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Evaluation of process management of postpartum hemorrhage due to uterine atony

Open Journal of Obstetrics and Gynecology 2013年第7期3卷 514-519页

作者： Iris Holzer rainer lehner Department of Obstetrics and Gynecology Division of Feto-Maternal Medicine and Obstetrics Medical University Vienna Vienna Austria

Objective: To evaluate the management process and the guidelines for management of postpartum hemorrhage due to uterine atony at the General Hospital Vienna, Medical University Vienna. Material and Methods: A retrospective analysis was carried out on all 24 cases of postpartum hemorrhage due to uterine atony with an estimated blood loss of more than 800 mL, in which standardized guidelines were obtained. We included all women who gave birth at the General Hospital of Vienna, the Medical University Vienna, during the period from January 1st 2003 and December 31st 2009 and who suffered blood loss 800 mL at minimum due to uterine atony. Results: The guidelines were in use for 14% - 71%. The average blood loss of the 24 cases with uterine atony was 1342 mL. Conclusion: The management process of postpartum hemorrhage due to uterine atony deviates from the hospital’s guidelines in many cases.

关键词： Postpartum Hemorrhage Uterine Atony Management Process

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Maternal and Neonatal Outcome for Singleton and Twin Pregnancies in Emergency Cesarean Section *** Cesarean Section in a Retrospective Evaluation from 2003-2012

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Open Journal of Obstetrics and Gynecology 2014年第14期4卷 881-888页

作者： Andrea Molgg Stefan Jirecek Victoria Girtler rainer lehner Department of Obstetrics and Gynecology Medical University of ViennaViennaAustria

Objectives: Emergency cesarean is performed, when a situation requires immediate action in order to reduce the risk to mother and/or child, while urgent cesarean is done if a non-life threatening but compromising situation occurs. The aim of the study was to investigate the maternal and fetal outcome for emergency and urgent cesarean. Study Design: A retrospective case-control study was performed;cases underwent emergency cesarean section, while controls underwent urgent cesarean section. We included 303 cases of women and 336 cases of children, and controls were matched. Maternal and fetal outcome parameters for singleton and twin pregnancies were investigated using the Wilcoxon test and the Chi-square-test. Results: Maternal outcome: Higher?blood loss (cases: mean 383.12 ± 232.89, range 100 - 2500 vs. controls: 336.06 ± 129.19, range 100?- 1000, p = 0.008), hemorrhage (34 vs. 11, p < 0.001) and puerperal anemia (30 vs. 10, p < 0.001). Neonatal outcome: One, five, and ten minutes Apgar levels and umbilical cord pH values are lower for cases (p < 0.001 and p < 0.001, respectively). Twins had lower five and ten minutes Apgar levels (p = 0.040 and 0.002), but higher umbilical cord pH values than singletons (p < 0.001). The perinatal mortality among singletons was 3.8%, among twins 8.1%. For cases the perinatal mortality among singletons was 5.7% and 17.14% for twins (control group 1.41% and 2.63%, respectively). Conclusion: The maternal and fetal outcome is poorer in emergency cesarean section. Especially the perinatal mortality is high in emergency cesarean section, particular for twins.

关键词： Emergency Cesarean Section Maternal Outcome Neonatal Outcome Twins Urgent Cesarean Section

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Surgical experience in splitting donor liver into left lateral and right extended lobes

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World Journal of Gastroenterology 2005年第27期11卷 4220-4224页

作者： Ji-Qi Yan Thomas Becker Michael Neipp Cheng-Hong Peng rainer Lueck Frank lehner Hong-Wei Li Juergen Klempnauer Department of Surgery Ruijin Hospital Affiliated to Shanghai Second Medical University Shanghai 200025 China Department of Abdominal and Transplant Surgery Medical School of Hannover Carl-NeubergStr. 1 Hannover 30625 Germany

AIM： To outline the surgical experience with donor liver splitting in split liver ***： From March 1 to September 1 in 2004, 10 donor livers were split ex situ into a left lateral lobe （segments Ⅱ and Ⅲ） and a right extended lobe （segments Ⅰ, Ⅳ-Ⅷ） in Medical School of Hannover, and thereafter split liver transplantation was performed successfully in 29 cases. The average age, weight and ICU slaying period of the donors were 32.7 years （25-52 years）, 64.5 kg（45-75 kg） and 2.4 d （2-8 d） ***： The average weight of the whole graft and the left lateral lobe was 2 322.6 g （956-2 665 g） and 282.8 g （298-373 g） respectively, and the average ratio of left lateral lobe to the whole graft was 0.225 （0.278-0.274）.The average graft to recipient weight ratio （GRWR） of the left lateral lobe and the right extended lobe reached 2.44% （2.22-5.42%） and 2.73% （2.32-2.30%） *** average it took approximately 205 min （85-235 rain）to split the donor liver. Five donor organs showed anatomic variation including the left hepatic vein variation in two cases, the left hepatic artery variation in two cases and the bile duct variation in one ***： Split liver transplantation has become a mature surgical technique to expand the donor pool with promising results. In the process of graft splitting, close attention needs to be paid to potential anatomic variations,especially to variations of the left hepatic vein, the left hepatic artery, and the bile duct.

关键词： Split Donor liver Anatomic variation

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