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Article in Chinese | WPRIM | ID: wpr-910165


Objective:To study the risk factors of adverse pregnancy outcomes for induced abortion of cesarean scar pregnancy in midtrimester.Methods:A national multicenter retrospective study was conducted. A total of 154 singletons pregnant women with cesarean scar pregnancy during the second trimester induced abortion by various reasons in 12 tertiary A hospitals were selected, their pregnant outcomes were observed and the risk factors of serious adverse outcomes were analyzed with univariate and multivariate logstic regression; the role of ultrasound and MRI in predicting placenta accreta and severe adverse outcomes was evaluated, the effectiveness of uterine artery embolization (UAE) in preventing hemorrhage in pregnant women with and without placenta accreta was compared.Results:Among 154 subjects, the rate of placenta accreta was 42.2% (65/154), the rate of postpartum hemorrhage≥1 000 ml was 39.0% (60/154), the rate of hysterectomy was 14.9% (23/154), the rate of uterine rupture was 0.6% (1/154). The risk factor of postpartum hemorrhage≥1 000 ml and hysterectomy was placenta accreta ( P<0.01). For each increase in the number of parity, the risk of placenta accreta increased 2.385 times (95% CI: 1.046-5.439; P=0.039); and the risk of placenta accreta decreased with increasing ultrasound measurement of scar myometrium thickness ( OR=0.033, 95% CI: 0.001-0.762; P=0.033). The amount of postpartum hemorrhage and hysterectomy rate in the group with placenta accreta diagnosed by ultrasound combined with MRI were not significantly different from those in the group with placenta accreta diagnosed by ultrasound only or MRI only (all P>0.05). For pregnant women with placenta accreta, there were no significant difference in the amount of bleeding and hysterectomy rate between the UAE group [median: 1 300 ml; 34% (16/47)] and the non-embolization group (all P>0.05); in pregnant women without placenta accreta, the amount of bleeding in the UAE group was lower than that in the non-embolization group (median: 100 vs 600 ml; P<0.01), but there was no significant difference in hysterectomy rate [2% (1/56) vs 9% (3/33); P>0.05]. Conclusions:(1) Placenta accreta is the only risk factor of postpartum hemorrhage≥1 000 ml with hysterectomy for induced abortion of cesarean scar pregnancy in midtrimester; multi-parity and ultrasound measurement of scar myometrium thickness are risk factors for placenta accreta. (2) The technique of using ultrasound and MRI in predicting placenta accreta of cesarean scar pregnancy needs to be improved. (3) It is necessary to discuss of UAE in preventing postpartum hemorrhage for induced abortion of cesarean scar pregnancy in midtrimester.

Chongqing Medicine ; (36): 577-579, 2017.
Article in Chinese | WPRIM | ID: wpr-509682


Objective To explore the value of human epididymis protein 4(HE4),cancer antigen 125(CA125) and the risk of ovarian malignancy algorithm(ROMA) in the diagnosis of ovarian cancer.Methods Electrochemical luminescence and Enzymelinked immunosorbent assay (ELISA) were used to determine the levels of serum HE4,CA125 in 56 patients with ovarian carcinoma,73 cases of ovarian benign tumor and 50 health women,and the ROMA was calculated by HE4 and CA125 levels depending on the menopause state,drawing the receiver operating characteristics(ROC) curve and calculating the area under the curve(AUC).Results The average levels of the HE4,CA125 and the value of the ROMA were (345.33±605.03)pmol/L,(701.46±1 500.30) U/mL,(58.72±31.00) % in the ovarian carcinoma group,(53.84± 14.68)pmol/L,(44.25±45.81)U/mL,(10.80± 6.75) % in the ovarian benign tumor group,and (46.03±10.26)pmol/L,(17.39±10.64)U/mL,(6.92±3.85)% in the health control group respectively,compared with the benign tumor group and the health control group,the ovarian carcinoma group were higher in HE4,CA125 and the ROMA value,and the difference were significantly (P<0.05),whereas compared in the ovarian benign group and the health group,except the CA125 was higher in the benign group and the difference had statistical significance(P<0.05),the HE4 level and the value of the ROMA had no statistical significance(P>0.05).The sensitivities of the HE4,CA125 and ROMA were 71.43%,76.79 %,89.28%,the specificities were 93.15 %,53.42%,94.52 % and the ROC-AUCs were 0.930,0.809,0.937 respectively.When the specificity for the diagnosis of the ovarian carcinoma was 95.00%,the sensitivities of the HE4,CA125 and ROMA were 80.40%,53.60%,83.90% respectively.Conclusion HE4 and CA125 combined detection to calculate the ROMA can elevate the sensitivity and specificity for the ovarian carcinoma diagnosis.

