ABSTRACT
L'objectif était d'évaluer les facteurs de risque de la RU et de proposer les aspects thérapeutiques. Matériels et méthodes : Nous avons réalisé une étude cas-témoins au centre de santé de Référence de Bougouni en 2019. Résultats : De janvier au 31 décembre 2019; sur 1161 accouchements 43 RU ont été enregistrées soit 3,7% correspondant à une RU pour 27 accouchements. Les patientes de 35 ans et plus ont été plus touchée par la RU (44,2%) avec ORaIC95%= 6,3 [1,5 - 26,3]. Les évacuations obstétricales avaient un ORaIC95%=25,6 [7,8- 83,7]. La totalité des patientes étaient des femmes au foyer (97,7%) des cas versus (82,3%) des témoins avec ORaIC95%= 8,9 (1,1-69). Les Paucipares et multipares avaient respectivement un ORaIC95%= 6,2 [1,8 - 20,3] et 4,1[1,3 - 12,9]. La cicatrice utérine (20,9%) des cas contre 8,1 % les témoins avait un ORaIC95%= 2,9 [1,1 - 8,7]. En effet l'absence de CPN étaient un facteur de risque, ORaIC95%= 3,0 [1,3 6,9]. Le délai de la RU était Ë 6 heures chez 95%. En effet 34 RU complètes (79,1%) et 9 RU incomplètes (20,9%) ont été notées. Seulement 2,3 % des cas avaient accouché par voie basse. Le traitement de la RU reposait sur la chirurgie (100%) complétée par celui du choc (51,2%) des cas et de l'infection (100%) des cas. Conclusion: La RU est fréquente dans nos pays sous médicalisés. Sa prévention efficace passe par des stratégies visant à agir sur les facteurs de risque
The objective was to assess the risk factors for and to suggest therapeutic aspects. Materials and methods: We carried out a case-control study at the Bougouni Reference health center in 2019. Results: From January to December 31, 2019; out of 1161 deliveries, 43 uterine rupture were recorded, 3.7% corresponding to one uterine rupture for 27 deliveries. Patients 35 years and older were more affected by uterine rupture (44.2%) with ORaIC95% = 6.3 [1.5 - 26.3]. Obstetric evacuations had an ORaIC95% = 25.6 [7.8-83.7]. All of the patients were housewives (97.7%) versus (82.3%) controls with ORaIC95% = 8.9 (1.1-69). Pauciparous and multiparous had an ORaIC95% = 6.2 [1.8 - 20.3] and 4.1 [1.3 - 12.9], respectively. The uterine scar (20.9%) of cases versus 8.1% of controls had a 95% ORaIC95% = 2.9 [1.1 - 8.7]. Indeed the absence of ANC was a risk factor, ORaIC95% = 3.0 [1.3 - 6.9]. The time to uterine rupture was Ë 6 hours in 95%. In fact 34 complete uterine rupture (79.1%) and 9 incomplete uterine rupture (20.9) were noted. Only 2.3% of cases gave birth vaginally. Treatment of uterine rupture was based on surgery (100%) supplemented by shock (51.2%) of cases and infection (100%) of cases. Conclusion: Uterine rupture is common in our countries under medical care. Its effective prevention involves strategies aimed at acting on risk factors.
Subject(s)
Uterine Rupture , Risk Factors , Diagnostic Test Approval , Anger Management Therapy , Complementary Therapeutic MethodsABSTRACT
Objective To evaluate the rupture risk of carotid atherosclerotic plaque under cervical rotatory manipulation. Methods The fluid-structure interaction (FSI) model of carotid atherosclerotic plaque was established, and tensile deformation of the plaque and lumen under cervical rotatory manipulation was simulated.Mechanical parameters such as the maximum flow shear stress(FSS), the maximum wall shear stress (WSS), the maximum plaque wall stress (PWS), wall tensile stress (WTS) and wall pressure (WP) of the plaque and lumen were recorded. Results Under 16% carotid tensile deformation, the maximum WSS of the plaque was 40.54 Pa. The maximum PWS was 66.16 kPa, which was far smaller than the threshold of plaque rupture.The maximum WTS of fiber cap and the maximum strain were 156.75 kPa and 0.56, which were larger than the fracture strain range. The maximum WTS of the lumen was 1 040.30 kPa, which approached the threshold of medial membrane rupture and might cause vascular injury. Conclusions When the cervical spine rotates to the end range of motion, large carotid artery stretch may cause damage to epidermal tissues of the plaque, leading to abscission. Lesions, ulcers, bleeding and vascular damage may form inside the plaque, which will affect stability of the plaque. Cervical rotatory manipulation should be performed cautiously in patients with cervical diseases who also have carotid atherosclerotic plaques.The finite element assessment of plaques before manipulation may be an effective safety screening method.
