induction

摘要： Introduction: The artificial induction of labor is increasingly common. Objective: Evaluate the maternal-fetal prognosis of artificial induction with misoprostol at the referral health center of the commune II. Methods: This is a cross-sectional, prospective, descriptive and analytical study which took place from September 1, 2019 to December 31, 2020. Included in the study were pregnant women carrying an evolving or terminated single-fetal pregnancy of at least 28 WA in cephalic presentation on a healthy uterus. The trigger has been made with 50 μg misoprostol administered sublingually into the posterior vaginal fornix. The dose was renewed as needed every 6 hours, until sufficient uterine contractions were obtained without exceeding 200 μg. Results: The frequency of artificial induction of labor was 1.25%. Indications were dominated by premature rupture of membranes (29.8%), overdue (19.1%), high blood pressure (19.1%), suitability of pregnant women (14.9%) and terminated pregnancies (10.6%). The vaginal delivery rate was 85.1% The Apgar score was greater than or equal to 7 in 83.3% of cases at the 1stminute. Maternal morbidity was marked by postpartum hemorrhage due to uterine atony in 4.3% cases. No maternal and neonatal deaths were noted. Conclusion: Induction of labor with misoprostol is a safe and effective method if careful selection of patients is made.

摘要： Background: Induction of labor is an artificial termination utilized to decrease both maternal and neonatal morbidity and mortality. The study was aimed to assess the epidemiology of induction of labor among women aged 15 - 49 who delivered at Shaafi Hospital in Hodon District, Mogadishu Somalia 2020. Methodology: A cross-sectional and retrospective hospital-based study was conducted among 30 women aged 15 - 49 who had undergone induction of labor who were delivered at Shaafi Hospital Mogadishu during the period of the study from May-July 2020. Data were collected by interview method using structured questionnaire. Data analyzed was performed using Statistical Package for Social Science version 20. Results: The study showed that the majority of respondents 12 (40%) had undergone induction once time previously, followed by 8 (27%) had undergone induction previously two times, while 6 (20%) had undergone previously three times, 4 (13%) more than four times. 21 (70%) were delivered Spontaneous Vagina delivery (SVD), 6 (20%) were Cesarean section (CS) and 3 (10%) instrumental vaginal delivery. A total of (60%) were delivered in public hospitals, followed by (23%) were delivered in private hospitals and 5 (17%) home delivery. In addition the reasons of induction of labor a total of 27 (90%) were post term, followed by 2 (7%) were Intrauterine fetal death (IUFD), while few proportion of 1 (3%) were Pregnancy induced hypertension (PIH). Finally, the study revealed that the socio-demographic and obstetrical determinants such as age and daily meal intake as well as antenatal care visit and reasons for induction of labor e.g. Post term (Post-mature), Intrauterine fetal death (IUFD) and Pregnancy induced hypertension (PIH) showed significant association with their the induced labor (P < 0.001). While not significant have been observed with mother’s gestational age with their induction of labor. Conclusion and Recommendations: The study recommended that ministry of health especially maternal and reproductive health unit should ensure that every pregnant woman has access to skilled maternal counseling and improve quality of antenatal, develop a national guideline of induction labor and continue training health workers at health facilities and monitor its implementations across the country.

摘要： This paper introduces how to use geometric figures to represent integers, and successfully proves Goldbach’s conjecture by using the mapping relationship between the internal angles of circles and sectors and the number of integers. It is also explained and proved that w(n) is the function that calculates the lower limit of the number of prime pairs. A very effective new method is found to solve this kind of integer problems.

