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BACKGROUND: Previous Caucasian studies have described venous thromboembolism in pregnancy; however, little is known about its incidence during pregnancy and early postpartum period in the Chinese population. We investigated the risk of venous thromboembolism in a “real-world” cohort of pregnant Chinese women with no prior history of venous thromboembolism. METHODS: In this observational study, 15,325 pregnancies were identified in 14,162 Chinese women at Queen Mary Hospital, Hong Kong between January 2004 and September 2016. Demographic data, obstetric information, and laboratory and imaging data were retrieved and reviewed. RESULTS: The mean age at pregnancy was 32.4±5.3 years, and the median age was 33 years (interquartile range, 29–36 yr). Pre-existing or newly diagnosed diabetes mellitus was present in 627 women (4.1%); 359 (0.7%) women had pre-existing or newly detected hypertension. There was a small number of women with pre-existing heart disease and/or rheumatic conditions. Most deliveries (86.0%) were normal vaginal; the remaining were Cesarean section 2,146 (14.0%). The incidence of venous thromboembolism was 0.4 per 1,000 pregnancies, of which 83.3% were deep vein thrombosis and 16.7% were pulmonary embolism. In contrast to previous studies, 66.7% of venous thrombosis occurred in the first trimester. CONCLUSION: Chinese women had a substantially lower risk of venous thromboembolism during pregnancy and the postpartum period compared to that of Caucasians. The occurrence of pregnancy-related venous thromboembolism was largely confined to the early pregnancy period, probably related to the adoption of thromboprophylaxis, a lower rate of Cesarean section, and early mobilization.
Subject(s)
Female , Humans , Pregnancy , Asian People , Cesarean Section , Cohort Studies , Diabetes Mellitus , Early Ambulation , Heart Diseases , Hong Kong , Hypertension , Incidence , Observational Study , Postpartum Period , Pregnancy Trimester, First , Pregnant Women , Pulmonary Embolism , Venous Thromboembolism , Venous ThrombosisABSTRACT
This prospective study was conducted to assess the rate of resolution of second trimester placenta previa in women with anterior placenta and posterior placenta,and that in women with and without previous cesarean section.In this study,placenta previa was defined as a placenta lying within 20 mm of the internal cervical os or overlapping it.We recruited 183 women diagnosed with previa between 20+0 weeks and 25+6 weeks.They were grouped according to their placenta location (anterior or posterior) and history of cesarean section.Comparative analysis was performed on demographic data,resolution rate of previa and pregnancy outcomes between anterior group and posterior group,and on those between cesarean section group and non-cesarean section group.Women with an anterior placenta tended to be advanced in parity (P=0.040) and have increased number of dilatation and curettage (P=0.044).The women in cesarean section group were significantly older (P=0.000) and had more parity (P=0.000),gravidity (P=0.000),and dilatation and curettage (P=0.048) than in non-cesarean section group.Resolution ofprevia at delivery occurred in 87.43％ women in this study.Women with a posterior placenta had a higher rate of resolution (P=0.030),while history of cesarean section made no difference.Gestational age at resolution was earlier in posterior group (P=0.002) and non-cesarean section group (P=0.008) than in anterior group and cesarean section group correspondingly.Placenta location and prior cesarean section did not influence obstetric outcomes and neonatal outcomes.This study indicates that it is more likely to have subsequent resolution of the previa when the placenta is posteriorly located for women who are diagnosed with placenta previa in the second trimester.
