Keywords pregnancy; puerperium; cerebral venous thromboembolism; anticoagulant agents; thrombolysis Background Previous investigations have demonstrated a relatively low incidence of stroke among young women, though ...Keywords pregnancy; puerperium; cerebral venous thromboembolism; anticoagulant agents; thrombolysis Background Previous investigations have demonstrated a relatively low incidence of stroke among young women, though both pregnancy and delivery can substantially increase the risk. Cerebral venous thrombosis may manifest different characteristics during pregnancy and postpartum as a result of their specific physiological statuses. This study aimed to identify the clinical manifestations, diagnosis, treatment, and prognosis of cerebral venous thrombosis during pregnancy and postpartum. Methods We conducted a retrospective analysis of 22 patients with cerebral venous thrombosis who were assigned to either group A （during pregnancy） or group B （during postpartum）. The relevant risk factors, initiation and development of the disease, clinical presentations, diagnosis, treatment, and prognosis were compared between the two stages. Results Cerebral venous thrombosis occurred during both pregnancy and postpartum, but was more common postpartum. Patients in group A had a longer hospitalization period than those in group B. Confirmed predisposing factors in 85.7% of patients of group A were dehydration, infection, and underlying cerebrovascular disorders. No obvious predisposing factors were identified in group B. The most frequent symptom was headache, with epileptic seizures, hemiparalysis and aphasia being less frequent symptoms. Focal neurological symptoms （P=0.022） and cerebral infarction （P=0.014） occurred more frequently in group A than in group B. Anticoagulation therapy proved to be safe for cerebral venous thrombosis patients during puerperium, regardless of parenchymal hemorrhage. However, more attention should be paid to spontaneous in-site placental hemorrhage in pregnant patients. Both groups had similar prognoses （P=1.000）, with 36.3% patients suffering from consequential dysfunction or recurrent intracranial hypertension Delayed diagnosis was associated with a poorer prognosis. Conclusio展开更多
目的探讨妊娠及产褥期出血性脑卒中(hemorrhagic stroke during pregnancy and the puerperium,HSPP)的头部电子计算机体层扫描(CT)、磁共振成像(MRI)、三维计算机断层扫描血管造影(3D-CTA)、数字减影血管造影(DSA)表现的诊断价值。方法...目的探讨妊娠及产褥期出血性脑卒中(hemorrhagic stroke during pregnancy and the puerperium,HSPP)的头部电子计算机体层扫描(CT)、磁共振成像(MRI)、三维计算机断层扫描血管造影(3D-CTA)、数字减影血管造影(DSA)表现的诊断价值。方法 2004年6月至2007年7月中国医科大学附属盛京医院收治7例HSPP,回顾性分析其临床及影像学资料。7例患者发病后均行CT检查,行MRI检查1例,3D-CTA检查2例,DSA检查4例。结果 CT表现基底节或脑叶局部高密度影6例,双侧外侧裂少量高密度充填影1例。1例MRI表现T1WI等高混杂信号、T2WI低混杂信号;1例3D-CTA呈现左顶高密度不规则血管团,另1例3D-CTA正常。4例DSA证实3例脑血管动静脉畸形(arteriovenous malformation,AVM)、1例正常。3D-CTA检查结果与DSA相符。头部影像学检查提示蛛网膜下腔出血(subarachnoid hemorrhage,SAH)1例,基底节区脑出血2例,脑叶出血4例;病因为AVM破裂出血4例,依据DSA诊断3例,依据CT表现及既往病史诊断1例。结论头部CT及MRI是诊断HSPP的首选手段,3D-CTA及DSA有助于病因判断。展开更多
