scholarly journals Different Methods for Termination of Mid-trimester Pregnancy With Placenta Previa 

2021 ◽  
Author(s):  
Qingyun Long ◽  
Shiyao Wu ◽  
Shuguo Du ◽  
Ruyan Li ◽  
Yun Zhao ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Postpartum Hemorrhage ◽  
Placenta Previa ◽  
Combination Method ◽  
Control Group ◽  
Observation Group ◽  
Artery Embolization ◽  
Good Tool ◽  
Puerperal Infection ◽  
Normal Placenta

Abstract Objective: Investigate the different methods for termination at mid-trimester in pregnant women with placenta previa. Methods: A retrospective study was conducted on 264 cases for termination at mid-pregnancy in our hospital, and 34 cases with placenta previa were set as the observation group, and 230 cases with normal placenta were set as control group. Among them, the preferred methods of termination at first were Mifepristone combined with Misoprostol/Rivanol in the observation group, and Mifepristone combined with Misoprostol/Rivanol/cervical double balloon (CDB) in the control group. If the volume of prenatal bleeding was up to 100 mL in the observation group, emergency artery embolization (UAE) was implemented to stop bleeding, then CDB plus with curettage were used in order. If it failed to induce in the control group, CDB was used subsequently followed with Misoprostol/Rivanol. Then, all those cases were set as the comprehensive-induce group, and the others were set as the simple-induce group.Results: the average maternal age, the number of gravidity/parities, the rate of cesarean section, the hospitalization days and cost, the induction time, the rate of postpartum hemorrhage, puerperal infection were higher in the observation group than those in the control group(p<0.05). There were 4 cases used UAE+CDB+curettage in the observation group and 6 cases used CDB after Misoprostol/Rivanol in the control group. The duration time of termination, the rate of postpartum hemorrhage and transferring to ICU, hospitalization days and cost in the comprehensive-induce group were significantly higher than those in the simple-induce group (p<0.05). All cases were delivered through vaginal successfully.Conclusion: We should pay more attention to the complications of prenatal bleeding, postpartum hemorrhage, puerperal infection during the induction at mid-trimester in pregnant women with placenta previa. Emergency UAE + CDB +curettage is a good combination method in prenatal hemorrhage of placenta previa during termination, and CDB was a good tool for cervical ripen with immature cervical condition in mid-trimester for induction of labor.

Radiologic Intervention of Internal Iliac Artery Occlusion During Cesarean Section for Dangerous Placenta Previa

2020 ◽  
Vol 10 (12) ◽  
pp. 2931-2934
Author(s):  
Qingzhen Zhao ◽  
Na Zhao ◽  
Dengdeng Luo ◽  
Sheng Yue
Keyword(s):  
Cesarean Section ◽  
Iliac Artery ◽  
Internal Iliac Artery ◽  
Placenta Previa ◽  
Artery Occlusion ◽  
Control Group ◽  
Observation Group ◽  
Iliac Artery Occlusion ◽  
Significant Difference ◽  
Internal Iliac

Objective: The cesarean section of dangerous placenta previa always faces the problem of massive hemorrhage. The aim of this study was to analyze the clinical effect of internal iliac artery occlusion combined with obstetric autotransfusion in cesarean section of dangerous placenta previa. Method: From November 2017 to November 2019, 20 patients with placenta previa undergoing cesarean section in our hospital were selected. According to the preoperative MRI and ultrasound diagnosis, the amount of bleeding was evaluated and divided into observation group (n = 6) and control group (n = 14). All patients underwent routine cesarean section and prepared the obstetric autotransfusion device. In the observation group, the internal iliac artery balloon was placed under DSA before operation. After the fetus was taken out, the internal iliac artery was blocked. The internal iliac artery occlusion was not needed in the control group. The total length of stay, Apgar score, the incidence of disseminated intravascular coagulation (DIC), hemorrhagic shock, postoperative infection and renal dysfunction were compared between the two groups. Result: Compared with the relative data in control group, the operation time and postoperative hospital stay of the observation group were significantly shorter, the intraoperative blood loss and blood transfusion were significantly lesser, and the hemoglobin difference before and after operation was significantly lesser. There was no significant difference in the incidence of DIC, hemorrhagic shock, postoperative infection and renal dysfunction between two groups; There was no significant difference in neonatal body mass, Apgar score at 1 min and 5 min. Conclusion: The internal iliac artery occlusion can effectively reduce the amount of bleeding in delivery, promote the recovery of negligence, and have no adverse effect on complications and neonatal outcome.

