Making decisions regarding the mode of delivery in the cases of meconium amniotic fluid (MAF) presents a challenge for healthcare providers. We aimed to compare the neonatal outcome of MAF cases delivered via cesarean section (CS) versus those delivered vaginally to determine if CS is a protective factor against the adverse neonatal outcomes.
In this retrospective study, we assessed singleton pregnant mothers diagnosed with MAF who gave birth at a tertiary hospital in Bandar Abbas, Iran, between January 2020-2022. Mothers with certain adverse pregnancy conditions were excluded from the study. These conditions included: abnormal fetal heart rate and pattern, bloody amniotic fluid, malpresentation, abnormal placentation, chorioamnionitis, intrauterine growth restriction, intrauterine fetal death, obstructed labor, and maternal comorbidities. The MAF mothers were divided into two groups based on the method of delivery: those who had CS and those who had a normal vaginal delivery (NVD). Demographic factors, obstetrical factors, and neonatal outcomes were compared between the two groups.
Out of 746 MAF mothers, 213 (28.5%) underwent CS, while 533 (71.4%) had NVD. There were no significant differences between the groups in terms of demographic characteristics. Among MAF mothers who had CS, 66.2% were primiparous, and 33.8% were multiparous. For those who had NVD, 35.1% were primiparous, and 64.9% were multiparous. The first and 5-min Apgar values, rates of asphyxia, neonatal intensive care unit (NICU) admission, and neonatal death were not statistically different between the two delivery modes. The rate of newborns who breastfed within the first hour did not differ depending on the mode of delivery. Although initial resuscitation steps were required more frequently in MAF mothers with NVD than in those with CS (11.1% vs. 2.3%), no correlation was found between the mode of delivery and the need for resuscitation using logistic regression.
Our research findings suggest that there were no superior neonatal outcomes in terms of CS compared to NVD in MAF mothers. Further studies are needed to provide more substantial evidence to support this conclusion.
Pelvic organ prolapse commonly affects the upper two-thirds of the vagina. However, evaluating this region in its normal position presents challenges. This study aimed to assess the anatomical axis of this vaginal segment using pelvic magnetic resonance imaging measurements.
A retrospective study of 614 hospitalized women from two hospitals, who were rigorously screened to exclude those with Pelvic Organ Prolapse or known anatomical variations (median age: 43 years, range: 17–76 years). Two reference lines were used: the pubococcygeal line (PCL) and a line from the inferior pubic symphysis to the third sacral vertebra (PS3L). Distances between the distal, middle, and apical points of the upper vagina and the reference lines, as well as the angles between the upper vagina and the reference lines, were measured. Comparisons were made among different age groups.
The median distances from the distal, middle, and apical vaginal points to the PCL were 0.4 cm (interquartile range [IQR]: 0.0–0.7 cm), 2.1 cm (IQR: 1.7–2.5 cm) and 3.1 cm (IQR: 2.5–3.7 cm), respectively. The median PCL-vaginal angle was 29.0° (IQR: 23.0–34.0°). The median distances from the distal, middle, and apical vaginal points to the PS3L were -0.5 cm (IQR: -0.9–0.0 cm), 0.0 cm (IQR: -0.4–0.6 cm), and -0.2 cm (IQR: -0.9– 0.0 cm), respectively. The median PS3L-vaginal angle was 0.0° (IQR: -4.0–7.0°). Women aged 50 years or older had slightly lower vaginal points and slightly larger angles than younger groups in relation to both reference lines (p < .001). The vaginal axis in younger groups appeared parallel to the PS3L.
The axis of the upper two-thirds vagina was proximate to a line from the inferior pubic symphysis to the third sacral vertebra, particularly in younger women. It will likely become a simplified method for roughly assessing the vaginal axis in its situ at first glance.
In response to the incidence of cervical intraepithelial neoplasia and cervical cancer in China and global screening strategies, a collaborative effort was undertaken by seven Chinese medical associations to develop this guideline for cervical cancer screening. The guideline recommends high-risk human papillomavirus (hr-HPV) testing as the preferred method for primary screening, which should have been approved by authoritative institutions and clinically validated for primary screening. In areas without access to HPV testing, cytology can be used as an alternative. However, it is recommended to replace cytology with HPV-based screening as conditions permit. Cotesting (HPV testing in combination with cytology) is recommended for areas with sufficient medical resources, opportunistic screening populations, and partial special populations. The guideline recommends that individuals with a cervix initiate cervical cancer screening at the age 25 years and undergo HPV testing alone or cotesting every five years, or cytology alone every three years. Women over the age of 65 who have had documented adequate negative prior screening in the past may terminate screening. Corresponding screening programs are proposed for different special populations. The development of these guidelines is an important step in the effort to eliminate cervical cancer in China.
