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Objective:To investigate the safety of the Triple-P procedure in women complicated with severe placenta accreta spectrum disorders (PAS) and its influence on second pregnancy.Methods:From January 2015 to December 2017, the outcomes of the second pregnancy after the Triple-P procedure in 11 pregnant women complicated with PAS in the Third Affiliated Hospital of Guangzhou Medical University and the First Affiliated Hospital of Zhengzhou University were retrospectively analyzed.Results:By December 2021, a total of 11 pregnant women who underwent the Triple-P procedure for PAS had a second pregnancy, with a median interval of 3 years (2-3 years). Of the 11 pregnant women, 7 delivered after 36 weeks of gestation. The median gestational age was 38 weeks, and 4 terminated within the first trimester. PAS recurred in 1 of 7 pregnant women (1/7) and was associated with placenta previa. All of the 7 pregnant women were delivered by cesarean section, with a median postpartum blood loss of 300 ml (200-450 ml), and only one pregnant woman required blood transfusion. None of the pregnant women were transferred to the intensive care unit, and there were no uterine rupture, bladder injury, puerperal infection, and neonatal adverse outcomes.Conclusion:Pregnant women who underwent the Triple-P procedure for severe PAS could be considered for second pregnancy with strictly management by an experienced multidisciplinary team, which may result in a good outcome.
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Objective:To investigate the effect of pelvic packing on the control of intractable postpartum hemorrhage after emergency perinatal hysterectomy (EPH).Methods:Eleven cases with complete clinical data of pelvic packing due to failure of hemostasis after EPH were collected to evaluate the outcome, complications, hospital stay of pregnant women, and to analyze the factors affecting the effect of pelvic packing. The cases included patients who were admitted to the Third Affiliated Hospital of Guangzhou Medical University after pelvic packing treatment in the other hospital due to continuous bleeding after EPH or who were referred to our hospital for pelvic packing treatment due to continuous bleeding after EPH from January 2014 to August 2021.Results:The median gestational week of 11 pregnant women was 38.3 weeks(38.0-39.9 weeks) , and the methods of termination of pregnancy were cesarean section in 7 cases (7/11) and vaginal delivery in 4 cases (4/11). The median time between postpartum hemorrhage and pelvic tamponade was 10 hours (5-57 hours), the median amount of bleeding was 8 500 ml(4 800-15 600 ml) , the median number of pelvic tamponade was 3 pieces (2-7 pieces), and the median retention time of gauze pad was 6.0 days (3.0-6.0 days). The median frequency of laparotomy in this pregnancy was 3 times (2-3 times), with a maximum of 4 among the 11 cases, the first pelvic packing was successful in hemostasis in 9 cases, and the final successful treatment in all of the 11 cases. All parturients had hemorrhagic shock (11/11) and disseminated intravascular coagulation (11/11) before pelvic packing. Other common complications were multiple organ dysfunction syndrome (9/11), cardiac arrest (4/11), deep vein thrombosis (3/11), septic shock (3/11), and intestinal obstruction (1/11). All parturients took out the gauze after the coagulation function returned to normal and there was no active bleeding. The recovery time of coagulation function in 11 cases was 3 days (3-5 days), the retention time of gauze pad was 6 days (3-6 days), the median length of stay in intensive care unit was 14 days (11-26 days), and the median total length of stay was 22 days (16-49 days).Conclusions:Pelvic packing could be used as a temporary strategy for intractable postpartum hemorrhage after EPH, which provides a key time for injury control resuscitation for patients with unstable vital signs. This technology provides an opportunity for referral to superior medical institutions and further treatment.