摘要： BACKGROUND Pre-clinical simulation-based training(SBT)in endoscopy has been shown to augment trainee performance in the short-term,but longer-term data are lacking.AIM To assess the impact of a two-day gastroscopy induction course combining theory and SBT(Structured PRogramme of INduction and Training–SPRINT)on trainee outcomes over a 16-mo period.METHODS This prospective case-control study compared outcomes between novice SPRINT attendees and controls matched from a United Kingdom training database.Study outcomes comprised:(1)Unassisted D2 intubation rates;(2)Procedural discomfort scores;(3)Sedation practice;(4)Time to 200 procedures;and(5)Time to certification.RESULTS Total 15 cases and 24 controls were included,with mean procedure counts of 10 and 3(P=0.739)pre-SPRINT.Post-SPRINT,no significant differences between the groups were detected in long-term D2 intubation rates(P=0.332)or discomfort scores(P=0.090).However,the cases had a significantly higher rate of unsedated procedures than controls post-SPRINT(58%vs 44%,P=0.018),which was maintained over the subsequent 200 procedures.Cases tended to perform procedures at a greater frequency than controls in the post-SPRINT period(median:16.2 vs 13.8 per mo,P=0.051),resulting in a significantly greater proportion of cases achieving gastroscopy certification by the end of follow up(75% vs 36%,P=0.017).CONCLUSION In this pilot study,attendees of the SPRINT cohort tended to perform more procedures and achieved gastroscopy certification earlier than controls.These data support the role for wider evaluation of pre-clinical induction involving SBT.

摘要： Introduction: Rupture of unscarred uterus (primary uterine rupture) is a rare peripartum complication often associated with catastrophic maternal and neonatal outcomes. Case presentation: A 27-year-old primigravid lady, previously healthy, at 40 weeks + 2 days presented to a midwife’s clinic for routine antenatal consultation. She was advised to have induction of labor. This was initiated with 2 tablets of Misoprostol (400 mcg) vaginally. Twelve hours later, and after remaining at full cervical dilation for 4 hours, she was referred to our maternity service for alleged failure to descend. On arrival, she was apprehensive, exhausted but hemodynamically stable. Pelvic exam disclosed a fully dilated cervix with the vertex at S + 1 and a caput reaching the introitus. No fetal heart rate could be elicited by the CTG monitor and this was verified by a bedside ultrasonography. Operative vaginal delivery was performed due to maternal exhaustion. This was complicated by transient shoulder dystocia. Manual revision of the birth canal and the uterine cavity disclosed a suspicion of left vaginal vault gapping together with a left fundal uterine rupture. Consequently, the patient was rushed to the operating room for an urgent exploratory laparotomy. The rupture sites were identified and repaired while a large broad ligament hematoma on the same side was explored and hemostasis secured with ipsilateral uterine artery ligation of the fundal and cervical branches. The postoperative course was smooth and the patient left the hospital on the 5th day postpartum. Conclusion: Cases of unscarred uterine rupture are limited. One of the most frequent risk factor is the injudicious use of Misoprostol for labor induction. Sudden arrest of progress of labor or failure to descend might mask uterine rupture. We recommend that all birth attendants be familiar with the guidelines issued by FIGO, ACOG and other societies for the safe use of these potent uterotonics.

摘要： Background: Induction of labor is the stimulation of the uterus to initiate the labor process whether by administering oxytocin, prostaglandin or reputing the membrane [1]. It was realized that the number of induction of labor patients was thought to be increasing in comparison with the spontaneous labor patients. Therefore, the complications of induced labor were higher. A detailed analysis was needed to confirm that. Objective: The aim of the study is to analyze the outcomes between spontaneous versus induced labor. Materials and Methods: A retrospective analysis was conducted at our tertiary care university hospital, in the period from December 2015 to December 2016 when 311 women were divided into two groups: group 1, women who had spontaneous labor (n = 106) compared with group 2, women who were labor induced (n = 205). Complications of pregnancy, delivery type, tear, episiotomy, blood transfusion and instruments used were analyzed retrospectively. Results: The mean ± SD of baseline characteristics, like age, height, weight, BMI and hemoglobin level for all study samples was 28.59 ± 5.95 years, 1.58 ± 0.06 m, 71.77 ± 13.42 kg, 28.59 ± 5.89 kg/m2 and 11.08 ± 1.45 g/dl respectively. A statistically significant difference was noticed in the duration of labor between spontaneous and induced labor (95% CI: 9.194 - 152.130;p-value 0.004 and OR: 0.239). There was no significant difference in complications, delivery type (Spontaneous Vaginal Delivery (SVD) or other), blood transfusion, and instrument used between women who had spontaneous labor versus induced labor. However, significant differences in tear (95% CI: 4.354 - 0.996;p-value 0.035) and episiotomy (95% CI: 0.928 - 0.224;p-value 0.028) were found between the two groups. In conclusion, the induced labor was found to be associated with high incidence of duration of labor, tear and episiotomy. Patients should always be counseled when there it is an option between the two delivery types.

