Obstetrics Research Articles

Combined Maternal Serum C3 Activation and Uterine Artery Doppler at 14-20 Weeks as Predictors for Pre-Eclampsia in Primigravida

Background: Preeclampsia is a multisystem disorder of pregnancy, which complicates 3%-5% of pregnancies in the western world. It is a major cause of maternal morbidity and mortality worldwide. The cardinal clinical features of the condition are hypertension and proteinuria occurring after 20 weeks gestation in women who were not previously known to be hypertensive. Objective: This study was aimed to assess the efficacy of C3 estimation and measurement of bilateral uterine artery Doppler before 20 weeks of pregnancy for prediction of preeclampsia in primigravida. Methods: The study was performed at the Antenatal Care Unit, Obstetrics and Gynecology Department, Sayed Galal Hospital, Al Azhar University on 131 pregnant women at 14-20 gestational weeks during period from July 2017 to December 2017 gestation attending. Results: On follow up the population of the study 131 pregnant women had completed the study that were classified to 119 (90.8%) with no pre-eclampsia and 12 (9.2%) developed preeclampsia, As regards the Patients characteristics there was no statistical significant difference between the two groups as regard age, height, weight, gestational age, SBP and DPB at enrollment (p-value>0.05). There was a significant difference regarding BMI as (p value < 0.05), with more increasing BMI and decreasing gestational age at delivery in preeclampsia group in comparison with the no preeclampsia group. As regards the C3, there was statistically highly significant difference between the two groups regarding serum C3 level as p value <0.05, with lower levels of C3 serum levels in preeclampsia group. Receiver operator characteristics (ROC) curves were constructed for estimating the association between pre-eclampsia and serum C3 level. A significant association was found with serum C3 level being a significant predictor with lower values in cases with pre-eclampsia than in normal cases [area under the curve (AUC) = 0.935, 95% CI (0.878 to 0.9711.35), best cut off (≤53.1), sensitivity of 83.3%, specificity of 100% positive predictive value (PPV) of 100% and negative predictive value (NPV) of 98.3%. Conclusion: This study demonstrates that lower level of maternal serum C3 in the early second trimester (14-20 weeks gestation) and abnormal increasing in uterine artery indices (PI and RI) are associated with developing pre-eclampsia several months later in pregnancy.

Current situation and influencing factors of weight loss among hospitalized full-term neonates

Objective To explore the current situation and influencing factors of weight loss among hospitalized full-term neonates so as to provide a basis for weight monitoring among neonates. Methods From October to December 2016, we selected 200 full term neonates of rooming-in at a ClassⅢ gynaecology and obstetrics hospital in Shanghai. The weight loss of neonates was investigated with the self-designed questionnaire for influencing factors of weight loss among hospitalized full-term neonates. We also analyzed the differences between the weight loss of neonates ≥ 7% and < 7% its influencing factors. Results Among 200 hospitalized neonates, the weight loss was (251±102) g with 3.2% to 7.6% for the decline. Single factor analysis showed that there were statistical differences in the weight loss of neonates ≥7% and < 7% among full-term neonates with different methods of delivery and feeding, whether they used labor analgesia, whether they were with intravenous fluids, lactation times, sexes of neonates and excretion times (P<0.05) . Logistic regression analysis showed that the main influencing factors of weight loss in hospitalized neonates included methods of delivery and feeding, fluid infusion during childbirth as well as excretion times of neonates. Conclusions The influencing factors of weight loss in hospitalized neonates include methods of delivery and feeding, fluid infusion during childbirth as well as excretion times of neonates. Hospitals can make intervention based on influencing factors and monitor the weight changes so as to prevent excessive pathological weight loss and to promote healthy growth of neonates. Key words: Hospitalized; Infant, newborn; Term birth; Weight loss; Influencing factors

Clinical study on independent risk factors and neonatal complications in discordant twins