ABSTRACT
Objective To preliminarily analyze the risk factors for rupture of intracranial aneurysms combined with proximal parent artery stenosis. Methods From June 2016 to December 2018, 52 admitted patients with intracranial aneurysms combined with proximal parent artery atherosclerotic stenosis and admitted in Neurosurgery Department of First Hospital Affiliated to Naval Military Medical University were enrolled. All patients were diagnosed by DSA. The 52 patients were divided into the ruptured group and the unruptured group, with each group containing 26 patients. The baseline data, 3D DSA data, morphology and hemodynamic parameters of intracranial aneurysms with parent artery stenosis were collected and compared between the two groups. The baseline data included age, gender, prior history of hypertension, smoking, diabetes, cerebral infarction, oculomotor palsy and multiple aneurysms. 3 D DSA data included degree of stenosis (mild to severe). Morphological and hemodynamic parameters included normalized wall shear stress (NWSS), percentage of low wall shear stress area (LSA), aspect ratio (AR), distance of stenosis, size ratio (SR) and degree of stenosis (quantitative index). Results (1) The proportion of female in the ruptured group was higher than that in the unruptured group (80.8% [21/26] vs. 53. 8% [14/26] , χ2 =4. 282, P = 0. 039). There was no difference in ypertension, diabetes, smoking history, multiple aneurysms, cerebral infarction and oculomotor paralysis between the two groups (all P >0. 05). (2) There was no difference in the degree of stenosis (mild to severe) between the two groups (P > 0.05). (3) The ruptured group had lower NWSS than that of the unruptured group, but higher LSA and AR(0.691 [0. 560, 0. 867] vs. 0.852 [0.701, 1.097], Z = -2. 397; 7. 91% [1.28%, 11. 94%] vs. 1.36%[0.28%, 3.48%], Z = 2.581;[1. 1 ±0. 3] vs. [0. 9 ±0.4], t =2.751; all P 0. 05). Conclusion Female, high LSA, high AR and low NWSS may have an impact on the rupture of intracranial aneurysms with parent artery stenosis.
ABSTRACT
In recent years, computational fluid dynamics (CFD) has been widely used in fundamental and clinical researches of cerebral aneurysms. The research direction involves: ① the hemodynamic risk factors associated with initiation, evolution and rupture of cerebral aneurysms, ② the assessment of flow field changes in cerebral aneurysms after the implantation of coils and stent as well as the effect of such endovascular treatment by establishing the patient-specific models. This review elaborates the research progress in hemodynamics of cerebral aneurysms from 3 aspects: the development of CFD models, the morphological and hemodynamic parameters for rupture risk assessment of aneurysms and the role of CFD in the endovascular treatment of cerebral aneurysms.
ABSTRACT
An abdominal aortic aneurysm (AAA) is a vascular pathology associated with localized and balloon-like dilatations of abdominal aorta. An untreated AAA may lead to an eventual rupture with a high mortality rate. In recent studies, the biomechanics of AAA has been widely used to assess the rupture risk in clinic. In this review paper, biomechanical testing methods on intraluminal thrombi and AAA are discussed, so as to fully understand biomechanical properties of intraluminal thrombi and aneurysmal tissues, as well as the influence of mechanical property changes on the AAA growth and remodeling under pathological environment. Then representative research findings on prediction of rupture risk by a series of experimental and computational biomechanical methods are reviewed, including finite element analysis on stress distributions on AAA wall, assessment of rupture risk index and judgment of rupture locations. The relevant microstructural changes caused by thrombus aging are described in detail, and the current situation of biomechanical studies on AAA and future challenges are briefly summarized.
ABSTRACT
The American College of Obstetricians and Gynecologists (ACOG) has recommended that the most women with one previous cesarean delivery with a low-transverse incision are candidates for vaginal birth after cesarean and should be counseled about VBAC and offered a trial of labor in the hospital which has physicians immediately available to provide emergency care including cesarean section and personnel familiar with the potential complications of a trial of labor who should be vigilant for nonreassuring fetal heart rate patterns and inadequate progress of labor. The safer VBAC will be provided when the physicians and patients are alert about the risk, benefit and disadvantage of VBAC, and when the reasonable management of the labor is performed. The success of VBAC will contribute to prevent unnecessary primary cesarean and reduce the overall cesarean delivery rate.
Subject(s)
Female , Humans , Pregnancy , Cesarean Section , Emergency Medical Services , Heart Rate, Fetal , Trial of Labor , Vaginal Birth after CesareanABSTRACT
The American College of Obstetricians and Gynecologists (ACOG) has recommended that the most women with one previous cesarean delivery with a low-transverse incision are candidates for vaginal birth after cesarean and should be counseled about VBAC and offered a trial of labor in the hospital which has physicians immediately available to provide emergency care including cesarean section and personnel familiar with the potential complications of a trial of labor who should be vigilant for nonreassuring fetal heart rate patterns and inadequate progress of labor. The safer VBAC will be provided when the physicians and patients are alert about the risk, benefit and disadvantage of VBAC, and when the reasonable management of the labor is performed. The success of VBAC will contribute to prevent unnecessary primary cesarean and reduce the overall cesarean delivery rate.
Subject(s)
Female , Humans , Pregnancy , Cesarean Section , Emergency Medical Services , Heart Rate, Fetal , Trial of Labor , Vaginal Birth after CesareanABSTRACT
Intracranial aneurysm is a common disorder. With the ongoing improvement of medical imaging technique, the chance of finding an unruptured intracranial aneurysm in clinical practice has steadily increased. The rupture of aneurysms can result in subarachnoid hemorrhage and even in life-threatening conditions. Recent researches have indicated that the rupture risk of intracranial aneurysms bears a close relationship to the aneurysm's features, such as the size, site, shape, number, growth orientation, growth rate, etc. A further understanding of the features of unruptured intracranial aneurysm is very valuable for the effective prevention of its rupture.