Objective To investigate the clinical characteristics and treatment of severe H1N1 influenza during pregnancy and postpartum.Methods Clinical data of 7 pregnant women and 2 postpartum women with severe H1N1 influenza admitted from October to December 2009 were reviewed. Results Three pregnant women underwent caesarean section during hospitalization. The main symptoms included fever ( in9 cases, and fever lasted more than 3 days in 7 cases) , cough and sputum ( in 9 cases) , and dyspnea ( in 7 cases) . Asthenia and muscular soreness were not serious, and there were no accompanying symptoms of digestive tract. Moist rales were heard in 5 cases. White blood cell count decreased in 3 cases, neutrophils increased in 6 cases, and lymphocytes reduced in 7 cases. Hepatic enzymes were abnormal in 4 cases, and myocardial enzymes were abnormal in5 cases. 8 patients had hypoxemia, with PaO2 less than 40 mmHg in5 cases. Chest X-ray films and CT showed double pneumonia in 9 patients. 9 patients were given oseltamivir antiviral treatment. 8 cases were given antibiotic therapy. 5 patients with bilateral severe pneumonia and respiratory failure were given corticosteriod therapy. 5 severe patients were treated with non-invasive ventilation. One case switched to invasive ventilation and eventually died. Conclusions Pregnant and postpartum women with influenzaH1N1 are likely to develop into severe condition which is commonly rapidlyprogressive and even life-threatening. The main causes of death are pneumonia and acute respiratory distress syndrome.
Objective To identify the high risk factors related to postpartum suicide. Methods A total of 40 women with postpartum depression who had suicidal act or ideation were included in the study. They were evaluated by the Edinburgh Postpartum Depression Scale (EPDS), the Life Events Scale (LES) and the Social Support Rate Scale (SSRS), and compared with healthy postpartum women. The multi-element gradual regression analysis was performed to identify the high risk factors. Results Such factors as prior history of depression, negative life events within the previous half year, absence of social support, disease of mothers or infants, and conjugal relationship were significantly correlated with postpartum suicide. Conclusion It might be helpful to reduce the incidence of postpartum suicide by prenatal mental intervention and postpartum crisis intervention.
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.
ObjectiveTo systematically evaluate the detection rate of postpartum depression in Chinese maternal population and to provide a scientific basis for the prevention and treatment of postpartum depression.MethodsWe searched CNKI, WanFang Data, VIP, PubMed, EMbase and The Cochrane Library databases to collect studies on the detection rate of postpartum depression in Chinese maternal population from January, 2001 to August, 2019. Two reviewers independently screened literature, extracted data and evaluated the risk of bias of included studies. Meta-analysis was performed using Stata15.0 software.ResultsA total of 24 studies involving 38 357 cases were included. Meta-analysis results showed that the total detection of postpartum depression in Chinese females was 15% (95% CI 12% to 17%). Subgroup analysis showed that the detection of postpartum depression was 12.3% (95% CI 9.3% to 15.2%) in the south and 17.3% (95%CI 12.1% to 22.5%) in the north. According to the Edinburgh postpartum depression scale, the rate was 14.5% (95%CI 11.4% to 17.5%); and for other scales, the rate was 15.0% (95% CI 8.9% to 21.2%); simple random sampling method was 14.8% (95%CI 11.0% to 18.7%), and cluster sampling was 16.3% (95%CI 12.0% to 20.5%). The rate was 15.8% (95%CI 9.3% to 22.3%) from 2001 to 2010, 13.5% (95%CI 7.7% to 19.2%) from 2011 to 2014, and 14.8% (95%CI 10.9% to 18.6%) from 2015 to 2019. Sensitivity analysis showed that the combined results were stable.ConclusionsThe detection rate of postpartum depression in Chinese maternal population is high, and early screening and related intervention should be paid more attention to these population.
ObjectiveTo systematically review the efficacy and safety of acupuncture on postpartum depression (PPD).MethodsPubMed, EMbase, The Cochrane Library, Web of Science, CNKI, WanFang Data and VIP databases were electronically searched to collect randomized controlled trials (RCTs) on the efficacy and safety of acupuncture in treatment of PPD from inception to February 2021. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies. Meta-analysis was then performed by using Stata16.0 software.ResultsA total of 13 RCTs involving 899 patients were included. The results of meta-analysis showed that there was no significant difference between hand acupuncture and fluoxetine hydrochloride in HAMD score (MD=0.45, 95%CI −0.52 to 1.41, P=0.36), clinical effective rate (RR=0.93, 95%CI 0.70 to 1.23, P=0.59), and clinical cure rate (RR=0.88, 95%CI 0.44 to 1.76, P=0.73). However, hand acupuncture was superior in safety to fluoxetine hydrochloride (RR=0.04, 95%CI 0.01 to 0.28, P<0.05). There was no significant difference in clinical effective rate (RR=1.08, 95%CI 0.87 to 1.36, P=0.49) and cure rate (RR=1.31, 95%CI 0.84 to 2.04, P=0.24) between both groups.ConclusionsThe current evidence shows that there are no differences between hand acupuncture and non-acupuncture in reducing HAMD score, improving the clinical effective rate and clinical cure rate. Due to the limited quality and quantity of the included studies, more high-quality studies are needed to verify the above conclusions.
