ABSTRACT
Objective To explore the risk factors for septicemia after cesarean section,and provide reference for clinical prevention of postoperative septicemia.Methods Clinical data of patients who underwent cesarean section in a maternal and child health hospital between January 1,2013 and October 31,2016 were collected by retrospective survey method,risk factors were analyzed by multivariate logistic regression model.Results A total of 4 604 cases of cesarean section were selected,32 cases of septicemia occurred,incidence was 0.70％.Multivariate logistic regression analysis showed that there were seven independent risk factors for septicemia:gestational diabetes mellitus (OR =4.03),trying vaginal delivery(OR =15.86),No.of vaginal examination ≥3 times(OR =6.77),premature rupture of membrane≥12 hours(OR =3.47),intra-operative bleeding≥1 000 mL(OR =4.66),postoperative duration of indwelling urinary catheter≥24 hours(OR =2.83),and antimicrobial use within a week(OR =3.20).Four factors were protective factors:gestational weeks≥34 weeks(OR =0.20),hemoglobin≥100 g/L(OR =0.40),albumin≥35 g/L(OR-0.28),and amniotic fluid volume at a normal level(OR =0.22).Conclusion It is possible to prevent and control the occurrence of septicemia after cesarean section through strict management of independent risk factors and intervention in protective factors of pregnant women during peri-operative period.
ABSTRACT
21-hydroxylase deficiency [21-OHD] caused congenital adrenal hyperplasia [CAH] is a group of autosomal recessive genetic disorders resulting from mutations in genes involved with cortisol [CO] synthesis in the adrenal glands. Testicular adrenal rest tumors [TARTs] are rarely the presenting symptoms of CAH. Here, we describe a case of simple virilizing CAH with TARTs, in a 15-year-old boy. The patient showed physical signs of precocious puberty. The levels of blood adrenocorticotropic hormone [ACTH], urinary 17-ketone steroids [17-KS], dehydroepiandrosterone sulfate [DHEA-S], and serum progesterone [PRGE] were elevated, whereas those of follicle-stimulating hormone [FSH], luteinizing hormone [LH], and CO were reduced. Computed tomography [CT] of the adrenal glands and magnetic resonance imaging [MRI] of the testes showed a soft tissue density [more pronounced on the right side] and an irregularly swollen mass [more pronounced on the left side], respectively. Pathological examination of a specimen of the mass indicated polygonal/circular eosinophilic cytoplasm, cord-like arrangement of interstitial cells, and lipid pigment in the cytoplasm. Immunohistochemistry results precluded a diagnosis of Leydig cell tumors. DNA sequencing revealed a hackneyed homozygous mutation, I2g, on intron 2 of the CYP21A2 gene. The patient's symptoms improved after a three-month of dexamethasone therapy. Recent radiographic data showed reduced hyperplastic adrenal nodules and testicular tumors. A diagnosis of TART should be considered and prioritized in CAH patients with testicular tumors. Replacement therapy using a sufficient amount of dexamethasone in this case helps combat TART