Risk Association of the Development of Disseminated Intravascular Coagulation (DIC) in Obstetrical Cases

Background: Disseminated intravascular coagulation (DIC) is a syndrome that can be initiated by a myriad of medical, surgical, and obstetric disorders. Also known as consumptive coagulopathy, DIC is a common contributor to maternal morbidity and mortality and is associated with up to 25% of maternal deaths.Aim of the study: To determine the risk factors associated with the development of disseminated intravascular coagulation (DIC) in obstetrical cases.Material & Methods:This descriptive type of study was carried out in the Department of Obstetrics and Gynecology of Janaki Medical College Teaching Hospital, RamdaiyaBhawadi, Janakpurdham, Nepal from January 2016 to December 2021. A total of 500 pregnant women complicated with DIC admitted for termination of pregnancy were included in this study. History and clinical examination were completed. The adverse obstetrical event that causes DIC is identified from clinical diagnosis and relevant investigations. Statistical analysis of the results was obtained by using windows computer software with Statistical Packages for Social Sciences (SPSS-version 26).Results:More than half (58.0%) of the patients did not receive any antenatal checkup. Regarding the risk factors for the development of DIC; abruptio placenta was associated with 185(37.0%) cases followed by PPH 147(29.4%) and preeclampsia and eclampsia 119(23.8%). Patients with risk factors of DIC were hypertension 360(72.0%), Antepartum heamorrhage 227(45.4%) and PPH 193(38.6%) these are the most common presenting features. More than two-thirds of the patients (68.0%) had spontaneous vaginal delivery. Almost two-thirds (64.0%) of patients stayed in the hospital for 8-14 days. Maternal death was found in 60(12.0%) cases and perinatal death in 121(24.2%) cases.Conclusion:Maternal and perinatal mortality in patients with DIC were 12.0% and 24.0% respectively. The major determinant of survival is prompt identification of the underlying trigger, elimination of the cause and appropriate management.

Medical treatment in pregnant women with subclinical hypothyroidism: systematic review and meta-analysis / Tratamiento médico en gestantes con hipotiroidismo subclínico: revisión sistemática y meta-análisis

Abstract Objectives: to determine the effectiveness of medical therapy in reducing complications associated with subclinical hypothyroidism during pregnancy. Methods: in 2021, a systematic review of available cohort studies was carried out in three databases, with no publication date limit. Study selection and data extraction were performed in duplicate. Random-effects meta-analysis was performed, and odds ratios were calculated, with the corresponding 95% confidence intervals. Cohort risk of bias was assessed using the Newcastle-Ottawa Scale (NOS). The certainty of the evidence was assessed using the GRADE methodology. Results: five studies were included for qualitative and quantitative synthesis. A statistically significant relationship was found between medical treatment in pregnant women with subclinical hypothyroidism with respect to spontaneous abortion (p=0.03; OR=0.77; CI95%=0.61-0.97), and no statistically significant relationship was found for delivery preterm (p=0.46; OR=1.11; CI95%=0.85-1.44), nor for abrupt placentae (p=0.56; OR=1.60; CI95%=0.33-7.66). Three studies were at moderate risk of bias, and two were at low risk of bias. In all the results the certainty was very low. Conclusions: medical treatment of subclinical hypothyroidism during pregnancy can have a beneficial effect in reducing cases of spontaneous abortion.

Resumo Objetivos: determinar la efectividad de la terapia médica para disminuir las complicaciones asociadas al hipotiroidismo subclínico durante la gestación. Métodos: en el 2021 se realizó una revisión sistemática de estudios de cohortes disponibles en tres bases de datos, sin límite de fecha de publicación. La selección de estudios y extracción de datos se realizaron por duplicado. Se realizó metaanálisis de efectos aleatorios y se calcularon los Odds ratio, con los correspondientes intervalos de confanza al 95%. El riesgo de sesgo de las cohortes se evaluó mediante la escala de Newcastle-Ottawa (NOS). La certeza de la evidencia se evaluó con la metodología GRADE. Resultados: cinco estudios fueron incluidos para síntesis cualitativa y cuantitativa. Se encontró una relación estadísticamente significativa del tratamiento médico en gestantes con hipotiroidismo subclínico con respecto al aborto espontáneo (p=0,03; OR=0,77; IC95%=0,61-0.97), no se encontró relación estadísticamente significativa para parto pre término (p=0.46; OR=1,11; IC95%=0.85-1.44), ni para abrupto placentae (p=0.56; OR=1,60; IC95%=0.33-7.66). Tres estudios tenían riesgo moderado de sesgo, y dos tenían riesgo de sesgo bajo. En todos los resultados la certeza fue muy baja. Conclusiones: el tratamiento médico del hipotiroidismo subclínico durante la gestación puede tener un efecto beneficioso para reducir los casos de aborto espontaneo.

