ObjectiveTo discuss clinical characteristics and nursing countermeasure of pregnant/delivery women with tuberculosis. MethodsFrom January 2012 to December 2013, 52 cases of pregnant women complicated with tuberculosis were included. We offered specific nursing according to the psychological counseling, reasonable administration, diet nursing, fever and prevention of hospital infection on the base of their clinical features, and then analyzed the effect. ResultsIn 52 patients who had undergone the tuberculosis and obsterrics and gynecology treatment, 4 puerperal patients died of severe pneumonia and multiple organ failure; in 48 gestational patients with tuberculosis, 23 early-middle term patients accept termination of pregnancy, and in 25 middle-late term patients, 3 had full-term natural labor, 4 underwent full-term cesarean section, 5 had premature labor, and 13 continued the pregnacy. Sixteen neonatus (including 4 given at the other hospitals) had normal results of physical examination without any deformity, in whom 5 had low body weight (body weight less than 2500 g), with negative results of tuberculin test and the result of 3-moth follow-up was normal. Three months after the anti-tuberculosis treatment, the lesion was obviously absorbed in 25 patients and in 23 patients within half of a year. No patients had hospital infection. ConclusionNursing care of pregnant patients with tuberculosis should strengthen the guidance on the patients health education, improve their compliance and self-protection knowledge. Also should strengthen the basic level medical personnel training and improve the ability of early diagnosis of tuberculosis and early treatment to reduce maternal mortality.
【摘要】 目的 从法医病理学角度分析引起医疗纠纷的孕产妇死亡原因、医疗纠纷发生原因并提出相关防范措施。 方法 对1999年1月-2008年12月间46例引起医疗纠纷的孕产妇死亡案例进行回顾性分析。 结果 孕产妇死亡年龄以30岁以上多见，死亡时妊娠时间以围产期居多（87.0%）。死亡原因中产科失血性休克死亡21例（45.7%），栓塞类疾病死亡8例（17.4%），感染性疾病死亡5例（10.8%），其他原因死亡12例（26.1%）。46例中属非医疗过失性医疗纠纷8例（17.4%），医疗过失性纠纷38例（82.6%），医疗过失的原因主要为抢救不及时、处理不当、误诊误治等。涉及纠纷的医院以县区级医院居多（54.3%）。 结论 通过法医病理学司法鉴定查明死亡原因，明确医疗责任及医疗纠纷原因，已成为解决孕产妇死亡医疗纠纷的重要手段。【Abstract】 Objective To analyze the causes of maternal death with medical disputes, the causes of medical disputes, and to recommend the related preventions through a forensic pathological angle. Methods We retrospectively analyzed 46 cases of maternal death with medical disputes which were collected by West China Center of Forensic Medicine Service in Sichuan between January 1999 and December 2008. Results Most maternal deaths occurred over 30 years old. They most frequently happened during the peri-natal period (87.0%). The causes of death included obstetric hemorrhagic shock in 21 cases (45.7%), embolism-like diseases in 8 cases (17.4%), infectious diseases in 5 cases (10.8%) and other reasons in 12 cases (26.1%). Among all the 46 cases of medical disputes, 8 (17.4%) were not due to medical malpractices, while the other 38 cases (82.6%) had something to do with such medical malpractices as delayed or inappropriate treatment, misdiagnosis and so on. Most of the malpractices in these cases involved medical institutions at a county level (54.3%). Conclusion Forensic judicatory appraisal is important to resolve medical disputes of maternal death by finding out the cause of death, clarifying the medical responsibility and clearing the cause of medical disputes.
