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Laryngeal Mask Airway for cesarean Delivery： A 5-Year Retrospective Cohort Study

Chinese Medical Journal 2017年第4期130卷 404-408页

作者： Zhi-Yu Geng Dong-Xin Wang Department of Anesthesiology Peking University First Hospital Beijing 100034 China

Background： The laryngeal mask airway （LMA） is the most commonly used rescue airway in obstetric anesthesia. The aim of this retrospective cohort study was to evaluate the application of the LMA in parturients undergoing cesarean delivery （CD） for 5 years in our hospital. As a secondary objective, we investigated the incidence of airway-related complication in obstetric general anesthesia （GA）. Methods： We collected electronic data for all obstetric patients who received GA for CD between January 2010 and December 2014 in Peking University First Hospital. Based on the different types of airway device, patients were divided into endotracheal intubation （ET） group and LMA group. The incidences of regurgitation and aspiration, as well as maternal and neonatal postoperative outcomes were compared between groups. Results： During the 5-year study, GA was performed in 192 cases, which accounted for 2.0% of all CDs. The main indications fbr GA were contraindication to neuraxial anesthesia or a failed block. Among these, ET tube was used in 124 cases （68.9%） and LMA in 56 cases （31.1%）. The percentage of critical patients above the American Society of Anesthesiologists＇ Grade II was 24/124 in ET group and 4/56 in LMA group （P = 0.036）. The emergent delivery rate was 63.7% for ET group and 37.5% for LMA group （P = 0.001）. None of the patients had regurgitation or aspiration. There were no significant differences in terms of neonatal Apgar scores, maternal and neonatal postoperative outcomes between the two groups. Conclusions： Our results suggested that GA was mainly used for contraindication to neuraxial anesthesia or a failed block, and emergent CDs accounted for most cases. The second-generation LMA could be used for obstetric anesthesia, but correct position to achieve a good seal is the key to prevent reflux and aspiration. Whether they could replace the tracheal tube in routine practice needs further large prospective studies.

关键词： Anesthesia, General Anesthesia, Obstetric cesarean section Laryngeal Masks

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A Marked Increase in Obstetric Hysterectomy for Placenta Accreta

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Chinese Medical Journal 2015年第16期128卷 2189-2193页

作者： Xiao-Yu Pan Yu-Ping Wang Zheng Zheng Yan Tian Ying-Ying HU Su-Hui Han Department of Obstetrics and Gynecology China-Japan Friendship Hospital Beijing 100029 China Department of Ultrasound Diagnosis China-Japan Friendship Hospital Beijing 100029 China Department of Radiology China-Japan Friendship Hospital Beijing 100029 China

Background：Obstetric hysterectomy （OH） as a lifesaving measure to manage uncontrolled uterine hemorrhage appears to be increasing recently.The objective of this study was to determine the etiology and changing trends of OH and to identify those at particular risk of OH to enhance the early involvement of multidisciplinary intensive care.Methods：A retrospective study was carried out in patients who had OH in China-Japan Friendship Hospital from 2004 to 2014.Maternal characteristics,preoperative evaluation,operative reports,and prenatal outcomes were studied in detail.Results：There were 19 cases of OH among a total of 18,838 deliveries.Comparing the study periods between 2004-2010 and 2011-2014,OH increased from 0.8/1000 （10/12,890） to 1.5/1000 （9/5948）.Indications for OH have changed significantly during this study period with uterine atony decreasing from 50.0% （5/10） to 11.1% （1/9）（P 〈 0.05）,and placenta accreta as the indication for OH has increased significantly from 20.0% （2/10） to 77.8% （7/9）（P 〈 0.05）.Ultrasonography and magnetic resonance imaging （MRI） have been used to make an exact antepartum diagnosis of placenta accreta.A multidisciplinary management led to improved outcomes for patients with placenta accreta.Conclusion：As the multiple cesarean delivery rates have risen,there has been a dramatic increase in OH for placenta accreta.An advance antenatal diagnosis of ultrasonography,and MRI,and a multidisciplinary teamwork can maximize patients＇ safety and outcome.