Study Of Maternal And Perinatal Outcome In Patients With Abruption Placenta

Background:Abruptionplacenta is one of a serious obstetrics emergency. It is defined as partial or complete separation of normally implanted placenta after 28 weeks of gestation, prior to delivery of the fetus. Placental abruption complicates about 1% of pregnancies and is aleading cause of vaginal bleeding in the latter half of pregnancy.1 AIMS:To study maternal outcome in patients with abruption placenta. To study perinatal out come in patients with abruption placenta. Material And Methods:A prospective observational study was carried out at tertiary hospital for 6 months from September 2019 to February 2020. 30 cases of abruption placenta were enrolled in this study. Results:Maximum patients (56.6%) were from 26 –30 year age group. (63.3%) were having second gravida. Maximum (56.6%) patients admitted were between 33 –36 week gestational age group. Most of (60%) patients were having revealed type of bleeding. (52.3%) patients were having grade 2. Major maternal morbidities were PPH (36.6%), severe shock (23.3%) and DIC (6.6).(26.6%) babies had birth asphyxia, (16.6%) developed ARDS. Sepsis and ICH was seen in (10%) each whereas necrotizing enterocolitis and stillbirth was found in (13.3%). Perinatal death was seen in (6.6%). Conclusion:Abruption placenta is associatedwith poor maternal and fetal outcome. Early diagnosis and prompt resuscitative measures are essential to prevent both perinal and maternal morbidity and mortality.

Placental abruption an obstetric emergency: management and outcomes in 180 cases

Background: During a period of eight months, 180 cases of abruption that occurred from January 2007 to August 2007 at GMH, Nayapool, Hyderabad were analysed. Total number of deliveries during the study period of eight months were 14004. Incidence of abruption cases delivered was - 1.3%. In this series 88% were unbooked in our hospital, were referrals. Objective of this study was to study maternal fetal outcome of placental abruption.Methods: Initial clinical assessment, investigations for maternal fetal wellbeing, expedite delivery, manage complications as per accepted protocol. In this series of cases, ARM was done in 85 cases (47.22%), ARM was done and oxytocin drip was started in 36 (20%), ARM was done and PGE1 tablet 25 mcg. was inserted in the vagina in 39 (21.66%).Results: The bleeding was revealed in 146-81.1% and concealed in 34-18.88%. The number of cases with hypertension complicating pregnancy were 102-57%, hypotension in 16-8.88%, prolonged clotting time 13-7.22%, the number of patients who received blood transfusions were 105 (58.3%), number of patients who received fresh frozen plasma, FFP transfusions were 65-36.11%. Taken for LSCS at admission were - 46. Failure to progress after ARM or other methods of labour augmentation were 20 cases. The total number of caesarean deliveries were 66/180 - (36.66%), number of vaginal deliveries were 114 (63.33%). Perinatal outcome: the total number of intra uterine fetal deaths (IUFD) at admission were 103-57.2%. The number of still births were 7-3.8%. Live born babies were 70- 38.8%. Neonatal deaths were 11-6.1% and total perinatal deaths were 121-67.2%. (IUFD at admission-103, + still births - 7, + neonatal deaths - 11=121 perinatal deaths. There were five maternal deaths in 180 cases of placental abruption, 2.7% mortality.Conclusions: Need to consider measures to reduce the occurrence of this condition.

Management of disseminated intravascular coagulation associated with placental abruption and measures to improve outcomes

Placental abruption is a condition that should be carefully considered in perinatal management because it is associated with serious events in both the mother and neonate, such as intrauterine fetal death, cerebral palsy, obstetric critical bleeding, and uncontrollable bleeding. The concomitant presence of disseminated intravascular coagulation (DIC) more easily causes critical bleeding that may necessitate hysterectomy or multi-organ failure resulting in maternal death. Therefore, early management should be provided to prevent progression to serious conditions by performing both hemostatic procedures and DIC treatment. To take measures to improve the outcomes in both the mother and neonate, health guidance for pregnant women, early diagnosis, early treatment, development of the emergency care system, and provision of a system for transport to higher-level medical institutions should be implemented.

