The vehicle routing problem(VRP) is a well-known combinatorial optimization issue in transportation and logistics network systems. There exist several limitations associated with the traditional VRP. Releasing the res...The vehicle routing problem(VRP) is a well-known combinatorial optimization issue in transportation and logistics network systems. There exist several limitations associated with the traditional VRP. Releasing the restricted conditions of traditional VRP has become a research focus in the past few decades. The vehicle routing problem with split deliveries and pickups(VRPSPDP) is particularly proposed to release the constraints on the visiting times per customer and vehicle capacity, that is, to allow the deliveries and pickups for each customer to be simultaneously split more than once. Few studies have focused on the VRPSPDP problem. In this paper we propose a two-stage heuristic method integrating the initial heuristic algorithm and hybrid heuristic algorithm to study the VRPSPDP problem. To validate the proposed algorithm, Solomon benchmark datasets and extended Solomon benchmark datasets were modified to compare with three other popular algorithms. A total of 18 datasets were used to evaluate the effectiveness of the proposed method. The computational results indicated that the proposed algorithm is superior to these three algorithms for VRPSPDP in terms of total travel cost and average loading rate.展开更多
This study examined the non-medical factors that influence expectant mothers to opt for caesarean deliveries in Ghana. Data on 395 expectant mothers across the ten regions of Ghana who were located in urban, semi-rura...This study examined the non-medical factors that influence expectant mothers to opt for caesarean deliveries in Ghana. Data on 395 expectant mothers across the ten regions of Ghana who were located in urban, semi-rural and rural areas, and spanned a period of five years (from 2012 to 2016) were obtained from the Ghana Health Service. In fitting the logistic regression model, data on 355 expectant mothers (i.e. 89.9% of the data) was assigned to the analysis sample while 40 (i.e. 10.1%) was assigned to the hold-out sample. The hold-out sample together with other statistical measures of overall model fit, pseudo R2 measures and classification accuracy were used to validate the results obtained from the analysis sample. Significance was tested at p = 0.05. Determinants including, educational level of expectant mother, parity of expectant mother, baby’s birth weight, previous caesarean delivery, location of expectant mother, age of expectant mother and, period within the year of childbirth had a significant effect on caesarean delivery. The study recommended that health practitioners should be able to foretell expectant mothers who are likely to undergo caesarean delivery in order for them to prepare financially and psychologically to avoid further complications. Due to the significant positive attitude of women towards caesarean delivery rather than normal delivery, it is necessary to inform them about the advantages of normal delivery and the health hazards associated with caesarean delivery to the mother and child.展开更多
Background: Current guidelines recommend regional anesthesia versus general as a method of choice for women undergoing cesarean deliveries (CS). However, little is known about the surgical times in the operating room ...Background: Current guidelines recommend regional anesthesia versus general as a method of choice for women undergoing cesarean deliveries (CS). However, little is known about the surgical times in the operating room and a choice of anesthesia for cesarean deliveries. Objective: This study was designed to compare times from the arrival to the OR to the delivery of the fetus between regional and general anesthesia along with maternal and fetal outcomes, for patients undergoing cesarean sections for non-reassuring fetal tracing. Study Design: Records were reviewed for patients who underwent cesarean delivery for non-reassuring fetal heart rate tracing from February 2012 to May 2018. A total of 190 charts were selected. Seven patients who received epidural or spinal anesthesia and then converted to general anesthesia (GA) were excluded. The primary outcomes were: 1) entering the operating room to skin incision (min);2) the time from entering the operating room to delivery of the fetus (min). These times were compared among the patients who underwent epidural, spinal and general anesthesia. The secondary criteria included time from skin incision to delivery of the fetus (min), estimated blood loss (ml), Apgars scores, Arterial/venous cord pH, NICU admissions and fetal complications. ANOVA or Kruskal-Wallis Test was used for the continuous variable and Fisher’s exact test was used for the categorical variable to test the differences between groups. Logistic regression model was used for the binary outcomes after adjusting for age, BMI and number of prior laparotomies. Results: Infants in the GA group were delivered significantly faster when compared to epidural and spinal group separately with a P-value of 0.001. The mean time from arrival to OR to delivery of the newborn in GA group was 12.7 minutes, compared to 27 minutes in epidural group and 32.7 minutes in the spinal group. Time intervals from time in the OR to incision and time from incision to delivery of the fetus were also calculated and were significantly 展开更多
