Amount Of Postpartum Hemorrhage Research Articles

Study on the Application Effect of Flexible Nursing Care in Patients with Postpartum Urinary Retention and its Effect on Lactation

Objective: To study the application effect of flexible nursing in patients with postpartum urinary retention and its effect on lactation. Methods: A total of 200 cases of postpartum urinary retention patients admitted between January 2021 and January 2022 were selected and randomly grouped into two groups, a control group (conventional nursing) and an observation group (flexible nursing), of 100 cases each. The time of onset of lactation, the lactation volume score, urinary indicators, the amount of post-partum hemorrhage, and the quality of life score of the two groups were compared. Results: The observation group’s lactation initiation time (21.41 ± 1.52) h and lactation volume score (2.11 ± 0.52) were better than that of the control group (P < 0.05). The observation group’s first urination time (2.11 ± 0.51) min was lower than the control group, while the urinary retention completely relieved time (33.12 ± 8.61) h, and first urinary volume (262.17 ± 52.41) mL was higher than that of the control group (P < 0.05). The amount of postpartum hemorrhage in the observation group (151.21 ± 22.12) mL was less than that in the control group (P < 0.05). The scores of somatic functioning (86.25 ± 2.20), psychological functioning (91.56 ± 1.45), social functioning (89.25 ± 2.45), and material life (89.75 ± 1.45) of the observation group were higher than those of the control group after nursing (P < 0.05). Conclusion: Flexible nursing care in patients with postpartum urinary retention exhibited significant nursing effects and lactation function was effectively improved.

Relationship between the natural cessation time of umbilical cord pulsation in full-term newborns delivered vaginally and maternal-neonatal outcomes: a prospective cohort study

BackgroundTo analyze the impact of the time of natural cessation of the umbilical cord on maternal and infant outcomes in order to explore the time of clamping that would be beneficial to maternal and infant outcomes.MethodsThe study was a cohort study and pregnant women who met the inclusion and exclusion criteria at the Obstetrics and Gynecology Department of Qilu Hospital of Shandong University from September 2020 to September 2021. Analysis using Kruskal-Wallis rank sum test, Pearson’s Chi-squared test, generalized linear mixed model (GLMM) and repeated measures ANOVA. If the difference between groups was statistically significant, the Bonferroni test was then performed. A two-sided test of P < 0.05 was considered statistically significant.ResultsA total of 345 pregnants were included in this study. The subjects were divided into the ≤60 seconds group (n = 134), the 61–89 seconds group (n = 106) and the ≥90 seconds group (n = 105) according to the time of natural arrest of the umbilical cord. There was no statistically significant difference in the amount of postpartum hemorrhage and the need for iron, medication, or supplements in the postpartum period between the different cord spontaneous arrest time groups for mothers (P > 0.05). The weight of the newborns in the three groups was (3316.27 ± 356.70) g, (3387.26 ± 379.20) g, and (3455.52 ± 363.78) g, respectively, and the number of days of cord detachment was 12.00 (8.00, 15.75) days, 10.00 (7.00, 15.00) days and 9.00 (7.00, 13.00) days, respectively, as the time of natural cessation of the cord increased. The neonatal lymphocyte ratio, erythrocyte pressure, and hemoglobin reached a maximum in the 61–89 s group at (7.41 ± 2.16) %, (61.77 ± 8.17) % and (194.52 ± 25.84) g/L, respectively. Lower incidence of neonatal hyperbilirubinemia in the 61–89 s group compared to the ≥90s group 0 vs 4.8 (P < 0.05).ConclusionsIn full-term singleton vaginal births, maternal and infant outcomes are better when waiting for 61–89 s after birth for the cord to stop pulsating naturally, suggesting that we can wait up to 90s for the cord to stop pulsating naturally, and if the cord does not stop pulsating after 90s, artificial weaning may be more beneficial to maternal and infant outcomes.

