Monitoring of maternal mortality levels in sub-Saharan Africa (SSA) to assess the achievements of safe motherhood programmes and for MDG-5 has been made difficult because of the lack of precise estimates of the maternal mortality ratio (MMR). Projections based on the slow rate of decline of the MMR indicate that MDG-5 may not be reached before the end of this century in this region. Measurements done using demographical and health surveys, statistical modelling and censuses are imprecise and do not allow trends in individual countries to be established. SSA countries should be encouraged to measure mortality levels from their own resources, using methods that produce precise estimates such as population-based surveys. Establishment of the trends will lead to country-specific program targets. The less frequent but more precise measurements can be afforded by SSA countries, as a case study from Zimbabwe shows. 相似文献
Background: Ambulatory epidural analgesia (AEA) is a popular choice for labor analgesia because ambulation reportedly increases maternal comfort, increases the intensity of uterine contractions, avoids inferior vena cava compression, facilitates fetal head descent, and relaxes the pelvic musculature, all of which can shorten labor. However, the preponderance of evidence suggests that ambulation during labor is not associated with these benefits. The purpose of this study is to determine whether ambulation with AEA decreases labor duration from the time of epidural insertion to complete cervical dilatation.
Methods: In this prospective, randomized study, 160 nulliparous women with AEA were randomly assigned to one of two groups: AEA with ambulation and AEA without ambulation. AEA blocks were initiated with 15-20 ml ropivacaine (0.07%) plus 100 [mu]g fentanyl, followed by a continuous infusion of 0.07% ropivacaine plus 2 [mu]g/ml fentanyl at 15-20 ml/h. Maternal measured variables included ambulation time, time from epidural insertion to complete dilatation, stage II duration, pain Visual Analogue Scale scores, and mode of delivery. APGAR scores were recorded at 1 and 5 min. Results are expressed as mean +/- SD or median and analyzed using the t test, chi-square, or the Mann-Whitney test at P <= 0.05.
Results: The ambulatory group walked 25.0 +/- 23.3 min, sat upright 40.3 +/- 29.7 min, or both. Time from epidural insertion to complete dilatation was 240.9 +/- 146.1 min in the ambulatory group and 211.9 +/- 133.9 min in the nonambulatory group (P = 0.206). 相似文献
PURPOSE: This study compares plasma lidocaine concentrations in 16-sets of twin neonates to 16-singleton neonates all of whom were delivered by Cesarean section under lumbar epidural anesthesia (LEA). METHODS: Lidocaine 1.5% with epinephrine 5 microg x mL(-1) was used for activation of LEA. Upon delivery plasma lidocaine concentrations were measured from the maternal vein (MV), neonatal umbilical vein (UV) and umbilical artery (UA) using TDx fluorescence polarization immunoassay. RESULTS: MV lidocaine concentrations were similar in both twin and singleton mothers. Both mean lidocaine UV and UA levels were 35% higher in twin A (first-delivered) compared to the singleton neonate, (P < 0.01, t test). Similarly, twin B mean UV and UA lidocaine levels were 35% and 53% higher than the singleton value (P < 0.01). Mean UV and UA lidocaine fetal/maternal ratios in both twins were at least 18% higher than the singleton value (P < 0.05). CONCLUSION: Even though there were no differences in neonatal outcome, a potential does exist for high plasma lidocaine concentrations in twin fetuses, suggesting that the total maternal dose of lidocaine must be regulated carefully. 相似文献
1. Interactions between autacoids may play important roles in the regulation of blood flow in the foetal placenta. In order to investigate this aspect of placental haemodynamics, human normal-term placentae were perfused in vitro and the responses of the foetal vessels to various combinations of vasoactive agents were determined. 2. Vasoconstriction responses to 5-hydroxytryptamine (5-HT) were potentiated in the presence of endothelin-1 (ET-1), the thromboxane A2-mimetic U46619 and a nitric oxide synthase inhibitor, N-nitro-l -arginine (NOLA), but not in the presence of angiotensin II. 3. N-Nitro-l -arginine caused vasoconstriction of the perfused placenta and indomethacin attenuated this effect and blocked the potentiation of the 5-HT response by NOLA. 4. Indomethacin did not affect ET-1-induced pressure increases and infusion of U46619 had no effect on release of ET-Iike immunoreactivity into the foetal placental circulation. 5. The present study provides evidence of interactions between several autacoids in human perfused placentae in vitro. These interactions may play important roles in foetal placental haemodynamics in normal or pathological situations. 相似文献