Objective To evaluate the efficacy and safety of uterine artery embolization(UAE) in the management of primary postpartum hemorrhage associated with placenta accreta. Methods We retrospectively reviewed the medical re...Objective To evaluate the efficacy and safety of uterine artery embolization(UAE) in the management of primary postpartum hemorrhage associated with placenta accreta. Methods We retrospectively reviewed the medical records of patients with placenta accreta between January 2010 and August 2014. Totally 18 women(mean age 30.8±4.2 years) of primary massive postpartum hemorrhage with diagnosis of placenta accrete received treatment of UAE after delivery. Images of DSA and medical records were reviewed. Technical success was defined as control of bleeding after embolization. The complications, control of hemorrhage and recurrent bleeding of the placenta left inside the uterus were retrospectively collected for assessment. Results All patients underwent transcatheter embolization of bilateral uterine arteries. The technical success rate of embolization was 100%. Bleeding was controlled in 17 of 18 patients(94%) during follow-up period(median 18 months, 3-31months) without further bleeding recurred. One patient with placenta percreta undertook an emergent hysterectomy along with surgical bladder repair after UAE because of persistent uterine bleeding. Eight patients had postembolization syndrome and no other complications occurred. Conclusion Uterine artery embolization is an effective and safe treatment for the management of primary postpartum massive hemorrhage associated with placenta accreta.展开更多
Purpose: To investigate the efficacy of uterine arterial embolization (UAE) in patients with post-partum hemorrhage (PPH). Materials and Methods: The subjects were 40 women (mean age, 33 years;age range, 21 - 42 years...Purpose: To investigate the efficacy of uterine arterial embolization (UAE) in patients with post-partum hemorrhage (PPH). Materials and Methods: The subjects were 40 women (mean age, 33 years;age range, 21 - 42 years) who underwent UAE for PPH at two institutes from June 2001 to May 2011. The rates of clinical success (avoidance of hysterectomy) and complications were calculated. Differences in related factors between primary PPH and secondary PPH and between caesarean section and vaginal delivery were examined. The risk factors associated with hysterectomy were also examined. Results: The overall clinical success rate was 90% (93% of primary PPH, 77% of secondary PPH, and 87.5% of PPH with cesarean section), and the overall complication rate was 10%. There were significant differences in time to PPH (P < 0.0001) and in blood infusion after UAE (P = 0.0158) between subtypes of primary and secondary PPH and in blood infusion before UAE (P = 0.0052) between delivery methods. The significant factors associated with hysterectomy were cesarean section (P = 0.02), severe PPH (>1000 mL bleeding, P = 0.03), and embolization of non-uterine arteries (P = 0.02).展开更多
Objective: To evaluate the management process and the guidelines for management of postpartum hemorrhage due to uterine atony at the General Hospital Vienna, Medical University Vienna. Material and Methods: A retrospe...Objective: To evaluate the management process and the guidelines for management of postpartum hemorrhage due to uterine atony at the General Hospital Vienna, Medical University Vienna. Material and Methods: A retrospective analysis was carried out on all 24 cases of postpartum hemorrhage due to uterine atony with an estimated blood loss of more than 800 mL, in which standardized guidelines were obtained. We included all women who gave birth at the General Hospital of Vienna, the Medical University Vienna, during the period from January 1st 2003 and December 31st 2009 and who suffered blood loss 800 mL at minimum due to uterine atony. Results: The guidelines were in use for 14% - 71%. The average blood loss of the 24 cases with uterine atony was 1342 mL. Conclusion: The management process of postpartum hemorrhage due to uterine atony deviates from the hospital’s guidelines in many cases.展开更多
