Risk Stratification in Obstetrics: An Integrated Approach to Maternal Health

Introduction: Prenatal care is crucial for maternal and fetal health, highlighting the importance of obstetric risk stratification. This enables personalized care, avoiding unnecessary interventions and reducing costs. Conditions such as first trimester bleeding, spontaneous abortion, gestational trophoblastic disease, and ectopic pregnancy require specific approaches. Early identification of these complications is vital, especially in urgent and emergency obstetric cases, which demand immediate hospital attention. Objective: Comprehensive review of first trimester pathologies and gestational hypertension, focusing on obstetric risks and personalized prenatal management. Methods: Literature review on bleeding and gestational hypertension. Results: The study provides a detailed analysis of pathologies associated with first trimester uterine bleeding and hypertensive disorders, focusing on obstetric risk stratification. The main causes of maternal and fetal mortality are hypertensive disorders, hemorrhages, infections, childbirth complications, and abortion. Spontaneous abortion is common, with different classifications, ranging from threatened to missed abortion. Infected abortion is a severe complication. Brazil has restrictive abortion laws, but many unsafe abortions occur, resulting in high public health costs. Pharmacological treatment with misoprostol is a safe option. Other pathologies include gestational trophoblastic disease, ectopic pregnancy, and placenta previa. Preeclampsia and eclampsia are severe conditions requiring immediate treatment to avoid complications. Conclusion: Early identification and management of obstetric risk factors, such as uterine bleeding, are essential for positive maternal and fetal outcomes. A multidisciplinary approach is fundamental.

Studies on Relationship between Serum Nitric Oxide and Plasma Cyclic Guanosine Monophosphate and Prolonged Bleeding after Medical Abortion as well as Prophylaxis and Treatment of Bleeding with Traditional Chinese Medicine

Objectives To study the relationship between serum nitric oxide (NO and plasma cyclic guanosine monophosphate (cGMP) and prolonged bleeding after medical abortion. Methods A total of 120 women having received medical abortions at random were recruited and divided into two groups: the one (Group A,n=60) taking 'Gong Fu Mixture(Uterus Recovering Mixture)' and the other (Group B,n=60) not taking it after abortion. On d 10, 20 and 30 after medical abortion, serum NO and plasma cGMP were tested before and after mifepristone administration and 10 d later by Gresis reaction method and radioimmunoassay respectively. Results NO concentration in serum and cGMP concentration in plasma decreased significantly after taking mifepristone given (P<0.05). Ten days later, the number of those with bleeding discontinuation in the group A was significantly greater than that in the group B (P<0.05). Serum NO level and plasma cGMP level in the group A decreased more significantly than those in the group B (P<0.05). Conclusion The slow decrease of serum NO and plasma cGMP is closely related to prolonged bleeding after medical abortion. “Gong Fu Mixture (uterus recovering mixture)” is effective in prevention and treatment of prolonged bleeding.

A Survey on TCM Treatment of Drug-Induced Postabortal Colporrhagia

Drug postabortal colporrhagia is one of the major problems that need to be solved in gynecoiatry. It is shown in the literature that TCM treatment of this disease has achieved quite good therapeutic effects. It is my opinion that the following works should be done for a better therapeutic effect: 1) study further the pathogeneses of the disease; 2) stipulate a unified criteria for typing, diagnosis and treatment; 3) develop specific prescriptions and new forms of preparation; and 4) further efforts should be also made on the other TCM therapies, such as acupuncture, physiotherapy, and massotherapy.

子宫压迫联合米索前列醇在子宫收缩乏力大出血中的应用价值

目的研究子宫压迫联合米索前列醇在子宫收缩乏力大出血中的应用价值。方法选择我院2014年8月—2016年6月期间收治子宫收缩乏力大出血100例,根据随机数字表法,分为2组,单一组和联合组。单一组给予单纯子宫压迫;联合组给予子宫压迫联合米索前列醇。就两组产妇止血时间、平均出血量、肾上腺素、去甲肾上腺素水平、血管紧张素II、肾素、治疗总有效率、晚期再出血发生率、产褥期感染发生率进行比较。结果联合组治疗总有效率高于单一组,P<0.05。联合组产妇晚期再出血发生率、产褥期感染发生率低于单一组,P<0.05。联合组产妇止血时间显著短于单一组、平均出血量明显低于单一组,P<0.05。联合组产妇肾上腺素、去甲肾上腺素水平、血管紧张素II、肾素均优于单一组,P<0.05。结论子宫压迫联合米索前列醇在子宫收缩乏力大出血中的应用价值高,可加快止血,减少出血量,降低机体应激水平,减少再出血和感染发生率,值得推广。