Objective To investigate the perinatal independent risk factors and neonatal complications of discordant twins. Methods Clinical data of 152 (76 pairs) discordant twins and 552 (276 pairs) concordant twins were enrolled at the Obstetrics of Peking University People′s Hospital from November 1, 2011 to October 31, 2016.The perinatal characteristics and the neonatal complications in 2 groups were analyzed and compared.Binary Logistic regression analysis was used to identify the independent risk factors associated with the occurrence of discordant twins. Results (1) The gestational age, the incidence of term infants and birth weight of the discordant twins were significantly lower than those of the concordant twins[(35.8±2.5) weeks vs.(36.7±1.8) weeks, 48.7% vs.60.2%, (2 277.1±575.7) g vs.(2 545.0±413.4) g], and the differences were statistically significant(all P<0.05). The incidence of premature infants, the incidence of infants small for gestational age and the rate of transferring discordant twins to pedia-tric department were significantly higher than that of concordant twins (51.3% vs.39.9%, 40.8% vs.13.2%, 46.1% vs.26.8%), and the differences were statistically significant(all P<0.05). (2) The incidence of neonatal asphyxia, neonatal respiratory distress syndrome, neonatal pneumonia, neonatal apnea, bronchopulmonary dysplasia, neonatal sepsis and neonatal intracranial hemorrhage were significantly higher than those of concordant twins (6.6% vs.2.5%, 7.2% vs.3.1%, 5.3% vs.1.3%, 9.2% vs.3.3%, 3.9% vs.0.9%, 3.3% vs.0.7%, 4.6% vs.0.7%), and the differences were statistically significant(all P<0.05). (3) The birth weight in the twins with low body weight group was significantly lower than that in the twins with high body weight group [(1 926.7±414.1) g vs.(2 618.7±504.6) g], and the differences were statistically significant (P<0.05). The incidence of small for gestational age, the rate of conversion to pediatrics and the incidence of neonatal intracranial hemorrhage in the twins with low body weight group were significantly higher than those in the twins with high body weight group (65.8% vs.6.6%, 56.6% vs.35.5%, 9.2% vs.0), and the differences were statistically significant(all P<0.05). (4)Logistic regression analysis showed that hypertensive disorder during pregnancy (OR=2.127, 95%CI: 1.392-3.253) and gestational diabetes mellitus (OR=1.684, 95% CI: 1.112-2.552) were independent risk factors for the occurrence of discordant twins. Conclusions Hypertensive disorder during pregnancy and gestational diabetes mellitus are independent risk factors for the occurrence of discordant twins, who are much more likely to develop various neonatal complications, particularly low-birth-weight infants.Timely surveillance and treatment of short-term complications and long-time follow-up are essential to discordant twins. Key words: Discordant twins; Twin pregnancy; Complication; Risk factor

Perioperative humanistic care among medium and advanced gynecologic malignant tumor patients

Objective To explore the effects of perioperative humanistic care on medium and advanced gynecologic malignant tumor patients. Methods From January 2015 to December 2016, we selected 102 medium and advanced gynecologic malignant tumor patients at Beijing Obstetrics and Gynecology Hospital of Capital Medical University. Humanistic care was carried out during the perioperative period. We observed postoperative recovery, psychological state and the incidence of complications among patients. Results Patients were all with successful operations, stable psychological state and no complications, and they discharged from hospitals steadily. Conclusions Perioperative humanistic care has important clinical significance in improving psychological state among medium and advanced gynecologic malignant tumor patients and promoting patients' recovery. Key words: Neoplasms; Rehabilitation; Nursing care; Gynecologic surgical procedures; Humanistic care

Abstract 184: “I’m Gonna Have the Baby and It’s Gonna Go Away:” Communicating Cardiovascular Risk After a Pregnancy Complicated by Preeclampsia