摘要： Background: Maternal obesity is reported to be associated with increased incidence of gestational diabetes mellitus and hypertension. These cause failure of labour induction, leading to higher incidence of cesarean section (CS). The aim of this study was to assess which reduces CS rate, labor induction at 39 weeks or leaving women for spontaneous labor onset till 41 weeks. Methodology: A randomized controlled trial was conducted in Ain Shams Maternity Hospital in Egypt from 2016 to 2018. Study population consisted of 200 term primigravida pregnant obese women delivered in Ain Shams Maternity Hospital. They were divided into two groups: Group A: induction of labor at 39 + 0 weeks (n = 100) by vaginal administration of 25 μg misoprostol (PGE1) every 6 hours for 5 doses;Group B: waiting spontaneous labor onset till 41 + 0 weeks (n = 100), and if no spontaneous labor occurred at 41 weeks, induction was performed in the same way. Results: Induction (Group A) vs. waiting spontaneous labor (Group B) showed the followings, which were significant: CS: 22% vs 39%, p = 0.009;maternal birth injury: 4% vs 12%, p = 0.037;non-assisted vaginal deliveries: 93.6% vs 78.7%, p = 0.034;APGAR scores at 1 & 5 min: 7.6 ± 0.8 vs 7.3 ± 1.1 p = 0.038, 8.4 ± 1.0 vs 8.1 ± 1.3 p = 0.040, respectively;birth weight;3.3 ± 0.1 vs 3.5 ± 0.2 kg, p < 0.001. The following did not show significance between Group A vs Group B but Group A showed lower incidence;postpartum hemorrhage: 3% vs 5%, blood transfusion: 1% vs 3%. Conclusion: CS rate was significantly lower in women with induction of labor at 39 weeks than those waiting for spontaneous labor onset till 41 weeks in obese Egyptian pregnant women.

摘要： International students contribute circa 25.8 billion in gross output for the UK economy(Universities UK,2017)[67].The new UK government Strategy in March(2019)is to cement Britain’s leading role in the global market by increasing the number of international students studying in the UK by more than 30%-helping boost the income generated by education exports to£35 billion(UK Government,2019).Therefore,the main aim of this research is to explore the experience of international students during their journey at one of UK Higher Education institutions.Previous studies covered one or two factors that affect the international students to study abroad such as costs,language,culture,etc.,.However,our study suggested six themes to cover the whole journey of the international students.The themes are:selection and admission;pre-arrival;induction;orientation and settlement,engagement;and teaching and learning.Our study offers some recommendations for each theme and for the university level.

摘要： Objective: To evaluate the effect of anesthesia induction under parental company for children receiving general anesthesia. Methods: The RCT results were collected on children’s preoperative anxiety, anesthesia coordination, anesthesia and recovery agitation, postoperative pain and parental preoperative anxiety intervention with or without parental accompany using RevMan 5.3 software based on Chinese and English database. We searched Cochrane Library, Pubmed, Medline, EMbase, Sciencedirect, SpringerLink, China Biomedical, CNKI, Wanfang, Weipu and other databases, and included 15 articles (5 Chinese, 10 English) with 1390 samples size, containing 700 cases of control group and 690 cases of testing group. Results: Our results showed that parents’ and children’s anxiety level, the incidence of restlessness during anesthesia induction and wake-up period were reduced, while the anesthesia coordination was enhanced and the pain of children after wake-up was alleviated under parental accompany. Conclusion: The risk and cost-free intervention of parental accompany could be recommended as appropriate in hospitals for its contribution to children’s surgery effect.

摘要： 1 Introduction Vegetation indices(VIs)derived from satellite observations are an essential source of information for operational monitoring of the Earth’s vegetation(Qu et al.,2018;Yan et al.,2008).However,soil background dramatically affects the performances ofⅥs(Baret and Guyot,1991;Gilabert et al.,2002;Huete,1988;Qi et al,1994).