Introduction: Multiple gestations or multiple pregnancies occur when two or more fetuses are conceived at the same time in the same woman. Therefore, a twin pregnancy is defined as the simultaneous development of two ...Introduction: Multiple gestations or multiple pregnancies occur when two or more fetuses are conceived at the same time in the same woman. Therefore, a twin pregnancy is defined as the simultaneous development of two fetuses in the same woman. It can either be a monozygotic or dizygotic pregnancy. Twin pregnancy is considered a high-risk pregnancy with variable incidence and outcomes worldwide. The adverse maternal and fetal outcomes of twin deliveries have not yet been investigated in our setting. Objectives: The main objective of this study was to evaluate the outcomes of twin deliveries at the Bamenda Health District. Methods: This was a hospital-based, cross-sectional analytic study done at the Bamenda Health District in three selected hospitals (Bamenda Regional Hospital, CMA Nkwen, and IHC Azire) from the 1<sup>st</sup> of January to the 10<sup>th</sup> of May 2018. 55 women with twin pregnancies and 55 women with singleton pregnancies at gestational ages of 28 completed weeks and above who came for delivery and who consented to the study were included. A face-to-face interview-administered questionnaire was used to obtain sociodemographic characteristics;a venous blood sample was collected from the mothers before and after delivery to determine the estimated blood loss based on haemoglobin level. The partogram was opened from 4 cm cervical dilatation for those who came in the first stage of labour and the mode of delivery was recorded. After delivery, outcome variables were 1<sup>st</sup>, 5<sup>th</sup>, and 10<sup>th</sup> min Apgar score, birth weight, and gestational age. Data were entered in CSPro 7.1 and exported to IBM SPSS version 23.0 for analysis. All variables with p < 0.05 were statistically significant, OR and 95% CI were calculated for all outcome variables to measure the association with twin deliveries. Results: During the study period, we included 110 participants (55 twin mothers and 55 singleton mothers). Women with twin gestations were mostly aged between 25 and 34 years with a mean mat展开更多
Equitable water allocation is essential in an irrigation scheme for obtaining potential crop yields from the entire scheme,especially when water supply is inadequate.An optimization model achieved this goal by couplin...Equitable water allocation is essential in an irrigation scheme for obtaining potential crop yields from the entire scheme,especially when water supply is inadequate.An optimization model achieved this goal by coupling an optimal water allocation model with available water supply and irrigation water demand for a river-fed rice irrigation system in Malaysia.This model consists of a paddy field water balance module and an optimization module.The outputs from the module are daily irrigation demand and surface runoff,if there is any.The optimization module consists of an objective function,which minimizes water shortage across the scheme area while maintaining equity in water allocation.This model performs optimization subject to several system constraints,and the decision variable of the model is daily releases or supply to the tertiary canals.Performance of this model remained unaffected under different water supply conditions,and the optimization model reliably examined the effects of alternate water allocation and management rules with field information.It improves efficiency and equity in water allocation with respect to crop growth stages and water shortages rather than simply cutting irrigation supply on a proportional basis to overcome water shortages.展开更多
Obesity is becoming a global health care problem and an increasing number of obese female patients are getting pregnant. Aim of our study was to know the prevalence of obesity in nulliparous women and its impact on pr...Obesity is becoming a global health care problem and an increasing number of obese female patients are getting pregnant. Aim of our study was to know the prevalence of obesity in nulliparous women and its impact on pregnancy as well as fetus. Patients and Methods: All nulliparous women with single pregnancy and gestational age of 37 weeks and above were included in the study. Primigradvida with multiple pregnancies, fetal abnormalities, and gestational age less than 37 weeks were excluded. Patients were divided into normal, overweight and obese group according to their prepragnancy body mass index (BMI). Results: Total 2243 nulliparous women were included in the study, majority (56.8%) of patients were in the normal BMI group and only 24.8% were obese. But a significantly higher number of obese nulliparous women were in the age group of 18 to 29 years (P < 0.05). Comorbidities were significantly higher in obese primigravida. The incidence of gestational diabetes and pregnancy induced hypertension was significantly higher (P 0.05) in obese nulliparous women. Overweight and obese nulliparous patients required significantly higher emergency caesarean section and assisted vaginal deliveries compared to the normal BMI nulliparous women (P < 0.03). Conclusion: Maternal obesity leads to prepartum, peripartum as well as fetal complication. Obese pregnant patients had a significant risk of developing gestational diabetes and pregnancy induced hypertension. In these patients the prevalence of assisted vaginal and cesarean deliveries is significantly high.展开更多