ObjectiveTo analyze the clinical data of pregnant females and children infected with H1N1 during the global pandemic in 2009, and summarize the epidemiological characteristics.MethodsPubMed, EMbase, The Cochrane Library, CNKI, VIP and WanFang Data databases were searched to collect studies on H1N1 infection in pregnant females and children during the 2009 pandemic from January 1st, 2009 to February 17th, 2020. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies, then, epidemiological characteristics were descriptively analyzed.ResultsA total of 33 studies involving 939 children, 5 newborns and 2 416 maternal infections were included. The results showed that the age span of children was 0 to 18, the male-to-female ratio was 1.2:1, and the history of close contact accounts was 18.8% (80/425). The primary symptoms were fever, cough, headache, vomiting and other symptoms in some children. More than half of the children received oseltamivir antiviral treatment (545/807, 67.5%), and 6 died (6/861, 0.7%). The primary symptoms of pregnant females were fever, cough, sore throat, muscle pain, fatigue, headache, diarrhea, and so on. The majority of patients received antiviral therapy (1 571 to 1 783, 88.1%). A total of 178 mortalities (178/2 335, 7.6%), 48 stillbirths (48/966, 5.0%), and 9 live birth mortalities (9/494, 1.8%) were reported. All 5 newborns were positive for RT-PCR detection, including 4 premature infants. The mode of transmission was close contact in 3 cases (including 1 case in contact with sick medical staff), 1 case of vertical transmission from mother to child, and 1 case of unknown. The primary clinical manifestation of newborns was dyspnea. After treatment with oseltamivir, 4 cases were cured and 1 case deceased.ConclusionsPregnant females and children are at high risk of serious complications of H1N1 influenza. H1N1 infection in pregnancy is associated with an increased risk of adverse pregnancy outcomes. The symptoms of H1N1 infection in children and pregnant females are similar to those in adults, primarily respiratory and systemic symptoms. Oseltamivir and zanamivir are effective antiviral drugs.
目的 探讨高龄初产妇临产前的心理状态，了解其负性心理原因，及时给予护理干预，使其顺利渡过围生期。 方法 2010年6月－2011年9月，将在待产且年龄≥35岁的60例初产妇归为高龄组，随机选取同期住院的适龄初产妇60例作为对照组，应用焦虑自评量表（SAS）、抑郁自评量表（SDS）及症状自评量表（SCL-90），对高龄初产妇进行产前心理评估及检测血中肾上腺素（E）和去甲肾上腺素（NE）水平。 结果 高龄初产妇产前的SAS和SDS评分及E和NE水平，SCL-90量表中总分及躯体化、强迫、焦虑、抑郁因子分与适龄组比较，差异有统计学意义（P＜0.01）；SAS评分与E、NE水平，SDS评分与E、NE水平均呈正相关，相关系数分别为：0.378、0.402、0.384、0.369（P＜0.01）。 结论 高龄初产妇分娩前多数存在不同程度的负性心理，应根据其不同情况给予相应的心理干预以促进产妇顺利渡过围生期。
ObjectivesTo systematically review the clinical characteristics of pregnant females, newborns, children and adolescents with SARS infection.MethodsThe clinical characteristics of patients with SARS infection were searched using PubMed, EMbase, Web of Science, The Cochrane Library, CNKI, WanFang Data and VIP databases. Descriptive analysis was performed to analyze the clinical characteristics of the patients, clinical manifestations, treatment and prognosis.ResultsA total of 13 studies including 19 pregnant females, 14 newborns, and 81 children and adolescents were identified. The ratio of male to female was 1 to 1.2 in children and adolescents patients aged 56 days to 17.5 years. Children under 12 years old accounted for 58.3% (28/48). Of the child patients, 34.0% (16/47) had close contact with patients with SARS. Fever (93.8%, 76/81) and cough (49.4%, 40/81) were the most common symptoms in children and adolescents with SARS infection, and 17.5% (11/63) occurred with shortness of breath or dyspnea. The positive ratio of nucleic acid detection for SARS-CoV was 9.2% (14/48), and the positive ratio of serum antibody was 92.9% (13/14). Peripheral blood lymphocyte reduction was approximately 65.7% (44/67). Approximately 70.8% (51/72) unilateral and 29.2% (21/72) bilateral lesions were found by thoracic X-ray or CT scan. No child fatalities were reported. As of maternal patients, aged 23 to 44 years, 10 cases (52.6%) were infected during early and middle pregnancy, and 9 cases (47.4%) during late pregnancy. Fever (100.0%, 19/19) and cough (78.9%, 15/19) were the main clinical symptoms, and shortness of breath/dyspnea occurred in 36.8% (7/19) of infected pregnant females. The positive ratio of nucleic acid detection for SARS-CoV was 50.0% (8/16), whereas the positive ratio of serum antibody was 93.3% (14/15). The ratios of thrombocytopenia, lymphopenia, and liver enzymes abnormalities were 38.9% (7/18), 61.1% (11/18) and 50.0% (3/6). All patients were identified for lesions by thoracic X-ray or CT scan examination. Seven cases were severe (36.8%). Five patients were treated with mechanical ventilation (26.3%). Three patients died (15.8%). Four patients were spontaneous abortion (40.0%, 4/10). Nine patients were cesarean sectioned (75.0%, 9/12). Six fetuses (46.2%, 6/13) with fetal distress, 7 cases (53.8%, 7/13) with premature delivery were identified. Three fetuses (23.1%) had intrauterine growth retardation. None of the fourteen newborns was diagnosed as SARS infection.ConclusionsThe clinical symptoms such as fever and cough in children and adolescents with SARS infection are similar to that of adult patients. However, children and adolescents are usually manifested as mild infection without reported death. There is no evidence to support that SARS-CoV could transmit vertically from infected mother to their fetuses.