Clinical analysis of 102 cases of labor induction in the third trimester on twin pregnancy

Objective: To investigate the clinical characteristics of induced labor in twin pregnancy and the related factors of induced labor failure. Methods: The clinical data of twin pregnant women who underwent induced labor in Peking University Third Hospital from January 2016 to December 2022 were retrospectively analyzed. According to whether they had labor or not after induction, pregnant women were divided into the success group (pregnant women who had labor after induction, 72 cases) and the failure group (pregnant women who did not have labor after induction, 30 cases). Logistic regression was used to analyze the related factors of induction failure in twin pregnant women. Results: The parity and cervical Bishop score in the failure group were significantly lower than those in the success group, while the proportion of dichorionic diamniotic twins, assisted reproductive technology pregnancy and cervical Bishop score <6, postpartum hospital stay and total hospital stay in the failure group were significantly higher than those in the success group (all P<0.05). The proportion of induced labor by artificial rupture of membranes ± oxytocin intravenous infusion in the success group was 72.2% (52/72), which was significantly higher than that in the failure group (46.7%, 14/30; P=0.030). There were no significant differences between the two groups in the gestational age at delivery, the incidence of severe postpartum hemorrhage and blood transfusion, the amount of postpartum hemorrhage, the neonatal weight of two fetuses, the incidence of neonatal asphyxia, and the proportion of neonates admitted to the neonatal intensive care unit (all P>0.05). There were no severe perineal laceration and hysterectomy in all pregnant women. Multivariate logistic regression analysis showed that primipara (OR=3.064, 95%CI: 1.112-8.443; P=0.030) and cervical Bishop score <6 (OR=5.208, 95%CI: 2.008-13.508; P=0.001) were the independent risk factors for induction failure in twin pregnancy. Conclusions: Elective induction of labor in twin pregnancy is safe and feasible. It is helpful to improve the success rate of induction of labor by strictly grasping the timing and indications of termination of pregnancy, choosing the appropriate method of induction according to the condition of the cervix, and actively promoting cervical ripening.

Effects of endometriosis on pregnancy outcomes in Fujian province.

Endometriosis is a common gynecological disease, affecting 5 to 10% of women of childbearing age. We analyzed pregnancy complications and neonatal outcomes of patients with pregnancies complicated with endometriosis. The aim of the study was to explore the effects of endometriosis on pregnancy and to evaluate the potential pregnancy risks associated with this disease. The retrospective study included 3,809 parturients who were routinely examined, hospitalized and underwent cesarean section delivery in Fujian Maternal and Child Health Hospital from January 2014 to December 2020. Among them, 1,026 parturients were diagnosed with endometriosis after the cesarean section (endometriosis group), and 2,783 parturients without endometriosis comprised the control group. The endometriosis group was further divided into subgroups according to the severity of the disease: 882 parturients with stage Ⅰ or Ⅱ of endometriosis, and 144 parturients with stage Ⅲ or Ⅳ of endometriosis. General data of all patients and medical records of pregnancy complications and neonatal outcomes for each group were collected and retrospectively analyzed. There were no statistically significant differences in the age, gestational age, gestation, and parity times between all groups (p>0.05). The incidence of preeclampsia and placenta previa in the endometriosis group was higher than that in the control group (p<0.05). There was no significant difference in rates of other pregnancy complications, such as chronic hypertension with pregnancy, preeclampsia with chronic hypertension, hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome, gestational diabetes mellitus (GDM), pregestational diabetes mellitus (PGDM), intrahepatic cholestasis of pregnancy (ICP), premature rupture of membranes or placental abruption between the two groups. The incidence of placenta previa in the group of patients with stage III/IV endometriosis was higher than in patients with stage I/II endometriosis (p<0.05). However, there was no significant difference in the incidence of other pregnancy complications. The amount of postpartum hemorrhage (1,000-1,500 ml) in the endometriosis group was greater than that in the control group, and the difference was statistically significant (p<0.05). However, there was no significant difference in the incidence of postpartum hemorrhage in patients with pregnancies complicated with endometriosis at different stages. In pregnant women, endometriosis is associated with an increased incidence of placenta previa that correlates with the severity of the disease. Pregnant women with endometriosis have higher rates of preeclampsia and postpartum hemorrhage, compared to women without endometriosis.