Based on self-reported surveys conducted by the Substance Abuse and Mental Health Services Administration, cannabis use in pregnant females has increased over the years. Despite the increasing trend, the relationship ...Based on self-reported surveys conducted by the Substance Abuse and Mental Health Services Administration, cannabis use in pregnant females has increased over the years. Despite the increasing trend, the relationship between cannabis use and fetal outcomes is not fully understood. This review paper evaluates the literature investigating the short-term and long-term fetal outcomes resulting from cannabis use during pregnancy. Additionally, the risk of chronic marijuana use leading to cannabis hyperemesis syndrome has been highlighted in this paper using conclusions compiled from several case studies. Several studies linked delayed mental growth and reduced cognitive function with prenatal cannabis use, but the literature <span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">was</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> limited to lower-quality observational studies and could not establish causality. One systematic review investigated short-term outcomes of low birth rates and preterm deliveries, where marijuana use in conjunction with tobacco use was associated with more preterm deliveries. Another study found that six-year-old patients exposed to cannabis prenatally were more likely to score lower in different categories on the Stanford-Binet scale test, which measures intelligence. The exposure in the first, second, or third trimester was associated with lower composite or subcategory scores such as verbal reasoning or short-term memory. Despite these results, the studies evaluated had limitations. They could not establish a clear relationship between cannabis use and fetal outcomes, but the literature showed a similar pattern of health, social and economic inequities among the populations who self-reported cannabis and substance use and non-users. Current organization guidelines advise against the use of cannabis use during pregnancy due to mixed and limited literature. However,展开更多
Objective: The aim of this study was to determine the incidence, risk factors, and outcomes of management of patients with placenta accreta. Background Placenta accreta occurs when the placental implantation is abnorm...Objective: The aim of this study was to determine the incidence, risk factors, and outcomes of management of patients with placenta accreta. Background Placenta accreta occurs when the placental implantation is abnormal. The marked increase in incidence has been attributed to the increasing prevalence of cesarean delivery in recent years. The most common theory is defective decidualization. The most important risk factor for placenta accreta is placenta previa after a prior cesarean delivery. The first clinical manifestation of placenta accreta is usually profuse, life-threatening hemorrhage. The recommended management of suspected placenta accreta is planned preterm cesarean hysterectomy with the placenta left in situ. Patients and methods: It’s a study of all cases of placenta accreta at El-Shatby Maternity University Hospital starting from 1/4/2016 till 1/10/2016. Selection of the cases will only be dependent upon their pregnancy gestational age above 28 weeks of gestation. Results: The incidence of placenta accreta was 1/75 cesarean deliveries. The ultrasonography and doppler had a false negative rate of 54.6% and a sensitivity of 45.2% in diagnosis of placenta accreta. The rate of blood transfusion was 79.6%. Uterine preserving procedures performed in 66%. Cesarean hysterectomy performed in 34%. Intensive care unit admission occurred in 27.3%. The mean gestational age at delivery was 33.8 ± 4.6 weeks’ gestation. 31.8% admitted to the neonatal intensive care unit. Conclusion: The incidence of placenta accreta increased due to the increasing rate of cesarean deliveries, prenatal diagnosis of placenta accreta is paramount, as most women are asymptomatic. Prenatal diagnosis allows time for a multidisciplinary team to make delivery plans, which will help decrease surgical complications.展开更多