关键词： cesarean section Hysterectomy Placenta Accreta

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Insights into Initial Demyelinating Episodes of Central Nervous System during Puerperium

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Chinese Medical Journal 2017年第15期130卷 1791-1795页

作者： Qian Wu Bo Chen Na Liu Yang Hu Chao Pan Ping Zhang Zhou-Ping Tang Bi-Tao Bu Department of Neurology Tongji Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan Hubei 430030 China

Background：Inflammatory demyelinating disease of central nervous system （CNS） is an inflammatory disease characterized by a high childbearing female predominance.Labor-related alterations for postpartum demyelinating attacks are not entirely clear.This study aimed to summarize clinical features of female patients of reproductive age with initial CNS inflammatory demyelinating attacks during puerperium.Methods：Fourteen female patients with initial demyelinating events during puerperium between January 2013 and December 2016 were retrospectively studied.Records of clinical features,neuroimaging,serum antibodies,cerebrospinal fluid （CSF） findings,annualized relapse rate （ARR）,and treatment were analyzed.Results：Among 14 patients,5 patients were diagnosed with multiple sclerosis （MS）,four as neuromyelitis optica （NMO）,two as longitudinal extensive transverse myelitis,two as clinical isolated syndrome （CIS）,and one as acute brainstem syndrome.All the 14 puerperal female patients presented with more than one manifestation of hemiplegia,paraplegia,uroschesis,visual loss or dysarthria,and with mild to moderate abnormalities of CSF.Attacks occurred during the first trimester postpartum and cesarean section was the main delivery way （n =10）.Median Expanded Disability Status Scale （EDSS） scores were 5.0 （range：2.0-9.0） at the onset and 2.5 （range：0-7.0） at the end of follow-ups.Patients with MS and CIS had a significantly lower EDSS scores than patients with NMO spectrum disorders （P 〈 0.05）.Median ARR was 0.46 （range：0-1.16）;all patients had a low ARR （0.49 ± 0.34,95% confidence interval：0.29-0.69） with standardized treatments.Conclusion：Labor-related alterations in the mother＇s immune system might result in newly-onset demyelinating diseases of central nervous system.

关键词： cesarean section Inflammatory Demyelinations Postpartum

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Effect of Primary Elective cesarean Delivery on Placenta Accreta： A Case-Control Study

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Chinese Medical Journal 2018年第6期131卷 672-676页

作者： Xiao-Ming Shi Yan Wang Yan Zhang Yuan Wei Lian Chen Yang-Yu Zhao Department of Obstetrics and Gynaecology Peking University Third Hospital Beijing 100191 China

Background： cesarean section （CS） is an independent risk factor for placenta accreta. Some researchers think that the timing of primary cesarean delivery is associated with placenta accreta in subsequent pregnancies. The aim of this study was to investigate the risk of placenta accreta following primary CS without labor, also called primary elective CS, in a pregnancy complicated with placenta previa. Methods： A retrospective, single-center, case-control study was conducted at Peking University Third Hospital. Relevant clinical data of singleton pregnancies between January 2010 and September 2017 were recorded. The case group included women with placenta accreta who had placenta previa and one previous CS. Control group included women with one previous CS that was complicated with placenta previa. Maternal age, body mass index, gestational age, fetal birth weight, gravity, parity, induced abortion, the rate of women received assisted reproductive technology, other uterine surgery, and primary elective CS were analyzed between the two groups. Results： The rate of primary elective CS （90.1% vs. 69.9%, P 〈 0.001 ） was higher, and maternal age was younger （32.7 ± 4.7 years vs. 34.6 ± 4.0 years, P 〈 0.001） in case group, compared with control group. Case group also had higher gravity and induced abortions compared with the control group （both P 〈 0.05）. Primary CS without labor was associated with significantly increased risk of placenta accreta in a subsequent pregnancy complicated with placenta previa （odds ratio： 3.32; 95% confidential interval： 1.68-6.58）. Conclusion： Women with a primary elective CS without labor have a higher chance of developing an accreta in a subsequent pregnancy that is complicated with placenta previa.