Objective:To explore the effect of carbetocin in preventing postpartum hemorrhage caused by uterine inertia.Methods: A total of 256 puerpera with single full-term delivery who were admitted in our hospital from May, 2...Objective:To explore the effect of carbetocin in preventing postpartum hemorrhage caused by uterine inertia.Methods: A total of 256 puerpera with single full-term delivery who were admitted in our hospital from May, 2015 to May, 2016 were included in the study and divided into the vaginal delivery group and cesarean section group with 128 cases in each group according to the delivery ways. According to the medication, each group was divided into the carbetocin group and oxytocin group with 64 cases in each group. After fetus delivery, the puerpera in the carbetocin group were given intravenous injection of carbetocin (100μg), while the puerpera in the oxytocin group were given intravenous injection of oxytocin (10 U)+0.9% NaCl (500 mL) for 2 h. The amount of bleeding at delivery, 2 h and 24 h after delivery in each group was observed. A volume of 5 mL elbow venous blood before delivery and 24 h after delivery was extracted. The automatic blood cell analyzer was used to detect the decreased value of 24 h hemoglobin in each group. The coagulation detector was used to detect PT, APTT, and FIB before delivery and 24 h after delivery. The blood pressure and heart rate before and after medication in each group were observed.Results: The amount of bleeding at delivery, 2 h and 24 h after delivery in the carbetocin group was signiifcantly less than that in the oxytocin group (P<0.05). The decreased value of 24 h hemoglobin after delivery in the carbetocin group was signiifcantly less than that in the oxytocin group (P<0.05). The indicators of coagulation function 24 h after delivery in each group were not signiifcantly changed (P>0.05). The heart rate and blood pressure after medication in each group were not significantly changed when compared with before medication (P>0.05).Conclusions:Carbetocin can effectively prevent the postpartum hemorrhage caused by uterine inertia, and is safe and effective in application of vaginal delivery and cesarean section;therefore, it deserves to be widely recommended in the clinic.展开更多
Objective:To study the correlation of large conductance Ca2+ activated K+ channel (BKCa)α andβ subunit expression in uterine smooth muscle with the postpartum hemorrhage induced by uterine inertia.Methods: The puerp...Objective:To study the correlation of large conductance Ca2+ activated K+ channel (BKCa)α andβ subunit expression in uterine smooth muscle with the postpartum hemorrhage induced by uterine inertia.Methods: The puerperae who underwent cesarean section and had postpartum hemorrhage induced by uterine inertia in Panzhihua Women and Children Health Hospital between March 2015 and May 2017 were selected as the hemorrhage group of the study, and the puerperae who underwent cesarean section and were without postpartum hemorrhage in Panzhihua Women and Children Health Hospital during the same period were selected as the control group. Proper amount of uterine muscle tissue was collected during the cesarean section to measure the expression of BKCaα andβ subunits and the levels of contraction-related proteins in uterine muscle as well as the contraction characteristic parameters of the uterine muscle.Results: The mRNA expression and protein expression of BKCaα andβ subunits in uterine muscle tissue of hemorrhage group were significantly higher than those of control group;the contraction amplitude, contraction frequency and contraction activity of uterine muscle tissue as well as the OTR, COX2, CX43 and HSP27 levels in uterine muscle tissue of hemorrhage group were significantly lower than those of control group;the BKCaα andβ subunit expression in uterine muscle tissue of hemorrhage group were negatively correlated with the contraction amplitude, contraction frequency and contraction activity as well as the OTR, COX2, CX43 and HSP27 levels.Conclusion: The high expression of BKCa in uterine smooth muscle can reduce the uterine muscle contractility and decrease the levels of contraction-related proteins, and it is closely related to the occurrence of postpartum hemorrhage induced by uterine inertia.展开更多
Objective:To study the effect of uterine water bag + gauze packing on coagulation function and stress response of patients with postpartum hemorrhage.Methods: Patients who gave birth and had postpartum hemorrhage in t...Objective:To study the effect of uterine water bag + gauze packing on coagulation function and stress response of patients with postpartum hemorrhage.Methods: Patients who gave birth and had postpartum hemorrhage in the hospital between June 2014 and May 2017 were chosen as the research subjects and divided into the combined group who received uterine water bag + gauze packing hemostasis, the control group 1 who received uterine water bag hemostasis and the control group 2 who received gauze packing hemostasis. The overall clinical efficacy was observed, and the serum levels of blood coagulation function indexes and stress response indexes were determined before treatment and after hemostatic treatment.Results: The intraoperative blood loss, postoperative blood loss and