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Objective:To analyze the clinical characteristics and outcomes of critically ill pregnant and parturient women in intensive care unit (ICU), and to provide clinical experience for the subspecialty construction of critical obstetrics.Methods:The clinical data of critically ill pregnant and parturient women admitted to the department of critical care medicine, the Second Affiliated Hospital of Kunming Medical University from January 2011 to December 2019 were collected. The main reasons for maternal transfer to ICU, the causes of maternal death, and organ support measures, etc. were summarized.Results:A total of 39 567 critically ill pregnant and parturient women were admitted to the department of obstetrics in our hospital, and 360 were transferred to ICU, with an average ICU transfer rate of 0.91%. Since 2016, the number of obstetric admissions, the number of ICU transfers and the ICU transfer rate had increased significantly. The average age of severe maternals admitted to ICU was (30.9±5.7) years old. The average acute physiology and chronic health evaluation Ⅱ(APACHEⅡ) score was 7 (4, 10). The average length of ICU stay was 1 (1, 2) day. The average ventilator duration was 9.0 (3.0, 17.5) hours. The main delivery mode of pregnant women in ICU was cesarean section (84.72%). Forty-eight patients (13.33%) underwent hysterectomy, of which 42 (87.5%) due to postpartum hemorrhage. The top 3 causes of ICU admission were severe postpartum hemorrhage [36.94% (133/360)], hypertensive disorders of pregnancy [21.67% (78/360)], pregnancy with cardiac disease [15.00% (54/360)]. The leading cause of postpartum hemorrhage in women transferred to ICU was placental abnormality [63.98% (103/161)], followed by uterine atony [28.57% (46/161)]. The average blood loss was (4 019±2 327) mL within 24 hours after delivery, and the number of women who underwent hysterectomy due to postpartum hemorrhage decreased year by year. During the study period, there were 2 maternal deaths, which were indirect obstetric deaths, 3 cases were discharged against-advice (expected death), including 1 indirect death and 2 direct obstetric death; the mortality in ICU was 1.39% (5/360).Conclusions:The most common reasons for pregnant and parturient women to be admitted to ICU were severe postpartum hemorrhage and hypertensive disorders of pregnancy. The leading cause of postpartum hemorrhage was placental problem. Indirect obstetric deaths exceeded direct obstetric deaths, mainly due to pregnancy complicated with cardiac disease and severe pneumonia. ICU has become an important battlefield for rescuing critically ill maternal and an important guarantee for reducing the maternal mortality.
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Objective:To observe the effects of evidence-based humanistic care on psychological status and pregnancy outcome in high-risk parturient women.Methods:A total of 92 high-risk pregnant women admitted to the First People′s Hospital of Lianyungang City from January 2019 to January 2020 were selected. According to the method of drawing samples from a random number table, the control group (46 cases) was given care according to the clinical nursing path of childbirth, and the observation group (46 cases) implemented evidence-based humanistic care on this basis.Scores of Chinese Perceived Stress Scale(CPSS) and Self-rating Anxiety Scale(SAS) before and after the intervention, and cesarean section rate, neonatal asphyxia rate, 2 h and 24 h postpartum blood loss were compared.Results:After the intervention, CPSS score (12.28 ± 4.34) and SAS score (47.32 ± 6.61) in observation group were lower than those in control group (16.26 ± 3.39) and (53.60 ± 5.46) ( t values were 4.902, 4.968, P< 0.05); cesarean section rate and neonatal asphyxia rate in observation group were 23.91% (11/46), 2.17%(1/46) lower than 45.65%(21/46)and 19.57%(9/46) in control group ( χ2 values were 4.791, 5.954, P<0.05), and postpartum hemorrhage volume in 2 hours (173.63±61.46) ml and 24 h blood loss (246.37±67.24) ml were less than those in control group (272.45 ±57.92) ml and (368.34±72.47) ml ( t values were 7.936, 8.368, P<0.05). Conclusions:Evidence-based humanistic care can relieve the psychological pressure and anxiety of high-risk parturient women and improve their pregnancy outcome.
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Background: Infant feeding is an integral part of the reproductive process with important implications for the health of mothers and their babies. However, various practices exist in different communities. It is therefore pertinent to know the infant feeding practices among rural dwellers, as well as the factors that influence them.Methods: This study was a cross sectional survey. A total of 372 volunteering parturient women were recruited using a multi-stage stratified sampling technique. Ethical approval and respondents’ informed consent was obtained. A self-developed and validated questionnaire was used to collect data. Descriptive and inferential statistics was used to analyse data.Results: Findings revealed that majority (84.4%) of the respondents were aware of exclusive breastfeeding (EBF), but only about half (50.5%) ever practiced exclusive breastfeeding. Also, a significant percentage of the respondents introduced complimentary feeding to the baby immediately after birth while 29.3% of participants reported drinking palm wine which is mainly alcoholic to stimulate breast milk secretion. Occupation of parturient women was associated with the practice of EBF (p=0.002).Conclusions: Almost half of our studied parturient women do not engage in EBF. There is need for health care workers to strategically educate parturient women and their significant others on the numerous benefits of exclusive breast feeding.
