Analysis of high risk factors and establishment of risk score model for postpartum massive blood transfusion / 中国输血杂志

【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.

Preventive effect of low-dose aspirin on preeclampsia occured in preeclampsia high-risk pregnant women and its mechanism / 吉林大学学报(医学版)

Objective: To observe the preventive effect of low-dose aspirin (LDA) in the preeclampsia (PE) high-risk pregnant women, and to elucidate the feasibility and clinical value of LDA in preventing PE. Methods: A total of 112 PE high-risk pregnant women with 16-22 gestational weeks were selected and randomly divided into control group (n = 5 8) and observation group (n = 5 4). The patients in control group were given placebo treatment, the patients in observation group were given 75 mg • d-1 LDA before going to bed until delivery. The incidence of PE, gestational age of onset, gestational age of delivery, neonatal birth weight, delivery mode, neonatal outcomes of the patients in two groups were observed. The patients in two groups were divided in to PE (+) (with PE) group and PE (-) (without PE) group according to whether PE occured or not. The coagulation function and the platelet parameters of the patients in two groups were detected; the levels of interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), thromboxane A2 (TXA2), P-selectin in placenta tissue of the patients in two groups were detected by ELISA method. Results: Compared with control group, the incidence of PE and the incidence of premature delivery of the patients in observation group were significantly decreased (P < 0. 05); the gestational age of delivery of the patients in observation group were prolonged (P < 0. 05), the neonatal birth weight was increased (P < 0. 01), and the full-term birth rate was increased (P < 0. 01). Compared with the PE (+) and PE (-) patients in control group, the prothrombin time (PT) and activated partial thromboplastin time (APTT) of the PE (-) patients in observation group were increased (P < 0. 01), and the PT of the PE (+) patients in observation group was decreased (P < 0. 01); the levels of prothrombin activity (P T A), fibrinogen (FIB) and D-dimer (D-D) of the PE (+) and PE (-) patients in observation group were decreased. Compared with control group, the levels of IL-6, TNF-αa, COX-2, TXA2 and P-selectin in placenta tissue of the patients in observation group were decreased significantly (P < 0. 01). Conclusion: LDA treatment within 16 - 22 weeks of gestation can effectively prevent the occurrence of PE in the PE high-risk pregnant women, its mechanism is related to improving the coagulation function and inhibiting the protein expressions of inflammatory factors in the PE high-risk pregnant women.

Relación entre niveles de vitamina D y perfil lipídico en embarazadas de alto riesgo / Relationship between level of vitamin D and lipid profile in high risk pregnant women

En la Argentina, las embarazadas presentan alta prevalencia (80%) de hipovitaminosis D y de sobrepeso u obesidad (27,4%). Ambas condiciones pueden aumentar la morbimortalidad materno-fetal. Bajos niveles de vitamina D se han relacionado con aumento del colesterol total, LDL, triglicéridos (Tg) y descenso de HDL. Objetivo: evaluar los niveles de 25-hidroxivitamina D (25OHD) y su relación con el perfil lipídico en pacientes embarazadas de alto riesgo. Materiales y métodos: estudio de corte transversal entre septiembre de 2016 y abril de 2017. Se excluyeron pacientes que recibieron suplementos de vitamina D, con disfunción tiroidea no compensada, malabsorción, insuficiencia cardíaca, renal o hepática y dislipidemia familiar. Niveles circulantes de 25OHD < 30 ng/ml se consideraron hipovitaminosis. Resultados: se evaluaron 86 embarazadas de 29,3 ± 7,1 años durante la semana 28 ± 6,5. El IMC pregestacional fue 28,3 ± 6,5 kg/m2 y la ganancia de peso 7 ± 4,3 kg. Perfil lipídico: colesterol total 240 ± 54 mg/dl; LDL 156 ± 54 mg/dl; HDL 66 ± 15 mg/dl; Tg 204 ± 80 mg/dl. La media de 25OHD fue de 23,8 ± 9 ng/ml, con una prevalencia de hipovitaminosis D de 77,9 %. Las pacientes con hipovitaminosis D presentaron mayores valores de colesterol total y LDL (p < 0,05), con tendencia no significativa a presentar mayores valores de Tg. Conclusión: en embarazadas de alto riesgo se observó una alta prevalencia de hipovitaminosis D, asociada con mayores concentraciones de colesterol total y LDL. (AU)