Morbilidad y mortalidad a largo plazo en mujeres con antecedente de desprendimiento prematuro de placenta normoinserta / Long-term morbidity and mortality in women with a history of premature placental abruption normoinserta

Resumen OBJETIVOS: Analizar las consecuencias a largo plazo del desprendimiento prematuro de placenta normoinserta, principalmente la incidencia de enfermedad cardiovascular y secundariamente otras causas de morbilidad y mortalidad (diabetes, neoplasias o trastornos psiquiátricos). MATERIALES Y MÉTODOS: Estudio de casos y controles, con recolección retrospectiva de datos de pacientes embarazadas que acudieron al Complexo Hospitalario Universitario de Ourense entre 1996 y 2008. El criterio de inclusión en el grupo casos fue el antecedente de desprendimiento prematuro de placenta normoinserta. El grupo control lo integraron pacientes con parto anterior y posterior al grupo de casos y que no habían sufrido desprendimiento de placenta. Las historias clínicas se analizaron mediante la recolección de datos de la "gestación índice" y se realizó el seguimiento a largo plazo para establecer el diagnóstico de hipertensión arterial, diabetes mellitus, enfermedad cardiovascular, neoplasias o alteraciones psiquiátricas. Para el análisis estadístico se requirió el programa SPSS15.0. Se consideró estadísticamente significativo el valor de p < 0.05. RESULTADOS: Se estudiaron 198 mujeres: 66 en el grupo de casos y 132 en el grupo control. Durante el seguimiento (15.8 ± 3.58 años), la incidencia de diabetes mellitus y dislipidemia fue mayor en el grupo de casos, pero sin significación estadística. No se encontraron diferencias en la incidencia de hipertensión arterial, síndrome metabólico, enfermedad cardiovascular ni trastorno ansioso-depresivo. En el grupo de casos se encontró una alta tasa de enfermedad neoplásica. CONCLUSIONES: No existe relación entre desprendimiento prematuro de placenta y enfermedad cardiovascular. Se carece de una explicación que justifique la alta tasa de patología tumoral en este grupo de pacientes.

Abstract OBJECTIVE: To analyze if women with a history of premature placental abruption have a long-term increase in morbidity and mortality. MATERIALS AND METHODS: Case-control study with retrospective data collection of pregnant women from the Hospital University Complex of Ourense between 1996 and 2008. The criteria for inclusion in the case group were the history of placental abruption. The control group was constituted by the women with previous and subsequent delivery to the case group and who had not presented placental abruption. The clinical histories were analyzed with data collection of the index pregnancy and a long-term follow-up was carried out to detect the subsequent diagnosis of arterial hypertension, diabetes mellitus, cardiovascular disease, as well as neoplastic and psychiatric pathology. The statistical study was carried out using the SPSS15.0 computer program. Values of p < 0,05 were considered significant results. RESULTS: A total of 198 women were studied, of which 66 belong to the case group and 132 to the control group. In the follow-up period (15,8±3,58 years) the incidence of diabetes mellitus and dyslipidemia was higher in the case group, but without statistical significance. No differences were found in the incidence of hypertension, metabolic syndrome, cardiovascular disease or anxiety-depressive illness. In the case group, a high rate of oncological pathology was found. CONCLUSIONS: We found no relationship between the history of placental abruption and cardiovascular disease. We lack an explanation that justifies the high rate of tumor pathology in this group of women.

Hemostatic function change during pregnancy of women with placental abruption and its application for predicting postpartum hemorrhage / 临床检验杂志

Objective@#To investigate whether the changes of hemostatic system in pregnant women with placental abruption are different from the pattern of the pregnant women without complications, and the tests of hemostatic function before labor are helpful for prediction and estimation of postpartum hemorrhage. @*Methods@#The pregnant women diagnosed with placental abruption who delivered at Peking University Third Hospital from December 1st, 2013 to December 1st, 2018 were enrolled. The normal pregnant women with matched age and gestational weeks and the women complicated with gestational diabetes mellitus (GDM) were also involved in our study as controls. Their medical records, pregnancy outcomes and all the results of hemostatic tests were completely collected and analysed. @*Results@#A total of 152 pregnant women with placental abruption, 268 normal pregnant women and 101 pregnant women with gestational diabetes mellitus were included. The hemostatic system in uncomplicated women and the women with GDM shared a similar course of changes, during which time PT, APTT and TT dropped, while Fib (fibrinogen), FDP and DD grew with increasing gestational weeks. However, in the women with placental abruption, Fib(g/L) presented downward trend in the second trimester and were significantly lower than the uncomplicated women at the same pregnancy period (4.11±0.17 vs 4.35±0.07, P=0.011). The Fib（g/L） levels in the women at delivery with placental abruption, whether complicated with GDM or not, showed significant difference between the women with and without postpartum hemorrhage (3.41±1.29 vs 4.30±0.94, P=0.001). According to the receiver operating charctistic curve, the area under the curve of Fib was 0.703 (95% confidence interval: 0.596-0.810) with cutoff value of 4.00 g/L and negative predictive value of 0.883. @*Conclusions@#The fibrinogen level in pregnant women with placental abruption did not increase with gestational weeks as it was in uncomplicated women and the women with GDM. Fib level at the time of delivery may contribute to predict the occurrence of postpartum hemorrhage in the women with placental abruption.

