Abstract Background Labor represents a period of significant physical activity. Inefficient energy supply may delay labor process and even lead to cesarean delivery. Herein we investigated whether ingestion of a carbohydrate-rich beverage could reduce cesarean delivery in laboring women with epidural analgesia. Methods This multicenter randomized trial was conducted in obstetrician-led maternity units of nine tertiary hospitals in China. Primigravidae with single term cephalic pregnancy who were preparing for vaginal birth under epidural analgesia were randomized to intake a carbohydrate-rich beverage or commercially available low-carbohydrate beverages during labor. The primary outcome was the rate of cesarean delivery. Secondary outcomes included maternal feeling of hunger, assessed with an 11-point scale where 0 indicated no hunger and 10 the most severe hunger, and maternal and neonatal blood glucose after childbirth. Results Between 17 January 2018 and 20 July 2018, 2008 women were enrolled and randomized, 1953 were included in the intention-to-treat analysis. The rate of cesarean delivery did not differ between the two groups (11.3% [111/982] with carbohydrate-rich beverage vs. 10.9% [106/971] with low-carbohydrate beverages; relative risk 1.04, 95% CI 0.81 to 1.33; p = 0.79). Women in the carbohydrate-rich beverage group had lower subjective hunger score (median 3 [interquartile range 2 to 5] vs. 4 [2 to 6]; median difference − 1; 95% CI − 1 to 0; p < 0.01); their neonates had less hypoglycemia (1.0% [10/968] vs. 2.3% [22/956]; relative risk 0.45; 95% CI 0.21 to 0.94; p = 0.03) when compared with those in the low-carbohydrate beverage group. They also had higher rates of maternal hyperglycemia (6.9% [67/965] vs. 1.9% [18/953]; p < 0.01) and neonatal hyperglycemia (9.2% [89/968] vs. 5.8% [55/956]; p < 0.01), but none required special treatment. Conclusions For laboring primigravidae with epidural analgesia, ingestion of a carbohydrate-rich beverage compared with low-carbohydrate beverages did not reduce cesarean delivery, but relieved maternal hunger and reduced neonatal hypoglycemia at the expense of increased hyperglycemia of both mothers and neonates. Optimal rate of carbohydrate supplementation remains to be determined. Trial registration www.chictr.org.cn ; identifier: ChiCTR-IOR-17011994 ; registered on 14 July 2017.

目的 构建产妇分娩过程中第二产程自由体位分娩决策辅助工具,并探讨其在临床中的应用效果.方法 基于渥太华决策支持框架,通过文献分析并结合前期研究结果形成决策辅助工具初稿;经2轮专家函询和邀请30名产妇进行半结构式访谈修订形成工具终版.2021年7月—10月,采用便利抽样法,选取北京市某三级甲等综合医院进行分娩的69名产妇为研究对象,采用随机数字表法随机分为试验组和对照组.试验组在常规护理宣教的基础上使用第二产程自由体位分娩决策辅助工具;对照组采用常规护理.比较两组干预前后自由体位知识问卷、决策困境量表、决策准备量表修订版和患者参与治疗决策问卷得分.结果 第二产程自由体位分娩决策辅助工具包含7项一级指标和31项二级指标.干预后,试验组自由体位知识问卷得分为[4.50(3.75,5.50)]分,高于对照组的[1.50(0.75,5.50)]分;决策准备量表修订版得分为(79.27±15.34)分,高于对照组的(46.07±20.68)分;决策困境量表得分为(20.26±11.34)分,低于对照组的(42.50±20.66)分,差异均具有统计学意义(P<0.05);试验组参与分娩体位决策的意愿与程度增加更明显.结论 第二产程自由体位分娩决策辅助工具科学性和实用性良好,可帮助产妇了解不同分娩体位的利弊、减少决策冲突,有助于实现医患共享决策,提升产妇分娩体验.

总结1例静脉畸形骨肥大综合征(Klippel-Trenaunay syndrome,KTS)病人分娩期的护理措施.护理要点:加强患肢护理,观察血液循环情况;做好阴道分娩准备及制定应急预案,尤其是产时出血的预防和评估;加强子宫收缩减少产后出血;加强健康教育并给予周到的心理护理;针对母婴分离情况做好母乳喂养指导.产妇于39+4周经剖宫产分娩1例足月男婴,体重2150 g,并顺利度过分娩期,情况稳定于术后6d顺利出院.

