Previable Premature Rupture of Membranes in Dichorionic Diamniotic Twin Gestation, Loss of Leading Twin, Emergency Cervical Cerclage and Ceaserean Delivery at Term

Introduction: Multiple pregnancies have a higher risk of premature delivery and a weakened cervix has been associated with it. In most cases, emergency cerclage has proved to be beneficial as the birth of the first twin is usually followed by the unavoidable delivery of the second twin and most fetus dies shortly after delivery. Studies have noted that delayed delivery of the second fetus in a twin pregnancy is an effective management choice and the use of cervical cerclage after the first delivery is associated with a longer inter-delivery interval. We present a case of previable premature rupture of membrane of a dichorionic diamniotic twin gestation leading to the loss of the leading twin and subsequently having emergency cervical cerclage for the second twin and caesarean delivery at term. Case Presentation: She was a case of a 29 years old, G6P1+4 with 1 living child at a gestational age of 17 weeks plus 5 days who initially was diagnosed with dichorionic diamniotic twin gestation following an early ultrasound but presented with a history of bleeding and passage of liquor per vaginam. Ultrasound done on admission showed cervical funneling and a stable state of the second twin. She subsequently had emergency cervical cerclage after stabilization on account of previable premature rupture of membrane of a dichorionic diamniotic twin gestation with the loss of the leading twin. A repeat ultrasound done prior to discharge showed closed cervical os and a good state of the fetus. She then had elective caesarean delivery at term with a good feto-maternal outcome. Conclusion: Emergency cervical cerclage should be part of the options of management after stabilization in cases of previable premature rupture of membrane in a dichorionic or multichoronic gestation so as to save the viable once.

Challenges to the early diagnosis and treatment of breast cancer in developing countries

This critical review of the literature assembles and compares available data on breast cancer clinical stage, time intervals to care, and access barriers in different countries. It provides evidence that while more than 70% of breast cancer patients in most high-income countries are diagnosed in stages Ⅰ and Ⅱ, only 20%-50% patients in the majority of low- and middleincome countries are diagnosed in these earlier stages. Most studies in the developed world show an association between an advanced clinical stage of breast cancer and delays greater than three months between symptom discovery and treatment start. The evidence assembled in this review shows that the median of this interval is 30-48 d in high-income countries but 3-8 mo in low- and middle-income countries. The longest delays occur between the first medical consultation and the beginning of treatment, known as the provider interval. The little available evidence suggests that access barriers and quality deficiencies in cancer care are determinants of provider delay in low- and middle-income countries. Research on specific access barriers and deficiencies in quality of care for the early diagnosis and treatment of breast cancer is practically non-existentin these countries, where it is the most needed for the design of cost-effective public policies that strengthen health systems to tackle this expensive and deadly disease.

双胎妊娠第二胎延迟分娩4例临床分析

目的:探讨双胎妊娠第二胎延迟分娩的临床情况、处理及妊娠结局。方法:回顾性分析2007～2010年间首都医科大学附属北京妇产医院及山东胜利油田中心医院发生的双胎妊娠第二胎延迟分娩共4例患者的临床资料。结果:4例双胎妊娠延迟分娩患者第一胎分娩孕周26～31周,平均28周;分娩体重140～980g,平均670g;1例死胎,1例死产,2例新生儿死亡。第一胎分娩后,予抗感染、保胎、促胎肺成熟等治疗,1例行宫颈环扎术。保胎期间宫颈分泌物培养3例阴性;1例发现粪肠球菌,其WBC(10.09×109～17.13×109/L)、C反应蛋白(4.32～47.7mg/L)监测升高;其余3例正常。第二胎分娩孕周为27～37周,平均31周;出生体重1020～2980g,平均1795g,皆存活。分娩间隔时间为7～43天,平均24天。结论:双胎妊娠第二胎延迟分娩是双胎妊娠的一种特殊并发症,处理得当可明显提高第二胎新生儿的存活率。

