ObjectiveTo overview of systematic reviews of the efficacy and safety of antimicrobials in the prevention of postpartum infection after vaginal delivery, and to provide evidence for the rational use of antimicrobials. MethodsThe CNKI, WanFang Data, VIP, PubMed, Embase, and Cochrane Library databases were searched to collect systematic reviews/meta-analyses on antibiotic prophylaxis for transvaginal delivery from inception to June 25, 2023. The data of the included systematic reviews were extracted by 2 investigators independently, and the methodological quality, risk of bias, and report quality were evaluated by AMSTAR 2.0 scale, ROBIS tool, and PRISMA, respectively. And a pool of outcomes for assessing the effectiveness of antimicrobials in prevention of postpartum infection after transvaginal delivery was developed. ResultsA total of 7 systematic reviews were included. And the AMSTAR 2.0 indicated that most studies (5/7) were from very low quality to low quality. The ROBIS tool showed 3 studies with low risk of bias, 3 with high risk of bias, and 1 with unclear risk of bias. The results of the PRISMA statement showed that the included system evaluation reports were relatively complete. The present evidence showed that prophylactic use of antimicrobials may be beneficial and recommended in women with Ⅲ-Ⅳ perineal fissures, with no significant benefit in women with manual placenta removal, but prophylactic use of antimicrobials was recommended considering their invasive nature, but it was controversial whether antimicrobials should be used in the categories of vaginal assisted delivery, perineal lateralization, and spontaneous delivery (without complications). ConclusionAntimicrobial prophylaxis may not be recommended for all the pregnant women undergoing vaginal delivery to prevent the postpartum infection, but considering the low methodological quality of the included systematic review and the inconsistent outcomes in this field, the conclusion should be further verified by future research with high-quality.
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.
Objective To explore the effect of epidural analgesia for labor on maternal temperature and the newborns. Methods This randomized trial was performed in West China Second Hospital between December 2015 and July 2016. Fifty puerperants were randomly divided into epidural analgesia (EA) group (natural labor under EA, n=25) or the control group (natural labor using Ramaze breathing method, n=25). Maternal tympanic temperature was recorded once per hour after treating with painless labor or blank control. The serum interleukin-1 beta (IL-1β) and heat shock protein 70 (HSP70) level were measured from the blood of the umbilical cord after the delivery. Apgar scores of the newborns were also recorded. Results There was a significant difference in the temperature between EA and control group one hour after the treatment of painless labor [ (36.9±0.7) and (36.4±0.5)℃]. The level of serum IL-1β and HSP70 were significantly higher in EA group [IL-1β: (0.308±0.036) ng/mL; HSP70: 1.175±0.196] than those in the control group [IL-1β: (0.244±0.031) ng/mL; HSP70: 0.935±0.308] (P<0.05). However, no significant difference was found in the neonatal Apgar score (P>0.05). Conclusions The increase of maternal temperature is greater in the EA labor puerperants compared with that in the controls, which may be related to the increase of IL-1β and HSP70. No adverse effect of labor analgesia on new borns is found
ObjectiveTo systematically review the effect of doula delivery on postpartum depression.MethodsWe searched The Cochrane Library, Web of Science, PubMed, EMbase, CBM, CNKI and WanFang Data databases to collect relevant randomized controlled trials (RCTs) about the effect of doula delivery on postpartum depression from inception to March 24th, 2017. Two reviewers independently screened literatures, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 19 RCTs involving 10 921 participants were included. The results of meta-analysis showed that the doula delivery could reduce the incidence of postpartum depression (RR=0.36, 95%CI 0.29 to 0.46, P<0.001), and SDS score in doula delivery group was superior to that in the control group (MD=–7.37, 95%CI –11.01 to –3.72, P<0.001).ConclusionThe current evidence shows that doula delivery can reduce the incidence of postpartum depression. Due to the limited quantity and quality of included studies, the above conclusion is still needed to be verified by more high quality studies.