Objective:To retrieve and analyze the relevant guidelines for the second and third stages of normal delivery, and summarize the evidence of high-quality guidelines so as to provide references for the formulation of clinical practice programs.Methods:We took Johns Hopkins evidence-based nursing practice model as theoretical guidance and set up an evidence-based team.We systematically searched major guideline publication websites, electronic resource databases, related academic groups and guideline networks at home and abroad, evaluated guidelines and summarized the best evidence, and the search time limit was up to June 1, 2019. The literature quality evaluation and evidence extraction were carried out independently by four researchers with evidence-based training.Results:This study included two guidelines, summarizing the 20 best evidences in 9 aspects of humanistic support, delivery companion, delivery position, fetal monitoring, delayed exertion, perineal protection, fundus compression, prevention of postpartum hemorrhage, and delayed umbilical cord clamping.Conclusions:Based on the existing evidence, it integrates the best evidence of nursing measures for the second and third stages of normal delivery. It is recommended that maternal and child institutions promote the transformation of the best evidence based on their actual conditions.

目的 探讨基于国际护理临床模拟教学协会最佳实践标准的产后出血模拟教学设计方法及实践效果.方法 遵循国际护理临床模拟教学协会最佳实践标准,设计产后出血模拟教学方案,对某大学2016级护理学专业58名本科生(三年级)展开教学,共1.5学时.课程结束后采用模拟教学运行过程质量评价表评价实施效果,并对6名学生进行一对一访谈,了解学生对于模拟教学过程和效果的整体评价与建议.结果 产后出血模拟教学方案符合最佳实践标准要求,学生对于模拟教学过程质量评价得分均数>4分.学生认为该教学目标设置合理,时间安排合适,但同时也提出希望调整课程人数安排,提供更好的学习环境和参与机会.结论 基于最佳实践标准进行的产后出血模拟教学设计达到了预期目标,具有一定的科学性和可行性,具有推广价值.

目的 探讨基于最佳证据的产妇正常分娩第二、三产程的护理方案,并评价其应用效果.方法 应用循证的方法系统检索产妇正常分娩第二、三产程护理方案的国内外指南,评价并汇总最佳证据,制订审查指标,进行基线审查,基于审查结果分析促进和障碍因素.比较证据应用前后产妇的分娩结局,助产士对产妇正常分娩第二、三产程护理措施的认知水平及审查指标的执行情况.结果 最佳证据应用后,产妇会阴完整率从7.9％提升到13.4％;助产士对产妇正常分娩第二、三产程护理措施的认知得分从培训前的25～85(54.9±14.3)分提升至50～100(77.1±13.8)分;除指标14、15外,证据应用前执行率＜50％指标的执行率均上升到70％以上.结论 本研究基于最佳证据,结合科室临床情境、患者意愿,并通过分析促进和障碍因素,制订产妇正常分娩第二、三产程的护理方案,证据应用后,产妇会阴完整率、助产士相关护理措施认知水平得到提高,助产士工作行为得到规范.

Objective:To evaluate the effect of new media among women with gestational diabetes mellitus (GDM) during postpartum period.Methods:The gestational diabetes maternal in the obstetrics department of Peking University First Hospital from May to June, 2017 was selected. We used excel generated random number table to divide the groups, there were 50 cases in the control group and 46 cases in the study group. The control group used routine postpartum routine health education, including informing 2 groups of maternal weight management diet and exercise plans, giving leaflets, and conducting telephone to supervise the quality control; based on these situations, the study group added group WeChat push reminders and Q&A, and "317 Protector" to push the heath education materials after discharge. Then we did comparison of oral glucose tolerance test (OGTT), lipid test results and body mass index (BMI) of the two groups on the 42nd day postpartum.Results:The recovery and control of the study group women were better than those of the control group. In the study group, BMI, fasting blood glucose, triglyceride, total cholesterol, high-density lipoprotein, and low-density lipoprotein were (22.13±2.91) kg/m 2, (5.06±0.39) mmol/L, (0.89±0.27) mmol/L, (5.61±0.68) mmol/L, (1.52±0.27)mmol/L, (3.16±0.71) mmol/L after 42 days of birth. While in the control group, these were (23.66±4.21)kg/m 2, (5.30±0.47) mmol/L, (1.03±0.36) mmol/L, (5.64±0.66) mmol/L, (1.63±0.30) mmol/L, (3.23±0.62) mmol/L. The difference between the two groups was statistically significant ( t value was -3.604-2.059, P<0.05 or 0.01). Conclusion:New media for postpartum follow-up of gestational diabetes can effectively help improve BMI, blood lipids and other indicators, and can also help blood sugar control effect.