关键词： cesarean section Placenta Accreta Placenta Previa

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International Association of Diabetes and Pregnancy Study Group criteria is suitable for gestational diabetes mellitus diagnosis： further evidence from China

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Chinese Medical Journal 2014年第20期127卷 3553-3556页

作者： Wei Yumei Yang Huixia Zhu Weiwei Yang Hongyun Li Haixia Yan Jie Zhang Cuilin Department of Obstetrics and Gynecology Peking Univesity FirstHospital Beijing 100034 China Department of Clinical Laboratory Peking University First HospitalBeijing 100034 China Division of Epidemiology Statistics and Prevention ResearchNICHD/National Institutes of Health 6100 Executive Blvd Rm7B03 Rockville MD 20852 USA

Background The International Association of Diabetes and Pregnancy Study Group （IADPSG） recommended new diagnostic criteria for gestational diabetes mellitus （GDM） after extensive analyses of the Hyperglycemia and Adverse Pregnancy Outcomes （HAPO） study. Unfortunately, there was no data from mainland of China in this study. We evaluated the feasibility of IADPSG criteria for GDM diagnosis in China. Methods A large prospective study was conducted. We reviewed medical records of a total of 25 674 pregnant women who underwent GDM screening and diagnosis between January 1, 2005 and December 31, 2012 in the Peking University First Hospital. The prevalence of gestational glucose metabolism abnormalities was calculated according to different cut off values defined by the National Diabetes Data Group （NDDG） or the IADPSG, and the incidence of adverse pregnancy outcomes related to GDM was analyzed. Results According to the cut off values of NDDG and IADPSG criteria, the prevalence of gestational glucose metabolism abnormalities was 8.4% and 18.9% （P 〈0.01） respectively, and the prevalence of cesarean section （52.5% vs. 46.0%, P 〈0.01）, macrosomia （7.5% vs. 6.3%, P 〈0.05）, neonatal hypoglycemia （1.6% vs. 1.0%, P 〈0.01）, and perinatal death （0.5% vs. 0.2%, P 〈0.01）; the prevalence was significantly lower when IADPSG criteria were applied. The prevalence of macrosomia, cesarean section, neonatal hypoglycemia, pregnancy induced hypertension, etc. was also higher in the GDM group than in the normal group. The prevalence of cesarean section （62.3%） and macrosomia （14.8%） was the highest in untreated mild GDM patients. Conclusions Our results indicated that treatment/intervention of women with GDM identified by IADPSG criteria was related to significantly lower risk of multiple adverse pregnancy outcomes. Such findings provide support for applying IADPSG criteria in China.

关键词： gestational diabetes mellitus macrosomia cesarean section neonatal hypoglycemia

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Factors affecting failed trial of labor and countermeasures:A retrospective analysis

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World Journal of Clinical Cases 2020年第16期8卷 3483-3492页

作者： Jin-Guang Wang Jing-Li Sun Jian Shen Department of Obstetrics and Gynecology General Hospital of Northern Theater Command(Heping Campus)Shenyang 110000Liaoning ProvinceChina