Background: Preeclampsia (PE) affects 5-8% of all pregnancies and is an underappreciated risk factor for hypertension after delivery and cardiovascular (CV) disease and stroke later in life. Women with PE are at a 2-fold higher risk of CV death and those with severe PE are at highest risk. The AHA recommends early risk factor screening and lifestyle modification in this at-risk population. Our objective was to understand barriers and facilitators of healthy lifestyle in an urban, racially diverse population of postpartum women with PE. Methods: We conducted qualitative, semi-structured interviews among women with a pregnancy complicated by severe PE in the past year. We randomly selected 10 women who had completed postpartum follow-up with an obstetrics (OB) and cardiology provider at the Hospital of the University of Pennsylvania within a 12-month period. Interviews were conducted at home or by phone and transcribed. Transcripts were coded and analyzed by 2 researchers using a grounded theory framework to identify major themes. Results: Of the 10 participants, 5 were black. The mean (SD) age was 33.0 (8.9) years and interviews were conducted on average 7.9 months postpartum (range 3.8-11.5 months). Mean BMI at the 6-week postpartum OB visit was 34.6 kg/m 2 (range 19.9-42.6 kg/m 2 ). Participants demonstrated understanding that PE was a hypertensive state during pregnancy but did not generally acknowledge long-term CV risk. Participants uniformly identified exercise as an important component of a healthy lifestyle but were unsatisfied with current levels of physical activity. Barriers to exercise included lack of time, childcare, and motivation. Identified facilitators included having a workout buddy, working with a trainer, and having an extrinsic source of accountability. On average women reported being 12 pounds above their pre-pregnancy weight. Patient understanding of the association between weight gain and health risk varied widely. Participants reported obtaining health information for their child from the pediatrician but were more likely to use information from the internet or family and friends for issues related to PE and their own health. Conclusion: In this urban, racially diverse population of postpartum women, understanding of the long-term CV risks of severe preeclampsia were poor despite established follow-up with OB and cardiology. Postpartum women may be responsive to exercise interventions designed with social support, structured work-out plans, and accountability. Further research is needed around how to promote weight loss and improve understanding of CV risk.

The use of honey and curcumin for episiotomy pain relief and wound healing: A three-group double-blind randomized clinical trial

Background: Episiotomy is the most common surgical procedure in obstetrics. It may be associated with wound infection and delayed wound healing. Objectives: This study aimed to compare the effects of honey and curcumin on episiotomy pain and wound healing. Methods: This double-blind three-group randomized controlled trial was done on 120 women admitted for vaginal delivery to Shahid Yahyanejad hospital, Babol, Iran. Participants were randomly assigned to three groups of 40 subjects and were taught to apply honey, curcumin, or placebo creams on their own episiotomy wound twice daily for 10 successive days after birth. Pain and wound healing were assessed 2 h, 5 days, and 10 days after birth via a visual analog scale and the Redness, Edema, Ecchymosis, Discharge, and Approximation scale. The primary outcomes of the study were episiotomy wound healing and pain intensity. The Chi-square test as well as the one-way analysis of variance and the repeated measures analyses of variance were conducted for data analysis. Results: The study was completed with 30 women in each of the honey and the curcumin groups and 29 in the placebo group. There were no statistically significant differences among the groups respecting the variations of pain intensity and wound healing mean scores across the three measurement time points. However, based on the complete pain relief on the 10th day and compared with the placebo group, number-to-treat values in the curcumin and the honey groups were around 6 and 5, respectively. Moreover, compared with the placebo group, number-needed-to-treat values for complete wound healing on the 10th day in the curcumin and the honey groups were 6 and 8, respectively. Conclusion: Curcumin and honey creams have almost the same effects on episiotomy wound healing and pain intensity.

In vitro fertilization-embryo transplantation combined with ovarian malignant tumor cause analysis and nursing

Objective The causes of ovarian malignant tumors after in vitro fertilization and embryo transplantation were analyzed retrospectively, and the preventive measures were put forward and the corresponding nursing measures were taken. Methods For confirmed after in vitro fertilization and embryo transplantation combined with ovarian malignant tumor in 5 patients with psychological care, perioperative observation and complications prevention treatment, chemotherapy nursing, health guidance, etc. Results Five patients were treated and treated with appropriate clinical care, including 4 cases of continuous pregnancy, 1 case of termination of pregnancy. Conclusions By analyzing the causes of such diseases and taking preventive measures, the occurrence of complications can be reduced and the multidisciplinary cooperation among gynecology, obstetrics and neonatology can be improved to improve the relevant nursing level. Key words: Fertilization in vitro; Embryo transfer; Ovarian neoplasms; Nursing care

The influence of information-based health education WeChat platformon on the cognition, attitude and behavior of pelvic floor muscle training of puerperal