Epidemiological characteristics and related risk factors on placental abruption in Hebei province / 中华流行病学杂志

Objective The aim of this study was to assess the risk factors and epidemiological characteristics of placental abruption (PA) in Hebei province.Methods A cross-sectional survey was conducted to collect data on 218 880 pregnant women who were hospitalized in 22 hospitals which were under a monitoring program,in Hebei province,from January 1,2013 to December 31,2016.Data regarding epidemiological characteristics as time distribution,population distribution and related risk factors of placental abruption were gathered and analyzed.Results In this cohort study,218 880 women were included,with 669 (0.31％) of the pregnant women having PA.The overall prevalence rates were higher in the South than in the north parts of the area and higher in more developed regional economic centers.The average age of women having the episode was (27.87 ± 4.50) years and presented “J” distribution on the prevalence of maternal age.Results from the multivariate regression analysis showed that the following factors were independently at risk for placental abruption:pregnancy the including hypertension (OR=1.65,95％CI:1.09-2.50),mild preeclampsia (OR=3.65,95％CI:2.40-5.56),severe preeclampsia (OR=4.72,95％CI:3.86-5.76) and anemia (OR=2.41,95％CI:2.05-2.83) which were all increased in pregnant women with PA compared with the normal female population without placental abruption.Conclusions Placental abruption seemed to be associated with a moderate increasing risk of age,and was seen higher in those population older than 35 or younger than 20 year-olds.It was suggested that appropriate inoculation programs should be taken in different regions,especially on high-risk groups.Health education on related disease was of great significance for improving the prenatal outcome.

Epidemiological characteristics and related risk factors on placental abruption in Hebei province / 中华流行病学杂志

Objective The aim of this study was to assess the risk factors and epidemiological characteristics of placental abruption (PA) in Hebei province.Methods A cross-sectional survey was conducted to collect data on 218 880 pregnant women who were hospitalized in 22 hospitals which were under a monitoring program,in Hebei province,from January 1,2013 to December 31,2016.Data regarding epidemiological characteristics as time distribution,population distribution and related risk factors of placental abruption were gathered and analyzed.Results In this cohort study,218 880 women were included,with 669 (0.31％) of the pregnant women having PA.The overall prevalence rates were higher in the South than in the north parts of the area and higher in more developed regional economic centers.The average age of women having the episode was (27.87 ± 4.50) years and presented “J” distribution on the prevalence of maternal age.Results from the multivariate regression analysis showed that the following factors were independently at risk for placental abruption:pregnancy the including hypertension (OR=1.65,95％CI:1.09-2.50),mild preeclampsia (OR=3.65,95％CI:2.40-5.56),severe preeclampsia (OR=4.72,95％CI:3.86-5.76) and anemia (OR=2.41,95％CI:2.05-2.83) which were all increased in pregnant women with PA compared with the normal female population without placental abruption.Conclusions Placental abruption seemed to be associated with a moderate increasing risk of age,and was seen higher in those population older than 35 or younger than 20 year-olds.It was suggested that appropriate inoculation programs should be taken in different regions,especially on high-risk groups.Health education on related disease was of great significance for improving the prenatal outcome.

Analysis of misssed diagnosis and misdiagnosis of 1212 cases with placental abruption / 中华妇产科杂志

Objective To investigate the risk factors and clinical manifestations of placental abruption, and to analyze the causes of missed diagnosis and misdiagnosis. Methods A retrospective analysis was conducted in 135584 women who delivered in Women′s Hospital, School of Medicine, Zhejiang University from January 2005 to December 2015. The diagnosis of placental abruption was made in 1212 cases. According to the consistency of prenatal and postnatal diagnosis, they were divided into 3 groups.(1) The diagnosis was consistent prenatally and postnatally in 715 cases(58.99%,715/1212) as the diagnosis group.(2)In 312 cases (25.74%,312/1212), the diagnosis was made after birth as the missed diagnosis group.(3)In 185 cases (15.26%,185/1212), the diagnosis was made prenatally but excluded after birth as the misdiagnosis group. The disease classification was made, and the risk factors, clinical manifestations, lab results, the time of termination and perinatal outcomes were recorded in the 3 groups. The reasons of missed diagnosis and misdiagnosis were analyzed. Results (1) In the 1212 cases, the diagnosis of placental abruption was confirmed in 1027 cases, with the incidence of 0.76%(1027/135584). The rate of missed diagnosis was 30.38%(312/1027), and the rate of misdiagnosis was 0.14%(185/134557). (2) There were significant differences in the degree of placental abruption among the 3 groups (P＜0.05). (3)Significant differences were found among the 3 groups regarding the ratio of hypertensive disorders, trauma, induced labor and advanced maternal age (all P＜0.05). (4) There were statistically significant differences among the 3 groups regarding the incidence of vaginal bleeding, persistent abdominal pain and uterine tenderness, bloody amniotic fluid, increased uterine tension and stillbirth (all P＜0.05). (5) There was no significant difference in the rate of abnormal fetal heart rate mornitoring among the 3 groups (P=0.22). The differences were statistically significant among the 3 groups when regarding the incidence of abnormal ultrasound finding and abnormal blood coagulation (P＜0.01), with the highest incidence of abnormal ultrasound in the diagnosis group (68.1%) and the highest incidence of abnormal coagulation in the misdiagnosis group (24.9%). (6)There was statistically significant difference among the 3 groups when comparing the ratio of termination of pregnancy within 24 hours (P=0.01). (7) There were statistically significant differences among the 3 groups when the ratios of postpartum hemorrhage, DIC, neonatal asphyxia and perinatal death were compared (all P＜0.05). The highest incidence of postpartum hemorrhage was in the diagnosis group (17.9%) and the lowest was in the misdiagnosis group (5.4%). The highest incidence of DIC was in the diagnosis group (3.9%) and the lowest was in the misdiagnosis group (0). The highest incidence of neonatal asphyxia was in the diagnosis group (30.6%) and the lowest was in the misdiagnosis group (7.6%). And for perinatal death, the highest incidence was in the diagnosis group (12.6%), the lowest was in the misdiagnosis group (2.2%). Conclusions Placental abruption could be misdiagnosed when depending on risk factors, such as trauma. And it could be missed diagnosis during the induction of labor. Uterine contraction, abnormal fetal heart rate mornitoring, abnormal ultrasound and abnormal coagulation function are important in the diagnosis of placental abruption.