目的总结孕产期脓毒症的临床特点。方法回顾性分析2016年1月至2019年12月首都医科大学附属北京妇产医院分娩的41例产妇的临床资料。发生孕产期脓毒症12例,即妊娠期和产褥期感染继发器官功能损害[序贯器官衰竭评分(sequential organ fail...目的总结孕产期脓毒症的临床特点。方法回顾性分析2016年1月至2019年12月首都医科大学附属北京妇产医院分娩的41例产妇的临床资料。发生孕产期脓毒症12例,即妊娠期和产褥期感染继发器官功能损害[序贯器官衰竭评分(sequential organ failure assessment, SOFA)≥2分];发生血流感染29例,即妊娠期和产褥期感染有感染临床表现和血培养阳性,但无器官损害。比较两组的一般情况、高危因素、感染诱因、感染发生时间及来源、感染病原体、炎症指标以及治疗方案,总结孕产期脓毒症的临床特点。结果与血流感染组相比,脓毒症组中≥2次宫腔操作者明显增多(OR=17.33, P=0.001);合并产后出血的病例数明显增加(OR=5.25, P=0.025)。两组WBC、CRP值比较,差异无统计学意义(P>0.05),脓毒症组的中性粒细胞数(P=0.010)和PCT值明显高于血流感染组(P=0.001)。脓毒症组中有3例需要介入治疗控制产前和产后出血,有3例需要外科手术将感染灶切除控制感染,血流感染组无上述处理,差异均有统计学意义(P=0.021)。此外,两组血培养为耐药病原体的比率的差异无统计学意义(P=0.098),但脓毒症组需联合使用抗菌药物(含酶抑制剂+氨基糖苷类或喹诺酮类/碳青霉烯类+氨基糖苷类或喹诺酮类)控制感染者5例,而血流感染组无需联合用药(P=0.001)。脓毒症组抗菌药物使用≥10 d者亦明显增加(P=0.000)。结论对于妊娠期和产褥期多次行宫腔操作、介入治疗、产后出血者,尤其是临床症状隐匿、实验室指标提示有感染可能时,更要警惕脓毒症。一旦发生脓毒症,需尽早联合应用敏感抗菌药物控制感染,必要时采用外科手术去除感染灶以改善预后。展开更多
2019年12月,英国皇家妇产科医师学会(RCOG)发布《孕期和产褥期孕产妇衰竭指南(2019)》(Maternal Collapse in Pregnancy and the Puerperium:Green-Top Guideline No.56),总结孕期和产褥期孕产妇衰竭(MCPP)的相关循证医学证据,详细探讨...2019年12月,英国皇家妇产科医师学会(RCOG)发布《孕期和产褥期孕产妇衰竭指南(2019)》(Maternal Collapse in Pregnancy and the Puerperium:Green-Top Guideline No.56),总结孕期和产褥期孕产妇衰竭(MCPP)的相关循证医学证据,详细探讨如何早期识别发生MCPP高风险与导致MCPP的病因、影响MCPP孕产妇复苏的孕期生理与解剖生理变化,以及如何进行MCPP最佳初始和持续管理,并对其围死亡期剖宫产术(PMCS)进行深入描述。该指南还特别强调MCPP救护的多学科团队人员组成与职责。笔者拟结合我国产科临床实践,对该指南涉及的MCPP风险如何早期识别及其病因、影响复苏的孕期生理与解剖生理变化、最佳初步处理措施、PMCS、持续管理、对于母儿的影响、多学科救护团队人员组成等产科临床关注的相关问题要点,进行解读、讨论。展开更多
脑静脉窦及静脉血栓形成(cerebral venous and sinus thrombosis,CVST)是缺血性脑血管病的特殊类型,好发于妊娠期和产褥期的孕产妇。发病率低,起病隐匿,临床表现错综复杂,易于误诊、漏诊,死亡率、致残率高,但早期诊断和干预则预后良好...脑静脉窦及静脉血栓形成(cerebral venous and sinus thrombosis,CVST)是缺血性脑血管病的特殊类型,好发于妊娠期和产褥期的孕产妇。发病率低,起病隐匿,临床表现错综复杂,易于误诊、漏诊,死亡率、致残率高,但早期诊断和干预则预后良好。本文重点就孕产妇CVST的早期诊断及误诊相关研究做一综述,以促进临床医师及早识别危险预警,避免误诊,早期诊断,及时干预。展开更多
文摘Keywords pregnancy; puerperium; cerebral venous thromboembolism; anticoagulant agents; thrombolysis Background Previous investigations have demonstrated a relatively low incidence of stroke among young women, though both pregnancy and delivery can substantially increase the risk. Cerebral venous thrombosis may manifest different characteristics during pregnancy and postpartum as a result of their specific physiological statuses. This study aimed to identify the clinical manifestations, diagnosis, treatment, and prognosis of cerebral venous