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Objective To investigate the clinical value , the motive regularity, the temporal and spatial correlation between myocardium and adjacent pericardium of left ventricular short -axis in normal adsults by using dual pulse wave Doppler echocardiography .Methods Tissue dual pulse spectral Doppler images about segmental myocardium and adjacent pericardial of three complete cardiac cycles in 99 normal adults were collected synchronously by using dual pulse wave Doppler techenology ,6 segments were enrolled in this study, including the anterior and posterior wall at mitral valve , papillary muscles, and apex level of left ventricular short-axis view.The motive regularity of myocardium and adjacent pericardium at different levels and segments were observed .Peak speed, onset time and peak time between myocardium and adjacent pericardium in anterior and posterior wall of three valves were measured online in systolic , early diastolic, and late diastolic, and the correlation between segmental myocardium and adjacent pericardium in speed and time were analyzed.Results Dual pulse wave Doppler echocardiography showed that in left ventricular short-axis view, motion between myocardium and adjacent pericardium in the same segment had consistent direction, motions between myocardium and adjacent pericardium in anterior and posterior wall at the same level had opposite directions .Comparison of peak velocity, in anterior wall, the peak velocities of myocardium in systolic and late diastolic at mitral valve level , and the peak velocity of myocardium in systolic at papillary muscle level were lower than that of adjacent pericardium .In posterior wall, the peak velocities of myocardium in early diastolic and late diastolic at mitral valve level , the peak velocities of myocardium in systolic and early diastolic at papillary muscle level , and the peak velocity of myocardium in early diastolic at apex level were higher than that of adjacent pericardium , with statistical significance (t=-4.207, -2.078, 4.575, -2.277, -2.440, -2.292, 5.980, 2.604, all P<0.05).Comparison of onset time, the onset time of myocardium in systolic at papillary muscle level in anterior wall , and the onset time of myocardium in early diastolic at mitral valve level in posterior wall were lower than that of adjacent pericardium, with statistical significance (t =-2.447, -2.020, both P<0.05).Comparison of peak time, except the peak time of myocardium in systolic and early diastolic at mitral valve level in posterior wall was lower than that of adjacent pericardium , the remaining differences were statistically significant ( t =-3.530, -2.411, both P<0.05).Peak velocity, onset times and peak times of each segment measured between myocardium and adjacent pericardium were well correlated (r =0.407 -0.933, all P <0.01). Conclusions Dual pulse wave Doppler echocardiography can provide relativity and accordance between motive velocity and direction of left ventricular myocardium and adjacent pericardium in normal adults .It is a promising new method for the clinical diagnosis of constrictive pericarditis and differentiation with restrictive cardiomyopathy.
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Objective To quantitatively analyze the coronary artery ostia by three-dimensional trans-esophageal echocardiography (3D-TEE).Methods The full-volume images of aortic root and coronary artery ostia were acquired by 3D-TEE in 95 adult patients.The Philips QLab 3DQ measurement technology was employed to determine three mutually perpendicular planes:(1) The transverse plane cross the bottom of three coronary artery sinus.(2) The sagittal plane perpendicular to sino-tubular junction.(3) The coronal plane perpendicular to the aforementioned two planes .The following relevant parameters were measured and recorded:(1) Length, width, height and area of bilateral coronary artery ostia .(2) The angle between coronary arterial outflow tract and aortic root in sagittal plane .(3) The spatial distribution of coronary artery ostia, aortic root and coronary artert sinus .Results The shape of left coronary artery ostia were more regular (round or oval) than right coronary artery ostia ( teardrop-shape or oval ).Calcification was more frequent in right coronary artery ostia (81/95, 85.26%) than that in left coronary artery ostia. There were statistical differences between left and right coronary artery in the parameters of ostial wide , area and height (t =3.85, 3.86, -4.49, all P<0.01).Most left coronary artery ostia were located inside the sinus (76/95, 80.00%), mainly in the upper third segment (69/95, 72.63%); while more than half of the right coronary artery ostia were found outside the sinus ( 53/95, 55.79%).The difference was statistically significant( χ2 =25.91, P<0.01).Conclusion The quantitative analysis of aortic root and coronary artery ostia based on the full-volume images originated from real-time 3D-TEE is feasible, which is helpful for further clinical research .
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Objective To evaluate the segmental myocardium of left ventricular wall in patients with myocardial hypertrophic cardiomyopathy (HCM) by TDI-Q, explore whether the segmental myocardium contractile function is changed or not and determine the myocardial mechanics parameters variation. Methods Thirty-two healthy volunteers and twenty-one patients with hypertrophic cardiomyopathy were included and the standard dynamic two-dimensional tissue Doppler imaging (TDI) of mitral, papillary muscle and apical short axis view were collected in three consecutive cardiac cycles. The mechanical parameters variation and characteristics of systolic radial peak displacement (RD) and time to peak in left ventricle subendocardial, mid-myocardium and epicardial myocardium at different level and segment were analyzed.Results In healthy control group, at left ventricular basal, apical and papillary muscle level, there was no significant difference for time to peak and systolic radial peak displacement (F=0.74, 1.28 and 1.79, all P>0.05). In patients with HCM, time to peak of systolic RD at left ventricular different level was asynchronous. Time to peak of RD in septum at papillary muscle levels and apical lateral wall were longer than those of other segments. In healthy control group, except for apical inferior and lateral wall, RD of subendocardial myocardium was significantly greater than that of epicardial myocardium at different segments (t=-1.903, 4.574,-3.552,-2.614,-1.728,-1.790,-1.836,-2.794 and 2.733, all P<0.05 ). In patients with HCM, RD of subendocardial myocardium was significantly greater than that of epicardial myocardium in posterior wall, septum at basal level and in inferior wall, posterior wall and lateral wall at papillary muscle level (t=-2.305,-2.148, 3.550,-1.182 and-3.602, all P < 0.05). At the same segment, transmural RD of subendocardial and subepicardial myocardium in healthy subjects were greater than that in patients with HCM. In inferior wall, posterior wall, lateral wall and septum at basal level, in inferior wall, posterior wall and septum at papillary muscle level, and in lateral wall and septum at apical level, differences of transmural RD were statistically significant (t=-3.787,-2.983,-4.325,-6.972,-2.352, 2.823,-3.274,-1.338 and-2.857, all P<0.05). Conclusions In patients with HCM, synchrony of left ventricular motion at different level was abnormal and transmural RD of endocardial and epicardial myocardium was decreased, which suggested regional systolic dysfunction. Ultrasound assessment of left ventricular segmental transmural mechanics can further reveal left ventricular mechanical characteristics in patients with hypertrophic cardiomyopathy.