多胎妊娠延迟分娩11例临床分析

目的:探讨多胎妊娠延迟分娩的围生期管理及母婴结局。方法:选择2013-2021年本院多胎妊娠延迟分娩11例临床资料进行回顾性分析,分析其临床处理、分娩孕周、延迟分娩间隔时间、新生儿及孕妇预后。将病例分为第1个胎儿娩出后1周C反应蛋白(CRP)正常范围组及CRP异常组,分析比较两组出现症状当日、第1个胎儿娩出当日、第1个胎儿娩出后1周的白细胞计数、中性粒细胞百分比,新生儿体重及延迟分娩间隔。结果:7例双胎妊娠,4例三胎妊娠。第1个胎儿平均分娩孕周18.8孕周,分娩体重平均190g,围生儿存活率0%。平均延迟间隔65.9(1~140)d。保留胎儿分娩孕周16~39周,平均分娩孕周28.0周。平均分娩体重1188g。共存活6个,保留胎儿存活6/14,围生期胎儿存活率23.1%(6/26)。存活新生儿平均出生体重2260(1550~2950)g。CRP正常组和CRP异常组保留胎儿分娩体重和分娩延迟间隔存在差异(P<0.05)。结论:多胎妊娠延迟分娩可显著延长妊娠孕周,提高围生儿存活率。第1个胎儿娩出后1周的CRP可作为预后预测指标。

双胎妊娠第二胎延迟分娩的临床分析

目的:探讨双胎妊娠第二胎延迟分娩的临床情况、处理及妊娠结局。方法:回顾分析2016年6月至2018年12月在华中科技大学同济医学院附属同济医院行双胎妊娠第二胎延迟分娩的8例患者的临床资料。结果:8例双胎妊娠延迟分娩患者中第一胎分娩平均孕周22.29周(16+4~29+5周),平均分娩体重462.5g(150~1400g),5例死胎,2例放弃,1例新生儿存活;第二胎分娩平均孕周23.98周(17+3~30+6周),出生平均体重661.25g(180~1600g),3例死胎,2例放弃,1例新生儿科死亡,2例存活预后良好。分娩间隔时间3~50天,平均11.88天。第一胎分娩后,均予抗感染、保胎、促胎肺成熟等治疗,2例行宫颈环扎术。孕妇中2例术后监测中出现感染给予抗炎治疗,2例因胎盘植入产后出血。结论:双胎妊娠第二胎延迟分娩处理得当可提高第二胎新生儿的存活率及预后,但需把握好指征,严密监测感染及胎儿胎盘情况,早期发现并发症,适时终止妊娠。

双胎妊娠第二胎延迟分娩三例及文献复习

双胎妊娠第二胎延迟分娩(delayed interval delivery of the twin,DIDT)是指双胎妊娠中第一个胎儿发生流产或早产后,通过保守治疗延长第二个胎儿的分娩间隔时间。本文报道河北医科大学第四医院东院产科收治的3例DIDT患者,第一个胎儿娩出后给予抗炎、保胎、促胎肺成熟等治疗,不同程度地延长了第二个胎儿的分娩间隔时间。延迟分娩处理得当可明显改善第二个胎儿的围生结局,已成为双胎妊娠中一胎流产或早产后处理的重要措施。由于延迟分娩中母婴均面临诸多并发症风险,故应在与患者及家属充分沟通、权衡利弊后实施。

双子宫双胎异期分娩1例报告并文献复习

双子宫双胎妊娠较为少见，异期分娩更是少之又少，本文报道1例双子宫双胎异期分娩病例并复习相关文献，对发生异期分娩的可能机制及处理进行分析。

双胎妊娠延迟分娩6例临床报道

目的探讨双胎妊娠延迟分娩(delayed interval delivery of the twin,DIDT)的临床处理及母婴结局。方法回顾性分析2019年1月至2022年7月北京大学第三医院收治的6例多胎妊娠延迟分娩病例,分析相关临床处理及母婴结局。结果6例患者中有1例为单绒毛膜双羊膜囊双胎,5例为双绒毛膜双羊膜囊双胎;2例患者在一胎儿娩出前已行宫颈环扎,一胎儿娩出后均未行宫颈环扎术。延迟分娩胎儿6例,存活5例。母体均未出现严重的感染、出血及宫颈撕裂等并发症。结论DIDT能延长孕周,在延迟分娩过程中需动态监测母儿情况及感染指标,预防性应用抗生素,个体化选择抑制宫缩、促胎肺成熟及宫颈环扎等治疗措施。