In Argentina, pregnant women have a high prevalence (80 %) of hypovitaminosis D and verweight/obesity (27.4%), conditions that can increase maternal-fetal morbidity and mortality. Low levels of 25-hydroxyvitamin D (25OHD) have been linked to an increase in total cholesterol, LDL cholesterol, triglycerides (TG) and a decrease in HDL cholesterol. Objective: to evaluate the levels of vitamin D and its relationship with the lipid profile in high risk pregnant patients. Materials and methods: cross-sectional study between September 2016 and April 2017. Patients who received vitamin D supplements or had non-compensated thyroid dysfunction, malabsorption, heart failure, renal or hepatic failure, or familial dyslipidemia were excluded. Hypovitaminosis D was defined as a circulating level of 25OHD < 30 ng/ml. Results: We assessed 86 women of 29.3 ± 7.1 years during pregnancy week 28 ± 6.5. Pre-gestational BMI was 28.3 ± 6.5 kg/m2. Their weight gain was 7 ± 4.3 kg. Lipid profile: total cholesterol 240 ± 54 mg/dl; LDL cholesterol 156 ± 54 mg/dl; HDL cholesterol 66 ± 15 mg/dL; TG 204 ± 80 mg/dl. The mean 25OHD level was 23.8 ± 9 ng/ml, with a 77.9 % prevalence of hypovitaminosis D. Patients with hypovitaminosis D had higher values of total cholesterol and LDL cholesterol (p<0.05), and a non-significant trend toward higher triglyceridemia. Conclusion: A high prevalence of hypovitaminosis D, associated with high total and LDL cholesterol was found in high risk pregnant women. (AU)

Diagnostic value of ultrasonography for placenta accreta in high risk first-trimester pregnant women / 中华全科医师杂志

The clinical data of 113 early pregnant (11-14 weeks) women with high risk of placenta accreta undergoing ultrasound examination in Jinhua Maternal and Child Health Hospital from June 2013 to June 2018 were retrospectively analyzed.Among them,there were 21 cases of placenta accreta (implanted group) and 92 cases without placenta accreta (non-implanted group).The diagnostic value of different μltrasound signs for placenta accreta was assessed.The sensitivity of loss of clear zone was 71％(15/21),and the specificity was 87％ (80/92);the sensitivity of placental lacunae and bladder wall interruption was 67％(14/21) and 62％(13/21),and the specificity was 78％(72/92) and 95％(87/92),respectively.The uterovesical hypervascularity has the lowest sensitivity (38％,8/21),but the highest specificity (98％,90/92).When combination of 2 sings was used for diagnosis,the sensitivity of the ultrasound examination was 76％ (16/21) and the specificity was 65％(60/92);when the combination of 3 signs was used,the sensitivity and specificity were 76％ (16/21) and 93％ (86/92),respectively.It is suggested that ultrasound examination in early pregnancy may find all types of placenta implants with good diagnostic accuracy.

Effects of Aroma Inhalation Therapy on Stress, Anxiety, Depression, and the Autonomic Nervous System in High-risk Pregnant Women

PURPOSE: The purpose of this study was to investigate the effect of aroma inhalation therapy on stress, anxiety, depression, and an autonomic nervous system reaction in high-risk hospitalized pregnant women. METHODS: A quasiexperimental study used a non-equivalent control group non-synchronized design. Fifty high-risk hospitalized pregnant women were selected as participants on delivery room and maternity ward at university hospital. Twenty-five were selected for the experimental group while 25 were assigned to a control group. Neroli essential oil was used for aroma therapy and was already identified as not being hazard to pregnant women. It provided emotional stability from previous study. The participants inhaled Neroli 2 minutes, 3 times (9 am to 10 am, 4 pm to 5 pm, just before sleep) a day. A total of 15 sessions were held from the day of the preliminary investigation. Pre and post written survey and measuring an autonomic nervous system reaction were collected from both groups. RESULTS: The data were analyzed by χ2 test, t-test, and paired t-test. There was a statistically significant difference in stress (t=-3.98, p<.001) between the experimental group and the control group. CONCLUSION: These findings indicate that aroma inhalation therapy is effective as a nursing intervention for the stress relief of hospitalized high-risk pregnant women.

Thyroid function change in pregnant women with gestational diabetes mellitus / 中华内分泌外科杂志

Objective To investigate changes of thyroid functions in high-risk pregnant women suffering from gestational diabetes mellitus(GDM).Methods From Feb.2013 to Jun.2014, 80 cases of high-risk preg-nant women suffering from GDM were selected as group A1(high-risk group), 80 cases of GDM pregnant women were selected as group A2(diabetic group), and 80 cases of healthy pregnant women were selected as group A 3 ( the control group ) .Indicators of thyroid function for the three groups were detected and compared .Results The positive rate of TPOAb in group A1 and A2 was significantly higher than that in group A 3, and the difference had statistical significance(P0.05), while FT4 level in group A1 and A2 was both significantly lower than that in group A3, and the difference had statistical significance (P<0.05).Conclusions The probability of thyroid dysfunction in GDM pregnant women and high-risk pregnant women is higher than that in the normal healthy pregnant women . For pregnant women with a family history of diabetes , thyroid functions should be checked comprehensively to prevent thyroid dysfunction .