The essential nutrition actions explain nutrition through life cycle approach addressing women’s nutrition during pregnancy and lactation, optimal infant and young children feeding, nutritional care for sick children...The essential nutrition actions explain nutrition through life cycle approach addressing women’s nutrition during pregnancy and lactation, optimal infant and young children feeding, nutritional care for sick children and control of anemia, iodine and vitamin A deficiencies. Essential nutrition action has been implemented and resulted in positive outcome in less developed countries. However, the status of practice and associated factors were not studied in Ethiopia. Thus, institution-based cross-sectional study was conducted to assess the practice of essential nutrition actions in healthcare deliveries of Shebedino District, South Ethiopia. Quantitative data were collected though face-to-face interview with health workers and triangulated with data obtained through in-depth interview with health managers in the district and non-participatory observation of client-provider interaction in health facilities. Data were analyzed using SPSS16.0 software. Descriptive and logistic regression analyses were undertaken. The study revealed that 61 (56.0%) health workers practiced essential nutrition actions. Seventy one (65.1%) health workers were trained on essential nutrition actions. The practice of essential nutrition actions was associated with career structure of the health workers (AOR = 6.79, 95%CI: 2.31, 19.98), essential nutrition actions knowledge of health workers (AOR = 6.87, 95%CI: 2.11, 21.51) and availability of monthly nutrition related report form (AOR = 4.95, 95%CI: 1.46, 16.81). The practice of essential nutrition actions was low. The factors affecting the practice were inadequate training and knowledge of essential nutrition actions, career structure of the health workers and availability of monthly report form. Training should be provided for health workers on essential nutrition actions;moreover, essential nutrition actions indicators should be included in monthly report forms of the health institutions.展开更多
Objective::The prevalence of midline birth defects, such as gastroschisis, has increased worldwide, over the last few decades. This study aims to explore the prevalence, maternal epidemiological characteristics, and n...Objective::The prevalence of midline birth defects, such as gastroschisis, has increased worldwide, over the last few decades. This study aims to explore the prevalence, maternal epidemiological characteristics, and natural history of neonates affected by gastroschisis at the University Hospital of Leon city, Nicaragua.Methods:Data were collected from the birth defect surveillance system of the Hospital Oscar Danilo Rosales (HEODRA). The analysis included all pregnancies that had gastroschisis complications between January 1 and December 31, 2020. The prevalence of gastroschisis was calculated according to maternal age. The mothers were interviewed, and the clinical records of the newborns were reviewed.Results::Among the 4,460 deliveries included in this study, four cases of gastroschisis were identified, including three live births and one stillbirth. The gastroschisis rate was 8.9 per 10,000 live births (95% confidence interval [CI]: 0.18-17.8). The prevalence among mothers younger than 20 years and those older than 20 years was 26.4 (95% CI: -3.43 to 56.25) and 3.01 (95% CI: 2.89-8.90)/10,000 births, respectively. Mothers of gastroschisis-affected fetuses were of rural origin ( n = 3), had normal body mass indexes ( n = 3), were exposed to tobacco and wood smoke ( n = 2), and one was exposed to pesticides during the periconceptional period. Primary closure of the gastroschisis was performed on one patient, and complex gastroschisis for intestinal perforation was observed in another patient. The mean hospitalization duration was 33 days, and two patients were discharged alive. Conclusions::Gastroschisis was a significant birth defect among children delivered at HEODRA in 2020. Its prevalence in Nicaragua was higher than that in other countries in the region. All complicated pregnancies were young women with unplanned pregnancies, from rural areas, with exposure to secondhand smoke, and without vitamin supplements before or during the first trimester of pregnancy. Only 67% of infants survived after hospital dis展开更多
基金Project supported by the National Natural Science Foundation of China(No.51138003)the National Social Science Foundation of Chongqing of China(No.2013YBJJ035)
文摘The vehicle routing problem(VRP) is a well-known combinatorial optimization issue in transportation and logistics network systems. There exist several limitations associated with the traditional VRP. Releasing the restricted conditions of traditional VRP has become a research focus in the past few decades. The vehicle routing problem with split deliveries and pickups(VRPSPDP) is particularly proposed to release the constraints on the visiting times per customer and vehicle capacity, that is, to allow the deliveries and pickups for each customer to be simultaneously split more than once. Few studies have focused on the VRPSPDP problem. In this paper we propose a two-stage heuristic method integrating the initial heuristic algorithm and hybrid heuristic algorithm to study the VRPSPDP problem. To validate the proposed algorithm, Solomon benchmark datasets and extended Solomon benchmark datasets were modified to compare with three other popular algorithms. A total of 18 datasets were used to evaluate the effectiveness of the proposed method. The computational results indicated that the proposed algorithm is superior to these three algorithms for VRPSPDP in terms of total travel cost and average loading rate.
