中医护理剖宫产术后再次妊娠阴道分娩产程临床观察

[目的]观察中医护理剖宫产术后再次妊娠阴道分娩产程。[方法]使用前瞻性设计方法,对80例住院患者评估、监护、产后护理(常规护理、耳穴压豆、乳房按摩、情志护理)护理剖宫产术后再次妊娠阴道分娩产程。连续护理14d为1疗程。观测临床症状、分娩状况、母婴情况、不良反应。护理1疗程,判定疗效。[结果]阴道成功分娩者73例,阴道助产5例;阴道试产不成功2例,改为行剖宫产。自然分娩产妇的出血量明显低于剖宫产产妇(P0.05)。[结论]中医护理剖宫产术后再次妊娠阴道分娩产程效果显著,值得推广。     

Uterine Arteriovenous Malformation:Inducedby A Cesarean Scar Pregnancy

Cesarean scar pregnancy (CSP) occurs when a gestation sac is implanted in the previous lower segment cesarean scar. The incidence of CSP is increasing worldwide. Uterine ateriovenous malformation (UAVM) is a rare gynecologic disease. Both of these diseases can cause severe vaginal bleeding and produce high morbidity rate. We describe a case of UAVM induced by a CSP. The patient suffered intermittent vaginal bleeding after two dilatation and curettage (D&C) one month before admission. The suspected diagnosis of CSP and UAVM were made after using transvaginal ultrasound with color Doppler and human chorionic gonadotropin (hCG) examination. Resection of the involved area including the cesarean scar and UAVM by laparotomy was performed successfully and the diagnosis was confirmed by the last pathologic result.     

Topical analgesic added to paraffin enhances paraffin bath treatment of individuals with hand osteoarthritis

Purpose.?To compare treating patients with symptomatic hand osteoarthritis (OA) with paraffin baths only (PO) (100% wax) or paraffin baths 80% wax with 20% topical analgesic (PTA).

Methods.?Subjects met criteria of the American College of Rheumatology for classifying symptomatic hand OA and had a Dreiser's index score >5 points. Current and average pain at rest and with movement was assessed with visual analogue scales. Hand function was assessed by the functional index for hand OA (FIHOA).

Results.?Both groups had a significant reduction in their ‘current’ pain 15?min after the first and twelfth treatments compared to pre-treatment but there was no difference between groups (t?=?0.10, p?>?0.05). The PTA group had greater improvement over the 12 treatment sessions for their pain at rest (t?=?2.92, p?<?0.05) and with movement (t?=?4.73, p?<?0.05) than the PO group. The PTA group also showed greater improvement in their FIHOA following 12 treatments than the PO group (t?=?3.52, p?<?0.05).

Conclusion.?Our results indicate that the addition of a topical analgesic to paraffin produced significantly greater pain relief at rest and during movement than paraffin baths alone after 12 treatments. Additionally, the PTA group experienced greater improved hand function.     

超声波技术替代冰冻切片技术在甲状腺术中快速制片的应用

目的试验超声波技术在甲状腺手术过程中替代冰冻切片技术快速制出病理切片,探寻适合甲状腺冰冻切片的替代制片技术。方法 2018年4月23日临床手术送检的活体组织,同一块组织按照1.0 cm×1.0 cm×0.1 cm取材六块,随机等分为三组。分别设置80 min,70 min,55 min每一个程序总的试验时间,观察最终切片与冰冻切片的质量对比。结果在取材标准的情况下,采用C组制片质量能够达到快速诊断要求,三组的切片质量均优于冰冻切片质量,差异有统计学意义(P0.05)。但是A、B两组相对组织处理的时间较长,三组切片质量均势的情况下,C组更能符合替代快速冰冻切片的要求。结论超声波快速处理仪可以帮助解决术中的甲状腺手术快速制片的要求。     

Tranexamic acid reduces blood loss during and after cesarean section: A double blinded,randomized, controlled trial

