RESUMEN
BACKGROUND: There are many drawbacks to the traditional midwifery service management model, which can no longer meet the needs of the new era. The Internet + continuous midwifery service management model extends maternal management from prenatal to postpartum, in-hospital to out-of-hospital, and offline to online, thereby improving maternal and infant outcomes. Applying the Internet + continuous midwifery service management model to manage women with high-risk pregnancies (HRP) can improve their psycho-emotional opinion and, in turn, minimize the risk of adverse maternal and/or fetal outcomes. AIM: To explore the effectiveness of a midwife-led Internet + continuous midwifery service model for women with HRP. METHODS: We retrospectively analyzed the clinical data of 439 women with HRP who underwent prenatal examination and delivered at Shanghai Sixth People's Hospital (affiliated to the Shanghai Jiao Tong University School of Medicine) from April to December 2022. Among them, 239 pregnant women underwent routine obstetric management, and 200 pregnant women underwent Internet + continuous midwifery service mode management. We used the State-Trait Anxiety Inventory, Edinburgh Postnatal Depression Scale, and analysis of delivery outcomes to compare psychological mood and the incidence of adverse delivery outcomes between the two groups. RESULTS: The data showed that in early pregnancy, the anxiety and depression levels of the two groups were similar; the levels gradually decreased as pregnancy progressed, and the decrease in the continuous group was more significant [31.00 (29.00, 34.00) vs 34.00 (32.00, 37.00), 8.00 (6.00, 9.00) vs 12.00 (10.00, 13.00), P < 0.05]. The maternal self-efficacy level and strategy for weight gain management were better in the continuous group than in the traditional group, and the effective rate of midwifery service intervention in the continuous group was significantly higher than in the control group [267.50 (242.25, 284.75) vs 256.00 (233.00, 278.00), 74.00 (69.00, 78.00) vs 71.00 (63.00, 78.00), P < 0.05]. The incidence of adverse delivery outcomes in pregnant women and newborns and fear of maternal childbirth were lower in the continuous group than in the traditional group, and nursing satisfaction was higher [10.50% vs 18.83%, 8.50% vs 15.90%, 24.00% vs 42.68%, 89.50% vs 76.15%, P < 0.05]. CONCLUSION: The Internet + continuous midwifery service model promotes innovation through integration and is of great significance for improving and promoting maternal and child health in HRP.
RESUMEN
OBJECTIVES: To investigate the clinical effects of different anesthesia methods in lateral episiotomy. Providing the guidance of choosing the appropriate anesthesia method in clinical operation. METHODS: A total of 300 primiparas with vaginal delivery were enrolled into this study. These primiparas were divided into three groups (n=100, each), according to the different methods of anesthesia: group A (pudendal nerve block anesthesia + stepwise dissection and incisional local anesthesia), group B (bilateral pudendal nerve block anesthesia), and group C (pudendal nerve block anesthesia + local infiltration anesthesia). The pain score of these primiparas at the time of perineal dissection and suturing, as well as suturing time and bleeding volume, were observed and compared among these three groups. RESULTS: In respect of pain scores at the time of suturing in lateral episiotomy, maternal pain score was significantly lower in group A than in groups B and C; and the difference was statistically significant (P<0.05). In respect of the time required for suturing in lateral episiotomy, suturing time was shorter in group A than in groups B and C; and the difference was statistically significant (P<0.05). In respect of the bleeding volume in lateral episiotomy, maternal bleeding volume was lesser in group A than in groups B and C; and the difference was statistically significant (P<0.05). CONCLUSIONS: Among these three commonly used methods of anesthesia in lateral episiotomy, the pudendal nerve block anesthesia + stepwise dissection and incisional local anesthesia method used in group A had the best analgesic effect, the shortest suturing time, and the lowest wound blood loss. KEY WORDS: Lateral episiotomy, Pudendal nerve block anesthesia, Local anesthesia, Pain score.
