产后急性肾衰(附12例报告)

本文报告12例产后急性肾衰,介绍了血液透析和综合治疗的体会,即加强血透,增加肝素量,控制高血压,注意心、脑、肺功能的监护,注意预防,加强营养疗法。并对发病机制和临床分型进行了讨论。     

Determining the reliability of ultrasound measurements and the validity of the formulae for ultrasound estimation of postvoid residual bladder volume in postpartum women.

AIMS: To determine the reliability and validity of ultrasonic assessment of the postvoid residual bladder volume (PVRBV) in postpartum women. METHODS: Ultrasound estimated PVRBVs were performed on 99 consecutive women with postpartum urinary retention, to validate 12 published bladder volume-estimation formulae. This ultrasound-predicted volume was compared with the immediately collected catheterized volume. Comparison of individual formula with the catheterized volumes was performed by using the Intraclass Correlation Coefficient (concordance), and difference plots (bias, linearity of the difference). All volumes were transformed logarithmically to ensure a normal distribution. RESULTS: The postpartum bladder maintained its ellipsoid appearance. One-way analysis of variance showed the variance of the individual formulae ranged from 83.42 to 3463.66 (SD 9.13 to 58.85). The four formulae with the least variance had an intraclass correlation coefficient ranging from 0.93 to 0.96, and a mean difference between volume estimated by the formula and catheterized volume ranging from -0.05 to -0.11 (SD 0.09 to 0.11). The error between the value predicted by the formulae and that of the catheterized volume was linear in only one formula: Volume = (pi x W x Dl x H) / 6. CONCLUSIONS: The results of this study have shown that ultrasonic assessment of the PVRBV in the postpartum period is accurate, and it can be used as a guide to whether transurethral catheterization is necessary.     

围产期脑静脉窦血栓形成临床分析

目的 :探讨围产期脑静脉窦血栓形成的原因、临床特点及治疗。方法 :对围产期脑静脉窦血栓形成 7例进行回顾性分析。结果 :7例患者中 4例合并妊高征 ,2例继发于感染 ,1例与脱水有关。结论 :围产期脑静脉窦血栓形成主要与妊高征、感染等因素有关 ,临床表现多样 ,首选肝素抗凝治疗     

Conditional cash transfers to improve education and health: an ex ante evaluation of red de protección social, nicaragua

Using baseline data from a randomized experiment, this article extends and tests in the context of health, the feasibility of a recently proposed reduced form approach to ex ante evaluations of social programs with an application to a conditional cash transfer program in Nicaragua. It uses a behavioural model to estimate the impact on preventive care utilization outcomes for children younger than 3 years. It validates the model with the results of the experiment and then simulates two alternate policy scenarios. The model performs well in predicting the health related outcomes and shows different results for the two sets of policy scenarios. In addition, simulations are also carried out for the school component of the cash transfer program. Copyright © 2012 John Wiley & Sons, Ltd.     

Development of a prenatal psychosocial screening tool for post-partum depression and anxiety

McDonald S, Wall J, Forbes K, Kingston D, Kehler H, Vekved M, Tough S. Development of a prenatal psychosocial screening tool for post‐partum depression and anxiety. Paediatric and Perinatal Epidemiology 2012; ?? : ??–??. Background: Post‐partum depression (PPD) is the most common complication of pregnancy in developed countries, affecting 10–15% of new mothers. There has been a shift in thinking less in terms of PPD per se to a broader consideration of poor mental health, including anxiety after giving birth. Some risk factors for poor mental health in the post‐partum period can be identified prenatally; however prenatal screening tools developed to date have had poor sensitivity and specificity. The objective of this study was to develop a screening tool that identifies women at risk of distress, operationalized by elevated symptoms of depression and anxiety in the post‐partum period using information collected in the prenatal period. Methods: Using data from the All Our Babies Study, a prospective cohort study of pregnant women living in Calgary, Alberta (N = 1578), we developed an integer score‐based prediction rule for the prevalence of PPD, as defined as scoring 10 or higher on the Edinburgh Postnatal Depression Scale (EPDS) at 4‐months postpartum. Results: The best fit model included known risk factors for PPD: depression and stress in late pregnancy, history of abuse, and poor relationship quality with partner. Comparison of the screening tool with the EPDS in late pregnancy showed that our tool had significantly better performance for sensitivity. Further validation of our tool was seen in its utility for identifying elevated symptoms of postpartum anxiety. Conclusion: This research heeds the call for further development and validation work using psychosocial factors identified prenatally for identifying poor mental health in the post‐partum period.     

Artesunate/dihydroartemisinin pharmacokinetics in acute falciparum malaria in pregnancy: absorption, bioavailability, disposition and disease effects

AIM

To determine if reported lower plasma concentrations of artemisinin derivatives for malaria in pregnancy result from reduced oral bioavailability, expanded volume of distribution or increased clearance.