Postpartum women encounter a diverse array of physiological challenges following childbirth, and they may also contend with issues such as a lack of self-care knowledge childcare knowledge, and childcare experience. This study aimed to explore the quality of discharge teaching for hospitalized postpartum women.
A total of 292 parturients who gave birth in a tertiary hospital were selected using the convenience sampling method and surveyed using a general data questionnaire and discharge teaching quality scale.
The total score for the quality of discharge teaching was 111.95 ± 28.64. In bivariate analysis, significant differences were identified between postpartum women with differences in postpartum complications, ambulation time, wound pain, infant health status, and infant feeding methods (p < 0.05). Wound pain and infant feeding methods were significant factors in a multiple linear regression model (p < 0.05).
Nursing staff should focus on psychological nursing care and give more personalized teaching to postpartum women with severe wound pain and who bottle feed their newborns.
HPV infection is the primary cause of cervical intraepithelial neoplasia (CIN), with persistent high-risk HPV infection being the leading factor in the development of cervical cancer. In addition to the application of large loop excision of the transformation zone (LLETZ) for the treatment of cervical pre-cancerous lesions, various ablative techniques, including thermal ablation, cryotherapy, carbon dioxide (CO2) laser therapy, and focused ultrasound therapy also play significant roles in the management of cervical intraepithelial neoplasia. This review presents a comprehensive overview of the pathophysiology of cervical HPV infection and discusses the ablative methods commonly used in clinical practice, along with their indication and contradiction, especially in women with high-grade squamous intraepithelial lesions. The aim is to identify safe and effective treatment strategies for treating cervical intraepithelial neoplasia, thereby avoiding under- or over-treatment, which may reduce the incidence and progression of cervical cancer through timely diagnosis and treatment.
To gain insights into the diagnosis and treatment of retroperitoneal para-aortic ectopic pregnancies (RPEP).
We conducted a review of the existing literature from the web of science, PubMed, and CNKI using the search terms "ectopic pregnancy" and "retroperitoneal." The present review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines.
After applying the inclusion and exclusion criteria, we included a total of 54 relevant works, encompassing 55 cases. The studies have revealed that a history of artificial abortion, embryo transfer, salpingectomy, and uterine cavity operation, accounted for 65.5 % (36/55) of the cases. Typical symptoms of RPEP include abdominal pain (43.6 %, 24/55) and vaginal bleeding (36.4 %, 20/55), with only 32.7 % (18/55) of cases being asymptomatic. The most common sites of RPEP are the abdominal aorta and the inferior vena cava (74.5 %, 41/55). There were no statistically significant differences in the incidence of acute abdomen, diameter of the pregnancy sac, number of surgeries, and the time for postoperative hCG to normalize in different pregnant site. The most effective imaging examination for RPEP was found to be abdominal ultrasound (72.7 %, 40/55), and the most commonly used treatment method was laparoscopy surgery (55.3 % ,21/38).
It is crucial to consider the possibility of RPEP when a pregnancy mass cannot be located during routine examinations. Expanding the scope of the scan may significantly expedite diagnosis and treatment.
Cervical precancers encompass high-grade squamous intraepithelial lesion and adenocarcinoma in situ. Treatment of precancerous lesions can reduce cervical cancer mortality and prevent the development of invasive cervical cancer. The choice of treatment regimen needs to follow the principle of individualization and should be based on a combination of factors, including the patient's age, fertility requirements, pregnancy status, pathological type, type of colposcopic transformation zone, patient's follow-up conditions, and the experience of the treating provider. This article presents an opinion regarding the appropriate indications for excisional surgery and total hysterectomy in the management of precancerous lesions of the cervix, with the aim of establishing standardized therapeutic approaches for the treatment of precancerous lesions of the cervix.
Trichomoniasis and HPV infection are common non-viral and viral sexually transmitted diseases worldwide. Emerging evidence shows that the female genital tract and its microbiota are greatly affected by these pathogens. However, the relationship between Trichomonas vaginalis, the vaginal microbiome, and High-risk (HR)-HPV infection is complex and multifaceted. Studies have proven that concurrent infections of HIV and HPV increase the risk of cervical cancer. With this basis, a question arises: How does the concurrent infection of trichomonas vaginalis and HPV affect genital tract health? Does this concurrent infection enhance or inhibit the development of cervical lesions? This review aims to bring light to these questions. This review also covers the association of trichomonas vaginalis and HPV with the microbiota of the genital tract.
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