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      Risk factors, changes in serum inflammatory factors, and clinical prevention and control measures for puerperal infection

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          Abstract

          Background

          To investigate the risk factors and changes in serum inflammatory factors in puerperal infection, and propose clinical prevention measures.

          Methods

          A total of 240 subjects with suspected puerperal infection treated in our hospital from January 2017 to December 2017 were collected, among which puerperal infection was definitely diagnosed in 40 cases, and it was excluded in 40 cases. Levels of interleukin‐6 (IL‐6), tumor necrosis factor‐α (TNF‐α), and high‐sensitivity C‐reactive protein (hs‐CRP) were compared between the two groups, and the change trends of IL‐6 and hs‐CRP were recorded.

          Results

          Levels of IL‐6, hs‐CRP, and TNF‐α in puerperal infection group were higher than those in non‐infection group ( P < .05). Levels of IL‐6 and hs‐CRP at enrollment and 1‐3 days after enrollment in infection group were higher than those in non‐infection group ( P < .05). The body mass index >25, placenta previa, placenta accreta, postpartum hemorrhage, premature rupture of membrane, gestational diabetes mellitus, and anemia during pregnancy were relevant and independent risk factors for puerperal infection. Puerperal infection occurred in uterine cavity, vagina, pelvic peritoneum, pelvic tissue, incision, urinary system, etc, and gram‐negative (G+) bacteria were dominated in pathogens.

          Conclusion

          The inflammatory response of patients with puerperal infection is significantly enhanced.

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          Most cited references20

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          New labor management guidelines and changes in cesarean delivery patterns

          Background In 2010 the Consortium on Safe Labor published labor curves. It was proposed that the rate of cesarean delivery (CD) could be lowered by avoiding the diagnosis of arrest of dilation before 6 cm. However, there is little information on the uptake of the guidelines and on changes in CD rates that may have occurred. Objective To test the hypotheses that: 1) among patients laboring at term, rates of arrest of dilation disorders have decreased leading to a decrease in the rate of CD; 2) in the second stage, pushing duration prior to diagnosis of arrest of descent has increased also leading to reduction in the rate of CD for this indication. As a secondary aim, we investigated changes in maternal and neonatal morbidity. Study Design This was a secondary analysis of a prospective cohort study of all patients presenting at ≥ 37 weeks’ gestation from 2010–2014 with a non-anomalous vertex singleton and no prior history of CD. Rates of CD, arrest of dilation, and changes in rates of maternal and neonatal morbidity were calculated in crude and adjusted models. Cervical dilation at diagnosis of arrest of dilation, time spent at the maximal dilation prior to diagnosis of arrest of dilation, and time in the second stage prior to diagnosis of arrest of descent were compared over the study period. Results There were 7845 eligible patients. The CD rate in 2010 was 15.8% and in 2014 17.7% (p-trend 0.51). In patients undergoing CD for arrest of dilation, the median cervical dilation at the time of CD was at 5.5 cm in 2010 and 6.0 cm in 2014 (p-trend 0.94). In these patients, there was an increase in the time spent at last dilation: 3.8h in 2010 to 5.2h in 2014 (p-trend 0.02). There was no change in the frequency of patients diagnosed with arrest of dilation at <6 cm: 51.4% in 2010 and 48.6% in 2014 (p-trend 0.56). However, in these patients, the median time spent at the last cervical dilation was 4.0h in 2010 and 6.7h in 2014 (p-trend 0.046). There were 206 CDs for arrest of descent. The median pushing time in these patients increased in multiparous patients from 1.1h in 2010 to 3.4h in 2014 (p-trend 0.009); in nulliparous patients these times were 2.7h in 2010 and 3.8h in 2014 (p-trend 0.09). There was a significant trend towards increasing adverse neonatal and maternal outcomes (p<0.001 for each). The aOR for adverse maternal outcome for 2014 compared to 2010 was 1.66 (95%CI 1.27, 2.17); however considering only transfusion, hemorrhage, or infection, there was no difference (p-trend 0.96). The aOR of adverse neonatal outcome in 2014 compared to 2010 was 1.80 (95%CI 1.36, 2.36). Conclusion Despite significant changes in labor management that have occurred over the initial years since publication of the new labor curves and associated guidelines, the primary CD rate was not reduced and there has been an increase in maternal and neonatal morbidity in our institution. A randomized controlled trial is needed.
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            Unpacking the enabling factors for hand, cord and birth-surface hygiene in Zanzibar maternity units