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Objetivos: Determinar la prevalencia de la depresión postparto en mujeres puérperas de la ciudad de Arequipa. Material y métodos: Estudio descriptivo. Se evaluaron a 113 madres que acudieron a sus controles postnatales en una posta de salud de la ciudad. Se utilizó la Escala de Depresión Postparto de Edimburgo, previo consentimiento informado. Para efectos del estudio, se valoraron las propiedades psicométricas del instrumento, reportándose adecuados niveles de validez y confiabilidad para la muestra evaluada. Resultados: Los resultados indican que aproximadamente, el 41% de las madres no tiene riesgo de depresión postparto, 14% presenta riesgo y 45% tiene síntomas de depresión postparto. Asimismo, se encontró que el grado de instrucción se relaciona de manera negativa con los niveles de depresión postparto, pero no hubo diferencias significativas en función del tipo de parto ni el estado civil de las madres. Conclusiones: Se concluye que el 45% de las mujeres puérperas evaluadas tienen síntomas de depresión postparto y que el grado de instrucción presenta correlaciones negativas con esta variable. (AU)
Objectives: To determine the prevalence of postpartum depression in puerperal women in the city of Arequipa. Methods: A descriptive study was conducted in 113 puerperal women that attended peripheral health care centers for postpartum control. Edinburgh scale for depression was used after getting inform consent. Psychometric properties of the tool were evaluated. Results: Our results indicate that 41% of mothers are not at risk of postpartum depression; 14% are at risk and 45% have symptoms of postpartum depression; the degree of education was inversely correlated with postpartum depression and we did not find statistical association with route of delivery and marital status. Conclusions: We conclude that 45% of puerperal women evaluated had depression and that the degree of education inversely correlated with it. (AU)
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Humanos , Femenino , Familia , Depresión Posparto , Periodo Posparto , Epidemiología DescriptivaRESUMEN
Pregnancy and childbirth are natural physiological processes for women, but most mothers, especially primipara, tend to suffer from anxiety, fear and other unhealthy psychology, accompanied by the occurrence of these bad emotions. It is a worthy concern that whether the subjective well-being of pregnant women will be affected by these bad emotions. However, there are few reports about subjective well-being of pregnant women in China. In this study, the subjective well-being′s concept, assessment tools and influencing factors of maternal subjective well-being were reviewed. The paper also described the research progress and development on the subjective well-being of pregnant women. The purpose of this paper is to provide reference for the study and practice of in China.
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Objective To observe the effect of pelvic floor muscle rehabilitation training combined with Buzhong Yiqi Pill at ultra-early stage or early stage on the recovery of postpartum pelvic floor muscle function, to explore the feasibility of intervention of postpartum rehabilitation training at ultra-early stage. Methods 314 patients were randomly divided into the ultra-early stage group and the early stage group, 157 cases for each group. Patients in the ultra-early group were guided to give Kegel exercise and the biofeedback electrical stimulation therapy in the seventh week combined with Buzhong Yiqi pill in 1-2 days after delivery , patients in the early group were given Kegel exercise and biofeedback electrical stimulation therapy in the seventh week combined with Buzhong Yiqi pill. Effects of treatment two groups were observed. Results There were significant increased in pelvic floor muscle activity compared with six weeks and 2 days after delivery between two groups (P<0.05), and there were significant increased in the ultra-early group compared with the same period in the early group (P<0.05) . There were significant increased in good rate in 12 weeks after delivery compared with immediate time and 2 days after delidery (P<0.05), and more significant increased in the ultra- early group than that in the early group (P<0.05). There were significant decreased in urinary urgency, lumbosacral painand tenesmus, vaginal relaxation, and vaginal dryness rate in 12 weeks after delivery compared between two groups (P<0.05). Conclusion There were good effects in pelvic floor muscle rehabilitation training combined with Buzhong Yiqi Pill at ultra-early stage on the recovery of pelvic floor muscle function after delivery, and be worthy of clinical application.
