Introduction: Multiple pregnancies have a higher risk of premature delivery and a weakened cervix has been associated with it. In most cases, emergency cerclage has proved to be beneficial as the birth of the first tw...Introduction: Multiple pregnancies have a higher risk of premature delivery and a weakened cervix has been associated with it. In most cases, emergency cerclage has proved to be beneficial as the birth of the first twin is usually followed by the unavoidable delivery of the second twin and most fetus dies shortly after delivery. Studies have noted that delayed delivery of the second fetus in a twin pregnancy is an effective management choice and the use of cervical cerclage after the first delivery is associated with a longer inter-delivery interval. We present a case of previable premature rupture of membrane of a dichorionic diamniotic twin gestation leading to the loss of the leading twin and subsequently having emergency cervical cerclage for the second twin and caesarean delivery at term. Case Presentation: She was a case of a 29 years old, G<sub>6</sub>P<sub>1</sub><sup>+4</sup> with 1 living child at a gestational age of 17 weeks plus 5 days who initially was diagnosed with dichorionic diamniotic twin gestation following an early ultrasound but presented with a history of bleeding and passage of liquor per vaginam. Ultrasound done on admission showed cervical funneling and a stable state of the second twin. She subsequently had emergency cervical cerclage after stabilization on account of previable premature rupture of membrane of a dichorionic diamniotic twin gestation with the loss of the leading twin. A repeat ultrasound done prior to discharge showed closed cervical os and a good state of the fetus. She then had elective caesarean delivery at term with a good feto-maternal outcome. Conclusion: Emergency cervical cerclage should be part of the options of management after stabilization in cases of previable premature rupture of membrane in a dichorionic or multichoronic gestation so as to save the viable once.展开更多
Sediment delivery ratio(SDR)for fluvial rivers was formulated with sediment rating curve.The observed data of SDR on flood event scale of the Lower Yellow River(LYR)were adopted to examine the formulation and to calib...Sediment delivery ratio(SDR)for fluvial rivers was formulated with sediment rating curve.The observed data of SDR on flood event scale of the Lower Yellow River(LYR)were adopted to examine the formulation and to calibrate the model parameters.A regression formula of SDR was then established and its 95%prediction interval was accordingly quantified to represent its overall uncertainties.Three types of factors including diversity of the incoming flow conditions,river self-regulation processes,and human activities were ascribed to the uncertainties.The following were shown:(1)With the incoming sediment coefficient(ISC)being a variable,it was not necessary to adopt the incoming flow discharge as the second variable in the formulation of SDR;and(2)ISC=0.003 and therefore SDR=2 might be a threshold for distinguishing the characteristics of sediment transport within the LYR.These findings would highlight sediment transport characteristics on the scale of flood event and contribute to uncertainty based analysis of water volume required for sediment transport and channel maintenance of the LYR.展开更多
Background： The one-step method was routine practices in China, scientific evidence to support this intervention is scarce. The purpose of this study was to observe the natural process of head-to-body delivery interv...Background： The one-step method was routine practices in China, scientific evidence to support this intervention is scarce. The purpose of this study was to observe the natural process of head-to-body delivery interval by waiting for at least one contraction （two-step） after head delivered in normal birth. Methods： From March 1 to March 30 in 2015 at Haikou Maternal and Child Hospital in China, normal vaginal birth with normal baby condition were recorded by video. Videotapes were transferred to computer then replayed and observed. Results： Ninety-two cases were enrolled in this study. The average head-to-body delivery interval by two-step delivery was 71.04± 61.02 s, （mean ＋ 2 standard deviation - 193.07 s, 95% confidence interval [15.65-229.15] s）. Fifty-one patients （51/92, 55.43%） were 〈60 s, 41 patients （41/92, 44.57%） were over 60 s. Shoulders delivered