Objective To construct and evaluate the effects of 4C characteristic home health care services model on the health of puerperas and fetuses.Methods A total of 162 puerperas and neonates were recruited,assigned by random nember table to routine community care condition and 4C characteristic home health care condition matched on the type and degree of health condition as well as the puerperas' culture background.The health condition of puerperas and neonates were investigated and compared between the two groups 42 days after delivery.Results The incidence of breast bilges,cracked nipple,re-visit the doctor,re-admission,anxiety and depression were significantly lower in the home health care group than routine community care group [3.7％ (3/81) vs.23.5％ (19/81),2.4％ (2/81) vs.17.3％ (14/81),2.5％ (2/81) vs.16.0％ (13/81),1.2％ (1/81) vs.16.0％ (13/81),(37.35±10.72) scores vs.(41.73±10.55) scores,(39.53±13.19) scores vs.(43.94±13.44) scores,x2=21.753,18.378,8.890,11.259,t=2.621,2.108,P ＜ 0.05 or 0.01].The success breastfeeding rates,correct rate of related knowledge and master degree of newborn,self-nursing newborn skills and puerperas and relatives' satisfaction scores were significantly higher in the home health care group than routine community care group [71.6％ (58/81) vs.37.0％ (30/81),95.1％ (77/81) vs.59.3％ (48/81),91.4％ (74/81) vs.53.1％ (43/81),（92.31±3.61) scores vs.(89.83±5.43) scores,x2=21.202,29.506,29.569,t=3.423,P＜ 0.01].In additon,the rate of re-visit the doctor,re-admission and omphalitis were significantly lower in home health care group than the routine community care group [2.5％ (2/81) vs.13.6％ (11/81),6.2％ (5/81) vs.23.5％ (19/81),4.9％ (4/81) vs.22.2％ (18/81),x2=6.774,9.172,9.288,P＜0.01 or 0.05].Conclusions 4C characteristic home health care reduced the probability of breast problems and unhealthy emotions for the puerperas,reducing the severity of jaundice as well as omphalitis for fetuses,reducing the probability of re-visit the doctor and re-admission for the puerperas and neonates,which can increase patients' satisfactory and promoting the mothers and their families to master self-nursing and newborn nursing skills and the other related knowledge.

Objective:To comprehensively evaluate and compare the early warning system's ability to predict the risk of maternal disease in China, such as the British National Intensive Care Audit and Research Center (ICNARC)-Obstetric Early Warning Score (OEWS) system, the National Maternal Safety Early Warning Standard (MEWC) recommended by the National Coalition for Maternal Safety, the Irish Maternity Early Warning System (IMEWS) proposed in the clinical practice guidelines issued by the head of health services at the Royal Medical College of Ireland.Methods:A total of 872 pregnant women who were admitted to the Women′s Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital were prospectively observed from January 2019 to December 2019. The data during hospitalization were collected to calculate the scores of the three obstetric early warning scoring systems, to compare and evaluate the prediction and identification ability of three early warning systems for critically ill pregnant women.Results:A total of 872 cases were included in this study, of which 167 were critically ill, accounting for 19.2%, and 705 were non-critically ill, accounting for 80.8%. The three obstetric early warning systems (OEWS,MEWC,IMEWS) in critical group scored 4(2, 6),3(0, 6),5(3, 6), and non-critical group scored 1(0, 1), 0(0, 0), 2(0, 3), respectively. The critical group scored significantly higher than the non-critical group ( P<0.001). The AUC of OEWS was 0.961 (95% CI 0.948-0.975, P<0.001) and that of MEWC was 0.803 (95% CI 0.757 - 0.850, P<0.001). The AUC of IMEWS was 0.853 (95% CI 0.817-0.888, P<0.001). No obstetric critical illness occurred when OEWS was 0. The positive likelihood ratio was 8.208 6 when OEWS≥6. Conclusions:Three kinds of early warning systems have good predictive ability for the occurrence of critical obstetric diseases in China. Among the three warning systems, OEWS has better predictive ability than the other two, and has better hierarchical ability. However, due to the differences in population, environment and conditions in different regions, each obstetric medical unit can improve OEWS according to its own conditions and design an obstetric early warning system that meets its own clinical needs.