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Objective To investigate the ratio of transfer cesarean section after trial of labor and maternal-fetal outcomes based on Robson classifications.Methods The delivery data by cesarean section in Third Affiliated Hospital of Guangzhou Medical University from January 1st,2009 to December 31st,2015 (gestational age ＞28 weeks and newborn birth weight ＞1 000 g) were retrospectively collected.The ratio of transfer cesarean section after trial of labor and maternal-fetal adverse outcomes were analyzed by weighted adverse outcome score in different Robson classifications.Results (1) The highest ratio of transfer cesarean section after trial of labor was classification 9 (all abnormal lies,including previous cesarean section and breech were excluded) reached 47.31％ (431/911),followed by classification 2 (nulliparous women with a single cephalic pregnancy,＞37 weeks gestation who had labour induced) accounted for 44.90％(409/911).(2)The tops of weighted adverse outcome score of transfer cesarean section after trial of labor were classification 10 (single cephalic pregnancy at ＜37 weeks gestation,including women with previous cesarean delivery) 24.55,classification 5 (single cephalic pregnancy multiparous women,with at least one previous cesarean delivery,＞37weeks gestation) 3.64.Conclusion Carefully evaluating the delivery mode and emphasizing the intrapartum management in nulliparous women with a single cephalic pregnancy,at ＞ 37 weeks gestation who had labour induced and trial of labor after cesarean section is essential to reduce the risk of adverse outcomes in transfer cesarean section after trial of labor.
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Objective To investigate the efficacy of anastomosis after circular resection of lower uterine segment of uterine ends in the treatment of pernicious placenta previa combined with placenta accreta.Methods Clinical data of three patients who were diagnosed with pernicious placenta previa combined with placenta accreta and treated with circular resection of lower uterine segment and anastomosis in Third Affiliated Hospital of Guangzhou Medical University from January to July 2016 were retrospectively analyzed.Efficacy of the treatment was evaluated by analyzing blood loss,vital signs and blood transfusion during operation,postoperative recovery and other parameters.Results Vital signs of the three patients were stable during operations.The volume of blood loss and blood transfusion during operation and operation time of the three patients were respectively 2 000 ml,400 ml and 110 min,1 520 ml,200 ml and 96 min,and 1 500 ml,200 ml and 90 min.None of them had postoperative infection and all were discharged within seven days after operation.The three patients all recovered well.Lochia discharge continued for 33,38 and 28 days,respectively.The menses were resumed respectively on the 289th,179th and 163rd day following operation without dysmenorrhea and all women had normal volume of menstruation.The cervical lengths of the three patients were 4.2,3.5 and 3.2 cm 90 days after operation,respectively.Results of imaging examination showed that uterine cavity were in normal shape and distinct endometrium were observed in all patients 90 days after operation.Conclusions Circular resection of lower uterine segment and anastomosis of lower ends of the uterine,which can effectively contol the intraoperative bleeding and retain the uteru,is highly effective for pernicious placenta previa combined with placenta accreta.
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Objective To investigate the effect of three-color warning management on maternal and child outcomes in high-risk pregnant women with major diseases and severe complications.Methods Retrospective analysis of hospitalized 703 cases of high risk obstetrics was included in the three color warning management of maternal data between May 2015 to July 2016 in our hospital.Maternal disease spectrum changes of three color warning,the rate of intensive care unit (ICU) admission,and maternal mortality rate were observed.Results There were 497 cases (70.70％) of blue warning,78 cases (20.48％) of yellow warning,and 62 cases (8.82％) of red warning.There was 1 case of maternal death and the rate of ICU admission was 7.85％ in blue warning;2 case of maternal death and the rate of ICU admission was 24.31％ in yellow warning;5 cases of maternal death,the rate of ICU admission was 43.55％ in red warning.Conclusions Three color warning management system can be used to assess the severity of the disease,improve the diagnosis and treatment of disease,improve patient survival,improve pregnancy outcomes,and reduce maternal complications.