the change of hemoglobin before treatment and after hemostatic treatment of combined group were less than those of control group 1 and control group 2;compared with those of same group before treatment, serum APTT and PT levels as well as FDP, ET-1, ANG-II, ALD, NE, E, TNF-α, IL-6, ICAM1 and VCAM1 contents after hemostatic treatment were significantly lower whereas PAI-1 and AT-III contents were significantly higher, and serum APTT and PT levels as well as FDP, ET-1, ANG-II, ALD, NE, E, TNF-α, IL-6, ICAM1 and VCAM1 contents of combined group after hemostatic treatment were significantly lower than those of control group 1 and control group 2 whereas PAI-1 and AT-III contents were significantly higher than those of control group 1 and control group 2.Conclusion: uterine water bag + gauze packing treatment of postpartum hemorrhage can achieve better efficacy than monotherapy and improve the coagulation function and stress response.展开更多
Objective:To observe the hemostatic effect of uterine arterial embolization in the treatment of postpartum hemorrhage and the effect on menstruation, sex hormone level, ovarian function, and pelvic floor function.Meth...Objective:To observe the hemostatic effect of uterine arterial embolization in the treatment of postpartum hemorrhage and the effect on menstruation, sex hormone level, ovarian function, and pelvic floor function.Methods:A total of 45 patients with postpartum hemorrhage who were admitted in the Department of Obstetrics of our hospital from January, 2014 to June, 2016 for uterine arterial embolization were included in the study and served as the treatment group. The postoperative menstruation recovery was recorded. The hormone levels, ovarian function, and pelvic floor function before and after treatment were recorded. A total of 42 normal puerpera were served as the control group. The menstrual status of the two groups after menstruation was compared.Results: Rapid and effective hemostasis could be obtained from patients in the treatment group after treatment with hemostasis success rate of 100%. The comparison of menstruation cycle and menstruation days after treatment between the two groups was not statistically significant. The levels of E2, P, FSH, LH and PRL, ovarian function index RI and PI, pelvic floor muscle fatigue and vaginal dynamic pressure before and after 3 and 6 months had no significant difference, and there was no significant difference between the 2 groups.Conclusions: Uterine arterial embolization in the treatment of postpartum hemorrhage is effective, and has no influence on the patient's menstrual conditions, sex hormone levels, ovarian and pelvic floor functions;therefore, it is worthy of clinical application.展开更多
With an incidence of 0.005%,unscarred uterine rupture is extremely rare.It is difficult to diagnose uterine rupture because of the absence of characteristic clinical symptoms.Here,we report a rare case of a 31-year-ol...With an incidence of 0.005%,unscarred uterine rupture is extremely rare.It is difficult to diagnose uterine rupture because of the absence of characteristic clinical symptoms.Here,we report a rare case of a 31-year-old woman with a uterine rupture that was accurately diagnosed and repaired by laparoscopy and hysteroscopy on postpartum day 69.The patient recovered uneventfully and was discharged on postoperative day 4.Three months after surgery,pelvic magnetic resonance imaging was performed,which confirmed wound repair.In women with a stable condition,laparoscopy with hysteroscopy could be an alternative choice for the diagnosis and treatment of suspected uterine rupture;however,more substantial studies are needed to confirm this surgical approach.展开更多
Among the most consolidated dogmas in obstetrics, we have the essential role of oxytocin during: labor by regulating, consolidating uterine contractions, by supporting the expulsive efforts of the patient during child...Among the most consolidated dogmas in obstetrics, we have the essential role of oxytocin during: labor by regulating, consolidating uterine contractions, by supporting the expulsive efforts of the patient during childbirth and after childbirth by preventing postpartum hemorrhage. But what challenged us to conduct our study is the large and increasing number of surgical operations for postpartum hemorrhage in patients who received oxytocin during labor. We assumed that the generalization use of oxytocin in all patients during labor is probably responsible of this increasing rate of incidents. To verify this assumption, we carried out a prospective randomized comparative study, involving 3990 pregnant patients admitted at the start of labor at term, with no contraindication for giving birth by