Full-term pregnancy with retroperitoneal giant mucinous cyst: A case report and literature review.

RATIONALE: Retroperitoneal benign cysts during pregnancy are extremely rare and often remain asymptomatic until they attain a very large size. Diagnosis typically relies on a pathological tissue biopsy. The decision to pursue 1-step or 2-step surgical treatment should be tailored to each individual case rather than generalized. PATIENT CONCERNS: This case report presents the unique scenario of a pregnant woman with a confirmed pregnancy complicated by a large retroperitoneal cyst. The patient had a retroperitoneal cyst during her initial pregnancy, which went undetected during the first cesarean section. However, it was identified during her second pregnancy by which time it had grown to 13.0 cm × 15.0 cm × 25.0 cm, and extended from the liver margin to right ovarian pelvic infundibulopelvic ligament. Consequently, it was removed smoothly during her second cesarean section. DIAGNOSES: Postoperative pathology results indicated a massive retroperitoneal mucinous cystadenoma. INTERVENTIONS: The giant retroperitoneal cyst was smoothly excised during the second cesarean delivery for 1-step surgical treatment. OUTCOMES: Under the combined spinal and epidural anesthesia, a live female infant was delivered at 38 3/7 gestational weeks and the neonatal weight was 3200g. Under general anesthesia with endotracheal intubation, the giant retroperitoneal cyst was excised smoothly without complications. LESSONS: The findings of this case report contribute to the understanding of the diagnostic modalities, surgical approaches and postoperative considerations of giant retroperitoneal cysts associated with pregnancy.

Effects of early- and late- neuraxial analgesia on multiparous women: a retrospective monocentric study.

BACKGROUND: The mechanism underlying maternal fever and prolonged labor progression associated with neuraxial analgesia (NA) remains elusive, raising concerns among certain pregnant women regarding the application of NA during vaginal delivery. This study aimed to investigate the impact of early and late NA on maternal and neonatal outcomes in multiparous women. METHODS: This retrospective study collected data from 1119 multiparous women with singleton pregnancies, full term and live births at our labor and delivery center between August 1st, 2021 and July 31st, 2022. Based on the timing of NA initiation, participants were categorized into three groups: no-NA, early-NA and late-NA. The no-NA group comprised of 172 women who did not receive NA during vaginal delivery; the early-NA group included 603 women in which NA was initiated when cervical dilation was between 0.5 and 2.0 cm; and the late-NA group comprising 344 cases in which NA was initiated at the cervical dilation of ≥ 2 cm. Maternal and neonatal outcomes were observed, including durations of the first, second, third and total stage of labor, the rate of intrapartum cesarean delivery (CD), intrapartum fever, postpartum hemorrhage (PPH), transfer to intensive care unit (ICU), admission to the neonatal intensive care unit (NICU), meconium-stained amniotic fluid, and neonatal Apgar scores at 1 and 5 min. RESULTS: No differences were noted in the maternal age, body mass index (BMI) on admission, gestations, parity, gestational weeks at delivery and neonatal birth weight, or the rate of gestational diabetes mellitus (GDM) and hypertension disorder did not significantly differ among the three groups (p > 0.05). The no-NA group had shorter durations of first stage, second stage of labor compared to the early-NA or late-NA group (median, 215.0 min and 10.0 min vs. 300.0 min and 12.0 min vs. 280.0 min and 13.0 min) (p < 0.05), but no differences were observed between the early-NA and late-NA group (p > 0.05). There were no differences in the rate of intrapartum CD, intrapartum fever, PPH, maternal transferred to ICU, neonatal transfer to NICU, meconium-stained amniotic fluid, and postpartum stay ≥ 7d, as well as the neonatal the Apgar scores at 1 and 5 min among the three groups (p > 0.05). CONCLUSION: NA is associated with extended durations of the first, second and total stages of labor. However, the early initiation of NA in multiparous women (cervical dilation within 0.5-2.0 cm) does not increase the risk of intrapartum CD or intrapartum fever. These findings endorse the secure utilization of early NA for pain relief during labor in multiparous women.

Duration time of labor progression for pregnant women of vaginal birth after cesarean in Hubei, China.

OBJECTIVE: There have been limited reports on the duration of labor progression in pregnant women undergoing vaginal birth after cesarean (VBAC). This study aimed to investigate the duration of labor progression during VBAC in Hubei, China. METHODS: A total of 359 pregnant women undergoing VBAC were enrolled as the VBAC group, meeting the following criteria: singleton pregnancy, gestational age ≥ 37 weeks, live birth, history of cesarean delivery, and a willingness to attempt a vaginal delivery. At the same time, 359 primiparas successfully undergoing vaginal delivery were randomly enrolled in the control group at a 1:1 ratio. Subsequently, the durations of the first, second, and third stages of labor were comparatively analyzed between the two groups. RESULTS: The duration of the first, second, and total stages of labor in the VBAC group was significantly shorter than that in the control group (p < 0.05). There was no significant difference in the duration of the third stage of labor between the two groups (p > 0.05). The amount of blood loss, the rate of postpartum hemorrhage (PPH), and episiotomy were higher in the VBAC group than in the control group (p < 0.05). The rate of labor analgesia and intrapartum fever in the VBAC group was significantly lower than that in the control group (p < 0.05). CONCLUSION: The duration of labor progression of the first, second, and total stages of VBAC is shorter than that in primiparous women in our observation in China.

Clinical analysis of prophylactic uterine artery embolization combined with double balloon catheter for second-trimester pregnancy termination in cases of complete placenta previa: A retrospective study.