Care of Preoperative Autologous Blood Donation in Late Pregnancy / 浙江中医药大学学报

[Objective] To ensure the safety of preoperative autologous blood donation in late pregnancy through a series of nursing measures.[Methods]From January 2010 to November 2011, 52 cases of pregnant women in late pregnancy took storage autotransfusion. After prenatal guardianship, psychological care, health education, blood were col ected before and after care, custody and from the blood transfusion care; record blood col ection process pregnant women with maternal-fetal reaction, the vital signs of pregnant women, birth outcomes, since the amount of al ogeneic blood transfusion, and achieve satisfactory re-sults.[Results] 52 cases of pregnant women with the blood col ection process were good, normal, with stable vital signs, abnormal fetal heart rate monitoring, one case of fetal moved too much, given the oxygen, improved with the left lateral decubitus position. In the process of self-blood transfusion, there's no ma-ternal discomfort, but with safe motherhood. [Conclusion] Effective care measures and storage of a pregnant woman autologous transfusion are relatively safe, economical and effective in the transfusion way, achieve good results, and help to improve the quality of obstetric care.

IgG Avidity Antibodies against Toxoplasma gondii in High Risk Females of Reproductive Age Group in India

Toxoplasma gondii is an obligate intracellular protozoan that is distributed worldwide. Recently, several tests for avidity of Toxoplasma IgG antibodies have been introduced to help discriminate between recently acquired and distant infections. The study was conducted in Jawaharlal Nehru Medical College and Hospital, India from February 2011 to September 2012. Serum specimens were subjected to Toxoplasma IgM ELISA and IgG avidity ELISA test. Out of 48 patients with abortions, 17 (35.4%) were positive for IgM ELISA, and 8 (16.6%) had low IgG avidity antibodies. Out of 48 patients with other obstetric problems, 23 (47.9%) were positive for IgM ELISA, and 17 (35.4%) had low IgG avidity antibodies. Combining both groups on avidity test, only 25 of 40 (62.5%) IgM-positive women had low-avidity IgG antibodies suggesting a recent T. gondii infection in these women. More importantly, 15 (37.5%) of the IgM-positive women had high-avidity antibodies suggesting that the infection was acquired before gestation The relation of IgM seropositivity with the following risk factors was not found to be statistically significant; contact with cats (0.13), non-vegetarian food habits (0.05), and low socio-economic status (0.49). While, for IgG avidity ELISA, only contact with cats (0.01) was significantly associated with seropositivity. All other risk factors have P-values of >0.05 (not significant). IgG avidity test when used in combination with IgM test was a valuable assay for diagnosis of ongoing or recently acquired T. gondii infection in India.

Effectiveness of Music Therapy on Anxiety and Depression Among High-risk Pregnant Women.

This study was intended to evaluate the effectiveness of music therapy on anxiety and depression, among high-risk pregnant women. The conceptual framework for this study was based on JW Kenny’s open system model. The research design for this study was pre-test, post-test, nonequivalent control group quasi experimental design. Setting of the study was selected by using convenient sampling technique. Samples were selected randomly for experimental and control group. Each group consisted of 30 samples. The tool used for assessing the anxiety and depression was hospital anxiety and depression scale. Content validity of the tool was outlined by seven experts in the field of psychiatric and obstetrics. Split half technique was used to assess the reliability of the tool. A pilot study was done among six subjects to check the feasibility of conducting the study. Data collection period was six weeks. Both descriptive and inferential statistics were used for this study. The music therapy was given to experimental group for 30 minutes a day for four weeks. The post-test was done using same tool after the intervention. The following were the findings of the study. The mean post-test level of anxiety in experimental group (13.23) is lesser than mean post-test level of anxiety in the control group (16.5). The obtained ‘t’ value is (3.99). The mean post-test level of depression in the experimental group (13.6) is lesser than mean post-test level of depression in the control group (14.96). The obtained ‘t’ value is (1.78). There was a significant reduction in post-test level of anxiety and depression in the experimental group. The study findings implies that the music therapy is effective in reducing the anxiety and depression among high-risk pregnant women.