normal ways, during a period of 10 months (January-October 2022). The patients have been divided into 2 groups. The first group comprises 1991 patients who were placed on admission on a glucose serum infusion with 4 ampoules of a non-anticholinergic musculotropic antispasmodic: “Hydrated phloroglucinol + trimethylphloroglucinol” (Each ampoule contains 40 mg of hydrated phloroglucinol and 0.04 mg of trimethylphloroglucinol) instead of receiving oxytocin during the active phase of their labor and a second group consisting of 1999 patients who received oxytocin during the active phase of their labor. The results were very surprising and contrary to the already consolidated evidence in our specialty. Indeed, the rate of postpartum hemorrhages was 10 patients (0.5%) in the 1st group vs 30 patients (1.5%) in the 2nd group, 9 patients (0.4%) presented fetal heart rate abnormalities in the 1st group vs 90 (4.5%) in the 2nd group, 8 cases (0.4%) of dynamic dystocia in the 1st group vs 132 cases (6.6%) in the 2nd group and 99 caesareans (5%) in the 1st group vs 299 (15%) in the 2nd group. Against all expectations the results were very surprising, with more details in the article.展开更多
Uterine atony remains the major cause of postpartum hemorrhage, and of death from postpartum hemorrhage in the United States. While existing guidelines outlining a general approach to postpartum hemorrhage are useful,...Uterine atony remains the major cause of postpartum hemorrhage, and of death from postpartum hemorrhage in the United States. While existing guidelines outlining a general approach to postpartum hemorrhage are useful, recent data suggest that greater specificity may be necessary to significantly impact mortality. We present a highly specific and methodical approach to the management of uterine atony, which addresses what we believe to be the most common cause of preventable maternal hemorrhagic death in the US—lack of an intensive, focused approach to atony and perseverance with therapies that are not working. This protocol should result in cessation of hemorrhage by medical or surgical means within 1 hour of diagnosis. We then apply this protocol to a number of illustrative cases of maternal death due to atony. An approach involving the active management of uterine atony may assist clinicians in avoiding severe morbidity and mortality from uterine atony.展开更多
In our medical practice, in particular obstetrics, it is difficult to change certain consolidated dogmas, but the necessity and the current situation of our obstetrical exercise pushed us to find new technical support...In our medical practice, in particular obstetrics, it is difficult to change certain consolidated dogmas, but the necessity and the current situation of our obstetrical exercise pushed us to find new technical supports, to make the exercise of our specialty as stripped of pitfalls as possible. Our work is summarized in a prospective comparative study, aimed at evaluating the existence or not of a difference between the administration of oxytocin just before the hysterotomy in a cesarean section and its administration after fetal extraction. We used a set of criteria to include patients in our study. This study took place over a period of one year (2020) in the Mother and Child regional center, in Meknes Imperial city, Morocco, involving a total number of 364 patients. With a group A comprising 176 patients 48% (176/364) who received oxytocin just before the hysterotomy and a group B of 188 patients 52% (188/364) who received it classically after fetal extraction. The difference was very significant as detailed in the article. Conclusion: the very convincing results of our study and the difference between the two groups, allowed us to demonstrate the effectiveness of our process and to endorse its use in our routine practice, with the perspective of conducting a prospective randomized study on a larger series.展开更多
Objective:To summarize the first aid and nursing of the operating room due to serious complications caused by postpartum massive bleeding.Methods:One case of emergency hemorrhage was ineffective in emergency hysterect...Objective:To summarize the first aid and nursing of the operating room due to serious complications caused by postpartum massive bleeding.Methods:One case of emergency hemorrhage was ineffective in emergency hysterectomy.Results:The uterus was successfully removed and the bleeding was successfully stopped.It was transferred to the ICU under general anesthesia.Conclusion:For pregnant women with postpartum massive bleeding and hemorrhagic shock and diffuse intravascular coagulation(DIC),targeted surgical treatment and complete operating room emergency care are of great significance to save maternal lives.展开更多
