Effects of Epidural Labor Analgesia plus Dexmedetomidine on Postpartum Depression in Parturients： A Prospective Study / 中山大学学报(医学科学版)

ObjectiveTo investigate the effects of epidural analgesia plus dexmedetomidine infusion on postpartum depression in parturients with natural childbirth. MethodsWe selected 70 parturients aged between 22 and 36， with singleton， term， cephalic presentation， natural delivery and ASA class I or Ⅱ. The cases undergoing epidural analgesia with ropivacaine and sufentanil were randomly divided into two groups by using a random number table （n=35 for each group）. The control group （Group C） used intravenous infusion of normal saline， while the experimental group （Group D） used equivalent volumes of intravenous infusion of dexmedetomidine. Participants were followed up at 1， 6， 12 weeks after childbirth to assess the severity of postpartum depression. Blood samples were collected at 12 h and 48 h after childbirth to measure the serum prolactin levels. The hemodynamic （HR and MAP） changes， VAS scores， and Ramsay scores were recorded at five time points： before analgesia （T1）， 10 min after analgesia （T2）， 30 min after analgesia （T3）， 12 h （T4） and 24 h （T5） after delivery. The number of analgesia pump presses and adverse events were also documented. ResultsCompared with Group C， Group D showed significantly lower EPDS scores at 1 week after childbirth， significantly higher prolactin concentrations at 12 h and 48 h after childbirth， significantly lower VAS scores at T2， T3 and T4， significantly higher Ramsay score at T3 and significantly reduced number of analgesia pump presses （P < 0.05）. ConclusionEpidural analgesia plus intravenous infusion of dexmedetomidine can alleviate early postpartum depression in women undergoing natural delivery， promote early prolactin secretion and provide a safe and effective adjunctive analgesic and sedative effect.

Analysis of the cost of hospital delivery for postpartum women in large public hospitals in Beijing / 中华医院管理杂志

Objective:To analyze the hospitalization costs of delivery for postpartum women with different delivery methods, ages and comorbidities or complications, for references for medical institutions and medical insurance management departments to develop payment and compensation standards for inpatient delivery.Methods:The first page of medical records of hospitalized delivery women admitted to 8 large tertiary hospitals in Beijing from January 2018 to December 2021 were selected. Descriptive analysis was made on the mode of delivery, age, hospitalization expenses and cost structure of puerpera, as well as the hospitalization expenses of puerpera with different complications or complications. Wilcoxon rank sum test, Kruskal-Wallis H test, and Chi-squared test were used to statistically compare the level and structure differences between groups. Results:A total of 23 320 pregnant women were included, with an average age of 32.3 years. There were 13 605 cases of natural delivery and 9 715 cases of caesarean section. The median cesarean section rate in the right age group (<35 years old) and the elderly group (35-50 years old) were 36.73% and 56.58%, respectively, and the median hospital expenses were 5 865 yuan and 7 042 yuan, respectively. The median hospital expenses for natural delivery and caesarean section were 4 452 yuan and 10 033 yuan, respectively. The highest proportion of hospitalization expenses for natural delivery and cesarean section were treatment expenses (23.45%) and medicine expenses (29.19%), respectively. The median of hospitalization cost for women with≥2 comorbidities or complications (6 736 yuan) was higher than that for women with 1 comorbidities or complications (5 794 yuan).Conclusions:The hospitalization cost of cesarean section was significantly higher than that of natural delivery and the rate of cesarean section and the cost of delivery in women aged 35 and above were higher than those under 35 years old. The structure of hospitalization cost was different in different delivery modes, and the complications or complications had a greater impact on the average hospitalization expenses.

Comparison of hospital delivery costs between cesarean section and natural delivery and analysis of influencing factors / 中南大学学报(医学版)

OBJECTIVES@#The increasing costs of hospital delivery have increased the economic burden of pregnant women, and the mode of delivery is the main factor affecting the costs of hospital delivery. This study aims to explore the difference in costs between cesarean section and natural delivery, and to provide reference for controlling the increase of hospital delivery costs.@*METHODS@#The data of inpatient delivery in the Hunan Maternal and Child Health Care Hospital from January 2016 to December 2020 were selected to compare the total inpatient costs and average daily costs of cesarean section and natural delivery. The linear trend model was used to analyze the trend change of inpatient delivery costs and the generalized linear model was used to analyze the influential factors for inpatient delivery costs.@*RESULTS@#The average hospitalization costs of cesarean section (10 447.25 yuan) were higher than that of natural delivery (5 567.95 yuan), and the average daily costs of cesarean section (1 902.57 yuan) were higher than those of natural delivery (1 666.40 yuan). There was no significant increase or decrease in trend for cesarean section, while the average annual growth rate of the costs of natural delivery was 11.79%. The main factors affecting the hospitalization costs of cesarean section and natural delivery included age, occupation, medical insurance, route of admission, length of stay, premature delivery and complications (all P<0.05).@*CONCLUSIONS@#The total hospitalization costs and average daily costs of cesarean section are higher than those of natural delivery, but the costs of natural delivery show a faster growth trend, and the hospitalization costs of cesarean section and natural delivery should be controlled by targeted measures.