文摘This study examined the non-medical factors that influence expectant mothers to opt for caesarean deliveries in Ghana. Data on 395 expectant mothers across the ten regions of Ghana who were located in urban, semi-rural and rural areas, and spanned a period of five years (from 2012 to 2016) were obtained from the Ghana Health Service. In fitting the logistic regression model, data on 355 expectant mothers (i.e. 89.9% of the data) was assigned to the analysis sample while 40 (i.e. 10.1%) was assigned to the hold-out sample. The hold-out sample together with other statistical measures of overall model fit, pseudo R2 measures and classification accuracy were used to validate the results obtained from the analysis sample. Significance was tested at p = 0.05. Determinants including, educational level of expectant mother, parity of expectant mother, baby’s birth weight, previous caesarean delivery, location of expectant mother, age of expectant mother and, period within the year of childbirth had a significant effect on caesarean delivery. The study recommended that health practitioners should be able to foretell expectant mothers who are likely to undergo caesarean delivery in order for them to prepare financially and psychologically to avoid further complications. Due to the significant positive attitude of women towards caesarean delivery rather than normal delivery, it is necessary to inform them about the advantages of normal delivery and the health hazards associated with caesarean delivery to the mother and child.
文摘Background: Current guidelines recommend regional anesthesia versus general as a method of choice for women undergoing cesarean deliveries (CS). However, little is known about the surgical times in the operating room and a choice of anesthesia for cesarean deliveries. Objective: This study was designed to compare times from the arrival to the OR to the delivery of the fetus between regional and general anesthesia along with maternal and fetal outcomes, for patients undergoing cesarean sections for non-reassuring fetal tracing. Study Design: Records were reviewed for patients who underwent cesarean delivery for non-reassuring fetal heart rate tracing from February 2012 to May 2018. A total of 190 charts were selected. Seven patients who received epidural or spinal anesthesia and then converted to general anesthesia (GA) were excluded. The primary outcomes were: 1) entering the operating room to skin incision (min);2) the time from entering the operating room to delivery of the fetus (min). These times were compared among the patients who underwent epidural, spinal and general anesthesia. The secondary criteria included time from skin incision to delivery of the fetus (min), estimated blood loss (ml), Apgars scores, Arterial/venous cord pH, NICU admissions and fetal complications. ANOVA or Kruskal-Wallis Test was used for the continuous variable and Fisher’s exact test was used for the categorical variable to test the differences between groups. Logistic regression model was used for the binary outcomes after adjusting for age, BMI and number of prior laparotomies. Results: Infants in the GA group were delivered significantly faster when compared to epidural and spinal group separately with a P-value of 0.001. The mean time from arrival to OR to delivery of the newborn in GA group was 12.7 minutes, compared to 27 minutes in epidural group and 32.7 minutes in the spinal group. Time intervals from time in the OR to incision and time from incision to delivery of the fetus were also calculated and were significantly
文摘Introduction: Multiple gestations or multiple pregnancies occur when two or more fetuses are conceived at the same time in the same woman. Therefore, a twin pregnancy is defined as the simultaneous development of two fetuses in the same woman. It can either be a monozygotic or dizygotic pregnancy. Twin pregnancy is considered a high-risk pregnancy with variable incidence and outcomes worldwide. The adverse maternal and fetal outcomes of twin deliveries have not yet been investigated in our setting. Objectives: The main objective of this study was to evaluate the outcomes of twin deliveries at the Bamenda Health District. Methods: This was a hospital-based, cross-sectional analytic study done at the Bamenda Health District in three selected hospitals (Bamenda Regional Hospital, CMA Nkwen, and IHC Azire) from the 1<sup>st</sup> of January to the 10<sup>th</sup> of May 2018. 55 women with twin pregnancies and 55 women with singleton pregnancies at gestational ages of 28 completed weeks and above who came for delivery and who consented to the study were included. A face-to-face interview-administered questionnaire was used to obtain sociodemographic characteristics;a venous blood sample was collected from the mothers before and after delivery to determine the estimated blood loss based on haemoglobin level. The partogram was opened from 4 cm cervical dilatation for those who came in the first stage of labour and the mode of delivery was recorded. After delivery, outcome variables were 1<sup>st</sup>, 5<sup>th</sup>, and 10<sup>th</sup> min Apgar score, birth weight, and gestational age. Data were entered in CSPro 7.1 and exported to IBM SPSS version 23.0 for analysis. All variables with p < 0.05 were statistically significant, OR and 95% CI were calculated for all outcome variables to measure the association with twin deliveries. Results: During the study period, we included 110 participants (55 twin mothers and 55 singleton mothers). Women with twin gestations were mostly aged between 25 and 34 years with a mean mat
文摘Equitable water allocation is essential in an irrigation scheme for obtaining potential crop yields from the entire scheme,especially when water supply is inadequate.An optimization model achieved this goal by coupling an optimal water allocation model with available water supply and irrigation water demand for a river-fed rice irrigation system in Malaysia.This model consists of a paddy field water balance module and an optimization module.The outputs from the module are daily irrigation demand and surface runoff,if there is any.The optimization module consists of an objective function,which minimizes water shortage across the scheme area while maintaining equity in water allocation.This model performs optimization subject to several system constraints,and the decision variable of the model is daily releases or supply to the tertiary canals.Performance of this model remained unaffected under different water supply conditions,and the optimization model reliably examined the effects of alternate water allocation and management rules with field information.It improves efficiency and equity in water allocation with respect to crop growth stages and water shortages rather than simply cutting irrigation supply on a proportional basis to overcome water shortages.
