Objective: To evaluate complications that occurred during the post-partum period for patients with preeclampsia or HELLP syndrome. Study design: Retrospective analysis of 453 patients. The main outcome measures were m...Objective: To evaluate complications that occurred during the post-partum period for patients with preeclampsia or HELLP syndrome. Study design: Retrospective analysis of 453 patients. The main outcome measures were maternal complications during post-partum period: fever >38.5° C with proved infection, abdominal or perineal abscess, thrombo-embolic events, reoperation, need for blood transfusion, acute renal failure, eclampsia or disseminated intravascular coagulation. Statistic tests included univariate and multivariate analysis with stepwise descending logistic regression. Results: Patients were divided into 305 preeclampsia (67.3% ) and 20 HELLP syndrome (4.4% ), 128 (28.3% ) had both. Eighty-five patients (18.8% ) had at least one post-partum complication. The most frequent complication was infection: fever (41 patients, 9.1% ) and abscess (30 patients, 6.6% ). Twenty-six transfusions (5.7% ), 10 disseminated intravascular coagulation (2.2% ), seven thrombo-embolic events (1.5% ), seven reoperations (1.5% ) and one eclampsia (0.2% ) were observed. There was no acute renal failure, no pulmonary oedema and no maternal death. Stepwise logistic regression showed five independent risk factors associated with post-partum complications: ascites or pulmonary oedema (OR: 1.84, 95% CI: 1.01- 3.37), platelet count < 100 000/mm3 (OR: 1.96, 95% CI: 1.18- 3.26), serum acid uric > 360 μ mol/l (OR: 2.36, 95% CI: 1.22- 4.52), serum creatinine > 120 μ mol/l (OR: 2.99, 95% CI: 1.32- 6.78), and proteinuria > 5 g/l (OR: 1.80, 95% CI: 1.06- 3.05). Conclusion: We conclude that severity criteria for preeclampsia or HELLP syndrome combined with caesarean section increased the risk of complication during the post-partum period.展开更多
Background: During the first trimester of pregnancy, unfractionated heparin is the standard anticoagulant treatment for pregnant women at high risk of thrombosis. Objective: To observe maternal and fetal tolerance for...Background: During the first trimester of pregnancy, unfractionated heparin is the standard anticoagulant treatment for pregnant women at high risk of thrombosis. Objective: To observe maternal and fetal tolerance for low-molecular- weight heparin begun in the first trimester of pregnancy. Methods: Observational study conducted from 1 January 1997 to 31 May 2001. All patients began treatment before the 15th week of pregnancy. The outcome measures were the incidence and causality of adverse events in mother and fetus. Results: The study included 97 patients(and 111 pregnancies) at very high risk for thrombosis. Seven fetal losses(6.3%) were observed: three early spontaneous abortions, three late spontaneous abortions and one medically indicated abortion. Twenty-five(22.5%)-bleeding events occurred during pregnancy, seven(6.3%) of which required medical intervention: five curettages for first trimester spontaneous abortions, one late abortion at 21 weeks and one placental abruption at 25 weeks. Of nine(8.1%)-primary postpartum hemorrhages involving a blood loss ≥500 mL, three involved losses of 1000 mL or more and one required embolization of the uterine arteries. Five patients had thrombocytopenia, but none was treatment-related. Local cutaneous reactions occurred in 33(29.7%) patients. Six(5.4%) maternal thromboembolic complications occurred during pregnancy or postpartum. At birth, two children had non-chromosomal congenital malformations(pyelectasia, cleft lip and palate). No fetal or neonatal complication was attributed to the treatment. Conclusion: The use of low-molecular-weight heparin(LMWH) for patients requiring anticoagulant treatment from the first trimester appears safe for mother and fetus.展开更多
Objective. - To determine if a trial of labor in twin pregnancy with previous cesarean section is an acceptable alternative to systematic cesarean section. Patients and methods. - Based on a retrospective and comparat...Objective. - To determine if a trial of labor in twin pregnancy with previous cesarean section is an acceptable alternative to systematic cesarean section. Patients and methods. - Based on a retrospective and comparative study from 1st January 1996 to 30th June 2003 in Maternit′ e Jeanne de Flandre (Lille) and Pavillon Paul Gell′ e (Roubaix), 35 trials of labor in twin pregnancies with previous cesarean section have been compared with 35 twin gestations attempting vaginal delivery without a prior cesarean. This comparative study has been led by sorting out the patients according to their gestational age, parity and maternity. Results. - Twenty seven women (77% ) delivered vaginally and eight (23% ) by elective caesarean section. Postpartum hemorrhage was more frequent for caesarean section (75% ). No scare dehiscence or rupture occurred. There was not any haemostasis hysterectomy or embolisation related to postpartum haemorrhage. Neonatal outcome was similar in both groups. Discussion and conclusion. - Twin trial of labor after a previous cesarean section seems to be a safe alternative to routine repeat cesarean delivery as maternal and fetal morbidity and mortality are safe.展开更多