Objective To study the application effect of information-based health education WeChat platform on the cognition, attitude and behavior of pelvic floor muscle training (pelvic floor muscle training, PFMT) of puerpera, in order to provide an effective intervention method and scientific basis to improve the compliance level of PFMT. Methods Full-term birth 329 cases of vaginal delivery have been chosen from August to September in 2017 in Beijing Obstetrics and Gynecology Hospital, Capital Medical University. They were divided into 3 groups: control group, audio group, video group by computer random digital table method. The number of the cases of the corresponding groups were 108,113, 108 cases. Control group was given general postpartum health education, audio group and video group were given continuation of voice remind audio guide and continuation of voice remind video guide respectively from postpartum 1 week to 7 weeks. The compliance level of PFMT of the three groups would be evaluated before and after the intervention. Results The KAP(Knowledge, Altitude and Practice, KAP) scores of PFMT of control group, audio group and video group were 9.0(7.0,10.0), 11.0(8.0,12.0), 12.0 (11.0,13.0) points, respectively. There were significant differences between the video group and the control group, between the video group and the audio group and between the audio group and the control group (Z =-4.302, -10.233, -6.429, P<0.01). Comparison of the PFMT scores before and after the three groups, there was a visibility significant statistical difference in KAP scores (Z =-5.596, -11.762. -15.061, P< 0.01). Conclusions The maternals' knowledge level and physical activity level of PFMT are relatively low. Health care workers should enhance their knowledge about PFMT and improve their understanding of PFMT. WeChat platform to continue voice remind audio guide and continue voice remind video guide way of health education, could improve the KAP level of maternal PFMT and adherence. The KAP level of video guide health education is superior to the audio guide way of health education, which has clinical significance, and is worth popularizing. Key words: Healthy education; Stress urinary incontinence; Informatization; Knowledge, altitude and practice

Application of objective structured clinical examination in the training of professional postgraduate students in obstetrics and gynecology

Objective To design and conduct objective structured clinical examination (OSCE) in professional postgraduates in obstetrics and gynecology, and to investigate the improvement measures for the teaching of professional postgraduates in obstetrics and gynecology by analyzing the performance of postgraduates in OSCE. Methods In October 2017, OSCE was performed for postgraduates in obstetrics and gynecology in the classes of 2016 and 2017 to evaluate their clinical ability. This OSCE consisted of the following four aspects: inquiry of standardized patients, basic practical skills in obstetrics and gynecology, utilization and interpretation of auxiliary examinations, and case analysis. The postgraduates were scored according to the following six items: doctor-patient communication skills, completeness of inquiry, basic practical skills in obstetrics and gynecology, utilization of auxiliary examinations, competence of clinical thinking, and mastery of medical knowledge. SPSS 18.0 was used for statistical analysis, and the t-test was used for comparison between groups. Results A total of 27 postgraduates participated in this OSCE. Among the six scoring items, completeness of inquiry had the lowest score (78±6), and utilization of auxiliary examinations had the highest score (85±3). Among the 27 postgraduates, 7 (25.9%) lacked doctor-patient communication skills, 6 (22.2%) showed serious problems in basic practical skills in obstetrics and gynecology, and 6 (22.2%) lacked the scientific thinking of clinical diagnosis. Conclusion In the training of professional postgraduate students in obstetrics and gynecology, doctor-patient communication skills and clinical thinking should be emphasized, and basic clinical skill training should be strengthened. Key words: Objective structured clinical examination; Obstetrics and gynecology; Professional postgraduate student

