http://repository.usmf.md:80/handle/20.500.12710/10713 2026-09-02T13:06:17Z http://repository.usmf.md:80/handle/20.500.12710/29004 Title: Assessment of the cases of postpartum hemorrhage in multiparous women Authors: Cemortan, Maria; Bubulici, Cristina; Vicol, Maria-Magdalena; Grajdean, Elena; Scripnic, Gabriela; Manic, Milena Abstract: Introduction. Postpartum hemorrhage (PPH) is one of the leading obstetric complications, affecting 5-15% births. Being a major factor in maternal mortality and morbidity, PPH causes about 25% of maternal deaths worldwide. Aim of study. The aim of the study was to assess the cases of PPH in multiparous women, admitted to the Tertiary Perinatal Center. Methods and materials. The retrospective study was performed by assessing 81 clinical cases of PPH in multiparous women. Total blood loss in labor or C-section was performed by using graduated vessels, and all the sterile material used was weighted. For continuous variables, the mean values and standard deviation of the mean were calculated; the median (Me) as well as the interquartile range (Q1;Q3) in the case of a distribution of characteristics that differs from the normal. Results. The average age of women was 31.6±5.5 years (Me 32 (28;35.5)), varying in the limits of 20-42 years. The majority of participants delivered for the second time - 38 cases (46.9% (95% CI 33.3-59.9)), however, 30 women (37.0% (95% CI 25.9-48.2)) gave birth for the third time, and 13 women (16.1% (95% CI 8.5-27.4)) had 4th – 9th delivery. In 41 cases (50.6% (95% CI 40.7- 61.7)) a c-section was performed. The mean blood loss in vaginal delivery was 850±308 (Me 800 (600;1050)) mL, varying in the limits of 500– 1600 mL. Compared to the mean blood loss in Csection – 1752±1093 (Me 1500 (1100;1850)) mL, varying in the limits of 1000 – 5250 mL. In the structure of PPH there were assessed 26 cases (32.1% (95% CI 20.9-47.0)) of the placental defect or placenta adherens, 15 cases (18.5% (95% CI 10.3-30.5)) of lacerations of the birth canal, 11 cases (13.6% (95% CI 7.4-23.4)) of uterine atonia, and 2 cases (2.5% (95% CI 0-7.3)) of uterine rupture. Hence, in 46 women (56.8% (95% CI 44.6-69.1)) it was applied conservative management of the cases. However, in 20 cases (24.6% (95% CI 15.0-38.1)) an operative management was applied, from which 7 cases (8.6% (95% CI 3.7-14.7)) hemostatic sutures were applied. In 13 cases (16.0% (95% CI 8.5-27.4)) hysterectomy was performed, from which 9 cases (69.2% (95% CI 31.6-100)) subtotal hysterectomy without annexes was the elective method for definitive hemostasis. Conclusion. PPH is a major obstetric complication, which occurs more frequently in multiparous women, in association with placental pathology and birth canal trauma, explained by overextension of the uterus and coagulation disorders, requiring extensive surgical management. 2024-01-01T00:00:00Z http://repository.usmf.md:80/handle/20.500.12710/28656 Title: The principles of the "fast track" program in obstetrical emergencies Authors: Vasilachi, Cristian Abstract: Introduction. Currently, the trend of contemporary surgery is to ensure a perioperative result of an increased quality, with the reduction of the stressful impact of the surgical act on the internal homeostasis of the human body. In Urgent Obstetrics, this element is very important, given the fact that it involves a pregnant patient, whose birth requires a quick solution, while ensuring, at the same time, high-performance results. It is exactly at this stage, when the ERAS (Enhanced Recovery After Surgery) programs steps in, especially "Fast Track" protocols. Given the specificity of these programs (they can be applied mainly in scheduled interventions), it is desired to determine those principles and manipulations, provided by them, which can also be useful during urgent interventions. The purpose of this study is to evaluate the procedures of the ERAS programs that can be applied in urgent obstetric situations, which would have a significantly better effect on the body of both the mother and the fetus; the conditions in which they can be applied and their efficiency, in order to ensure perioperative results of an increased quality. Aim of study. As for now, there exist different ERAS Society guidelines for perioperative care in obstetrics, regarding interventional delivery, that provide best practice recommendations in each phase of medical care, but almost all of them are implementing practice principles that could be used only in scheduled interventions. In the meantime – the efficiency and applicability of those are questionable regarding fast birth delivery, via cesarean surgical intervention. Thus it is extremely important to create a „focused” pathway process for urgent ERAS Cesarean Delivery, starting from „decision to operate” (up to 30 min before skin incision) – to hospital discharge, and therefore postpartum monitoring. Methods and materials. There was made a literature review, including recent studies made between 2017 - 2023, regarding the applicability of prophylaxis and treatment options, used in programmed cesarean delivery, that could be used in emergency surgical - birth solutions. Titles and abstracts were analyzed to identify potentially relevant articles. Meta Analysis, systematic reviews, randomized controlled studies, nonrandomized controlled studies, reviews, and case series were considered for each individual topic. Results. Guidelines for perioperative care in cesarean delivery: Enhanced Recovery After Surgery Society recommendations, that