目的观察卡前列素氨丁三醇与麦角新碱预防剖宫产产妇出血及对子宫复旧的作用。方法该项目为回顾性研究,选取2019年3月至2024年1月在合肥市第一人民医院行剖宫产术的产妇118例,根据产后药物干预方案分为A组(n=48,采用麦角新碱治疗)、B组(...目的观察卡前列素氨丁三醇与麦角新碱预防剖宫产产妇出血及对子宫复旧的作用。方法该项目为回顾性研究,选取2019年3月至2024年1月在合肥市第一人民医院行剖宫产术的产妇118例,根据产后药物干预方案分为A组(n=48,采用麦角新碱治疗)、B组(n=33,采用卡前列素氨丁三醇治疗)和C组(n=37,采用卡前列素氨丁三醇联合麦角新碱治疗)。收集3组患者临床资料,比较3组患者产后出血量、恶露持续时间、住院时间、产后出血发生率及子宫复旧情况,评估3组产妇药品不良反应。结果A组和B组产后2 h及24 h出血量、恶露持续时间和住院时间分别为[A:(343.58±49.32)mL,(426.35±68.65)mL,(18.25±3.21)d,(5.26±0.25)d;B:(341.63±54.27)mL,(431.25±63.59)mL,(17.98±2.66)d,(5.34±0.32)d]比较,差异无统计学意义(t=0.168,0.325,0.398,1.261,P=0.867,0.746,0.692,0.211)(P>0.05);C组产后2 h及24 h出血量,恶露持续时间和住院时间分别为(215.65±42.36)mL,(301.36±50.35)mL,(14.21±2.14)d,(4.21±0.43)d,均少于A组和B组(C vs A:t=16.968,13.030,9.465,20.289,均P<0.001;C vs B:t=15.267,12.372,8.070,19.950,均P<0.001)。3组产后出血发生率分别为4.17%,30.3%,0,差异无统计学意义(P=0.624)。A组和B组产后3 d、5 d的子宫下降程度分别为[A:(2.09±0.18)cm,(4.03±0.25)cm;B:(2.16±0.39)cm,(4.15±0.34)cm],均差异无统计学意义(t=1.088,1.831,P=0.280,0.071),C组以上指标分别为(2.94±0.23)cm,(4.89±0.29)cm,均大于A组和B组(C vs A:t=20.460,17.154,均P<0.001;C vs B:t=19.177,15.077,均P<0.001)。A,B,C组患者总不良反应发生率分别为14.58%,9.09%,24.32%,差异无统计学意义(χ^(2)=3.134,P=0.209)。结论卡前列素氨丁三醇与麦角新碱均可有效促进子宫收缩,预防产后出血,促进子宫复旧,两者联合可能具有协同作用,可更进一步的提高临床效果。展开更多
文摘Objective To evaluate the efficacy and safety of uterine artery embolization(UAE) in the management of primary postpartum hemorrhage associated with placenta accreta. Methods We retrospectively reviewed the medical records of patients with placenta accreta between January 2010 and August 2014. Totally 18 women(mean age 30.8±4.2 years) of primary massive postpartum hemorrhage with diagnosis of placenta accrete received treatment of UAE after delivery. Images of DSA and medical records were reviewed. Technical success was defined as control of bleeding after embolization. The complications, control of hemorrhage and recurrent bleeding of the placenta left inside the uterus were retrospectively collected for assessment. Results All patients underwent transcatheter embolization of bilateral uterine arteries. The technical success rate of embolization was 100%. Bleeding was controlled in 17 of 18 patients(94%) during follow-up period(median 18 months, 3-31months) without further bleeding recurred. One patient with placenta percreta undertook an emergent hysterectomy along with surgical bladder repair after UAE because of persistent uterine bleeding. Eight patients had postembolization syndrome and no other complications occurred. Conclusion Uterine artery embolization is an effective and safe treatment for the management of primary postpartum massive hemorrhage associated with placenta accreta.
文摘Purpose: To investigate the efficacy of uterine arterial embolization (UAE) in patients with post-partum hemorrhage (PPH). Materials and Methods: The subjects were 40 women (mean age, 33 years;age range, 21 - 42 years) who underwent UAE for PPH at two institutes from June 2001 to May 2011. The rates of clinical success (avoidance of hysterectomy) and complications were calculated. Differences in related factors between primary PPH and secondary PPH and between caesarean section and vaginal delivery were examined. The risk factors associated with hysterectomy were also examined. Results: The overall clinical success rate was 90% (93% of primary PPH, 77% of secondary PPH, and 87.5% of PPH with cesarean section), and the overall complication rate was 10%. There were significant differences in time to PPH (P < 0.0001) and in blood infusion after UAE (P = 0.0158) between subtypes of primary and secondary PPH and in blood infusion before UAE (P = 0.0052) between delivery methods. The significant factors associated with hysterectomy were cesarean section (P = 0.02), severe PPH (>1000 mL bleeding, P = 0.03), and embolization of non-uterine arteries (P = 0.02).
文摘Objective: To evaluate the management process and the guidelines for management of postpartum hemorrhage due to uterine atony at the General Hospital Vienna, Medical University Vienna. Material and Methods: A retrospective analysis was carried out on all 24 cases of postpartum hemorrhage due to uterine atony with an estimated blood loss of more than 800 mL, in which standardized guidelines were obtained. We included all women who gave birth at the General Hospital of Vienna, the Medical University Vienna, during the period from January 1st 2003 and December 31st 2009 and who suffered blood loss 800 mL at minimum due to uterine atony. Results: The guidelines were in use for 14% - 71%. The average blood loss of the 24 cases with uterine atony was 1342 mL. Conclusion: The management process of postpartum hemorrhage due to uterine atony deviates from the hospital’s guidelines in many cases.