scholarly journals Perinatal Mood Disorders in Second Trimester Pregnant Women with Cervical Insufficiency, a Population-based Cohort Study

2021 ◽  
Author(s):  
Chunqi Luo ◽  
Qiaojian Zou ◽  
Huiling Liang ◽  
Jingyi Chen ◽  
Xuanmin Chen ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Mood Disorders ◽  
Protective Factor ◽  
Multiple Logistic Regression Analysis ◽  
Anxiety And Depression ◽  
Control Group ◽  
Cervical Insufficiency ◽  
Observation Group ◽  
Second Trimester ◽  
Self Rating

Abstract Background: Perinatal mood disorders can seriously endanger the health of pregnant women and fetus, affect family relationships and cause heavy burden and potential hazards to family and society. This study aims to investigate anxiety and depression in second trimester pregnant women with cervical insufficiency (CI) and identify its risk factors, so as to provide guidance for daily clinic work.Methods: From April 2019 to July 2020, 98 mid-pregnancy women with CI underwent laparoscopic cervical cerclage in the First Affiliated Hospital of Sun Yat-sen University were selected as observation group and 166 normal pregnant women in second trimester were set as control group. Zung's Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS) were applied to evaluate perinatal mood disorders in both groups.Results: Pregnant women in CI group had a SAS score of 46.31±11.29 and SDS score of 54.12±11.72, higher than the SAS score of 41.63±7.70 and SDS score of 47.56±9.31 in control group (both P<0.001). While 32.65% and 67.35% of pregnant women in observation group were considered to have different degrees of anxiety and depression, only 15.06% and 30.72% of normal pregnant women meet the same condition (both P<0.001). Multiple logistic regression analysis indicated that educational experience is an independent protective factor for depression disorder in second trimester pregnant women with CI.Conclusion: Pregnant women with CI are prone to develop anxiety and depression in the second trimester than normal pregnant women, therefore doctors and nurses should pay more attention to them in clinic work.

scholarly journals Successful repeated uterine artery embolization in postpartum hemorrhage with disseminated intravascular coagulation: a case report and literature review

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Shunya Sugai ◽  
Taro Nonaka ◽  
Kana Tamegai ◽  
Tatsuhiko Sato ◽  
Kazufumi Haino ◽  
...  
Keyword(s):  
Risk Factor ◽  
Disseminated Intravascular Coagulation ◽  
Postpartum Hemorrhage ◽  
Uterine Artery Embolization ◽  
Uterine Artery ◽  
Placenta Previa ◽  
Blood Transfusions ◽  
Artery Embolization ◽  
Intravascular Coagulation ◽  
Uterine Arteries

Abstract Background Postpartum hemorrhage (PPH) is a potentially fatal condition requiring urgent and appropriate intervention. Uterine artery embolization (UAE) has a high hemostatic capacity for PPH, but it may fail. Disseminated intravascular coagulation (DIC) has been reported as a risk factor associated with the failure of UAE. Case presentation A 37-year-old primigravida with dichorionic diamniotic twins and placenta previa underwent cesarean section. The blood loss during surgery was 4950 mL. Hemostasis was achieved using an intrauterine balloon tamponade device. However, she lost a further 2400 mL of blood 5 h after surgery. We embolized both uterine arteries using gelatin sponges and confirmed hemostasis. She was suffering from DIC and received ample blood transfusions. However, a further 1300 mL of blood was lost 18 h after surgery and we performed repeated UAE, with complete recanalization of the uterine arteries on both sides and re-embolization with gelatin sponges. Her DIC was treated successfully by blood transfusions at this time, and she showed no further bleeding after the repeated UAE. Conclusions DIC is a risk factor for the failure of UAE. Repeated UAE may be effective after sufficient improvement of the hematological status in patients with PPH and DIC.

scholarly journals ANALISIS FAKTOR RISIKO YANG BERHUBUNGAN DENGAN KEJADIAN PLASENTA PREVIA

