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Este estudo analisa a experiência da maternidade tardia (35+ anos) e as suas implicações na fase avançada de vida, nomeadamente nas trajetórias pessoais e familiares. Trata-se de um estudo qualitativo com 15 díades compostas por mães tardias, atualmente idosas, e seus últimos filhos. Os resultados remetem para os riscos de saúde, distress emocional e julgamentos sociais da gestação tardia. Ao nível familiar destaca-se a presença de desafios da sobreposição de etapas distintas do ciclo de vida (cuidar de filhos pequenos e adolescentes vs. gestão da meia-idade) e, hoje, da (in)capacidade de cuidar dos netos. Os filhos evidenciam preocupações com a prestação de cuidados dos pais, tarefa que por ocorrer precocemente nas suas trajetórias desenvolvimentais, se pauta por dificuldades acrescidas.
This study focuses on the experience of late motherhood (35+ years) and its implications in the phase of advanced age, particularly in personal and family trajectories. It is a qualitative study of 15 dyads composed by older women who were late mothers and their last children. Results highlight the presence of several health risks, emotional distress and social judgments of late pregnancy. About family dynamics, challenges were mentioned by the overlapping of distinct stages of the life cycle (caring for small and teenage children vs. demands of middle age), and, currently, by the (in)capacity to take care of grandchildren. Children experienced several concerns related to their parent's caregiving, a demanding task that is perceived as happening too early in their developmental trajectories.
Este estudio analiza la experiencia de la maternidad tardía (más de 35 años) y sus implicaciones en la etapa avanzada de la vida, es decir, en las trayectorias personales y familiares. Este es un estudio cualitativo con 15 díadas compuestas por madres tardías, actualmente ancianas, y sus últimos hijos. Los resultados se refieren a los riesgos para la salud, la angustia emocional y los juicios sociales del embarazo tardío. A nivel familiar, destacamos la presencia de desafíos de la superposición de diferentes etapas del ciclo de vida (cuidado de niños pequeños y adolescentes frente a la gestión de la mediana edad) y, hoy, de la (in)capacidad de cuidar a los nietos. Los niños muestran inquietudes acerca de la provisión de cuidado parental, una tarea que, debido a que ocurre temprano en sus trayectorias de desarrollo, está marcada por mayores dificultades.
Subject(s)
Women , Aging , Pregnancy/psychology , Caregivers , Family RelationsABSTRACT
Fetal exposure to sevoflurane induces long-term cognitive impairment. Histone acetylation regulates the transcription of genes involved in memory formation. We investigated whether sevoflurane exposure during late-pregnancy induces neurocognitive impairment in offspring, and if this is related to histone acetylation dysfunction. We determined whether the effects could be reversed by an enriched environment (EE). Pregnant rats were exposed to 2.5% sevoflurane or control for 1, 3, or 6 h on gestational day 18 (G18). Sevoflurane reduced brain-derived neurotrophic factor (BDNF), acetyl histone H3 (Ac-H3), and Ac-H4 levels and increased histone deacetylases-2 (HDAC2) and HDAC3 levels in the hippocampus of the offspring on postnatal day 1 (P1) and P35. Long-term potentiation was inhibited, and spatial learning and memory were impaired in the 6-h sevoflurane group at P35. EE alleviated sevoflurane-induced cognitive dysfunction and increased hippocampal BDNF, Ac-H3, and Ac-H4. Exposure to 2.5% sevoflurane for 3 h during late-pregnancy decreased hippocampal BDNF, Ac-H3, and Ac-H4 in the offspring but had no effect on cognitive function. However, when the exposure time was 6 h, impaired spatial learning and memory were linked to reduced BDNF, Ac-H3, and Ac-H4, which could be reversed by EE.
