Objective To explore the influence of maternal free position combined with duole tools during the first labor stage on birth outcomes.Methods 600 normal pregnant women who were routinely examined in our hospital from May 2016 to December 2016 were selected.They were randomly divided into observation group and control group according to the number of prenatal date of pregnant women,each group in 300 cases.The control group was taken routine supine position in the first labor stage.The observation group used free position with duole tools during the first labor stage.The maternal first labor time,delivery mode,neonatal asphyxia,postpartum hemorrhage,maternal reproductive tract injury were observed.The maternal postpartum within 2 hours,the pain score,maternal childbirth response scale (CCB) and anxiety by comprehensive hospital anxiety and depression table (HAD) were assessed.Results The spontaneous delivery rate and tolerable pain of the observation group were 90.0％(270/300) and 73.7％ (221/300) respectively,which were higher than those of the control group [83.3％(250/300) and 62.0％ (186/300)].The maternal perineum II degree laceration and neonatal asphyxia rates of the observation group were 8.3％(25/300) and 1.7％ (5/300) respectively,which were lower than thsoe of the control group [12.3％(37/300) and 4.3％ (13/300) respectively],the differences were statistically significant(χ2=9.31,9.84,9.05,8.39,all P＜0.05).The maternal first labor time and postpartum hemorrhage of the observation group were (10.87±3.06)h and (121.60±15.11) mL,respectively,which were significantly lower than those of the control group [(11.69±2.48)h and (180.52±14.76)mL],the differences were statistically significant (t=8.92,9.74,all P＜0.05).The HAD score of the observation group was (6.04±1.95)pionts,which was lower than (8.76±1.21)points of the control group.CCB score of the observation group was (49.82±7.61)points,which was higher than (45.33±6.90)points of the control group,the differences were statistically significant (t=10.15,11.32,all P＜0.05).ConclusionTaking the free position with duole tools during maternal first labor stage can improve the natural delivery rate,tolerate pain and postpartum response ability significantly,the first labor stage significantly shortened,postpartum adverse reactions and psychological anxiety decreased.

Objective:To investigate the risk factors of low anterior resection syndrome (LARS)after low anterior resection of rectal cancer (Dixon).Methods:This retrospective study was conducted in Peking University First Hospital and Traditional Chinese Medicine Hospital of Shanxi Provice from Jan 2012 to Jun 2019. A cohort of 504 patients with rectal cancer was enrolled in the study. All the patients underwent anterior resection. The relationship between clinical-pathological data were analyzed retrospectively. Univariate analysis using χ 2 test. Logistic regression analysis was used to screen the influencing factors of LARS, and the Nomogram method was used to score each factors. Results:Univariate analysis showed that BMI≥28 kg/m 2(χ 2=9.450, P=0.002), the distance from the lower edge of the tumors to the anus <6 cm (χ 2=12.070, P=0.001), high ligation of the inferior mesenteric artery (IMA) (χ 2=8.279, P=0.004), preoperative neoadjuvant therapy (χ 2=11.230, P=0.001), postoperative anastomotic leakage (χ 2=11.840, P=0.001) were associated with severe LARS.Multivariate analysis showed that the distance from the lower edge of the tumors to the anus <6 cm ( OR=1.861, 95% CI: 1.289-2.688, P=0.001), BMI≥28 kg/m 2 ( OR=1.747, 95% CI: 1.022-2.987, P=0.041), high IMA ligation ( OR=1.688, 95% CI: 1.157-2.463, P=0.007), preoperative neoadjuvant therapy ( OR=2.719, 95% CI: 1.343-5.505, P=0.005) were independent risk factors for LARS. Nomogram model showed that the total factor ranged from 2 to 212, and the corresponding risk rate ranged from 30% to 80%. The patients with higher score have greater risk for severe LARS. The area under the predictive power curve of Nomogram model (AUC) was 0.749 (95% CI: 0.705-0.793, P<0.001). Conclusion:Lower tumor location, obesity, preoperative neoadjuvant therapy, high IMA ligation and postoperative anastomotic leakage increase the risk of severe LARS.