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Chinese Medicine Plaster as A New Treatment for Surgical Site Infection in Patients with cesarean delivery:A Randomized,Double-Blind,Controlled Trial

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Chinese Journal of Integrative Medicine 2023年第6期29卷 483-489页

作者： HAN Guan-ya WU Xiao-li LI Dong-mei CAI Hai-rui ZHOU Jun-jun HE Xiao-bo Department of Obstetrics Ningbo Women and Children's HospitalNingboZhejiang Province(315012)China Department of Medical Intensive Care Unit Ningbo Women and Children's HospitalNingboZhejiang Province(315012)China

Objective To evaluate the efficacy of Chinese plaster containing rhubarb and mirabilite on surgical site infection(SSI)in patients with cesarean delivery(CD)by performing a randomized controlled *** This randomized controlled trial included 560 patients with CD due to fetal head descent enrolled at a tertiary teaching center between December 31,2018 and October 31,*** patients were randomly assigned to a Chinese medicine(CM)group(280 cases)or a placebo group(280 cases)by a random number table,and were treated with CM plaster(made by rhubarb and mirabilite)or a placebo plaster,*** courses of treatment lasted from the day 1 of CD,followed day 2 until *** primary outcome was the total number of patients with superficial,deep and organ/space *** secondary outcome was duration of postoperative hospital stay,antibiotic intake,and unplanned readmission or reoperation due to *** reported efficacy and safety outcomes were confirmed by a central adjudication committee that was unaware of the study-group *** During the recovery process after CD,the rates of localized swelling,redness and heat were significantly lower in the CM group than in the placebo group[7.55%(20/265)vs.17.21%(47/274),P<0.01].The durution of postoperative antibiotic intake was shorter in the CM group than in the placebo group(P<0.01).The duration of postoperative hospital stay was significantly shorter in the CM group than in the placebo group(5.49±2.68 days vs.8.96±2.35 days,P<0.01).The rate of postoperative C-reactive protein elevation(≽100 mg/L)was lower in the CM group than in the placebo group[27.6%(73/265)vs.43.8%(120/274),P<0.01].However,there was no difference in purulent drainage rate from incision and superficial opening of incision between the two *** intestinal reactions and skin allergies were found in the CM *** CM plaster containing rhubarb and mirabilite had an effect on *** is safe for mothers and im

关键词： Chinese medicine plaster rhubarb and mirabilite surgical site infection cesarean delivery randomizedcontrolledtrial

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Effect of China's Universal Two-child Policy on the Rate of cesarean delivery: A Case Study of a Big Childbirth Center in China

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Current Medical Science 2020年第2期40卷 348-353页

作者： Shu-guo DU Fei TANG Yun ZHAO Guo-qiang SUN Ying LIN Zhi-hua TAN Xu-feng WU Department of Obstetrics Maternal and Child Health Hospital of Hubei ProvinceAffiliated Hospital of Tongji Medical CollegeHuazhong University of Science and TechnologyWuhan 430070China Department of Gynecology and Oncology Maternal and Child Health Hospital of Hubei ProvinceAfiliated Hospital of Tongji Medical CollegeHuazhong Universiry of Science and TechnologyWuhan 430070China

China's universal two child policy was released in October of *** would this new policy influence the rate of overall cesarcan delivery(CD)in China?The objective of this paper is to investigate the trend of overall CD rate with the increase of number of multiparous women based on a big childbirth center of China(a tertiary hospital)in *** this study,22530 cases from the medical record department of a big childbirth center of China from January 1 to December 31 in 2016 were entolled as research *** health records of these selected objects were *** t0 the history of childbirth,the selected cases were divided into primiparous group containing 16340 cases and multiparous group containing 6190 ***-square test was carried out to compare the rate of CD,neuraxial labor analgesia,maternity insurance between the two groups;1-test was performed to compare the in-hospital days and gestational age at birth between the two *** corrclation coefficient was used to evaluate the rclationship among observed monthly rate of multiparas,overall CD rate,and Elective Repeat cesarean delivery(ERCD)*** results showed that the CD rate in multiparous group was 55.46%,which was higher than that in primiparous group(34.66%,P<0.05).The rate of neuraxial labor analgesia in multiparas group was 9.29%,which was lower than that in primiparas group(35.94%,P<0.05).However,the rate of maternity insurance was higher in multiparas group(57.00%)than that in primiparas group(41.08%,P<0.05).The hospital cost and in-hospital days in multiparas group were higher,and the gcstational age at birth in multiparas group was lower than in primiparas group(P<0.05).The overall CD rate slightly dropped in the first 4 months of the year(P<0.05),then increased from 36.27%(April)to 43.21%(Dcember)(P<0.05).The rate of multiparas women and ERCD had the same trend(P<0.05).There were linear correlations among the rate of overall CD,the rate of multiparas women and t

