ObjectiveTo review the advances in the diagnosis and treatment of obstetric brachial plexus palsy (OBPP). MethodsThe incidence, risk factors, classification, and imaging tests of OBPP and indication, technique, and results of surgery were reviewed and summarized. ResultsThe incidence of OBPP is not declining in recent years. Birth weight of ≥4 kg, forceps delivery, and prepregnancy body mass index of ≥21 are considered to be major risk factors, and caesarean section delivery seems to be a protective factor. Neurophysiological investigations can be applied to qualitative diagnosis of OBPP, but can not to quantitative one. Sensitivity and specificity of both CT and MRI myelography are about 0.7 and 0.97, respectively. Narakas classification is widely used:C5, 6 injury as type I, C5-7 injury as type Ⅱ, C5-T1 injury as type Ⅲ, C5-T1 injury with Horner's syndrome as type IV. It is generally considered that the brachial plexus exploration should be undertaken for infants without spontaneous recovery of elbow flexion by a maximum of 3 months old; and 10% to 30% of patients may need nerve reconstruction surgery. It is advocated that traumatic neuroma of the upper trunk should be resected with nerve reconstruction. The final evaluation for surgical results should be at minimal 4 years for upper roots and 8 years for total roots. Scales of Mallet, Gilbert, and Raimondi are mostly used for assessing shoulder function, elbow function, and hand function. ConclusionBrachial plexus exploration should be undertaken for infants without flexion of elbow at the age of 3 months. Traumatic neuroma (even neuroma-in-continuity) resection followed by microsurgical reconstruction of the brachial plexus is favored.
ObjectiveTo systematically review the clinical efficacy and safety of glucocorticoids, acetaminophen and antimicrobial drugs in the treatment of intrapartum fever in labor analgesia. MethodsThe PubMed, Embase, Cochrane Library, Web of Science, CBM, VIP, and CNKI databases were electronically searched to collect randomized controlled trials (RCTs) of glucocorticoids, acetaminophen, and antimicrobial drugs for intrapartum fever in labor analgesia from inception to June 30, 2023. Two reviewers independently screened the literature, extracted data, and evaluated the risk of bias of the included literature. Meta-analysis was then performed by using RevMan 5.4 software. ResultsA total of 10 RCTs involving 1 337 women were included. Meta-analysis showed that the use of glucocorticoids reduced the incidence of intrapartum fever in women with labor analgesia compared with the control group (OR=0.52, 95%CI 0.33 to 0.82, P<0.01). But there was no statistically significant difference between acetaminophen or antimicrobial drugs and the control group. ConclusionCurrent evidence shows that the use of glucocorticoids can reduce the incidence of intrapartum fever in labor analgesia, but the use of acetaminophen and antimicrobial drugs cannot reduce the incidence of intrapartum fever. Due to the limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.
Objectives To systematically review the efficacy and safety of carbetocinversusoxytocin on the prevention of postpartum hemorrhage (PPH) for women undergoing vaginal delivery. Methods PubMed, The Cochrane Library, Web of Science, CBM, WanFang Data, CNKI and VIP databases were electronically searched to collect randomized controlled trials (RCTs) on carbetocinversusoxytocin on the prevention of PPH for women undergoing vaginal delivery from inception to January 2018. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 and Stata 12.0 software. Results A total of 16 RCTs including 2 537 patients were included. The results of meta-analysis showed that: compared to oxytocin, carbetocin could reduce the amount of blood loss within 24h (MD=–107.68, 95%CI–130.21 to –85.15, P<0.000 01) and 2h (MD=–85.98, 95%CI–93.37 to –78.59,P<0.000 01), hemoglobin (Hb) within 24h after delivery (MD=–5.63, 95%CI–6.82 to –4.43,P<0.000 01), the occurrence of PPH (RR=0.46, 95%CI 0.32 to 0.66,P<0.000 01) and the requirement for additional uterotonic agents (RR=0.63, 95%CI 0.48 to 0.84,P=0.002). There was no significant difference in the risk of adverse effects between two groups. Conclusions Current evidence shows that carbetocin is superior to oxytocin in the prevention of PPH for women undergoing vaginal delivery, without increasing the adverse effects. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above the conclusion.
Objective To assess the effects on labour, maternal, and neonatal outcomes of different techniques and drugs for analgesia during labour. Methods We searched The Cochrane Library (Issue 4, 2006) , MEDLINE (Jan. 1978 to Oct. 2006) and CBMdisc (Jan. 1980 to Oct. 2006) to collect the current best evidence of labor analgesia. Results We included eight Cochrane systematic reviews and six other meta-analyses. The evidence showed that epidural analgesia was associated with a longer second stage of labour, more frequent oxytocin augmentation, higher incidence of instrumental vaginal delivery and maternal fever. But it was unlikely to increase the risk of caesarean section. Conclusion Epidural analgesia is superior to other approaches.