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Objective To establish the model of maternal high salt exposure and investigate the effects of maternal high salt exposure on growth and blood pressure in maternal and offspring.Methods At the age of 3 weeks (after weaning) female specific pathogen free (SPF) Sprague Dawley (SD) rats fed for 1 weeks,were randomly divided into three groups,including the high diet salt group (group H,8％ NaCl),low salt diet group (group L,0.26％ NaCl),and normal diet salt group (group N,0.5％ NaCl).Breeding started in feeding until 12 weeks of age,and the inverted microscope was used to see male sperm full view as the zeroth day of pregnancy.Pregnant,lactating,postpartum were grouped by the corresponding feed.Rats fed high salt group after weaning rats continued to high salt diet,denoted as HH group;maternal low salt group after weaning rats received continued low salt diet,denoted as LL group;normal saline group rats after weaning rats fed with normal feed to salt,denoted as NN group.Each period of maternal and offspring weight were measured with the electronic balance.Maternal and offspring's blood pressure was detected with Softron BP-2010A intelligent non-invasive blood pressure instrument (Japan) in different periods.SPSS19.0 software was used to analyze the data,including One-way ANOVA analysis,SNK,and LSD methods.Results High salt exposure,maternal postpartum 2 weeks,and the weight of H group were higher than that of L group,there were no difference in other different periods of maternal.In the offspring,in addition to 32 weeks of age,weight of HH group was lower than that of LL group;and at the age of 8 weeks and 24 weeks,HH group rats body weight was less than the NN group,the differences were statistically significant (P ＜ 0.05).After high salt exposure,after 3 weeks postpartum maternal blood pressure in H group was the highest (158.79 ± 1.87)mmHg.In the offspring,the blood pressure of 60 weeks in the HH group was the highest (162.50 ±2.11) mmHg.At the age of 8 weeks,9 weeks,10 weeks,11 weeks,7 days gestation,pregnant 14 days,1 weeks postpartum,2 weeks postpartum,3 weeks postpartum of maternal,and high salt group's blood pressure were higher than those in normal group,at the age of 9 weeks,10 weeks,11 weeks,7 days of pregnancy,postpartum 1 weeks,2 weeks postpartum,postpartum 3 weeks of high salt group's blood pressure was higher than the low salt group.In the offspring each period of HH group,the blood pressure was higher than that of NN group and LL group,and in the 28,32,36,44,48,and 52 weeks,blood pressure of LL was higher than that of NN group,the differences were statistically significant (P ＜ 0.05).Conclusions Maternal high salt exposure can affect the growth and development of offspring and lead to the occurrence of maternal and offspring hypertension,and with the high salt exposure time,blood pressure was gradually rising trend.
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Objective To explore the natural courses of 11 patients with cesarean scar pregnancy (CSP) with expectant management. Methods Eleven patients with CSP who were diagnosed in the first trimester in the Third Affiliated Hospital of Guangzhou Medical University from January 2015 to March 2017 were recruited. All of them received expectant management. Nine pregnancies continued to the third trimester (the third trimester group), and 2 patients were expected to the second trimester (the second trimester group). The gestational age at diagnosis, CSP type, gravidity, parity, miscarriage and previous cesarean section history, gestational weeks at termination, amount of postpartum hemorrhage, prenatal and postnatal hemoglobin levels, pregnancy outcomes and obstetric complications were compared between the two groups. Results The third trimester group terminated pregnancies between 33 + 2 and 36 + 5 weeks. The second trimester group terminated in the second trimester because of rupture of uterus (at 17+2,17+3 weeks). There was no statistical difference between the two groups regarding the number of gravidity, parity and previous cesarean section(all P>0.05). The number of miscarriage in the second trimester group was 4.0 ± 2.8,and in the third trimester group was 1.3 ± 1.1(P<0.05). In the third trimester group, 7 cases were CSP typeⅠand 2 cases were CSPⅡ. In the second trimester group, 2 cases were both CSP typeⅢ. Eleven cases were diagnosed placenta accreta pathologically. There was no maternal death,and 6 cases received hysterectomy (6/11). The amount of postpartum hemorrhage increased remarkably and all neonates survived (pregnancy terminated between 33+2 and 36+5 weeks). Conclusions For those diagnosed as CSP typeⅠandⅡwho urge to continue pregnancies, it′s plausible to have expectant management with fully consent of obstetric hemorrhage, rupture of uterus and hysterectomy and close monitoring in tertiary hospital. The detailed expectant management of CSP is needed further exploration.