at the first contraction were 96.74% （89/92）, 3.26% （3/92） had delivered by the second contraction. Shoulders emerged from perineum were 71.73% （66/92）, 15.21% （14/92） transversely, and 13.04% （12/92） emerged from under pubic arch. Babies cried before the shoulder were 31.52% （29/92）, cried after birth 52.17% （48/92）, and 16.30% （15/92） did not cry after birth. Baby activities included as making faces, sucking, and bubbled from mouth and noses, and the lighter blue color of skin with good perfusion. Conclusions： The average time of head-to-body delivery interval was longer than 60 s by two-step delivery. Majority shoulders were delivered at the first contraction. Majority shoulders emerged from perineum rather from under pubic arch. The routine one-step method of shoulder delivery where the downward force applied is not necessary and is not the right direction. Baby＇s breath, making faces, sucking, bubble from noses and mouth, and the light blue color of the faces, all those signs during shoulder delivery indicated a normal live birth.展开更多
Objective: To evaluate the impact of an emergency cesarean standard operating procedure (SOP) on the decision-to-delivery interval (DDI) and to determine whether a shorter DDI improves neonatal outcome. Methods: Retro...Objective: To evaluate the impact of an emergency cesarean standard operating procedure (SOP) on the decision-to-delivery interval (DDI) and to determine whether a shorter DDI improves neonatal outcome. Methods: Retrospective analysis of emergency cesareans from 2004 (introduction of the new SOP) to 2009 in a Swiss Level 3 perinatal center. Primary endpoints were the DDI, the pathology-to-decision interval (PDI), the 5 year learning curve, and neonatal and maternal outcome. Results: In the emergency cesarean group (175 women and 188 infants), mean DDI decreased over the observation period from 15 to 9 minutes (mean 10 minutes 41 seconds), and mean PDI from 11 to 6 minutes (mean 8 minutes). Not only did the DDI not exceed 15 minutes in over 90% of cases during the 5 years, but it fell consistently below 10 minutes in the latter stages of the learning curve. Only 2/188 infants had an umbilical artery展开更多
目的探讨双胎妊娠延迟分娩(delayed interval delivery of the twin,DIDT)的临床处理及母婴结局。方法回顾性分析2019年1月至2022年7月北京大学第三医院收治的6例多胎妊娠延迟分娩病例,分析相关临床处理及母婴结局。结果6例患者中有1例...目的探讨双胎妊娠延迟分娩(delayed interval delivery of the twin,DIDT)的临床处理及母婴结局。方法回顾性分析2019年1月至2022年7月北京大学第三医院收治的6例多胎妊娠延迟分娩病例,分析相关临床处理及母婴结局。结果6例患者中有1例为单绒毛膜双羊膜囊双胎,5例为双绒毛膜双羊膜囊双胎;2例患者在一胎儿娩出前已行宫颈环扎,一胎儿娩出后均未行宫颈环扎术。延迟分娩胎儿6例,存活5例。母体均未出现严重的感染、出血及宫颈撕裂等并发症。结论DIDT能延长孕周,在延迟分娩过程中需动态监测母儿情况及感染指标,预防性应用抗生素,个体化选择抑制宫缩、促胎肺成熟及宫颈环扎等治疗措施。展开更多
文摘Introduction: Multiple pregnancies have a higher risk of premature delivery and a weakened cervix has been associated with it. In most cases, emergency cerclage has proved to be beneficial as the birth of the first twin is usually followed by the unavoidable delivery of the second twin and most fetus dies shortly after delivery. Studies have noted that delayed delivery of the second fetus in a twin pregnancy is an effective management choice and the use of cervical cerclage after the first delivery is associated with a longer inter-delivery interval. We present a case of previable premature rupture of membrane of a dichorionic diamniotic twin gestation leading to the loss of the leading twin and subsequently having emergency cervical cerclage for the second twin and caesarean delivery at term. Case Presentation: She was a case of a 29 years old, G<sub>6</sub>P<sub>1</sub><sup>+4</sup> with 1 living child at a gestational age of 17 weeks plus 5 days who initially was diagnosed with dichorionic diamniotic twin gestation following an early ultrasound but presented with a history of bleeding and passage of liquor per vaginam. Ultrasound done on admission showed cervical funneling and a stable state of the second twin. She subsequently had emergency cervical cerclage after stabilization on account of previable premature rupture of membrane of a dichorionic diamniotic twin gestation with the loss of the leading twin. A repeat ultrasound done prior to discharge showed closed cervical os and a good state of the fetus. She then had elective caesarean delivery at term with a good feto-maternal outcome. Conclusion: Emergency cervical cerclage should be part of the options of management after stabilization in cases of previable premature rupture of membrane in a dichorionic or multichoronic gestation so as to save the viable once.
