Objective To explore the effects of whole-stage labor analgesia on maternal and neonatal outcomes after the implementation of the new partogram.Methods A retrospective cohort study was performed in Peking University First Hospital.From June to December 2016,907 nulliparae with full-term singleton cephalic pregnancies that were expected to deliver vaginally and adhered to the new partogram were selected as the study group,and 982 cases that adhered to the old partogram (Friedman standard) from June to December 2012 were selected as the control group.Maternal basic characteristics and analgesic,obstetric and neonatal data were collected.Maternal and neonatal outcomes between the two groups were analyzed with independent sample t-test,rank sum test or Chi-square test (Fisher's exact test).Results (1) Maternal age and the proportion of gravidas of advanced maternal age in the study group were both higher than those in the control group [(30.2±3.0) vs (29.64-2.9) years,t=3.823;8.2％ (74/907) vs 4.2％ (41/982),x2=13.087;both P＜0.001].No statistically significant difference in the other basic characteristics was found between the two groups.(2) Women in the study group had significantly smaller cervical dilatation [M(P25-P75)] than that in the control group when analgesia was commenced [2(1-2) vs 2(1-3) cm,Z=-3.752].The intensity of pain quantified with numerical rating scale (NRS) before analgesia,and during the second stage of labor in the study group were less than that in the control group [8(8-9) vs 8(8-10) points,Z=-14.441;5(4-5) vs 6(5-7) points,Z=-16.495].The study group had longer median duration of analgesia than the control group [520(340-750) vs 300(200-453) min,Z=-17.801,P＜0.001].The overall dose of analgesics in injection pump in the study group was significantly higher compared with that used in the control group [68 (35-84) vs 30 (18-48) ml,Z=-18.004,P＜0.001].However,there was no significant difference in the incidence of analgesia-related complications (hypotension,accidental dura puncture,lower extremity numbness,pruritus and urinary retention) between the two groups.(3) The study group showed a higher percentage of spontaneous vaginal delivery,and a lower rate of converted cesarean section compared with the control group [71.8％ (651/907) vs 63.2％ (621/982),x2=15.623;13.6％ (123/907) vs 20.5％ (201/982),~=18.831;both P＜0.001].The study group had lower forceps-assisted vaginal delivery rate than the control group without statistically significant difference [14.8％ (133/907) vs 15.3％ (150/982),x2=0.093,P=0.797].The duration of the first,second and third stage of labor in the study group were all significantly longer than that of the control group [680 (470-900) vs 480 (360-660) min,Z=-12.490;56 (31-89) vs 37 (24-58) min,Z=-9.964;7 (5-10) vs 6 (5-8) min,Z=-6.673;all P＜0.001].Women in the study group had a lower rate of artificial rupture of membranes when comparing with the control group [55.2％ (501/907) vs 63.2％ (621/982),x2=12.516,P＜0.001].The incidence of fever,pathologically confirmed infection and postpartum hemorrhage were significantly higher in the study group than that in the control group [10.8％ (98/907) vs 6.4％ (63/982),x2=11.652;9.6％ (87/907) vs 3.7％ (36/982),x2=27.201;12.6％ (114/907) vs 5.7％ (56/982),x2=27.144;all P＜0.05].There was no significant difference in the rate of oxytocin use during labor or blood transfusion between the two groups.(4) Compared with the control group,the proportion of cesarean section due to arrested active stage of labor in the study group was significantly lower [5.7％ (7/123) vs 50.2％ (101/201),x2=68.173,P＜0.05],but the incidences of cesarean section due to intrauterine infection and relative cephalopelvic disproportion were higher in the study group [61.0％ (75/123) vs 30.8％ (62/201),x2=2.680;20.3％ (25/123) vs 8.0％ (16/201),x2=10.555;both P＜0.05].There was no significant difference in the proportion of fetal distress or other indications for cesarean section between the two groups.(5) There was no significant difference between the two groups in birth weight,macrosomia,fetal distress,neonatal asphyxia,or the proportion of neonatal intensive care unit admission.Conclusions After the implementation of the new partogram,analgesic pain relief covering the whole labor prolongs the average analgesic time and reduces the rate of cesarean section due to arrested active stage of labor.Although the risk of postpartum hemorrhage is slightly increased,analgesia itself does not pose additional risks on forceps-assisted delivery,maternal blood transfusion and neonatal asphyxia.