Analysis of the related factors of postpartum hemorrhage via vaginal delivery / 中国基层医药

Objective To analyze the relevant factors of vaginal delivery postpartum hemorrhage,and discussion how to prevent postpartum hemorrhage.Methods 2 417 maternal women who hospitalized vaginal delivery were selected.Preeclampsia,macrosomia,placental abruption,obesity,premature rupture of membranes,high blood pressure,gestational age,maternal age,maternal time,the number of abortion,scar uterus vaginal delivery,oxytocin induced labor,misoprostol for cervical mature,forceps midwifery,and the correlation of postpartum hemorrhage were analyzed.Results The incidence rate of postpartum hemorrhage was 15.22%.Pre -eciampsia,macrosomia,placental abruption had significant association with postpartum hemorrhage(χ2 =26.75,0.16,22.26,all P 0.05 ).Oxytocin induced labor,misoprostol for cervical mature,forceps midwifery were significantly associated with postpartum hemorrhage(χ2 =45.66,21.77,88.06,all P <0.01 ).Conclusion Prenatal maternal and neonatal weight control,prevention of preeclampsia,placental abruption occurred to prevent postpartum hemorrhage;Intrapartum avoid no indications oxytocin,misoprostol for cervical mature,forceps midwifery and reduce postpartum hemorrhage;Postpartum accurately estimated blood loss, active treatment,avoid serious complications.

Physical exercise during pregnancy and its influence in the type of birth / Exercício físico durante a gestação e sua influência no tipo de parto

OBJECTIVE: To verify if medium intensity exercise performed during pregnancy can influence in the type of delivery, and to observe compliance to an exercise program among primiparous women with different levels of schooling. METHODS: A study carried out at the Centro de Incentivo ao Aleitamento Materno, in São Sebastiao (SP), between April 7, 2008, and April 14, 2009. A prospective study involving 66 primiparous women who were divided into two groups: an Exercise Group, engaged in regular physical activity during pregnancy, and the Control Group, that did not participate in regular physical activity during the same period. Significance level in this project was 5% (p=0.05). RESULTS: The group that did engage in regular exercise had a higher rate of vaginal deliveries, with a statistically significance difference evaluated by the χ² test (p=0.031). The pregnant women with the highest level of schooling showed greater compliance with the exercise program, with a statistically significant difference (p=0.01736). CONCLUSION: Physical exercise in primiparous women increased the chances of vaginal deliveries, and there was greater compliance with the exercise program among those with a higher level of schooling when compared to those with a basic education.

OBJETIVO: Verificar se o exercício físico de média intensidade, realizado durante a gestação, pode influenciar na via de parto, e observar a adesão ao exercício entre primigestas com diferentes níveis de escolaridade. MÉTODOS: Estudo realizado no Centro de Incentivo ao Aleitamento Materno, em São Sebastião (SP), entre 7 de abril de 2008 a 14 de abril de 2009. Estudo prospectivo envolvendo 66 gestantes primíparas, as quais foram alocadas em dois grupos, um Grupo Exercício, que praticou atividade física regular durante a gravidez, e o Grupo Controle, que não praticou atividade física regular durante o mesmo período. O nível de significância adotado neste trabalho foi de 5% (p=0,05). RESULTADOS: O grupo que praticou exercício regular teve maior número de partos vaginais, com diferença estatística significativa avaliada pelo teste do χ² (p=0,031). As gestantes com melhor nível de escolaridade apresentaram maior adesão ao programa de exercícios, com diferença estatisticamente significante (p=0,01736). CONCLUSÃO: O exercício físico em primíparas aumentou as chances de ocorrência de parto vaginal e, ainda, foi observada maior adesão ao exercício entre grávidas com nível superior de escolaridade quando comparadas a grávidas com nível fundamental de escolaridade.

Influence of systematic prenatal education on outcome of childbirth / 中国实用护理杂志

Objective To study the effect of systematic prenatal education on the outcome of childbirth. Methods Pregnant women (200 cases) were randomly divided into 2 groups, 100 pregnant women who were willing to attend the maternity club to accept the systematic prenatal education were set as the experimental group, while 100 pregnant women who only accepted the regular prenatal health education as the control group. The experimental group not only received regular prenatal health education, but also had classes about prenatal gymnastics training exercise, the simulant delivery process, Lamaze pain relieving delivery, various postures of 3 delivery processes, the knowledge of husband assistance, the physical and psychological change and relevant coping method during gestation and postpartum, etc. The control group only accepted the regular prenatal health education, which was watching breastfecding VCD, having classes about the basic health knowledge and the physical process of pregnant period, delivery period, and puerperal period, the breasffecding knowledge, etc. Results The cesarean section rate and the total stage of labor of the experimental group was significantly less and shorter than that of the control group(P<0.05 and P<0.01). Conclusions The systematic prenatal e-ducation can improve pregnant women's knowledge of pregnancy and parturition, improve pregnant women's confidence of natural delivery, help to regulate nerve and the function of different organs, shorten the childbirth process, and reduce the cesarean section rate.