Background Use of an emergency peripartum hysterectomy （EPH） as a lifesaving measure to manage intractable postpartum hemorrhage （PPH） appears to be increasing recently around the world,and the indications for EPH...Background Use of an emergency peripartum hysterectomy （EPH） as a lifesaving measure to manage intractable postpartum hemorrhage （PPH） appears to be increasing recently around the world,and the indications for EPH have changed.The object of this study is to identify risk factors associated with EPH.Methods We conducted a case-control study of 21 patients who underwent EPH because of intractable PPH between January 1,2005 and June 30,2013,at the International Peace Maternity and Child Health Hospital Shanghai Jiao Tong University,School of Medicine （IPMCH）.The parametric t-test,chi-square tests and Logistic regression models were used for analysis to identify the risk factors.The results were considered statistically significant when P＜0.05.Results There were 89 178 deliveries during the study period.Twenty-one women had an EPH,with an incidence of 24 per 100 000 deliveries.The loss of blood during postpartum hemorrhage of the EPH group was （5 060.7±3 032.6）ml,and that of the control group was （2 040.8±723.5） ml.There was a significant difference of PHH between the EHP group and the control group （P=0.001）.Independent risk factors for EPH from a logistic regression model were：disseminated intravascular coagulation （DIC） （OR：9.9,95％ CI 2.8-34,P=0.003）,previous cesarean section （OR：5.27;95％ CI：1.48-17.9,P=0.009）,placenta previa （OR：6.9; 95％ CI 1.6-2.9,P=0.008）,the loss of PPH （OR：1.001; 95％ CI 1.001-1.002,P=0.002）,placenta accreta （OR：68; 95％ CI 10-456,P=0.004）,the use of tocolytic agents prenatally （OR：6.55,95％CI 1.34-32.1,P=0.049）,and fetal macrosomia （OR：6.9,95％ CI 1.25-38,P=0.049）.Conclusion Significant risk factors of EPH are DIC,placenta previa,PPH,previous cesarean delivery,and placenta accrete,the use of tocolytic agents prenatally,and fetal macrosomia.展开更多
Objective:To assess the effects of Thunbergia laurifolia L.extract(TLE)on gestational diabetes mellitus(GDM)in a rat model.Methods:Thunbergia laurifolin L.leaves were subjected to ethanolic extraction.In vivo study,50...Objective:To assess the effects of Thunbergia laurifolia L.extract(TLE)on gestational diabetes mellitus(GDM)in a rat model.Methods:Thunbergia laurifolin L.leaves were subjected to ethanolic extraction.In vivo study,50 pregnant rats were randomly divided into 5 groups(10 for each):non-GDM group,GDM induced by streptozotocin(STZ,60 mg/kg i.p.),metformin(MET)100 mg/kg,TLE 50,and 500 mg/kg groups.Administration was performed on gestation day 7 until term(day 21).The effects of TLE on blood glucose,insulin levels,lipid profiles,liver enzymes,and maternal performances were assessed.In in vitro study,the effect of TLE was examined using the organ bath for uterine force measurement.Results:In in vivo study,TLE significantly reduced blood glucose as compared to GDM(P<0.05)with gradually increased insulin level.This effect was consistent with islets of Langerhans restoration.Histologically,the uterine muscular layer displayed a marked increase in fiber area in response to both doses as compared to GDM(P<0.05).Additionally,TLE significantly reduced total cholesterol,triglyceride,and alanine transaminase levels(P<0.05).Intriguingly,TLE also led to a notable augmentation in gravid uterus size,live fetuses count,and implantation numbers,while significantly reducing the post-implantation loss rate associated with fetal classification(P<0.05).Thus,GDM improvements were close to those produced by MET.In in vitro study,TLE exerted a concentration-dependent inhibition of spontaneous uterine contractility(half-maximal inhibition concentration=1.2 mg/L).This inhibitory effect extended to potassium chloride depolarization and oxytocin-mediated contractions.When combined with its major constituent,rosmarinic acid,TLE produced an enhanced inhibitory effect(P<0.05).Conclusions:TLE ameliorated blood glucose levels,enhanced uterine muscular structure,and improved maternal and fetal performance in GDM.TLE also displayed tocolytic properties.These findings underscore the need for further exploration of TLE as a potential tocolytic agent to m展开更多
Purpose: Cavernous haemangiomas of the uterine cervix are very rare and usually harmless. It is a benign tumor that may cause gynecological obstetrical complications. Although it is a benign condition but it can have ...Purpose: Cavernous haemangiomas of the uterine cervix are very rare and usually harmless. It is a benign tumor that may cause gynecological obstetrical complications. Although it is a benign condition but it can have serious consequences for the mother as well as for the baby. The treatment is often surgical and diagnosis is histological. Methods and Result: we reported a case of cavernous haemangioma of the cervix in a 25-year old multiparous patient, referred to our Centre in the 33 - 34 gestational weeks for premature labor with membranes rupture. A 3 cm × 6 cm soft regular purplish red mass is found in the uterine cervix. Tocolosys, prophylactic antibiotic therapy and corticotherapy for fetus pulmonary maturation were then decided after elimination of chorioamniotite signs. Caesarean has been made during labor, a week later, for tumor previa. The tumor excision has been made through the vagina after fetus extraction. The histological examination confirmed diagnosis of the cavernous haemangioma. Discussion: Further to this observation, the clinical, histological and therapeutic characteristics of the cavernous haemangioma unusual presentation were drawn up and literature enriched since this pathology is rare. Most previous reports in the literature consist of singlecase histories, and the experience of individual institutions is limited. The patients dramatically present dilemmas in the disease management. This can result in uncontrolled bleeding especially during operative delivery and may require hysterectomy. To avoid unexpected bleeding from haemangioma, patients should be repeatedly examined for haemangioma of the birth canal, and special care should be taken in choosing the delivery mode.展开更多