thrombosis during pregnancy and postpartum. Methods We conducted a retrospective analysis of 22 patients with cerebral venous thrombosis who were assigned to either group A （during pregnancy） or group B （during postpartum）. The relevant risk factors, initiation and development of the disease, clinical presentations, diagnosis, treatment, and prognosis were compared between the two stages. Results Cerebral venous thrombosis occurred during both pregnancy and postpartum, but was more common postpartum. Patients in group A had a longer hospitalization period than those in group B. Confirmed predisposing factors in 85.7% of patients of group A were dehydration, infection, and underlying cerebrovascular disorders. No obvious predisposing factors were identified in group B. The most frequent symptom was headache, with epileptic seizures, hemiparalysis and aphasia being less frequent symptoms. Focal neurological symptoms （P=0.022） and cerebral infarction （P=0.014） occurred more frequently in group A than in group B. Anticoagulation therapy proved to be safe for cerebral venous thrombosis patients during puerperium, regardless of parenchymal hemorrhage. However, more attention should be paid to spontaneous in-site placental hemorrhage in pregnant patients. Both groups had similar prognoses （P=1.000）, with 36.3% patients suffering from consequential dysfunction or recurrent intracranial hypertension Delayed diagnosis was associated with a poorer prognosis. Conclusio
文摘目的探讨妊娠及产褥期出血性脑卒中(hemorrhagic stroke during pregnancy and the puerperium,HSPP)的头部电子计算机体层扫描(CT)、磁共振成像(MRI)、三维计算机断层扫描血管造影(3D-CTA)、数字减影血管造影(DSA)表现的诊断价值。方法 2004年6月至2007年7月中国医科大学附属盛京医院收治7例HSPP,回顾性分析其临床及影像学资料。7例患者发病后均行CT检查,行MRI检查1例,3D-CTA检查2例,DSA检查4例。结果 CT表现基底节或脑叶局部高密度影6例,双侧外侧裂少量高密度充填影1例。1例MRI表现T1WI等高混杂信号、T2WI低混杂信号;1例3D-CTA呈现左顶高密度不规则血管团,另1例3D-CTA正常。4例DSA证实3例脑血管动静脉畸形(arteriovenous malformation,AVM)、1例正常。3D-CTA检查结果与DSA相符。头部影像学检查提示蛛网膜下腔出血(subarachnoid hemorrhage,SAH)1例,基底节区脑出血2例,脑叶出血4例;病因为AVM破裂出血4例,依据DSA诊断3例,依据CT表现及既往病史诊断1例。结论头部CT及MRI是诊断HSPP的首选手段,3D-CTA及DSA有助于病因判断。
文摘2019年12月,英国皇家妇产科医师学会(RCOG)发布《孕期和产褥期孕产妇衰竭指南(2019)》(Maternal Collapse in Pregnancy and the Puerperium:Green-Top Guideline No.56),总结孕期和产褥期孕产妇衰竭(MCPP)的相关循证医学证据,详细探讨如何早期识别发生MCPP高风险与导致MCPP的病因、影响MCPP孕产妇复苏的孕期生理与解剖生理变化,以及如何进行MCPP最佳初始和持续管理,并对其围死亡期剖宫产术(PMCS)进行深入描述。该指南还特别强调MCPP救护的多学科团队人员组成与职责。笔者拟结合我国产科临床实践,对该指南涉及的MCPP风险如何早期识别及其病因、影响复苏的孕期生理与解剖生理变化、最佳初步处理措施、PMCS、持续管理、对于母儿的影响、多学科救护团队人员组成等产科临床关注的相关问题要点,进行解读、讨论。
文摘脑静脉窦及静脉血栓形成(cerebral venous and sinus thrombosis,CVST)是缺血性脑血管病的特殊类型,好发于妊娠期和产褥期的孕产妇。发病率低,起病隐匿,临床表现错综复杂,易于误诊、漏诊,死亡率、致残率高,但早期诊断和干预则预后良好。本文重点就孕产妇CVST的早期诊断及误诊相关研究做一综述,以促进临床医师及早识别危险预警,避免误诊,早期诊断,及时干预。