Couvelaire uterus – A case report.

“Couvelaire uterus” or “Utero-placental apoplexy” is a rare complication of severe forms of placental abruption. It occurs when vascular damage within the placenta causes hemorrhage that progresses to and infiltrates the wall of the uterus. We presented here rare case of 23 years old female with Couvelaire uterus.

RETROSPECTIVE STUDY OF 2014 PRENATAL MORTALITY DATA OF THE FIRST MATERNITY HOSPITAL OF ULAANBAATAR CITY / Шинэ санаа Шинэ нээлт

In the framework of the implementation of MDGs, Mongolian government aimed to decrease neonatal mortality by one third in 2015 in comparison with 2000. Rapid urbanization could be seen from the number of pregnancies delivered their babies at Urguu Maternal Hospital. We analyzed the 2014 prenatal mortality data by fetal growth and obstetric complications to find common risk factors for stillbirth and neonatal mortality.We retrospectively analyzed the prenatal mortality data of the Urguu Maternity hospital of Ulaanbaatar city in 2014.In 2014, from 16002 mothers delivered their babies at Urguu Maternity hospital had been registered 74 cases of the stillbirths which are equal to 0.46% and 51 cases of neonatal mortality which is 3.1%. In 2014, 21.6% (16 cases) of the stillbirths are happened for nulliparous women, which support their higher risk of stillbirths than multiparous women across all ages. Their mean age were 29.7, among them youngest is 18, and oldest is 32 years old. Also, 29 cases or 39% of the mothers had fourth and subsequent pregnancies and 17 /23%/ had their fourth and more babies. Regarding the baby sex, 42 cases /56.8%/ of babies were female, 2 case / 2.7%/ haven’t specified in the patient history. 17 had very low birth weight (<1500g), among them 8 were in their less than 30 gestational weeks, including one case of twins, 6 cases were in their 31-35 weeks, 2 including one twin cases were in their 36-41 gestational weeks. According the patient history, main obstetric challenges were 2 were caused by placental abruption, pre-eclampsia caused 3, premature rupture of membranes caused 3 and hemorrhage shock caused 1 case. Among the 21 cases with fetal weight between 1500-2500 g, 11 were in their 30-35, 3 were 36-37 gestational weeks and 6 were full term pregnancies with 37-41 gestational weeks. In one case haven’t identified the fetal sex. Obstetric complications were placental abruption in 7, among them 2 had serious late complications, congenital abnormalities in 2, intra- uterine growth restriction in 1, and 1 case of hemorrhage were identified. In the 34 cases with fetal weight above 2550 g, 12 cases had less than 38 gestational weeks, 16 were 38-40 weeks, and 6 were above 40 weeks age. Among them, 2 cases of twins, 1 case had congenital anomalies, 1 case haven’t received any prenatal services, and 1 case had unattended birth in home. Regarding the obstetric complications, placental abruption 3, uterine scar and placental insufficiency 1, weak contractions 1 case was documented. 3 cases from all 74 were delivered their babies in home, unattended births. Among 51 neonatal death cases, 26 or 51% were female. By classifying maternal age, 15 or 29.4% were nulliparous, from which 1/3 or 5 cases had abortions, previously. Also, 7 or 13.7% were delivered four or more babies, which increased their risks.Regarding the neonatal babies weight, 9 cases had less than 1500 g, with 8 were haven’t reached the 30 gestational weeks. 17 cases with 1500-2500 g weight, 11 were less than 34 weeks and 6 were 34- 38 weeks. For rest 25 cases, 10 were had above 3500 g weight. 94% / 48/ cases of neonatal deaths were happened in their first week. Reasons documented in the patient history were premature birth 7, natural normal birth 2 cases, spontaneous or ectopic birth 6, with 1 case of weak contraction during the labor. Common documented obstetric complications were premature rupture of membranes 9, oligohydramnios 1, polyhydramnios 1, placental abruption 6, placenta praevia 4, late pregnancy complications 12, fetal hypoxia 5, among them 3 were had emergency C-section and with chronic health conditions were in 6 cases. In 2010, there were 9163 mothers delivered 9200 live births, which in 2014 become 16002 mothers delivered 16107 live births at Urguu Maternity hospital. Neonatal morbidity also decreased 8.6%/795 cases/ in 2010 to the 4% /649 cases/ in 2014. Neonatal mortality was 4.8% /45 cases/ in 2010 and in 2014 counted as 3.1% /51/ at our hospital, from which premature infant mortality were 49% reduced as 39%, showed health care service quality improvement at Urguu maternity hospital. Stillbirth cases decreased from 0.5% /49 cases/ in 2010 to 0.4% /74 cases / in 2014. Single largest risk factor is unrecognized fetal growth restriction which was cause for 34.2% of the all stillbirths’ cases in 2014.