BACKGROUND Vaginal delivery is the ideal mode of delivery for the termination of a pregnancy.However,the cesarean section rate in China is much higher than the published by the World Health Organization in the Lancet in 2010.AIM To retrospectively analyze the factors related to failed trial of labor and the clinical indications for cesarean section conversion,explore how to promote the trial of labor success rate,and determine the feasibility of reducing the rate of conversion to cesarean section.METHODS A retrospective analysis was performed on 9240 maternal women who met vaginal delivery conditions and required a trial of labor from January 2016 to December 2018 at our hospital.Among them,8164 pregnant women who had a successful trial of labor were used as a control group,and 1076 pregnant women who had a failed trial of labor and converted to an emergency cesarean section were used as an observation group.The patients’clinical data during hospitalization were collected for comparative analysis,the related factors of the failed trial of labor were discussed,and reasonable prevention and resolution strategies were proposed to increase the success rate of trial of labor.RESULTS The analysis revealed that advanced age(≥35 years old),macrosomia(≥4000 g),delayed pregnancy(≥41 wk),use of uterine contraction drugs,primipara,and fever during labor were associated with conversion to an emergency cesarean section in the failed trial of labor.Multivariate regression analysis showed that age,gestational age,primipara,use of uterine contraction drugs,fever duringbirth,and newborn weight led to a higher probability of conversion to an emergency cesarean section in the failed trial of labor.The analysis indicated that the following clinical indications were associated with the conversion to cesarean section in the failed trial of labor:Fetal distress(44.3%),social factors(12.8%),malpresentation(face presentation,persistent occipitoposterior position,and persistent occipitotransverse position)(9.4%),and cephalopelvic dispropor

关键词： Trial of labor Vaginal delivery cesarean section Dystocia Retrospective analysis

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Relationship between Placenta Location and Resolution of Second Trimester Placenta Previa

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Journal of Huazhong University of Science and Technology(Medical Sciences) 2017年第3期37卷 390-394页

作者：冯云李学银肖娟李伟刘静曾雪陈曦陈凯月范磊陈素华 Department of Obstetrics and Gynecology Tongji Hospital Tongji Medical College Huazhong University of Science and Technology Department of Urology Zhengzhou First People's Hospital

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 of previa 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.

关键词： placenta previa cesarean section placenta location resolution ultrasound

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Case study of nursing care for a patient with pregnancy complicated by aortic dissection

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岭南心血管病杂志:英文版 2023年第2期24卷 79-84页

作者：程云清周颖珊杨圆圆李娜李淑妮孙图成 Guangdong Provincial People's Hospital(Guangdong Academy of Medical Sciences) Southern Medical UniversityGuangzhou510000GuangdongChina

Background This study aims to analyze and summarize the postoperative nursing care of a patient with pregnancy complicated by aortic dissection who achieved"four preservations"(preserving the fetus’life,the newborn’s life,the pregnant woman’s uterus,and the pregnant woman’s aortic valve)in our hospital,in order to explore nursing methods for such patients,summarize clinical experience,and guide clinical practice.Methods Our hospital treated a case of pregnancy complicated by aortic dissection in May 2022.After admission,the patient underwent major vascular surgery and developed chylothorax postoperatively.A nutritionist was consulted to calculate the patient’s nutritional needs and develop a daily meal plan.The nurse guided the patient to complete the required food intake.The patient underwent both major vascular surgery and cesarean section;finding a balance between anticoagulation and bleeding was essential.A group discussion was organized,with daily blood tests performed to maintain the patient’s INR between 1.8-2.5.How to initiate early postoperative activity for a pregnant patient after major vascular surgery has not been reported in the literature.The hospital’s cardiac rehabilitation doctors and nurses developed an exercise plan for the patient,and the nurse assisted the patient in gradually completing the program.The patient simultaneously faced the dual roles of a mother caring for a newborn and a patient recovering from aortic dissection surgery,enduring immense psychological pressure.To facilitate role transition and stress relief,a psychiatrist assessed the patient and provided psychological guidance and medication treatment based on the assessment results.The nurse was responsible for monitoring,evaluating,and recording the patient’s progress.Results The patient successfully underwent concurrent major vascular replacement surgery and cesarean section,ensuring a safe childbirth for the mother and a successful delivery for the baby.The surgery also preserved the patient’s aortic valve,eliminating the n

关键词： Pregnancy Major vascular disease cesarean section Case management

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Oxytocin Abuse and Postpartum Hemorrhage

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Open Journal of Obstetrics and Gynecology 2022年第12期12卷 1320-1327页