文摘Objective:To explore the effect of carbetocin in preventing postpartum hemorrhage caused by uterine inertia.Methods: A total of 256 puerpera with single full-term delivery who were admitted in our hospital from May, 2015 to May, 2016 were included in the study and divided into the vaginal delivery group and cesarean section group with 128 cases in each group according to the delivery ways. According to the medication, each group was divided into the carbetocin group and oxytocin group with 64 cases in each group. After fetus delivery, the puerpera in the carbetocin group were given intravenous injection of carbetocin (100μg), while the puerpera in the oxytocin group were given intravenous injection of oxytocin (10 U)+0.9% NaCl (500 mL) for 2 h. The amount of bleeding at delivery, 2 h and 24 h after delivery in each group was observed. A volume of 5 mL elbow venous blood before delivery and 24 h after delivery was extracted. The automatic blood cell analyzer was used to detect the decreased value of 24 h hemoglobin in each group. The coagulation detector was used to detect PT, APTT, and FIB before delivery and 24 h after delivery. The blood pressure and heart rate before and after medication in each group were observed.Results: The amount of bleeding at delivery, 2 h and 24 h after delivery in the carbetocin group was signiifcantly less than that in the oxytocin group (P<0.05). The decreased value of 24 h hemoglobin after delivery in the carbetocin group was signiifcantly less than that in the oxytocin group (P<0.05). The indicators of coagulation function 24 h after delivery in each group were not signiifcantly changed (P>0.05). The heart rate and blood pressure after medication in each group were not significantly changed when compared with before medication (P>0.05).Conclusions:Carbetocin can effectively prevent the postpartum hemorrhage caused by uterine inertia, and is safe and effective in application of vaginal delivery and cesarean section;therefore, it deserves to be widely recommended in the clinic.
文摘Objective:To study the correlation of large conductance Ca2+ activated K+ channel (BKCa)α andβ subunit expression in uterine smooth muscle with the postpartum hemorrhage induced by uterine inertia.Methods: The puerperae who underwent cesarean section and had postpartum hemorrhage induced by uterine inertia in Panzhihua Women and Children Health Hospital between March 2015 and May 2017 were selected as the hemorrhage group of the study, and the puerperae who underwent cesarean section and were without postpartum hemorrhage in Panzhihua Women and Children Health Hospital during the same period were selected as the control group. Proper amount of uterine muscle tissue was collected during the cesarean section to measure the expression of BKCaα andβ subunits and the levels of contraction-related proteins in uterine muscle as well as the contraction characteristic parameters of the uterine muscle.Results: The mRNA expression and protein expression of BKCaα andβ subunits in uterine muscle tissue of hemorrhage group were significantly higher than those of control group;the contraction amplitude, contraction frequency and contraction activity of uterine muscle tissue as well as the OTR, COX2, CX43 and HSP27 levels in uterine muscle tissue of hemorrhage group were significantly lower than those of control group;the BKCaα andβ subunit expression in uterine muscle tissue of hemorrhage group were negatively correlated with the contraction amplitude, contraction frequency and contraction activity as well as the OTR, COX2, CX43 and HSP27 levels.Conclusion: The high expression of BKCa in uterine smooth muscle can reduce the uterine muscle contractility and decrease the levels of contraction-related proteins, and it is closely related to the occurrence of postpartum hemorrhage induced by uterine inertia.
文摘Objective:To study the effect of uterine water bag + gauze packing on coagulation function and stress response of patients with postpartum hemorrhage.Methods: Patients who gave birth and had postpartum hemorrhage in the hospital between June 2014 and May 2017 were chosen as the research subjects and divided into the combined group who received uterine water bag + gauze packing hemostasis, the control group 1 who received uterine water bag hemostasis and the control group 2 who received gauze packing hemostasis. The overall clinical efficacy was observed, and the serum levels of blood coagulation function indexes and stress response indexes were determined before treatment and after hemostatic treatment.Results: The intraoperative blood loss, postoperative blood loss and the change of hemoglobin before treatment and after hemostatic treatment of combined group were less than those of control group 1 and control group 2;compared with those of same group before treatment, serum APTT and PT levels as well as FDP, ET-1, ANG-II, ALD, NE, E, TNF-α, IL-6, ICAM1 and VCAM1 contents after hemostatic treatment were significantly lower whereas PAI-1 and AT-III contents were significantly higher, and serum APTT and PT levels as well as FDP, ET-1, ANG-II, ALD, NE, E, TNF-α, IL-6, ICAM1 and VCAM1 contents of combined group after hemostatic treatment were significantly lower than those of control group 1 and control group 2 whereas PAI-1 and AT-III contents were significantly higher than those of control group 1 and control group 2.Conclusion: uterine water bag + gauze packing treatment of postpartum hemorrhage can achieve better efficacy than monotherapy and improve the coagulation function and stress response.