Objective:To summarize up the care experience about a woman with broad ligament haematoma after cesarean section.Methods:The clinical data of 1 case of broad ligament haematoma of uterus after cesarean section and summarized the main points of clinical nursing was reviewed. The nurse found the signs of intraperitoneal bleeding through closely observation, and it was confirmed to be a hematoma of broad ligament of uterus by B ultrasound. After removal of hematoma, the nurse strengthened the abdominal drainage and circulation monitoring to prevent re-bleeding in the abdominal cavity, nursing the fever in the process of hematoma absorption. At last, it was important to pay attention to psychological nursing, helping the maternal to live through acute period.Results:The woman was discharged on the 8 thpost-operative day. Conclusions:The nurses of obstetric should have the ability of critical thinking in clinical work, carry out postoperative monitoring strictly after cesarean section and timely find signs of internal bleeding. Through multidisciplinary rescue, a serious adverse outcome of broad ligament haematoma can be prevented.

Objective:To explore the current status and the influencing factors of protracted postpartum urinary retention(P-PUR) in women with labor analgesia, so as to provide evidences for early diagnosis and timely intervention for P-PUR.Methods:A total of 41 995 women who were given vaginal delivery under labor analgesia from January 2017 to October 2020 in Women′s Hospital of Nanjing Medical University were chosen as the research objects. A retrospective analysis was performed for the clinical data of 62 women with P-PUR, and a 1∶4 matching case control study was conducted. Logistic regression analysis was used to analyze the variables with statistical difference in univariate analysis, so as to explore the independent influencing factors of P-PUR in women with labor analgesia.Results:Among 41 995 women with labor analgesia, 62 women suffered from P-PUR, and the incidence was about 0.15% (62/41 995). The Logistic regression model showed that nulliparity ( OR=121.80, 95% CI 8.59-1 727.40, P<0.05), forceps delivery ( OR=13.41, 95% CI 2.21-81.58, P<0.05),Ⅱdegree porineal iaceration ( OR=0.04, 95% CI 0.01-0.11, P<0.05), episiotomy ( OR=0.13, 95% CI 0.04-0.47, P<0.05) and perineotomy with perineal laceration ( OR=0.20, 95% CI 0.06-0.63, P<0.05) were the independent risk factors. Conclusions:For primiparas with labor analgesia, interventions should be taken to reduce perineal injury, and indications of forceps delivery should be strictly controlled, so as to reduce P-PUR and adverse urinary tract complications.

Objective:To summarize the scope of relevant research on the psychological state of parents during perinatal loss of re-pregnancy, and summarize the research status, so as to provide reference for future research and intervention.Methods:From the establishment of the database to December 2020, the literatures of China biomedical literature database, China Knowledge Network, VIP, Wanfang database, Medline, CINAHL, Web of Science, psychINFO and Cochrane Library were searched, the studies related to the psychological state, feelings and experience of the population were screened, and the JBI scope Review Guide was used as the methodological framework for analysis.Select the research related to the psychological state, feelings and experience of the population, and use the JBI scope review guide as the methodological framework for analysis.Results:Finally, 25 literatures were included, including 11 qualitative studies and 14 quantitative studies. Perinatal loss leads to an increased risk of psychological diseases when parents were re-pregnants, facing a complex mixture of new hope and uncertainty, and fathers were even more troubled by dual identity, but some parents could still benefit from perinatal loss.Conclusions:At present, China is lack of attention to the parents of perinatal loss of re-pregnancy. Medical staff should respect the differences of parents′ emotional expression, formulate targeted intervention measures, reduce the negative impact of perinatal loss, and guide the generation of positive psychology of the parents of re pregnancy.