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Objective To investigate the risk factors of reversible posterior leukoencephalopathy syndrome (RPLS) in pre-eclampsia or eclampsia gravida. Methods This study was conducted in the Third Affiliated Hospital of Guangzhou Medical University between January 2013 and March 2016. A total of 100 patients who had no severe neurological diseases and were diagnosed pre-eclampsia or eclampsia, and underwent brain MRI were collected retrospectively. They were divided into 2 groups according to the MRI results, the RPLS group (n=49) and the non-RPLS group (n=51). The medical history, clinical symptoms and the results of laboratory examination were analyzed by the logistic regression, in order to explore the risk factors.Results In single factor analysis, HELLP syndrome, pregnancy associated with other diseases, poor prenatal care, grade 3 hypertension, elevated systolic blood pressure or diastolic blood pressure, elevated WBC, aspartate transaminase (AST), alanine aminotransferase (ALT), uric acid (UA) and lactate dehydrogenase (LDH), decreased platelet (PLT), headache, visual changes, seizures and conscious disturbance were more frequent in the RPLS group than those in the non-RPLS group (all P<0.05). According to the multivariate logistic regression analysis, the elevated WBC (OR=1.291, 95%CI:1.058-1.575, P=0.012), UA (OR=1.008,95%CI:1.001-1.016,P=0.032) and headache (OR=18.260, 95%CI:3.562- 93.607, P=0.000) were the independent risk factors.Conclusions Maternal history, clinical symptoms and some laboratory examinations might help in the early diagnosis of RPLS in pre-eclampsia or eclampsia gravida. Headache, the elevation of WBC and UA were the most significant factors.
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Objective To analyze the incidence and causes of stillbirth in 11 hospitals of Guangdong province, and to explore the appropriate interventions. Methods Clinical data of stillbirth in 11 hospitals of Guangdong province were collected from January 2014 to December 2016. The gestational weeks,causes,maternal conditions and other factors were analyzed.Results (1)From 2014 to 2016,103 472 newborns were delivered in the 11 hospitals,and the number of stillbirth was 2 204,with the incidence of 2.13%. Among them, 0.71%(738/103 472) was therapeutic induction, 1.42%(1 066/103 472) was natural stillbirth.At different gestational age(<28 weeks,28-<37 weeks and≥37 weeks),the incidence of stillbirth was 55.63% (1 226/2 204), 28.45% (627/2 204) and 15.92% (351/2 204), respectively, with statistically significant difference (P<0.01). (2) For stillbirth<28 weeks, the first reason was therapeutic induction, accounting for 53.34%(654/1 226).For stillbirth during 28-37 weeks,pre-eclampsia was the major cause, accounting for 40.67% (255/627). And for full-term stillbirth, the causes were umbilical cord factors (19.37%, 68/351), abnormal labor (17.09%, 60/351). (3) In all the stillbirth cases, the incidence of fetal growth restriction (FGR) <28 weeks was significantly higher than that during 28-37 weeks [23.49%(288/1 226)vs 18.02%(113/627), P<0.01]. (4) The stillbirth rate during labor was significantly higher in women ≥35 years old than in younger women [63.88%(191/299)vs 36.12%(108/299);χ2=9.346, P=0.000]. For the causes of stillbirth during labor, the incidence of severe maternal obstetrical complications [61.11%(33/54)vs 38.89%(21/54);χ2=3.323,P=0.002],abnormal labor[65.82%(52/79)vs 34.18%(27/79);χ2=4.067,P=0.001]and abnormal fetal position[66.63%(26/39)vs 33.37%(13/39);χ2=3.002,P=0.013] were higher in women ≥35 years old than in younger women. (5) Cesarean section during labor accounted for 33.77%(101/299)of stillbirth,including 76 cases of emergency cesarean section or converted to cesarean section during labor. Conclusions (1) The incidence of stillbirth in the 11 hospitals is high, and the causes are different at different gestational ages, therefore,different interventions are needed to reduce the incidence in different gestational weeks. Supervision of therapeutic induction should be strengthened <28 gestational weeks;standard management of pregnancy might decrease the occurrence of natural death ≥28 weeks. (2) Attention should be paid to fetal body weight during pregnancy, especially FGR. (3) The stillbirth rate is high in elderly pregnant women, so it is important to strengthen the management of the elderly pregnant women.
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Objective To investigate the effect of three-color warning management on maternal and child outcomes in high-risk pregnant women with major diseases and severe complications.Methods Retrospective analysis of hospitalized 703 cases of high risk obstetrics was included in the three color warning management of maternal data between May 2015 to July 2016 in our hospital.Maternal disease spectrum changes of three color warning,the rate of intensive care unit (ICU) admission,and maternal mortality rate were observed.Results There were 497 cases (70.70％) of blue warning,78 cases (20.48％) of yellow warning,and 62 cases (8.82％) of red warning.There was 1 case of maternal death and the rate of ICU admission was 7.85％ in blue warning;2 case of maternal death and the rate of ICU admission was 24.31％ in yellow warning;5 cases of maternal death,the rate of ICU admission was 43.55％ in red warning.Conclusions Three color warning management system can be used to assess the severity of the disease,improve the diagnosis and treatment of disease,improve patient survival,improve pregnancy outcomes,and reduce maternal complications.