Examining the Influence of Accompanying Midwifery with Position Guidance on Delivery Outcomes

Objective: To explore and analyze the influence of accompanying midwifery with position guidance on deliveryoutcomes. Methods: A total of 68 puerpera who were admitted to Dafeng People’s Hospital from April 2021 to April 2023 were recruited, grouped using odd and even number draw methods, and divided into cooperation and regular groups with 34 cases in each group. The patients in the cooperation group cooperated with the process of accompanying midwifery and position guidance, whereas the patients in the regular group had routine midwifery intervention. The delivery outcome, the duration of each labor process, the psychological state, and the amount of postpartum hemorrhage were compared between the groups. Results: The delivery outcomes of vaginal delivery and cesarean section in the cooperation group were significantly better than those in the regular group (P &lt; 0.05). The difference was not statistically significant when comparing the cooperation group with the regular group through a lateral vaginal incision (P &gt; 0.05). The duration of each labor process in the cooperation group was significantly shorter than in the regular group (P &lt; 0.05). Before the intervention, the HAMD and HAMA scores of the two groups were insignificant (P &gt; 0.05); but the HAMD and HAMA scores of the cooperation group were significantly lower than the regular group after the intervention (P &lt; 0.05). The amount of postpartum bleeding in the cooperation group was markedly lower than that in the regular group (P &lt; 0.05). Conclusion: Accompanying midwifery and position guidance throughout the delivery process can improve delivery outcomes and increase the natural delivery rate.

Examining the Impact of the Whole-Process Companionship and Responsible Midwifery Model on Delivery Outcomes

Objective: To explore and analyze the impact of the whole-process companionship and responsible midwiferymodel on delivery outcomes. Methods: 200 women who were about to give birth admitted to Lianyungang Maternal and Child Health Hospital’s Obstetrics and Gynecology Department from May 2021 to May 2023 were recruited and divided into whole process and ordinary groups by flipping a coin, with 100 cases in each group. The whole process group implemented the whole process companionship and responsible midwifery model, while the ordinary group implemented the conventional midwifery model. The duration of labor, delivery outcomes, psychological status, postpartum bleeding volume, and incidence of adverse neonatal outcomes were compared between groups. Results: All three stages of labor in the whole process group were significantly shorter than those in the ordinary group (P &lt; 0.05). The natural delivery rate and cesarean section rate in the whole process group were significantly better than those in the ordinary group (P &lt; 0.05). The difference was not statistically significant after comparing the lateral incision rate between the whole process group and the ordinary group (P &gt; 0.05). Before the intervention, the anxiety and depression scores between the groups weresimilar (P &gt; 0.05); after the intervention, the anxiety and depression scores in the whole process group were significantly lower than in the ordinary group (P &lt; 0.05). The amount of postpartum hemorrhage and the incidence of adverse neonatal outcomes in the whole process group were significantly better than those in the ordinary group (P &lt; 0.05). Conclusion: The whole-process companionship and responsible midwifery model has specific positive significance for delivery outcomes, and this midwifery model deserves to be widely used and promoted in clinical practice.

The effect of uterine massage after vaginal delivery on the duration of placental delivery and amount of postpartum hemorrhage.

