Evaluation of the etiology and risk factors for maternal sepsis: A single center study in Guangzhou, China

BACKGROUND Maternal sepsis is a major cause of gestational morbidity and neonatal mortality worldwide and particularly in China.AIM To evaluate the etiology of maternal sepsis and further identify its risk factors.METHODS In this retrospective study,we evaluated 70698 obstetric patients who were admitted to the Third Affiliated Hospital of Guangzhou Medical University between January 1,2009 and June 30,2018.Subjects were divided into sepsis group and non-sepsis group based on the incidence of sepsis.Data about medical history(surgical and obstetric history)and demographic information were collected.The Mann-Whitney U test was used to compare patient age,gestational age and duration of hospitalization between the two groups.Univariate and multivariate logistic regression models were used to analyze the etiology and the risk factors for maternal sepsis.Unadjusted and adjusted odds ratios(OR)are reported.RESULTS A total of 561 of 70698 obstetric patients were diagnosed with infection;of the infected patients,492 had non-sepsis associated infection(87.7%),while 69 had sepsis(12.3%).The morbidity rate of maternal sepsis was 9.76/10000;the fatality rate in the sepsis group was 11.6%(8/69).Emergency admission(OR=2.183)or transfer(OR=2.870),irregular prenatal care(OR=2.953),labor induction(OR=4.665),cervical cerclage(OR=14.214),first trimester(OR=6.806)and second trimester(OR=2.09)were significant risk factors for maternal sepsis.CONCLUSION Mode of admission,poor prenatal care,labor induction,cervical cerclage,first trimester and second trimester pregnancy were risk factors for maternal sepsis.Escherichia coli was the most common causative organism for maternal sepsis,and the uterus was the most common site of infection.

Transvaginal 3D Ultrasound Evaluation of Post-Cesarean Section Uterine Diverticulum

Objectives: This study focused on evaluating the value of transvaginal 3D ultrasound for the diagnosis and prognostic assessment of post-cesarean section uterine diverticulum. Materials and Methods: We retrospectively analyzed the data from 32 patients with post-cesarean section uterine diverticulum over three recent years. In all patients, transvaginal 3D ultrasound was used to measure the size of the uterine diverticulum and the thickness of the lower uterine segment (LUS) and myometrium. Patients with a LUS with a myometrial thickness under 4 mm underwent resection and repair surgery;those with a LUS with a myometrial thickness over 4 mm underwent hysteroscopic resection. The postoperative sonograms were compared with preoperative images to evaluate the efficacy of various treatments. Results: The mean length, width and depth of the uterine diverticula were 18.30 ± 2.80 mm, 9.14 ± 3.20 mm and 11.49 ± 2.71 mm, respectively. The average LUS myometrial thickness was 3.40 ± 0.80 mm (with a range of 1.6 mm - 6.3 mm). After surgery, two patients’ sonograms still showed diverticula at the post-cesarean section scar, measuring 6 mm × 7 mm × 6 mm and 6 mm × 8 mm × 4 mm. There were significant differences in the size of uterine diverticula between preoperative and postoperative sonograms (P < 0.05) and the effective rate of surgery was 93.75% (30/32). Conclusions: Transvaginal 3D ultrasound is an accurate method for detecting post-cesarean section uterine diverticulum and is helpful for assessing surgical options and prognosis. The LUS myometrial thickness, which is considered as an optional index of post-cesarean section uterine diverticulum, should be measured routinely.

Thrombotic pulmonary embolism of inferior vena cava during caesarean section:A case report and review of the literature

BACKGROUND Thrombotic pulmonary embolism(TPE)is one of the most critical diseases in obstetrics but is rarely reported in caesarean section(CS)because TPE patients in CS have a high risk of death and are difficult to diagnose.This case report of TPE during CS was recorded by transthoracic echocardiography(TTE)and can provide a reference for the differential diagnosis of critical illnesses in CS.CASE SUMMARY A 37-year-old pregnant woman with rheumatic heart disease(RHD),gravida 5 and para 1(G5P1),presented for emergency CS at 33 wk and 3 d of gestation under general anesthesia because of acute heart failure,pulmonary hypertension and arrhythmia.After placental removal during CS,TTE revealed a nascent thrombus in the inferior vena cava(IVC)that elongated,detached and fragmented leading to acute thromboembolic events and acute TPE.This report presents the whole process and details of TPE during CS and successful rescue without any sequelae in the patient.This case gives us new ideas for the diagnosis of death or cardiovascular accidents during CS in pregnant women with heart disease and the detailed presentation of the rapid development of TPE may also elucidate new ideas for treatment.This case also highlighted the importance of prophylactic anticoagulation in the management of heart disease during pregnancy.CONCLUSION Pregnancy with heart failure could trigger inferior vena cava(IVC)-origin TPE during CS.Detection and timely treatment can avoid serious consequences.

Updates on COVID-19 Infection During Pregnancy

The 2019 coronavirus disease(COVID-19)is a public health emergency in China this winter.Since it was first reported in Wuhan in December 2019,it has been quickly spreading across Hubei Province and the whole country,and even other parts of the world.As of February 23,2020,the total number of confirmed cases in China's Mainland has reached 77150.

Precision Surgery for Placenta Previa Complicated with Placenta Percreta

Objectives:To investigate whether a precise circular resection of the uterine tissue at the placental attachment part is effective in cases with placenta previa complicated with placenta percreta (PPWPP).Methods:Patients diagnosed with PPWPP were assessed for pregnancy termination at 34-36 weeks of gestation.During the operation,we performed circular resection of the uterine tissue at the placental attachment part.Then the characteristics of the operation and the follow-ups were recorded.Results:During the operation,the vital signs were stable.The mean intraoperative blood loss,packed red blood cells units transfusion,fresh frozen plasma transfusion,and operation time were 2140 mL,6 U,440 mL,and 179.8 minutes,respectively.There was no bowel,ureter,or bladder injury.And there was no patient transferred to the ICU after operation.The mean postoperative blood loss was 458.6mL.There was no fever,infection,intestinal obstruction,or other complications after operation during the hospitalization.The shape and the blood flow of the uterus were normal.After the patients were discharged,one had developed cesarean scar diverticulum.The mean lochia duration was 30 days.The menstrual cycle and volume were as before.The shape and the blood flow of the uterus and the ovarian were normal.Conclusions:The circular resection following end-to-end anastomosis is an effective precision surgical approach for PPWPP.It can achieve the purpose of hemostasis while maximizing the protection of organ function and reducing surgical trauma.