Objective To study the clinical significance of the microorganism culture result of amniotic fluid in cesarean section in the treatment of anti-infection after operation. Methods From August 2016 to May 2017 in Women’s and Children’s Hospital of Sichuan Province, 502 amniotic fluid samples were collected in cesarean section to carry out bacteria culture. The correlations between the amniotic fluid culture result and the preoperative and intraoperative risk factors and the correlations between postoperative infection and the preoperative and intraoperative risk factors were analyzed. Results In the 502 amniotic fluid samples, there were 131 samples culture-positive. The microbiological culture results of amniotic fluid were statistically different between the puerperae with gestational age<37 weeks and the ones with gestational age≥37 weeks (P=0.001). Postoperative infection occurred in 6 puerperae, in whom the amniotic fluid culture results were positive in 3 puerperae. There was no statistical difference in the occurrence of postoperative infection between the puerperae with amniotic fluid culture-positive results and the ones with negative results (P=0.382). The occurrence of postoperative infection was associated with preoperative infections, gestational age, using time of antimicrobial, and preoperative rupture of membranes (P<0.05). Conclusions The contamination rate of amniotic fluid specimen was high, which was of low reference value to anti-infection treatment after operation. When an extension of anti-infection treatment be carried out after cesarean section, suitable specimens should be selected according to the infection site.
ObjectiveTo systematically evaluate the detection rate of postpartum depression in Chinese maternal population and to provide a scientific basis for the prevention and treatment of postpartum depression.MethodsWe searched CNKI, WanFang Data, VIP, PubMed, EMbase and The Cochrane Library databases to collect studies on the detection rate of postpartum depression in Chinese maternal population from January, 2001 to August, 2019. Two reviewers independently screened literature, extracted data and evaluated the risk of bias of included studies. Meta-analysis was performed using Stata15.0 software.ResultsA total of 24 studies involving 38 357 cases were included. Meta-analysis results showed that the total detection of postpartum depression in Chinese females was 15% (95% CI 12% to 17%). Subgroup analysis showed that the detection of postpartum depression was 12.3% (95% CI 9.3% to 15.2%) in the south and 17.3% (95%CI 12.1% to 22.5%) in the north. According to the Edinburgh postpartum depression scale, the rate was 14.5% (95%CI 11.4% to 17.5%); and for other scales, the rate was 15.0% (95% CI 8.9% to 21.2%); simple random sampling method was 14.8% (95%CI 11.0% to 18.7%), and cluster sampling was 16.3% (95%CI 12.0% to 20.5%). The rate was 15.8% (95%CI 9.3% to 22.3%) from 2001 to 2010, 13.5% (95%CI 7.7% to 19.2%) from 2011 to 2014, and 14.8% (95%CI 10.9% to 18.6%) from 2015 to 2019. Sensitivity analysis showed that the combined results were stable.ConclusionsThe detection rate of postpartum depression in Chinese maternal population is high, and early screening and related intervention should be paid more attention to these population.
Objective To explore maternal health services utilization in rural areas in Rongchang County, and to analyze the influencing factors. Methods Seven hundred pregnant women were enrolled by stratified cluster sampling. The data was analyzed in SAS 8.2. Results Ninety-five percent of pregnant women had an antenatal examination, 69.3% had it for 5 times or more, and 75.4% received checking in the earlier stage of pregnancy; 98.3% were delivered in hospital, 26.3% had postpartum visit 3 times or more, and 16.7% had been systematically managed. The main influencing factors of systematic management rate were family yearly income before pregnancy whether or not the patient participated in the new rural cooperative medical scheme, and the number of pregnancies. Conclusion The maternal systematic management rate in the county has yet to be improved. Health education to improve prenatal care and postnatal visit status should be strengthened, and women should be guided to participate in the new rural cooperative medical scheme.