2021 ◽  
Vol 6 (2) ◽  
pp. 100
Author(s):  
Nurul Huda Mursalim ◽  
Saharuddin Saharuddin ◽  
Azizah Nurdin ◽  
Jelita Inayah Sari
Keyword(s):  
Risk Factors ◽  
Caesarean Section ◽  
Pregnant Women ◽  
Placenta Previa ◽  
Case Control ◽  
Control Group ◽  
Chi Square ◽  
Purposive Sampling ◽  
Chi Square Test ◽  
History Of

Tujuan penelitian ini adalah untuk mengetahui hubungan variabel dependen yaitu umur, paritas, riwayat sectio sesarea, riwayat gemelli dengan variabel independen yaitu plasenta previa di RSUD Batara Guru dan RS Hikmah Sejahtera Kabupaten Luwu Tahun 2018-2019. Pada studi ini memanfaatkan metode analitik observasional dengan pendekatan case control. Sampel ditentukan melalui perbandingan kelompok kasus sebanyak 50 sampel dengan kelompok kontrol 50 sampel. Teknik sampling menggunakan purposive sampling. Untuk mengetahui hubungan faktor risiko memanfaatkan uji chi square. Hasil terbanyak didapatkan 78 ibu hamil risiko rendah, 76 ibu hamil dengan multipara, ibu hamil dengan tidak ada riwayat sectio sesarea didapatkan 76 ibu hamil dan ibu yang tidak memiliki riwayat gemelli ada 97 ibu hamil. Hasil penelitian menujukkan dari uji chi square antara umur dengan plasenta previa didapatkan (P= 0.008 < 0,05) untuk hubungan paritas dengan plasenta previa didapatkan (P= 0,815 > 0,05) hubungan riwayat sectio sesarea didapatkan sebesar (P= 0.035 < 0,05) dan untuk hubungan riwayat gemelli sebesar (P= 1,000 > 0,05). Kesimpulan dari penelitian ini adalah tidak terdapat hubungan faktor risiko paritas, riwayat gemelli pada kejadian plasenta previa dan didapatkan hubungan faktor risiko antara umur, riwayat sectio sesarea dengan kejadian plasenta previa di RSUD Batara Guru dan RS Hikmah Sejahtera Kabupaten Luwu Tahun 2018-2019. Kata kunci: Umur, paritas, riwayat sectio sesarea, riwayat gemelli, plasenta previa ABSTRACTThe major objective of this study was to investigate the risk factors that affect the occurrences of placenta previa, such as ages, parity, caesarean section history, and gemelli history of pregnant women. This study was conducted at Batara Guru Hospital and Hikmah Sejahtera Hospital of Luwu Regency in 2018 to 2019. The methodological approach taken in this study was observational analytic by using a case control approach. The samples used in this research consisted of 50 samples for the case group and 50 samples for the control group. The sampling technique used was a purposive sampling. A chi square test was performed in this experiment in order to understand the risk factors. From this research, it was apparent that 78 pregnant women were with the low risk of getting placenta previa, 76 pregnant women were with multiparous, 76 pregnant women were with no history of cesarean section, and 79 pregnant women were without a gemelli history. Based on the chi square test, the results of this study indicated that various relationships were obtained such as the relationship between ages and placenta previa occurrences with (P = 0.008 <0.05), the correlation among parity and placenta previa occurrences with (P = 0.815> 0.05), the correlation among caesarean section history and placenta previa occurrences with (P = 0.035 <0,05), and the correlation among gemelli history and placenta previa occurrences with (P = 1,000> 0.05). This research concludes that there was no relationship between parity and gemelli history factors and the occurrences of placenta previa. In contrast, it was evident that there were close relationships between the ages and caesarean section history factors and the occurrences of placenta previa at Batara Guru Hospital and Hikmah Sejahtera Hospital of Luwu Regency in 2018 to 2019.Keywords: ages, parity, caesarean sectio history, gemelli history, placenta previa

scholarly journals Prediction of Placenta Accreta Using Hyperglycosylated Human Chorionic Gonadotropin

