孕妇使用白茅根的注意事项

The cytotoxicity of the root’s methanol extract of Imperata cylindrica (ICR). was previously reported in a panel of human cancer cell lines, including multi-drug resistant phenotypes. The aim of this study was to assess the acute and sub-chronic oral toxicity of methanol root extract of Imperata cylindrica. The acute toxicity was carried out according to the experimental protocol of OECD. The plant extract was administered orally to female rats at a single dose of 5000 mg/kg for 14 days and the animals were observed for any behavioral changes or mortality. For sub-chronic toxicity study, ICR was orally administered daily to male and female rats at different doses (250, 500 and 1000 mg/kg per b.w.) for 30 days. During these treatment days the animals were observed for any appearance of toxicity symptoms; following the treatment period, animals were sacrificed for hematological, biochemical and histopathology analysis. From the results of the acute oral toxicity assay, ICR was found to be non-toxic at the dose of 5000 mg/kg b.w. During the period of sub-chronic toxicity test, observation of signs, behavior and health status of the animals showed no abnormality in the groups of animals treated with ICR as compared to the controls. Significant variation of the relative body weights of heart and kidney were observed at dose a 1000 mg/kg b.w. Significant decrease of aspartate aminotransferase, creatinine level, low density lipoprotein concentration, triglyceride and total cholesterol were observed. In males, we noticed a significant decrease of the level of granulocytes with an increase of lymphocytes and mean corpuscular hemoglobin concentration levels. Histological examinations performed on kidney and liver showed a normal kidney architecture and liver also presented a normal hepatic architecture with slight degeneration at a dose 1000 mg/kg b.w. ICR is safe for acute oral administration; however, for long-term oral administration, safety measures should be taken. Thus, oral sub-chronic exposure of ICR at lower doses are recommended while higher doses around 1000 mg/kg b.w. should be discouraged.

Optimizing health outcomes among historically marginalized racial and ethnic communities, especially in obstetrics, has tremendous potential to improve the lives of not only patients and their families but also future generations. Understanding potential drivers of health inequities in obstetrics is critical to eliminating them. This Special Statement delivers a comprehensive, action‐driven framework that builds on the recommendations in Society for Maternal‐Fetal Medicine Consult Series #62: Best Practices in Equitable Care Delivery—Addressing Systemic Racism and Other Social Determinants of Health as Causes of Obstetrical Disparities. We provide strategies to integrate the evaluation of social drivers of health and health disparities into quality and safety case reviews, thereby advancing equity as a fundamental dimension of healthcare excellence. We demonstrate how to incorporate a health equity lens into patient safety events, specifically severe maternal morbidity case reviews and root cause analyses. Through an enhanced case review process that considers health and healthcare inequities as potential contributing factors, hospital quality improvement efforts can target upstream contributors to health outcomes so that adverse outcomes around the time of delivery may be averted.

BackgroundIn 2007, 95% of women in Botswana delivered in health facilities with 73% attending at least 4 antenatal care visits. HIV-prevalence in pregnant women was 28.7%. The maternal mortality ratio in 2010 was 163 deaths per 100 000 live births versus the government target of 130 for that year, indicating that the Millennium Development Goal 5 was unlikely to be met. A root-cause analysis was carried out with the aim of determining the underlying causes of maternal deaths reported in 2010, to categorise contributory factors and to prioritise appropriate interventions based on the identified causes, to prevent further deaths.MethodsCase-notes for maternal deaths were reviewed by a panel of five clinicians, initially independently then discussed together to achieve consensus on assigning contributory factors, cause of death and whether each death was avoidable or not at presentation to hospital. Factors contributing to maternal deaths were categorised into organisational/management, personnel, technology/equipment/supplies, environment and barriers to accessing healthcare.ResultsFifty-six case notes were available for review from 82 deaths notified in 2010, with 0–4 contributory factors in 19 deaths, 5–9 in 27deaths and 9–14 in nine. The cause of death in one case was not ascertainable since the notes were incomplete. The high number of contributory factors demonstrates poor quality of care even where deaths were not avoidable: 14/23 (61%) of direct deaths were considered avoidable compared to 12/32 (38%) indirect deaths. Highest ranking categories were: failure to recognise seriousness of patients’ condition (71% of cases); lack of knowledge (67%); failure to follow recommended practice (53%); lack of or failure to implement policies, protocols and guidelines (44%); and poor organisational arrangements (35%). Half the deaths had some barrier to accessing health services.ConclusionsRoot-cause analysis demonstrates the interactions between patients, health professionals and health system in generating adverse outcomes for patients. The lessons provided indicate where training of undergraduate and postgraduate medical, midwifery and nursing students need to be intensified, with emphasis on evidence-based practice and adherence to protocols. Action plans and interventions aimed at changing the circumstances that led to maternal deaths can be implemented and re-evaluated.