Analysis of 124 cases of placental abruption and its early diagnosis / 重庆医学

Objective To analyze the clinical manifestations of placental abruption ,and try to provide evidence‐based data for early diagnosis .Methods Retrospective cases of placental abruption from January 2008 to March 2014 were analyzed ,the clinical characteristics ,etiological factor and outcomes were compared .Results There were 58 cases in Ⅰ degree ,45 cases in Ⅱ degree and 21 cases in Ⅲ degree .The incidence of PIH in Ⅰ degree group was significantly lower than that in Ⅱ degree group ,the incidence of PROM in Ⅰ degree group was significantly higher than that in Ⅱ and Ⅲ degree groups(P< 0 .05) .The main symptoms of Ⅰ degree group were vaginal bleeding .The main performances of Ⅱ and Ⅲ degree group were abdominal pain with or without vaginal bleed‐ing .The cesarean section rate of Ⅰ degree group was significantly lower than that of Ⅲ degree group ,and the rate of maternal‐fetal adverse outcomes was statistically lower than Ⅱ and Ⅲ degree groups (P< 0 .05) .Conclusion It is helpful for early diagnosis of placental abruption and improving prognosis by regular prenatal care ,analyzing and combining with history or risk factors ,ultra‐sound ,physical examination ,and paying attention to clinical performance like abdominal pain and vaginal bleeding ,as well as impro‐ving the ability to identify the abnormal FHR .

RETROSPECTIVE STUDY OF 2014 PRENATAL MORTALITY DATA OF THE FIRST MATERNITY HOSPITAL OF ULAANBAATAR CITY / Шинэ санаа Шинэ нээлт

