ObjectiveTo construct and verify the nomogram prediction model of pregnant women's fear of childbirth. MethodsA convenient sampling method was used to select 675 pregnant women in tertiary hospital in Tangshan City, Hebei Province from July to September 2022 as the modeling group, and 290 pregnant women in secondary hospital in Tangshan City from October to December 2022 as the verification group. The risk factors were determined by logistic regression analysis, and the nomogram was drawn by R 4.1.2 software. ResultsSix predictors were entered into the model: prenatal education, education level, depression, pregnancy complications, anxiety and preference for delivery mode. The areas under the ROC curves of the modeling group and the verification group were 0.834 and 0.806, respectively. The optimal critical values were 0.113 and 0.200, respectively, with sensitivities of 67.2% and 77.1%, the specificities were 87.3% and 74.0%, and the Jordan indices were 0.545 and 0.511, respectively. The calibration charts of the modeling group and the verification group showed that the coincidence degree between the actual curve and the ideal curve was good. The results of Hosmer-Lemeshow goodness of fit test were χ2=6.541 (P=0.685) and χ2=5.797 (P=0.760), and Brier scores were 0.096 and 0.117, respectively. DCA in modeling group and verification group showed that when the threshold probability of fear of childbirth were 0.00 to 0.70 and 0.00 to 0.70, it had clinical practical value. ConclusionThe nomogram model has good discrimination, calibration and clinical applicability, which can effectively predict the risk of pregnant women's fear of childbirth and provide references for early clinical identification of high-risk pregnant women and targeted intervention.
OBJECTIVE: To search for the operation timing and methods for obstetrical brachial plexus injury (OBPI). METHODS: Thirty-two children with upper OBPI were treated by microsurgical procedure from October 1997 to April 2001. The average age of patients was 10 months, ranged from 3 months to 24 months; of them, 19 were below 6 months while 13 were over 6 months. Surgical procedure included neurolysis(n = 12), coaptation after resection of the neuroma without function (n = 7), phrenic nerve transfer to anterior cord of upper trunk or musculocutaneous nerve (n = 7) and intercostal nerves transfer to musculocutaneous nerve(n = 6). The children underwent operation with microsurgical technique and 7/0 or 9/0 nylon was used for nerve suture. RESULTS: Thirty cases were followed up for 21 months postoperatively; the excellent and good rate was 76.7% (23/30). The results of the children under 6 months were better than those over 6 months. CONCLUSION: The microsurgical operation might be considered at the age of 3-6 month infants who had shown little or no improvement in elbow flexion. Neurolysis and nerve coaptation are superior to neurotization. The appropriate procedure should be selected according to the findings of exploration.
Objective To investigate and analyze the cognition of intraspinal labor analgesia (ILA) of women in labor and its influencing factors. Methods A total of 322 women in labor in West China Second University Hospital of Sichuan University between May and September 2015 were investigated by questionnaire, which included the general situation, the pregnancy status, the understanding for labor pain, and the cognition of ILA. Investigator introduced the knowledge of ILA to them after the investigation, and then they were re-investigated for the choice of ILA. Results Only 22.67% of these women in labor knowed ILA clearly, 53.42% heared it but did not understand, and 49.38% liked to use it. The proportion of women in labor who liked to use it increased to 81.89% after introduction, and the difference was significant (P<0.001). Among all factors, the acknowledgement level of ILA and the choice to use it were mainly related to the family awareness concept for labor pain. Conclusions The cognition of ILA of women in labor is not enough, and their using desire is not strong. The family awareness concept is one of the important factors. The education and advertise to the women in labor and their family members after admiting to labor room can increase the choice rate of ILA significantly.
