageal cancer, the VMAT plans with a gantry angle of 3° had a better quality than those with a gantry angle of 4° ( P=0. 010?0. 048) . Compared with those with a gantry angle of 2° , the VMAT plans with a gantry angle of 3° had a slightly better dose distribution in the target volume ( P=0. 046 ) , but a slightly higher dose to lung tissue ( V25 and V30 , P=0. 007 and 0. 026) . Conclusions The optimal initial parameters of a VMAT plan for cervical and upper esophageal cancer are a collimator angle of 45°, a maximum delivery time of 80 s, and a gantry angle of 3°.
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OBJETIVOS: Determinar si el intervalo de nacimiento vía vaginal entre gemelos, se relaciona con un descenso de pH arterial/venoso de cordón umbilical del segundo gemelo respecto al primero, y establecer si el pH acidótico del primer gemelo predice la acidosis del segundo. MÉTODO: Estudio de cohortes retrospectivo en 77 pares de gemelos realizado en el Hospital de Getafe, España, en el periodo 2008-2013. Se relacionó el tiempo transcurrido entre el nacimiento de los gemelos con el resultado del pH de cordón y el exceso de bases. Estudiamos la correlación entre el tiempo transcurrido entre ambos nacimientos y la diferencia entre los valores de pH del primer y segundo gemelo, y la correlación con la diferencia de exceso de base. RESULTADOS: Hubo correlación lineal significativa entre el tiempo transcurrido entre el nacimiento de los gemelos y la diferencia de pH venoso del segundo gemelo respecto del primero (R=0,560; p=0,0001), así como con el pH arterial (R=0,502; p=0,0001). El pH <7,20 del primer gemelo se asoció con acidosis en el cordón del 2° gemelo (<7,20, p=0,000; <7,15, p=0,0001; <7,10, p=0,0001; <7,05, p=0,001; <7,00, p=0,0001). CONCLUSIONES: El pH del segundo gemelo siempre fue igual o menor que el del primer gemelo, hubo una correlación lineal entre el intervalo de nacimiento entre gemelos y el descenso del pH venoso y arterial del segundo gemelo respecto al primero. El pH acidótico del primer gemelo predice la acidosis del segundo.
OBJETIVOS: Determinate if the twin-to-twin vaginal delivery time interval, is related with a decline of the arterio-venous cord blood pH of the second twin regarding to the first twin, and to evaluate if the acidotic pH of first twin can predict the acidosis status of the second one. METHOD: A retrospective descriptive cohort study was performed at the Hospital of Getafe, Spain, in the period 2008-2013, with 77 pairs of twins that were registered and met the inclusion criteria. The twin-to-twin delivery time interval and the cord blood status results were registered. A statistical analysis was performed to study the relation of the twin-to-twin delivery time interval with the pH value differences between first and second twins, and with the base excess. RESULTS: A positive linear correlation between the twin-to-twin delivery time interval and the difference of venous pH of the second twin respect to the first one was found (R=0.560; p=0.0001), and also with the difference on arterial pH (R=0.502; p=0.0001). A pH value <7.20 of the first twin was associated with blood cord acidosis of the second twin (<7.20, p=0.000; <7.15, p=0.0001; <7.10, p=0.0001; <7.05, p=0,001; <7.00, p=0.0001). CONCLUSIONS: The second twin pH was equal to or less than the first twin pH in all cases. There is a linear relation between twin-to-twin delivery time interval and the decrease of the pH value of the second twin regarding to the first one. The acidosis of first twin could predict the acidosis status of the second twin.
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Humans , Female , Pregnancy , Infant, Newborn , Adult , Acidosis/blood , Fetal Blood/chemistry , Pregnancy, Twin , Hydrogen-Ion Concentration , Spain , Acid-Base Equilibrium , Time Factors , Umbilical Arteries , Umbilical Cord , Umbilical Veins , Birth Order , Retrospective Studies , Cohort StudiesABSTRACT
Objective To analyse the effect of progesterone on peripheral blood corticotropin releasing hormone ( CRH ) and delivery time in women with premature rupture of membranes ( PROM ) .Methods 80 patients who were diagnosed with PROM in Department of Obstetrics and Gynecology, China Medical University were collected.Randomly divided into dexamethasone (DEX) group, dexamethasone plus progesterone (DEX+P) group, progesterone ( P) group and control group, three groups were detected on admission, admission 24 h, 48 h on peripheral white blood cell count, C-reaction protein, CRH level and time of delivery, neonatal weight, and analysis of CRH the level of the correlation and delivery time.Results Compared with the other three groups, the level of CRH in peripheral blood of DEX group were higher (P<0.05);CRH (P<0.05) increased faster;shorter delivery time (P<0.05); the level of CRH was negatively correlated with delivery time (r=-0.832, P<0.05).The results were statistically significant.Conclusion Dexamethasone treatment can make the premature rupture of fetal membranes of peripheral blood CRH levels rise, shorten the delivery time, progesterone can inhibit this process.
