Objective To analyze the relation between the mode of delivery and postpartum lower extremity deep venous thrombosis （DVT）， and discuss the therapy methods. Methods The clinical data of 48 patients with postpartum lower extremity DVT from 2006 to 2012 in this hospital were analyzed retrospectively. Results There were 15 897 patients with the delivery， of whom were 10 097 cases of cesarean section and 5 800 cases of spontaneous delivery， the incidence rate of lower extremity DVT in the patients with cesarean section was significantly higher than that in the patients with spontaneous delivery〔0.41% （41/10 097） versus 0.12% （7/5 800）， χ2=9.94，P＜0.005〕. The higher incidence rate of cesarean section， the higher incidence rate of lower extremity DVT， which was a positive correlation between them （rs=0.87，P＜0.05）. Forty-three cases were only treated by drug therapy， 2 cases were performed operation combined with drug therapy， and 5 cases were placed the inferior vena cava filter. Forty-eight cases were cured and discharged. Conclusions The incidence rate of lower extremity DVT of cesarean section is higher as compared with the spontaneous delivery. The thrombolysis and （or） anticoagulation therapy is an effective way in the treatment for DVT. Controlling indications of cesarean section and early postpartum out-of-bed can decrease the DVT.
Objective To explore maternal health services utilization in rural areas in Rongchang County, and to analyze the influencing factors. Methods Seven hundred pregnant women were enrolled by stratified cluster sampling. The data was analyzed in SAS 8.2. Results Ninety-five percent of pregnant women had an antenatal examination, 69.3% had it for 5 times or more, and 75.4% received checking in the earlier stage of pregnancy; 98.3% were delivered in hospital, 26.3% had postpartum visit 3 times or more, and 16.7% had been systematically managed. The main influencing factors of systematic management rate were family yearly income before pregnancy whether or not the patient participated in the new rural cooperative medical scheme, and the number of pregnancies. Conclusion The maternal systematic management rate in the county has yet to be improved. Health education to improve prenatal care and postnatal visit status should be strengthened, and women should be guided to participate in the new rural cooperative medical scheme.
ObjectivesTo systematically review the clinical characteristics of pregnant females and juveniles (<18 years) with Middle East Respiratory Syndrome (MERS), so as to provide evidence for epidemic prevention and treatment of COVID-19.MethodsPubMed, EMbase, Web of Science, The Cochrane Library, CNKI, VIP and WanFang Data databases were electronically searched to collect studies on clinical characteristics of pregnant females and juveniles with MERS from inception to February 15th, 2020. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies. Descriptive analysis was then performed.ResultsA total of 12 studies involving 12 pregnant females, and 21 juveniles with MERS were included. The results of studies showed that the male to female ratio of juveniles patients was 1 to 1.63 and the age ranged from 9 months to 16 years. The primary transmission route of juveniles cases was family contact infection, accounting for 57.1% (12/21). Asymptomatic juveniles accounted for 57.1% (12/21), and the most common symptoms were fever, cough and shortness of breath. Some patients exhibited gastrointestinal symptoms such as vomiting and diarrhea. The positive rate of MERS-CoV RCT test was 100.0% (21/21). As for chest radiograph, 73.7% (14/19) cases showed no obvious lesions, and juveniles with lesions were mainly bilateral. 3 patients with underlying diseases developed severe cases, the mortality was 9.5% (2/21). The age range of pregnant women was 27 to 39, with the gestational age from 6 to 38 weeks. The primary transmission route for pregnant women was nosocomial infection, accounting for 57.1% (4/7). Fever, cough, shortness of breath were common manifestations, while abdominal pain occurred in two female patients. The positive rate of MERS-CoV RCT test was 100.0% (11/11). The chest radiograph findings were mainly bilateral lesions, accounting for 55.6% (5/9). 80.0% of whole pregnant females were severe cases (8/10), 4 of them died, with the 50.0% (4/8) mortality in severe pregnant cases. Among the infective pregnant women, 2 were stillborn and 10 were delivered, of which 1 died due to premature delivery. The remaining 9 surviving newborns were not infected with MERS-CoV and there was no evidence of mother-to-child transmission.ConclusionsThe clinical symptoms of MERS in juveniles are similar to those in adults, however, considerably milder. Severe case rate is higher in patients with underlying diseases. However, maternal infections could be much severe with higher mortality. It is particularly important to strengthen the management of pregnant females, especially prevent hospital infection. There is still no evidence of MERS-CoV mother-to-child transmission.