Subject(s)
Animals , Female , Pregnancy , Rats , Cognitive Dysfunction , Acetylation , Histones , Maze Learning , Brain-Derived Neurotrophic Factor , Sevoflurane , HippocampusABSTRACT
Aim: The aim of this study was to determine the prevalence of GBS colonization among HIV positive and HIV negative pregnant women in relation to CD4 cell counts.Materials and Methodology: This was a hospital based descriptive cross-sectional study of 200 pregnant women (100 HIV positive and 100 HIV negative) and 100non-pregnant women (50 HIVpositive and 50 HIV negative) obtaining health care at the Jos University Teaching Hospital betweenJuly 2017 and November 2017. Systematic sampling technique and written informed consent were used in recruiting subjects for this study. High vaginal and anorectal swabs were collected from each subject after filling a structured questionnaire. CD4 cell count was also done for all the HIV positive patients at Aids Prevention Initiative in Nigeria (APIN) of Jos University Teaching Hospital (JUTH). The results from the laboratory analysis of the specimens were computed using SPSS version 21.Results: A colonization rate of 7.3% was observed in HIV positive patients compare to 5.3% in HIV negative. The different in colonization rate between the two groups was not statistically significant (X2 = 0.507; P = 0.477) (Table 1). In pregnant women living with HIV, colonization rate was 8.0% compare to 5.0% observed in non-pregnant women living with HIV. This however, was not statistically significant (Table 2) (χ2 = 0.013; P = 0.908). HIV positive subjects with low CD4 counts (<200cells/μl) were observed to have highcolonization rate (20.0%) than patients with high CD4 counts (≥500 cells/μl). Those with CD4 counts between 200-499 cells/μl had 8.1% colonization rate. These findings, though not statistically significant (Table 4) (χ2 = 1.3814; P = 0.2399), the increased colonization rate in low CD4 cell counts may be due to inability of the patient to mount immune response against the organism.Conclusion: There was no statistically significant difference in GBS colonization among HIV positive patients. A higher colonization rate was observed in HIV patients among the age group 21-25 years; ager was not significantly risk factor for GBS colonization in HIV patients. CD4 cell counts seem not to play any significant role in GBS colonization rate. Although, it was observed to be higher in patients with low CD4 cell counts; the different was not statistically significant
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Pregnancy has increased susceptibility to H1N1 influenza virus infection. Maternal influenza infection is associated with increased risk of morbidity and mortality. A case of influenza A (H1N1) during late pregnancy (pregnancy 1, birth 0, pregnancy 30+2 weeks) was admitted to the Second Affiliated Hospital of Kunming Medical University on December 16th, 2018. The patient was set on mechanical ventilation with a FiO2 of 1.0, a positive end-expiratory pressure (PEEP) of 15 cmH2O (1 cmH2O = 0.098 kPa), and a tidal volume of 4-6 mL/kg (ideal body weight). However the pulse oxygen saturation (SpO2) could only be maintained at about 0.85. The disease was controlled by the treatments of anti-infection, mechanical ventilation, immune therapy, nutritional support, preventive anticoagulant treatment by heparin sodium, adequate negative fluid balance, and other organ support therapy. This article introduced the treatment process of the patient in detail, and provided experience for clinical treatment.
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Objective@#To assess the longitudinal mitral annular plane systolic excursion (MAPSE) of different directions in normal fetuses during mid-late pregnancy based on two-dimensional speckle tracking imaging (STI).@*Methods@#Seventy-six normal fetuses during middle and late pregnancy were selected at 26-32 weeks of gestation. The peak MAPSE was measured by free angle M-mode echocardiography (FAM) perpendicular to the lateral annulus in the mitral annular plane. The time-displacement curves of interventricular septal mitral annulus in three different directions including points A, B and C through transverse level of apex were recorded by STI. The peak MAPSE of interventricular septal mitral annulus (SEPT-MAPSE-A, SEPT-MAPSE-B, SEPT-MAPSE-C) in three different directions including points A, B and C and the time to peak (TTP: SEPT-TTP-A, SEPT-TTP-B, SEPT-TTP-C) were recorded respectively. The time-displacement curves of lateral mitral annulus in three different directions including points A, B and C through transverse level of apex were recorded by STI. The peak MAPSE of lateral mitral annulus (LAT-MAPSE-A, LAT-MAPSE-B, LAT-MAPSE-C) in three different directions including points A, B and C, the time to peak(LAT-TTP-A, LAT-TTP-B, LAT-TTP-C) were recorded respectively. Finally, the data were analyzed statistically.@*Results@#The peak MAPSE of the lateral mitral annulus in 3 different directions including points A, B and C[LAT-MAPSE-A (3.62±1.01)mm, LAT-MAPSE-B (3.95±1.04)mm, LAT-MAPSE-C (4.45±1.05)mm] were greater than those of the interventricular septum mitral annulus[SEPT-MAPSE-A (3.41±0.63)mm, SEPT-MAPSE-B (3.07±0.50)mm, SEPT-MAPSE-C (2.82±0.51)mm]. LAT-MAPSE-C and SEPT-MAPSE-A were the largest longitudinal excursions of mitral annulus. The differences were statistically significant in points B and C (P<0.05). There was no significant difference in point A (P>0.05). LAT-MAPSE-C was less than FAM-MAPSE[(6.06±1.35)mm]. There was a significant difference between them(P<0.05). Strong correlation was found between them(r=0.896, P<0.05). There were no significant differences in the time to peak of interventricular septal mitral annulus [SEPT-TTP-A (0.210±0.008)s, SEPT-TTP-B (0.213±0.008)s, SEPT-TTP-C (0.210±0.005)s] in directions including points A, B, C(P>0.05). There were no significant differences in time to peak of lateral mitral annulus[LAT-TTP-A(0.210±0.008)s, LAT-TTP-B(0.213±0.006)s, LAT-TTP-C(0.210±0.007)s] in directions inclucling points A, B, C(P>0.05).@*Conclusions@#Longitudinal systolic motion of fetal left ventricular wall during mid-late pregnancy has good synchronization. Longitudinal motion of fetal mitral annulus is a comprehensive movement of multiple directions and different degrees of displacement, with the movement perpendicular to the annulus as the maximum displacement direction. The displacement parameters of mitral annulus measured by STI can reflect the left ventricular longitudinal systolic function and have clinical application value in evaluating the left ventricular longitudinal systolic function of fetuses.