关键词： cesarean delivery elective repeat cesarean delivery Trial of Labor After cesarean Section(TOLAC)

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Effect of Nurse-Assisted Early Warning Intervention for Prevention of Venous Thromboembolism Following cesarean delivery

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Maternal-Fetal Medicine 2024年第4期6卷 225-231页

作者： Bichao Wan Dongying Fu Shijang Chen Fuying Tao Jianan Jiang Yingying Tian Department of Operating Room Nurses Women’s Hospital of Nanjing Medical UniversityNanjing Maternity and Child Health Care HospitalNanjing 210004China.

Objective To assess the role of a nurse-assisted early warning intervention in improving prophylaxis against obstetric venous thromboembolism(VTE)and preventing VTE following cesarean delivery(CD).Methods A prospective cohort study conducted between January 1,2020,and December 30,2022,enrolled pregnant women who underwent CD in the obstetric unit of Women’s Hospital of Nanjing Medical University,Nanjing Maternity and Child Health Care *** patients were assigned to a control group(routine nursing care)or the intervention group(nurse-assisted early warning intervention)depending on whether or not the nurse-assisted early warning intervention had been ***χ2 test and Student’s t-test were used for statistical *** primary outcome was the incidence of systemic VTE following CD,and secondary outcomes were the rates of mechanical or pharmacologic prophylaxis receipts for VTE and the frequency and severity of adverse events related to pharmacologic *** A total of 27,074 cases were *** incidence of symptomatic VTE following CD was significantly lower in the intervention group(0.29 per 1000 deliveries)than in the control group(2.4 per 1000 deliveries)(P<0.001).Significantly more cases received mechanical and pharmacological VTE prophylaxis in the intervention group than in the control group(respectively,19.8%vs.12.6%receiving mechanical prophylaxis and 0.9%vs.0.2%receiving pharmacological prophylaxis).No cases of life-threatening bleeding occurred in either *** The application of nurse-assisted early warning intervention may be an effective method for preventing VTE following CD.

关键词： cesarean delivery Deep vein thrombosis Nurse-assisted early warning intervention Pregnancy related venous thromboembolism Pulmonary embolism

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Emergency cesarean delivery in a Parturient with Fontan Circulation and Reduced Platelets: A Case Report

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Chinese Medical Sciences Journal 2017年第3期32卷 204-205页

作者： Si Chen Hongju Liu Department of Anesthesiology Peking Union Medical College Hospital Chinese Academy of Medical Sciences & Peking Union Medical College

NOWADAYS,Fontan circulation always refers to the hemodynamic status after total cavo-pul-monary connection, which was first created in the 1990s. There are two modern surgeryforms, one creating a channel within the right atrium and another making an extra-cardiac channel to connect infe-rior venous cava directly to the right pulmonary artery. Parturients with Fontan circulation are at increased risk of cardiac morbidity and thrombotic complications. We pre-sented a parturient with reduced platelet status of un-known reason undergoing an emergent cesarean delivery.

关键词： Fontan circulation cesarean delivery reduced platelet

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The Dose-response of Intrathecal Ropivacaine Co-administered with Sufentanil for cesarean delivery under Combined Spinal-epidural Anesthesia in Patients with Scarred Uterus

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Chinese Medical Journal 2015年第19期128卷 2577-2582页

作者： Fei Xiao Wen-Ping Xu Yin-Fa Zhang Lin Liu Xia Liu Li-Zhong Wang Department of Anesthesia Jiaxing Maternity and Child Care HospitalJiaxingZhejiang 314050China Jiaxing Genetic and Reproductive Medicine Research Institute JiaxingZhejiang 314050China Department of AnesthesiaJiaxing Maternity and Child Care HospitalJiaxingZhejiang 314050China

