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Experts question out of the gold content

Tuesday, March 17th, 2009

Experts question the patient on value

Today, the hospital at all levels of the "experts" to enable patients to have some doubts about the three large class hospitals, small rural hospitals, the experts really do have better skill? With these questions, this reporter began an investigation.
Do not be superstitious expert patient

The survey found that some hospitals there are many experts out the little-known insider.

Some experts are "endurance", who

On experts, since there is no uniform national standard, it does not mean that professors, associate professors and other technical titles, it does not mean master, doctoral qualifications. Therefore, experts can only be a folk who have the professional expertise of a honorific. Is generally believed that experts should be dedicated to a particular job and those who study and quite accomplished. Medical experts, of course should be the treatment of certain diseases, professional expertise. This is the scarcity of experts in this, but now in many hospitals, "experts" do not lack. Some hospitals in order to attract patients to their doctors do not have the qualifications of experts to package the "certain experts" Zuozhen, a city in Henan province's municipal hospital that dental total of eight doctors, and public posting of the "expert doctors "reached six. In those small hospitals, for every one "expert" even more numerous.

Even in some large hospitals, not all experts are "true." Now the hospitals have to comply with such an unwritten rule: Where have these titles, deputy director of medical doctors, can be identified as "experts", can take an expert patient. However, the existing job classification, assessed by way of a director of the physician and deputy director of the physician, does not mean they have the clinical ability to solve difficult cases. Many so-called experts, but by endurance boil out of the clinical level is often the attending physician with the GOP is almost the same. There are many sections of the Division Director, although the rise to the director of administrative functions, but the technology has not yet promoted to the title "Deputy High", in order to facilitate the "expert patient" Zuozhen, hospitals altogether to a "low vocational high school recruits," attending physician shake themselves become deputy director of the physician. Become "experts." Some hospital specialists, only to large hospitals had specialist training. Also taking a hospital, select a number of wrinkles and more elderly long beard posing expert doctors.

Money flooded out of interest to experts

For those eager to treat the patients, the hospital specialist outpatient course of choice. And because experts outpatient clinic registration fee is much higher than normal, or even 10 times higher, hang a No. 30 yuan, 50 yuan, 80 yuan, or 300 yuan, so that those patients with daunting financial difficulties.

Experts are now out-patient general hospital overcrowding almost every day, many patients are directed at experts to go, wanted to spend more money to buy peace of mind. Patients with this kind of psychological disorder just to meet a number of hospitals run specialist clinics. Income and inspection commission of experts, see a doctor how many are related, so the significance of expert medical care has changed. Some people lamented, now the "expert patient" has become some of the hospital a new "economic growth."

Specialist out-patient "assembly line" operations

There misdiagnosis risks

Wang is a specialist out-patient was diagnosed with diabetes and hypertension, heart disease patients. 8 years, she had pressed the "experts" in the diagnosis of eating numerous antihypertensive drugs and hypoglycemic agents, 8 years been a physician discovered that she is suffering from pheochromocytoma (an adrenal gland tumor). This case once again raises questions about the current hotbed of specialist clinics, diagnosis and treatment of a hurry a few minutes really can diagnose the exact cause of the patient. According to the physicians say, he asked the experts completed before the patient after diagnosis, because very little day-patients, he did not immediately prescribe medication to patients, but asked in detail about the situation from the other patients. After careful examination, found that patients who suffer from diabetes is not simple, but pheochromocytoma secondary diabetes. Now the patients after tumor resection after recovery. The attending physician that the medical treatment to a patient, not only to ask the patient's main symptoms, hidden symptoms, but also the history of past medical history and diagnosis, while the necessary medical examination, usually takes more than 15 minutes. In the present case, the experts look at out-patient one day or even a hundred eighty-seven patients, as an "assembly line" operations, like. Experts not for everyone asking for detailed and comprehensive, objective reasons most of the experts diagnosed a hurry to prescribe a few minutes to solve the problem. As a result, misdiagnosis is inevitable phenomenon.

How do experts read out in the end

Registered the wrong subjects, and experts into "lay"
Mr. Zhao's children 6 months to grow a recent series of forehead acne How many pieces of small white family was particularly anxious, hurried to the children's hospital. Only general hospital dermatology clinic, but medical experts out there, Mr. Zhao did not hesitate to hang a number of experts. Overcrowding can be an expert patient, waiting for more than an hour before discharged to, experts looked at the child's situation, or suggestions to the skin examination. Results dermatology medical examination and told the young Mr. Zhao, because the baby caused by intake of balanced nutrition, there is no right, just appropriate some vitamin supplements can be.