In the framework of the implementation of MDGs, Mongolian government aimed to decrease neonatal mortality by one third in 2015 in comparison with 2000. Rapid urbanization could be seen from the number of pregnancies delivered their babies at Urguu Maternal Hospital. We analyzed the 2014 prenatal mortality data by fetal growth and obstetric complications to find common risk factors for stillbirth and neonatal mortality.We retrospectively analyzed the prenatal mortality data of the Urguu Maternity hospital of Ulaanbaatar city in 2014.In 2014, from 16002 mothers delivered their babies at Urguu Maternity hospital had been registered 74 cases of the stillbirths which are equal to 0.46% and 51 cases of neonatal mortality which is 3.1%. In 2014, 21.6% (16 cases) of the stillbirths are happened for nulliparous women, which support their higher risk of stillbirths than multiparous women across all ages. Their mean age were 29.7, among them youngest is 18, and oldest is 32 years old. Also, 29 cases or 39% of the mothers had fourth and subsequent pregnancies and 17 /23%/ had their fourth and more babies. Regarding the baby sex, 42 cases /56.8%/ of babies were female, 2 case / 2.7%/ haven’t specified in the patient history. 17 had very low birth weight (<1500g), among them 8 were in their less than 30 gestational weeks, including one case of twins, 6 cases were in their 31-35 weeks, 2 including one twin cases were in their 36-41 gestational weeks. According the patient history, main obstetric challenges were 2 were caused by placental abruption, pre-eclampsia caused 3, premature rupture of membranes caused 3 and hemorrhage shock caused 1 case. Among the 21 cases with fetal weight between 1500-2500 g, 11 were in their 30-35, 3 were 36-37 gestational weeks and 6 were full term pregnancies with 37-41 gestational weeks. In one case haven’t identified the fetal sex. Obstetric complications were placental abruption in 7, among them 2 had serious late complications, congenital abnormalities in 2, intra- uterine growth restriction in 1, and 1 case of hemorrhage were identified. In the 34 cases with fetal weight above 2550 g, 12 cases had less than 38 gestational weeks, 16 were 38-40 weeks, and 6 were above 40 weeks age. Among them, 2 cases of twins, 1 case had congenital anomalies, 1 case haven’t received any prenatal services, and 1 case had unattended birth in home. Regarding the obstetric complications, placental abruption 3, uterine scar and placental insufficiency 1, weak contractions 1 case was documented. 3 cases from all 74 were delivered their babies in home, unattended births. Among 51 neonatal death cases, 26 or 51% were female. By classifying maternal age, 15 or 29.4% were nulliparous, from which 1/3 or 5 cases had abortions, previously. Also, 7 or 13.7% were delivered four or more babies, which increased their risks. Regarding the neonatal babies weight, 9 cases had less than 1500 g, with 8 were haven’t reached the 30 gestational weeks. 17 cases with 1500-2500 g weight, 11 were less than 34 weeks and 6 were 34- 38 weeks. For rest 25 cases, 10 were had above 3500 g weight. 94% / 48/ cases of neonatal deaths were happened in their first week. Reasons documented in the patient history were premature birth 7, natural normal birth 2 cases, spontaneous or ectopic birth 6, with 1 case of weak contraction during the labor. Common documented obstetric complications were premature rupture of membranes 9, oligohydramnios 1, polyhydramnios 1, placental abruption 6, placenta praevia 4, late pregnancy complications 12, fetal hypoxia 5, among them 3 were had emergency C-section and with chronic health conditions were in 6 cases. In 2010, there were 9163 mothers delivered 9200 live births, which in 2014 become 16002 mothers delivered 16107 live births at Urguu Maternity hospital. Neonatal morbidity also decreased 8.6% /795 cases/ in 2010 to the 4% /649 cases/ in 2014. Neonatal mortality was 4.8% /45 cases/ in 2010 and in 2014 counted as 3.1% /51/ at our hospital, from which premature infant mortality were 49% reduced as 39%, showed health care service quality improvement at Urguu maternity hospital. Stillbirth cases decreased from 0.5% /49 cases/ in 2010 to 0.4% /74 cases / in 2014. Single largest risk factor is unrecognized fetal growth restriction which was cause for 34.2% of the all stillbirths’ cases in 2014.

The clinical characteristics and coagulation parameters of the infants with placental abruption / 重庆医学

Objective To analyze the clinical characteristics and coagulation parameters of the infants with placental abruption . Methods Analysis was made on clinical and laboratory indexes of the hospitalized children of the NICU of Bayi Clinical Medical College of South Medical University ,enrolled from August 2012 to January 2013 ,including 60 infants with placental abruption as observation group and 60 infants without placental abruption as the control group .Results From clinical manifestations and lab date ,significant differences were found in gestational age ,polyembryony ,premature rupture of membrane ,birth weight ,intrauterine growth retardation ,motherhood gestational hypertension ,mother gestational diabetes mellitus ,asphyxia ,APTT ,D-dimer on admis-sion between the observation group and control group (P<0 .05) .Conclusion Placental abruption is the result of placental insuffi-ciency ,which may cause coagulation disorder and thus show the pathological state of high condensation in infants .

Etiological and Clinical Analysis of 45 Cases of Placental Abruption / 昆明医科大学学报

Objective To analyze the risk factors and clinical characteristic of placental abruption. Methods We retrospectively analyzed the medical documents of 45 patients treated in the first affiliated hospital of Kunming medical university during 2010 to 2012. All mild placental abruption patients and severe placental abruption patients were used to analyze the high risk factors and outcomes of pregnancy. Results The incidence of placental abruption was 0.41%. Seventeen severe placental abruption patients and 28 mild placental abruption cases were included in this study. The incidence of uteroplacental apoplexy and perinatal infant outcomes were significant diferenct between two groups (P≤0.023) .The high risk factors were hypertensive disorders in pregnancy, premature rupture of membranes,complicated with other diseases in pregnancy, and so on. About 22.2%placental abruption couldn't be explained by any reasons. Conclusions Severe placental abruption can occur in pregnant women with no high risk factors and cause bad pregnant outcomes. To improve the skills of medical personnel is the powerful measure in placental abruption treatment.