基金supported by the Ministry of Science and Technology (Grant No.2006BAB06B04)the National Natural Science Foundation of China(Grant No.50725930)
文摘Sediment delivery ratio(SDR)for fluvial rivers was formulated with sediment rating curve.The observed data of SDR on flood event scale of the Lower Yellow River(LYR)were adopted to examine the formulation and to calibrate the model parameters.A regression formula of SDR was then established and its 95%prediction interval was accordingly quantified to represent its overall uncertainties.Three types of factors including diversity of the incoming flow conditions,river self-regulation processes,and human activities were ascribed to the uncertainties.The following were shown:(1)With the incoming sediment coefficient(ISC)being a variable,it was not necessary to adopt the incoming flow discharge as the second variable in the formulation of SDR;and(2)ISC=0.003 and therefore SDR=2 might be a threshold for distinguishing the characteristics of sediment transport within the LYR.These findings would highlight sediment transport characteristics on the scale of flood event and contribute to uncertainty based analysis of water volume required for sediment transport and channel maintenance of the LYR.
文摘Background： The one-step method was routine practices in China, scientific evidence to support this intervention is scarce. The purpose of this study was to observe the natural process of head-to-body delivery interval by waiting for at least one contraction （two-step） after head delivered in normal birth. Methods： From March 1 to March 30 in 2015 at Haikou Maternal and Child Hospital in China, normal vaginal birth with normal baby condition were recorded by video. Videotapes were transferred to computer then replayed and observed. Results： Ninety-two cases were enrolled in this study. The average head-to-body delivery interval by two-step delivery was 71.04± 61.02 s, （mean ＋ 2 standard deviation - 193.07 s, 95% confidence interval [15.65-229.15] s）. Fifty-one patients （51/92, 55.43%） were 〈60 s, 41 patients （41/92, 44.57%） were over 60 s. Shoulders delivered at the first contraction were 96.74% （89/92）, 3.26% （3/92） had delivered by the second contraction. Shoulders emerged from perineum were 71.73% （66/92）, 15.21% （14/92） transversely, and 13.04% （12/92） emerged from under pubic arch. Babies cried before the shoulder were 31.52% （29/92）, cried after birth 52.17% （48/92）, and 16.30% （15/92） did not cry after birth. Baby activities included as making faces, sucking, and bubbled from mouth and noses, and the lighter blue color of skin with good perfusion. Conclusions： The average time of head-to-body delivery interval was longer than 60 s by two-step delivery. Majority shoulders were delivered at the first contraction. Majority shoulders emerged from perineum rather from under pubic arch. The routine one-step method of shoulder delivery where the downward force applied is not necessary and is not the right direction. Baby＇s breath, making faces, sucking, bubble from noses and mouth, and the light blue color of the faces, all those signs during shoulder delivery indicated a normal live birth.
文摘Objective: To evaluate the impact of an emergency cesarean standard operating procedure (SOP) on the decision-to-delivery interval (DDI) and to determine whether a shorter DDI improves neonatal outcome. Methods: Retrospective analysis of emergency cesareans from 2004 (introduction of the new SOP) to 2009 in a Swiss Level 3 perinatal center. Primary endpoints were the DDI, the pathology-to-decision interval (PDI), the 5 year learning curve, and neonatal and maternal outcome. Results: In the emergency cesarean group (175 women and 188 infants), mean DDI decreased over the observation period from 15 to 9 minutes (mean 10 minutes 41 seconds), and mean PDI from 11 to 6 minutes (mean 8 minutes). Not only did the DDI not exceed 15 minutes in over 90% of cases during the 5 years, but it fell consistently below 10 minutes in the latter stages of the learning curve. Only 2/188 infants had an umbilical artery
文摘目的探讨双胎妊娠延迟分娩(delayed interval delivery of the twin,DIDT)的临床处理及母婴结局。方法回顾性分析2019年1月至2022年7月北京大学第三医院收治的6例多胎妊娠延迟分娩病例,分析相关临床处理及母婴结局。结果6例患者中有1例为单绒毛膜双羊膜囊双胎,5例为双绒毛膜双羊膜囊双胎;2例患者在一胎儿娩出前已行宫颈环扎,一胎儿娩出后均未行宫颈环扎术。延迟分娩胎儿6例,存活5例。母体均未出现严重的感染、出血及宫颈撕裂等并发症。结论DIDT能延长孕周,在延迟分娩过程中需动态监测母儿情况及感染指标,预防性应用抗生素,个体化选择抑制宫缩、促胎肺成熟及宫颈环扎等治疗措施。