The so-called experts are not omnipotent, if it is truly an expert, that would only show that he was a professional or even a have a deeper study of a disease, but compared to other branches of the disease, perhaps the layman. In other words, medical experts could not see skin diseases such as skin of the general practitioners, even a layman. Therefore, we must choose their strengths and their own expertise disease expert counterparts. Even experts in the same family also have their own strengths as a gastroenterology specialist, and some expertise in the treatment of liver cirrhosis, and some expertise in the treatment of liver cancer. With the general surgeons, and some specialize in cancer surgery, cancer surgery, some good, some are good at vascular surgery. With a dental expert, and some expertise in the extraction, some specializing in fillings, and some expertise in the denture, some are specialized in maxillofacial surgery. Therefore, only fully understand the expert's expertise before they can better choose their own experts. Generally to the hospital's consulting expertise of the experts help desk inquiries. Be experts in the hospital lobby bar of understanding, but also more understanding of the hospital's Web site can also be introduced by patients or through mutual acquaintances about the work in the hospital.

Best to look at the common newly diagnosed patient

Ms. Lee often joint pain recently, her daughter with her to Medical College hospital. To cure his mother's illness as soon as possible, his daughter hung 50 most expensive checkups special needs specialist out-patient fee. I did not expect that the number of experts ranked early in the morning there are more than 40 people, inside and outside the consulting room full of people. In desperation, they hand out in the expert line up, while they spent 5.5 yuan hung up a general orthopedic clinic. Fewer patients attending general, the doctor asked in detail about, the first one opened a few tests to further determine the condition. Mother and daughter waited until 12 o'clock finally discharged to a well-known experts in diagnosis, but experts asked about the condition, the first while opening a few and a few undifferentiated general out-patient laboratory.

No. medical experts who will hang, this is not desirable, particularly new patients. Whether expert or general practitioner, faced with the patient first of all have to understand the condition, medical history, carry out the necessary checks. Many diseases have been a test examination, imaging studies and other supplementary examination before we can get a clear diagnosis and treatment, which doctors can do general work. So sick patients, the best first general out-patient newly diagnosed, after inspection, or no clear diagnosis of incurable diseases, to find experienced professionals, which patients, can save the cost and number of experts linked to line up the waste of time, do not delay diagnosis and treatment.

To be well prepared

Specialist outpatient more, each patient is unlikely to make a long chat with the experts, so the limited time patients should talk to the expert condition accurately, it is best to do to prepare in advance. You may wish to see a doctor before you make a list of the main symptoms, sick time, whether there are incentives in place to bad habits, my medical history, family history, history of exposure to infectious diseases, and efficacy of treatment received which record how problems . These experts are ready and then look out, saving time and omission does not occur, but also conducive to an accurate diagnosis and treatment of a doctor. Many cities are now more than two hospitals in a single examination report is usually common. Remember when the doctor is ready to bring all medical records, according to chronological order is good, experts can be made by reference to medical records of the correct diagnosis, but also conducive to an expert on the disease continuous observation and analysis. This can also reduce unnecessary re-examination, save time and money. In addition, the statement history when you make the most painful, the most urgent need to address the condition, then tell the doctors with concise, focused, said disease, then according to the doctor's questions, one by one to answer, you made it clear that doctors could hear clearly thinking on Diagnostics clear.

In the limited time

As much as possible with experts

Experts not only to answer questions truthfully, but also to the expert as much as possible about their condition. For example, "I have what disease? Might cause that? Why eat this medicine? How to eat? Have no side effects? Medicine to take finished how do? Much time would be better? There are other possible treatments you ? in the future should pay attention to? when the doctor again? best experts to question their own one-time medical consultation. Remember, when the experts when others do not see the doctor interrupted to ask questions, then questions arise allow experts and other patients revulsion.