METHODS

In a sequentially assigned crossover treatment study, pregnant women with uncomplicated falciparum malaria received i.v. artesunate (i.v. ARS) (4 mg kg⁻¹) on the first day and oral ARS (4 mg kg⁻¹) on the second, or, oral on the first and i.v. on the second, in both groups followed by oral ARS (4 mg kg⁻¹ day⁻¹) for 5 days. Plasma concentrations of ARS and dihyroartemisinin (DHA) were measured by liquid chromatography-mass-spectrometry on days 0, 1, 2 and 6. Controls were the same women restudied when healthy (3 months post partum).

RESULTS

I.v. ARS administration resulted in similar ARS and DHA pharmacokinetics in pregnant women with malaria (n = 20) and in controls (n = 14). Oral administration resulted in higher total drug exposure in pregnancy [AUC (95% CI) in (ng ml⁻¹ h)/(mg kg⁻¹)] of 55.1 (30.1, 100.0) vs. 26.5 (12.2, 54.3) for ARS, P = 0.002 and 673 (386, 1130) vs. 523 (351, 724) for DHA, P = 0.007. The corresponding median absolute oral bioavailability (F%) was 21.7 (12.6, 75.1) vs. 9.9 (6.0, 36.81) for ARS (P = 0.046) and 77.0 (42.2, 129) vs. 72.7 (42.0, 87.7) for DHA, P = 0.033. Total DHA exposure was lower at day 6 in pregnant women with malaria (P < 0.001) compared with day 0 or 1, but not in the controls (P = 0.084).

CONCLUSIONS

This study demonstrates the effects of malaria on oral ARS drug disposition are greater than those of pregnancy. This probably results from a disease related reduction in first pass metabolism. The data are reassuring regarding current dosing recommendations.     

Could adverse perinatal outcome be predicted from intrapartum umbilical vessels Doppler in women with abnormal cardiotocography?

ObjectivesTo evaluate the value of umbilical artery and umbilical vein Doppler study in predicting adverse perinatal events in low risk women with abnormal cardiotocography during labor.DesignProspective cohort study.SettingEmergency unit of obstetrics & gynecology department, Royal Commission hospital, El Gubail Industrial City, Saudi Arabia.PopulationSixty-six women with uncomplicated pregnancy were classified according to cardiotocography (CTG) findings during the active phase of labor into, 33 cases with normal CTG (group 1) and 33 cases with pathological CTG (group 2). Colour Doppler study of the umbilical artery (UA) and umbilical vein (UV) were performed for both groups and the results were correlated to perinatal outcome.Main outcome measuresMeconium stained amniotic fluid, emergency Cesarean deliveries for suspected fetal distress. Apgar score at 1 and 5 min, UA and UV cord blood pH, and the need for neonatal intensive care unit (NICU) admission.ResultsIn the pathological CTG group two (6.1%) cases had high UA Doppler indices with no adverse perinatal outcome, while 13 (39.4%) cases showed UV pulsations of them 12 (92.3%) cases underwent emergency cesarean section for fetal distress, 5 (38.4%) cases delivered babies with UV pH < 7.2.Normal UA Doppler indices and no UV pulsations were seen in all cases with normal CTG group with no adverse perinatal outcome.ConclusionUV Doppler study in combination with CTG monitoring as a part of the intra partum fetal surveillance in low risk pregnancy might give additional useful information about fetal condition and suspected intrapartum fetal hypoxia.     

'It should be the most natural thing in the world': exploring first-time mothers' breastfeeding difficulties in the UK using audio-diaries and interviews

Breastfeeding is a practice which is promoted and scrutinized in the UK and internationally. In this paper, we use interpretative phenomenological analysis to explore the experiences of eight British first-time mothers who struggled with breastfeeding in the early post-partum period. Participants kept audio-diary accounts of their infant feeding experiences across a 7-day period immediately following the birth of their infant and took part in related semi-structured interviews a few days after completion of the diary. The overarching theme identified was of a tension between the participants' lived, embodied experience of struggling to breastfeed and the cultural construction of breastfeeding as 'natural' and trouble-free. Participants reported particular difficulties interpreting the pain they experienced during feeds and their emerging maternal identities were threatened, often fluctuating considerably from feed to feed. We discuss some of the implications for breastfeeding promotion and argue for greater awareness and understanding of breastfeeding difficulties so that breastfeeding women are less likely to interpret these as a personal shortcoming in a manner which disempowers them. We also advocate the need to address proximal and distal influences around the breastfeeding dyad and, in particular, to consider the broader cultural context in the UK where breastfeeding is routinely promoted yet often constructed as a shameful act if performed in the public arena.