文摘Obesity is becoming a global health care problem and an increasing number of obese female patients are getting pregnant. Aim of our study was to know the prevalence of obesity in nulliparous women and its impact on pregnancy as well as fetus. Patients and Methods: All nulliparous women with single pregnancy and gestational age of 37 weeks and above were included in the study. Primigradvida with multiple pregnancies, fetal abnormalities, and gestational age less than 37 weeks were excluded. Patients were divided into normal, overweight and obese group according to their prepragnancy body mass index (BMI). Results: Total 2243 nulliparous women were included in the study, majority (56.8%) of patients were in the normal BMI group and only 24.8% were obese. But a significantly higher number of obese nulliparous women were in the age group of 18 to 29 years (P < 0.05). Comorbidities were significantly higher in obese primigravida. The incidence of gestational diabetes and pregnancy induced hypertension was significantly higher (P 0.05) in obese nulliparous women. Overweight and obese nulliparous patients required significantly higher emergency caesarean section and assisted vaginal deliveries compared to the normal BMI nulliparous women (P < 0.03). Conclusion: Maternal obesity leads to prepartum, peripartum as well as fetal complication. Obese pregnant patients had a significant risk of developing gestational diabetes and pregnancy induced hypertension. In these patients the prevalence of assisted vaginal and cesarean deliveries is significantly high.
文摘Based on self-reported surveys conducted by the Substance Abuse and Mental Health Services Administration, cannabis use in pregnant females has increased over the years. Despite the increasing trend, the relationship between cannabis use and fetal outcomes is not fully understood. This review paper evaluates the literature investigating the short-term and long-term fetal outcomes resulting from cannabis use during pregnancy. Additionally, the risk of chronic marijuana use leading to cannabis hyperemesis syndrome has been highlighted in this paper using conclusions compiled from several case studies. Several studies linked delayed mental growth and reduced cognitive function with prenatal cannabis use, but the literature <span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">was</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> limited to lower-quality observational studies and could not establish causality. One systematic review investigated short-term outcomes of low birth rates and preterm deliveries, where marijuana use in conjunction with tobacco use was associated with more preterm deliveries. Another study found that six-year-old patients exposed to cannabis prenatally were more likely to score lower in different categories on the Stanford-Binet scale test, which measures intelligence. The exposure in the first, second, or third trimester was associated with lower composite or subcategory scores such as verbal reasoning or short-term memory. Despite these results, the studies evaluated had limitations. They could not establish a clear relationship between cannabis use and fetal outcomes, but the literature showed a similar pattern of health, social and economic inequities among the populations who self-reported cannabis and substance use and non-users. Current organization guidelines advise against the use of cannabis use during pregnancy due to mixed and limited literature. However,
文摘Objective: The aim of this study was to determine the incidence, risk factors, and outcomes of management of patients with placenta accreta. Background Placenta accreta occurs when the placental implantation is abnormal. The marked increase in incidence has been attributed to the increasing prevalence of cesarean delivery in recent years. The most common theory is defective decidualization. The most important risk factor for placenta accreta is placenta previa after a prior cesarean delivery. The first clinical manifestation of placenta accreta is usually profuse, life-threatening hemorrhage. The recommended management of suspected placenta accreta is planned preterm cesarean hysterectomy with the placenta left in situ. Patients and methods: It’s a study of all cases of placenta accreta at El-Shatby Maternity University Hospital starting from 1/4/2016 till 1/10/2016. Selection of the cases will only be dependent upon their pregnancy gestational age above 28 weeks of gestation. Results: The incidence of placenta accreta was 1/75 cesarean deliveries. The ultrasonography and doppler had a false negative rate of 54.6% and a sensitivity of 45.2% in diagnosis of placenta accreta. The rate of blood transfusion was 79.6%. Uterine preserving procedures performed in 66%. Cesarean hysterectomy performed in 34%. Intensive care unit admission occurred in 27.3%. The mean gestational age at delivery was 33.8 ± 4.6 weeks’ gestation. 31.8% admitted to the neonatal intensive care unit. Conclusion: The incidence of placenta accreta increased due to the increasing rate of cesarean deliveries, prenatal diagnosis of placenta accreta is paramount, as most women are asymptomatic. Prenatal diagnosis allows time for a multidisciplinary team to make delivery plans, which will help decrease surgical complications.