Do not underestimate young doctor

Most people think that old doctor experienced, good, expert senior experts naturally better. But now the hospital's deputy director of a number of young physician or chief physician, they usually have high academic qualifications, so they have a high level of knowledge and technology and to master the world's latest medical concepts, medical technology, so some of them Diagnosis and treatment of difficult and severe cases may Jiyaqunfang come from behind, because they are young and do not miss the opportunity to seek treatment. If you are suffering from surgical diseases need major surgery, then select an expert surgeon in the most appropriate, because this age extensive clinical expertise, skilled operative, eyes do not flower, do not shake hands, move cleanly. If circumstances permit, you can also asked the hospital to let the old experts to guide surgery.

Newspaper correspondent Wei Yiming

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Treatment of cancer is to better living

Saturday, September 13th, 2008

Treatment of cancer is to better living

News Background
Since the 20th century, with surgery, radiotherapy and chemotherapy as the representative of the three major arms of treatment and rehabilitation for cancer make a great contribution, but these traditional treatments have their limitations in cancer treatment failed to reach an overall satisfactory results. A harsh reality is that cancer incidence and mortality showed an upward trend, although medical scientists have been perfecting the three major treatment, but patients who survive more than 5 years only 25% of all cancer patients and 35% , 65% of patients is difficult to endure 3 to 5 years. Many cancer patients did not receive appropriate treatment, combined with systemic chemotherapy, surgery is not uncommon for abuse, inappropriate treatment not only increased the suffering of patients, and even speed up the patient's death.

Situation grim Cancer scientists around the world to promote a deep reflection on the past in the cancer problem committing a strategic error, that is only concerned with the destruction of the tumor was found, ignored after treatment to prevent recurrence and metastasis, called for further play of Traditional Chinese Medicine the unique role of natural therapies. The treatment of cancer from the past, "disease as the core" changes to "patient-centered" human therapeutic model. How, then, the most simple way, the minimum cost of access to the best overall treatment effect?
How to carry out scientific and rational comprehensive cancer treatment to adjust the zero drug to prevent recurrence and metastasis after treatment?
These are all preventable and curable cancer to achieve the urgent need to address the problem. With these questions, this reporter interviewed a famous tumor expert, the Chinese Society of Psychosomatic Medicine, Shanghai University of Traditional Chinese Medicine PhD supervisor Professor He Yumin.
A "annihilation" is easy to turn
Reporter: dealing with cancer treatment is the classic Western to find and destroy cancer cells until the final elimination. What do you think?

Yu-min: surgical resection, radiotherapy and chemotherapy to kill tumor cells in direct response, we call it "hard measures." Denied, cancer stressed the "three early" (early discovery, early diagnosis and treatment) is an important meaning. Exclude patients with early cancer and other natural factors of longer survival, "three early" there are still a hypothetical possibility that part of the treatment of patients most likely completely without mercy by cancer cells, so this is an important way to improve the efficacy. However, for other cancer patients who want to kill all cancer cells, but also easier said than done?

The most commonly used surgery, radiotherapy and other methods are local treatment. Now a more consistent view is that cancer is a local performance-based systemic disease, simple excision or wide resection or high-dose radiotherapy, large areas, do not increase the cure rate, it will lead to a decline in quality of life . Although the systemic chemotherapy treatment, but not very efficient, the price is extraordinarily high; good little toxic side effects. No matter how many times repeated chemotherapy and radiotherapy can not be true 100% way to remove cancer cells.

In addition, studies have shown that some "early" cancer, although by the time of diagnosis of advanced equipment and technology available detailed examination failed to find distant metastasis (dominant transfer), but in fact there is considerable time patients have distant metastases (occult lymph node, that is, sub-clinical lesions), cancer statistics, if people have transferred 60% of the time of diagnosis. The United States are diagnosed each year about 800 000 solid cancer patients with tumors diagnosed at that time about 50 million patients have been transferred. Such as with PET-CT examination, but also can find a lot of CT, MRI examination revealed the modern advanced equipment that can not be "hidden" transfer.

Reporter: Western scientists to statistics, about 45% of cancer patients can be clinically cured, the effective rate of surgical treatment of 22%, 18% radiotherapy and chemotherapy and other methods of 5%.

Yu-min: For suffering has been considered "incurable" cancer patients, these are remarkable achievements in the (tens of thousands of patients, according to our long-term observation, the only effective treatment with Western medicine, can exceed 15% long-term health of cancer patients alive, of which about 4% to 5% of the clinical examination of cancer disappear, we do not think this is entirely the result of cancer cells without mercy). Even so, it still means that there are as many as 40% to 50% of patients unable to clinical cure.