were demonstrated as grade A : Antibacterial prophylaxis is mandatory less than an hour before skin-incision Use of body-warm solutions and increased operating room temperature results in better post-operative recuperation Special cesarean delivery surgical techniques do not improve the final outcome, in comparison with the traditional ones Perioperative fluid management should be done using the 2 : 1 coefficient, regarding the overall blood loss Regardless of the fetal status – immediate neonatal resuscitation team is mandatory Use of analgesic potentiators is essential, in order to reduce the need of morphine derivated drugs Early patient mobilization (4h after cesarean delivery) results in faster recuperation of self-care and child-care activities Conclusion. We are looking to detect optimized perioperative conduct methods, to elaborate a guideline, in order to improve the surgical result of obstetrical patients, increase the efficiency of the medical act, reduce its costs and enhance the trust level of citizens towards the local health system. increased quality, with the reduction of the stressful impac t of the surgical act on the internal homeostasis of the human body. In Urgent Obstetrics, this element is very important, given the fact that it involves a pregnant patient, whose birth requires a quick solution, while ensuring, at the same time, high-performance results. It is exactly at this stage, when the ERAS (Enhanced Re covery After Surgery) programs steps in, especially "Fast Track" protocols. Given the specificity of these programs (they can be applied mainly in scheduled interventions), it is desired to determine those pr inciples and manipulations, provided by them, which can also be useful during urgent interventions. The purpos e of this study is to evaluate the procedures of the ERAS programs that can be applied in urgent obstetri c situations, which would have a significantly better effect on the body of both the mother and the fetus; t he conditions in which they can be applied and their efficiency, in order to ensure perioperative results o f an increased quality. Aim of study. As for now, there exist different ERAS Society guidelines for perioperative care in obstetrics, regarding interventional delivery, that provide best practi ce recommendations in each phase of medical care, but almost all of them are implementing practice prin ciples that could be used only in scheduled interventions. In the meantime – the efficiency and applicabi lity of those are questionable regarding fast birth delivery, via cesarean surgical intervention. Thus it is extremely important to create a „focused ” pathway process for urgent ERAS Cesarean Delivery, starting from „decision to operate” (up to 30 min before skin incision) – to hospital discharge, and therefore postpartum monitoring. Methods and materials. There was made a literature review, including recent studi es made between 2017 - 2023, regarding the applicability of prophylaxis and treatment opt ions, used in programmed cesarean delivery, that could be used in emergency surgical - birth sol utions. Titles and abstracts were analyzed to identify potentially relevant articles. Meta Analysis, syst ematic reviews, randomized controlled studies, nonrandomized controlled studies, reviews, and case series were con sidered for each individual topic. Results. Guidelines for perioperative care in cesarean delivery: Enhanc ed Recovery After Surgery Society recommendations, that were demonstrated as grade A : Antibact erial prophylaxis is mandatory less than an hour before skin-incision Use of body-warm solutions and increased operating room temperature results in better post-operative recuperation Special cesarean delivery surgical techniques do not improve the final outcome, in comparison with the traditional ones Perioperative fluid management should be done using the 2 : 1 coefficient, regarding the overall blood loss Regardless of the fetal status – immediate neonatal resuscitation team is mandatory Use of analgesic potentia tors is essential, in order to reduce the need of morphine derivated drugs Early patient mobilization (4h af ter cesarean delivery) results in faster recuperation of self-care and child-care activities Conclusion. We are looking to detect optimized perioperative conduct methods, to elaborate a guideline, in order to improve the surgical result of obstetrical patient s, increase the efficiency of the medical act, reduce its costs and enhance the trust level of citizens towards the local health system. Description: Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”, Chişinău, Republica Moldova 2024-01-01T00:00:00Z http://repository.usmf.md:80/handle/20.500.12710/28662 Title: What do students know about sexually transmitted diseases and methods of contraception? A survey study about knowledge and sexual risk behaviours among university students Authors: Jurca, Denisa-Amalia Abstract: Introduction. Sexual life is of considerable importance, particularly in youngsters, not only because of its Sexual life is extremely important, especially for young people, not just because it affects intellectual development but also because of potential health effects. STIs are among the most prevalent diseases in the world, and unwanted pregnancies and sexually transmitted diseases (STDs) rank among the most serious issues globally. Every day around the world, more than 1 million STIs are acquired and every year there are around 500 million new infections, most commonly syphilis, chlamydia, trichomoniasis and