The aim of this study was to investigate the effects of uterine massage performed before placental delivery on the third stage of labor and postpartum hemorrhage after vaginal delivery. The study was designed as a prospective randomized controlled study. Between June 2018 and June 2019, 242 women who gave birth in Istanbul Kanuni Sultan Suleyman Training and Research Hospital were included in the study. The women were divided into two groups; group 1 received uterine massage after vaginal delivery before placental delivery (n: 128) and group 2 did not receive massage (n: 114). Demographic characteristics, delivery times of the baby and placenta, duration of uterine massage, amount of postpartum hemorrhage and postpartum hemoglobin values of both groups were recorded. Baseline characteristics were similar in both groups. Placental output time after delivery was 8.3 ± 4.2min in group 1 and 13.5 ± 6.3min in group 2. The third stage of labor was significantly shorter in group 1 (p = 0.012). The amount of blood loss of 500mL or more after delivery was higher in group 2 but not statistically different (p > 0.05). Hemoglobin value measured within 12-24h after delivery was significantly lower in group 2 (hemoglobin < 8g/dL after 12-24h p = 0.003; hemoglobin < 10g/dL after 12-24h p = 0.001). Delta hb value was also significantly lower in group 2 (p = 0.03). With this result, it was determined that bleeding intense enough to require transfusion was more common in group 2. In patients delivering vaginally, uterine massage before placental delivery shortens the placental delivery time and reduces postpartum hemorrhage. In addition to oxytocin and controlled cord traction to reduce postpartum blood loss, uterine massage should be routinely used in the active management of the third stage of labor. NCT03858569.

Analysis of Maternal and Infant Outcomes and Related Factors of Vaginal Delivery of Second Pregnancy after Cesarean Section.

Objective To explore the clinical effect of different delivery methods and the safety of vaginal delivery of second pregnancy after cesarean section and analyze the related factors. Methods A total of 738 eligible pregnant women who underwent cesarean section from September 2018 to August 2020 were randomly selected from our hospital. Among them, 527 pregnant women successfully delivered vaginally were selected as the observation group, and 211 pregnant women who failed vaginal delivery were selected as the control group. To analyze the factors that influence the success of vaginal delivery of second pregnancy after cesarean section and compare the outcomes of mother and infant in two groups. Results There was no significant difference in age, prenatal body mass index (BMI), and thickness of lower uterine segment between the two groups (P > 0.05). There were significant differences in fetal head orientation, fetal abdominal circumference, fetal biparietal diameter, uterine height, premature rupture of membranes, Bishop score, and epidural anesthesia during labor between the two groups (P < 0.05). Multivariate logistic regression analysis showed that fetal abdominal circumference, fetal head orientation, Bishop score, and epidural anesthesia during labor were independent factors affecting the success of VBAC (P < 0.05). There was no significant difference in the incidence of uterine rupture between the two groups (P > 0.05). The amount of postpartum hemorrhage in the observation group was significantly lower than that in the control group (P < 0.05). There was no significant difference in Apgar score, asphyxia rate, and hospitalization rate between the two groups (P > 0.05). There was no significant difference in the incidence of complications between the two groups (P > 0.05). Conclusion There are many factors that influence the success of vaginal delivery after cesarean section. Through prenatal comprehensive evaluation of vaginal delivery conditions, we can guide the parturient to choose a reasonable mode of delivery, reduce the incidence of complications, and improve the outcome of mother and baby.

Effect of Oxytocin Combined with Different Volume of Water Sac in High-Risk Term Pregnancies.

Objective The study estimated the impacts of water sac of different capacities combined with oxytocin (OXT) on pregnant women with high-risk term pregnancies. Methods Women with high-risk term pregnancies who received OXT were enrolled to perform labor induction using 30 mL (group A), 80 mL (group B), and 150 mL (group C), followed by the comparisons regarding to the success rate of labor induction, cesarean section rate, duration of induced labor to labor, duration of the first stage of labor, postpartum blood loss, the incidence of adverse reactions, and the assessment of cervical ripening using Bishop Score. Besides, neonatal weight, Apgar score, as well as psychological status, and satisfaction of patients were compared among these groups. Results As compared with group A, the success rate of induced labor was higher in groups B and C with lower cesarean section rate and shorter duration of induced labor to labor, but the duration of the first stage of labor in group B was the shortest among the three groups. The amount of postpartum hemorrhage decreased stepwise from groups A to B to C. In addition, groups A and B showed a reduced incidence of adverse reactions than group C, but the highest level of cervical ripening and highest patient satisfaction was revealed in group C and group B, respectively. Furthermore, the highest patient satisfaction was found in group B. Conclusion The usage of an 80 mL water sac combined with OXT in high-risk term pregnancy has ideal induction effects, which can guarantee maternal cervical maturity and shorten the time of the first stage of labor.

