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
Background: Peripartum cardiomyopathy (PPCM) is a rare disease that typically affects young, healthy women. Because PPCM is associated with significant mortality, timely diagnosis and management are essential. Ventric...Background: Peripartum cardiomyopathy (PPCM) is a rare disease that typically affects young, healthy women. Because PPCM is associated with significant mortality, timely diagnosis and management are essential. Ventricular tachycardia (VT) is a major complication and contributor to sudden death. Available data on VT in patients with PPCM are limited. Aim: This case report demonstrates the clinical presentation, antenatal care, and management of labor and delivery in a patient with PPCM complicated by VT. Case report: 36-year old patient G4P3 presents at 27 weeks gestation to the emergency department complaining of chest tightness, palpitations, and profuse sweating. Peripartum cardiomyopathy was diagnosed after her last pregnancy a few years prior. Ventricular tachycardia was diagnosed at this visit and treated successfully. The remainder of the pregnancy was uneventful until she had another episode of ventricular tachycardia during labor. Treatment using antiarrhythmics (diltiazem, amiodarone, adenosine) highlights the importance of prompt intervention and the need for a range of therapeutic options. Results: This case demonstrated successful VT management during pregnancy and labor, emphasizing multidisciplinary collaboration, influencing maternal and fetal outcomes positively, providing insights into optimal care strategies. Conclusion: Peripartum cardiomyopathy complicated by ventricular tachycardia is a life-threatening combination. This case highlights the importance of timely diagnosis and management with combined care between cardiologists, maternal fetal medicine specialists and anesthesiologists to prevent morbidities and sudden maternal death.展开更多
乙型肝炎病毒(hepatitis B virus,HBV)是一种常见的全球血液传播病原体,其导致的部分慢性乙肝患者可发展为肝硬化和肝癌,甚至导致死亡[1]。据统计,全世界约有640万名五岁以下儿童患有慢性HBV感染,中国是世界上HBV感染负担最大的国家,201...乙型肝炎病毒(hepatitis B virus,HBV)是一种常见的全球血液传播病原体,其导致的部分慢性乙肝患者可发展为肝硬化和肝癌,甚至导致死亡[1]。据统计,全世界约有640万名五岁以下儿童患有慢性HBV感染,中国是世界上HBV感染负担最大的国家,2019年中国约2.96亿人感染HBV,每年150万新增感染,其中,围产期母婴传播是HBV传播的主要途径之一,新生儿乙肝感染的风险为95%[2]。目前,我国育龄期妇女HBsAg的阳性率为5%~6%,HBsAg阳性孕妇的新生儿是HBV感染的高危人群[3]。阻断母婴传播是预防HBV的源头,母婴阻断主要是通过一定的医疗技术手段,阻止母体HBV传播给婴幼儿的方式。研究表明,母婴阻断对于新生儿乙肝预防和人类生命健康具有重要意义[4]。本文对围产期HBV母婴传播阻断进行综述。展开更多
Introduction: Peripartum cardiomyopathy (PPCM) is a rare pathology in Western countries but is common in Africa. Its progression is highly variable, left ventricular function improves in almost one-third to one-half o...Introduction: Peripartum cardiomyopathy (PPCM) is a rare pathology in Western countries but is common in Africa. Its progression is highly variable, left ventricular function improves in almost one-third to one-half of patients. In sub-Saharan Africa, there are few prospective cohort studies. We aimed to describe the long-term evolutionary aspects of this pathology in a sub-Saharan African country, so we developed a PPCM registry;here, we present the first results after 2 years of follow-up. Methodology: This work was performed at the cardiology clinic of the Aristide Le Dantec Teaching Hospital of Dakar from January 01, 2017, to January 01, 2021, for a total duration of 4 years. This was an observational, longitudinal prospective study including patients admitted for peripartum cardiomyopathy. Results: During our study, 5372 patients were admitted to the cardiology clinic. Considering the inclusion criteria, 79 patients were consecutively recruited. The mean age was 30.5 ± 6.7 years, ranging from 18 to 42 years. Half of the patients came from rural areas (56.3%), and 78.2% of patients had a low socioeconomic status. Multiparity and twin pregnancies were noted in 72.8% and 20% of the patients, respectively. A total of 91% of patients had advanced NYHA stage 4 heart failure, and 3 patients had cardiogenic shock. Left ventricular dilatation was found in 52 patients, and severe left ventricular systolic dysfunction was found in 50 patients (90.9%). During hospitalization, 19 patients (34.5%) had complications. The evolution in the hospital was favourable in 45 patients (81.8%). The global mortality rate was 7.3% at 2 years. In multivariate analysis, fewer patients with a dilated left ventricle, a severe alteration of the LVEF and an advanced age progressed towards remission. Conclusion: The long-term evolution of PPCM is very variable. Despite a good rate of remission, progression to end-stage heart failure and death is not negligible in cases of advanced maternal age and severe left ventricular impairment.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.