B Chinese cancer
Also need to reflect

Reporter: In recent years, Chinese medicine in cancer treatment is gradually outweighed the advantages, but it does have some deficiencies, could be more specific about.

Yu-min: TCM treatment of cancer focus on the systemic treatment of human organs has strong resilience to adjust to all kinds of western medicine is not the body kill tumor cells are the body's immune system clear, the purpose to cure cancer. Strengths of Chinese medicine but also in radiation therapy can enhance, reduce side effects of chemotherapy agents. Shortcomings is the role of local tumor treatment is not strong, the destruction of tumor cells and insufficient. Although the side effects, but the effective slow. Therefore, we Chinese medicine called "soft measures."

Reporter: Traditional banner name of the treatment of various tumors of publicity everywhere, whether all of the treatments are effective?

Yu-min: We still need to look at the development of some traditional Chinese thinking. In this view, some treatment must be carefully used.

"Ruanjian product" in the past, as the main method of treatment of thyroid cancer is one. But research shows that, at least in the Shanghai area, many thyroid tumors, "iodine" dependent, while many of the soft drug firm is a high iodine, such as seaweed, kelp, Prunella, mountain Arrowhead, etc., these should be taboo. I have encountered one case of lung metastasis of breast cancer patients, drug therapy with a zero, stability has reached more than 3 years, by the end of 2004 she listen to the experiences of others, said that seaweed can be cancer, so large doses eat. Department of left neck pop up a hard thyroid nodule - Thyroid cancer, then a trace of its people 25 years ago, had thyroid cancer, breast, lung transfer under control, thyroid cancer has recurred, it is clear that a large number of fresh seaweed culprit.

Another 10-year-old patient, is a position of cadres, has now become my friend. Bladder cancer, a tonic medicine for large doses, including wild ginseng, etc., 10 years ago, more than 280 yuan for each quote should drug money, while eating Chinese medicine, while doing cleaning, not only microscopic examination after 3 months that see relapse, and medication and has been feeling lower abdomen bulge, discomfort, it is actually abuse Yong Zhi Qi tonic to help the growth of cancer due. Electrotherapy, the use of agents with zero clearing antitumor drug therapy, not only were very comfortable, and has survived 10 years.

Reporter: Chinese medicine in cancer treatment, there will be new breakthroughs?

Yu-min: Chinese unclear because of the theoretical concepts, ambiguous, resulting in the slow development of its own, the doctors and other medical has been competing at a disadvantage, people are looking for the key moment of the treatment of cancer tend to western medicine, some to late stage cancer patients think Chinese medicine, this is the proof. In recent years, began to extract active ingredients from herbal technology quite quickly, so you can make the side effects of herbal treatment of cancer is almost zero. Chinese medicine hair of the dog if the idea of changing the past, which, combined with traditional Chinese medicine in the treatment of cancer diseases overall superiority can not be replaced, Chinese medicine will be better prospects for development.

C tumor be people-oriented governance
Reporter: tumor-round match today, we thought it should be a new change?

Yu-min: We have a clear idea of tumor treatment, the past, mainly invasive means, the first time thoroughly to kill (and often over-treatment) cancer thought unworthy; even late in an attempt to bet the same as the charge through the last chemotherapy, are also often involved in other to turn the tide of no practical significance and possibilities. On the contrary, in most cases, especially in elderly patients, to their class of cancer as a chronic disease, to consider short-term goal to pursue the best effect on both, but the pursuit of long-term stability and good quality of life. Treatment on stress is reasonable, appropriate and comprehensive. Implementation of palliative care for most patients and the "maintenance treatment" idea ... ... In short, in many cases, "CAREFUL IN THE SUMMER" are often the consequences will be better and more consistent long-term best interests of patients. The whole treatment, surgery, chemotherapy and radiotherapy, the choice of more invasive means to be "the person and should," "moderate shelling ceased." This goes back to a Chinese medicine "the person should," "Big drug treatment, 10 to its six" "food nutrition, do" traditional thinking. Really highlights the medical "people-oriented" basic purpose, which we thought called "clever countermeasures."

Reporter: So, "a clever countermeasures" The key is it?