对全球新生儿皮肤接触相关研究进展、存在问题进行回顾和整理,为我国新生儿皮肤接触开展提供参考和借鉴.

Objective To explore the effects of whole-stage labor analgesia on maternal and neonatal outcomes after the implementation of the new partogram.Methods A retrospective cohort study was performed in Peking University First Hospital.From June to December 2016,907 nulliparae with full-term singleton cephalic pregnancies that were expected to deliver vaginally and adhered to the new partogram were selected as the study group,and 982 cases that adhered to the old partogram (Friedman standard) from June to December 2012 were selected as the control group.Maternal basic characteristics and analgesic,obstetric and neonatal data were collected.Maternal and neonatal outcomes between the two groups were analyzed with independent sample t-test,rank sum test or Chi-square test (Fisher's exact test).Results (1) Maternal age and the proportion of gravidas of advanced maternal age in the study group were both higher than those in the control group [(30.2±3.0) vs (29.64-2.9) years,t=3.823;8.2％ (74/907) vs 4.2％ (41/982),x2=13.087;both P＜0.001].No statistically significant difference in the other basic characteristics was found between the two groups.(2) Women in the study group had significantly smaller cervical dilatation [M(P25-P75)] than that in the control group when analgesia was commenced [2(1-2) vs 2(1-3) cm,Z=-3.752].The intensity of pain quantified with numerical rating scale (NRS) before analgesia,and during the second stage of labor in the study group were less than that in the control group [8(8-9) vs 8(8-10) points,Z=-14.441;5(4-5) vs 6(5-7) points,Z=-16.495].The study group had longer median duration of analgesia than the control group [520(340-750) vs 300(200-453) min,Z=-17.801,P＜0.001].The overall dose of analgesics in injection pump in the study group was significantly higher compared with that used in the control group [68 (35-84) vs 30 (18-48) ml,Z=-18.004,P＜0.001].However,there was no significant difference in the incidence of analgesia-related complications (hypotension,accidental dura puncture,lower extremity numbness,pruritus and urinary retention) between the two groups.(3) The study group showed a higher percentage of spontaneous vaginal delivery,and a lower rate of converted cesarean section compared with the control group [71.8％ (651/907) vs 63.2％ (621/982),x2=15.623;13.6％ (123/907) vs 20.5％ (201/982),~=18.831;both P＜0.001].The study group had lower forceps-assisted vaginal delivery rate than the control group without statistically significant difference [14.8％ (133/907) vs 15.3％ (150/982),x2=0.093,P=0.797].The duration of the first,second and third stage of labor in the study group were all significantly longer than that of the control group [680 (470-900) vs 480 (360-660) min,Z=-12.490;56 (31-89) vs 37 (24-58) min,Z=-9.964;7 (5-10) vs 6 (5-8) min,Z=-6.673;all P＜0.001].Women in the study group had a lower rate of artificial rupture of membranes when comparing with the control group [55.2％ (501/907) vs 63.2％ (621/982),x2=12.516,P＜0.001].The incidence of fever,pathologically confirmed infection and postpartum hemorrhage were significantly higher in the study group than that in the control group [10.8％ (98/907) vs 6.4％ (63/982),x2=11.652;9.6％ (87/907) vs 3.7％ (36/982),x2=27.201;12.6％ (114/907) vs 5.7％ (56/982),x2=27.144;all P＜0.05].There was no significant difference in the rate of oxytocin use during labor or blood transfusion between the two groups.(4) Compared with the control group,the proportion of cesarean section due to arrested active stage of labor in the study group was significantly lower [5.7％ (7/123) vs 50.2％ (101/201),x2=68.173,P＜0.05],but the incidences of cesarean section due to intrauterine infection and relative cephalopelvic disproportion were higher in the study group [61.0％ (75/123) vs 30.8％ (62/201),x2=2.680;20.3％ (25/123) vs 8.0％ (16/201),x2=10.555;both P＜0.05].There was no significant difference in the proportion of fetal distress or other indications for cesarean section between the two groups.(5) There was no significant difference between the two groups in birth weight,macrosomia,fetal distress,neonatal asphyxia,or the proportion of neonatal intensive care unit admission.Conclusions After the implementation of the new partogram,analgesic pain relief covering the whole labor prolongs the average analgesic time and reduces the rate of cesarean section due to arrested active stage of labor.Although the risk of postpartum hemorrhage is slightly increased,analgesia itself does not pose additional risks on forceps-assisted delivery,maternal blood transfusion and neonatal asphyxia.