文摘Background: Peripartum cardiomyopathy (PPCM) is a rare disease that typically affects young, healthy women. Because PPCM is associated with significant mortality, timely diagnosis and management are essential. Ventricular tachycardia (VT) is a major complication and contributor to sudden death. Available data on VT in patients with PPCM are limited. Aim: This case report demonstrates the clinical presentation, antenatal care, and management of labor and delivery in a patient with PPCM complicated by VT. Case report: 36-year old patient G4P3 presents at 27 weeks gestation to the emergency department complaining of chest tightness, palpitations, and profuse sweating. Peripartum cardiomyopathy was diagnosed after her last pregnancy a few years prior. Ventricular tachycardia was diagnosed at this visit and treated successfully. The remainder of the pregnancy was uneventful until she had another episode of ventricular tachycardia during labor. Treatment using antiarrhythmics (diltiazem, amiodarone, adenosine) highlights the importance of prompt intervention and the need for a range of therapeutic options. Results: This case demonstrated successful VT management during pregnancy and labor, emphasizing multidisciplinary collaboration, influencing maternal and fetal outcomes positively, providing insights into optimal care strategies. Conclusion: Peripartum cardiomyopathy complicated by ventricular tachycardia is a life-threatening combination. This case highlights the importance of timely diagnosis and management with combined care between cardiologists, maternal fetal medicine specialists and anesthesiologists to prevent morbidities and sudden maternal death.
文摘乙型肝炎病毒(hepatitis B virus,HBV)是一种常见的全球血液传播病原体,其导致的部分慢性乙肝患者可发展为肝硬化和肝癌,甚至导致死亡[1]。据统计,全世界约有640万名五岁以下儿童患有慢性HBV感染,中国是世界上HBV感染负担最大的国家,2019年中国约2.96亿人感染HBV,每年150万新增感染,其中,围产期母婴传播是HBV传播的主要途径之一,新生儿乙肝感染的风险为95%[2]。目前,我国育龄期妇女HBsAg的阳性率为5%~6%,HBsAg阳性孕妇的新生儿是HBV感染的高危人群[3]。阻断母婴传播是预防HBV的源头,母婴阻断主要是通过一定的医疗技术手段,阻止母体HBV传播给婴幼儿的方式。研究表明,母婴阻断对于新生儿乙肝预防和人类生命健康具有重要意义[4]。本文对围产期HBV母婴传播阻断进行综述。
文摘Introduction: Peripartum cardiomyopathy (PPCM) is a rare pathology in Western countries but is common in Africa. Its progression is highly variable, left ventricular function improves in almost one-third to one-half of patients. In sub-Saharan Africa, there are few prospective cohort studies. We aimed to describe the long-term evolutionary aspects of this pathology in a sub-Saharan African country, so we developed a PPCM registry;here, we present the first results after 2 years of follow-up. Methodology: This work was performed at the cardiology clinic of the Aristide Le Dantec Teaching Hospital of Dakar from January 01, 2017, to January 01, 2021, for a total duration of 4 years. This was an observational, longitudinal prospective study including patients admitted for peripartum cardiomyopathy. Results: During our study, 5372 patients were admitted to the cardiology clinic. Considering the inclusion criteria, 79 patients were consecutively recruited. The mean age was 30.5 ± 6.7 years, ranging from 18 to 42 years. Half of the patients came from rural areas (56.3%), and 78.2% of patients had a low socioeconomic status. Multiparity and twin pregnancies were noted in 72.8% and 20% of the patients, respectively. A total of 91% of patients had advanced NYHA stage 4 heart failure, and 3 patients had cardiogenic shock. Left ventricular dilatation was found in 52 patients, and severe left ventricular systolic dysfunction was found in 50 patients (90.9%). During hospitalization, 19 patients (34.5%) had complications. The evolution in the hospital was favourable in 45 patients (81.8%). The global mortality rate was 7.3% at 2 years. In multivariate analysis, fewer patients with a dilated left ventricle, a severe alteration of the LVEF and an advanced age progressed towards remission. Conclusion: The long-term evolution of PPCM is very variable. Despite a good rate of remission, progression to end-stage heart failure and death is not negligible in cases of advanced maternal age and severe left ventricular impairment.