Yu-min: The key is to improve the quality of life of patients. Improve the quality of life and prolonging life has become the gold standard of modern cancer treatment, in this context, the patient should be integrated under the circumstances, the light of evidence based medicine, the use of standardized and individualized therapy combined, and finally to a variety of cancer patients prolonged survival. In the new outcome measures, we select the treatment program should be in the "eradication of cancer" and "protection of the body" to strike a balance between, choose a maximum protection of both the human body function, to avoid trauma or side effects, while inhibition of tumor cells to the treatment program. In short, scientific, comprehensive, and reasonable treatment principles, so we only concerned with biological tumor suppression kill shifted to more attention to improve the patients quality of life and prolong survival as the goal of "people-oriented" treatment, which reflects the significant changing attitudes.

Reporter: You mentioned several times in the comprehensive treatment of cancer, we all know, the combined treatment is not a simple superposition. How, then, to achieve the 1 +1> 2 effect?

Yu-min: in the development of cancer treatment, we must grasp the principle of comprehensive treatment. Cancer is a systemic disease in a partial reflection of the complexity of the decision of any condition of a single treatment were not sufficient to obtain very reliable efficacy. Meanwhile, as the medical model into the biological model of biological - psychological - social model, and are turning to biological - psychological - social - ethical model, and the tumor itself is the result of interaction of many factors, so the treatment of cancer should be treated as an integrated principle. Should be based on the patient's general condition, psychological state, the organs function, the specific tumor site, histological type, extension of the development trend and disease of the morning and evening, etc., combined with the characteristics of cell and molecular biology, planned, optimized and reasonable manner Combined application of various existing effective treatment, and the most appropriate economic cost to obtain the best treatment, patients should also maximize the improvement of the quality of life. Such as solid tumor indications for surgery are advised to have surgery, radiotherapy and chemotherapy for stage in the appropriate use of radiotherapy and chemotherapy should also make full use of and treatment with Chinese medicine, biological treatment, to a total playing anti-cancer, tumor, attenuated efficiency, reduce toxicity, relieve pain patients, improve symptoms, quality of life and prolong survival in the consolidated results. In addition, we pay attention to psychological adjustment, social support, home care and so on.

In the emphasis on integrated treatment, in particular, highlight the medical treatment, psychological treatment and the combined effect of social support. In fact, Chinese medicine treatment of outstanding significance in the malignant tumor, in a long time been seriously underestimated or misunderstood, and psychological and social support has long been ignored, this is the tumor mortality in China today is still high important factor. Must work now to correct this error, full attention to the significance of combined therapy to improve tumor response time.

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"Birth of a baby really is not easy" series of reports -

Monday, November 12th, 2007

"Birth of a baby really is not easy" series of reports -
Lateral is timely help or worse

In recent years, the rise in caesarean section rate at the same time, episiotomy rate rise. A survey data show that domestic maternal episiotomy rate in some hospitals up to 85%, higher than the World Health Organization's less than or equal to 20% of the standard.

What is a "lateral"
"Lateral" refers to the mothers in the natural delivery process for the episiotomy. Perineum is between the vagina and anus a few centimeters of the narrow part in the birth mothers have not started when it is taut, when the pain started to become a regular when the formal labor pains. It becomes as soft as pudding. This is a hormone called prostaglandin secretion caused by a large number of changes, for the baby was delivered successfully, the perineum must become soft and have a good stretch. When the delivery to the exit from the birth canal can see baby's head, so not hard to see when the fetal head, the perineum is stretched oppressed fetus, gradually become as thin as paper. Lateral episiotomy suture that is on the second stage of labor for the simple minor surgery, to avoid delivery of the baby when the mother severe pelvic soft tissue around the fetal head laceration and reduce pressure. This procedure usually performed under local anesthesia, in the perineal incision 2 to 3 cm wound, the baby is delivered after the suture, 3 to 4 days postpartum suture. Now Multi-absorbable sutures, usually do not need stitches.
Lateral, is timely help, or worse

