Objective: This study was undertaken to evaluate the association between protein Z concentration and pregnancy complications. Study design: A prospective case-control study was conducted over a 2-year period to evalua...Objective: This study was undertaken to evaluate the association between protein Z concentration and pregnancy complications. Study design: A prospective case-control study was conducted over a 2-year period to evaluate the prevalence of protein Z deficiency in pregnancy complications. Protein Z levels were measured at the time of diagnosis of complications such as preeclampsia, intrauterine growth restriction, and intrauterine fetal demise. Protein Z deficiency was defined as a plasma level below 1.2 mg/L. In addition to patients presenting with pregnancy complications, healthy age-matched nonpregnant and pregnant women were invited to participate. Results: A total of 145 women were included in the study: 50 nonpregnant women, 34 healthy pregnant women, 29 women with preeclampsia, 25 women presented with intrauterine growth restriction, and 7 women with intrauterine fetal demise. The median protein Z level was similar in healthy pregnant and nonpregnant women (1.63 0.47-3.1 mg/L and 1.69 0.7-3 mg/L, respectively). Three women with normal pregnancies had a low protein Z level (8.8%), compared with 8 patients presenting with intrauterine growth restriction (33.3%) and 8 patients with intrauterine fetal demise (50%). Compared with normal pregnancy, the frequency of decreased protein Z was significantly higher in cases of intrauterine growth restriction and in intrauterine fetal demise (relative risk RR 1.96, 95%CI 1.16-3.32; P = .041 and RR 3.36, 95%CI 1.65-6.8; P = .0031, respectively), but not in preeclampsia (RR 1.6, 95%CI 0.9-2.8; P = .23). Placenta histologic examination revealed vascular lesions in 50%of patients with protein Z deficiency and in 33%of patients with normal levels of protein Z (RR 0.84; 95%CI 0.6-1.2). Conclusion: Protein Z deficiency is associated with late fetal demise and intrauterine growth restriction. The pathophysiologic role of protein Z deficiency, either congenital or caused by the presence of specific antibodies remains unclear and should be further investigated.展开更多
Objective.-To evaluate a post -partum hemorrhage treatment guideline,using rectall y administered misopros-tol.Patients and methods.-A descriptive study was carried out in a tertiary referral center from January 2002t...Objective.-To evaluate a post -partum hemorrhage treatment guideline,using rectall y administered misopros-tol.Patients and methods.-A descriptive study was carried out in a tertiary referral center from January 2002to March 2003.During this period,2670patients delivered and 41(1.5%)with severe postpartum hemorrhage u nre-sponsive to oxytocin received 1000μg of misoprostol(five tablets)rectally while awaiting sulproston e.Twenty -eight had delivered by the vaginal route an d 13by cesarean section.Results.-Hemorrhage was c ontrolled among63%(26/41)of the patients within 10min of the ad-ministration of rectal misoprostol.Fifteen(37%)patients received both misoprostol and sulpr ostone and no major adverse effects were noted when comb ining these two prostaglandins.Overall,hemorrhage was controlled among87%(36/41)of the patients when oxytocics were c om-bined with misoprostol and sulprostone.Five patients(12%)did not respond to the combination of uterotonicsand required a conservative surgica l treatment.Discussion and conclusion.-Rectal misoprosto l may be an effective second line treatment for the manage ment of post -partum hemorrhage unresponsive to oxytocin.We did not observe major side effects when combining mi soprostol with sul-prostone.Our findings encourage fu rther research on rectal misoprostol in the treatment of postpartum hemorrhage.展开更多
文摘Objective: This study was undertaken to evaluate the association between protein Z concentration and pregnancy complications. Study design: A prospective case-control study was conducted over a 2-year period to evaluate the prevalence of protein Z deficiency in pregnancy complications. Protein Z levels were measured at the time of diagnosis of complications such as preeclampsia, intrauterine growth restriction, and intrauterine fetal demise. Protein Z deficiency was defined as a plasma level below 1.2 mg/L. In addition to patients presenting with pregnancy complications, healthy age-matched nonpregnant and pregnant women were invited to participate. Results: A total of 145 women were included in the study: 50 nonpregnant women, 34 healthy pregnant women, 29 women with preeclampsia, 25 women presented with intrauterine growth restriction, and 7 women with intrauterine fetal demise. The median protein Z level was similar in healthy pregnant and nonpregnant women (1.63 0.47-3.1 mg/L and 1.69 0.7-3 mg/L, respectively). Three women with normal pregnancies had a low protein Z level (8.8%), compared with 8 patients presenting with intrauterine growth restriction (33.3%) and 8 patients with intrauterine fetal demise (50%). Compared with normal pregnancy, the frequency of decreased protein Z was significantly higher in cases of intrauterine growth restriction and in intrauterine fetal demise (relative risk RR 1.96, 95%CI 1.16-3.32; P = .041 and RR 3.36, 95%CI 1.65-6.8; P = .0031, respectively), but not in preeclampsia (RR 1.6, 95%CI 0.9-2.8; P = .23). Placenta histologic examination revealed vascular lesions in 50%of patients with protein Z deficiency and in 33%of patients with normal levels of protein Z (RR 0.84; 95%CI 0.6-1.2). Conclusion: Protein Z deficiency is associated with late fetal demise and intrauterine growth restriction. The pathophysiologic role of protein Z deficiency, either congenital or caused by the presence of specific antibodies remains unclear and should be further investigated.
文摘Objective.-To evaluate a post -partum hemorrhage treatment guideline,using rectall y administered misopros-tol.Patients and methods.-A descriptive study was carried out in a tertiary referral center from January 2002to March 2003.During this period,2670patients delivered and 41(1.5%)with severe postpartum hemorrhage u nre-sponsive to oxytocin received 1000μg of misoprostol(five tablets)rectally while awaiting sulproston e.Twenty -eight had delivered by the vaginal route an d 13by cesarean section.Results.-Hemorrhage was c ontrolled among63%(26/41)of the patients within 10min of the ad-ministration of rectal misoprostol.Fifteen(37%)patients received both misoprostol and sulpr ostone and no major adverse effects were noted when comb ining these two prostaglandins.Overall,hemorrhage was controlled among87%(36/41)of the patients when oxytocics were c om-bined with misoprostol and sulprostone.Five patients(12%)did not respond to the combination of uterotonicsand required a conservative surgica l treatment.Discussion and conclusion.-Rectal misoprosto l may be an effective second line treatment for the manage ment of post -partum hemorrhage unresponsive to oxytocin.We did not observe major side effects when combining mi soprostol with sul-prostone.Our findings encourage fu rther research on rectal misoprostol in the treatment of postpartum hemorrhage.