Background：Spinal anesthesia is considered as a reasonable anesthetic option in lower abdominal and lower limb *** study was to determine the dose-response of intrathecal ropivacaine in patients with scarred uterus undergoing cesarean delivery under combined spinal-epidural ***：Seventy-five patients with scarred uterus undergoing elective cesarean delivery under combined spinal-epidural anesthesia were enrolled in this randomized,double-blinded,dose-ranging *** received 6,8,10,12,or 14 mg intrathecal hyperbaric ropivacaine with 5 μg *** spinal anesthesia was defined as a T4 sensory level achieved with no need for epidural *** 50％ effective dose （ED50） and 95％ effective dose （ED95） were calculated with a logistic regression ***：ED50 and ED95 ofintrathecal hyperbaric ropivacaine for patients with scarred uterus undergoing cesarean delivery under combined spinal-epidural anesthesia （CSEA） were 8.28 mg （95％ confidence interval [CI]：2.28-9.83 mg） and 12.24 mg （95％ CI：10.53-21.88 mg）,***：When a CSEA technique is to use in patients with scarred uterus for an elective cesarean delivery,the ED50 and ED95 of intrathecal hyperbaric ropivacaine along with 5 μg sufentanil were 8.28 mg and 12.24 mg,*** addition,this local anesthetic is unsuitable for emergent cesarean delivery,but it has advantages for ambulatory patients.

关键词： cesarean delivery Dose-response Ropivacaine Scarred Uterus Spinal

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Goal-directed Fluid Therapy May Improve Hemodynamic Stability of Parturient with Hypertensive Disorders of Pregnancy Under Combined Spinal Epidural Anesthesia for cesarean delivery and the Well-being of Newborns

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Chinese Medical Journal 2015年第14期128卷 1922-1931页

作者： Wei Xiao Qing-Fang Duan Wen-Ya Fu Xin-Zuo Chi Feng-Ying Wang Da-Qing Ma Tian-Long Wang Lei Zhao Department of Anesthesiology Xuan Wu Hospital Capital Medical University Beijing 100053 China Department of Obstetrics and Gynecology Xuan Wu Hospital Capital Medical University Beijing 100053 China Department of Surgery and Cancer Pain Medicine and Intensive Care Faculty of Medicine Chelsea and Westminster Hospital Imperial College London United Kingdom

Background： Hypotension induced by combined spinal epidural anesthesia in parturient with hypertensive disorders of pregnancy （HDP） can easily compromise blood supply to vital organs including uteroplacental perfusion and result in fetal distress. The aim of this study was to investigate whether the goal-directed fluid therapy （GDFT） with LiDCOrapid system can improve well-being of both HDP parturient and their babies. Methods： Fifty-two stable HDP parturient scheduled for elective cesarean delivery were recruited. After loading with 10 ml/kg lactated Ringer＇s solution （LR）, parturient were randomized to the GDFT and control group. In the GDFT group, individualized fluid therapy was guided by increase in stroke volume （ASV） provided via LiDCO rapid system. The control group received the routine fluid therapy. The primary endpoints included maternal hypotension and the doses of vasopressors administered prior to fetal delivery. The secondary endpoints included umbilical blood gas abnormalities and neonatal adverse events. Results： The severity of HDP was similar between two groups. The total LR infusion （P 〈 0.01） and urine output （P 〈 0.05） were higher in the GDFT group than in the control group. Following twice fluid challenge tests, the systolic blood pressure, mean blood pressure, cardiac output and SV in the GDFT group were significantly higher, and the heart rate was lower than in the control group. The incidence of maternal hypotension and doses of phenylephrine used prior to fetal delivery were significantly higher in the control group than in the GDFT group （P 〈 0.01）. There were no differences in the Apgar scores between two groups. In the control group, the mean values of pH in umbilical artery/vein were remarkably decreased （P 〈 0.05）, and the incidences of neonatal hypercapnia and hypoxemia were statistically increased （P 〈 0.05） than in the GDFT group. Conclusions： Dynamic responsiveness guided fluid therapy with the LiDCOrapid system may provide po

关键词： cesarean delivery Fluid Therapy Hypertensive Disorders of Pregnancy LiDCOrapid System Parturient