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Objective To assess the longitudinal mitral annular plane systolic excursion ( M APSE) of different directions in normal fetuses during mid‐late pregnancy based on two‐dimensional speckle tracking imaging ( ST I) . Methods Seventy‐six normal fetuses during middle and late pregnancy were selected at 26－32 weeks of gestation . T he peak M APSE was measured by free angle M‐mode echocardiography ( FAM ) perpendicular to the lateral annulus in the mitral annular plane . The time‐displacement curves of interventricular septal mitral annulus in three different directions including points A ,B and C through transverse level of apex were recorded by STI . T he peak M APSE of interventricular septal mitral annulus ( SEPT‐M APSE‐A ,SEPT‐M APSE‐B ,SEPT‐M APSE‐C) in three different directions including points A ,B and C and the time to peak ( T T P :SEPT‐T T P‐A ,SEPT‐T T P‐B ,SEPT‐T T P‐C) were recorded respectively . T he time‐displacement curves of lateral mitral annulus in three different directions including points A ,B and C through transverse level of apex were recorded by STI . T he peak M APSE of lateral mitral annulus ( LAT‐M APSE‐A ,LAT‐MAPSE‐B ,LAT‐MAPSE‐C) in three different directions including points A ,B and C ,the time to peak( LA T‐T T P‐A ,LA T‐T T P‐B ,LA T‐T T P‐C) were recorded respectively . Finally ,the data were analyzed statistically . Results T he peak M APSE of the lateral mitral annulus in 3 different directions including points A ,B and C[ LA T‐M APSE‐A ( 3 .62 ± 1 .01) mm ,LA T‐M APSE‐B ( 3 .95 ± 1 .04) mm ,LAT‐M APSE‐C ( 4 .45 ± 1 .05) mm ] were greater than those of the interventricular septum mitral annulus[ SEPT‐MAPSE‐A (3 .41 ± 0 .63)mm ,SEPT‐MAPSE‐B (3 .07 ± 0 .50) mm ,SEPT‐MAPSE‐C (2 .82 ± 0 .51) mm] . LAT‐M APSE‐C and SEPT‐M APSE‐A were the largest longitudinal excursions of mitral annulus . T he differences were statistically significant in points B and C ( P ＜0 .05) . T here was no significant difference in point A ( P ＞0 .05) . LA T‐M APSE‐C was less than FAM‐M APSE [ ( 6 .06 ± 1 .35 ) mm ] . T here was a significant difference between them ( P ＜0 .05 ) . Strong correlation was found between them ( r ＝0 .896 , P＜0 .05) . T here were no significant differences in the time to peak of interventricular septal mitral annulus [ SEPT‐T T P‐A ( 0 .210 ± 0 .008 ) s ,SEPT‐T T P‐B ( 0 .213 ± 0 .008 ) s ,SEPT‐T T P‐C ( 0 .210 ± 0 .005 ) s] in directions including points A ,B ,C ( P＞ 0 .05 ) . T here were no significant differences in time to peak of lateral mitral annulus [ LAT‐T T P‐A ( 0 .210 ± 0 .008 ) s , LAT‐T T P‐B ( 0 .213 ± 0 .006 ) s , LAT‐T T P‐C ( 0 .210 ± 0 .007) s] in directions inclucling points A ,B ,C ( P ＞0 .05) . Conclusions Longitudinal systolic motion of fetal left ventricular wall during mid‐late pregnancy has good synchronization . Longitudinal motion of fetal mitral annulus is a comprehensive movement of multiple directions and different degrees of displacement ,with the movement perpendicular to the annulus as the maximum displacement direction . T he displacement parameters of mitral annulus measured by ST I can reflect the left ventricular longitudinal systolic function and have clinical application value in evaluating the left ventricular longitudinal systolic function of fetuses .