Article in Chinese | WPRIM | ID: wpr-618768


Objective:To compare the effect of laparoscopic uterine isthmus cerclage and transvaginal uterine isthmus cerclage in the treatment of cervical incompetence at non pregnant condition.Methods:A total of 63 patients with cervical incompetence from May 2013 to May 2015 in our hospital were enrolled in the retrospective analysis,all the enrolled patients had naturally conceived single birth with complete data after laparoscopic uterine isthmus cerclage or transvaginal uterine isthmus cerclage and were divided into two groups according to two different surgical methods for uterine isthmus cerclage to compare the clinical effect.30 patients treated with laparoscopic uterine isthmus cerclage were,in the research group and the other 33 patients treated with transvaginal uterine isthmus cerclage were in the control group.Results:The treatment success rate of research group (96.67%) was significantly higher than that of the control group(51.52%) (P < 0.05).The research group had got a longer average pregnancy period than control group (P < 0.05).Postoperative abortion rate (3.33%) and preterm birth rate(10.00%) of research group were obviously lower than the control group (48.48%,30.30%)(P<0.05).The term infant rate of research group (86.67%) was higher than control group (21.21%) (P <0.05).The operation time((37.27 ± 1.93 min) and hospital stay(5.17 ±0.38 d) of the research group were less than the control group(P<0.05).The bleeding amount in surgery of research group(13.13 ±1.57ml) was significantly lower than the control group(31.61 ± 1.87 ml) (P < 0.05).The complication rate of observation group was 0,and the control group was 18.18%.The difference was significant(P < 0.05).Conclusions:Laparoscopic uterine isthmus cerclage in treatment of cervical imcompetence at non pregnant condition has better clinical effect than transvaginal uterine isthmus cerclage.It has higher security and feasibility.It is worth clinically promoting.

Article in Chinese | WPRIM | ID: wpr-468935


To compare the effects of laparoscopic total or subtotal hysterectomy and myomectomy on ovarian reserve by measuring the serum level of anti-Mullerian hormone (AMH).A total of 96 patients with uterine fibroids underwent total laparoscopic hysterectomy (TLH group,n =32),laparoscopic subtotal hysterectomy (LSH group,n =31) and laparoscopic myomectomy (LM group,n =33).Changes in ovarian reserve were examined by measuring the level of AMH pre-operation and at 1 and 4 months post-operation.No significant differences existed in AMH in LM group[(1.42 ±0.65),(1.31 ±0.53) & (1.33 ±0.61) μg/L,P > 0.05].The levels of AMH in both groups were significantly lower than those at pre-operation [(1.17 ± 0.11),(1.01 ±0.10),(0.48±0.54) & (1.18±0.93),(0.45 ±0.39),(0.14±0.0) μg/L,P<0.001].The mean percentage decrease in AMH was lower in TLH group than that in LSH group at 4-month follow-up [(-37.4 ± 37.6) % vs.(-27.0 ± 23.0) %,P =0.017].The results showed that LM had no effect on ovarian reserve.Both LSH and TLH had adverse effects on ovarian reserve and TLH was more marked.