The Effect of Oxytocin plus Carboprost Methylate in Preventing Postpartum Hemorrhage in High-Risk Pregnancy and Its Effect on Blood Pressure.

Objective. This study aimed to explore and analyze the effectiveness of oxytocin plus carboprost methylate in preventing postpartum hemorrhage in high-risk pregnancies and its effect on blood pressure. A total of 60 women with high-risk pregnancies who gave birth in our hospital from January 2020 to May 2021 were recruited and assigned via random number table method (1 : 1) to receive either oxytocin (control group) or oxytocin plus carboprost methylate (observation group). Outcome measures included hemorrhage and blood pressure. The bleeding volume of the women in the observation group (210.55 ± 45.98, 45.21 ± 9.27, and 73.74 ± 12.18) was significantly less than that in the control group during delivery and 2h and 24h after the delivery (276.91 ± 49.21, 72.98 ± 19.68, and 92.61 ± 15.67) (all P < 0.05). The observation group showed a significantly lower bleeding rate (6.67%) than the control group (16.67%) (P < 0.05). The two groups showed similar diastolic and systolic blood pressures (P > 0.05). Oxytocin plus carboprost methylate suppository effectively prevents postpartum hemorrhage in high-risk pregnancies, significantly reduces the amount of postpartum hemorrhage in high-risk pregnancies, and has little effect on the blood pressure of patients. Given its favorable treatment efficiency and high safety profile, this treatment protocol shows great potential for clinical application.

Effects of skin-to-skin contact on afterpain and postpartum hemorrhage: A randomized controlled trial.

This study determined the effects of skin-to-skin contact between the mother and the infant during the third stage of labor on postpartum hemorrhage and pain. This assessor-blinded randomized controlled trial was conducted with primiparous women. Skin-to-skin contact interventions between the infants and their mothers occurred for 30 min after birth (n=34), whereas the infants in the control group were provided routine care (n=34). Data were gathered using a Personal Information Form, the Visual Analog Scale-Pain, postpartum bleeding follow-up bags, and records of blood oxytocin and beta endorphin levels. There was no significant difference in beta-endorphin levels in both groups (p= 0.771), whereas it was determined that the 30th min oxytocin level was significantly higher in the intervention group (The Visual Analog Scale-Pain score at the postpartum sixth hour was significantly lower in the intervention group. It was found that skin-to-skin contact made at the third stage of labor reduced the amount of postpartum hemorrhage. The results of this study suggested that skin-to-skin contact intervention may have beneficial effects on postpartum pain and postpartum hemorrhage in the early postpartum period.

Analysis of Factors Affecting Postpartum Hemorrhage in Twin Pregnancy

Objective: To explore the factors affecting postpartum hemorrhage in twin pregnancy. Methods: The clinical data of 839 twin pregnancy patients who delivered at the Second Hospital of Shandong University from May 2010 to July 2020 were retrospectively analyzed. According to the amount of postpartum hemorrhage, patients were divided into postpartum hemorrhage group (PPH group) and non- PPH group. The basic population information and clinical data during pregnancy were compared between the two groups. Results: A total of 839 women with twin pregnancy were included in this study, and hemorrhage occurred in 11% (n=96). The Binary logistic regression model predicts the risk of factor of postpartum hemorrhage in twin pregnancy: gestation week of delivery, placenta previa, polyhydramnios, acute delivery, anemia, placental adhesions and DIC (disseminated intravascular coagulation). Conclusions: There are many factors that affect postpartum hemorrhage in twin pregnancy. Choosing the right gestational week for delivery, strengthening pregnancy management, and improving pregnancy complications can reduce the risk of postpartum hemorrhage in twin pregnancy.