2018 ◽  
Vol 8 (2) ◽  
pp. 142-146
Author(s):  
Maad Mahdi Shalal ◽  
Shaymaa Kadhim Jasim ◽  
Huda Khalil Abd
Keyword(s):  
Caesarean Section ◽  
Pregnant Women ◽  
Chorionic Gonadotropin ◽  
Gestational Age ◽  
Human Chorionic Gonadotropin ◽  
Placenta Accreta ◽  
Placenta Previa ◽  
Control Group ◽  
Previous Caesarean Section ◽  
Hyperglycosylated Human Chorionic Gonadotropin

Objectives: Hyperglycosylated human chorionic gonadotropin (hCG) is a variant of hCG. In addition, it has a different oligosaccharide structure compared to the regular hCG and promotes the invasion and differentiation of peripheral cytotrophoblast. This study aimed to measure hyperglycosylated hCG as a predictor in the diagnosis of placenta accreta. Materials and Methods: In general, 90 pregnant women were involved in this case-control study among which, 30 ladies (control group) were pregnant within the gestational age of ≥36 weeks with at least one previous caesarean section and a normal sited placenta in transabdominal ultrasound (TAU). The other 60 pregnant women (case group) were within a gestational age of ≥36 weeks at least, one previous caesarean section and placenta previa with or without signs of placenta accreta in TAU. Hyperglycosylated hCG and total hCG were measured in each group and the results of the surgery were followed up. Results: Hyperglycosylated hCG showed higher serum levels in patients with placenta accreta compared to those with placenta previa and control women. Hyperglycosylated hCG with an optimal cut point of (3) IU/L predicted placenta accreta in pregnant women with 90% specificity, 76.7% sensitivity, and 81.1% accuracy. Conclusions: The high specificity of the above approach makes it a good diagnostic tool (as a single test) for confirming placenta accreta in clinical settings. When this test is added to our established workup, its high positive predictive value makes it a suitable method within the algorithm of accreta confirmation when there is a high suspicion or insufficient evidence to the diagnosis of placenta accreta.

scholarly journals Effects of Misoprostol and Oxytocin Combined with Calcium Gluconate on Delivery Time of Parturient with High-risk Postpartum Hemorrhage and Neonatal Outcomes

2020 ◽  
Vol 4 (3) ◽  
Author(s):  
Rongfang Chen ◽  
Wenwen Shuo
Keyword(s):  
High Risk ◽  
Calcium Gluconate ◽  
Apgar Score ◽  
Postpartum Hemorrhage ◽  
Effective Rate ◽  
Control Group ◽  
Observation Group ◽  
Delivery Time ◽  
Significant Difference ◽  
The Difference

Objective: To investigate the effect of misoprostol and oxytocin combined with calcium gluconate on parturient with high-risk postpartum hemorrhage. Methods: The clinical data of 80 parturient with high-risk postpartum hemorrhage who were treated in our hospital from July 2016 to July 2019 were retrospectively analyzed. According to different treatment methods, they were divided into control group (treated with misoprostol combined with oxytocin, 40 cases) and observation group (treated with misoprostol and oxytocin combined with calcium gluconate, 40 cases), compared the clinical efficacy, delivery time, postpartum hemorrhage 2 hour after delivery, postpartum hemorrhage 24 hours after delivery and Apgar score of the newborns at 1min after birth. Results: The total effective rate (95.00%) in the observation group was higher than that in the control group (77.50%), and the difference was statistically significant (P<0.05). The third delivery stage in the observation group was shorter than that in the control group, and the postpartum hemorrhage volume was less than that in the control group. The difference was statistically significant (P<0.05). There was no significant difference in Apgar score of the two groups of newborns (P>0.05). Conclusion: Misoprostol and oxytocin combined with calcium gluconate is effective in treating high-risk postpartum hemorrhage parturient, which not only can effectively reduce postpartum hemorrhage and shorten the delivery time, but also is beneficial for neonatal outcome and worthy of clinical application.