Lateral, a timely help or worse? The medical profession is still controversial. Proponents believe that episiotomy can reduce that pain, but also conducive to eugenics, on the maternal and fetal beneficial, it should be said to be timely assistance. Fetus from the birth, mother's birth canal, including the bone birth canal birth canal (pelvic cavity) and the soft birth canal (the lower uterus, cervix, vagina, perineum), the perineum is the last paragraph of the birth canal. Childbirth, the cervix and vagina of fetal first disclosed by the Department needs to expand slowly, perineum also need some time to expand the song. Although the fetus through the birth canal time varies, but generally longer than the average of 12 hours, first born child's mother will be longer. The longer, fetal hypoxia or even the greater the chance of suffocation. So, seize the opportunity to do perineal incision to expand, the fetus can be shortened stay hang on in production, both to protect the fetus, but also reduce the mother's labor pain. If you do not do lateral, when about 10 cm in diameter, and matrix fetal head was delivered from the maternal vagina, if there is no midwife on the maternal protection of the perineum, so that mothers will Yinfa Sheng will be varying degrees of tearing, or more seriously, uterine prolapse occurs, incontinence and other consequences. Mothers will Yinfa Sheng tear, its very neat wound edge. This will not only maternal perineal wound healing time prolonged, and in wound healing, but also the formation of scar easily, so that when the lived sex for foreign body sensation. Therefore, if women give birth in a timely manner so episiotomy technique, you can avoid this from happening. Therefore, maternal natural childbirth, even if born, midwives are often cut for maternal knife.

However, in recent years, against the indiscriminate use of the voice of lateral growing. Opponents argue that, lateral, after all, a traumatic surgery, which has suffered the pain of childbirth the mother is undoubtedly worse. Not only to increase lateral maternal physical pain, and increased health care costs and medical risks. In favor of the lateral's main point is lateral to avoid possible risk of perineal tearing. So, if the strengthening of maternal prenatal training and education, to strengthen midwifery and nursing products, both to prevent maternal perineal tear, not to suffer knife lateral up to it not better? It was observed 1558 cases of maternal, natural results and perineal laceration compared with suturing episiotomy rate of postoperative infection, wound healing time is long, expensive hospital stay, length of stay is long. Therefore believe that clinical practice in obstetrics, medical staff to improve accountability, strengthen the production process to improve midwifery skills of observation and to minimize the episiotomy in vaginal delivery patients.
Lateral risk

Many obstetricians and midwives on the risk of lateral insufficient understanding, coupled with the easier route and to reduce the trouble of midwifery, so many instincts of maternal suffering from multi-lateral endured a knife. A group survey, nearly 92% of the natural mother had received lateral production operation; of which 77% of people do not know why in the end to accept lateral; about 44% of the people to lateral and no anesthesia before surgery; nearly 32% of people think that lateral postpartum sex life for their impact; early maternal perineal incision was nearly Jiucheng, such a high rate can be won the world title.

In fact, maternal episiotomy often occur following risks: 1. Wound hematoma: performance in the suture 1 to 2 hours after the knife-edge position that is in serious pain, but more important, even a heavy feeling in the anus. You should immediately tell the staff, check in time, probably not enough doctors to stop bleeding in the suture. This situation, as long as the time open seams, remove the hematoma, suture live bleeding, re-sutured wound, treated the pain will usually disappear quickly, most can be healed normally. 2. Wound infection: the performance in the 2 to 3 days postpartum, the wounds of local red, swelling, heat, pain, inflammation, etc., and may have induration, purulent discharge when squeezed. In such cases, should take the appropriate antibiotics, and removal of sutures, to pus out. Also can be used to help the anti-inflammatory therapy, or 1:5000 potassium permanganate solution temperature hip bath. These measures, due to perineal rich blood supply, there is a strong healing ability, it is generally 1 to 2 weeks after will get better or heal. 3. Wound dehiscence after suture removal: Some mothers in the perineal wound dehiscence occurred after suture removal, this time as have been discharged, shall immediately go to hospital treatment. If the wound tissue fresh, split time is short, can be properly disinfected immediately after the second suture, 5 days after the removal of stitches, mostly good long again; if the wound tissue is not new and there is discharge can not be repaired, available potassium hip bath potassium solution, and antibiotics to prevent infection, wait until after the partial formation of scar healing.
Lateral indication to strictly control

The following some cases of maternal, consider doing episiotomy procedure: 1. Perineal elasticity is poor, narrow vagina or perineal inflammation, edema, etc., when the fetus is estimated that there will be severe perineal tear. 2. Fetal larger fetal head position is not correct, coupled with weak productivity, fetal head was blocked in the perineum. 3.35 years of age or older mothers, or associated with heart disease, pregnancy induced hypertension and other high-risk pregnancy, in order to reduce maternal physical exertion, reduce labor, reduce the threat of delivery on maternal and child, when the fetal head down to the perineum, the episiotomy can be considered done. 4. I have to open the whole uterus, fetal head low, but the phenomenon of fetal hypoxia significantly, abnormal fetal heart rate changes or heart rhythm irregularity, and turbidity or a mixture of meconium and amniotic fluid. 5. Fetus can not smooth delivery, requires the use of forceps delivery time.