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Pregnancy has increased susceptibility to H1N1 influenza virus infection. Maternal influenza infection is associated with increased risk of morbidity and mortality. A case of influenza A (H1N1) during late pregnancy (pregnancy 1, birth 0, pregnancy 30+2 weeks) was admitted to the Second Affiliated Hospital of Kunming Medical University on December 16th, 2018. The patient was set on mechanical ventilation with a FiO2 of 1.0, a positive end-expiratory pressure (PEEP) of 15 cmH2O (1 cmH2O = 0.098 kPa), and a tidal volume of 4-6 mL/kg (ideal body weight). However the pulse oxygen saturation (SpO2) could only be maintained at about 0.85. The disease was controlled by the treatments of anti-infection, mechanical ventilation, immune therapy, nutritional support, preventive anticoagulant treatment by heparin sodium, adequate negative fluid balance, and other organ support therapy. This article introduced the treatment process of the patient in detail, and provided experience for clinical treatment.
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RESUMO A ascensão profissional feminina, dentre outras mudanças sociais e culturais, tem modificado os padrões das famílias na contemporaneidade. Um dos padrões refere-se ao adiamento da maternidade e como os casais vivenciam esta decisão, na relação conjugal. O objetivo desse estudo é compreender a decisão dos casais, principalmente da mulher, de adiar a parentalidade e como esta decisão impacta na relação conjugal. A pesquisa é de cunho qualitativo, transversal e descritivo. Participaram 16 indivíduos heterossexuais casados que responderam a uma entrevista semiestruturada. A análise das entrevistas foi realizada por meio da análise de conteúdo, da qual emergiram três categorias: (a) questão financeira no processo parental: 'ter filho com que dinheiro?', (b) tentativa de controle versus surpresa da gestação, e (c) gestação tardia e calmaria na conjugalidade. Evidenciou-se uma preocupação significativa quanto à seguridade financeira para gestar, assim como o desejo de controle dos casais com relação ao momento adequado da gestação e da maturidade emocional vivenciada pelos entrevistados quanto à gestação tardia. No que diz respeito à conjugalidade, os casais manifestam que a mesma trouxe união e compreensão.
RESUMEN La ascensión profesional femenina, entre otros cambios sociales y culturales, ha modificado los patrones de las familias en la contemporaneidad. Uno de dichos patrones se refiere a la prórroga de la maternidad y cómo las parejas experimentan, en la relación conyugal, esa decisión. El objetivo de este estudio ha sido comprender la decisión de las parejas, principalmente de la mujer, de posponer la etapa parental y cómo esa decisión impacta en la relación conyugal. La investigación posee cuño cualitativo, transversal y descriptivo. Participaron dieciséis individuos heterosexuales casados que respondieron a una entrevista semiestructurada. Las entrevistas se han evaluado según el análisis de su contenido, del cual surgieron tres categorías: (a) La cuestión financiera en el proceso parental: '¿es asumible económicamente tener un hijo?', (b) La tentativa de control versus la sorpresa del embarazo, y (c) El embarazo tardío y la tranquilidad en la relación conyugal. Se ha evidenciado una preocupación significativa en cuanto a la seguridad financiera para la gestación, así como el deseo de control de las parejas con respecto al momento adecuado del embarazo, y de la madurez emocional vivenciada por los entrevistados en función del embarazo tardío. En lo que se refiere a la relación conyugal, las parejas manifiestan que la misma trae unión y comprensión.