Objective To systematically review the performance of postpartum hemorrhage risk prediction models, and to provide references for the future construction and application of effective prediction models. Methods The CNKI, WanFang Data, VIP, CBM, PubMed, EMbase, The Cochrane Library, Web of Science, and CINAHL databases were electronically searched to identify studies reporting risk prediction models for postpartum hemorrhage from database inception to March 20th, 2022. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias and applicability of the included studies. Results A total of 39 studies containing 58 postpartum hemorrhage risk prediction models were enrolled. The area under the curve of 49 models was over 0.7. All but one of the models had a high risk of bias. Conclusion Models for predicting postpartum hemorrhage risk have good predictive performance. Given the lack of internal and external validation, and the differences in study subjects and outcome indicators, the clinical value of the models needs to be further verified. Prospective cohort studies should be conducted using uniform predictor assessment methods and outcome indicators to develop effective prediction models that can be applied to a wider range of populations.
ObjectiveTo systematically evaluate postpartum depression risk prediction models in order to provide references for the construction, application and optimization of related prediction models. MethodsThe CNKI, VIP, WanFang Data, PubMed, Web of Science and EMbase were electronically searched to collect studies on predictive model for the risk of postpartum from January 2013 to April 2023. Two reviewers independently screened the literature, extracted data, and assessed the quality of the included studies based on PROBAST tool. ResultsA total of 10 studies, each study with 1 optimal model were evaluated. Common predictors included prenatal depression, age, smoking history, thyroid hormones and other factors. The area under the curve of the model was greater than 0.7, and the overall applicability was general. Overall high risk of bias and average applicability, mainly due to insufficient number of events in the analysis domain for the response variable, improper handling of missing data, screening of predictors based on univariate analysis, lack of model performance assessment, and consideration of model overfitting. ConclusionThe model is still in the development stage. The included model has good predictive performance and can help early identify people with high incidence of postpartum depression. However, the overall applicability of the model needs to be strengthened, a large sample, multi-center prospective clinical study should be carried out to construct the optimal risk prediction model of PPD, in order to identify and prevent PPD as soon as possible.
ObjectiveTo systematically review the effects of core training for diastasis recti abdominis (DRA) in postpartum period. MethodsThe PubMed, EMbase, EBSCO, Cochrane Library, CNKI, CBM and WanFang Data databases were electronically searched to collect randomized controlled trials (RCTs) on core training for patients with DRA postpartum from inception to December 7, 2022. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias of the included studies. Meta-analysis was then performed using RevMan 5.4 software. ResultsA total of 12 RCTs were included, involving 741 patients with DRA postpartum. The results of the meta-analysis demonstrated that core training significantly reduced inter-recti distance (IRD) above the umbilicus (SMD=−1.37, 95%CI −2.30 to −0.44, P<0.05), below the umbilicus (SMD=−0.82, 95%CI −1.28 to −0.36, P<0.05), at the level of the umbilicus during contraction of the rectus abdominis (RA) (SMD=−0.76, 95%CI −1.24 to −0.28, P<0.05) and above the umbilicus during RA contraction (SMD=−3.41, 95%CI −5.12 to −1.69, P<0.05) in patients with DRA postpartum. Additionally, the results indicated that core training could improve visual analogue scale, abdominal circumference, waist-hip ratio, lumbopelvic control impairment, lumbopelvic proprioception, the static and dynamic overall balance stability, the static and dynamic anterior-posterior balance stability, medial-lateral static balance stability and Oswestry disability index in patients with DRA postpartum (P<0.05). However, no significant improvement was observed in inter-recti distance (IRD) below the umbilicus during RA contraction, the score of inventory of functional status after childbirth questionnaire, the score of multidimensional body-self relations questionnaire, medial-lateral dynamic balance stability or the score of pelvic floor impact questionnaire in patients with DRA postpartum (P>0.05). ConclusionCore training may improve IRD, pain intensity, total abdominal fat and fat distribution and balance in patients with DRA postpartum, but its efficacy in improving postpartum functional status, body image satisfaction or the degree of dysfunction is unclear. Due to the limited quality and quantity of the included studies, more high quality studies are required to verify the above conclusion.