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PURPOSE: The study was done to examine the effects of San-Yin-Jiao(SP6) acupressure treatment on subjective labor pain, length of delivery time in women during labor. METHOD: The study design was a randomized controlled clinical trial study using a double-blinded method. Data were collected using a structured questionnaire, a subjective labor pain scale and measurement of delivery time. The experimental group(n=29) was received SP6 acupressure and control group(n=29), SP6 touch for the duration of each uterine contraction, during 30 minutes after 3cm dilatation of cervical os. RESULT: The subjective labor pain scores was significantly different between the two groups(p=0.042). The total length of delivery time in the group which had the SP6 acupressure was shorter than SP6 touch group (p=0.036). CONCLUSION: These findings showed that SP6 acupressure was effective related to labor pain, length of time for delivery. SP6 acupressure during labor could be applied as an effective nursing treatment.
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The study examined the effects of San-Yin- Jiao(SP-6) acupressure treatment on labor pain, length of delivery and anxiety for women in the labor. The effects of using SP-6 acupressure were evaluated by comparing two groups, a SP-6 acupressure group (22) and a control group (17), for a total of 39 women in labor who had a normal vaginal delivery. Data were collected using a structured questionnaire which included general characteristics, a subjective labor pain scale, measurement of duration of delivery time and a subjective anxiety scale. Data were collected before treatment (pre) and after treatment (post). The results of this study are summarized as follows : 1. The post-scores for total labor pain increased over the pre-scores but the difference between the two groups was not statistically significant(p=0.219). Wilcoxon signed rank test of the difference in pre-post labor pain scores for the SP-6 acupressure group was not statistically significant (p=0.081) but the increase for the control group was statistically significant (p=0.001).2. The length of time for the delivery in the group which had the SP-6 acupressure was shorter (143.91+/-67.77) than the control group (197.94+/-89.64). The difference between the two groups was statistically significant (p=0.028).3. The post-scores for anxiety increased over the pre-scores but the difference between the two groups was not statistically significant (p=0.426). The scores of SP-6 acupressure group did not show a significant increase by the Wilcoxon signed rank test (p=0.194) but in the control group showed a significant increase (p=0.008).This study showed that SP-6 acupressure was effective in relation to labor pain, length of time for delivery and anxiety for labor women. But it is necessary to replicate the study with a larger number of participants to generalize the results.
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Female , Humans , Pregnancy , Acupressure , Anxiety , Labor Pain , Pilot Projects , Surveys and QuestionnairesABSTRACT
The purpose of this study was to examine the effects on labor pain and duration of delivery time for primipara women treated by San-Yin-Jiao(SP-6) and Hob-Gog(LI-4) acupressure. The design of this study was a nonequivalent control group non-synchronizedpost test only design. It was done to identify the effects of SP-6 acupressure or LI-4 acupressure on labor pain in primipara women. The benefits of using SP-6 acupressure or LI-4 acupressure were evaluated by comparing three groups, a SP-6 acupressure group, a LI-4 acupressure group and a control group, not treated with acupressure. The participants included 192 primiparas who underwent vaginal delivery, 72 primiparas in the control group, 71 in the SP-6 acupressure group and 49 in the LI-4 acupressure group. Data were collected using a structured questionnaire consisting of general characteristics, a subjective labor pain scale (Johnson, 1974), and measurement of duration of delivery time. The results of this study are summarized as follows : 1. Differences in the acupressure effect for SP-6 and LI-4 were analyzed using Scheffe's test which showed that differences in the control group vs the SP-6 group and the control group vs the LI-4 group were statistically significant (t=21.767, p<0.05; t=23.923, p<0.05), but the SP-6 group vs the LI-4 group showed no significant differences. 2. The duration of delivery time in the group which had SP-6 acupressure or LI-4 acupressure was shorter (400.77+/-153.34; 379.10+/-127.60) than in the control group (528.68+/-239.08). Differences in the effects of acupressure with SP-6 and LI-4 were also analyzed by Scheffe's test. Control group vs SP-6 group and Control group vs LI-4 group were significantly different(t=127.91, p<0.05; t=149.58, p<0.05), but the SP-6 group vs the LI-4 group did not show any statistically significant difference (t=21.67). This study has shown that SP-6 and LI-4 acupressure were both effective in relation to labor pain and duration of delivery time for primiparas. But it is necessary to replicate the study with a larger number of participants to generalize of the results.