ObjectiveTo evaluate the efficacy of tranexamic acid in reduction of blood loss during and after cesarean section.MethodsWomen included in the current double blinded, randomized, controlled trial were recruited from women attending for elective cesarean section and randomized into two groups; study group: received tranexamic acid with induction of anesthesia plus 10 IU of oxytocin injection after delivery of the baby. Control group: received only oxytocin 10 IU injection after delivery of the baby.ResultsTwenty four hours post-operative hemoglobin level was significantly higher in study group (11.2 ± 1.5 mg/dL) compared to control (9.6 ± 1.2 mg/dL), also 24 hours post-operative hematocrit was significantly higher in study group (30.2 ± 6.6) compared to control (29.2 ± 2.8). Calculated total blood loss from placental delivery till end of cesarean section was significantly less in study group compared to control (369.5 ± 198.0 versus 606.8 ± 193.0 mL; respectively), also, calculated vaginal bleeding during first 6 hours post-operative was significantly less in study group compared to control (85.0 ± 30.7 mL versus130.8 ± 49.3 mL, respectively). The incidence of post-partum hemorrhage was significantly less in study group compared to control (31.1% versus 63.2%; respectively), also the need for iron replacement therapy was significantly less frequent in study group compared to control (0.9% versus 6.6%, respectively).ConclusionsTranexamic acid can be used safely to reduce blood loss during cesarean section. Reduced blood loss after tranexamic acid was associated with improvement of post-operative hemoglobin, hematocrit and with reduction of post-partum need for iron replacement.     

A Novel Approach to Detecting Postpartum Hemorrhage Using Contrast-Enhanced Ultrasound

The aim of this study was to estimate the efficacy of contrast-enhanced ultrasound (CEUS) in detecting postpartum hemorrhage (PPH) after cesarean section. This is the first study of CEUS in obstetric hemorrhage. A total of 37 patients, operated at Nagoya University Hospital, underwent CEUS. We evaluated the findings of CEUS, which were qualitatively defined as positive when pooling or leakage of contrast agent was observed in the uterine cavity, by measuring the amount of bleeding during the first 4 h after cesarean section. The time–intensity curve patterns of leaked contrast agents were also analyzed for quantitative prediction of the amount of blood loss. Significant differences between the excessive hemorrhage (N = 7) and non-excessive hemorrhage groups (N = 30) were noted in the occurrence of positive CEUS (p = 0.011). Additionally, mean postpartum blood loss markedly increased in patients with a positive CEUS (p = 0.002). From a quantitative perspective, the time until leakage of contrast agents was detected correlated with the amount of bleeding, but the other characteristics of the time–intensity curve pattern did not provide valuable information. In conclusion, CEUS, which enables bedside assessment and rapid diagnosis, is a promising strategy for the detection of PPH.     

Chlorhexidine vaginal wipes prior to elective cesarean section: does it reduce infectious morbidity? A randomized trial

Objective: To evaluate the efficacy of preoperative vaginal cleansing using chlorhexidine 0.25% antiseptic wipes on rates of postcesarean section (CS) infectious morbidities (endometritis, febrile morbidity and wound infection).

Methods: This prospective randomized trial was conducted among 218 pregnant women scheduled for term elective CS. Patients were equally divided into two groups by simple randomization. After spinal anesthesia and catheterization under aseptic technique, the study group had preoperative vaginal cleansing using chlorhexidine 0.25% antiseptic wipes for about 1?min, while the control group did not. All cases received the prophylactic antibiotics and the usual abdominal scrub. All participants received the routine postoperative care without other interventions. Adverse postcesarean infectious morbidities such as endometritis, febrile morbidity and wound infection were observed at the time of hospital discharge and weekly for 6 weeks postpartum.

Results: Both groups were matched regarding the baseline patients’ characteristics (age, gestational age, BMI, operative time and postoperative hospital stay). Overall, post-CS infectious morbidity were significantly reduced from 24.4% in the control group to 8.8% in the intervention group; p value?<0.05. Marked reduction was seen in the incidence of endometritis (13.2% in the control group versus 2.9% in the intervention group; p value?<0.05). However, fever and wound infection showed no significant difference between both groups.

Conclusion: Cleansing the birth canal with chlorhexidine 0.25% wipes prior to elective CS appears to be effective in reducing rates of post-CS infectious morbidity mainly endometritis.