Currently, cardiac arrest has become a major public health problem, which has a high incidence rate and a high mortality rate in humans. With the continuous advancement of cardiopulmonary resuscitation techniques, the overall prognosis of cardiac arrest victims is gradually improved. However, cardiac arrest events under special circumstances are still serious threats to human health. This article reviews the progress of epidemiology, pathogenesis, treatment characteristics, and key points of cardiopulmonary resuscitation in those special cardiac arrest events associated with trauma, poisoning, drowning and pregnancy.
Objective To explore the effects of utilization of new partogram on the progress of labor and intervention in the labor. Methods We reviewed nulliparous women who had vaginal delivery at our hospital from January 1st, 2015 to December 31st, 2017. They were divided into control group (group A) (n=200; the old labor standard was used during this time) and observation group (the new labor standard was used at the same time). The observation group was sub-divided into group B (n=100, the duration of dilatation of cervix from 0 to 3 centimeters greater than or equal to 16 hours after parturition), group C1 [n=100; the second-stage duration (t) was greater than or equal to 2 hours, and less than 3 hours), and group C2 (n=100; t was greater than or equal to 3 hours). We compared the differences in intervention at the stages of labor such as using oxytocin to strengthen the contractions, artificial rupture of membranes, using phloroglucinol to soften the cervix, urinary catheterization, and manual rotation of fetal head among the groups. We also compared the differences in fetal presentation position, head tumor, fetal position, cephalopelvic disproportion and progress of the drop when the dilatation of cervix get to 10 centimeters among the groups. Results In the comparison among group A, B, C1 and C2 in rates of using oxytocin to strengthen the contractions, using phloroglucinol to soften the cervix, urinary catheterization and manual rotation of fetal head, the differences were statistically significant between group C2 and the other groups (P<0.008 5). The differences among group C1, C2 and A were statistically significant in duration of the first stage of labor (P<0.05). The same result was found between group B and A in duration of the second stage of labor (P<0.05). In the comparison of the different ratios of fetal presentation position between group A and C1, and group A and C2, when the dilatation of cervix get to 10 centimeters, the differences were significant (P<0.017), except at +1 position. The differences in whether the fetal presentation was producing head tumor and occipital anterior position among group A, C1, and C2 were statistically significant (P<0.017), but there was no difference between group A and C1 (P>0.017) in occipital anterior position. In the comparison of the different progress of the drop when the dilatation of cervix had got to 10 centimeters, 0–1 hours: the differences were statistically significant among group A, C1, and C2 (P<0.05) ; 1–2 hours: the difference was statistically significant between groups C1 and C2 (P<0.05). In group C1, there was a statistically significant difference between 0–1 hour and 1–2 hours (P<0.05). In group C2, there was no statistically significant difference among 0–1 hour, 1–2 hours and 2–3 hours (P>0.05). Conclusions According to the new labor standard, the rates of intervention in the labor would not increase, but when the second-stage duration is greater than or equal to 3 hours, the frequency would increase. We should deal with the abnormal factors affecting labor in time, and try to control the duration in 3 hours.
