Empowering the Nurse Practitioner With the Reproductive Justice Framework

On June 24, 2022, the Supreme Court of the United States ruled to strike down Roe v. Wade (1973), a landmark decision that legalized access to abortion under the right to privacy. By overturning Roe, the decision now leaves the regulation of abortion up to each individual state. Consideration of the consequences that will affect vulnerable populations is paramount now that Roe v. Wade is overturned. Nurse practitioners who are impartial toward abortion should be introduced to Reproductive Justice, which can help them better understand the lived experiences of people with the capacity for pregnancy and the complexities surrounding abortion.     

Louisiana's “Medically Futile” Unborn Child List: Ethical Lessons at the Post-Dobbs Intersection of Reproductive and Disability Justice

Ableist attitudes and structures are increasingly recognized across all sectors of health care delivery. After Dobbs, novel questions arose in the United States concerning how to protect reproductive autonomy while avoiding discrimination against and devaluation of disabled persons. In this essay, we examine the Louisiana Department of Health's emergency declaration, “List of Conditions That Shall Deem an Unborn Child ‘Medically Futile,’” issued August 1, 2022. We raise a number of medical, ethical, and public health concerns that lead us to argue that the declaration should be rescinded. Analysis of this ethically objectionable declaration provides valuable lessons about how to uphold both reproductive and disability justice in a post-Dobbs landscape.     

复发性流产患者病因构成分析

背景　复发性流产（RSA）发病率呈逐年上升趋势，严重影响妇女身心健康，目前现代医学对RSA的病因和发病机制尚未完全明确。目的　了解RSA病因的分布情况，以及流产孕周与流产次数和RSA病因之间的关系。方法　选取2018年在新疆医科大学第二附属医院确诊为RSA的患者198例，收集患者的一般资料包括年龄、自然流产次数、流产孕周，并筛查患者的病因：染色体异常、生殖道解剖结构异常、内分泌系统异常、生殖道感染、自身免疫异常等，并对这些资料进行回顾性分析。根据患者的流产孕周，分为早期RSA组（<12周）（155例）和晚期RSA组（≥12周）（43例）；根据流产次数分为2次组（123例）和≥3次组（75例）。分析RSA患者各病因所占比例，以及RSA病因在不同流产孕周组和不同流产次数组间的差异。结果　198例RSA患者，染色体异常9例（4.55%），生殖道解剖结构异常11例（5.56%），内分泌系统异常36例（18.18%），生殖道感染14例（7.07%），自身免疫异常30例（15.15%），不明病因98例（49.49%）。晚期RSA组患者生殖道解剖结构异常发生率大于早期RSA组，不明病因发生率低于早期RSA组（P<0.05）；早期RSA组与晚期RSA组患者染色体异常、内分泌系统异常、生殖道感染、自身免疫异常发生率比较，差异均无统计学意义（P>0.05）。流产次数2次组和流产次数≥3次组患者染色体异常、生殖道解剖结构异常、内分泌系统异常、生殖道感染、自身免疫异常、不明病因发生率比较，差异均无统计学意义（P>0.05）。结论　导致RSA的病因有多种，包括染色体异常、生殖道解剖结构异常、内分泌系统异常、生殖道感染、自身免疫异常及不明病因等多种因素，其中不明病因的RSA占多数；生殖道解剖结构异常对妊娠晚期的影响大于妊娠早期。     

微信平台在门诊人工流产妇女延续护理中的应用效果

目的 调查基于微信公众平台在门诊人工流产妇女延续护理中的应用效果。 方法 选取234例门诊人工流产妇女,根据患者的入院顺序奇偶数进行编号分为微信组和普通组,每组117例,普通组采用传统门诊宣教,微信组在此基础上应用微信公众平台进行网络健康教育、多层次的医患沟通、门诊预约就诊等延续护理,比较2组避孕措施的掌握情况、避孕措施的运用情况。 结果 干预1个月后微信组避孕措施掌握情况明显好于普通组(t=3.923,P<0.001);干预4个月后,微信组未使用避孕措施的患者少于普通组(χ²=4.294,P=0.038)。 结论 微信延续护理可提高对人工流产妇女的关爱,降低重复流产率。     

