Obstetricians' perspectives on trial of labor after cesarean (TOLAC) under the two-child policy in China: a cross-sectional study.

BACKGROUND: As the birth policy has been adjusted from one-child-one-couple to universal two-child-one-couple in China, there is an increasing number of women undergoing a second pregnancy after a previous cesarean section (CS). Undertaking an elective repeat CS (ERCS) has been taken for granted and has thus become a major contributor to the increasing CS rate in China. Promoting trial of labor after CS (TOLAC) can reduce the CS rate without compromising delivery outcomes. This study aimed to investigate Chinese obstetricians' perspectives regarding TOLAC, and the factors associated with their decision-making regarding recommending TOLAC to pregnant women with a history of CS under the two-child policy. METHODS: A cross-sectional survey was carried out between May and July 2018. Binary logistic regression was used to determine the factors associated with the obstetricians' intention to recommend TOLAC to pregnant women with a history of CS. The independent variables included sociodemographic factors and perceptions regarding TOLAC (selection criteria for TOLAC, basis underlying the selection criteria for TOLAC, and perceived challenges regarding promoting TOLAC). RESULTS: A total of 426 obstetricians were surveyed, with a response rate of ≥83%. The results showed that 31.0% of the obstetricians had no intention to recommend TOLAC to pregnant women with a history of CS. Their decisions were associated with the perceived lack of confidence regarding undergoing TOLAC among pregnant women with a history of CS and their families (odds ratio [OR] = 2.31; 95% CI: 1.38-1.38); obstetricians' uncertainty about the safety of TOLAC for pregnant women with a history of CS (OR = 0.49; 95% CI: 0.27-0.96), and worries about medical lawsuits due to adverse delivery outcomes (OR = 0.14; 95% CI: 0.07-0.31). The main reported challenges regarding performing TOLAC were lack of clear guidelines for predicting or avoiding the risks associated with TOLAC (83.4%), obstetricians' uncertainty about the safety of TOLAC for women with a history of CS (81.2%), pregnant women's unwillingness to accept the risks associated with TOLAC (81.0%) or demand for ERCS (80.7%), and the perceived lack of confidence (77.5%) or understanding (69.7%) regarding undergoing TOLAC among pregnant women and their families. CONCLUSION: A proportion of Chinese obstetricians did not intend to recommend TOLAC to pregnant women with a history of CS. This phenomenon was closely associated with obstetricians' concerns about TOLAC safety and perceived attitudes of the pregnant women and their families regarding TOLAC. Effective measures are needed to help obstetricians predict and reduce the risks associated with TOLAC, clearly specify the indications for TOLAC, improve labor management, and popularize TOLAC in China. Additionally, public health education on TOLAC is necessary to improve the understanding of TOLAC among pregnant women with a history of CS and their families, and to improve their interactions with their obstetricians regarding shared decision making.

Clinical observation of Weining boil-free granule combined with auricular point pressing with bean in the treatment of chronic atrophic gastritis with liver-stomach disharmony / 中国基层医药

Objective To investigate the clinical effect of Weining boil -free granule combined with auricular point pressing with bean in the treatment of chronic atrophic gastritis with liver -stomach disharmony .Methods 120 patients with chronic atrophic gastritis of liver -stomach disharmony were selected .They were randomly divided into treatment group (n=60) and control group (n=60) according to the digital table.The control group was treated with routine western medicine ,and the treatment group received Weining boil -free granule combined with auricular point pressing with bean .The clinical efficacies of the two groups was compared .Results The total effective rate of the treatment group was 95.0%,which was significantly higher than 76.6% of the control group,the difference was statistically significant(χ2 =8.29,P<0.05).Conclusion The effect of Weining boil -free granule combined with auricular point pressing with bean in the treatment of chronic atrophic gastritis with liver -stomach disharmony is better than that of the routine western medicine .

Preparation and in vitro Dissolution Behavior Investigation of Frovatriptan Succinate Film-coated Tablet / 中国药房

OBJECTIVE:To prepare Frovatriptan succinate film-coated tablet,and investigate its in vitro dissolution behavior. METHODS:Using lactose monohydrate,microcrystalline cellulose,dioxide,silica,sodium carboxymethyl starch and magnesium stearate as accessories,Frovatriptan succinate tablet was prepared. Using opadry premix spray-coating liquid,Frovatriptan succinate film-coated tablet was prepared. Single factor test was used,using moisture,angle of repose,rigidity,friability,disintegration time and dissolution rate as indexes,to screen the formulation;using dissolution degree as index,coating material dosage was screened. The dissolution curves in vitro of self-made tablets and imported tablets in water,0.1 mol/L HCL,pH of 5.5,6.8 phos-phate buffer solutions were compared. RESULTS:The optimal formulation of Frovatriptan succinate uncoated tablet was as follow as frovatriptan succinate 3.91 mg,lactose monohydrate 99.18 mg,microcrystalline cellulose 33.06 mg,magnesium stearate 1.40 mg,sodium carboxymethyl starch 1.05 mg,silica 1.40 mg;optimal coating weighed quality was 2.0%-4.0%. In the 4 mediums, the dissolution behavior of self-made tablets and imported tablets were similar. CONCLUSIONS:Frovatriptan succinate film-coated tablet is prepared successfully,and its in vitro dissolution behavior is similar to the imported preparations.