A comparison of maternal fear of childbirth,labor pain intensity and intrapartum analgesic consumption between primiparas and multiparas: A cross-sectional study

ObjectivesTo describe and compare fear of childbirth and in-labor pain intensity between primiparas and multiparas and explore the association between the amount of actual pain relief and fear of childbirth.MethodsA convenience sampling method was used. A total of 260 women undergoing spontaneous or induced labor, including 97 primiparas and 163 multiparas, were recruited in a large academic specialized hospital in Guangzhou, China, from February 2018 to August 2019. The clinical data of maternal and neonatal were extracted from a structured electronic medical record system. Other demographic information, such as employment and family monthly income, was collected by a questionnaire. The Numeric Rating Scale (NRS) and the Chinese version of the Childbirth Attitude Questionnaire (C-CAQ) were applied to assess maternal in-labor pain intensity and fear of childbirth. The analgesic consumption and the frequency of manual boluses as rescue analgesia were stored and collected from the analgesia pump.ResultsEighty-two (84.5%) primiparas and ninety-nine (60.7%) multiparas received epidural analgesia (P < 0.001). In the epidural subgroup, the primiparous average fear of childbirth (36.46 ± 10.93) was higher than that of the multiparas (32.06 ± 10.23) (P = 0.007). However, multiparas reported more intense in-labor pain [8.0 (8.0, 9.0) vs. 8.0 (7.0, 8.0)], had more successful manual boluses per hour [2.68 (1.65, 3.85) vs. 1.77 (0.90, 2.47)], more hourly analgesic consumption [23.00 (16.00, 28.25) vs. 17.24 (11.52, 21.36) mL] and more average analgesic consumption [0.35 (0.24, 0.45) vs. 0.26 (0.19, 0.35) mL/(h·kg)] than the primiparas (P < 0.05). Spearman’s correlation analysis showed that the maximum in-labor pain was weakly positively correlated with fear of childbirth (r = 0.09) (P < 0.05), hourly analgesic consumption (r = 0.16) (P < 0.01) and average analgesic consumption (r = 0.17) (P < 0.05). No statistically significant association was uncovered between analgesic consumption and maternal fear of childbirth.ConclusionsFear of childbirth is a potential predictor of labor pain intensity. Further study is needed to explore its role and value in pain management during delivery. Parity is not a determinant of pain relief use and should not be a preconceived preference of obstetric care team members to determine the distribution of epidural analgesia, especially when analgesia resources are insufficient.     

The Impact of Sexual Satisfaction,Functioning, and Perceived Contraceptive Effects on Sex Life on IUD and Implant Continuation at 1 Year

Introduction

Contraceptives improve women's lives and public health, but many women discontinue their contraceptive method owing to dissatisfaction. An underexamined aspect of contraceptive discontinuation is sexual acceptability, or how contraception affects sexual experiences. Investigators' aims were two-fold: 1) to document changes in multiple domains of women's sexual experiences with their intrauterine device (IUD) or contraceptive implant over time and 2) to examine whether these sexuality factors were associated with method continuation at 12 months.

产妇孕期护理保健状况及其对母婴健康的影响

目的：分析孕期护理保健对产妇及新生儿健康状况的影响,提高产妇围产期保健水平。方法：回顾性分析我院产科产妇孕期护理保健情况及母婴健康状况资料,并整理后对影响母婴健康的因素进行统计学分析。结果：观察组与对照组在文化程度方面差异无统计学意义（P〉0．05）,观察组妊娠并发症发生率为28．26％,对照组为62．65％,差异有统计学意义（P〈0．05）;观察组与对照组在新生儿性别方面差异无统计学意义（P〉0．05）,两组产妇在Apgar评分方面差异有统计学意义（P〈0．05）。结论：孕期保健护理干预可促进产妇母婴健康,降低妊娠并发症的发生,促进新生儿健康,对母婴健康具有积极影响。     

医学人文精神对创建优质护理服务的启示与实践

目的创建优质护理服务,改善医患、护患关系。方法通过创建优质护理服务的具体措施,向患者提供人文关怀服务。结果护理质量和患者满意度比上一年均有显著提高。结论创建优质护理服务,既教育和激励了护理人员文明行护、敬业爱岗、换位思考、精益求精的服务理念,又满足了患者正当的需求,减少了医疗纠纷和医患、护患矛盾,充分显示了医学人文精神的重要性。     

