Effectiveness of an intervention on uptake of maternal care in four counties in Ningxia, China.

OBJECTIVES: To understand the utilisation of prenatal care and hospitalised delivery among pregnant Muslim women in Ningxia, China, and to explore the effectiveness of the integrated interventions to reduce maternal mortality. METHODS: Cross-sectional surveys before and after the intervention were carried out. Using multistage sampling, 1215 mothers of children <5 years old were recruited: 583 in the pre-intervention survey and 632 in the post-intervention study. Data on prenatal care and delivery were collected from face-to-face interviews. Maternal mortality ratio (MMR) data were obtained from the local Maternal and Child Mortality Report System. RESULTS: After the intervention, the MMR significantly decreased (45.5 deaths per 100,000 live births to 32.7 deaths). Fewer children were born at home after the intervention than before the intervention (OR, 0.11; 95% CI, 0.08-0.15). The proportion of women who attended prenatal care at least once increased from 78.2% to 98.9% (OR, 24.55; 95% CI, 11.37-53.12). The proportion of women who had prenatal visit(s) in the first trimester of pregnancy increased from 35.1% to 82.6% (OR, 8.77; 95% CI, 6.58-11.69). The quality of prenatal care was greatly improved. Effects of the intervention on the utilisation of maternal care remained significant after adjusting for education level and household possessions. CONCLUSIONS: The findings suggest that integrated strategies can effectively reduce maternal mortality.

Using DynaCT rotational angiography for angioarchitecture evaluation and complication detection in spinal vascular diseases.

OBJECTIVE: Preoperative comprehension of the complex angioarchitecture and intraoperative complication detection are essential in endovascular treatment and surgical planning for spinal vascular diseases. We aimed to illustrate the application of DynaCT rotational angiography for the treatment of such diseases. METHODS: We retrospectively analyzed the medical records of 23 patients with spinal vascular disease who underwent DynaCT and three-dimensional (3D) rotational angiography between January 2012 and December 2013. Diseases included spinal arteriovenous malformation, spinal dural arteriovenous fistula, and hypervascular neoplasm. Radiological post-processing images and procedural complications were reviewed to compare the advantage of rotational angiography and digital subtraction angiography (DSA). RESULTS: Rotational angiography more clearly revealed the complex angioarchitecture in cases of spinal vascular diseases based on coronal, sagittal, and transverse views compared with DSA. Subarachnoid hemorrhage was confirmed with DynaCT in one patient with spinal arteriovenous malformation, which was not shown on DSA. Both two-dimensional and 3D angiograms effectively identified the fistulous points in five cases of spinal dural arteriovenous fistula while rotational angiography vividly demonstrated the relationship of the fistulous point with the osseous structures in dual-volume mode. Tumor feeders were clearly delineated in 3D reconstructed images and easily cauterized in patients with hemangioblastoma. CONCLUSIONS: Rotational angiography clarified the relationship between the vasculature and surrounding osseous structures for surgical or endovascular therapy of spinal vascular diseases. DynaCT can detect intraoperative subarachnoid hemorrhage in a timely manner during endovascular treatment of spinal vascular diseases.