Complete placenta previa often causes significant bleeding in a short period during second-trimester pregnancy termination. This can destabilize the mother's circulation, threatening her life. Furthermore, the condition is complicated by an immature cervix, making it a challenging clinical problem. The aim of this study was to investigate the effect of prophylactic uterine artery embolization (UAE) combined with double balloon catheter (DBC) deal with those cases. A total of 7 patients who underwent pregnancy termination in the second-trimester in Maternal and Child Health Hospital of Hubei Province between March 1st, 2021 and August 31st, 2023 were retrospectively analyzed in this study. All patients were diagnosed with complete placenta previa status and placenta accreta spectrum, and were treated with prophylactic UAE combined with DBC, and/or dilation and evacuation. All the patients received mifepristone, and 5 of them underwent medical termination with ethacridine lactate. Following prophylactic UAE combined with DBC, 6 patients underwent dilation and evacuation, which was monitored by ultrasound. And one patient experienced natural delivery of their fetus and placenta. Only one patient (patient 3) developed an intrapartum fever after prolonged duration of 18 hours from ethacridine to UAE and 56 hours from UAE to DBC. The amount of intrapartum hemorrhage ranged from 20 mL to 300 mL. The combined therapy of prophylactic UAE and DBC is a preferred option for patients with complete placenta previa undergoing second-trimester pregnancy termination. The use of dilation and evacuation may depend on the cervical condition, bleeding, or infection.

Novel efficient capture of hexavalent chromium by polyethyleneimine/amyloid fibrils/polyvinyl alcohol aerogel beads: Functional design, applicability, and mechanisms.

The harmful effects of hexavalent chromium (Cr(VI)) on the environment and human health have aroused wide public concern. In this study, bulk spherical aerogel beads (PAP) were synthesized from polyethyleneimine (PEI), protein amyloid fibrils (AFL), and polyvinyl alcohol (PVA) through green technology and its removal of Cr(VI) from wastewater was comprehensively studied. The results showed that although the bulk PAP beads (∼ 5 mm) only had an average pore size of 16.88 nm and a BET surface area of 12 m2/g, its maximum adsorption capacity for Cr(VI) reached 121.44 mg/g (at 298 K). Cr(VI) adsorption onto PAP conformed to pseudo-second-order adsorption kinetics and was endothermic. The adsorption of Cr(VI) decreased stepwise with the increase of solution alkalinity (pH = 2: 91.97%; pH = 10: 0.04%). Importantly, PAP showed high selectivity towards Cr(VI) in mixed heavy metal solutions (Cr(VI) > Pb(II) > Ni(II) > Cu(II) > Cd(II)) and good reusability (removal efficiency > 88% after 5 cycles). PAP had excellent anti-interference ability against FA and HCO3- with the overall removal rate exceeding 87% in the presence of 5 - 25 mg/L of these ions. Cations such as Na+, Mg2+, and other heavy metal ions at high concentrations could promote the removal efficiency of Cr(VI). The removal rates of Cr(VI) and Cr(III) by PAP in a tannery wastewater were 34.4% and 59.3%, respectively. Meanwhile, the removal rates of Cr(VI) in a electroplating wastewater and a contaminated soil leachate reached 84.4∼89.7%, showing high practicability. Mechanism studies revealed that electrostatic attraction, hydrogen bonding, reduction, and complexation were the main reactions for Cr(VI) removal by PAP. In general, the study of PAP provides a new insight into using bulk monolith materials for treating Cr(VI) contaminated wastewater.

Highly efficient removal of Cr(VI) from wastewater using electronegative SA/EGCG@Ti/SA/PVDF sandwich membrane.

The use of green, non-toxic raw materials is of great significance to the sustainable development of the environment, among which epigallocatechin gallate (EGCG) is a renewable carbon source from plants. At present, there is a lack of research on the metal-polyphenol nanomaterials their use in water decontamination. In this study, a novel SA/EGCG@Ti/SA/PVDF (SESP) sandwich membrane was prepared to effectively solve the problems of difficult recovery of nanomaterials and the leaching of metal ions. The membrane was made by scraping SA on the surface of the PVDF substrate as the bottom protective layer, depositing EGCG@Ti NPs as the functional layer, then coating SA as the surface isolation layer, and finally cross-linking with anhydrous calcium chloride. Results showed that EGCG@Ti NPs dispersed well on the surface of the SA/PVDF basement membrane. SESP sandwich membrane had good hydrothermal and acid-base stability, and it can be applied to wastewater with multiple co-existing heavy metals (e.g., Cu, Pb, Cd, and Ni). The contact angle and pure water flux of the SESP sandwich membrane with a negatively charged surface were 14.0-15.6° and 171.40 L/m2 h, respectively. The pure water flux of the regenerated membrane after BSA pollution recovered to 98.68 L/m2 h, and the interception efficiency and the interception flux of Cr(VI) were 100 % and 72.92 L/m2 h at 40 min of interception, respectively. Additionally, the removal efficiency of Cr(VI) by SESP sandwich membrane was maintained above 83 % for simulated wastewater and 100 % for actual wastewater after five adsorption-desorption cycles. Cr(VI) and Cr(III) can be removed simultaneously with the negatively charged SESP sandwich membrane. EDS and XPS analysis showed that the removal of Cr(VI) was controlled by the Donnan effect, anion exchange, chelation/complexation, and reduction mechanism. In contrast, Cr(III) was mainly influenced by electrostatic attraction and chelation/complexation mechanisms. In conclusion, the newly prepared sandwich membrane has good application potential in treating Cr(VI) wastewater.