Coagulopathy complicating intraoperative blood salvage in patients receiving cesarean section: three case reports and a literature review

Background: Intraoperative cell salvage (ICS) has been used in more than 1100 published obstetrics cases and can reduce the need for allogeneic transfusion effectively. However, ICS could lead to a life-threatening coagulopathy called salvaged blood syndrome (SBS). SBS was reported in several non-obstetric cases but has rarely been reported in obstetric patients. Cases: We reviewed all 841 cell savage cases that occurred in our hospital prior to October 2018. Here, we present 3 cases of coagulopathy in patients who received ICS after cesarean section. The rate of obstetrical SBS in our hospital was 0.46%. Dicussion: Cesarean section was performed without severe hemorrhage, and we performed the surgical hemostatic procedures as usual. Then, several hours after the surgery and after ICS, bleeding occurred, in which hypofibrinogenemia was more severe than expected based on the amount of postpartum hemorrhage. In addition, other marked changes in coagulation function-related parameters, including a decline in the platelet count and obvious prolongation of the PT and aPTT levels, were also observed. More specific and in-depth studies concerning obstetric SBS are needed.

Evaluation on the Influence of the Timing of Twin Pregnancy Termination on the Outcome of Mother and Infants

Objective: To observe the maternal and infant outcomes of pregnant women with twins terminating their pregnancy at different timings. Methods: Among the twin pregnant women admitted to our hospital from August 2019 to August 2020, 50 primiparous women who opted to terminate their pregnancies at 5 different timings of “34——34+6 weeks”, “35——35+6 weeks”, “36——36+6 weeks”, “37——37+6 weeks”, “38——38+6 weeks” were selected as the research subjects. According to the timing of pregnancy termination, they were divided into 5 groups, each with 10 cases of pregnant women, and the impact of the timing of pregnancy termination on the outcome of the mothers and infants were compared. Results: The “37——37+6 weeks” group had the largest amount of postpartum hemorrhage, and the difference in Hb level before and after delivery was the largest. With the increase in gestational week, the weight of both large and small fetuses increased. In terms of neonatal diseases, the comparison between “34——34+6 weeks”, “35——35+6 weeks”, “36——36+6 weeks” and “37——37+6 weeks”, “38——38+6 weeks”, P＜0.05, the comparison between “37——37+6 weeks” and “38——38+6 weeks”, P&gt;0.05. Conclusion: The extension of the gestational week of twin pregnancies has no effect on postpartum hemorrhage, but it can improve the outcome of infants.

Uterine massage to reduce blood loss after vaginal delivery

Postpartum hemorrhage (PPH) is a major cause of maternal mortality and disability. A need for simple, inexpensive techniques to prevent PPH and provide treatment exists, particularly in cases where uterotonics cannot be accessed. Uterine massage is recommended as part of the routine active management of the third stage of labor. This study was conducted to determine the effectiveness of uterine massage after delivery of the placenta in reducing postpartum blood loss. Thus, a randomized controlled trial was conducted in Turkey between March 2018 and September 2018. A total of 176 pregnant women (88 in the control and 88 in the uterine massage groups) were randomly allocated to the two groups: one group receiving sustained uterine massage, while the other comprising the control group. The uterine massage group was administered transabdominal uterine massage, starting immediately after delivery of the placenta and continuing every 15 min for a duration of 2 h until the uterus hardened. The blood loss within 2 h of delivery was recorded. Level of significance was taken as p < 0.05, and the chi-square, t, and Mann–Whitney U tests as well as Spearman’s correlation and linear regression were employed in the analysis of the data. The average amount blood loss within 2 h of the delivery was significantly higher in the control group than in the massage group (X = 170.49 ± 61.46 and X = 186.20 ± 47.59, p < 0.05). A statistically significant difference was present between the uterine massage and control groups in terms of hemoglobin, hematocrit, WBC, and RCB pre-delivery and pre-discharge (first 24 h) values and in the use of additional uterotonics and the amount of blood loss (p < 0.05). The results of the analysis show that postpartum uterine massage has a reducing effect on the amount of PPH.

Association between the number of pulls and adverse neonatal/maternal outcomes in vacuum-assisted delivery.