gonorrhoea (WHO,2014). Sexual behaviour is the key determinant of STI transmission all over the world. ( Fenton, 2004). Adolescents and young adults are at higher risk for such behaviour, frequently as a result of their immature decision making. Additionally, these sexual risk behaviour patterns may persist into adulthood (Epstein et al., 2014). Aim of study. This study aims to investigate the level of knowledge, perception, sexual risk behaviours and attitudes about sexual matters, among university students. Furthermore, to improve strategies for family planning and sexual health education among youths. Methods and materials. The study was conducted with an online survay questionnaire. The link was shared with students attending different universities. The questionnaire was divided into 3 parts: the first part includes general information; the second includes questions related to sexual matters; the third aims to assess students’ knowledge. The statistical analysis was conducted using SPSS software. Results. The total number of participants was 564. The majority were Romanians, female, Orthodox, 21-25 years old, Caucasian, single and studying at a biomedical university. The most knowledgeable students about sexual matters were Serbians studying in a biomedical faculty. The most commonly used source of information was the Internet-TV (76.80%) while the most commonly used contraceptive method was the condom. Most students never received sexual health education (51.06%), and among those who received it, the majority were Serbians. Regarding FP, the majority would like to have their first child at 26-29 years. Students who were less engaged in sexual risk behaviors were females, Muslims black/African-American with few sexual partners. Students who used the EC pill multiple times were mainly Romanian. Conclusion. Students who received sexual education were more knowledgeable about sexual matters. Sociodemographic and cultural factors are all aspects that influence sexual risk behaviours. Improvement of students’ knowledge, perceptions, and attitudes towards these topics is still needed. because of its Sexual life is extremely important, especia lly for young people, not just because it affects intellectual development but also because of pote ntial health effects. STIs are among the most prevalent diseases in the world, and unwanted pregnancies and sexually transmitted diseases (STDs) rank among the most serious issues globally. Ever y day around the world, more than 1 million STIs are acquired and every year there are around 500 million new infections, most commonly syphilis, chlamydia, trichomoniasis and gonorrhoea ( WHO,2014). Sexual behaviour is the key determinant of STI transmission all over the wor ld. ( Fenton, 2004). Adolescents and young adults are at higher risk for such behaviour, frequently as a result of their immature decision making. Additionally, these sexual risk behaviour patterns ma y persist into adulthood (Epstein et al., 2014). Aim of study. This study aims to investigate the level of knowledge, perce ption, sexual risk behaviours and attitudes about sexual matters, among university students. Furthermore, to improve strategies for family planning and sexual health education amon g youths. Methods and materials. The study was conducted with an online survay questionnaire. The link was shared with students attending different universities. The questionnaire was divided into 3 parts: the first part includes general information; the sec ond includes questions related to sexual matters; the third aims to assess students’ knowledge. The statistical analysis was conducted using SPSS software. Results. The total number of participants was 564. The majority were Romanians, female, Orthodox, 21-25 years old, Caucasian, single and studying at a biomedical university. The most knowledgeable students about sexual matters were Serbians st udying in a biomedical faculty. The most commonly used source of information was the Internet -TV (76.80%) while the most commonly used contraceptive method was the condom. Most stude nts never received sexual health education (51.06%), and among those who received it, the major ity were Serbians. Regarding FP, the majority would like to have their first child at 26-29 ye ars. Students who were less engaged in sexual risk behaviors were females, Muslims black/African-Amer ican with few sexual partners. Students who used the EC pill multiple times were mainly Romani an. Conclusion. Students who received sexual education were more knowledgeable about sexual matters. Sociodemographic and cultural factors are all as pects that influence sexual risk behaviours. Improvement of students’ knowledge, perceptions, and attitudes towards these topics is still needed. Description: Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”, Chişinău, Republica Moldova 2024-01-01T00:00:00Z http://repository.usmf.md:80/handle/20.500.12710/28652 Title: Simulation as an efficient training tool in obstetric emergencies Authors: Coșpormac, Mihaela; Manic, Milena; Budianu, Cătălina Abstract: Introduction. Despite the era of high-tech medicine, high quality obstetric management requires a good collaboration between multidisciplinary professionals based on the improvement and acquisition of knowledge and practical skills. Simulation is a great method of transposing clinical cases in practice, as it allows the acquisition of knowledge through communication and error management. Aim of study. The Aim of the study was to assess the efficiency of simulation and its impact on multidisciplinary teamwork in obstetric emergency service providers training Methods and materials. 