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The pre-hospitalization service is an important initiative for medical institutions to implement the national reform of the medical security system. In 2018, Zhejiang province proposed the " most run once reform", requiring the establishment of an admission preparation center to carry out pre-hospitalization services. In June 2021, a certain maternal and child health hospital conducted a process reengineering for the pre admission process of the admission preparation center by applying the combined process analysis and failure mode and effects analysis, high-risk points of the hospitalization process were screened, the job value and job functions of each sector were sorted out, and the sector for improvement sector was evaluated, to launch an independent information system, establish a one click automatic import of pre hospital medical orders function, and remove on-site billing physicians from various specialties for improvement measures. The steps of the process had been optimized, inlcuding issuing pre hospital medical orders, waiting for pre-hospitalization, pre-hospitalization, and so on. The completeness rate of pre hospital medical orders, average waiting days before hospitalization, and patient satisfaction scores of pre hospitalization centers had changed from 91%, 2.99 days, and 93.46 points before process reengineering to 92%, 2.44 days, and 95.80 points after reengineering, respectively. This practice had achieved dual improvements in pre admission service quality and efficiency, so as to provide a reference for China′s medical institutions to carry out safe and efficient pre admission services.
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OBJECTIVE@#To assess the performance of non-invasive prenatal testing (NIPT) for the detection of fetal chromosomal aneuploidies and its value for the prevention of birth defects.@*METHODS@#In total 28 033 pregnant women underwent NIPT test. The results were compared with that of amniotic fluid and cord blood chromosomal karyotyping analysis. A few cases were verified by array comparative genome hybridization (aCGH). All pregnant women and their fetuses were followed up until after birth.@*RESULTS@#NIPT has indicated a high risk for fetal chromosomal aneuploidies in 186 cases (0.66%), among which 101 (67.33%) were confirmed as 21, 18 and 13 trisomies by invasive prenatal diagnosis, which yielded a diagnostic rate of 86.52%, 50.00% and 19.05%, respectively. The diagnostic rates were 81.28%, 67.85%, 62.79% and 76.00% respectively for those ≥40, ≥35, 25 to 34, and <25. And the diagnostic rates were 65.91%, 60.78%, 71.79% and 80.00% for those over 35, with high risk by prenatal screening, critical risk by prenatal screening and ultrasound abnormality, respectively.@*CONCLUSION@#The NIPT is effective for screening common chromosomal aneuploidies and preventing births of neonates with trisomy 21, trisomy 18 and trisomy 13.
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Objective To explore the effects of early essential newborn care (EENC) on short-term maternal and neonatal health and to evaluate the satisfaction and acceptability of both patients and medical staff in the operating room regarding the implementation of EENC during term cesarean section(CS). Methods Two hundred gravidas who underwent CS in Wenzhou Medical University Affiliated Women and Children Hospital from January 2018 to April 2018 were recruited in this prospective study. According to the odd or even number of their medical records, these women were randomly divided into EENC or control group, 100 in each. EENC was offered to those in the EENC group immediately after birth, including drying the newborn immediately and thoroughly, mother–infant skin-to-skin contact at least 90 min and initiating the first breastfeeding, and delayed cord clamping until l-3 min after birth. Routine neonatal care was provided to the control group, including regular drying, insufficient skin-to-skin contact and cord clamping within 1 min after birth. Differences were compared between the two groups in the incidence of abnormal pulse, low oxygen saturation, hypothermia and mild asphyxia from the neonatal aspect and the incidence of postpartum hemorrhage and early initiation of breastfeeding from the maternal aspect. The acceptability and satisfaction of all the participants and the medical staff were also analyzed. t-test and Chi-square test were used as statistical methods. Results All of the 200 participants were finally analyzed. In the EENC group, the incidence of neonatal hypothermia [2% (2/100) vs 13% (13/100), χ2=8.721, P=0.003] and maternal postpartum hemorrhage [1% (1/100) vs 6% (6/100), χ2=5.701, P=0.035] were lower comparing to the control group, while the initiation rate of early breastfeeding was higher [56% (56/100) vs 5% (5/100), χ2=61.352, P<0.001]. There was no significant difference in the incidence of neonatal abnormal pulse, low oxygen saturation or mild asphyxia between the two groups (all P>0.05). The scores of maternal satisfaction (24.6±0.4 vs 23.4±1.9, t=6.443, P=0.001) and acceptability (24.3±0.5 vs 23.5±1.4, t=5.436, P=0.001) in the EENC group were also significantly higher than those in the control. For the obstetric operation team, the acceptability scores among obstetricians (22.6±0.8 vs 21.6±1.3, t=2.379, P=0.019), instrument nurses (23.2±0.9 vs 21.3±1.1, t=13.592, P<0.001) and anesthetists (22.6±0.9 vs 21.5±1.7, t=5.625, P=0.001) in the EENC group were higher than those in the control group. However, no significant difference was observed in the acceptability among rounding nurses between the two groups (P=0.086). Conclusions EENC during CS could stabilize the neonatal temperature, reduce postpartum hemorrhage, promote early breastfeeding and improve the maternal satisfaction as well as the acceptability of both obstetric operation team and puerperae. There is a clinical significance to promote EENC during CS.
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Objective To evaluate the effects of kangaroo mother care (KMC) during cesarean section on neonatal health parameters in the "golden hour" of late preterm infants. Methods A total of 120 singleton pregnant women undergoing preterm cesarean section (34-36+6 gestational weeks) from January 1 to December 31, 2018 in Jiaxing Women and Children's Hospital Affiliated to Wenzhou Medical University were prospectively enrolled and divided into two groups (observation and control groups) with 60 cases in each by random number table method. During cesarean section, the both groups received the thorough drying immediately and delayed cord clamping, in addition, the observation group adopted KMC, while the control group received routine maternal and infant care. Several parameters including changes in body temperature, crying, respiration, oxygen saturation and other vital signs, as well as the incidence of hypothermia, transfer to the Department of Neonatology and the success rate of early breastfeeding initiation during the "golden hour" were compared between the two groups. Satisfaction of obstetricians, pediatricians, the pregnant women and their families to KMC and routine maternal and infant care were compared. Two-independent sample t test and Chi-square test were used as statistical methods. Results In total, 113 cases (58 in the observation group and 55 in the control group) were finally analyzed. The body temperature of the late preterm infants at 5 and 10 min after birth in the observation group was higher than that in the control group (36.5 vs 36.0 ℃, 36.4 vs 35.8 ℃, t=11.756 and 7.512, both P<0.05), and the body temperature during 15 min-1 h after birth was also higher in the observation group but without statistical significance (all P>0.05). The observation group had a lower incidence of hypothermia [0% (0/58) vs 15% (8/55), χ2=9.079, P<0.001] and a higher success rate of early breastfeeding initiation [86% (50/58) vs 58% (32/55), χ2=11.137, P<0.001] than the control group. The satisfaction scores of obstetricians (19.3±1.1 vs 13.4±1.9, t=20.517), pediatricians (18.2±1.8 vs 12.6±2.1, t=15.382), gravidas (19.6±0.4 vs 13.6±1.6, t=27.723) and their family members (18.2±0.9 vs 15.3±1.1, t=11.535) were all higher in the observation group than those in the control group (all P<0.001). Conclusions KMC during cesarean section can improve the body temperature of late premature infants in the "golden hour", reduce the occurrence of hypothermia, facilitate early initiation of breastfeeding and improve the satisfaction of doctors and patients on health care.