Improved functional outcome after early reduction in Bosworth fracture-dislocation

BackgroundBosworth described an unusual fracture-dislocation of the ankle with fixed posterior fracture-dislocation of the fibula. Previous epidemiological data on the prevalence and characteristics of patients with Bosworth ankle fractures have been limited. Bosworth fracture-dislocations are often missed in patients with ankle fractures. We investigated the outcomes of missed diagnosis and the prevalence of Bosworth fracture-dislocation in patients with ankle fractures.MethodsWe conducted a retrospective analysis of inpatients aged 15 years and older with an ankle fracture, who underwent surgery between 2007 and 2016 in 4 Korean hospitals. The patient demographics, risk factors, fracture characteristics, treatment data, outcomes, and complications were analyzed.ResultsWe reviewed 3405 hospital admissions for ankle fractures. During the study period, Bosworth fracture-dislocations were diagnosed in 51 cases. The prevalence of Bosworth fracture-dislocations (n = 51) was 1.62% among patients with ankle fractures who were enrolled in this study (n = 3140). Emergency surgery was performed within 24 h of injury in 36 cases (group A) and delayed surgery was performed in 15 cases (group B). The mean patient age at admission was 35.97 (standard deviation [SD], 1.643) years in group A and 34.33 (SD, 2.296) years in group B. Men were more commonly affected than women, with a 32:19 ratio. Most of the patients with Bosworth fracture-dislocations were young adults with high-energy trauma. The most frequent mechanism of trauma was falling down stairs (n = 27, 52.94%), followed by traffic accidents. Patient outcomes were significantly better in group A than in group B.ConclusionThe prevalence of Bosworth fracture-dislocations was higher than expected. If unrecognized, it can result in inappropriate treatment and permanent disability. With accurate diagnosis and prompt treatment, excellent results can usually be obtained.Level of clinical significance4.     

孕激素类药物对妊娠期糖尿病的影响

孕激素类药物在临床应用非常广泛，非妊娠期可用于避孕、治疗子宫内膜异位症、调理月经等妇科疾病，妊娠期使用主要用于黄体支持治疗、预防和治疗先兆流产以及预防和治疗早产。孕激素在我国应用于孕早期保胎非常普遍且呈滥用趋势，近年有研究发现孕激素在孕期的使用可能导致妊娠期糖尿病的发生。本文从孕激素的分类、孕激素在妊娠期的使用与妊娠期糖尿病的相关性及孕激素导致妊娠期糖尿病发生的可能机制等方面对孕激素在妊娠期的使用对妊娠期糖尿病的影响做一综述，为临床在妊娠期合理使用孕激素类药物提供参考。     

浅谈“百病皆在调气血”在哈氏妇科的应用

气血理论是中医重要理论，妇科疾病应首调其气血，哈氏妇科是全国中医妇科十大流派之一，诊治疾病独具特色，哈孝廉教授宗古人"百病皆在调气血"思想，治疗崩漏、产后身痛、滑胎等妇科常见疾病，疗效显著，值得深入学习与探讨。     

Rethinking “Elective” Procedures for Women's Reproduction during Covid-19

Common hospital and surgical center responses to the Covid-19 pandemic included curtailing “elective” procedures, which are typically determined based on implications for physical health and survival. However, in the focus solely on physical health and survival, procedures whose main benefits advance components of well-being beyond health, including self-determination, personal security, economic stability, equal respect, and creation of meaningful social relationships, have been disproportionately deprioritized. We describe how female reproduction-related procedures, including abortion, surgical sterilization, reversible contraception devices and in vitro fertilization, have been broadly categorized as “elective,” a designation that fails to capture the value of these procedures or their impact on women's overall well-being. We argue that corresponding restrictions and delays of these procedures are problematically reflective of underlying structural views that marginalize women's rights and interests and therefore threaten to propagate gender injustice during the pandemic and beyond. Finally, we propose a framework for triaging reproduction-related procedures during Covid-19 that is more individualized, accounts for their significance for comprehensive well-being, and can be used to inform resumption of operations as well as subsequent restriction phases.