196 people were part of an obstetric emergencies simulation training program. The program was based on the "at the patient's bedside" principle and included 18 courses that lasted 3 days each within the Simulation Center. 78 people were surveyed, of which 41 doctors (52.6%) and 37 nurses (47.4%). The teams included specialists that were subjected to five scenarios. The cognitive learning model was based on factual articulation and conceptual articulation. To assess the degree of satisfaction, the participants completed an anonymous survey, which included 43 questions. Results. Participants highlighted a general interest in simulation training in 76 cases (97.4%). Despite the initial reservations in 37 trainees (47.3%), at the end of the training all the surveyees described it as "a positive experience, which must be repeated at least once a year". The simulation consisted of briefing, simulation, and debriefing. The trainees were monitored by video and audio. Structured and constructive feedback was provided while encouraging assertive and non-judging communication. The mutual emotional support was emphasized in 74 cases (94.9%), in particular the importance of communication. During each scenario the team developed the standard management, being able to perform it repeatedly afterwards to strengthen their skills and reinforce the quality of the communication process. All participants specified that the proposed scenarios were well adapted and have greatly facilitated the learning process. According to 76 people (97.4%), there was an improvement in team dynamics, but the majority expressed the need for a leader (75 cases – 96.2%). 77 participants (98.7%) conveyed the importance of simulation as a training process and 75 people (96.15%) underlined its positive impact in dealing with obstetric emergenciesSimulation was proven to be an essential training specialists tool. Moreover, in 68 cases (87.2%), participants believe that the acquired skills will improve the workplace yield. Conclusion. Simulation training led to better obstetric emergencies management through teamwork and correct decision making. It implemented the acquired theoretical knowledge through practical and communication skills developpement. The importance of communication while working in a multidisciplinary team was determined, with repeated simulation training serving as a model for continuing education. good collaboration between multidisciplinary professionals based on the improvement and acquisition of knowledge and practical skills. Simulation is a great method of transposing clinical cases in practice, as it allows the acquisition of knowledge through communication and erro r management. Aim of study. The Aim of the study was to assess the efficiency of s imulation and its impact on multidisciplinary teamwork in obstetric emergency service pr oviders training Methods and materials. 196 people were part of an obstetric emergencies simulation trai ning program. The program was based on the "at the patient's bedside" principle and included 18 courses that lasted 3 days each within the Simulation Center. 78 peopl e were surveyed, of which 41 doctors (52.6%) and 37 nurses (47.4%). The teams included specialists that were subjected to five scenarios. The cognitive learning model was based on factual articulat ion and conceptual articulation. To assess the degree of satisfaction, the participants completed an anonymous survey, which included 43 questions. Results. Participants highlighted a general interest in simulation training in 76 ca ses (97.4%). Despite the initial reservations in 37 trainees (47.3%), at the end of the t raining all the surveyees described it as "a positive experience, which must be repeated at least onc e a year". The simulation consisted of briefing, simulation, and debriefing. The trainees were monitored by video and audio. Structured and constructive feedback was provided while encouraging assertive and non-judging communication. The mutual emotional support was emphasized in 74 cases (94.9%), in particu lar the importance of communication. During each scenario the team developed the sta ndard management, being able to perform it repeatedly afterwards to strengthen their skills and reinforce the quality of the communication process. All participants specified that the prop osed scenarios were well adapted and have greatly facilitated the learning process. According to 76 people (97.4%), there was an improvement in team dynamics, but the majority expressed the ne ed for a leader (75 cases – 96.2%). 77 participants (98.7%) conveyed the importance of simulation as a trai ning process and 75 people (96.15%) underlined its positive impact in dealing with obstetric e mergenciesSimulation was proven to be an essential training specialists tool. Moreover, in 68 cases (87.2%), participa nts believe that the acquired skills will improve the workplace yield. Conclusion. Simulation training led to better obstetric emergencies manageme nt through teamwork and correct decision making. It implemented the acquired theoretica l knowledge through practical and communication skills developpement. The importance of communica tion while working in a multidisciplinary team was determined, with repeated sim ulation training serving as a model for continuing education. Description: Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”, Chişinău, Republica Moldova 2024-01-01T00:00:00Z