Objective To explore the effect of quality control circle ( QCC) activities on increasing early neonatal contact rate of mother and early breast sucking rate .Methods Set up a QCC,then follow the steps of QCC with professional tools to solve existing problems in early skin-to-skin contact for mothers and their healthy newborn infants and early breast sucking .Rate was compared before and after the improvements .Results The early neonatal contact rate of mother and early breast sucking rate increased from 80.94% to 93.57%,and the difference was significant (χ2 =35.07,P<0.001).Conclusions The application of the quality improvement tool of QCC could improve the early skin-to-skin contact for mothers and their healthy newborn infants and early breast sucking , and helps the mother to breastfeed successfully .

Objective With methods of literature review, item test, reliability and validity test, etc., to develop a fall risk assessment scale specific to the obstetrical department, which, after reliability and validity test, can be used for women health care before, at and after delivery.Methods Items in the fall risk assessment scale for pregnant and maternal women were determined and weights were assigned by reviewing relative risk factors in literature, referring to items in other fall risk assessment tools from home and aboard. After a preliminary scale was formed, 154 pregnant and maternal women hospitalized from May to December 2016 were assessed, so that reliability and validity of the scale were tested.Results In this fall risk assessment scale for the obstetrical department, test-retest reliability was 0.822, interrater reliability was 0.926, content validity of expertise was 0.927, and area under the curve (ROC) was 0.750 (P<0.05). When the dividing value was 3.5, sum of sensitivity (0.714) and specificity (0.714) reached the max.Conclusions The new fall risk scale, with favorable reliability and validity, can filter patients with high risk of fall, yet, it is still to be testified and perfected in future application.

Objective To explore the effects of two kinds preoperative fasting and liquid-fasting time before caesarean section on blood glucose of puerperae with GDM before and after the operation,intra-operative complications and on blood glucose of neonates.Methods With prospective study method,162 puerperae with GDM admitted to obstetrical department of Peking University First Hospital and received cesarean section under combined spinal-epidural anesthesia between April 1st and Sep. 30th in 2015,were selected as the research object,and were divided into the control group (admitted on odd-numbered days) and the observation group (admitted on even-numbered days). Puerperae in the control group were forbidden to eat solid food for 8 h and drink transparent liquid for 6 h before the operation,while those in the observation group were forbidden to eat solid food for 6 h and drink transparent liquid for 2 h before the operation. Puererae in two groups were compared about their preoperative blood glucose,incidence of intraoperative nausea and vomiting or aspiration,intra-operative quality of bleeding,postoperative exsufflation time and blood glucose half an hour after the operation, meanwhile,neonates in two groups were compared about their Apgar scores 1 min and 5 min after birth,and their blood glucose half an hour after birth. Statistical analysis was done by independent-samplest test,Mann-WhitneyU test and χ2 test.Results Difference of preoperative blood glucose of puererae in two groups was statistically significant (P<0.01). Differences of intraoperative bleeding of puererae in two groups and blood glucose of neonates half an hour after birth in two groups were statistically significant (P<0.05). There was no statistic difference in the incidence of intraoperative nausea and vomiting or aspiration,postoperative exsufflation time of puererae,or Apgar scores 1 min and 5 min after birth of neonates in two groups(P>0.05).Conclusions The scheme of forbidding puererae from eating solid food for 6 h and drinking transparent liquid for 2 h before cesarean section can reduce the incidence of preoperative hypoglycemia,maintain a smooth post-operative blood glucose, reduce intraoperative bleeding without increasing the incidence of intraoperative complications like nausea,vomiting or aspiration,or hypoglycemia of the neonates. The new fasting and liquid-fasting scheme is safe and feasible,which makes it worth promoting in clinic.

Objective:To explore the effect of early essential newborn care technology during cesarean section on early health outcomes of mothers and infants and breast feeding.Methods:This study was a randomized controlled study. From October 2020 to August 2021, 104 delivery women and their newborns who were scheduled for full-term cesarean section in Peking University First Hospital were selected as the study subject. The subjects were randomly divided into control group and intervention group, 52 cases in each group. The control group received routine nursing of the newborn after cesarean section, while the intervention group received early essential newborn care technology after cesarean section. The amount of postpartum hemorrhage, hospital stay, Apgar score at one and five minutes after birth, the incidence of abnormal conditions within 90 minutes after birth, the time of umbilical cord shedding, the time of the first feeding sign of the newborn, the success rate of early initiation of breastfeeding and the implementation of breast feeding at discharge were compared between the two groups.Results:There was no statistical difference between the two groups in the amount of postpartum hemorrhage within two hours, the amount of postpartum hemorrhage within two to 24 hours and the number of days in hospital ( P>0.05) . There was no statistical difference between the two groups in Apgar scores at one and five min after birth ( P>0.05) . There was no statistical difference between the two groups in the occurrence of re-attraction, respiratory abnormalities, resuscitation, Neonatal Intensive Care Unit (NICU) transfer and other abnormalities within 90 minutes after birth ( P>0.05) . There was no statistical difference in the time of umbilical cord shedding between the two groups ( P>0.05) , and no umbilical infection occurred. The first foraging reflex in the intervention group was earlier than that in the control group, and the success rate of early initiation of breastfeeding was higher than that in the control group, and the differences was statistically significant ( P<0.05) . There was no statistical difference in the implementation of breast feeding between the two groups at discharge ( P>0.05) . Conclusions:It is safe and feasible to implement early essential newborn care technology during cesarean section, and it can effectively promote early initiation of breastfeeding, which is of great significance for breast feeding and has the value of clinical promotion.