ObjectiveTo explore the corresponding intervention measures to reduce maternal mortality rate by analyzing the causes and problems of maternal deaths. MethodsA retrospective analysis was conducted to analyze all cases of maternal mortality from January 2005 to June 2013 in West China Second University Hospital. ResultsAmong the 14 cases of maternal deaths, the main diseases of the patients were pregnancy complicated with heart disease, hypertensive disorders, obstetric hemorrhage, amniotic fluid embolism and ectopic pregnancy. Four cases got prescriptive prenatal care during pregnancy, accounting for 28.6% (4/14), while 10 cases did not, accounting for 71.4% (10/14). Six patients died in prenatal period which accounted for 42.9% (6/14), while 8 died in postnatal period which accounted for 57.1% (6/14) and 5 died within 24 hours which accounted for 62.5% (5/8). Seven underwent cesarean section and 6 fetuses survived. Two went through trial of labor and no fetus survived. There was no ordered postmortem. ConclusionIntensifying education of prenatal care during pregnancy, improving quality of obstetrical service and diathesis of healthcare professionals, strengthening the supervision of high-risk pregnancy and timely choosing the time and manner of delivery are the main measures to decrease the maternal mortality.
ObjectiveTo systematically review the infection and colonization of Mycoplasma genitalium (Mg) in the reproductive tract of pregnant females in China. MethodsPubMed, Web of Science, SinoMed, CNKI, VIP and WanFang Data databases were electronically searched to collect cross-sectional studies on Mg infection in pregnant females in China from inception to October 10, 2021. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies; then, meta-analysis was performed by using R1.1.463 software. ResultsA total of 23 cross-sectional studies were included. The results of meta-analysis showed that the prevalence rate of Mg infection in pregnant females was 4.86% (95%CI 2.84% to 7.38%). The prevalence rates of Mg infection in females with ectopic pregnancy, spontaneous abortion, induced abortions and PROM were 13.01% (95%CI 6.90% to 20.69%), 11.81% (95%CI 3.30% to 24.59%), 6.11% (95%CI 2.70% to 10.77%), and 12.63% (95%CI 9.56% to 16.06%), respectively. ConclusionCurrent evidence shows that the prevalence rate of Mg infection in females with ectopic pregnancy, spontaneous abortion and premature rupture of membranes are higher than those in other pregnant females. Due to limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.
【摘要】 目的 从法医病理学角度分析引起医疗纠纷的孕产妇死亡原因、医疗纠纷发生原因并提出相关防范措施。 方法 对1999年1月-2008年12月间46例引起医疗纠纷的孕产妇死亡案例进行回顾性分析。 结果 孕产妇死亡年龄以30岁以上多见，死亡时妊娠时间以围产期居多（87.0%）。死亡原因中产科失血性休克死亡21例（45.7%），栓塞类疾病死亡8例（17.4%），感染性疾病死亡5例（10.8%），其他原因死亡12例（26.1%）。46例中属非医疗过失性医疗纠纷8例（17.4%），医疗过失性纠纷38例（82.6%），医疗过失的原因主要为抢救不及时、处理不当、误诊误治等。涉及纠纷的医院以县区级医院居多（54.3%）。 结论 通过法医病理学司法鉴定查明死亡原因，明确医疗责任及医疗纠纷原因，已成为解决孕产妇死亡医疗纠纷的重要手段。【Abstract】 Objective To analyze the causes of maternal death with medical disputes, the causes of medical disputes, and to recommend the related preventions through a forensic pathological angle. Methods We retrospectively analyzed 46 cases of maternal death with medical disputes which were collected by West China Center of Forensic Medicine Service in Sichuan between January 1999 and December 2008. Results Most maternal deaths occurred over 30 years old. They most frequently happened during the peri-natal period (87.0%). The causes of death included obstetric hemorrhagic shock in 21 cases (45.7%), embolism-like diseases in 8 cases (17.4%), infectious diseases in 5 cases (10.8%) and other reasons in 12 cases (26.1%). Among all the 46 cases of medical disputes, 8 (17.4%) were not due to medical malpractices, while the other 38 cases (82.6%) had something to do with such medical malpractices as delayed or inappropriate treatment, misdiagnosis and so on. Most of the malpractices in these cases involved medical institutions at a county level (54.3%). Conclusion Forensic judicatory appraisal is important to resolve medical disputes of maternal death by finding out the cause of death, clarifying the medical responsibility and clearing the cause of medical disputes.