Objective To determine the effects of delayed umbilical cord clamping on the postpartum hemorrhage,instant and long-term newborn anemia,newborn jaundice.Methods In total,303 infants were selected during October 2016 to June 2017 in three hospitals in Beijing.They were randomly allocated into two groups receiving instant clamping of umbilical cord (less than 60s after delivery,n=158) and delayed clamping of umbilical cord(after cord pulsation ceased,n=145).Relevant indicators of maternal and neonatal outcomes are compared.Results There were significant differences between two groups in instant hemoglobin concentration and in 5～7 days (P＜0.05).There were no differences between two groups in transcutaneous bilirubin,the risk of anemia in three months,the risk of jaundice in 5～7 days and the need of blue-light therapy (P＞0.05).There were no differences between two groups of women in postpartum hemorrhage,the length of third stage of labor and the rate of breast feeding (P＞0.05).Conclusion Clamping the umbilical cord when cord pulsation has ceased does not have negative effects on delivery process and postpartum hemorrhage,but it increases the instant hemoglobin concentration and hemoglobin concentration after delivery in 5～7 days.Still it is unclear whether it will affect the risk of jaundice.

Objective To explore the effects of two kinds preoperative fasting and liquid-fasting time before caesarean section on blood glucose of puerperae with GDM before and after the operation,intra-operative complications and on blood glucose of neonates.Methods With prospective study method,162 puerperae with GDM admitted to obstetrical department of Peking University First Hospital and received cesarean section under combined spinal-epidural anesthesia between April 1st and Sep. 30th in 2015,were selected as the research object,and were divided into the control group (admitted on odd-numbered days) and the observation group (admitted on even-numbered days). Puerperae in the control group were forbidden to eat solid food for 8 h and drink transparent liquid for 6 h before the operation,while those in the observation group were forbidden to eat solid food for 6 h and drink transparent liquid for 2 h before the operation. Puererae in two groups were compared about their preoperative blood glucose,incidence of intraoperative nausea and vomiting or aspiration,intra-operative quality of bleeding,postoperative exsufflation time and blood glucose half an hour after the operation, meanwhile,neonates in two groups were compared about their Apgar scores 1 min and 5 min after birth,and their blood glucose half an hour after birth. Statistical analysis was done by independent-samplest test,Mann-WhitneyU test and χ2 test.Results Difference of preoperative blood glucose of puererae in two groups was statistically significant (P<0.01). Differences of intraoperative bleeding of puererae in two groups and blood glucose of neonates half an hour after birth in two groups were statistically significant (P<0.05). There was no statistic difference in the incidence of intraoperative nausea and vomiting or aspiration,postoperative exsufflation time of puererae,or Apgar scores 1 min and 5 min after birth of neonates in two groups(P>0.05).Conclusions The scheme of forbidding puererae from eating solid food for 6 h and drinking transparent liquid for 2 h before cesarean section can reduce the incidence of preoperative hypoglycemia,maintain a smooth post-operative blood glucose, reduce intraoperative bleeding without increasing the incidence of intraoperative complications like nausea,vomiting or aspiration,or hypoglycemia of the neonates. The new fasting and liquid-fasting scheme is safe and feasible,which makes it worth promoting in clinic.