ABSTRACT Women professional growth, among other social and cultural changes, has modified the standards of families in the contemporary world. One of these standards refers to the postponement of motherhood, and how couples experience this decision in the marital relationship. This study aimed to understand the decision of couples, especially women, to delay parenting, and how this decision influences the marital relationship. The research is qualitative, cross-sectional, and descriptive. Sixteen heterosexual married individuals participated in a semi-structured interview. The analysis of the interviews was performed through content analysis, from which emerged three categories: (a) Financial issue in the parental process: 'can we afford having a child?', (b) Attempt of control versus surprise of pregnancy, and (c) Late pregnancy and calmness in the conjugal relationship. There was a significant concern with respect to the financial security to get pregnant, besides the couples' desire to control the appropriate time to pregnancy, and emotional maturity experienced by the interviewees related to late pregnancy. Regarding the conjugal relationship, couples manifested that it brought unity and understanding.
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Humans , Women , Career Mobility , Marriage , Pregnancy/statistics & numerical dataABSTRACT
Objective To study the colonization rate and antibiotic resistance of group B Streptococcus (GBS) in gravidas during late pregnancy,and to evaluate the effectiveness of GBS screening in late pregnancy and intrapartum antibiotic prophylaxis (IAP) for the prevention of neonatal early-onset GBS disease (EOGBS).Methods A retrospective study was conducted to analyze the colonization rate and antibiotic resistance pattern of GBS in 14 204 gravidas who were screened for GBS at 35-37 gestational weeks during March 2016 to March 2018 in the University of Hongkong-Shenzhen Hospital (HKU-SZH).Differences in the incidence of EOGBS before and after GBS screening and IAP were analyzed using Chi-square or Fisher's exact test.Results Among the 14 204 gravidas,2 027 cases were GBS positive with a colonization rate of 14.27％.Incidence rates of EOGBS before and after GBS screening were 0.6‰ (4/6 356) and 0.07‰ (1/14 403),respectively (Fisher's exact test,P=0.033).GBS isolates were 100％ (2 027/2 027) sensitive to penicillin and vancomycin.Resistance rates to clindamycin and erythromycin were 67.2％(1 363/2 027) and 65.7％ (1 332/2 027),respectively.Conclusions Routine GBS screening in late pregnancy and IAP can significantly decrease the incidence of EOGBS.Penicillin is the optimal choice for prevention and treatment of GBS infection.
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Objective To study the association of maternal calcium supplementation and dietary calcium intake with the preterm birth so that to provide scientific basis for effective intervention of preterm birth. Methods Normal pregnant women who were followed up all through to childbirth in Gansu Provincial Maternity and Child Care Hospital were selected. Multivariate logistic regression was used to evaluate the associ-ation of calcium supplementation and intake with preterm birth. Results After confounding factors were adjus-ted, pregnant women who took calcium supplement for more than 3 months before and/or during pregnancy had the risk of preterm birth reduced by 14% which was dose-responding ( OR=0. 86, 95% CI=0. 77-0. 96, P<0. 05). Through stratifying by trimesters of pregnancy, it was found that calcium supplement in the third trimes-ter was a protective factor for preterm birth and especially significant in early and very early pregnancy ( OR=0. 75, 95% CI=0. 62-0. 92, P<0. 05). Through stratifying by dietary calcium intake, pregnant women who took dietary calcium more than 465. 55 mg/d had the risk of preterm birth significantly reduced which was shown by the reduction of preterm birth of different degrees, controlled preterm labor and spontaneous premature dilivery (OR=0. 66, 95% CI=0. 53-0. 82, P<0. 05). Conclusion Appropriate calcium supplementation or dietary calcium intake before and during pregnancy can reduce the risk of preterm birth, which is especially sig-nificant in late pregnancy.
