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Caesarian Section for Placenta Praevia: Does Booking Status Affect Maternofetal outcome?

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Open Journal of Obstetrics and Gynecology 2016年第5期6卷 306-312页

作者： Oshodi Yusuf Abisowo Akinola Oluwarotimi Ireti Fabamwo Adetokunbo Olusegun Olaifa Ibrahim Adeniyi Oyedele Yekeen Oyedokun Department of Obstetrics and Gynaecology Lagos State University Teaching Hospital Ikeja Nigeria

Background: Placenta praevia accounts for significant maternal morbidity and perinatal morbidity and mortality. Despite advances in blood transfusion technique and surgical procedure, abnormal placentation still remains a difficult challenge for obstetricians. Objective: To determine the influence of booking status on the fetal and maternal outcome among parturients with placenta praevia that underwent caesarian delivery. Methodology: This was a comparative and retrospective study between booked and unbooked subjects with significant placenta praevia that were delivered by caesarian section between January 1st 2004 and December 31st 2008 with respect to maternal and fetal outcome. Result: Out of 14,344 deliveries during study period, 123 cases of placenta praevia that underwent caesarian delivery were identified giving a prevalence rate of 0.86%. 49 subjects were booked while 74 were unbooked. There was no statistically significant difference between booked and unbooked cases with respect to risk factors (30.6% of booked and 23% of unbooked), X2(4) = 7.203, P = 0.126 and the mean blood loss at surgery (870.4 ± 486.9 ml in booked versus 779.7 ± 380.96 ml in unbooked), X2(1) = 0.202, P = 0.653. However, antepartum transfusion (12.2% booked versus 34.7% unbooked) and postpartum transfusion (51% booked versus 72% unbooked) showed statistically significant difference, X2(1) = 9.744, P = 0.002. One maternal death occurred amongst the unbooked cases and none among the booked cases. Statistically significant differences were also noted in the apgar score at 1 minute X2(3) = 15.528, P = 0.001 and 5 minutes X2(3) = 12.912, P = 0.005 respectively. More babies died in the unbooked group (19) compared to two (2) in the booked mothers. Conclusion: Unbooked status in placenta previa significantly increases the risk for antepartum and postpartum transfusion, is associated with higher mortality, increased p

关键词： Placenta Praevia Maternal outcome fetal outcome Booking Status Caesarian Delivery

Bile acids evoke placental inflammation by activating Gpbar1/NF-κB pathway in intrahepatic cholestasis of pregnancy

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Journal of Molecular Cell Biology 2016年第6期8卷 530-541页

作者： YouHua Zhang YouDong Pan ChangDong Lin YaJuan Zheng Hao Sun HaiLong Zhang JunLei Wang MengYa Yuan Tao Duan QiaoLing Du JianFeng Chen State Key Laboratory of Cell Biology CAS Center for Excellence in Molecular Cell ScienceInstitute of Biochemistry and Cell BiologyShanghai Institutes for Biological SciencesChinese Academy of SciencesShanghai 200031China Department of Obstetrics Shanghai First Maternity and Infant HospitalTongji University School of MedicineShanghai 200040China

Intrahepatic cholestasis of pregnancy(ICP)is a cholestatic disorder with potentially deleterious consequences for *** a clear correlation between the elevated levels of maternal serum bile acids and deficient fetal outcome has been established in clinical practice,the underlying mechanisms remain ***,we report that bile acids induce NF-κB pathway activation via G protein-coupled bile acid receptor 1(Gpbar1),with consequent upregulation of inflammatory genes in trophoblasts,leading to aberrant leukocyte infiltration and inflammation in *** acid(UDCA),a drug used clinically to treat ICP,competes with other bile acids for binding with Gpbar1 and thus inhibits bile acid-induced inflammatory response in trophoblasts and improves fetal survival in pregnant rats with obstructive ***,inhibition of NF-κB by andrographolide is more effective than UDCA in benefiting placentas and ***,anti-inflammation therapy targeting Gpbar1/NF-κB pathway could be effective in suppressing bile acid-induced inflammation and alleviating ICP-associated fetal disorders.

关键词： fetal outcome G protein-coupled receptor maternal cholestasis placental inflammation ursodeoxycholic acid

Intrahepatic cholestasis of pregnancy-current achievements and unsolved problems

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World Journal of Gastroenterology 2008年第38期14卷 5781-5788页

作者： Jurate Kondrackiene Limas Kupcinskas Department of Gastroenterology Kaunas University of MedicineKaunas 50009 Lithuania

Intrahepatic cholestasis of pregnancy （ICP） is the most common pregnancy-related liver disorder. Maternal effects of ICP are mild; however, there is a clear association between ICP and higher frequency of fetal distress, preterm delivery, and sudden intrauterine fetal death. The cause of ICP remains elusive, but there is evidence that mutations in genes encoding hepatobiliary transport proteins can predispose for the development of ICP. Recent data suggest that ursodeoxycholic acid is currently the most effective pharmacologic treatment, whereas obstetric management is still debated. Clinical trials are required to identify the most suitable monitoring modalities that can specifically predict poor perinatal outcome. This article aims to review current achievements and unsolved problems of ICR

关键词： Cholestasis of pregnancy Canalicular ABC transporters Pruritus fetal outcome Ursodeoxycholic acid

Liver disease in pregnancy

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World Journal of Gastroenterology 2009年第8期15卷 897-906页

作者： Noel M Lee Carla W Brady Department of Medicine Duke University Medical Center Durham NC 27710 United States Division of Gastroenterology Duke University Medical Center Durham NC 27710 United States