文摘Objective:To observe the hemostatic effect of uterine arterial embolization in the treatment of postpartum hemorrhage and the effect on menstruation, sex hormone level, ovarian function, and pelvic floor function.Methods:A total of 45 patients with postpartum hemorrhage who were admitted in the Department of Obstetrics of our hospital from January, 2014 to June, 2016 for uterine arterial embolization were included in the study and served as the treatment group. The postoperative menstruation recovery was recorded. The hormone levels, ovarian function, and pelvic floor function before and after treatment were recorded. A total of 42 normal puerpera were served as the control group. The menstrual status of the two groups after menstruation was compared.Results: Rapid and effective hemostasis could be obtained from patients in the treatment group after treatment with hemostasis success rate of 100%. The comparison of menstruation cycle and menstruation days after treatment between the two groups was not statistically significant. The levels of E2, P, FSH, LH and PRL, ovarian function index RI and PI, pelvic floor muscle fatigue and vaginal dynamic pressure before and after 3 and 6 months had no significant difference, and there was no significant difference between the 2 groups.Conclusions: Uterine arterial embolization in the treatment of postpartum hemorrhage is effective, and has no influence on the patient's menstrual conditions, sex hormone levels, ovarian and pelvic floor functions;therefore, it is worthy of clinical application.
文摘With an incidence of 0.005%,unscarred uterine rupture is extremely rare.It is difficult to diagnose uterine rupture because of the absence of characteristic clinical symptoms.Here,we report a rare case of a 31-year-old woman with a uterine rupture that was accurately diagnosed and repaired by laparoscopy and hysteroscopy on postpartum day 69.The patient recovered uneventfully and was discharged on postoperative day 4.Three months after surgery,pelvic magnetic resonance imaging was performed,which confirmed wound repair.In women with a stable condition,laparoscopy with hysteroscopy could be an alternative choice for the diagnosis and treatment of suspected uterine rupture;however,more substantial studies are needed to confirm this surgical approach.
文摘Among the most consolidated dogmas in obstetrics, we have the essential role of oxytocin during: labor by regulating, consolidating uterine contractions, by supporting the expulsive efforts of the patient during childbirth and after childbirth by preventing postpartum hemorrhage. But what challenged us to conduct our study is the large and increasing number of surgical operations for postpartum hemorrhage in patients who received oxytocin during labor. We assumed that the generalization use of oxytocin in all patients during labor is probably responsible of this increasing rate of incidents. To verify this assumption, we carried out a prospective randomized comparative study, involving 3990 pregnant patients admitted at the start of labor at term, with no contraindication for giving birth by normal ways, during a period of 10 months (January-October 2022). The patients have been divided into 2 groups. The first group comprises 1991 patients who were placed on admission on a glucose serum infusion with 4 ampoules of a non-anticholinergic musculotropic antispasmodic: “Hydrated phloroglucinol + trimethylphloroglucinol” (Each ampoule contains 40 mg of hydrated phloroglucinol and 0.04 mg of trimethylphloroglucinol) instead of receiving oxytocin during the active phase of their labor and a second group consisting of 1999 patients who received oxytocin during the active phase of their labor. The results were very surprising and contrary to the already consolidated evidence in our specialty. Indeed, the rate of postpartum hemorrhages was 10 patients (0.5%) in the 1st group vs 30 patients (1.5%) in the 2nd group, 9 patients (0.4%) presented fetal heart rate abnormalities in the 1st group vs 90 (4.5%) in the 2nd group, 8 cases (0.4%) of dynamic dystocia in the 1st group vs 132 cases (6.6%) in the 2nd group and 99 caesareans (5%) in the 1st group vs 299 (15%) in the 2nd group. Against all expectations the results were very surprising, with more details in the article.