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@#Objective To study the clinical characteristics, therapy strategies and the outcomes of female patients with acute aortic dissection during late pregnancy and puerperal period. Methods We retrospectively analyzed the clinical data of 7 patients with acute aortic dissection during late pregnancy and puerperal period in Shanghai Changhai Hospital between August 2012 and June 2017. Five of the 7 patients were late stage pregnancy, 2 were puerperal period (1 at the postpartum night, 1 in 18 days after delivery). There were 6 patients of Stanford type A aortic dissection (85.7%), and 1 patient of type B aortic dissection (14.3%). The age of the patients ranged from 26 to 34 (30.8±3.1) years. Cardiac ultrasonography of patients with type A showed that the maximum diameter of the ascending aortas was 4.2–5.7 (4.7±0.6) cm, of which 2 patients were aneurysm of aortic sinus, 3 patients were with Marfan syndrome. Bentall procedure was conducted in 1 patient, Bentall+Sun’s surgery in 2 patients, ascending aorta replacement+Sun’s+coronary artery bypass grafting surgery in 1 patient, aortic root remodeling+ascending aorta replacement+Sun’s surgery in 2 patients. One patient with Stanford type B acute aortic dissection was performed with thoracic endovascular aortic repair (TEVAR) after cesarean section. Results Aortic blocking time ranged from 51 to 129 (85.5±22.9) min. Cardiopulmonary bypass time was 75–196 (159.0±44.0) min. Moderate hypothermic circulation arrest with selective cerebral perfusion time was 20–30 (23.8±3.5) min. All maternal and fetuses survived. The infant whose mother received aortic repair in early stage and then received cesarean section was diagnosed with cerebral palsy. Maternal and fetuses were followed up for 9 months to 4 years. During the follow up period, all the fetuses grew well except the cerebral palsy one, and all maternal recovered well. The patient who received aortic repair in the early stage, had a sigmoid rupture during cesarean section and was treated with sigmoid colostomy. Another patient with Stanford type A dissection was diagnosed as left renal vein entrapment syndrome after 2 years. Conclusion Type A aortic dissection is more common in late pregnancy and puerperal patients. And Marfan syndrome is a high-risk factor for acute aortic dissection in pregnancy women. Early and appropriate surgical treatment strategy based on the type of aortic dissection and gestational age are the key points to achieve good outcomes both for maternal and fetus.
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OBJECTIVE: To assess the safety and efficacy of transcutaneous electrical acupoint stimulation (TEAS) for depression in late pregnancy and impacts on inflammatory cytokines. METHODS: A total of 150 pregnant women with depression in late pregnancy were randomized into a high intensity group (n＝52), a low intensity group (n＝49) and a control group (n＝49). TEAS was applied at bilateral Neiguan (PC 6) and Shenmen (HT 7) for 6 weeks. The intensities of TEAS in the high intensity group, the low intensity group and the control group were 10, 5 and 0 mA, respectively. During the process of TEAS, the blood pressure, pulse, uterine contraction and the fetal heart rate were recorded. Depression was evaluated by 24-item Hamilton depression scale (HAMD) before TEAS and after 2-week, 4-week, 6-week treatment. Serum levels of tumor necrosis factor-α (TNF-α), interleukin-1 β (IL-1 β) and IL-6 were detected by enzyme-linked immunosorbent assay (ELISA) before and after 6-week treatment. Delivery outcomes were observed. The correlation was analyzed between HAMD difference value and the diffe-rence values of TNF-α， IL-1 β and IL-6, respectively. RESULTS: The blood pressure, pulse and fetal heart rate had no statistical significance before and after treatment in the three groups (P>0.05). The HAMD scores at all the time points were lower than that before treatment in the high intensity group (P0.05). The variation of HAMD score did not have significant correlation with those of TNF-α， IL-1 β and IL-6 (P>0.05). CONCLUSION: TEAS is safe and effective for depression in late pregnancy and can regulate the serum levels of IL-1 β and IL-6 without influencing on delivery outcome.
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@#Introduction: Unforeseen emergency in late pregnancy can be catastrophic and cause unexpected maternal and foetal demise. Moreover, lack of awareness and failure of prompt treatment raise mortality rate. Such fatalities warrant a forensic autopsy as it may raise redundant medico-legal concerns. Case Report: We report a case that revealed significant intra-abdominal haemorrhage at autopsy. The source of haemorrhage was at the spleen hilum and histology established rupture of splenic artery aneurysm. There was no associated obstetric cause found. Conclusion: Knowledge of spontaneous rupture of splenic artery aneurysm in late pregnancy is essential for monitoring maternal and foetal, morbidity and mortality. However, in the eventuality of death a comprehensive forensic autopsy is the only investigation to recognise such calamity and clear clinical confusion.
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Objective To investigate psychological intervention on the treatment of the patients with rivanol induced labor in late pregnancy with depressive.Methods From March 2014 to February 2017 in Shaoxing central hospital, 54 cases with late pregnancy as the research object, who were induced labor to terminate pregnancy with rivanol because severe fetal deformity.According to the wishes of this patients, they were randomly divided into the control group and the observation group, 27 cases in each group.The control group were received conventional nursing, at this basis, the observation group were given psychological intervention.Hamilton Depression Scale(HAMD) score in the two groups were observed and compared before and after nursing intervention.Results After nursing intervention, the depression scores were decreased significantly(P<0.05), and the depression scores in the observation group decreased significantly than that in the control group(P<0.05).Conclusion The psychological nursing intervention for patients in late pregnancy with depression Noel induced labor in late pregnancy who were induced labor to terminate pregnancy with rivanol has important significance in the peri operative treatment, which can effectively reduce the negative emotions, improve the prognosis, and is worthy of clinical application.