Radiologic Intervention of Internal Iliac Artery Occlusion During Cesarean Section for Dangerous Placenta Previa

2020 ◽  
Vol 10 (12) ◽  
pp. 2931-2934
Author(s):  
Qingzhen Zhao ◽  
Na Zhao ◽  
Dengdeng Luo ◽  
Sheng Yue
Keyword(s):  
Cesarean Section ◽  
Iliac Artery ◽  
Internal Iliac Artery ◽  
Placenta Previa ◽  
Artery Occlusion ◽  
Control Group ◽  
Observation Group ◽  
Iliac Artery Occlusion ◽  
Significant Difference ◽  
Internal Iliac

Objective: The cesarean section of dangerous placenta previa always faces the problem of massive hemorrhage. The aim of this study was to analyze the clinical effect of internal iliac artery occlusion combined with obstetric autotransfusion in cesarean section of dangerous placenta previa. Method: From November 2017 to November 2019, 20 patients with placenta previa undergoing cesarean section in our hospital were selected. According to the preoperative MRI and ultrasound diagnosis, the amount of bleeding was evaluated and divided into observation group (n = 6) and control group (n = 14). All patients underwent routine cesarean section and prepared the obstetric autotransfusion device. In the observation group, the internal iliac artery balloon was placed under DSA before operation. After the fetus was taken out, the internal iliac artery was blocked. The internal iliac artery occlusion was not needed in the control group. The total length of stay, Apgar score, the incidence of disseminated intravascular coagulation (DIC), hemorrhagic shock, postoperative infection and renal dysfunction were compared between the two groups. Result: Compared with the relative data in control group, the operation time and postoperative hospital stay of the observation group were significantly shorter, the intraoperative blood loss and blood transfusion were significantly lesser, and the hemoglobin difference before and after operation was significantly lesser. There was no significant difference in the incidence of DIC, hemorrhagic shock, postoperative infection and renal dysfunction between two groups; There was no significant difference in neonatal body mass, Apgar score at 1 min and 5 min. Conclusion: The internal iliac artery occlusion can effectively reduce the amount of bleeding in delivery, promote the recovery of negligence, and have no adverse effect on complications and neonatal outcome.

scholarly journals Prenatal Plasma Fibrinogen Level Predicts Postpartum Hemorrhage of Patients With HELLP Syndrome

2020 ◽  
Vol 26 ◽  
pp. 107602961989405
Author(s):  
Chanjuan Cui ◽  
Sisi Ma ◽  
Rui Qiao
Keyword(s):  
Pregnant Women ◽  
Postpartum Hemorrhage ◽  
Hellp Syndrome ◽  
Operating Characteristic ◽  
Fibrinogen Level ◽  
Characteristic Curve ◽  
Area Under The Curve ◽  
Control Group ◽  
Elevated Liver Enzymes ◽  
Peking University

Hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome is a serious complication of pregnancy. Postpartum hemorrhage indicates poor prognosis of pregnant women with HELLP syndrome. The aim of our study is to investigate the predictive value of coagulation markers for postpartum hemorrhage of pregnant women with HELLP syndrome. In a retrospective cohort study, 106 patients who were diagnosed as pregnant women with HELLP syndrome in Peking University Third Hospital from August 2010 to January 2017 were analyzed. The demographic characters of maternal and fetus, days of hospital stay, postpartum complications, and the laboratory tests of coagulation markers within 3 days before delivery were collected. In addition, 100 healthy pregnant women were collected as a control group. The result showed that the incidence of preeclampsia in pregnant women with postpartum hemorrhage was higher than that in pregnant women without hemorrhage ( P = .011). The level of fibrinogen (FIB) in postpartum hemorrhage pregnant women with HELLP syndrome was lower than that in nonpostpartum hemorrhage pregnant women with HELLP syndrome and healthy pregnant women (2.3 [1.68-2.81] vs 3.64 ± 0.95, P = .000; 2.3 [1.68-2.81] vs 4.48 ± 0.62, P = .000). Multivariate analysis showed that decreased FIB levels independently predicted the postpartum hemorrhage of pregnant women with HELLP syndrome (odds ratio = 7.374, 95% confidence interval [CI], 1.551-35.05, P = .012). The receiver operating characteristic curve showed that the area under the curve of FIB level when predicting postpartum hemorrhage is 0.841 (95% CI, 0.708-0.976). When the cutoff value of FIB was 3.04 g/L, the sensitivity was 90.90% and the specificity was75.80%. Therefore, the low level of prenatal FIB is a reliable biomarker to predict postpartum hemorrhage of pregnant women with HELLP syndrome, which make it useful for pregnant women with HELLP syndrome in guiding surveillance therapy and prognosis assessment.