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Female , Humans , Pregnancy , Acupressure , Labor Pain , Surveys and QuestionnairesABSTRACT
Various factors ; i.e., maternal and fetal conditions, method of ansthesia, induction delivery time (IDT), induction uterine incision time (1UT), uterine incision - delivery time (UDT), surgical experience (specialists vs. residents), and gestational age ; which might intluence neonatal outcome follwing cesarean section were investigated in sixty-one patients who underwent cesarean section at Han Yang University Hospital between August 1992 and March 1993. Neonatal outcome was assessed by 1-and 5-minute Apgar scores, and umbilical vein blood gas analysis (UVBGA) taken immediately after birth. The results were as follows. 1) Preoperative maternal conditions did not affect neonatal outcome. For the neonates of normal and abnormal maternal conditions, the 1-minute Apgar score were 7.2+/-1.0 and 6.8+/-1.0, respectively. In the same groups of neonates, The UVBGA showed pHa 7.33+/-0.04 and 7.33+/-0.05; PaCO2 44.7+/-5.1 and 44.4+/-7.4 mmHg; PaO2 30.5+/-7.1 and 27.9+/-6.3 mmHg; and BE -2.7+/-3.5 and -3.8+/-3.5 mEq/L, respectively. 2) Method of anesthesia did not change neonatal outcome. In the general and epidural anestheia groups, the 1- minute Apgar scores were 7.1+/-1.0 and 7.3+/-0.8, respectively. The UVBGA in the same groups showed pHa 7.33+/-0.05, 7.34+/-0.03; PaCO2 44.6+/-6.1, 41.0+/-6.1 mmHg ; PaO2 29.5+/-6.8, 28.7+/-6.6 mmHg; and BE -3.2+/-3.5, -4.0+/-3.6 mEq/L, respectively. 3) IDT did not influence neonatal outcome. In the groups with IDT exceeding or equal to 10 ininutes and less than 10 minutes, the 1-minute Apgar scores were 7.2+/-1.0 and 7.0+/-1.0 with IDT, respectively. In the same groups, the UVBGA revealed pHa 7.33+/-0.04, 7.33+/-0.05; PaCO2 40.0+/-6.2, 44.9+/-6.1 mmHg; PaO2 28.8+/-7.1, 29.9+/-6.7 mmHg; and BE -2.8+/-3.5, -3.8+/-3.5 mEq/L, respectively. IDT was more than 10 minutes in all epidural anesthesia cases. 4) In the groups with UDT more than or equal to 3 minutes and less than 3 minutes, the 1- minute Apgar scores were 7.0+/-1.1 and 6.7+/-1.6, respectively. In the same groups, the UVBGA revealed pHa 7.32+/-0.05, 7.33+/-0.05; PaCO2 41.8+/-5.1, 44.4+/-6.4 mmHg; PaO2 28.3+/-6.2, 29.5+/-6.9 mmHg; and BE -3.9+/-3.6, -5.0+/-2.8 mEq/L, respectively. 5) Surgical experience did not contribute to the neonatal outcome. The 1-minute Apgar scores were 7.2+/-1.0 and 7.0+/-1.1 in the groups where cesarean section were performed by specialists and residents, respectively. UVBGA showed PHa 7.33+/-0.04, 7.32+/-0.06; PaCO2 44.8+/-6.5, 44.3+/-5.8 mmHg; PaO2 30.2+/-6.9, 28.5+/-6.9 mmHg; and BE -2.6+/-3.4, -3.9+/-3.6 mEq/L, respectively in the same groups. 6) Gestational age, determined as fullterm or preterm did not influence neonatal outcome. In the fullterm and preterm neonates, the 1-minute Apgar scores were 7.1+/-1.0 and 6.6+/-1.1, respectively. UVBGA showed pHa 7.33+/-0.05, 7.32+/-0.05; PaCO2 44.5+/-6.3, 45.0+/-4.9 mmHg ; PaO2 29.4+/-6.9, 30.0+/-6.6 mmHg ; and BE -3.2+3.6, -2.7+2.1 mEq/L respectivly. It appears that maternal and fetal conditions, method of anesthesia, IDT and UDT, experience of surgery, and gestational age do not influence post-cesarean neonatal outcome.
Subject(s)
Female , Humans , Infant, Newborn , Pregnancy , Anesthesia , Anesthesia, Epidural , Apgar Score , Blood Gas Analysis , Cesarean Section , Gestational Age , Parturition , Specialization , Umbilical VeinsABSTRACT
The anesthesia for cesarean section is concerned not only with the fetus but also with mother. The physiological changes of the patient are manifold and drugs which are used during cesarean section may have effects on the fetus. The rate of cesarean section has increased during recent years due to frequent fetal monitoring, medical insurance and the threat of malpractice suits. A total of 1225 cesarean sections were performed under general anesthesia during the year period from 1983 to 1987. The following are the clinical observations: 1) The cesarean section rate was 19.03% and this has been increasing during recent year. 2) The delivery time from induction was less than 15 min in 80.5% of cases. 3) Apgar scores were: more than 7 in 1 minute: 92% more than 7 in 5 minutes: 95.8%. 4) The infant resuscitation rate was 4.57% and more than 7 of the Apgar scores were noted after resuscitation. 5) The mean hemoglobin was 10gm% and the blood transfusion rate was 7.92%.