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Obstetric Anesthesia Practice Significantly Evolved: A Field for cesarean delivery Parturient for the Provision of Safe Anesthesia in Urgent Circumstances

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Open Journal of Anesthesiology 2024年第3期14卷 66-92页

作者： Mustafa Zakaria Amal Haoudar Said Makani Mariame Kabbour Oumaima Taoussi Karim Elaidaoui Yousra Rajaa Chafik El Kettani Adil Elghanmi Department of Anesthesia and Resuscitation Hospital ZNA Middelheim Antwerpen Belgium European Society of Anaesthesiology and Intensive Care Ghent Belgium Anesthesia and Resuscitation Services Mohammed VI University of Sciences and Health-UM6SS Casablanca Morocco Cardiologist Vascular Surgery Mohammed VI University of Sciences and Health-UM6SS Casablanca Morocco Faculty of Science and Technology Hassan II University of Casablanca Casablanca Morocco Departement of Services Cardiology Mohammed VI University of Sciences and Health-UM6SS Casablanca Morocco Department of Anesthesia and Resuscitation Mohammed VI University of Sciences and Health-UM6SS Casablanca Morocco Obstetrics and Gynecology Services Mohammed VI University of Sciences and Health-UM6SS Casablanca Morocco

General anesthesia and Obstetric Anesthesia is the gold standard for a cesarean section but there are some cases where general anesthesia is unavoidable. The use of general anesthesia for cesarean delivery has decreased in recent years due to the widespread use of neuraxial techniques. The choice of anesthesia techniques for cesarean delivery depends on several factors, including the patient’s psychology and the attending physician’s experience. It is chosen because of its safety profile and its benefits to the mother and fetus. It may be indicated due to emergency, maternal refusal of regional techniques, or regional contraindications. Major complications include failed intubation, gastric content aspiration, and increased bleeding risk. This study aims to evaluate the impact of a newly launched team on obstetric anesthesia practice.

关键词： General Anesthesia cesarean delivery Intubation Maternal Refusal Obstetric Anesthetists

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Gastric Perforation after cesarean delivery: An Unintended Consequence of the Opioid Epidemic

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Open Journal of Obstetrics and Gynecology 2021年第5期11卷 563-568页

作者： Tesia A. McKenzie Eugene Zurkovsky Jonathan D. Baum Department of Obstetrics and Gynecology Departments Affiliated with Jersey Shore University Medical Center Hackensack Meridian Health System Neptune USA Department of General Surgery Departments Affiliated with Jersey Shore University Medical Center Hackensack Meridian Health System Neptune USA

30 year old female now para 1 presented to the Emergency Department with nausea, vomiting, and abdominal pain 6 days after an uncomplicated primary cesarean delivery. She did not respond to conservative management and underwent exploratory laparotomy for worsening pain, pneumoperitoneum and intraabdominal fluid collections. Gastric perforations required repair via gastrojejunostomy. Postoperative course was unremarkable. The anti-opioid campaign has altered the approach to postoperative pain management in both positive and negative ways. It has sparked new interest in alternative approaches to postoperative pain management, which include an increased role for non-steroidal anti-inflammatory drugs (NSAIDs). We present a case of a woman who had a significant complication due to the reliance of non-opioid pain medications after cesarean delivery.

关键词： Opioid Opioid Epidemic Gastric Perforation Gastrojejunostomy cesarean delivery

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Postpartum Hemorrhage Following cesarean delivery in Women with a Scarred Uterus:A Retrospective Cohort Study

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Reproductive and Developmental Medicine 2019年第4期3卷 230-234页

作者： Bing-Nan Chen Di Wang Jia-Po Li Li-Yang Zhang Chong Qiao Department of Obstetrics and Gynaecology Shengjing Hospital of China Medical UniversityShenyang 110004China Key Laboratory of Maternal-Fetal Medicine China Medical UniversityShenyang 110004China Research Center of China Medical University Birth Cohort Shenyang 110004China