            Abstract Recent national surveys in The United Republic of Tanzania have revealed poor standards of hygiene at birth in facilities. As more women opt for institutional delivery, improving basic hygiene becomes an essential part of preventative strategies for reducing puerperal and newborn sepsis. Our collaborative research in Zanzibar provides an in-depth picture of the state of hygiene on maternity wards to inform action. Hygiene was assessed in 2014 across all 37 facilities with a maternity unit in Zanzibar. We used a mixed methods approach, including structured and semi-structured interviews, and environmental microbiology. Data were analysed according to the WHO ‘cleans’ framework, focusing on the fundamental practices for prevention of newborn and maternal sepsis. For each ‘clean’ we explored the following enabling factors: knowledge, infrastructure (including equipment), staffing levels and policies. Composite indices were constructed for the enabling factors of the ‘cleans’ from the quantitative data: clean hands, cord cutting, and birth surface. Results from the qualitative tools were used to complement this information. Only 49% of facilities had the ‘infrastructural’ requirements to enable ‘clean hands’, with the availability of constant running water particularly lacking. Less than half (46%) of facilities met the ‘knowledge’ requirements for ensuring a ‘clean delivery surface’; six out of seven facilities had birthing surfaces that tested positive for multiple potential pathogens. Almost two thirds of facilities met the ‘infrastructure (equipment) requirement’ for ‘clean cord’; however, disposable cord clamps being frequently out of stock, often resulted in the use of non-sterile thread made of fabric. This mixed methods approach, and the analytical framework based on the WHO ‘cleans’ and the enabling factors, yielded practical information of direct relevance to action at local and ministerial levels. The same approach could be applied to collect and analyse data on infection prevention from maternity units in other contexts.
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              LABOR, DELIVERY AND POSTPARTUM COMPLICATIONS IN NULLIPAROUS WOMEN WITH FEMALE GENITAL MUTILATION ADMITTED TO KARAMARA HOSPITAL.

              To assess labor, delivery and postpartum complications in nulliparous women with FGM/C and evaluate the attitude of mothers towards elimination of FGM.
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                Author and article information

                Contributors
                kelihu6lv@163.com
                Journal
                J Clin Lab Anal
                J. Clin. Lab. Anal
                10.1002/(ISSN)1098-2825
                JCLA
                Journal of Clinical Laboratory Analysis
                John Wiley and Sons Inc. (Hoboken )
                0887-8013
                1098-2825
                28 December 2019
                March 2020
                : 34
                : 3 ( doiID: 10.1002/jcla.v34.3 )
                : e23047
                Affiliations
                [ 1 ] Department of Obstetrics Guizhou Provincial People's Hospital Guiyang China
                Author notes
                [*] [* ] Correspondence

                Keli Hu, Department of Obstetrics, Guizhou Provincial People's Hospital, No.1, Baoshan South Road, Guiyang 550002, Guizhou, China.

                Email: kelihu6lv@ 123456163.com

                Author information
                https://orcid.org/0000-0002-5873-9663
                Article
                JCLA23047
                10.1002/jcla.23047
                7083398
                31883276
                d57be859-e92b-486c-b990-281299dcad5f
                © 2019 The Authors. Journal of Clinical Laboratory Analysis Published by Wiley Periodicals, Inc.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

                History
                : 13 May 2019
                : 08 July 2019
                : 15 July 2019
                Page count
                Figures: 1, Tables: 3, Pages: 6, Words: 3765
                Funding
                Funded by: Special fund for clinical research of Wu Jieping medical fund
                Award ID: 320.6750.17173
                Categories
                Research Article
                Research Articles
                Custom metadata
                2.0
                March 2020
                Converter:WILEY_ML3GV2_TO_JATSPMC version:5.7.8 mode:remove_FC converted:20.03.2020

                Clinical chemistry
                inflammatory factors,prevention measures,puerperal infection,risk factors
                Clinical chemistry
                inflammatory factors, prevention measures, puerperal infection, risk factors

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