体现实践成果，引领未来方向:国际妇产科联盟2018年宫颈癌分期解读

一直以来,国际妇产科联盟(International Federation of Gynecology and Obstetrics,FIGO)的宫颈癌分期都是临床分期。但随着诊断技术的发展、手术方式的进步以及对宫颈癌预后的了解加深,过去的FIGO分期已不能很好地推测宫颈癌预后及指导临床治疗选择。因此,FIGO在2009年宫颈癌分期的基础上,引入了近10年来宫颈癌诊治的新进展,形成了2018年宫颈癌分期。新的分期主要体现在肿瘤大小的分层更加细化,且纳入了淋巴结转移情况。本文对FIGO的2018年宫颈癌分期变化及其临床意义进行解读。     

Effect of instrument preference for operative deliveries on obstetrical and neonatal outcomes

Objectives

To examine the relationship between physicians’ instrument preference and obstetrical and neonatal outcomes.

Study design

A retrospective cohort study comparing obstetrical and neonatal outcomes of second stage deliveries between obstetricians who prefer forceps (forceps ≥90%) with obstetricians with no preference to forceps (either instrument <90%) was completed using the McGill Obstetrical and Neonatal Database. Logistic regression analysis was used to obtain an adjusted odds ratio controlling for maternal, intrapartum and neonatal confounders.

Results

Two thousand and three hundred thirteen infants were delivered by 5 obstetricians who preferred forceps, and 9261 infants were delivered by 15 obstetricians with no instrument preference. Baseline characteristics were similar between the two groups. As compared to obstetricians who preferred forceps, obstetricians with no instrument preference had a higher rate of operative vaginal deliveries 1.5 (1.1–2.0), a higher cesarean section rate 2.5 (1.3–4.9) and a higher episiotomy rate in non-operative vaginal deliveries 3.4 (2.7–4.3). Infants delivered by obstetricians with no instrument preference were less likely to have significant bruising 0.3 (0.2–0.6) but more likely to have a cephalohematoma 3.0 (1.1–8.3).

Conclusion

Physician instrument preference is an important determinant of outcomes that should be considered in studies evaluating instrumental deliveries.     

Efficacy of n-3 fatty acids supplementation on the prevention of pregnancy induced-hypertension or preeclampsia: A systematic review and meta-analysis

The efficacy of n-3 fatty acids supplementation on the prevention of pregnancy-induced hypertension or preeclampsia remains unclear. The aim of study was to examine the effect of supplementation with EPA, and/or DHA, and/or ALA during pregnancy on the pregnancy-induced hypertension or preeclampsia. A systematic search was performed on Scopus, PubMed, Web of Science (WoS), Cochrane Library, and Google scholar, which covered the period between 1991 and 2018. The clinical trials with any control groups (i.e. placebo or other supplementation) were selected. The whole process of meta-analysis and data analysis was done using Comprehensive Meta-Analysis (Version 2.0, Biostat). The searched keywords were: “Fatty Acids, Omega-3”, “n-3 Polyunsaturated Fatty Acid” “Eicosapentaenoic Acid”, “Docosahexaenoic Acids”, “n-3 Polyunsaturated Fatty Acid”, “n-3 PUFAs”, “alpha-Linolenic Acid”, “fish oil”, “Nuts”, “nutrient”, or their synonyms “pregnancy induced hypertension” and preeclampsia. In addition, some key journals, according to Scopus report and the references of the original and review articles, were manually searched for possible related studies. The meta-analysis of the 14 comparisons demonstrated that n-3 fatty acids supplementation played a protective role against the risk of preeclampsia (RR, 0.82; 95% CI, 0.70–0.97; p = 0.024; I2 = 19.0%). The analysis of the 10 comparisons revealed that n-3 fatty acid supplements for pregnant women did not mitigate the risk of pregnancy-induced hypertension (RR, 0.98; 95% CI, 0.90–1.07; p = 0.652; I2 = 0%). The n-3 fatty acid supplements are an effective strategy to prevent the incidence of preeclampsia in women with low-risk pregnancies.