A 39-year-old 34-week-pregnant woman was referred to our hospital for preterm labor and fetal dysfunction. Fetal middle cerebral artery systolic maximum blood flow velocity was high, so fetal anemia was suspected. Blo...A 39-year-old 34-week-pregnant woman was referred to our hospital for preterm labor and fetal dysfunction. Fetal middle cerebral artery systolic maximum blood flow velocity was high, so fetal anemia was suspected. Blood type was O-type Rh (+) and fetal hemoglobin was 0.4%;tests for irregular antibody and human parvovirus B19 IgM were negative. A high brightness echoic mass was observed in fetal stomach bubble, and amniotic fluid appeared bright. Labor suppression was disabled, and emergency cesarean section was performed. Amniotic fluid turbidity was observed, and on suctioning the stomach content of the infant, turbid amniotic fluid containing blood was obtained. On placental pathological examination, the cause of bloody amniotic fluid was not identified. The infant’s hemoglobin level was low at 8.7 g/dL, so the infant received red cell concentrate, with improvement of general condition.展开更多
A 40-year-old woman with a history of cesarean section and 3 episodes of uterine curettage for spontaneous or induced abortion presented with massive genital hemorrhage in the ninth week of gestation;she was treated w...A 40-year-old woman with a history of cesarean section and 3 episodes of uterine curettage for spontaneous or induced abortion presented with massive genital hemorrhage in the ninth week of gestation;she was treated with red cell concentrate and fresh frozen plasma transfusion. She was admitted to our hospital at the 11th week of gestation for continuous genital hemorrhage and cervical shortening (20 mm). Ultrasonography revealed placenta previa totalis. A lowlying gestational sac in early pregnancy, vascular lacunae, and an obscured retroplacental sonolucent zone indicated placenta percreta;magnetic resonance imaging showed similar findings. Owing to placenta percreta, uterus preservation was considered impossible. Elective cesarean section followed by total hysterectomy was performed at the 37th week of gestation, with bilateral internal iliac artery balloon catheter occlusion for reducing blood loss. The perioperative blood loss was 2,835 mL, for which the patient received blood transfusion. The postoperative course was uncomplicated.展开更多
Objective: To determine outcomes and prognostic factors for early-stage cervical adenocarcinoma/ adenosquamous carcinomas (AC/ASC) patients who are treated with radical hysterectomy and adjuvant therapy to optimize th...Objective: To determine outcomes and prognostic factors for early-stage cervical adenocarcinoma/ adenosquamous carcinomas (AC/ASC) patients who are treated with radical hysterectomy and adjuvant therapy to optimize their treatment. Methods: We retrospectively reviewed the medical records of 26 patients with International Federation of Gynecologists and Obstetricians stage IB-IIB cervical AC/ASC who were treated with radical hysterectomy and adjuvant therapy. Overall survival (OS) and progression-free survival (PFS) were calculated using the Kaplan-Meier method and compared using the log-rank test. The prognostic significance of various clinical features was determined by using multivariate analysis with the Cox proportional hazards regression model. Results: Univariate analysis revealed that OS was significantly shorter in patients with lymph node metastasis and lymphovascular space invasion. Similarly, PFS was significantly shorter for patients with lymph node metastasis and parametrial invasion. Furthermore, multivariate analysis showed that lymph node metastasis was the only independent predictor for PFS (hazard ratio: 6.47, 95% confidence interval: 1.33 - 31.44, p = 0.021). However, the use of adjuvant chemoradiotherapy did not have any significant effect on either OS or PFS, regardless of lymph node metastasis. Conclusions: Lymph node metastasis is an independent prognostic factor for poor survival in cervical AC/ASC patients treated with radical hysterectomy and adjuvant therapy. In addition, adjuvant chemoradiotherapy does not improve their survival, regardless of lymph node metastasis, which suggests that novel or personalized adjuvant therapeutic strategies with fewer adverse effects than existing strategies are needed.展开更多
文摘A 39-year-old 34-week-pregnant woman was referred to our hospital for preterm labor and fetal dysfunction. Fetal middle cerebral artery systolic maximum blood flow velocity was high, so fetal anemia was suspected. Blood type was O-type Rh (+) and fetal hemoglobin was 0.4%;tests for irregular antibody and human parvovirus B19 IgM were negative. A high brightness echoic mass was observed in fetal stomach bubble, and amniotic fluid appeared bright. Labor suppression was disabled, and emergency cesarean section was performed. Amniotic fluid turbidity was observed, and on suctioning the stomach content of the infant, turbid amniotic fluid containing blood was obtained. On placental pathological examination, the cause of bloody amniotic fluid was not identified. The infant’s hemoglobin level was low at 8.7 g/dL, so the infant received red cell concentrate, with improvement of general condition.
文摘A 40-year-old woman with a history of cesarean section and 3 episodes of uterine curettage for spontaneous or induced abortion presented with massive genital hemorrhage in the ninth week of gestation;she was treated with red cell concentrate and fresh frozen plasma transfusion. She was admitted to our hospital at the 11th week of gestation for continuous genital hemorrhage and cervical shortening (20 mm). Ultrasonography revealed placenta previa totalis. A lowlying gestational sac in early pregnancy, vascular lacunae, and an obscured retroplacental sonolucent zone indicated placenta percreta;magnetic resonance imaging showed similar findings. Owing to placenta percreta, uterus preservation was considered impossible. Elective cesarean section followed by total hysterectomy was performed at the 37th week of gestation, with bilateral internal iliac artery balloon catheter occlusion for reducing blood loss. The perioperative blood loss was 2,835 mL, for which the patient received blood transfusion. The postoperative course was uncomplicated.
文摘Objective: To determine outcomes and prognostic factors for early-stage cervical adenocarcinoma/ adenosquamous carcinomas (AC/ASC) patients who are treated with radical hysterectomy and adjuvant therapy to optimize their treatment. Methods: We retrospectively reviewed the medical records of 26 patients with International Federation of Gynecologists and Obstetricians stage IB-IIB cervical AC/ASC who were treated with radical hysterectomy and adjuvant therapy. Overall survival (OS) and progression-free survival (PFS) were calculated using the Kaplan-Meier method and compared using the log-rank test. The prognostic significance of various clinical features was determined by using multivariate analysis with the Cox proportional hazards regression model. Results: Univariate analysis revealed that OS was significantly shorter in patients with lymph node metastasis and lymphovascular space invasion. Similarly, PFS was significantly shorter for patients with lymph node metastasis and parametrial invasion. Furthermore, multivariate analysis showed that lymph node metastasis was the only independent predictor for PFS (hazard ratio: 6.47, 95% confidence interval: 1.33 - 31.44, p = 0.021). However, the use of adjuvant chemoradiotherapy did not have any significant effect on either OS or PFS, regardless of lymph node metastasis. Conclusions: Lymph node metastasis is an independent prognostic factor for poor survival in cervical AC/ASC patients treated with radical hysterectomy and adjuvant therapy. In addition, adjuvant chemoradiotherapy does not improve their survival, regardless of lymph node metastasis, which suggests that novel or personalized adjuvant therapeutic strategies with fewer adverse effects than existing strategies are needed.