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Objective To evaluate left ventricular function in patients with hypertensive hypertrophic cardiomyopathy(HHC)using real-time 3-dimensional echocardiography(RT-3DE).Methods Thirty patients with HHC and 32 control subjects were studied.Full-volume RT-3DE data from apical window were acquired,and regional volumetric time curves of 17 segments were obtained by fast 3-dimensional border detection software.Several left ventricular function parameters were calculated semiautomatically,including global left ventricular end-diastolic volume(EDV),end-systolic volume(ESV),left ventricular ejection fraction(LVEF),the ratio of ESV/EDV of 17 segments,the standard deviation(SD)and difference(Dif)(adjusted by the R-R interval) of time to minimum systolic volume(Tmsv)in 16 segments(Tmsv16-SD and Tmsv16-Dif).Results EDV and ESV were significantly larger in patients with HHC than that in control subjects[(88±29)ml vs (72±15) ml,t=-2.680,P=0.008;(28±10)ml vs (22±6 )ml,t=-2.613,P=0.01].HHC had a higher ratio of ESV/EDV at interventricular septum(IVS)compared with control group[mid-segments of anterior IVS:(40.51±20.28)% vs (26.43±10.10)%,t=-3.378,P=0.002;mid-segments of posterior IVS:(41.44±23.55)% vs (24.46±8.12)%,t=-3.688,P=0.001;apical segments of IVS:(30.96±21.31)% vs (19.53±7.33)%,t=-2.745,P=0.01].In patients with HHC,Tmsv16-SD and Tmsv16-Dif were significantly longer[(2.48±1.38)% vs (1.16±0.26)%,t=-5.117,P＜0.001;(7.67±5.07)% vs (3.95±1.48)%,t=-3.865,P＜0.001].And the prevalence of left ventricular dyssynchrony was higher than that in control subjects(43% vs 3%).Conclusions HHC patients may have regional left ventricular systolic dysfunction before global changes,and have a higher prevalence of left ventricular dyssynchrony.RT-3DE is a useful imaging modality for assessing left ventricular systolic function.
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<p><b>OBJECTIVE</b>To demonstrate the abnormal intima rotation pattern of the carotid atherosclerosis plaque using velocity vector imaging, and to develop a new method for the clinical mechanical state assessment of the plaque intima.</p><p><b>METHODS</b>The rotation movement and rotation angle on the serial dynamic ultrasonic short-axis gray scale views of 48 isolated atherosclerosis plaques (i. e., upstream, midstream, and downstream) and nearby reference segments of carotid artery in 46 patients were derived and analyzed using a dedicated velocity vector imaging workstation. The incidence of intima rotation movement and the rotation angle at different sections of the plaque and nearby reference segments before and after the standard grip stress test during systole and diastole respectively were counted and measured.</p><p><b>RESULTS</b>Before and after the stress test, the intima rotation movement occurred at the majority of the short-axis sections of the plaque and the nearby reference segments during cardiac cycle. Before the stress test, the incidence of intima rotation movement at the upstream section of the plaque during systole was significantly higher than that of reference segment (P = 0.036) The reversal direction of the intima rotation at those sections and reference segment during systole and diastole was demonstrated. After the stress test, the incidence of intima rotation movement at the midstream section of the plaque during diastole was significantly lower than that of reference segment (P = 0.031). The incidence of the intima rotation movement changed at the sections of upstream, midstream, and downstream of the plaque before and after the stress test also were explored (i. e., increased in systole and decreased in diastole) except the reference segment intima.</p><p><b>CONCLUSIONS</b>The intima rotation movement occurs at the majority of the isolated plaque and nearby reference segment, and the incidences of the intima rotation movement at the plaque is different from that of the reference segment during systole and diastole respectively. The abnormal pattern of intima rotation movement may be used to indicate the unstable mechanical state of the isolated plaque intima.</p>