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Objective To establish the model of maternal high salt exposure and investigate the effects of maternal high salt exposure on growth and blood pressure in maternal and offspring.Methods At the age of 3 weeks (after weaning) female specific pathogen free (SPF) Sprague Dawley (SD) rats fed for 1 weeks,were randomly divided into three groups,including the high diet salt group (group H,8％ NaCl),low salt diet group (group L,0.26％ NaCl),and normal diet salt group (group N,0.5％ NaCl).Breeding started in feeding until 12 weeks of age,and the inverted microscope was used to see male sperm full view as the zeroth day of pregnancy.Pregnant,lactating,postpartum were grouped by the corresponding feed.Rats fed high salt group after weaning rats continued to high salt diet,denoted as HH group;maternal low salt group after weaning rats received continued low salt diet,denoted as LL group;normal saline group rats after weaning rats fed with normal feed to salt,denoted as NN group.Each period of maternal and offspring weight were measured with the electronic balance.Maternal and offspring's blood pressure was detected with Softron BP-2010A intelligent non-invasive blood pressure instrument (Japan) in different periods.SPSS19.0 software was used to analyze the data,including One-way ANOVA analysis,SNK,and LSD methods.Results High salt exposure,maternal postpartum 2 weeks,and the weight of H group were higher than that of L group,there were no difference in other different periods of maternal.In the offspring,in addition to 32 weeks of age,weight of HH group was lower than that of LL group;and at the age of 8 weeks and 24 weeks,HH group rats body weight was less than the NN group,the differences were statistically significant (P ＜ 0.05).After high salt exposure,after 3 weeks postpartum maternal blood pressure in H group was the highest (158.79 ± 1.87)mmHg.In the offspring,the blood pressure of 60 weeks in the HH group was the highest (162.50 ±2.11) mmHg.At the age of 8 weeks,9 weeks,10 weeks,11 weeks,7 days gestation,pregnant 14 days,1 weeks postpartum,2 weeks postpartum,3 weeks postpartum of maternal,and high salt group's blood pressure were higher than those in normal group,at the age of 9 weeks,10 weeks,11 weeks,7 days of pregnancy,postpartum 1 weeks,2 weeks postpartum,postpartum 3 weeks of high salt group's blood pressure was higher than the low salt group.In the offspring each period of HH group,the blood pressure was higher than that of NN group and LL group,and in the 28,32,36,44,48,and 52 weeks,blood pressure of LL was higher than that of NN group,the differences were statistically significant (P ＜ 0.05).Conclusions Maternal high salt exposure can affect the growth and development of offspring and lead to the occurrence of maternal and offspring hypertension,and with the high salt exposure time,blood pressure was gradually rising trend.
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Objective To explore the natural courses of 11 patients with cesarean scar pregnancy (CSP) with expectant management. Methods Eleven patients with CSP who were diagnosed in the first trimester in the Third Affiliated Hospital of Guangzhou Medical University from January 2015 to March 2017 were recruited. All of them received expectant management. Nine pregnancies continued to the third trimester (the third trimester group), and 2 patients were expected to the second trimester (the second trimester group). The gestational age at diagnosis, CSP type, gravidity, parity, miscarriage and previous cesarean section history, gestational weeks at termination, amount of postpartum hemorrhage, prenatal and postnatal hemoglobin levels, pregnancy outcomes and obstetric complications were compared between the two groups. Results The third trimester group terminated pregnancies between 33 + 2 and 36 + 5 weeks. The second trimester group terminated in the second trimester because of rupture of uterus (at 17+2,17+3 weeks). There was no statistical difference between the two groups regarding the number of gravidity, parity and previous cesarean section(all P>0.05). The number of miscarriage in the second trimester group was 4.0 ± 2.8,and in the third trimester group was 1.3 ± 1.1(P<0.05). In the third trimester group, 7 cases were CSP typeⅠand 2 cases were CSPⅡ. In the second trimester group, 2 cases were both CSP typeⅢ. Eleven cases were diagnosed placenta accreta pathologically. There was no maternal death,and 6 cases received hysterectomy (6/11). The amount of postpartum hemorrhage increased remarkably and all neonates survived (pregnancy terminated between 33+2 and 36+5 weeks). Conclusions For those diagnosed as CSP typeⅠandⅡwho urge to continue pregnancies, it′s plausible to have expectant management with fully consent of obstetric hemorrhage, rupture of uterus and hysterectomy and close monitoring in tertiary hospital. The detailed expectant management of CSP is needed further exploration.