scholarly journals Analysis of the clinical characteristics of pregnant women who were hospitalized for more than 7 days after the implementation of the two-child policy

2019 ◽  
Author(s):  
Xin Yan ◽  
Yongqing Wang
Keyword(s):  
Cesarean Section ◽  
Pregnant Women ◽  
Clinical Characteristics ◽  
Placenta Previa ◽  
Health Resources ◽  
Control Group ◽  
Management Approach ◽  
Study Group ◽  
Cesarean Sections ◽  
Child Policy

Abstract Background: To analyze the clinical characteristics of pregnant women who were hospitalized for more than 7 days after the implementation of the two-child policy. Methods: The patients who were hospitalized for more than 7 days before and after the implementation of the two-child policy were divided into a study group (after the implementation of the two-child policy) and a control group (before the implementation of the two-child policy). Data on the clinical diagnosis, rate of cesarean sections, incidence of severe placenta previa, characteristics of the ICU cases and cost of hospitalization in the two groups were analyzed and compared. Result: The proportion of patients who were hospitalized for more than 7 days after the implementation of the two-child policy increased from 28.09% to 32.44% (P < 0.05). Regarding older patients, the proportion of those with a cesarean section history increased from 15.92% to 30.15%; however, the rate of cesarean section decreased from 59.26% to 54.35% (P < 0.05). Among patients who underwent cesarean sections, the proportion of those with placental previa, postpartum hemorrhage, ART and a cesarean section history increased (P < 0.05). Compared with that in the control group, the proportion of patients with severe placenta previa in the study group increased from 3.86% to 8.73 (P < 0.05). The proportion of patients admitted to the ICU increased from 2.90% to 4.68% (P < 0.05). Conclusion: Changes in the characteristics of obstetrics inpatients after the implementation of the two-child policy are a challenge for obstetricians. Diagnosis and treatment standardization, a more detailed and comprehensive inpatient management approach, and the rational use of health resources should be promoted.

scholarly journals Study on the Correlation between the Levels of HtrA3 and TGF-β2 in Late Pregnancy and Preeclampsia

2022 ◽  
Vol 2022 ◽  
pp. 1-5
Author(s):  
Wenying Huang ◽  
Shuxuan Zhang
Keyword(s):  
Pregnant Women ◽  
Color Doppler ◽  
Late Pregnancy ◽  
Maternal Blood ◽  
Maternal Plasma ◽  
Maternal Serum ◽  
Adverse Outcomes ◽  
Control Group ◽  
Observation Group ◽  
Set Up

Preeclampsia (PE) is a common and proprietary complication during pregnancy. The correlation was found between the levels of HtrA3 and TGF-β 2 and preeclampsia (PE). This study aimed to detect the HtrA3 and TGF-β2 in different parts of the third trimester (maternal serum, placenta). The 102 pregnant women who were eligible for enrollment in the obstetric examination at Tengzhou Maternity and Child Health Hospital from June 2020 to December 2020 were selected as the research objects. 28 cases diagnosed with PE were set up as the observation group 1, and 24 cases diagnosed with severe PE were set up as the observation group 2. Select 50 normal pregnant women as the control group and research the expressions of HtrA3 and TGF-β2 in maternal blood and placental tissues of patients with PE. ELISA was used to measure the concentration of HtrA3 and TGF-β2 in maternal blood. The distribution of HtrA3 and TGF-β2 in the placenta was observed by immunohistochemical techniques (IHC) and mean optical density value (MOD). S/D was measured by using color Doppler ultrasonic. The concentration of HtrA3 and TGF-β2 in the maternal blood and placenta tissue was higher in severe PE compared with PE and normotensive pregnancy, respectively ( P < 0.05 ). There is a negative correlation between the level of HtrA3 and TGF-β2 and the birthweight of newborns both in maternal plasma and placenta tissue in preeclampsia and positive correlation between HtrA3 and TGF-β2 levels and S/D. HtrA3 and TGF-β2 may correlate with severity of PE and their neonatal adverse outcomes.

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