文摘Uterine atony remains the major cause of postpartum hemorrhage, and of death from postpartum hemorrhage in the United States. While existing guidelines outlining a general approach to postpartum hemorrhage are useful, recent data suggest that greater specificity may be necessary to significantly impact mortality. We present a highly specific and methodical approach to the management of uterine atony, which addresses what we believe to be the most common cause of preventable maternal hemorrhagic death in the US—lack of an intensive, focused approach to atony and perseverance with therapies that are not working. This protocol should result in cessation of hemorrhage by medical or surgical means within 1 hour of diagnosis. We then apply this protocol to a number of illustrative cases of maternal death due to atony. An approach involving the active management of uterine atony may assist clinicians in avoiding severe morbidity and mortality from uterine atony.
文摘In our medical practice, in particular obstetrics, it is difficult to change certain consolidated dogmas, but the necessity and the current situation of our obstetrical exercise pushed us to find new technical supports, to make the exercise of our specialty as stripped of pitfalls as possible. Our work is summarized in a prospective comparative study, aimed at evaluating the existence or not of a difference between the administration of oxytocin just before the hysterotomy in a cesarean section and its administration after fetal extraction. We used a set of criteria to include patients in our study. This study took place over a period of one year (2020) in the Mother and Child regional center, in Meknes Imperial city, Morocco, involving a total number of 364 patients. With a group A comprising 176 patients 48% (176/364) who received oxytocin just before the hysterotomy and a group B of 188 patients 52% (188/364) who received it classically after fetal extraction. The difference was very significant as detailed in the article. Conclusion: the very convincing results of our study and the difference between the two groups, allowed us to demonstrate the effectiveness of our process and to endorse its use in our routine practice, with the perspective of conducting a prospective randomized study on a larger series.
文摘Objective:To summarize the first aid and nursing of the operating room due to serious complications caused by postpartum massive bleeding.Methods:One case of emergency hemorrhage was ineffective in emergency hysterectomy.Results:The uterus was successfully removed and the bleeding was successfully stopped.It was transferred to the ICU under general anesthesia.Conclusion:For pregnant women with postpartum massive bleeding and hemorrhagic shock and diffuse intravascular coagulation(DIC),targeted surgical treatment and complete operating room emergency care are of great significance to save maternal lives.
文摘目的观察卡前列素氨丁三醇与麦角新碱预防剖宫产产妇出血及对子宫复旧的作用。方法该项目为回顾性研究,选取2019年3月至2024年1月在合肥市第一人民医院行剖宫产术的产妇118例,根据产后药物干预方案分为A组(n=48,采用麦角新碱治疗)、B组(n=33,采用卡前列素氨丁三醇治疗)和C组(n=37,采用卡前列素氨丁三醇联合麦角新碱治疗)。收集3组患者临床资料,比较3组患者产后出血量、恶露持续时间、住院时间、产后出血发生率及子宫复旧情况,评估3组产妇药品不良反应。结果A组和B组产后2 h及24 h出血量、恶露持续时间和住院时间分别为[A:(343.58±49.32)mL,(426.35±68.65)mL,(18.25±3.21)d,(5.26±0.25)d;B:(341.63±54.27)mL,(431.25±63.59)mL,(17.98±2.66)d,(5.34±0.32)d]比较,差异无统计学意义(t=0.168,0.325,0.398,1.261,P=0.867,0.746,0.692,0.211)(P>0.05);C组产后2 h及24 h出血量,恶露持续时间和住院时间分别为(215.65±42.36)mL,(301.36±50.35)mL,(14.21±2.14)d,(4.21±0.43)d,均少于A组和B组(C vs A:t=16.968,13.030,9.465,20.289,均P<0.001;C vs B:t=15.267,12.372,8.070,19.950,均P<0.001)。3组产后出血发生率分别为4.17%,30.3%,0,差异无统计学意义(P=0.624)。A组和B组产后3 d、5 d的子宫下降程度分别为[A:(2.09±0.18)cm,(4.03±0.25)cm;B:(2.16±0.39)cm,(4.15±0.34)cm],均差异无统计学意义(t=1.088,1.831,P=0.280,0.071),C组以上指标分别为(2.94±0.23)cm,(4.89±0.29)cm,均大于A组和B组(C vs A:t=20.460,17.154,均P<0.001;C vs B:t=19.177,15.077,均P<0.001)。A,B,C组患者总不良反应发生率分别为14.58%,9.09%,24.32%,差异无统计学意义(χ^(2)=3.134,P=0.209)。结论卡前列素氨丁三醇与麦角新碱均可有效促进子宫收缩,预防产后出血,促进子宫复旧,两者联合可能具有协同作用,可更进一步的提高临床效果。