Analysis of short-term survival rate and morbidity of extremely preterm infants

Objective To assess survival rates and major complications of extremely preterm infants (EPI) discharged from the hospital, in order to provide some evidence for the treatment of such cases in the future. Methods A retrospective study was performed by reviewing the clinical data of 299 infants at gestational age (GA)<28 weeks who were admitted at the Neonatal Intensive Care Unit (NICU) of Tianjin Central Hospital of Gynecology Obstetrics from January 1st 2011 to December 31st, 2017.The survival rates and major morbidities of EPI according to different GA were compared by trend Chi-square and t test. Results A total of 299 cases of EPI were included in the study, with a mean GA of 26.5 weeks(22+ 3-27+ 6 weeks) and mean birth weight of 958.5 g(360-1 550 g). From 2011 to 2017, the number of hospitalized EPI increased gradually(from 21 cases in 2011 to 79 cases in 2017), especially in EPI of lower GA (GA<25 weeks)which increased from 4 cases in 2011-2014 to 26 cases in 2015-2017.The rates of survival infants with GA<28 weeks were 78.6%(235/299 cases), including 18.2%(2/11 cases)at GA≤23 weeks, 52.6%(10/19 cases)at 24 weeks, 75.8%(25/33 cases)at 25 weeks, 78.5%(62/79 cases)at 26 weeks and 86.6%(136/157 cases)at 27 weeks, respectively, which showed that survival rates increased with the growth of GA (χ2=31.3, P=0.000). Major morbidities among the survival infants were severe retinopathy of prematurity (ROP, stage Ⅲ or above according to international classification and received treatment) [16.2%(38/235 cases)], bronchopulmonary dysplasia (BPD, supplemental oxygen use at a postmenstrual age of 36 weeks) [15.3%(36/235 cases)], late-onset sepsis (LOS) [24.7%(58/235 cases)], intraventricular hemorrhage(IVH), grade 3 or 4)or periventricular leukomalacia(PVL) [9.4%(22/235 cases)], necrotizing enterocolitis(NEC), stage≥Ⅱof Bell, criteria) [3.0%(7/235 cases)], and decreased with increased gestational age (χ2=18.450, 19.773, 15.024, all P=0.000). Rates of ROP, BPD and LOS in EPI with GA<25 weeks were 41.7%(5/12 cases), 58.3%(7/12 cases) and 66.7%(8/12 cases), respectively, which were much higher than those of EPI with GA 25-28 weeks [14.8%(33/223 cases), 13.0%(29/223 cases), 22.4%(50/223 cases)](all P<0.05). Conclusions From 2011 to 2017, the number of hospitalized EPI increased gradually and the rate of survival rose with every 1-week increase in GA, while major morbidities were reduced accordingly.EPI of GA<25 weeks had a greater risk of mortality and major morbidities. Key words: Extremely preterm infants; Survival rate; Morbidity; Mortality; Neonatal Intensive Care Unit

Obstetric factors for maternal depression/anxiety

Objective To investigate the current situation of depression/anxiety in gravidas and to analyze the related obstetric factors. Methods A questionnaire survey was conducted among 6 923 gravidas who registered for their first prenatal examination at Obstetrics and Gynecology Hospital of Fudan University from September 2015 to September 2016. Self-Rating Depression Scale (SDS) and Self-Rating Anxiety Scale (SAS) were completed during the survey and general obstetric conditions and medical history were reviewed. Related obstetric factors were statistically analyzed by Chi-square test and logistic regression. Results In this study, the positive rates of depression and anxiety screening were 23.15% (1 603/6 923) and 9.56% (659/6 893), respectively. Univariate analysis showed that maternal depression was associated with maternal age, gravidity, parity and history of adverse pregnancies (all P<0.05), while anxiety was related to maternal age, gravidity and history of adverse pregnancies (all P<0.05). Multivariate analysis showed that younger gravidas (<25 years old) had higher risks of depression and anxiety than those aged between 25 and 35 (OR=2.945, 95%CI: 2.266-3.829; OR=1.959, 95%CI: 1.381-2.780; both P<0.05). Compared to primiparas with a history of conception, the first-time pregnant women had lower risks of depression and anxiety (OR=0.732, 95%CI: 0.630-0.851; OR=0.630, 95%CI: 0.512-0.775; both P<0.05), and the risk of anxiety in multiparas was also decreased (OR=0.748, 95%CI: 0.561-0.996, P<0.05). In addition, gravidas with previous adverse pregnant outcome showed higher risks of depression and anxiety (OR=1.549, 95%CI: 1.123-2.137; OR=1.712, 95%CI: 1.138-2.577; both P<0.05). Conclusions The positive rates of depression and anxiety are high in gravidas, especially younger or primiparas with a history of conception and those with history of adverse pregnancies. Clinicians should pay attention to any obstetric factors related to maternal depression and anxiety. Key words: Pregnant women; Depression; Anxiety; Psychiatric status rating scales; Age factors; Pregnancy outcome

Prenatal diagnosis of two Turner syndrome fetuses with 46,X,i(X)(q10)

