Objective To evaluate clinical efficacy and safety of single puncture and irrigation with Mammotome system in treatment of lactational breast abscess without drainage. Methods 32 patients with lacta-tional breast abscess were treated with ultrasound-guided puncture and irrigation by Mammotome system. Pus was cleared and necrotic material was removed. The residual cavity was irrigated with 3% hydrogen peroxide solution and Kangfuxin solution and no drainage was placed. Breast-feeding on time was encouraged. Results All pa-tients were successfully treated with single puncture and irrigation. The average length of hospital stay was 4 days. Except for 3 cases actively requesting to stop lactating, the other 29 patients continued to breast-feed. There was one case with postoperative hematoma, one with wound granuloma, and no other complications occurred. There was no relapse during the follow-up of 3 to 36 months. All patients were satisfied with the appearance of the breasts. Conclusions Single puncture and irrigation with Mammotome system without drain placement is a safe procedure in treatment of lactational breast abscess with the advantage of minimal invasion, low complication and does not affect breastfeeding.

Objective:To systematically observe the location and severity of perineal lacerations during childbirth and explore the relationship between the length/depth and the degrees of perineal lacerations.Methods:This prospective study recruited full-term singleton cephalic pregnant women planning vaginal delivery at the Fourth Hospital of Shijiazhuang from March 2023 to July 2023. Before the second stage of labor, the perineal body length (PBL) was measured. After delivery, the locations of all birth canal lacerations, the perineal skin lacerations length (PSLL), and the perineal lacerations depth (PLD) were measured and recorded. A magnifying glass was used to identify the layers of the skin and photographs were taken if necessary. Statistical methods such as t-test, rank-sum test, and Chi-square test (or Fisher's exact test) were used to compare the basic conditions and birth canal lacerations between primiparous and multiparous women. The receiver operating characteristic (ROC) curve was used to analyze the sensitivity and specificity of PSLL, PLD, and the PSLL/PBL ratio. Results:During the study period, 200 women were included, of which 189 had vaginal deliveries (173 primiparous and 16 multiparous) and 11 had emergency cesarean sections (10 primiparous and one multiparous). Among the 173 primiparous women with vaginal deliveries, 33 (19.1%) underwent episiotomy, and the other 140 (80.9%) had perineal lacerations. Among these cases of perineal lacerations, nine were complicated by vaginal wall lacerations, 20 by labial lacerations, and four by clitoral and urethral lacerations. There were 32 (22.9%) primiparous women with first-degree perineal lacerations and 108 (77.1%) with second-degree perineal lacerations. Among the 16 multiparous women who delivered vaginally, two had intact birth canals without lacerations, and 14 had perineal lacerations (eight with first-degree and six with second-degree perineal lacerations). Besides, none of them underwent episiotomy or assisted vaginal delivery. The rates of episiotomy and second-degree perineal lacerations were higher in primiparous women than in multiparous women [19.1% (33/173) vs. 0/16, 77.1% (108/173) vs. 6/14, Fisher's exact test, both P<0.05). The PSLL, PLD, and PSLL/PBL ratio were significantly lower in the primiparous women with first-degree perineal lacerations than in the primiparous women with second-degree perineal lacerations [0.0 mm (0.0-10.0 mm) vs. 30.0 mm (25.5-40.0 mm), 5.0 mm (1.5-10.0 mm) vs. 14.0 mm (10.0-15.0 mm), 0.0 mm (0.0-21.1 mm) vs. 63.6 mm (50.0-77.3 mm); Z values were－8.04,－6.46, and－7.75, respectively, all P<0.05]. The optimal cut-off values of PSLL, PLD, and PSLL/PBL ratio for differentiating between first-degree and second-degree perineal lacerations were 15 mm, 9 mm, and 33.33%, with the area under the ROC curve (AUC) of 0.965, 0.869, and 0.951 and the sensitivity of 91.67%, 91.67%, and 89.81%, respectively. The AUC of PSLL was significantly greater than that of PLD ( Z=2.55, P=0.011), but the AUC of PSLL/PBL ratio showed no significant difference with that of PSLL or PLD ( Z=1.18 and 1.89, both P>0.05). Conclusions:It is difficult for full-term primiparas to maintain perineal integrity during vaginal delivery. Measuring the PSLL, PLD, and PSLL/PBL ratio of primiparous women will be useful for distinction between first- and second-degree perineal lacerations.