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Objective To explore the application value of INTERGROWTH-21st standard evaluate intrauterine growth restriction (IUGR).We aimed at predicting IUGR with ultrasonic fetal growth measurements.Methods A prospective cohort of singleton pregnancy scanned after 28 gestational weeks was constructed.The Z-score values of growth measurements were calculated using the INTERGROWTH-21st standard.Logistic regression equation was used to establish the prediction formula.Finally,the new formula was compared with the traditional Hadlock method to predict the accuracy of IUGR.We assessed outcomes for consenting participants who attended research scans and delivered at the Obstetrics and Gynecology Hospital of Fudan University.Results A total of 834 patients fulfilling the inclusion criteria were included.After the exclusion of 143 lost cases,565 of control cases and 126 of IUGR cases were obtained.The sensitivity,specificity,positive predictivevalue,negative predictive value,false positive rate and false negative rate of prediction model wererespectively:88.9 ％,85.4 ％,57.7 ％,97.2 ％,14.6 ％,11.1 ％.In contrast,the values of Hadlock wererespectively:81.7％,82.7％,51.2％,95.3％,17.3％,18.3％.Conclusions This study shows aprediction model of IUGR.INTERGROWTH-21st standard improved the diagnostic accuracy of IUGR,especially enhanced the positive predictive value.
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Objective To investigate the effect of carboprost tromethamine combined with oxytocin on postpartum hemorrhage of scarred uterus in late pregnancy, and to provide theoretical basis for the application of carboprost tromethamine combined with oxytocin. Methods From May 2015 to May 2017, 52 pregnant woman with postpartum hemorrhage with scarred uterus in late pregnancy in the sixth hospital in Beijing were divided into the control group and the observation group. The control group was treated with oxytocin, and the observed value was treated with progesterone tromethamine injection and oxytocin. Postpartum hemorrhage, the incidence of postpartum hemorrhage in the two groups were compared. Results The intraoperative blood loss, postoperative 2 h and postoperative 24 h bleeding in the observation group were significantly lower than those in the control group, the difference was statistically significant (P<0.05). The incidence of postpartum hemorrhage in the observation group was 3.85％, significantly lower than 11.54％ in the control group, the difference was statistically significant (P<0.05). Conclusion carboprost tromethamine combined with oxytocin in the treatment of postpartum hemorrhage in the pregnant woman with scarred uterus in late pregnancy is effective and can reduce the rate of postpartum hemorrhage and the amount of bleeding, so it is worthy of popularization and application.
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Objective To analysis the characteristics of thromboelastography and coagulation test in patients with advanced pregnancy combined with severe preeclampsia. Methods A retrospective single?center study was conducted. 35 patients with advanced pregnancy combined with se?vere preeclampsia who were admitted to hospital from January 2012 to December 2014 were analyzed compared to 43 third trimester patients with?out any complication. All the patients were treated based on the routine strategy. Blood sample were taken from the middle elbow vein to test blood cell count,serum biochemistry test,routine coagulation test and thromboelastography. All the results,including R,K,CI,α?angle and MA value, were compared between two groups. Analysis was performed to evaluate the correlation between all parameters of TEG and coagulation test. Re?sults There was no statistical significance between two groups in age ,prothrombin time and activated partial prothrombin time. In the severe pre?eclampsia group,the R value of TEG was increased(5.21±1.20 min vs 6.19±1.55 min,t=-3.144,P=0.002),α?angel was decreased(64.43°± 7.90° vs 60.37°±7.09°,t=2.367,P=0.02),and CI was decreased(0.81±2.27 vs-0.37±1.82,t=2.495,P=0.015). In blood cell count test,the platelets count was decreased in severe preeclampsia group[(217.48±65.68)×109/L vs(166.65±61.39)×109/L,t=3.500,P=0.001]. In routine coagulation test,only thrombin clotting time was increased in severe preeclampsia group(14.59±0.51 s vs 15.28±0.97 s,F=-3.800,P<0.001). In serum biochemistry test,the albumin was decreased in severe preeclampsia group(34.75±3.90 g/L vs 28.77±4.05 g/L,t=6.632,P<0.001),while serum urea nitrogen was increased(2.78±0.87 mmol/L vs 5.98±8.07 mmol/L,F=-2.333,P=0.026). In correlation analysis,thrombin clot?ting time had relationship between R(r=0.290,P=0.010),CI(r=-0.257,P=0.023)andα?angle(r=-0.243,P=0.032). Platelets count cor?related with CI(r=0.383,P=0.001),K(r=-0.409,P<0.001),α?angle(r=0.375,P=0.001)and MA(r=0.512,P<0.001). Conclusion For those who suffered from severe preeclampsia patients with advanced pregnancy,low coagulation function occurs in most of the patients com?pared to those patients without any complications. Thromboelastography may be helpful for those who have high risk factors ,especially with low platelets count and increased thrombin clotting time ,so as to reduce the incidence of bleeding or thromboembolic diseases.