Objective To summarize the prenatal diagnosis and genetic counseling of Turner syndrome fetuses with 46,X,i(X)(q10). Methods Two gravidas admitted to the Obstetrics and Gynecology Hospital of Dalian were enrolled in this study. One gravida, who was admitted in October 2016, was classified as high risk of Down syndrome based on prenatal serologic screening and systematic ultrasonography, which found remarkably shorter humeri and femora than fetus of the same gestations. The other was suggested to be monosomy X after non-invasive prenatal testing and admitted in November 2017. Fluorescence in situ hybridization (FISH) and karyotyping were performed for prenatal diagnosis. Peripheral blood karyotyping was also offered to the two women and their partners. Results FISH test for amniotic fluid did not find numerical abnormality in 13, 18, 21, and sex chromosomes in these two fetuses. Karyotype analysis showed that the two fetuses were both 46, X, i(X) (q10), while their parents were normal. Both cases were terminated after genetic counseling. Conclusions Prenatal serological screening, systematic ultrasonography and non-invasive prenatal testing may help to identify Turner syndrome fetus of 46, X, i(X) (q10). Timely and accurate prenatal diagnosis may prevent the affected fetus from being born. Key words: Turner syndrome; Prenatal diagnosis; Genetic counseling; Isochromosomes

Effects of new nursing model on reducing the rate of cesarean delivery in primiparas

Objective To explore the effects of the new nursing model on reducing the rate of cesarean delivery, anxiety and depression in primiparas. Methods Totally 360 primiparas from Beijing Daxing Maternal and Child Care Hospital from March 2017 to March 2018 were selected by convenient sampling and divided into the observation group (n=180) and the control group (n=180) based on their personal willingness after informed consent. Primiparas in the control group received conventional nursing care for gynaecology and obstetrics patients, while primiparas in the observation group were treated based on the new nursing model, including health education, psychological counseling and whole-course guidance and companion. The selection rate of delivery mode, anxiety, depression and satisfaction with nursing in the primiparas were compared between the two groups. Results The selection rates of spontaneous labor or cesarean delivery in the control group were 50.56% (91/180) and 49.44% (89/180) ; the selection rates of spontaneous labor or cesarean delivery in the control group were 85.56% (154/180) and 14.44% (26/180) . There was statistical difference in the selection rates of spontaneous labor or cesarean delivery between the two groups (P<0.01) . The anxiety and depression scores of the observation group were lower than those of the control group post intervention, and the differences were statistically significant (P<0.01) . The observation group's satisfaction with nursing was 98.33% (177/180) , while that of the control group was 92.78% (167/180) , and the difference was statistically significant (P<0.05) . Conclusions The new nursing model can effectively reduce the anxiety and depression in primiparas, encourage them to select spontaneous labor and reduce the rate of cesarean delivery, which is worth promoting in clinical practice. Key words: Cesarean delivery; Primiparas; Delivery mode; Nursing model; Effects observation

Qualitative study on experience and nursing demands of spouses of in-hospital puerpera in the puerperium

Objective To explore the mental response and nursing demands of spouses of puerpera in the puerperium and to provide support and assistance to family-centered humanistic nursing in the department of obstetrics. Methods Totally 15 spouses of puerpera at day 3 post delivery in a Class Ⅲ Grade A hospital in Suzhou were selected by purposive sampling from November 2017 to January 2018. Their real experience was collected by live recording and semi-structured in-depth interview using qualitative phenomenological methods, and the data were organized, summarized and analyzed using content analysis. Results Totally 4 categories were refined: adaptation to the role of husband, adaptation to the role of father, mental response and nursing demands. Conclusions The emotions of the spouses of puerpera in the puerperium fluctuated significantly, and their mental response vary from phase to phase. Attention should be paid to the role awareness, responsibility, mental activity and nursing demands and information support and psychological care should be properly provided according to their role awareness, responsibility and mental response. Key words: Delivery; Emotion; Puerperium; Spouses; Nursing demands

Effects of different medication time of cefuroxime sodium on nosocomial infections of surgical incision and C-reactive protein in patients of Department of Obstetrics and Gynecology