文摘The essential nutrition actions explain nutrition through life cycle approach addressing women’s nutrition during pregnancy and lactation, optimal infant and young children feeding, nutritional care for sick children and control of anemia, iodine and vitamin A deficiencies. Essential nutrition action has been implemented and resulted in positive outcome in less developed countries. However, the status of practice and associated factors were not studied in Ethiopia. Thus, institution-based cross-sectional study was conducted to assess the practice of essential nutrition actions in healthcare deliveries of Shebedino District, South Ethiopia. Quantitative data were collected though face-to-face interview with health workers and triangulated with data obtained through in-depth interview with health managers in the district and non-participatory observation of client-provider interaction in health facilities. Data were analyzed using SPSS16.0 software. Descriptive and logistic regression analyses were undertaken. The study revealed that 61 (56.0%) health workers practiced essential nutrition actions. Seventy one (65.1%) health workers were trained on essential nutrition actions. The practice of essential nutrition actions was associated with career structure of the health workers (AOR = 6.79, 95%CI: 2.31, 19.98), essential nutrition actions knowledge of health workers (AOR = 6.87, 95%CI: 2.11, 21.51) and availability of monthly nutrition related report form (AOR = 4.95, 95%CI: 1.46, 16.81). The practice of essential nutrition actions was low. The factors affecting the practice were inadequate training and knowledge of essential nutrition actions, career structure of the health workers and availability of monthly report form. Training should be provided for health workers on essential nutrition actions;moreover, essential nutrition actions indicators should be included in monthly report forms of the health institutions.
文摘Objective::The prevalence of midline birth defects, such as gastroschisis, has increased worldwide, over the last few decades. This study aims to explore the prevalence, maternal epidemiological characteristics, and natural history of neonates affected by gastroschisis at the University Hospital of Leon city, Nicaragua.Methods:Data were collected from the birth defect surveillance system of the Hospital Oscar Danilo Rosales (HEODRA). The analysis included all pregnancies that had gastroschisis complications between January 1 and December 31, 2020. The prevalence of gastroschisis was calculated according to maternal age. The mothers were interviewed, and the clinical records of the newborns were reviewed.Results::Among the 4,460 deliveries included in this study, four cases of gastroschisis were identified, including three live births and one stillbirth. The gastroschisis rate was 8.9 per 10,000 live births (95% confidence interval [CI]: 0.18-17.8). The prevalence among mothers younger than 20 years and those older than 20 years was 26.4 (95% CI: -3.43 to 56.25) and 3.01 (95% CI: 2.89-8.90)/10,000 births, respectively. Mothers of gastroschisis-affected fetuses were of rural origin ( n = 3), had normal body mass indexes ( n = 3), were exposed to tobacco and wood smoke ( n = 2), and one was exposed to pesticides during the periconceptional period. Primary closure of the gastroschisis was performed on one patient, and complex gastroschisis for intestinal perforation was observed in another patient. The mean hospitalization duration was 33 days, and two patients were discharged alive. Conclusions::Gastroschisis was a significant birth defect among children delivered at HEODRA in 2020. Its prevalence in Nicaragua was higher than that in other countries in the region. All complicated pregnancies were young women with unplanned pregnancies, from rural areas, with exposure to secondhand smoke, and without vitamin supplements before or during the first trimester of pregnancy. Only 67% of infants survived after hospital dis
文摘The government looks to enhance the booming,yet disorganized,express delivery industry With the rapid development of the express delivery industry in