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Objective To compare the effect of the oxytocin, dinoprostone suppositoriesository and cervical dilation balloon in odinopoeia of late pregnancy.Methods A total of 90 patients with late pregnancy singletons primipara were randomly divided into 3 groups with 30 cases in each group. Patients in the group A were treated by dinoprostone suppositoriesository, patients in the group B were treated by oxytocin, patients in the group C were treated by the cervical dilation balloon, the cervical, childbirth, complications and newborns in the 3 groups were observed and compared. Results Compared with group B and group C, late pregnancy induced labor curative effect in group A was better:cervical Bishop score was higher after intervention 6h and 12 h (P<0.05), and promote cervical mature rate and success rate of induced labor were higher(P<0.05), labor time was shorter (P<0.05).The incidence of delivery complications was lower(P<0.05).Conclusion Dinoprostone suppositories can reduce labor time significantly in the treatment of late pregnancy, and improve the success rate of induced labor, the effect is superior to oxytocin and cervical dilation balloon.
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OBJECTIVE:To discuss the role of clinical pharmacist participating in drug therapy for severe ulcerative colitis (UC)during late pregnancy. METHODS:Clinical pharmacists participated in the therapy for a UC patients during late pregnancy, assisted the doctors to optimize and improve drug therapy plan from antidiarrheal,anti-intestinal inflammation,regulating intestinal flora,recovering damaged mucosa;suggested regimen was as follows:montmorillonite powder 3 g,pr,qd,to avoid drug interac-tion;hydrocortisone 100 mg,ivgtt,bid to resist intestinal inflammation;prednisone 30 mg,po,qd+20 mg,po,qn,instead after symptom relieved;stopping taking Bifid triple viable capsules,supplementing Human serum albumin injection,Nutrients,Potassi-um chloride injection,Concentrated sodium chloride injection,etc. RESULTS:The suggestion provided by clinical pharmacists was adopted by doctors,and the patient was recovered. There was no significant difference in the intelligence development,body weight and height charge between born baby boy and infants with same month age. CONCLUSIONS:Clinical pharmacists assist physician to optimize and improve drug therapy plan to promote rational drug use in the clinic and guarantee the safety of drug use.
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Objective To compare the colonization rates of group B streptococcus (GBS) detected by using fluorescent PCR and bacterial culture in late pregnant women in Xuzhou area and analyze the drug resistance of GBS .Methods The fluorescence PCR assay and bacterial culture assay for GBS were both performed for the late‐pregnant women′s vaginal swabs and anal swabs samples which were collected in this area .The diagnostic efficiency were compared between the two methods .Then the drug sensitivity test were performed for stains isolated for the bacteria culture .Results Among the 484 spcimens ,53 cases were positive detected by u‐sing fluorescent PCR ,and the positive rate was 11 .0% ,the sensitivity was 100 .0% .31 cases were detected positive by using bacte‐rial culture ,and the positive rate was 6 .4% ,the sensitivity was 59 .6% .There were statistically significant differences between the positive rate and the sensitivity of the two groups(P<0 .05) .The drug sensitivity test showed that the sensitive rates were 100 .0%to penicillin ,ceftriaxone ,vancomycin .The resistance rates to erythromycin ,clindamycin ,levofloxacin were 71 .0% ,64 .5% and 58 .1% ,respectively .Conclusion The screening rate of GBS in late pregnant women is not low in Xuzhou area .PCR is a more rap‐id ,specificific and sensitive method .Routine detection of GBS should carried out by using the method of fluorescent PCR .Resistance rate of GBS to erythromycin and clindamycin were high in Xuzhou area .More attention should be paid to the rational use of antibi‐otics to prevent drug‐resistant producing in strains of GBS .