文摘Background Use of an emergency peripartum hysterectomy （EPH） as a lifesaving measure to manage intractable postpartum hemorrhage （PPH） appears to be increasing recently around the world,and the indications for EPH have changed.The object of this study is to identify risk factors associated with EPH.Methods We conducted a case-control study of 21 patients who underwent EPH because of intractable PPH between January 1,2005 and June 30,2013,at the International Peace Maternity and Child Health Hospital Shanghai Jiao Tong University,School of Medicine （IPMCH）.The parametric t-test,chi-square tests and Logistic regression models were used for analysis to identify the risk factors.The results were considered statistically significant when P＜0.05.Results There were 89 178 deliveries during the study period.Twenty-one women had an EPH,with an incidence of 24 per 100 000 deliveries.The loss of blood during postpartum hemorrhage of the EPH group was （5 060.7±3 032.6）ml,and that of the control group was （2 040.8±723.5） ml.There was a significant difference of PHH between the EHP group and the control group （P=0.001）.Independent risk factors for EPH from a logistic regression model were：disseminated intravascular coagulation （DIC） （OR：9.9,95％ CI 2.8-34,P=0.003）,previous cesarean section （OR：5.27;95％ CI：1.48-17.9,P=0.009）,placenta previa （OR：6.9; 95％ CI 1.6-2.9,P=0.008）,the loss of PPH （OR：1.001; 95％ CI 1.001-1.002,P=0.002）,placenta accreta （OR：68; 95％ CI 10-456,P=0.004）,the use of tocolytic agents prenatally （OR：6.55,95％CI 1.34-32.1,P=0.049）,and fetal macrosomia （OR：6.9,95％ CI 1.25-38,P=0.049）.Conclusion Significant risk factors of EPH are DIC,placenta previa,PPH,previous cesarean delivery,and placenta accrete,the use of tocolytic agents prenatally,and fetal macrosomia.
基金Supported by the Institute of Research and Development,Suranaree University of Technology(Ph.D.Scholarship,No.SUT-PhD/14/2554)。
文摘Objective:To assess the effects of Thunbergia laurifolia L.extract(TLE)on gestational diabetes mellitus(GDM)in a rat model.Methods:Thunbergia laurifolin L.leaves were subjected to ethanolic extraction.In vivo study,50 pregnant rats were randomly divided into 5 groups(10 for each):non-GDM group,GDM induced by streptozotocin(STZ,60 mg/kg i.p.),metformin(MET)100 mg/kg,TLE 50,and 500 mg/kg groups.Administration was performed on gestation day 7 until term(day 21).The effects of TLE on blood glucose,insulin levels,lipid profiles,liver enzymes,and maternal performances were assessed.In in vitro study,the effect of TLE was examined using the organ bath for uterine force measurement.Results:In in vivo study,TLE significantly reduced blood glucose as compared to GDM(P<0.05)with gradually increased insulin level.This effect was consistent with islets of Langerhans restoration.Histologically,the uterine muscular layer displayed a marked increase in fiber area in response to both doses as compared to GDM(P<0.05).Additionally,TLE significantly reduced total cholesterol,triglyceride,and alanine transaminase levels(P<0.05).Intriguingly,TLE also led to a notable augmentation in gravid uterus size,live fetuses count,and implantation numbers,while significantly reducing the post-implantation loss rate associated with fetal classification(P<0.05).Thus,GDM improvements were close to those produced by MET.In in vitro study,TLE exerted a concentration-dependent inhibition of spontaneous uterine contractility(half-maximal inhibition concentration=1.2 mg/L).This inhibitory effect extended to potassium chloride depolarization and oxytocin-mediated contractions.When combined with its major constituent,rosmarinic acid,TLE produced an enhanced inhibitory effect(P<0.05).Conclusions:TLE ameliorated blood glucose levels,enhanced uterine muscular structure,and improved maternal and fetal performance in GDM.TLE also displayed tocolytic properties.These findings underscore the need for further exploration of TLE as a potential tocolytic agent to m
文摘Purpose: Cavernous haemangiomas of the uterine cervix are very rare and usually harmless. It is a benign tumor that may cause gynecological obstetrical complications. Although it is a benign condition but it can have serious consequences for the mother as well as for the baby. The treatment is often surgical and diagnosis is histological. Methods and Result: we reported a case of cavernous haemangioma of the cervix in a 25-year old multiparous patient, referred to our Centre in the 33 - 34 gestational weeks for premature labor with membranes rupture. A 3 cm × 6 cm soft regular purplish red mass is found in the uterine cervix. Tocolosys, prophylactic antibiotic therapy and corticotherapy for fetus pulmonary maturation were then decided after elimination of chorioamniotite signs. Caesarean has been made during labor, a week later, for tumor previa. The tumor excision has been made through the vagina after fetus extraction. The histological examination confirmed diagnosis of the cavernous haemangioma. Discussion: Further to this observation, the clinical, histological and therapeutic characteristics of the cavernous haemangioma unusual presentation were drawn up and literature enriched since this pathology is rare. Most previous reports in the literature consist of singlecase histories, and the experience of individual institutions is limited. The patients dramatically present dilemmas in the disease management. This can result in uncontrolled bleeding especially during operative delivery and may require hysterectomy. To avoid unexpected bleeding from haemangioma, patients should be repeatedly examined for haemangioma of the birth canal, and special care should be taken in choosing the delivery mode.