至2002年4月,分娩期会阴保护的证据如下: ①合成的可吸收材料在分娩期外阴1、2度撕伤修补和外阴切开中的应用(可以减少疼痛时间):1个系统评价发现,使用合成的可吸收缝合线相对于普通肠线明显减少了分娩后10天内镇痛药的使用剂量.对于分娩期的疼痛和分娩3个月后的性交痛,合成的可吸收材料与普通肠线无显著差别.系统评价中的一个大规模RCT发现,合成的可吸收材料在分娩后12个月显著降低性交痛. ②皮下连续缝合材料在外阴1、2度撕伤修补和外阴切开中的应用(减少疼痛时间):1个系统评价发现,皮下连续缝合相对间断缝合明显减轻了分娩后10天以内的疼痛.③分娩期对病人持续的支持(减少助产器械的使用):1个系统评价发现,分娩期对产妇持续的支持(注释:分娩过程中有护士、助产士等专业人士陪伴,并提供咨询)明显减少了助产器械的使用及会阴切开,但不能防止分娩期损伤的发生.④各种方法和材料在3、4度撕伤修补中的应用: 我们没有找到评论外阴3、4度撕伤修补最好的材料和方法的RCT.⑤硬膜外麻醉(增加了助产的机率,从而增加了会阴损伤的机率):1个系统评价没有找到直接的证据来比较硬膜外麻醉和其他麻醉对会阴损伤的影响.但是,一些RCT发现,仅在第一产程使用硬膜外麻醉和在第一产程及二、三产程都使用硬膜外麻醉相比,后者的器械助产及会阴损伤风险显著升高.⑥不协助孕妇分娩和协助分娩的比较( 增加了孕妇疼痛,无证据显示会阴损伤风险及会阴切开机率减少):1个RCT发现,不协助孕妇分娩(不接触胎儿头部或者保护产妇会阴)与协助产妇分娩(分娩期在胎头上施压及保护产妇会阴)相比,显著增加了产后10天的疼痛但却减少了会阴切开的机率.但无证据显示前者增加了会阴损伤风险或3、4度外阴撕伤风险.⑦会阴正中切开(相比会阴侧切增加了3、4度会阴撕伤机率):无证据显示会阴正中切开能比会阴侧切减少会阴疼痛或者伤口裂开的机率.一项来自半随机试验的有限证据表明,会阴正中切开可能增加3、4度会阴撕伤的机率.⑧会阴2度撕伤及会阴切开后不缝合会阴肌肉: 1个小样本RCT发现,在皮肤烧灼感和痛觉上,缝合与不缝合肌肉在产后2～3天,愈合后2～3天或产后8周没有差别.⑨会阴1、2度撕伤和切开后不缝合会阴皮肤(减少了性交痛): 1个大样本RCT发现,不缝合皮肤与常规缝合相比,产后10天疼痛没有显著差异,但却显著减少了分娩3个月后的性交痛.⑩第二产程胎头被动下降: 1个RCT比较了胎头被动下降和主动推动胎头快速下降,结果发现二者对会阴损伤没有差别.(11)限制性的会阴切开 (减少了后壁的损伤): 1个系统评价发现,对有胎儿或母亲指征的产妇限制性使用会阴切开能显著减少会阴后壁的撕伤,但却增加了阴道前壁及阴唇的损伤风险.(12)持续性的屏气向下用力:1篇来自2个质量不高的临床对照试验的系统评价发现,第二产程向下用力时,屏气与不屏气对会阴撕伤的发生率及程度没有影响.1篇RCT比较胎头被动下降与屏气用力推动胎头下降,二者对会阴撕伤率也没有影响.(13)分娩期体位:1个系统评价比较了直立位、仰卧位和侧卧位,结果发现分娩期直立位显著降低了会阴切开机率,却明显增加了会阴2度撕伤的风险.(14)胎头吸引(相比产钳减少了会阴损伤,但增加了新生儿脑出血风险):1个系统评价发现,胎头吸引器与产钳相比,显著降低了会阴损伤机率,但增加了新生儿脑出血和视网膜出血的风险.
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 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.