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Fetomaternal hemorrhage (FMH) syndrome refers to a group of symptoms, including fetal anemia and maternal hemolytic transfusion reaction caused by fetal blood entering the maternal circulation through intervillous space. Diagnosis of FMH can be easily missed due to its non-specific symptoms and may lead to high perinatal mortality. The degree of fetal anemia and the volume of blood loss can be clinically evaluated by ultrasound measurement of middle cerebral artery peak systolic velocity and Kleihauer-Betke test. Clinical management is based on the degree of fetal anemia and gestational age. Intrauterine blood transfusion and termination are standard management. Fetal-maternal transfusion over 20 ml/kg is associated with fetal/neonatal morbidity or mortality. The incidence of FMH in twin pregnancy is rarely reported. We here report a case of dichorionic diamniotic twin pregnancy. Intrauterine death occurred to one of the twins because of FMH, and the other fetus was delivered at term with good outcome based on close monitoring.
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Objective To investigate the safety and effectiveness of external cephalic version for breech presentation in singleton term pregnancies. Methods This study retrospectively analyzed the clinical data of 195 singleton pregnancies with gestational weeks ≥37 and breech presentation that has received external cephalic version in University of Hong Kong-Shenzhen Hospital from January 2014 to December 2016. The success rate of external cephalic version, delivery modes, maternal and neonatal complications and adverse outcomes were analyzed. Results Of the 195 cases, 62.6% (122/195) were successful, among which 107 vaginally delivered and 15 underwent the cesarean section. Maternal and neonatal outcomes of all 195 cases were good. The success rate of external cephalic version in the multipara was higher than that of the primipara [84.5%(71/84) vs 45.9%(51/111), χ2=30.383, P<0.001]. No neonatal asphyxiation or postpartum hemorrhage was reported. Conclusions External cephalic version is an effective and safe method to convert breech presentation and reduce cesarean section rate in the third trimester.
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Objective To study the colonization rate and antibiotic resistance of group B Streptococcus (GBS) in gravidas during late pregnancy,and to evaluate the effectiveness of GBS screening in late pregnancy and intrapartum antibiotic prophylaxis (IAP) for the prevention of neonatal early-onset GBS disease (EOGBS).Methods A retrospective study was conducted to analyze the colonization rate and antibiotic resistance pattern of GBS in 14 204 gravidas who were screened for GBS at 35-37 gestational weeks during March 2016 to March 2018 in the University of Hongkong-Shenzhen Hospital (HKU-SZH).Differences in the incidence of EOGBS before and after GBS screening and IAP were analyzed using Chi-square or Fisher's exact test.Results Among the 14 204 gravidas,2 027 cases were GBS positive with a colonization rate of 14.27％.Incidence rates of EOGBS before and after GBS screening were 0.6‰ (4/6 356) and 0.07‰ (1/14 403),respectively (Fisher's exact test,P=0.033).GBS isolates were 100％ (2 027/2 027) sensitive to penicillin and vancomycin.Resistance rates to clindamycin and erythromycin were 67.2％(1 363/2 027) and 65.7％ (1 332/2 027),respectively.Conclusions Routine GBS screening in late pregnancy and IAP can significantly decrease the incidence of EOGBS.Penicillin is the optimal choice for prevention and treatment of GBS infection.
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Objective To evaluate the feasibility,safety and effectiveness of modified associating liver partition and portal vein ligation for staged hepatectomy (ALPPS).Methods The published literatures associated with modified ALPPS were pooled from Embase,Pubmed,Medline,Google Scholar databases.The studies were included or excluded depends on our predetermined criteria.We selected data and performd descriptive analysis from the included studies.Results Five articles were included and reviewed.A total of 62 patients underwent five modified procedures,including monosegment ALPPS (m-ALPPS),anterior approach ALPPS,partial-ALPPS,radiofrequency-assisted liver partition with portal vein ligation (RALPP) and associating liver tourniquet and portal ligation for staged hepatectomy (ALTPS).There were 50 (80.6％) patients diagnosed liver metastatic colorectal cancer.The average operation interval of modified ALPPS was between 8 ～ 22 days and growth rate of future liver remnant (FLR) ranged from 48.7％ to 62.3％,the feasibility to perform ALPPS stage 2 was 98.4％.The incidence of severe postoperative complications were between 11.8％ ～33.3％.The 90-day mortality for monosegment ALPPS,partial-ALPPS and RALPP was 0,while the figure was 8.3％ in ALTPS.The in-hospital morbidities were 5.9％ and 8.3％ for anterior approach ALPPS and ALTPS,respectively,which were 0 in the other three modified groups.Clinical response evaluation,including R0 resection rate,overall survival rate,disease-free and recurrence rates were merely presented 83.3％,80％,50％,50％ in m-ALPPS group,while 100％,100％,95％,5％ in modified ALTPS group.Conclusion Modified ALPPS with improved safety is feasible in clinical practice.However,the effectiveness still needs further studies.
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Objective To analyze the complications of pregnant secondary cesarean in scar uterus,to provide theoretical guidance for cesarean section.Methods 160 pregnant women of secondary cesarean uterine scar were chosen as the study group.80 pregnant women of non-scar uterine were chosen as the control group.Results The bleeding volume during operation,operation time,operation fee,postoperative bleeding,uterine resection rate,neonatal asphyxia in study group were (432 ± 331) mL,(64 ± 21) min,(0.91 ± 0.11) million,(262 ± 187) mL,4.4％,11.9％,which in the control group were (361 ± 209) mL,(44 ± 16) min,(0.63 ± 0) million,(184 ± 132) mL,1.3％,6.3％ respectively,the differences were significant (t =2.52,8.19,26.10,4,4.76,x2 =3.98,all P ＜ 0.05).The two groups had no statistically significant difference in organ damage situation (P ＞ 0.05).Conclusion Secondary cesarean uterine scar easily lead to maternal blood loss and increased postoperative bleeding,prolonged surgery,increased hysterectomy rate,increased incidence of neonatal asphyxia and other complications.Pregnant uterine scar pregnancy is a high-risk pregnancy,pregnancy for maternal uterine scar secondary surgical indications should be strictly controlled.