Because of the perineum after vaginal o anal close before, many bacteria, it is not a sterile perineal incision surgery. Moreover, there are many vaginal bacteria parasitic, if premature rupture of membranes, prolongation, usually inflammation of the vagina and perineum, and edema, the perineum may be poor healing of the incision. With postpartum bowel movement, lochia discharge, also subject to pollution can cut inflammation. As an additional lateral to the perineum wound, so the need to strengthen post-natal care.
The new law could greatly reduce health care midwifery lateral rate

In order to improve the quality of midwifery, to lower the episiotomy rate
Health care in clinical practice in recent years, explored and summed up by hand with care anal vaginal expansion of the Combination of protection of the perineum method proved effective. Began to allocate a specific method is revealed when the fetal head, according to routine cleaning and disinfecting, shop towel. Mothers who stand on the right side of midwifery, first check the thickness of the hymen, if the hymen thick can be cut into jagged, bleeding hemostasis when the use of gauze, left thenar part of the touch of occipital fetal head, so fetal head overlooking the song, right four fingers (thumb excluded) inserted into the vagina posterior perineal Department, pulp out, slightly forced outward, downward expansion, contraction intermittent stops, so repeated several times, allowed to fully expand . At this time, decreased fetal head, right hand placed on the joint Department of perineum, side pull side of the situation observed expansion of the perineum. To prevent perineal tearing. When the fetal head with crown, the right to stop the expansion, to prop up anal method. Intermittent contractions when to let go a little to avoid oppression for too long causes tissue edema, but need to stay in place do not move to prevent uterine contraction suddenly pressed, midwifery were too late to protect. Left hand to help expulsion of fetal head, shoulders and torso, his right hand before being let go. The method for expanding protection of the perineum anus vagina Fa Jiatuo to full rate of maternal perineum increased by 8% episiotomy rate has dropped 12%
.

The traditional trust law to protect the perineum anus is upward and inward trying to lift up the power of the perineum, to control the discharge and helped to increase the export of perineal relaxation. Now many people think that this approach does not fully expand to the perineum, reduced exports, lower the perineal skin, muscle flexibility, easily lead to perineal tear. Even if the perineum good condition, no tear, may result in multiple laceration occurred on both sides of the vaginal wall, resulting in difficulties or suture closure extended, affecting wound healing. Care anal law alone, probably because of the long duration of perineal compression resulted in local tissue ischemia, edema, may also affect wound healing, but also probably because of compression of fetal head a long time, resulting in relaxation of pelvic floor tissue, causing postpartum urinary retention. Anal vaginal Fa Jiatuo by expansion method can avoid this from happening. This is because the late pregnant maternal perineal and vaginal soft thickened, loose connective tissue has softened, the vagina longer and wider, have great skin stretch muscles, pelvic relaxation occurs in all joints to accommodate the expansion of high birth . Expansion method using the full expansion to the perineum, vaginal cleft increased, the export increase, flexibility increase, when the fetal head with crown-Yang Shen, the midwife who use child care anal law, the amount left to support the Department of the fetal head to assist in fetal head Yang extension, and has asked the maternal use of abdominal pressure, slow fetal head was delivered. Maternity and midwifery were then asked appropriate cooperation is an important factor to prevent perineal tearing. The midwifery process, should guide the proper use of the maternal abdominal pressure, should also pay particular attention, although the perineal skin and muscles have a certain extend, but not unlimited expansion. Shen Yang in the fetal head and therefore use care when rectal method, so that slow fetal head is delivered, before they can avoid or reduce perineal laceration. The law conditions for success: 1. Fetus: the fetal heart sounds good, no fetal distress as soon as possible indications for the end of the second stage of labor, weighing 4,000 g or less. 2. Maternal: the perineum in good condition, no need to end delivery of obstetric complications, no extension of the second stage of labor, maternal in with.

Newspaper correspondent Wei Yiming

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