Objective To study the effect of different medication time of cefuroxime sodium on nosocomial infections of surgical incision and C-reactive protein (CRP) in patients of Department of Obstetrics and Gynecology. Methods A total of 158 surgery patients in Department of Obstetrics and Gynecology who were treated in the People's Hospital of Qing County from July 2015 to November 2017 were enrolled in the study.According to random number method, they were randomly divided into control group and observation group, with 79 cases in each group.The observation group received the treatment of cefuroxime sodium in the perioperative period, the control group was given cefuroxime sodium treatment after surgery.The differences of the probability of a nosocomial infection and CRP between the two groups who chose different medication time were compared. Results The observation group had 45 patients appearing abnormal temperature after surgery, and the temperature restoring normal time was (40.17±10.35)h.The control group had 59 patients appearing abnormal temperature after surgery, and the temperature restoring normal time was (56.35±9.87)h, which of the observation group were less than that of the control group, the differences were statistically significant(χ2=5.513, P=0.019; t=8.163, P=0.000). The levels of CRP and procalcitonin of the observation group after surgery were (2.34±0.66)mg/L, (2.48±0.79)mg/L, respectively, which were lower than those of the control group[(3.46±0.84)mg/L, (3.19±0.96)mg/L], the differences were statistically significant(t=9.260, P=0.000; t=5.104, P=0.000). The observation group had 2 patients appeared incision infection after surgery, the control group had 9 patients appeared incision infection after surgery, there was statistically significant difference between the two groups(χ2=4.788, P=0.029). The hospitalization time of the observation group was (6.70±1.04)d, which was shorter than (8.26±1.25)d of the control group, there was statistically significant difference between the two groups(t=8.513, P=0.000). The quality of life score of the observation group after surgery was (85.63±15.30)points, which was higher than (71.29±11.07)points of the control group, there was statistically significant difference between the two groups(t=-6.748, P=0.000). Conclusion Using cefuroxime sodium in the perioperative period can reduce the probability of nosocomial infection in surgical patients, improve the level of inflammation in vivo, shorten the hospital stay and improve the quality of life of patients. Key words: Department of obstetrics and gynecology; Surgery patient; Cefuroxime sodium; Nosocomial infection; C-reactive protein

"Digital SACCIA-Safe, Digitally Supported Communication in Gynecology and Obstetrics: Digital SACCIA"

"Digital SACCIA-Safe, Digitally Supported Communication in Gynecology and Obstetrics: Digital SACCIA"

Effects of empowerment education on lactogenesis, psychological resilience and quality of life among patients with gestational diabetes

Objective To explore the effects of family-centered empowerment education on delayed onset of lactogenesis (DOL) , psychological resilience and quality of life among patients with gestational diabetes mellitus (GDM) . Methods From August 2017 to July 2018, we selected 160 GDM patients of department of obstetrics at a ClassⅢ Grade A hospital in Beijing as subjects by convenience sampling. A total of the 160 patients were divided into control group (odd numbers) and observation group (even numbers) according to the number based on time sequence of diagnosis of GDM, 80 cases in each group. Two groups all carried out routine health education for GDM patients. On that basis, observation group implemented family-centered empowerment education started from the diagnosis of GDM from 24 to 28 weeks of gestation one time per week until the end of delivery in hospital. The intervention effects were evaluated with the incidence of DOL, Connor-Davidson Resilience Scale (CD-RISC10) , WHO Quality of Life Scale Brief Version (WHOQOL-BREF) for patients between two groups. Results There were 76 cases in observation group and 72 cases in control group completing this study. The onset time of lactogenesis of observation group was (58.21±15.78) hours earlier than that of control group with a statistical difference (t=2.231, P<0.05) . The incidence of DOL of observation group and control group was 14.47% and 34.72% respectively with a statistical difference (χ2=8.235, P<0.05) . The total score of psychological resilience and quality of life of observation group was statistically higher than those of control group 42 days after childbirth (P<0.05) . Conclusions Family-centered empowerment education can make the onset time of lactogenesis ahead, reduce the incidence of DOL, and improve psychological resilience as well as quality of life of GDM patients. Key words: Diabetes, gestational; Lactation; Resilience, psychological; Quality of life; Delayed onset; Empowerment education

Research on primary and advanced levels of laparoscopic simulation training on improving laparoscopic skills of gynecologic residents with different seniority

