ABSTRACT
【Objective】 To screen the risk factors of severe postpartum hemorrhage that can be found at 32 weeks of pregnancy through univariate and multivariate analysis and establish the risk prediction diagram. 【Methods】 A retrospective analysis was performed on pregnant women who gave birth and received blood transfusion in Women's Hospital of Nanjing Medical University from 2019 to 2021. According to the blood transfusion volume during and after operation, the patients were divided into low/moderate transfusion group (transfusion volume <2 000 mL) and massive-transfusion group (transfusion volume ≥2 000 mL), and the basic information of puerperal, single high risk factor, measures of operation and use of blood preparations were recorded. The differences of physiological and pathological factors between the low/moderate transfusion group and the massive transfusion group were analyzed by univariate analysis. Multivariate analysis and nomogram were performed on the statistically significant factors to calculate the consumption of blood components and hemostatic measures in the massive transfusion group. 【Results】 There were significant differences in age, number of pregnancies, advanced age at first delivery, history of abortion, scar uterus, pernicious placenta previa, placenta accreta, eclampsia/pre-eclampsia and acquired coagulopathy between the low/moderate transfusion group (n=930) and the massive transfusion group (n=108) (P<0.05), among which the number of pregnancies, advanced age for the first delivery, pernicious placenta previa, placenta accreta, and eclampsia/pre-eclampsia were independent risk factors for severe postpartum hemorrhage at 32 weeks of gestation. The scores of risk factors for massive blood transfusion from high to low were placenta accreta, primiparity at advanced age, eclampsia/pre-eclampsia, pernicious placenta previa, number of pregnancies≥4 and scar uterus. 【Conclusion】 The possibility of severe postpartum hemorrhage can be accurately evaluated in the third trimester (around 32 weeks) by univariate analysis, multivariate analysis and nomogram drawing. Among the puerpera underwent blood transfusion, the risk factors for massive hemorrhage included pregnancies ≥4 times, primiparity at advanced age, pernicious placenta previa, placenta accreta, and eclampsia/pre-eclampsia. The model based on these factors has a good prediction effect on massive hemorrhage.
ABSTRACT
Objective:To investigate the impact of human umbilical cord-derived mesenchymal stem cells on the activation ,the survival of human peripheral blood mononuclear cell ( hPBMC) and the proportions of each human lymphoid subgroup .Methods:PB-MC were isolated from healthy donors by density gradient centrifugation , then cultured in MSC-CM as treatment group after being acti-vated by OKT3.Each lymphoid subgroup proportion was analyzed by flow cytometry to observe the difference between treatment and control group .The effect of MSC-CM on activated PBMC for the production of IFN-γand IL-10 were tested by ELISA .The level of ap-optosis was assessed by flow cytometry with Annexin-V/PI as fluorescent marker .Results:Compared with the control group , MSC-CM down-regulated the ratio of CD4 +T cell to CD8 +T cell, and increased the proportion of CD4 +CD25 +CD127low Treg cell, thus other subgroup had no significant difference .MSC-CM inhibited the production of IFN-γby PBMC, but promoted the secretion of IL-10, and protected PBMCs from apoptosis when activated with OKT 3.Conclusion:hUC-MSC may play a role of immunosuppression by promo-ting the proliferation and activation of Treg cell .This kind of inhibitory activity is neither relied direct or indirect contact with the lym -phocytes , nor influenced by inducing immune cells apoptosis .