Objective To determine the effects of delayed umbilical cord clamping on the postpartum hemorrhage,instant and long-term newborn anemia,newborn jaundice.Methods In total,303 infants were selected during October 2016 to June 2017 in three hospitals in Beijing.They were randomly allocated into two groups receiving instant clamping of umbilical cord (less than 60s after delivery,n=158) and delayed clamping of umbilical cord(after cord pulsation ceased,n=145).Relevant indicators of maternal and neonatal outcomes are compared.Results There were significant differences between two groups in instant hemoglobin concentration and in 5～7 days (P＜0.05).There were no differences between two groups in transcutaneous bilirubin,the risk of anemia in three months,the risk of jaundice in 5～7 days and the need of blue-light therapy (P＞0.05).There were no differences between two groups of women in postpartum hemorrhage,the length of third stage of labor and the rate of breast feeding (P＞0.05).Conclusion Clamping the umbilical cord when cord pulsation has ceased does not have negative effects on delivery process and postpartum hemorrhage,but it increases the instant hemoglobin concentration and hemoglobin concentration after delivery in 5～7 days.Still it is unclear whether it will affect the risk of jaundice.

Objective:To retrieve and analyze the relevant guidelines for the second and third stages of normal delivery, and summarize the evidence of high-quality guidelines so as to provide references for the formulation of clinical practice programs.Methods:We took Johns Hopkins evidence-based nursing practice model as theoretical guidance and set up an evidence-based team.We systematically searched major guideline publication websites, electronic resource databases, related academic groups and guideline networks at home and abroad, evaluated guidelines and summarized the best evidence, and the search time limit was up to June 1, 2019. The literature quality evaluation and evidence extraction were carried out independently by four researchers with evidence-based training.Results:This study included two guidelines, summarizing the 20 best evidences in 9 aspects of humanistic support, delivery companion, delivery position, fetal monitoring, delayed exertion, perineal protection, fundus compression, prevention of postpartum hemorrhage, and delayed umbilical cord clamping.Conclusions:Based on the existing evidence, it integrates the best evidence of nursing measures for the second and third stages of normal delivery. It is recommended that maternal and child institutions promote the transformation of the best evidence based on their actual conditions.

Objective: To evaluate the effect of new media among women with gestational diabetes mellitus (GDM) during postpartum period. Methods: The gestational diabetes maternal in the obstetrics department of Peking University First Hospital from May to June, 2017 was selected. We used excel generated random number table to divide the groups, there were 50 cases in the control group and 46 cases in the study group. The control group used routine postpartum routine health education, including informing 2 groups of maternal weight management diet and exercise plans, giving leaflets, and conducting telephone to supervise the quality control; based on these situations, the study group added group WeChat push reminders and Q&A, and "317 Protector" to push the heath education materials after discharge. Then we did comparison of oral glucose tolerance test (OGTT), lipid test results and body mass index (BMI) of the two groups on the 42nd day postpartum. Results: The recovery and control of the study group women were better than those of the control group. In the study group, BMI, fasting blood glucose, triglyceride, total cholesterol, high-density lipoprotein, and low-density lipoprotein were (22.13±2.91) kg/m², (5.06±0.39) mmol/L, (0.89±0.27) mmol/L, (5.61±0.68) mmol/L, (1.52±0.27)mmol/L, (3.16±0.71) mmol/L after 42 days of birth. While in the control group, these were (23.66±4.21)kg/m², (5.30±0.47) mmol/L, (1.03±0.36) mmol/L, (5.64±0.66) mmol/L, (1.63±0.30) mmol/L, (3.23±0.62) mmol/L. The difference between the two groups was statistically significant (t value was -3.604-2.059, P<0.05 or 0.01). Conclusion New media for postpartum follow-up of gestational diabetes can effectively help improve BMI, blood lipids and other indicators, and can also help blood sugar control effect.