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Objective To study the clinical significance of dexamethasone (DT) in the combined spinal and epidural anesthesia for delivery of elderly parturient women. Methods 134 elderly parturient women were selected as the research object, and randomly divided into two groups. 69 cases in DT group received intramuscular injection of dexamethasone and combined anesthesia, while 65 cases in INN group received intramuscular injection of tramadol (INN) and combined spinal and epidural anesthesia. The anesthetic effect of the two groups were observed. Results After treatment, the interleukin (IL-6), myeloperoxidase (MPO), tumor necrosis factor-α (TNF-α) and methane dicarboxylic aldehyde (MDA) in DT group were significantly higher than INN group (P<0.05). The five kinds of immunoglobulins levels (IgA, IgD, IgE, IgG and IgM) in DT group were higher than those in INN group (P<0.05). The heart rate (HR) in DT group was lower and mean arterial pressure (MAP) was higher than that in INN group(P<0.05). There was 1 cases of macrosomia, 2 cases of premature delivery in DT group, the adverse pregnancy outcomes was 4.35%(3/69). there was 1 cases of macrosomia, 1 cases of congenital deformity, 1 cases of premature delivery and 1 case of postterm delivery in DT group, the adverse pregnancy outcomes was 5.80%(4/69), with no significant difference between two groups. Conclusion Dexamethasone combined with anesthesia is very effective for delivery of elderly parturient women which shows very good anti-inflammatory and immunoregulation.
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Objective To investigate the off-label use status in obstetrics ward so as to provide references for carrying out obstetrics pharmaceutical care and promoting safe medication use in pregnant and parturient women. Methods The prescriptions for pregnant and parturient women from January to June, 2015 in obstetrics ward were investigated. According to drug instructions, the off-label drug use of prescriptions of all selected patients was analyzed in the following aspects:the category of off-label drug use, and drugs use information. In addition, a logistic regression was conducted that modeled the odds of receiving an off-label prescription as a function of the following possible risk factors:pregnant, parturient women and the rank of doctors. The clinical results including the unreasonable drug application, abortion rate and birth defect were compared between the off-label drug use and on-label drug use groups. Results Total of 384 patients were selected, and 5330 prescriptions involving 50 drugs were analyzed. The rate of off-label drug use was 68. 5%, 27. 7% and 24. 0% in patients, prescriptions and drug categories, respectively. The main categories of off-label drug use were super solvent use ( 76. 6%) and indication (14. 3%). The top 3 drugs of off-label use were those for urinary and reproductive (56. 2%), alimentary tract (46. 9%) and traditional Chinese medicine (43. 4%). In addition, there was no significant correlation between the risk of off-label drug use and maternal status and the level of doctors. And no significant difference between the two groups in the unreasonable drug application, abortion rate and birth defect was detected. Conclusion The off-label drug use in obstetrics ward is common in this hospital and most of them are supported by clinical evidence. Due to the lack of more authoritative evidence-based medication, the doctors are suggested to use the drug according to provisions of the drug instructions. When off-label drug use is really needed, it should be based on the surpport of evidence basde medicine,so as to ensure the drug safety for pregnant and parturient women and avoid professional risks.
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Introduction: Epidural analgesia is said to have depressive effects on neonates. There seems to be sufficient instances in the literature that have compared maternal outcomes in relation to epidural analgesia. However, there is lack of instances in the literature on neonatal outcomes occurring with respect to epidural labour analgesia. This study therefore aims at unravelling neonatal outcomes following epidural labour analgesia. Methods: This randomised controlled trial study compared the outcomes of babies of mothers who received epidural labour analgesia with those who did not receive any form of labour analgesia. One hundred and two (102) parturient women were recruited into the study and 51 of them assigned to the epidural group and the other 51 were assigned to the control group. Measures were taken with respect to: APGAR scores at first, fifth and tenth minutes; level of neonatal resuscitation; temperature; and neonatal complications. Results: It was reveal that there was no statistical difference in the APGAR scores at first, fifth and tenth minutes (P = 0.55, P = 0.33, P = 0.58, respectively). The mean temperatures were 36.13°C for the control group and 35.61°C for epidural group (P = 0.40), indicating no statistical significance between the two groups. Conclusion: Complications noted in epidural group were not statistically different from those in the control group and therefore with proper monitoring, epidural labour analgesia is safe for the foetus and the neonate.
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Objective To investigate the distribution and antimicrobial resistance of clinical bacterial strains isolated from the cervical secretions of parturient women .Methods A total of 239 bacterial strains were isolated from 1 519 cervical specimens of parturient women .These strains were identified and tested by Kirby‐Bauer method for their susceptibility to antimicrobial agents .Results Escherichia coli was the most frequently isolated bacteria ,accounting for 34 .3% .The bacterial strains were more or less resistant to commonly used antimicrobial agents .Conclusions Various bacterial species are identified in the cervical secretions of parturient women ,primarily Escherichia coli and Staphylococcus aureus .Bacterial culture and antimicrobial susceptibility testing are important for clinicians to take appropriate measures to reduce the incidence of mother‐to‐child infections .