摘要：目的：探討晚期產后大出血的發生原因，提出防治措施。方法：對我院1992年1月至2000年1月收治的晚期產后大出血36例病例進行回顧性分析。結果：晚期產后出血的原因依次為胎盤殘留、子宮復舊不全、切口裂開。結論：重視第三產程的處理，特別是對產時出血米索前列醇的應用，可有效預防大出血的發生。采用宮縮素及抗感染、清宮術等對癥治療可獲得滿意的治療效果，對嚴重急性出血者可行子宮切除術。
Objective To investigate and analyze the cognition of intraspinal labor analgesia (ILA) of women in labor and its influencing factors. Methods A total of 322 women in labor in West China Second University Hospital of Sichuan University between May and September 2015 were investigated by questionnaire, which included the general situation, the pregnancy status, the understanding for labor pain, and the cognition of ILA. Investigator introduced the knowledge of ILA to them after the investigation, and then they were re-investigated for the choice of ILA. Results Only 22.67% of these women in labor knowed ILA clearly, 53.42% heared it but did not understand, and 49.38% liked to use it. The proportion of women in labor who liked to use it increased to 81.89% after introduction, and the difference was significant (P<0.001). Among all factors, the acknowledgement level of ILA and the choice to use it were mainly related to the family awareness concept for labor pain. Conclusions The cognition of ILA of women in labor is not enough, and their using desire is not strong. The family awareness concept is one of the important factors. The education and advertise to the women in labor and their family members after admiting to labor room can increase the choice rate of ILA significantly.
Objective To explore the effect of pain management by anesthesia nurses on labor analgesia. Methods A total of 100 parturient women in the Affiliated Hospital of North China University of Science and Technology between July and August 2015 were randomly divided into two groups: analgesia group and control group with 50 in each. Both two groups accepted labor analgesia routine maternity nursing. Analgesia group accepted maternal perinatal term pain management in addition to the routine nursing. Then we compared degree of pain during the production process, labor time and perineal injury between the two groups of women. Results The number of women with a labor pain degree of 0-Ⅲ in the analgesia group was respectively 36 (72%), 12 (24%), 2 (4%) and 0 (0%), and the number in the control group was respectively 23 (46%), 17 (34%), 8 (16%), and 2 (4%). The above difference between the two groups was statistically significant (Z=–2.908, P =0.004). The number of women with intact perineum, perineal injury of lateral and median cut, and Ⅰ-Ⅲ degree laceration in the analgesia group was respectively 31 (62%), 7 (14%), 8 (16%), 4 (8%) and 0 (0%); and the number in the control group was respectively 21 (42%), 12 (24%), 10 (20%), 7 (14%) and 0 (0%), also with significant difference between the two groups (Z =–2.028, P =0.043). The first and second labor stage of the analgesia group was (462.32±101.27) and (63.58±10.38) minutes, and was (568.27±113.28) and (76.92±11.24) minutes in the control group, with significant differences between the two groups (P<0.001). There was no statistically significant difference between the two groups in the third labor stage (5.78±3.02) and (5.97±2.96) minutes, (P=0.654). Conclusions The implementation of pain management by anesthesia nurses on labor analgesia can significantly reduce maternal labor pain, shorten the time of labor, and the condition of the perineal injury is mild and easily acceptable. It is worthy of clinical promotion.
Objective To explore the effect of different pre-labor position for premature rupture of membrane (PROM) after 37 weeks with vertex and engaged presentation on the maternal and neonatal outcomes. Methods A total of 120 women over 37 weeks PROM with single fetus in vertex presentation and engaged head were randomly allocated into two groups. The trial group (60 women) received no limit of movement after hospitalization and before labor while the control group (60 women) adapted lateral and supine position alternatively with hip-up. Labor process and neonatal outcomes were observed and recorded. SPSS 13.0 software was adopted to analyze the data. Results Compared with the control group, the trial group had higher rate of normal birth (70% vs. 46.7%, χ2=6.72, P=0.01), shorter first and second stage of labor (t=2.11, P=0.039; t=2.75, P=0.007), fewer incidence of dysuria during labor (χ2=8.11, P=0.0041), and less amount of amniotic fluid (107±55 mL vs. 248±42 mL, t=4.188, P=0.000 1). Conclusion For PROM over 37 weeks pregnancy with single vertex presentation and engaged head, no limit on the position before labor is safe and feasible, and it can improvie spontaneous delivery rate, shorten labor process, decrease amount of amniotic fluid, and eliminate the incidence of dysuria. It is worth to be popularized in the clinic.