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Objective To study the clinical characteristicsand perioperative managementof complicated placenta increta, effectively reduce the maternal adverse perinatal outcomes. Methods Retrospective analysis 25 cases of complicated placenta increta between January 2013 and December 2015 in the Third Affiliated Hospital Of Guangzhou Medical University. Grouped into preoperative line 9 cases of ureteral catheter group and without catheter group 16 cases; Conventional hysterectomy group of 17 cases and the posterior hysterectomy group of 8 cases , compare the operation time , postpartum hemorrhage , blood transfusion amount , bladder injury or ureteral injury rate , rate of transferred to the ICU and hospital stay. Results 76% appear repeatedly painless vaginal bleeding during pregnancy , 56% appear bleeding before delivery. Prenatal diagnosis of 17 cases (68%). The preoperative line cystoscopy + bilateral retrograde ureteral catheter or after the posterior hysterectomy , shorter operation time , less postpartum hemorrhage , reduce blood transfusion volume , no urinary tract injury rate, transferred to the ICU rate is low, the difference was statistically significant (P < 0.05). Conclusions We should attach importance to repeated painless vaginal bleeding , improve prenatal diagnostic rate of complicated placenta increta. The perioperative managementis more comprehensive , effective and standard participation , preoperative ureteral catheter and the posterior hysterectomy can effectively reduce the maternal adverse perinatal outcomes.
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Objective To study the feasibility and safety of trial of labor after cesarean section (TOLAC). Methods Retrospective analysis of five medical center of Guangdong province from January 2011 to December 2015 hospitalized delivery information, compare the same scar TOLAC (research group) with the scar pregnancy (control group) pregnancy outcomes, to study the feasibility and safety of TOLAC. Results (1)During 2011-2015, total delivery 95 600 cases in five medical center, 13 824 cases of thme with uterine scar pregnancy, including 12 027 cases elective repeat cesarean section and 1 797 cases (13.00%, 1 797/13 824) with scar uterus vaginal trial of labor. Among 1 308 cases of vaginal delivery,the success for trial of labor rate was 72.79% (1 308/1 797). From 2011 to 2015, there were increased rate of pregnancy after cesarean section, which were respectively 10.71%, 13.28%, 14.45%, 15.54%and 16.98%. The will of vaginal birth were rising and the rate were respectively 11.85%, 12.25%, 13.49%, 13.82%and 12.93%. (2) There were 489(27.21%,489/1 797) cases of scar uterus maternal emergency cesarean section in the trial of labor, reason for“social factors”require for cesarean delivery have 68 cases, the percentage was 13.91% (68/489), compared with control group (7.18%, 206/2 869), the difference was statistically significant difference (χ2=27.356,P=0.000). Doctors diagnosed as“aura uterine rupture”in the labor was 11.86% (58/489), compared with that in control group (1.43%, 41/2 869), the differences were statistically significant difference (χ2=1 578.223,P=0.000). (3) The incidence of uterine rupture of the research group(0.74%,9/1 211)was significantly higher than that of control group (0.01%,2/31 200;χ2>2 000,P=0.000). The incidence of postpartum hemorrhage in research group was 6.94% (84/1 211), compared with that in the control group (3.05%, 951/31 200), there was statistically significant difference (χ2=16.328,P=0.000). While, there were no statistical significancefor the labor time limit,birth rate of severe asphyxia and neonatal birth weight average differences between two groups (P>0.05). Conclusions The rate of pregnancy after cesarean section is increasing year by year, and the will of vaginal birth is increasing, while it still are generally low. TOLAC is safe and feasible, but also significantly higher risk, strictly labor monitoring and can proceed fast cesarean delivery in delivery room is an important guarantee of safe delivery.