To determine the association between the number of pulls during vacuum-assisted deliver and neonatal and maternal complications. This was a single-center observational study using a cohort of pregnancies who underwent vacuum-assisted delivery from 2013 to 2020. We excluded pregnancies transitioning to cesarean section after a failed attempt at vacuum-assisted delivery. The number of pulls to deliver the neonate was categorized into 1, 2, 3, and≥4 pulls. We used logistic regression models to investigate the association between the number of pulls and neonatal intensive care unit (NICU) admission and maternal composite outcome (severe perineal laceration, cervical laceration, transfusion, and postpartum hemorrhage≥500mL). We extracted 480 vacuum-assisted deliveries among 7,321 vaginal deliveries. The proportion of pregnancies receiving 1, 2, 3, or≥4 pulls were 51.9, 28.3, 10.8, and 9.0%, respectively. The crude prevalence of NICU admission with 1, 2, 3, and≥4 pulls were 10.8, 16.2, 15.4, and 27.9%, respectively. The prevalence of NICU admission, amount of postpartum hemorrhage, and postpartum hemorrhage≥500mL were significantly different between the four groups. Multivariable logistic regression analysis found the prevalence of NICU admission in the≥4 pulls group was significantly higher compared with the 1 pull group (adjusted odds ratio, 3.3; 95% confidence interval, 1.4-7.8). In contrast, maternal complications were not significantly associated with the number of pulls. Vacuum-assisted delivery with four or more pulls was significantly associated with an increased risk of NICU admission. However, the number of pulls was not associated with maternal complications.

RETRACTED: The application value of midwifery leading companion doula in puerpera birth nursing

Purpose To evaluate the effect of midwifery-led doula companion care in puerpera delivery nursing. Methods 126 primiparas were admitted to our hospital from June 2018 to November 2019 by random sampling method. According to the order of admission of primiparas, they were divided into conventional group (63 cases) and study group (63 cases). The routine group of primiparas were given routine delivery care, while the research group of primiparas were given doula accompanied care by midwives. The time of labor, pregnancy outcome, delivery pain score, delivery control and anxiety score of the two groups were compared and analyzed. Results Compared with the conventional group, the time of the first, second and total labor was significantly shorter in the study group (P &lt; 0.05). The amount of postpartum hemorrhage in the study group was significantly less than that in the conventional group (P &lt; 0.05). The rate of perineal incision and perineal laceration in the study group was significantly lower than that in the conventional group (P &lt; 0.05). There was no significant difference in Apgar score &lt;8 points compared with the control group (P &gt; 0.05). The scores of pain and anxiety in the second stage of labor were significantly lower in the study group than in the conventional group (P &lt; 0.05). The control score of the puerpera in the study group was significantly higher than that in the conventional group (P &lt; 0.05). Conclusion The intervention measures of companion doula led by midwives can effectively shorten the time of labor, reduce the anxiety and pain score and improve the sense of control during labor of primiparas. This nursing method has clinical promotion and application value.

Sezaryen sonrası rektal olarak uygulanan misoprostolün bağırsak motilitesi ve uterus kanaması üzerine etkileri

Purpose: This study was designed to determine the effectiveness of rectal misoprostol administered in primiparous women after elective cesarean to the motility of the gastrointestinal tract and postpartum hemorrhage.Materials and Methods: This study was conducted as a retrospective cohort study of 240 patients who were administrated rectal misoprostol (misoprostol group, n=120) or intravenous oxytocin (non-misoprostol group n=120) during the postpartum period in a single institution between April 2018 and March 2019Results: The median values of the first flatulation and defecation time were statistically significantly earlier in the misoprostol group than in the non-misoprostol group (the first flatulation time was 18 hours and 24 hours respectively, the first defecation time was 29 hours and 36 hours respectively). The comparison of the two groups in terms of postoperative hemoglobin and hematocrit values demonstrated that hemoglobin and hematocrit values measured at the postoperative 24th hour (the hemoglobin was 11 g/dL and 10,2 g/dL respectively, the hematocrit was 33% and 30.6% respectively) were statistically significantly higher in the misoprostol group than were those in the non-misoprostol group. Postoperative fever and shivering, negative effects of misoprostol, were more frequent in the misoprostol group than in the non-misoprostol group. Conclusions: In the present study, demonstrated that the administration of rectal misoprostol after CS led to the early flatulation and defecation by increasing the motility of the gastrointestinal tract and reduced the amount of postpartum hemorrhage in the women.