文摘Objective: To evaluate complications that occurred during the post-partum period for patients with preeclampsia or HELLP syndrome. Study design: Retrospective analysis of 453 patients. The main outcome measures were maternal complications during post-partum period: fever >38.5° C with proved infection, abdominal or perineal abscess, thrombo-embolic events, reoperation, need for blood transfusion, acute renal failure, eclampsia or disseminated intravascular coagulation. Statistic tests included univariate and multivariate analysis with stepwise descending logistic regression. Results: Patients were divided into 305 preeclampsia (67.3% ) and 20 HELLP syndrome (4.4% ), 128 (28.3% ) had both. Eighty-five patients (18.8% ) had at least one post-partum complication. The most frequent complication was infection: fever (41 patients, 9.1% ) and abscess (30 patients, 6.6% ). Twenty-six transfusions (5.7% ), 10 disseminated intravascular coagulation (2.2% ), seven thrombo-embolic events (1.5% ), seven reoperations (1.5% ) and one eclampsia (0.2% ) were observed. There was no acute renal failure, no pulmonary oedema and no maternal death. Stepwise logistic regression showed five independent risk factors associated with post-partum complications: ascites or pulmonary oedema (OR: 1.84, 95% CI: 1.01- 3.37), platelet count < 100 000/mm3 (OR: 1.96, 95% CI: 1.18- 3.26), serum acid uric > 360 μ mol/l (OR: 2.36, 95% CI: 1.22- 4.52), serum creatinine > 120 μ mol/l (OR: 2.99, 95% CI: 1.32- 6.78), and proteinuria > 5 g/l (OR: 1.80, 95% CI: 1.06- 3.05). Conclusion: We conclude that severity criteria for preeclampsia or HELLP syndrome combined with caesarean section increased the risk of complication during the post-partum period.
文摘Background: During the first trimester of pregnancy, unfractionated heparin is the standard anticoagulant treatment for pregnant women at high risk of thrombosis. Objective: To observe maternal and fetal tolerance for low-molecular- weight heparin begun in the first trimester of pregnancy. Methods: Observational study conducted from 1 January 1997 to 31 May 2001. All patients began treatment before the 15th week of pregnancy. The outcome measures were the incidence and causality of adverse events in mother and fetus. Results: The study included 97 patients(and 111 pregnancies) at very high risk for thrombosis. Seven fetal losses(6.3%) were observed: three early spontaneous abortions, three late spontaneous abortions and one medically indicated abortion. Twenty-five(22.5%)-bleeding events occurred during pregnancy, seven(6.3%) of which required medical intervention: five curettages for first trimester spontaneous abortions, one late abortion at 21 weeks and one placental abruption at 25 weeks. Of nine(8.1%)-primary postpartum hemorrhages involving a blood loss ≥500 mL, three involved losses of 1000 mL or more and one required embolization of the uterine arteries. Five patients had thrombocytopenia, but none was treatment-related. Local cutaneous reactions occurred in 33(29.7%) patients. Six(5.4%) maternal thromboembolic complications occurred during pregnancy or postpartum. At birth, two children had non-chromosomal congenital malformations(pyelectasia, cleft lip and palate). No fetal or neonatal complication was attributed to the treatment. Conclusion: The use of low-molecular-weight heparin(LMWH) for patients requiring anticoagulant treatment from the first trimester appears safe for mother and fetus.
文摘Objective. - To determine if a trial of labor in twin pregnancy with previous cesarean section is an acceptable alternative to systematic cesarean section. Patients and methods. - Based on a retrospective and comparative study from 1st January 1996 to 30th June 2003 in Maternit′ e Jeanne de Flandre (Lille) and Pavillon Paul Gell′ e (Roubaix), 35 trials of labor in twin pregnancies with previous cesarean section have been compared with 35 twin gestations attempting vaginal delivery without a prior cesarean. This comparative study has been led by sorting out the patients according to their gestational age, parity and maternity. Results. - Twenty seven women (77% ) delivered vaginally and eight (23% ) by elective caesarean section. Postpartum hemorrhage was more frequent for caesarean section (75% ). No scare dehiscence or rupture occurred. There was not any haemostasis hysterectomy or embolisation related to postpartum haemorrhage. Neonatal outcome was similar in both groups. Discussion and conclusion. - Twin trial of labor after a previous cesarean section seems to be a safe alternative to routine repeat cesarean delivery as maternal and fetal morbidity and mortality are safe.