Objective To explore the effect of kangaroo mother care(KMC)on breastfeeding, behavior,body temperature and weight of full-term newborn. Methods A total of 80 full-term newborns from March to December of 2017 were selected by the convenience sampling method, and were randomly divided into control group and intervention group, with 40 cases each group. Routine obstetric nursing was provided for the newborns in the control group. In addition,one hour of KMC was provided for the newborns in the intervention group. The LATCH scores, neonatal behaviors, body temperature and weight were observed on daily basis. Meanwhile, an interview was conducted to investigate mothers′attitudes towards KMC. Results The LATCH scores of the intervention group for the second and third days were respectively (6.52±0.81) and (7.75±1.08), which were higher than that in control group (5.95±0.95), (7.02± 1.07). The differences were statistically significant (t=2.887,3.010,P<0.05). The behavioral status of neonates in the intervention group for 3 days was (3.65±1.12), (3.42±0.87), (3.35±1.07), all of which were lower than that in control group (4.57 ± 0.98), (4.50 ± 1.24), (4.65 ± 1.27), and the differences were statistically significant (t=-4.593,-8.285,-7.029, P<0.01). The interviews showed that 100.0％(40/40) of mothers were satisfied with KMC and were very happy in the process.95.0％(38/40)of mothers believe that KMC can increase mother-child relationships.82.5％(33/40)of mothers believe that KMC can keep children quiet.72.5％(29/40)of mothers feel that KMC can relieve pain in the abdomen or perineum. Conclusions In the hospital, 1h of KMC can make breastfeeding more effective and the newborn condition is more stable, which is worthy of clinical application.

Objective To describe the status of the post-discharge coping difficulties in women with hypertensive disorders of pregnancy(HDP),and to explore its influencing factors.Methods A total of 280 women with HDP from a tertiary A maternity hospital in Nanjing City were investigated with the general information questionnaire,the post-discharge coping difficulty scale-new mother form,the readiness for hospital discharge study-new mother form,the family APGAR index.The factors influencing post-discharge coping difficulties in women with HDP were analyzed using univariate analysis and multiple linear regression.Results 238 valid questionnaires were collected,with a response rate of 85.0%.The score of the post-discharge coping difficulties in women with HDP was 5.07±1.69,which is at a middle level.The results of multiple linear regression analysis showed that parity,primary caregiver during the postpartum period,HDP type,readiness for hospital discharge,family APGAR index were influencing factors of post-discharge coping difficulties in women with HDP(P＜0.05).Conclusion Post-discharge coping difficulties in women with HDP remains to be further improved,and it is affected by many factors.Medical staff should pay more attention to post-discharge coping difficulties of such parturients,formulate targeted continuation care programs according to relevant influencing factors,comprehensively improve their coping ability,and reduce their coping difficulties after discharge.

Objective:To investigate the status of grief among maternal spouse after perinatal loss, and analyze its influencing factors, so as to provide some reference for male grief supporting strategic.Methods:Using the convenient sampling method, 180 male spouses of hospitalized women in the Department of Obstetrics from Nanjing Maternity and Child Health Care Hospital from March to October 2022 were recruited. A cross-sectional survey was conducted by the general questionnaire, the Perinatal Grief Scale, the Family Adaptability and Cohesion Scale Ⅱ-Chinese Version, the Social Support Rating Scale, and the Simplified Coping Style Questionnaire.Results:The overall score of the Perinatal Grief Scale in male spouses of women who experienced a perinatal loss was (61.57 ± 14.14) points. The score of the Family Adaptability and Cohesion Scale Ⅱ-Chinese Version was (121 ± 14.42) points, the score of the Social Support Rating Scale was (34.23 ± 7.21) points, and the score of the Simplified Coping Style Questionnaire was (36.08 ± 7.64) points. Multiple linear regression analysis showed that participation in fetal interaction, loss of fetal age, social support and family adaptability were the main factors affecting male grief ( P<0.05). Conclusions:The grief among male spouses of women who experienced a perinatal loss is at a low level. The clinical medical staff can refer to the influencing factors and implement effective support, such as respecting the male's father status, coordinating social support resources, and improving the family's coping ability, in order to alleviate men's grief and help them return to normal life.