作者： Loutfi Guennoun Abdelmounaim Mohammed Khouchoua Nouha Nhiri Naouale Biougnache Mohamed Adnane Rhaidouni Ouassila Laouji Fatima El Hadraoui Safae Habib Rabbi Omar El Ayoubi Omar Alaoui Samir Messnan Said Lafkir The Head of Pol Mother and Child Department in Sidi Said Hospital Meknes Morocco Prefectorial Epidemiology Cell Ministry of Health Meknes Morocco Gynecology and Obstetrics Department Pagnon Hospital Meknes Morocco The Head Midwives of Two Teams in Pagnon Hospital Meknes Morocco Master in Communication Moulay Ismail University Meknes Morocco Medical Administration and Epidemiological Services Meknes Morocco

Among the most consolidated dogmas in obstetrics, we have the essential role of oxytocin during: labor by regulating, consolidating uterine contractions, by supporting the expulsive efforts of the patient during childbirth and after childbirth by preventing postpartum hemorrhage. But what challenged us to conduct our study is the large and increasing number of surgical operations for postpartum hemorrhage in patients who received oxytocin during labor. We assumed that the generalization use of oxytocin in all patients during labor is probably responsible of this increasing rate of incidents. To verify this assumption, we carried out a prospective randomized comparative study, involving 3990 pregnant patients admitted at the start of labor at term, with no contraindication for giving birth by normal ways, during a period of 10 months (January-October 2022). The patients have been divided into 2 groups. The first group comprises 1991 patients who were placed on admission on a glucose serum infusion with 4 ampoules of a non-anticholinergic musculotropic antispasmodic: “Hydrated phloroglucinol + trimethylphloroglucinol” (Each ampoule contains 40 mg of hydrated phloroglucinol and 0.04 mg of trimethylphloroglucinol) instead of receiving oxytocin during the active phase of their labor and a second group consisting of 1999 patients who received oxytocin during the active phase of their labor. The results were very surprising and contrary to the already consolidated evidence in our specialty. Indeed, the rate of postpartum hemorrhages was 10 patients (0.5%) in the 1st group vs 30 patients (1.5%) in the 2nd group, 9 patients (0.4%) presented fetal heart rate abnormalities in the 1st group vs 90 (4.5%) in the 2nd group, 8 cases (0.4%) of dynamic dystocia in the 1st group vs 132 cases (6.6%) in the 2nd group and 99 caesareans (5%) in the 1st group vs 299 (15%) in the 2nd group. Against all expectations the results were very surprising, with more details in the article.

关键词： Oxytocin Antispasmodic Postpartum Hemorrhage Uterine Inertia Dynamic Dystocia cesarean section Abnormal Fetal Heart Rate

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What to do when it is breech? A state-of-the-art review on management of breech presentation

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World Journal of Obstetrics and Gynecology 2023年第1期12卷 1-10页

作者： Afshin Azimirad Department of Obstetrics and Gynecology Tufts Medical CenterBostonMA 02111United States Diabetes Clinical Research Center Massachusetts General HospitalHarvard Medical SchoolBostonMA 02114United States

Any non-cephalic presentation in a fetus is regarded as malpresentation.The most common malpresentation,breech,contributes to 3%-5%of term pregnancies and is a leading indication for cesarean delivery.Identification of risk factors and a proper physical examination are beneficial;however,ultrasound is the gold standard for the diagnosis of malpresentations.External cephalic version(ECV)refers to a procedure aimed to convert a non-cephalic presenting fetus to cephalic presentation.This procedure is performed manually through the mother’s abdomen by a trained health care provider,to reduce the likelihood of a cesarean section.Studies have reported a version success rate of above 50%by ECV.The main objective of this review is to present a broad perspective on fetal malpresentation,ECV,and delivery of a breech fetus.The focus is to elaborate all clinical scenarios of breech and to provide an evidence-based clinical approach for them.After discussing breech prevalence,risk factors,diagnosis,and management,an updated review of ECV is presented.Moreover,ECV indications/contraindications,alternatives,clinical techniques on how to perform ECV and breech vaginal delivery,and obstetrical considerations for the delivery of malpresentations are thoroughly discussed.

关键词： Labor presentation Breech presentation Obstetric delivery cesarean section External cephalic version Fetal version

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