Liver diseases in pregnancy may be categorized into liver disorders that occur only in the setting of pregnancy and liver diseases that occur coincidentally with pregnancy. Hyperemesis gravidarum, preeclampsia/eclampsia, syndrome of hemolysis, elevated liver tests and low platelets (HELLP), acute fatty liver of pregnancy, and intrahepatic cholestasis of pregnancy are pregnancy-specific disorders that may cause elevations in liver tests and hepatic dysfunction. Chronic liver diseases, including cholestatic liver disease, autoimmune hepatitis, Wilson disease, and viral hepatitis may also be seen in pregnancy. Management of liver disease in pregnancy requires collaboration between obstetricians and gastroenterologists/hepatologists. Treatment of pregnancy-specific liver disorders usually involves delivery of the fetus and supportive care, whereas management of chronic liver disease in pregnancy is directed toward optimizing control of the liver disorder. Cirrhosis in the setting of pregnancy is less commonly observed but offers unique challenges for patients and practitioners. This article reviews the epidemiology, pathophysiology, diagnosis, and management of liver diseases seen in pregnancy.

关键词： Liver disease Pregnancy Maternal outcome fetal outcome Cesarean section Cholestasis Viral hepatitis.

Prenatal ultrasonographic characteristics and prognosis of isolated redundant foramen ovale flap

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Gynecology and Obstetrics Clinical Medicine 2022年第3期2卷 141-146页

作者： Yuntao Li Qiuyan Pei Zhenjuan Yang Yani Yan Xiaowei Xue Department of Obstetrics&Gynecology Peking University People's HospitalNo 11 Xizhimen South StreetBeijing100044China

Objective:To analyze the prenatal ultrasonographic characteristics and prognosis of the isolated redundant foramen ovale flap(RFOF).Methods:From January 2014 to December 2021,we collected data on fetal echocardiography analyses and perinatal outcomes for fetuses with isolated RFOF in Peking University People's ***:We found that 0.31%(87/28308)of participants have *** four-chamber results of the foramen ovale flap(FOF)showed that it was stiff and extended>50%or reached the lateral wall of the left atrium(LA)in *** seen from the foramen ovale(FO)channel and four-chamber views,the hypermobile and redundant flap were observed shrinking and stretching with the fetal cardiac cycle,which is similar to *** lateral displacement of flow from LA to the left ventricle(LV)around the FOF on color doppler demonstrated thin linear blood flow from the right to left and a reversal of flow across FO.A uniphasic,but not biphasic,pattern of FOF displacement was observed on *** I(23/87)and II(51/87)had a higher ratio of ventricular disproportion than Stage 0(11/87)and III(2/87).We observed the RA/LA(right/left atrium)>1.2 in 53 cases(60.9%),RV/LV(right/left ventricle)>1.2 in 53 cases(60.9%),PA/AO(pulmonary/aortic artery)>1.2 in 53 cases(60.9%),and moderate or severe tricuspid regurgitation in 10 cases and moderate pericardial effusion in 2 cases(2.2%).Seventy-four RFOF cases had follow-up *** death occurred in 2 cases;72 fetuses survived with normal or minor heart ***:RFOF should be considered if the left side of the heart of a fetus is smaller and related to hypermobile *** isolated RFOF cases,a monthly follow-up is recommended to monitor arrhythmia or fetal hydrop *** treatment is recommended for those with adequate gestational age and lung maturity.

关键词： Isolated Redundant foramen ovale flap fetal echocardiography Ultrasound fetal outcome

Fetomaternal outcome in Maternal Hypothyroidism Complicating Pregnancies at Paropakar Maternity and Women’s Hospital

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Open Journal of Obstetrics and Gynecology 2022年第11期12卷 1121-1128页

作者： Radhika Kunwar Sarmila Prajapati Anamika Jha Anupama Bhattarai Umesh Bahadur Bogatee Department of Obstetrics and Gynaecology Paropakar Maternity and Women Hospital Kathmandu Nepal Kathmandu Model Hospital Kathmandu Nepal

Background: Thyroid disorders are the most common endocrine disorders in pregnancy accounting for 10% of subclinical hypothyroidism in all pregnancies. Screening for hypothyroidism is essential in all pregnant women, especially in Nepal, a low-income region where women have an increased risk of developing iodine deficiency during pregnancy. Hence this study is to analyze fetomaternal outcomes in maternal hypothyroidism complicating pregnancies. Methods: This retrospective observational study was carried out at Paropakar Maternity and Women Hospital, a tertiary center located in Kathmandu, Nepal. The Subjects of this study were 330 antenatal women with a singleton pregnancy with hypothyroidism admitted for delivery in the obstetrics ward, and informed consent was obtained. Women were chosen irrespective of age, parity, residency, and socioeconomic status. Women with multiple pregnancies and any preexisting medical disorders including heart disease, diabetes, and hypertension were excluded. Routine hematological parameters and estimations of T3, T4, and thyroid stimulating hormone (TSH) were conducted. Patients with hypothyroidism were divided into overt and subclinical and were subsequently assessed for maternal and fetal complications. The occurrence of maternal outcomes and perinatal outcomes were recorded. Result: Out of 470 total hypothyroid cases, 330 were enrolled in the study and the remaining 140 were excluded. In our study, the incidence of hypothyroidism in pregnancy was 2.11% with 1.7% of subclinical hypothyroidism and 0.31% of overt hypothyroidism. The mean age of the patient was >30 years with 53.3% (n = 176) primigravida. Mostly 70.3% (n = 232) from rural areas. Pre-Eclampsia, gestational diabetes abruptio placenta, and postpartum hemorrhage were the adverse maternal outcome with a higher percentage of these in overt hypothyroidism which was statistically significant. Concerning fetal outcome APGAR score <6 in 5 min, Intrauterine growth restriction (IUG

关键词： fetal outcome Maternal outcome Overt Hypothyroidism Subclinical Hypothyroidism