Efficacy of Qiancao(Radix Rubiae Cordifoliae) and Haipiaoxiao(Endoconcha Sepiellae), a traditional Chinese herb pair, on abnormal uterine bleeding in rats with incomplete abortion

OBJECTIVE: To investigate the most effective weight ratio of Qiancao(Radix Rubiae Cordifoliae) and Haipiaoxiao(Endoconcha Sepiellae) used to produce decoction for the treatment of abnormal uterine bleeding(AUB) in rats with incomplete abortion, and to study the possible mechanism. METHODS: The models of AUB were established by incomplete drug abortion with mifepristone and misoprostol in pregnant rats. The therapeutic effects of decoctions made by eight different weight ratios of Qiancao(Radix Rubiae Cordifoliae) and Haipiaoxiao(Endoconcha Sepiellae) were observed. RESULTS: Statistical analysis revealed that the most effective weight ratio of Qiancao(Radix Rubiae Cordifoliae) and Haipiaoxiao(Endoconcha Sepiellae) to treat AUB in this study was 2∶1. CONCLUSION: The insights gained from this study would improve understanding of the mechanisms involved in the effect of Qiancao(Radix Rubiae Cordifoliae) and Haipiaoxiao(Endoconcha Sepiellae) on AUB.

Vascular endothelial growth factor mRNA and its protein expression in decidua after terminating early pregnancy by mifepristone plus misoprostol

Objective To investigate the action of mifepristone plus misoprostol on decidua at the level of vascular endothelial growth factor (VEGF) mRNA and its protein expression, as well as the mechanism of prolonged uterine hemorrhage after terminating early pregnancy with these drugs.Methods Forty-five decidua specimens were obtained from 45 pregnant women with amenorrhea of 6 - 7 weeks' duration, in which 15 women were treated with mifepristone and 15 were given mifepristone plus misoprostol. Enzyme-linked immunosorbant assay (ELISA) and reverse transcription-polymerase chain reaction (RT-PCR) were used to detect VEGF protein and mRNA levels in decidua.Results In all three groups, only the VEGF121 amplification product of 452 bp was visualized. The mRNA and protein levels of VEGF showed no significant differences among the three groups ( P ＞ 0.05).Conclusion In humans, early decidua VEGF121 mRNA is the main isoform. The action of mifepristone plus misoprostol on blood vessels in human decidua may be medicated by some factors other than VEGF.

Tissue-type plasminogen activator and plasminogen activator inhibitor type-1 mRNA and their protein expression levels in human decidua after early pregnancy termination by mifepristone plus misoprostol

Objective To investigate the mechanism of prolonged uterine hemorrhage after terminating early pregnancy by mifepristone plus misoprostol.Methods Forty-five decidua specimens were obtained from 45 pregnant women with amenorrhea of 6-7 week duration. Fifteen women were treated with mifepristone and 15 were treated with mifepristone plus misoprostol. The remaining 15 served as controls. The tPA and PAI-1 mRNA levels were estimated by reverse transcription-polymerase chain reaction. Chromogenic assay and enzyme-linked immunosorbent assay were used to detect tPA activity and PAI-1 protein level in decidua. Results The activities of tPA in the mifepristone plus misoprostol group and in the mifepristone group were 46.91±20.74?IU/mg*protein and 64.25±35.81?IU/mg*protein respectively, lower than those in the normal decidua group (99.76±58.61?IU/mg*protein, P<0.05). tPA mRNA levels in the mifepristone plus misoprostol group were the highest (1.43±0.39) among the groups. In the mifepristone group, tPA mRNA level (0.90±0.16) was not significantly different from that in the normal decidua group (0.94±0.17). The protein and mRNA expression levels of PAI-1 were not significantly different among the three groups (P>0.05).Conclusions Mifepristone plus misoprostol decreased tPA activity in human early decidua by post-transcription pathways, which may influence decidua shedding, endometrial angiogenesis, endometrial remodeling, and cause prolonged uterine hemorrhage after drug abortion.