ObjectiveTo explore the practice effect of "disease-characteristics nursing quality improvement" program (DNQIP) in patients with gestational diabetes mellitus (GDM).Methods Totally 841 GDM patients were selected by convenience sampling method and were divided into two groups based on whether they were nursed by the "DNQIP" program. Totally 236 GDM patients diagnosed between July 1st,2011 and June 30th,2012 were selected as the control group,while 605 GDM patients diagnosed from July 1st,2012 to April 30th,2015 were selected as the intervention group. Patients in the intervention group were cared with the "DNQIP" mode,which meant "looking for optimal evidence,relying on optimal processes and displaying optimal care". Finally,maternal and fetal outcomes,patient satisfaction and nursing quality ratings for various nursing units in two groups were compared.Results The differences in the incidence of macrosomia and hypertensive disorder complicating pregnancy between two groups were of no statistical significance (P>0.05);the incidence of premature delivery in the intervention group (7.2%) was significantly lower than that in the control group (16.0%) (χ2=15.04,P<0.01). In terms of patient satisfaction,the intervention group obtained higher scores than the control group in all items except for "nurses′ operation" (P<0.01). Composite score of special inspection for nursing quality of various nursing units after the implementation was higher than that before the implementation (P<0.05).Conclusions The DNQIP can reduce the incidence of premature delivery among GDM patients, improve the satisfaction of patients and optimize the quality of nursing service.

Objective With methods of literature review, item test, reliability and validity test, etc., to develop a fall risk assessment scale specific to the obstetrical department, which, after reliability and validity test, can be used for women health care before, at and after delivery.Methods Items in the fall risk assessment scale for pregnant and maternal women were determined and weights were assigned by reviewing relative risk factors in literature, referring to items in other fall risk assessment tools from home and aboard. After a preliminary scale was formed, 154 pregnant and maternal women hospitalized from May to December 2016 were assessed, so that reliability and validity of the scale were tested.Results In this fall risk assessment scale for the obstetrical department, test-retest reliability was 0.822, interrater reliability was 0.926, content validity of expertise was 0.927, and area under the curve (ROC) was 0.750 (P<0.05). When the dividing value was 3.5, sum of sensitivity (0.714) and specificity (0.714) reached the max.Conclusions The new fall risk scale, with favorable reliability and validity, can filter patients with high risk of fall, yet, it is still to be testified and perfected in future application.

Objective To explore the effect of quality control circle ( QCC) activities on increasing early neonatal contact rate of mother and early breast sucking rate .Methods Set up a QCC,then follow the steps of QCC with professional tools to solve existing problems in early skin-to-skin contact for mothers and their healthy newborn infants and early breast sucking .Rate was compared before and after the improvements .Results The early neonatal contact rate of mother and early breast sucking rate increased from 80.94% to 93.57%,and the difference was significant (χ2 =35.07,P<0.001).Conclusions The application of the quality improvement tool of QCC could improve the early skin-to-skin contact for mothers and their healthy newborn infants and early breast sucking , and helps the mother to breastfeed successfully .

Objective To investigate the influence of two labor analgesia methods on pregnancy outcomes and incidence of adverse events during analgesia. Methods The study retrospectively investigated 121 healthy parturient women as the control group who received EA+PCEA analgesia from November 2013 to March 2014 and had full-term, single fetal head fetus without obstetric pathological conditions such as cephalopelvic disproportion or pregnancy with internal diseases. The observation group included 110 healthy parturient women who received EA + PCEA within background mode from November 2014 to March 2015. Numeric rating scale ( NRS) was used to evaluate the pain at 10 min, 30 min, and 1 h after the delivery. Meanwhile, adverse pregnancy outcome and incidence of adverse events were compared between two groups. Results 1 h NRS score and urinary catheterization times had statistical differences (P <0. 01). But the differences of duration of labor, postpartum hemorrhage, delivery mode and neonatal outcome between two groups had no statistical significance (P>0. 05). Conclusions EA+PCEA within background mode performs better in effective and lasting analgesia, but has no influence on postpartum hemorrhage, delivery mode and neonatal outcome.

目的：了解妊娠期糖尿病( GDM)孕妇糖尿病相关知识、态度、行为现状,为今后GDM健康教育提供参考。方法采用自行设计GDM孕妇糖尿病相关知信行问卷对2014年1—6月就诊于北京大学第一医院的124例GDM孕妇进行调查,对调查结果进行频度描述及相关分析。结果124例GDM孕妇知、信、行总得分为(28.24±4.90)分,及格率为83.1%。 GDM孕妇糖尿病相关知识、态度、行为呈正相关(r值分别为0.345,0.440,0.289；P<0.01)。认知得分及格组的孕妇其妊娠结局优于不及格组。结论 GDM孕妇对糖尿病防治态度普遍较好,认知和行为正确率有待提高,应针对薄弱环节对GDM孕妇及家属加强产前健康教育指导。