Abstract Background Inadequate milk production during the immediate postpartum period is a common problem. Shatavari (Asparagus racemosus), a revered herb in Ayurveda, is traditionally used as a galactagogue. The objective of this study is to assess the safety and effectiveness of Shatavari root extract (SHT) on lactation in post-partum women. Methods This prospective, randomised, double-blind, placebo-controlled study enrolled post-partum women (≥37 weeks’ gestation, aged 20–40 years) with uncomplicated vaginal or caesarean deliveries who intended to breastfeed. Participants received either Shatavari root extract (SHT; 300 mg) or placebo (PL) capsules once daily for 72 h postpartum. The primary outcomes included time to evident breast fullness after the last feeding and the total milk volume expressed at 72 h. The secondary outcomes were maternal and investigator-rated satisfaction (e.g. noticeable breast fullness, maternal/infant wellbeing), assessed by a five-point Likert scale. Safety was assessed through adverse event reports. Results From the 120 enrolled participants, seven participants (3 SHT, 4 PL) did not complete the study, yielding a per-protocol dataset of 113 women (57 SHT and 56 PL). The baseline characteristics were comparable across groups. The time to evident breast fullness after the last feeding was significantly shorter in the SHT group (p = 0.002), and milk volume at 72 h was significantly higher (p < 0.001). Maternal satisfaction with lactation was higher in the SHT group (52.63% vs. 25.00%, p = 0.008). SHT participants also reported greater satisfaction with infant well-being. Investigators rated maternal and infant well-being higher for SHT than placebo (80.70% vs. 64.29%). No adverse events occurred, and treatment compliance was high. Conclusion Shatavari root extract improved the milk volume and maternal satisfaction about lactation, indicating its potential as a safe, effective galactagogue. PLAIN LANGUAGE SUMMARY Breastfeeding is vital for both the mother and the baby. After childbirth, a few mothers might experience challenges with producing sufficient breast milk. The current study tested whether a natural herbal remedy called Shatavari could help increase breast milk production in mothers after delivering the baby. A total of 120 women who had recently given birth took part in the study. Half of them were given 300 mg of Shatavari root extract, while the other half were given an inactive ingredient (called a placebo), and the results were measured after 72 h. Researchers observed changes in milk supply volume, the time it took for the mothers to feel their breasts were full, and how satisfied the mothers felt with breastfeeding. After 72 h, the mothers who took Shatavari had more breast milk, felt breast fullness sooner, and were more satisfied with breastfeeding than those in the placebo group. Importantly, no side effects were observed in any of the mothers who took Shatavari root extract. These results suggest that immediate post-partum use of Shatavari root extract may be a safe and effective natural option to increase breast milk volume.

Background Maternal and newborn healthcare providers are essential professional groups vulnerable to physical and psychological risks associated with the COVID-19 pandemic. This study uses machine learning algorithms to create a predictive tool for maternal and newborn healthcare providers’ perception of being safe in the workplace globally during the pandemic. Methods We used data collected between 24 March and 5 July 2020 through a global online survey of maternal and newborn healthcare providers. The questionnaire was available in 12 languages. To predict healthcare providers’ perception of safety in the workplace, we used features collected in the questionnaire, in addition to publicly available national economic and COVID-19-related factors. We built, trained and tested five machine learning models: Support Vector Machine (SVM), Random Forest (RF), XGBoost, CatBoost and Artificial Neural Network (ANN) for classification and regression. We extracted from RF models the relative contribution of features in output prediction. Results Models included data from 941 maternal and newborn healthcare providers from 89 countries. ML models performed well in classification and regression tasks, whereby RF had 82% cross-validated accuracy for classification, and CatBoost with 0.46 cross-validated root mean square error for regression. In both classification and regression, the most important features contributing to output prediction were classified as three themes: (1) information accessibility, clarity and quality; (2) availability of support and means of protection; and (3) COVID-19 epidemiology. Conclusion This study identified salient features contributing to maternal and newborn healthcare providers perception of safety in the workplace. The developed tool can be used by health systems globally to allow real-time learning from data collected during a health system shock. By responding in real-time to the needs of healthcare providers, health systems could prevent potential negative consequences on the quality of care offered to women and newborns.

Maternal morbidity and mortality is on the rise in the United States. Several local, state, and nationwide organizations have worked toward reducing maternal mortality by improving patient safety. Early warning systems unique to the obstetric population have been developed to provide early intervention and to prevent patients from decompensating. Patient care bundles, supported by the American College of Obstetricians and Gynecologists, as well as The Council on Patient Safety, provide a standardized approach to obstetric care. Monitoring outcomes through root cause analysis is key to improving patient safety and outcomes.