Objective To explore the value of primary and Advanced levels of laparoscopic simulating training in different seniority of gynecologic residents. Methods 77 residents in their first to forth training-year were divided into two groups: 1-2 year resident and 3-4 year resident, trained with different levels of simulating training plans respectively and then assessed in the Department of Obstetrics and Gynecology in Peking University Third Hospital. Results The qualified rate of primary and advanced simulation training was 85.7% and 57.1% respectively. The qualified rate of primary training (80.4% vs. 100.0%, P=0.028) and advanced training (12.5% vs. 57.14%, P=0.000) were significantly different between 1-2 year residents and 3-4 year residents. The operative skills improved significantly in all the residents. In the 1-2 year residents, the scores of the primary training increased more obviously, while in the 3-4 year residents, the scores of the advanced training increased significantly. Conclusion It might be more effective for residents with different seniority to receive different levels of simulating training accordingly, so as to improve their laparoscopic operative skills more effectively. Key words: Laparoscopy; Simulation training; Resident; Department of gynecology

The application of appropriate midwifery technologies in China

At present, the clinically prominent problem in obstetrics is that the rate of cesarean section declines slowly. After the implementation of the two-child policy, the issues caused by the re-pregnancy of a large number of cesarean section mothers have become an obstetric problem. The implementation and promotion of appropriate midwifery technologies in China to ensure maternal and child safety and the healthy development of obstetrics are necessary for the current state of obstetrics. Therefore, this study summarizes WHO's classification of obstetric intervention methods and the main measures of appropriate midwifery technologies in China, and makes some suggestions for further developing appropriate technologies for midwifery. Key words: Guidebooks; Midwifery; Appropriate technology; Application

Epidural analgesia in latent phase of labor for preeclamptic women attempting vaginal delivery

Objective To evaluate the efficacy of epidural analgesia in latent phase of labor for preeclamptic women undergoing vaginal delivery. Methods A prospective study was conducted on 80 nulliparae of singleton pregnancy with preeclampsia and cephalic presentation in Tianjin Central Hospital of Gynecology Obstetrics from August 2016 to July 2017. All subjects were randomly divided into two groups including labor analgesia in active phase group (labor analgesia was commenced at cervical dilation over≥4 cm, n=40, group 1) and the whole labor analgesia in latent phase group (labor analgesia was comenced at the onset of labor, n=40, group 2). Visual analogue score (VAS) was used to evaluate pain intensity at different time points. Maternal venous blood samples were collected at the time of parturient and fetal delivery to determine the serum concentrations of cortisol (Cor) and adrenocorticotropic hormone (ACTH) by enzyme-linked immunosorbent assay (ELISA). Clinical data was statistically analyzed using t-test or Chi-square test. Results (1) Compared with group 1, the duration of the first stage of labor [(521.3±103.5) vs (570.3±116.2) min, t=0.366, P<0.05], the VAS scores immediately after analgesic administration and at cervical dilation of 2 and 3 cm [4.1±1.1 vs 7.3±1.2, 3.5±0.9 vs 7.6±1.7, 3.7±0.7 vs 8.1±1.4; t=4.387, 9.652, 5.321; all P<0.05], the mean arterial pressure at cervical dilation of 2 and 3 cm [(98.3±9.1) vs (125.3±10.6) mmHg (1 mmHg=0.133 kPa), (98.6±10.4) vs (127.5±9.6) mmHg; t=8.014, 5.496; both P<0.05] and the cesarean delivery rate [15.0% (6/40) vs 27.5% (11/40), χ2=4.012, P<0.05] were all lower in group 2. (2) The serum levels of Cor [(565±76) vs (231±64) nmol/L, (457±79) vs (233±55) nmol/L; t=6.028, 5.126; both P<0.05] and ACTH [(81±14) vs (38±11) pg/ml, (71±16) vs (39±10) pg/ml, t=5.984, 6.028; both P<0.05] in group 1 and group 2 were both increased significantly after delivery as compared with those at the time of parturient, and they also showed significant differences between the two groups after delivery (t=5.009, 3.862; both P<0.05). Conclusions Epidural analgesia in latent phase of labor can be implemented in preeclamptic women attempting vaginal delivery through alleviating labor pain as sooner and earlier as possible, reducing their stress responses and maintain hemodynamic stability. Key words: Pre-eclampsia; Analgesia, epidural; Analgesia, obstetrical; Natural childbirth; Labor stage, first