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Objective To explore the effect of continued nursing on postpartum breastfeeding within 6 months. Methods Two hundred and twenty parturient women were randomly divided into the observation group and the control group using random digits table. The control group received breastfeeding knowledge education and nursing skills instruction. The observation group was given continued nursing and breastfeeding guidance . The two groups were compared in terms of breastfeeding rates at 1 , 2 , 3 , 4 , 5 , 6 months . Result The breastfeeding rates of the observation group were significantly higher than those of the control group at each time point ( all P < 0 . 05 ) . Conclusion According to reasons why the parturient women don′t breastfeed , they are given continued nursing and detailed solutions after discharge , to make them confident in breast feeding and improving breastfeeding rate within six months after delivery .
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Objective To establish reference range of fibrinogen (FIB) for normal parturient women in labor in Hefei area and compare it with previous FIB reference .Methods FIB of plasma samples for normal parturient women in labor were determined by Sysmex CA7000 automated blood coagulation analyzer and supporting reagent .All the FIB results were statistically analyzed and the reference range of FIB for normal parturient women was established in our laboratory .Consistency checking was applied for the comparisonwithpreviousreferencefromNationalClinicalLaboratorySOP (2.00-4.00g/L)anddecidedbytheKappavalue.Re‐sults The single sample K‐S test showed that distribution of FIB results for samples was skewed (P=0 .001) .The present FIB reference(P2 .5 ~ P97 .5 ) investigated was 4 .15(2 .81 -5 .40 g/L) .Compared to the previous FIB reference ,after using present FIB reference interval the abnormal rate was reduced from 61 .36% (991/1 615) to 5 .02% (81/1 615) .Through the consistency test ,we figured out that Kappa=0 .015(<0 .40) ,U=2 .25 ,P<0 .05 and these two reference intervals were inconsistent in criteria jud‐ging .These results showed that two reference intervals had poor judgment standard of consistency ,the previous reference range was not suitable for normal parturient women in labor .Conclusion The previous FIB reference range was not suitable for normal partu‐rient women in labor and we should establish a new FIB reference range in order to improve the evaluation of the accuracy of the parturient women in labor individual risk .
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Objective To study the effects of peer education on sleep quality in the elderly parturient women.Methods One hundred and twelve elderly parturient women were divided randomly into control and intervention groups,with 56 cases in each group. The patients in control group received routine health education,while the intervention group peer education besides routine health education for 8 weeks. The two groups were compared using Pittsburg sleep quality index(PSQI)and self-rating anxiety scale (SAS).Results After intervention,the two groups were significantly developed in terms of the PSQI and SAS scores compared to post-intervention,respectively(P<0.05). In comparison of the two group,the PSQI and SAS scores in the intervention group were statistically significantly different(P<0.01).Conclusion Peer education can improve the sleep quality of the elderly parturient women and mental status.
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Objective To know the influence of psychological intervention on delivery results of par-turient women, and then reference to certain effective psychological nursing cares for clinical field. Methods Divided 226 partreient women of spontaneous labor into the experimental group and the control group randomly, there were 113 eases in each group. Traditional routine nursing cares was used in the control group, psychological intervention was used in the experimental group in addition. Compared the condi-tion of birth process and the incidence rate of labor-related complications between the two groups. Re-sults There were significant differences between the two groups about all the indexes which had indicated the delivery. Conclusions Correct psychoanalysis and proper nursing intervention and effective release the pains for parturient women, and then decrease the incidence rate of medical negligence.
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The purpose of this study is to understand home care needs for parturient women and neonates up to the postpartum period. MEHTODS: The design of this study is a cross-sectional survey study. The subjects of this study are 88 postpartum mothers who delivered a first baby during the period from December 1996 to July 1997. Data collection was done with a structured questionnaire by mailing. Data were collected at the point of six months after delivery. A structured questionnaire composed of items related to home care needs. Data analysis was done with descriptive statistics. The study results are as follows: 1) The highest need was personal hygiene(93.2%) for the parturient women, and the peak period was the two week period after delivery. 2) The most frequent maternal needs regarding neonates were cord care(72.4%) during the first week, elimination(67.9%) during the first two weeks, baby crying(88.3%) and sleeping pattern(71.5%) at one month after delivery, and baby temperament(30.4%) at sixth months after delivery. 3)The mothers requested home care methods such as written material for self health care(35%) and counseling(34%) and direct home visits(5%) for neonate care. CONCLUSION: The most important period for home health care needs was one week after delivery, and the health care needs for neonate temperament, behavior and sleeping pattern rose rapidly at the period of 6 months after delivery. Therefore it could be concluded that the postpartum home care should be done by those, written material should be enhanced for parturient women care, and counseling enhanced for neonate care.