Application of the PDCA cycle for implementing the WHO Safe Childbirth Checklist in women with vaginal deliveries.

The World Health Organization Safe Childbirth Checklist (SCC) has been recommended globally. However, the results are inconsistent. The aim of this study was to investigate the effectiveness of implementing the SCC based on plan-do-check-act (PDCA) cycle management. From November 2019 to October 2020, women who were hospitalized and had vaginal deliveries were enrolled in this study. Before October 2020, the PDCA cycle was not applied for the SCC, and women who had vaginal deliveries were included in the pre-intervention group. From January 2021 to December 2021, the PDCA cycle was applied for the SCC, and women who had vaginal deliveries were included in the post-intervention group. The SCC utilization rate and the incidence of maternal and neonatal complications were compared between the 2 groups. The SCC utilization rate in the post-intervention group was higher than that in the pre-intervention group (P < .01). The postpartum infection rate in the post-intervention group was lower than that in the pre-intervention group, and the difference was statistically significant (P < .05). After the intervention, postpartum hemorrhage, neonatal mortality, and neonatal asphyxia rates were also reduced, although no significant differences were observed between the 2 groups. There was no significant difference in the third-degree perineal laceration or neonatal intensive care unit hospitalization rate between the 2 groups (P > .05). Application of the PDCA cycle can improve the SCC utilization rate, and the SCC combined with the PDCA cycle can effectively reduce the postpartum infection rate.

The status quo and influencing factors of knowledge, attitude and practice of obstetric staff on the safe childbirth checklist.

Practical Guidelines for Safe Childbirth Checklist has not been widely used in medical institutions at all levels in China. This study aims to understand the current status of knowledge, attitude and practice of obstetric medical staff toward the Safe Childbirth Checklist and analyze its influencing factors to provide a reference for establishing the promotion of the checklist. Convenience sampling was used in a cross-sectional survey of 685 obstetric medical staff in Chongqing using a self-designed questionnaire to analyze their knowledge, attitude and practice of the checklist. The scores of knowledge, attitude and practice of obstetric medical staff on the checklist were 29.96 ±â€…5.44, 62.87 ±â€…9.11, and 37.74 ±â€…6.82, respectively. Occupation and hospital level were influencing factors of the knowledge and practice scores, while length of service was the only influencing factor of the knowledge score. Education was the influencing factor of attitude score. The total effects of the knowledge, facilitation and inhibition dimensions on practice were 0.671, 0.263 and -0.135, respectively. Mediating effects presented in the facilitation and inhibition of attitude in safe childbirth. Obstetrics medical staff know the checklist well, however, their attitudes and practices need to be improved. Managers should take targeted measures to strengthen the attitudes and practices of obstetric medical staff toward safe childbirth and promote the use of the checklist, thus providing a powerful safeguard for higher delivery quality and safer delivery.

Simulating Urban Expansion Based on Ecological Security Pattern-A Case Study of Hangzhou, China.

Disordered urban expansion has encroached on a large amount of ecological land, resulting in the steady degradation of urban ecology, which has an adverse effect on the sustainable development of the region. An ecological security pattern can effectively control urban expansion, and it is of great significance to balance urban development and ecological protection. In order to analyze the impact of ecological security patterns on urban expansion, Hangzhou was taken as an example, the CA-Markov model and FLUS model were used to simulate the urban expansion pattern in 2030 under the natural development scenario and the ecological security scenario. The results showed that (1) the ecological source area in the study area is 630.90 km2 and was mainly distributed in the western mountainous area. There are 14 ecological corridors, primarily composed of valleys and rivers. Ecological nodes are mainly distributed on the north and south sides of the main urban area. (2) From 2000 to 2018, the annual increase index (AI) of construction land decreased in the northeast and southeast directions but increased in the northwest and southwest directions, and in the northeast direction the value was always the highest. Except for the southwest direction, the average annual growth rate (AGR) of construction land in the other directions decreased. At a distance from the city center of 30 km, AI was relatively higher and was increasing, while AGR was declining. At a distance of 30-45 km, both AI and AGR were increasing, indicating that the focus of construction land was moving outwards. (3) From 2018 to 2030, under both natural development scenario and ecological security scenario, construction land would keep expanding, but the construction land area, proportion, AI, and AGR of the latter would both be smaller than the former, indicating that the ecological security pattern can effectively curb urban expansion. Because of a large amount area of ecological sources, the expansion of construction land in the southwest direction would be constrained, especially under the ecological security scenario. The methods and results of this study can provide theoretical and application references for urban planning and green development in metropolises.

Effect of second child intent on delivery mode after Chinese two child policy implementation: a cross sectional and prospective observational study of nulliparous women in Chongqing.

OBJECTIVES: To assess the influence of second child intent on the delivery preferences and final delivery modes of nulliparous women, particularly caesarean delivery on maternal request (CDMR), after implementation of China's two child policy. DESIGN: Cross sectional and prospective observational study. SETTING: A tertiary teaching hospital in Chongqing, China. PARTICIPANTS: 1000 low risk nulliparous women were initially involved, and were divided into two groups based on their intent on having a second child. 814 women who completed all interviews were analysed. MAIN OUTCOME MEASURES: Preferred mode of delivery in second trimester and at admission; final delivery mode, CDMR. RESULTS: 814 women who completed all interviews were analysed, in whom 51.2% intended to have a second child. The preference for caesarean delivery (CD) at the second trimester between the intent and no intent group was 6.2% versus 17.9% (adjusted RR 0.35, 95% CI 0.20 to 0.63) and increased to 24.2% versus 37.3% (adjusted RR 0.65, 95% CI 0.45 to 0.94) at admission, respectively. The overall CD rates between the two groups were 41.0% versus 50.4% (adjusted RR 0.84, 95% CI 0.60 to 1.18), and the CDMR rates were 16.7% versus 29.0% (adjusted RR 0.56, 95% CI 0.37 to 0.86), respectively. CONCLUSIONS: Women who intend to have a second child are less likely to request a CD, and high rates of CD and CDMR in nulliparous women may have decreased after implementation of China's two child policy.