Objective To explore the effect of different pre-labor position for premature rupture of membrane (PROM) after 37 weeks with vertex and engaged presentation on the maternal and neonatal outcomes. Methods A total of 120 women over 37 weeks PROM with single fetus in vertex presentation and engaged head were randomly allocated into two groups. The trial group (60 women) received no limit of movement after hospitalization and before labor while the control group (60 women) adapted lateral and supine position alternatively with hip-up. Labor process and neonatal outcomes were observed and recorded. SPSS 13.0 software was adopted to analyze the data. Results Compared with the control group, the trial group had higher rate of normal birth (70% vs. 46.7%, χ2=6.72, P=0.01), shorter first and second stage of labor (t=2.11, P=0.039; t=2.75, P=0.007), fewer incidence of dysuria during labor (χ2=8.11, P=0.0041), and less amount of amniotic fluid (107±55 mL vs. 248±42 mL, t=4.188, P=0.000 1). Conclusion For PROM over 37 weeks pregnancy with single vertex presentation and engaged head, no limit on the position before labor is safe and feasible, and it can improvie spontaneous delivery rate, shorten labor process, decrease amount of amniotic fluid, and eliminate the incidence of dysuria. It is worth to be popularized in the clinic.
Objectives To systematically review the efficacy and safety of carbetocinversusoxytocin on the prevention of postpartum hemorrhage (PPH) for women undergoing vaginal delivery. Methods PubMed, The Cochrane Library, Web of Science, CBM, WanFang Data, CNKI and VIP databases were electronically searched to collect randomized controlled trials (RCTs) on carbetocinversusoxytocin on the prevention of PPH for women undergoing vaginal delivery from inception to January 2018. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 and Stata 12.0 software. Results A total of 16 RCTs including 2 537 patients were included. The results of meta-analysis showed that: compared to oxytocin, carbetocin could reduce the amount of blood loss within 24h (MD=–107.68, 95%CI–130.21 to –85.15, P<0.000 01) and 2h (MD=–85.98, 95%CI–93.37 to –78.59,P<0.000 01), hemoglobin (Hb) within 24h after delivery (MD=–5.63, 95%CI–6.82 to –4.43,P<0.000 01), the occurrence of PPH (RR=0.46, 95%CI 0.32 to 0.66,P<0.000 01) and the requirement for additional uterotonic agents (RR=0.63, 95%CI 0.48 to 0.84,P=0.002). There was no significant difference in the risk of adverse effects between two groups. Conclusions Current evidence shows that carbetocin is superior to oxytocin in the prevention of PPH for women undergoing vaginal delivery, without increasing the adverse effects. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above the conclusion.
摘要：目的：探讨晚期产后大出血的发生原因，提出防治措施。方法：对我院1992年1月至2000年1月收治的晚期产后大出血36例病例进行回顾性分析。结果：晚期产后出血的原因依次为胎盘残留、子宫复旧不全、切口裂开。结论：重视第三产程的处理，特别是对产时出血米索前列醇的应用，可有效预防大出血的发生。采用宫缩素及抗感染、清宫术等对症治疗可获得满意的治疗效果，对严重急性出血者可行子宫切除术。
ObjectiveTo systematically review the efficacy of non-pharmacological interventions to reduce fear of childbirth. MethodsThe Cochrane Library, PubMed, EMbase, Web of Science, CNKI, WanFang Data, VIP, and CBM databases were electronically searched to collect randomized controlled trials (RCTs) of the efficacy of non-pharmacological interventions to reduce fear of childbirth from inception to December 2021. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias of the included studies; then, a network meta-analysis was performed using Stata 15.0 software. ResultsA total of 19 RCTs involving 3 409 patients were included. Ten non-pharmacological interventions (prenatal education, scenario-based health education, psychological guidance, yoga training, hypnosis, mobile learning education, cognitive behavioral therapy, physical relaxation guidance, breathing guidance, and usual care) were included. The results of the reticulated meta-analysis of the Wijma Delivery Expectancy Questionnaire (W-DEQ-A) showed that the rankings of the interventions were as follows: prenatal education > yoga training > cognitive behavioral therapy > situational simulation health education > psychological guidance > physical relaxation guidance > conventional care. The results of the Wijma Experience of Childbirth Questionnaire (W-DEQ-B) mesh meta-analysis showed that the rankings of the interventions were as follows: mobile learning education > prenatal education > scenario-based health education > cognitive behavioral therapy > breathing instruction > hypnosis > psychological instruction > physical relaxation instruction > usual care. ConclusionThe current evidence suggests that prenatal education, mobile learning education, situational simulation health education, and yoga training may be effective interventions in improving maternal fear of childbirth. Due to the limited quality and quantity of the included studies, more high-quality studies are needed to verify the above conclusion.