Objective:To develop a model to predict the risk of postpartum hemorrhage(PPH)following cesarean delivery in women with a scarred ***:A total of 4,637 pregnant women with scarred uterus who underwent a cesarean delivery at a large hospital between January 2014 and December 2017 were *** women were divided into PPH(n=287)and non-PPH(n=4,350)groups.A model to predict PPH(blood loss≥1,000 mL within 24 h following cesarean delivery)was developed using multivariate logistic regression *** operating characteristic curve was drawn,and the area under curve(AUC)was ***:The incidence of PPH was 6.19%(287 of 4,637 women).Seven independent risk factors were associated with PPH:maternal age(odds ratio[OR]=1.42,95%confidence interval[CI]:1.02-1.97),previous gravidity(OR=1.24,95%CI:1.01-1.50),placental location(posterior wall of uterus,OR=0.69,95%CI:0.47-1.02;other locations,OR=1.21,95%CI:0.81-1.80),placenta previa(incomplete placenta previa,OR=10.51,95%CI:5.99-18.42;complete placenta previa,OR=31.65,95%CI:21.07-47.54),placenta accreta(OR=6.39,95%CI:4.02-10.16),hypertensive disorders of pregnancy(OR=2.27,95%CI:1.40-3.68),and fetal position(breech position,OR=2.07,95%CI:1.19-3.60;transverse position,OR=1.07,95%CI:0.48-2.41).A predictive model with AUC of 0.89 was developed(95%CI:0.86-0.91,Pcesarean delivery in women with a scarred uterus.

关键词： cesarean delivery Logistic Regression Postpartum Hemorrhage Prediction Risk Factors

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The Impact of Spontaneous Labor Before Elective Repeat cesarean delivery on Pregnancy Outcome:A Prospective Cohort Study

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Maternal-Fetal Medicine 2021年第4期3卷 255-262页

作者： Mohamad K.Ramadan Ibtissam Jarjour Manal Hubeish Saad Eddine Itani Sirin Mneimneh Dominique A.Badr Department of Obstetrics and Gynecology Makassed General HospitalBeirut 10310Lebanon Maternal-Fetal-Medicine-Unit Makassed General HospitalBeirut 10310Lebanon Department of Pediatrics Neonatal Intensive Care UnitMakassed General HospitalBeirut 10310Lebanon Department of Obstetrics and Gynecology Brugmann University HospitalUniversitéLibre de BruxellesBrussels 1020Belgium.

and neonatal ***:This was a prospective cohort *** consecutive ERCDs,occurring at≥37 weeks of gestation between July 1,2017 and December 31,2019 in Makassed General Hospital,were *** maternal and neonatal outcomes of 183 laboring women undergoing unscheduled repeat cesarean delivery(URCD)group were compared with those of 204 women undergoing cesarean delivery(CD)without spontaneous labor(ERCD)*** outcomes were“composite adverse maternal outcome”and“composite adverse neonatal outcome.”Fisher’s exact and Student’s t tests were used to assess the significance of differences in dichotomous and continuous variables,*** logistic regression models were constructed to identify risk factors with most significant influence on the rate of composite adverse maternal and neonatal ***:“Composite adverse maternal outcome”was significantly more common in women who underwent spontaneous labor((40/183)21.9%vs.(19/204)9.3%,P=0.001,relative risk(RR):2.7,95%confidence interval(CI):1.50–4.90).Similarly,“composite adverse neonatal outcome”was significantly increased in the URCD group((24/183)13.1%vs.(12/204)5.9%,P=0.014,RR:2.4,95%CI:1.18–4.98).These adverse effects persisted after adjustment for *** regression models revealed that,besides labor,CD-order impacted maternal outcome(RR:1.5,95%CI:1.02–2.30,P=0.036),while CD-order and teenage pregnancy influenced neonatal outcome(RR:2.1,95%CI:1.29–3.38,P=0.003,and RR:16.5,95%CI:2.09–129.80,P=0.008,respectively).Conclusion:In our study,spontaneous labor before ERCD,including deliveries at term,was associated with adverse maternal and neonatal outcomes,indicating that it is preferable to conduct ERCD before the onset of *** women with MRCD may identify those at increased risk for spontaneous labor for whom CD could be scheduled 1–2 weeks *** large prospective studies to assess the effects of such an approach on maternal and neonatal outco

关键词： cesarean section,repeat cesarean delivery Emergency cesarean Maternal outcome Neonatal outcome Spontaneous labor Unplanned cesarean

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