Rates of preterm birth, low birth weight, and Neonatal Intensive Care Unit (NICU) admissions continue to rise in the United States (US). Social determinants of health (SDOH) are recognized as significant contributors to infant and maternal health, underscoring the need for use of research frameworks that incorporate SDOH concepts. The Restoring Our Own Through Transformation (ROOTT) theoretical framework is rooted in reproductive justice (i.e. reproductive rights and social justice-based framework) and emphasizes both structural and social determinants as root causes of health inequities. The impact of SDOH on maternal and infant mortality and morbidity can often be traced to structural determinants unique to the US, including slavery, Jim Crow laws, redlining, and the GI Bill. Using data from the Pregnancy Risk Assessment Monitoring System (PRAMS) 8 database, we aimed to evaluate relationships between SDOH (as guided by the ROOTT Framework) and maternal and infant health outcomes. Data were analyzed from 11 states that included the SDOH supplement in their PRAMS 8 data collection. We used bivariate analyses to examine relationships between SDOH measures guided by the ROOTT framework (e.g. abuse during pregnancy, access to prenatal care, housing stability and education) and maternal morbidity (i.e., gestational hypertension and gestational diabetes) and infant outcomes (i.e., preterm birth, NICU admission, breastfeeding). Pre-identified covariates were controlled for in the logistic and linear regression models. Preterm birth, NICU admission, breastfeeding, and maternal morbidities were significantly associated with SDOH measures linked to structural determinants in the US. Abuse during pregnancy, access to prenatal care, housing, and education were all significantly associated with poorer infant health outcomes in the final regression models. Women who received prenatal care beginning in the 3rd trimester were twice as likely to develop gestational hypertension. SDOHs rooted in structural determinants are important predictors of poorer maternal and infant health outcomes. Evaluating health outcomes using a reproductive justice framework reveals modifiable risk factors, including access to stable healthcare, safety, and housing. Comprehensive healthcare provision must ensure early and consistent access to healthcare and resources for safety and housing stability to support maternal and infant health.

No abstract available

Abstract Background Even through the fact that pregnant women are more and more severely infected with COVID-19 disease, there are still doubts about vaccinating these people due to the lack of sufficient evidence base information. So in this systematic review, we decided to study vaccinated and unvaccinated pregnant women regarding maternal, fetal and neonatal complications and outcomes. The strategy of searching Between 30 December 2019 and 15 October 2021, electronic searches were performed on the databases of PubMed, Scopus, Google Scholar, and Cochrane library by searching in English and free full text. Keywords searched included these: maternal outcome, neonatal outcome, pregnancy, and COVID-19 vaccination. Among 451 articles, finally, seven studies were included to study pregnancy outcomes in vaccinated women compared to unvaccinated for systematic review purposes Results In this study 30257 vaccinated women in their third trimester compared to 132339 unvaccinated women in terms of age, the root of delivery, neonatal adverse outcomes. There were no significant differences between two groups in terms of: IUFD, and 1 min Apgar score, C/S rate, and NICU admission between the two groups, however, the rate of SGA, IUFD, and also neonatal jaundice, asphyxia, and hypoglycemia was more significant in the unvaccinated group comparing to the vaccinated group as a result. Among them, the chance of preterm labor pain was reported more among vaccinated patients. Emphasizing that, except 7.3% of the case population, everyone in the second and third trimesters had been vaccinated with mRNA COVID-19 vaccines Conclusion COVID-19 vaccination during the second and third trimesters appears to be the right choice due to the immediate impact of COVID-19 antibodies on the developing fetus and formation of neonatal prophylaxis, as well as the absence of adverse outcomes for both the fetus and mothers.

Objective This study aimed to develop a patient safety culture (PSC) scale for maternal and child healthcare (MCH) institutions in China. Methods A theoretical framework of PSC for MCH institutions was proposed through in-depth interviews with MCH workers and patients and Delphi expert consultations. The reliability and validity of the PSC scale were tested in a cross-sectional survey of 1256 MCH workers from 14 MCH institutions in Zhejiang province of China. The study sample was randomly split into half for exploratory and confirmatory factor analyses, respectively. Test–retest reliability was assessed through a repeated survey of 63 voluntary participants 2 weeks apart. Results The exploratory factor analysis extracted 10 components: patient engagement in patient safety (six items), managerial response to patient safety risks (four items), perceived management support (five items), staff empowerment (four items), staffing and workloads (four items), reporting of adverse events (three items), defensive medical practice (three items), work commitment (three items), training (two items) and transfer and handoff (three items). A good model fit was found in the confirmatory factor analysis: χ2/df=1.822, standardised root mean residual=0.048, root mean square error of approximation=0.038, comparative fit index=0.921, Tucker-Lewis index=0.907. The PSC scale had a Cronbach’s α coefficient of 0.89 (0.59–0.90 for dimensional scales) and a test–retest reliability of 0.81 (0.63–0.87 for dimensional reliability), respectively. The intracluster correlation coefficients confirmed a hierarchical nature of the data: individual health workers nested within MCH institutions. Conclusion The PSC scale for MCH institutions has acceptable reliability and validity. Further studies are needed to establish benchmarking in a national representative sample through a multilevel modelling approach.

No abstract available