The effect of tissue factor gene silencing on human umbilical vein endothelial cell with placental abruption / 中国小儿急救医学

Objective To silence the expression of tissue factor(TF) gene of human umbilical vein endothelial cell(HUVECs) of the newborns with placental abruption(PA) and normal newborns.Methods There were two groups in the experiment,normal group and PA group.Three different treatments were established in each group:(1) the blank; (2) the false-intervention ; (3) the TF gene silencing.There were three samples in each treatments.After these treatments,the changes of mRNA expression of the HUVECs were observed before and aftcr thc gene silencing and the changes of the immunofluorescence of the TF protein level.Results After amplificated,plasmid DNA were sequenced to show that the pENTRTM/U6-TF-shRNA was the positive clone.After the transfected,the levels of the mRNA of TF decreased from 0.657 ± 0.097 to 0.220 ± 0.030 and 1.323 ± 0.323 to 0.207 ± 0.150 in the normal and PA group respectively.Compared with the normal group,there were significant differences for the levels of TF mRNA in PA group with the blank,(1.323 ± 0.323 vs 0.657 ± 0.097,P =0.023) and the same result for the second management (1.057 ±0.178 vs 0.540 ± 0.079,P =0.01).But there was no significant difference between the normal and PA group after RNA interference gene silencing (0.220 ± 0.030 vs 0.207 ± 0.150,P ＞ 0.05).Meanwhile,there were significant differences among the three managements in the themselves groups of normal and pathological ones(F =19.30,P =0.002 ;F =27.66,P =0.001).Conclusion The vectors are transfected into HUVECs and play the biological function.And they silence the expression of TF mRNA.PENTRTM/U6-TF-shRNA could inhibit the expression of TF mRNA of HUVECs in the PA newborn.

Urgencias en obstetricia / Emergencies in obstetrics

Tradicionalmente, el embarazo es considerado un evento fisiológico. Sin embargo, cerca de un 20 por ciento de las embarazadas desarrolla patologías obstétricas que se asocian a mortalidad materna y perinatal. A nivel mundial, cada año medio millón de mujeres fallece durante el embarazo y parto debido a estas complicaciones. Desafortunadamente, un número significativo de las urgencias obstétricas ocurre en pacientes sin factores de riesgo, por lo que la prevención, identificación precoz e intervención a tiempo de estos eventos juegan un rol fundamental para contrarrestar un resultado perinatal adverso. En el presente capítulo hemos seleccionado las emergencias que concentran la mayor morbimortalidad de nuestra especialidad. Si bien algunas han quedado fuera, creemos que los temas aquí presentados representan las urgencias obstétricas más importantes que enfrentamos a diario, para las cuales debemos estar preparados con el fin de realizar un manejo óptimo del embarazo y parto para la obtención de un resultado perinatal favorable.

Traditionally, pregnancy is considered a physiologic condition. However, close to 20 percent of pregnant women develop obstetrical diseases that are associated to maternal and perinatal mortality. World wide, every year half a million of women die during pregnancy, labor and delivery due to these complications. Unfortunately, a significant number of obstetrical emergencies occur among patients without risk factors, so that prevention, early identification and timely intervention play a key role to overcome an adverse pregnancy outcome. In the present chapter, we have selected the emergencies that concentrate most of the morbidity and mortality of our field. Although some have not been included, we believe that the obstetrical emergencies presented here in represent the most important ones that we face daily, and for which we should be prepared in order to execute the best possible obstetrical care either during pregnancy or at the time of delivery to obtain a favourable perinatal outcome.

A case of placental abruption diagnosed at 31 weeks by ultrasonography in bicornuate uterus / 대한산부인과학회지

Placental abruption is defined as the early separation a normal placenta from the wall of the uterus before delivery of the fetus. The incidence of it is known 1% of all pregnancies and perinatal mortality rates from abruption range from 20% to 40% in recent studies. The most common symptom is vaginal bleeding. The causes are associated with preeclampsia, other hypertensive disorders, and premature rupture of membranes. It is diagnosed by clinical symptom, sign, and ultrasonography. Recently we have experienced a case of placental abruption diagnosed at 31 weeks by ultrasonography in bicornuate uterus with a brief review of the literature.

Clinical analysis of 17 cases of multiple organ failure in obstetrics / 中国综合临床

Objective To explore the clinical diagnosis and treatment of multiple organ failure(MOF)in obstetrics.Methods 17 cases of MOF in obstetrics were studied retrospectively.Results Postpartum hemorrhage,severe regnancy-induced hypertension syndrome(PIH),amniotic fluid embolism,and placental abruption were the major factors leading to MOF from the 17 cases.The blood coagulation dysfunction and the renal failure were the most common organ dysfunction.8 cases died and the fatality rate was 47.06%.Conclusion The key to lowering the fatality rate of MOF is to prevent and treat the primary diseases,diagnose and treat blood coagulation dysfunction and renal failure early.