Effect of transcutaneous electrical acupoint stimulation on labor analgesia

To observe the effect of transcutaneous electrical acupoint stimulation (TEAS) on labor pain. A total of 151 primiparas who were vaginal delivery were randomized into a TEAS group (76 cases) and a peridural group (75 cases). In the peridural group, peridural blockage was applied to analgesia. In the TEAS group, TEAS was applied at Hegu (LI 4)，Neiguan (PC 6), Jiaji T10~L1 (EX-B 2) and Ciliao (BL 32), disperse-dense wave (2 Hz/100 Hz), 15-50 mA in current intensity. The analgesic time was from 3 cm to completely opening of cervix. The visual analogue scale (VAS) scores were observed before analgesia, after 30, 60, 120 min of analgesia in the two groups. The time of different stages of labor, usage rate of oxytocin, incidence rate of adverse reaction and amount of postpartum hemorrhage were recorded. The newborn's 1 and 5 min Apgar scores were evaluated. The VAS scores showed a downward trend in the two groups after analgesia (P<0.01), and the change of the TEAS group was less than the peridural group (P<0.01). The active phase on the first stage and second stage of labor in the TEAS group were shorter than the peridural group (P<0.01, P<0.05), there was no significant difference in the time of third stage of labor between the two groups (P>0.05). The usage rate of oxytocin and incidence rate of adverse reaction in the TEAS group were 9.2% (7/76) and 2.6% (2/76), which were lower than 34.7% (26/75) and 18.7% (14/75) in the peridural group (P<0.01). There was no significant difference in the amount of postpartum hemorrhage and newborn's 1 and 5 min Apgar scores between the two groups (P>0.05). The analgesic effect of TEAS is inferior to peridural blockage, but TEAS could relieve labor pain to the tolerance, shorten the time of active phase on the first stage and second stage of labor and reduce the use of oxytocin, has mild adverse reaction.

The effectiveness of delivery ball use versus conventional nursing care during delivery of primiparae.

Objective:To analyze the clinical effect of delivery ball and free position delivery nursing in primipara delivery.Methods:Total 110 primipara who were admitted to the department of gynecology and obstetrics of our hospital from August 2017 to August 2018 were included in the study. They were randomly divided into an observation group and a control group, 55 each group. The control group adopted conventional nursing measures, while the observation group adopted delivery ball combined with free position midwifery nursing on the basis of conventional nursing. The pain degree, comfort degree, pregnancy outcome and sense of delivery control were compared between the two groups.Results:The number of puerperae with grade 0 and 3 labor pain in the two groups had no statistically significant difference (P>0.05). The number of puerperae with grade 1 and 2 had significant difference (P<0.05). As to the comparison of the delivery mode between the two groups, there were 9 cases of cesarean delivery and 46 cases of vaginal delivery in the observation group; there were 19 cases of cesarean delivery and 36 cases of vaginal delivery in the control group; the differences had statistical significance (P<0.05). In the comparison of the birth process time of the vaginal delivery puerperae, the time of the first and second stages of labor in the observation group was shorter than that in the control group, and the differences were statistically significant (P<0.05); there was no difference in the time of the third stage of labor between the two groups (P>0.05). The amount of hemorrhage of the observation group 2 hours after labor was 172.50±40.60 mL and that of the control group was 224.45±32.80 mL; the difference between the two groups was statistically significant (P<0.05). The sense of delivery control of the puerperae who suffered vaginal delivery was compared between the two groups using Labor Agentry Scale (LAS); the sense of delivery control of the observation group was stronger than that of the control group, and the differences had statistical significance (P<0.05).Conclusion:In the delivery of primipara, delivery ball combined with free position delivery can help the primipara relieve pain, improve comfort degree, reduce the amount of postpartum hemorrhage, shorten the duration of various stages of labor, and improve the delivery outcome. It has a high clinical promotion value.