Síndrome tirogástrico autoinmune en mujer joven

RESUMEN El síndrome tirogástrico autoinmune es la asociación entre dos patologías de origen autoinmune: la anemia perniciosa y la tiroiditis autoinmune, generalmente de presentación en adultos mayores. Se presenta caso de una mujer de 34 años que acude por derrame pericárdico asociado a una pancitopenia por déficit de vitamina B12 debida a una gastritis atrófica de origen autoinmunitaria. Se diagnostica una tiroiditis autoinmune. Recibe tratamiento con complejo B y levotiroxina, con mejoría del derrame. Es importante que ante patologías autoinmunitarias se realice la búsqueda sistemática de otras enfermedades de la misma estirpe para el mejor manejo clínico.

ABSTRACT Autoimmune thyrogastric syndrome is the association between two pathologies of autoimmune origin: pernicious anemia and autoimmune thyroiditis, which usually presents in older adults. We present the case of a 34-year-old woman who consult about pericardial effusion associated with pancytopenia caused by vitamin B12 deficiency due to autoimmune atrophic gastritis. Autoimmune thyroiditis is diagnosed. She receives treatment with complex B and levothyroxine, with improvement of the effusion. It is important that in the case of autoimmune pathologies, a systematic search for other diseases of the same lineage is carried out for the best clinical management.

Refractory iron deficiency anemia as an early manifestation of autoimmune gastritis in a teenager / Anemia ferropénica refractaria como presentación temprana de gastritis autoinmune en un adolescente

Abstract Autoimmune gastritis is an underdiagnosed disease in the pediatric population due to the absence of specific signs and symptoms and late clinical manifestations. Iron deficiency anemia has recently been identified as an early hematological manifestation, allowing an early diagnostic approach. We present the case of a Colombian teenager, with no history of autoimmunity, with refractory iron deficiency. He underwent extension studies; biopsies and serology compatible with autoimmune gastritis were documented, requiring parenteral iron in its evolution. This pathology is underdiagnosed in our context since early diagnosis requires a high index of suspicion to prevent associated complications.

Resumen La gastritis autoinmune es una enfermedad subdiagnosticada en la población pediátrica. Lo anterior se debe a la ausencia de signos y síntomas específicos y manifestaciones clínicas tardías. Recientemente se ha identificado la anemia ferropénica como una manifestación hematológica precoz, lo que permite un enfoque diagnóstico temprano. Se presenta el caso de un adolescente colombiano, sin antecedentes de autoinmunidad, con ferropenia refractaria, en el que se realizaron estudios de extensión y se documentaron biopsias y serología compatible con gastritis autoinmune, con requerimiento de hierro parenteral en su evolución. Esta patología es subdiagnosticada en nuestro medio, ya que el diagnóstico temprano requiere un alto índice de sospecha, lo que permite la prevención de las complicaciones asociadas.

Pregnancy outcome analysis on second pregnancy women with scarred uterus / 上海预防医学

Objective To analyse the pregnant outcome of second pregnancy women with scarred uterus after two-child policy was issued. Methods In this study, 51 308 pregnant women who gave birth in 6 hospitals in Minhang District from Jan 2015 to Dec 2018 were studied to analyze the delivery mode and pregnancy outcome in women with scarred uterus. Results ① From 2015 to 2018, there were 9 762 (19.03%) pregnant women with scarred uterus in Minhang District and 91 (0.93%) of them delivered vaginally.Scarred uterus was the most frequent indication of cesarean section (42.06%).② The incidence of severe postpartum hemorrhage (bleeding volume≥2 000 mL) in scarred uterus group was higher than that in no-scar uterus group(χ2=8.268, P=0.004).③ Adverse pregnancy outcomes were noted:there were 42 cases of pernicious placenta previa (4.30‰), 6 cases of hysterectomy (0.61‰) and 22 cases of critical rescue (2.25‰) in scarred uterus group, with higher risk than those in no-scar uterus group(χ2=178.9, P < 0.001;Fisher exact probability method P=0.000;χ2=4.272, P=0.039).There was no significant difference in perinatal mortality between scarred uterus group and no-scar uterus group (χ2=3.240, P=0.072);The maternal mortality rate among both groups was 0. Conclusion With the adjustment of fertility policy, the number of pregnant women with scarred uterus and the risk of pregnancy increase.It is necessary to strengthen the management of early warning and assessment of risk during pregnancy of scarred uterus.By effectively controlling the first cesarean section, the risk of scarred uterus re-pregnancy should be avoided.

Study to assess the etiology of vitamin b12 deficiency in patients of North Karnataka

Background: Vitamin B12 deficiency related anemia is a common form of anemia noted in our patients. Due to rising clinical awareness, the deficiency is recognized with increasing frequency. B12 deficiency is also known to have varied clinical spectrum than previously recognized. Prognosis of B12 deficiency is variable and its outcome may vary from complete recovery to permanent neurological deficits. Aim and objectives: To assess the etiology of Vitamin B12 deficiency in patients with B12 deficiency related anemia. Materials and methods: 75 patients diagnosed with vitamin B12 deficiency were assessed to study the etiology. Data collected was analyzed and different levels of vitamin B12 and different age groups were correlated with sex, diet pattern, etiology, anti-intrinsic factor antibody (AIFA) and levels of B12 deficiency. Results: Of the 75 patients analyzed, 44 (58.7%) were males and 31(41.3%) were females. The mean age was 35.8 year with majority of patients (33.3%) in the age group 21-30 years. 57 (76%) patients were strict vegetarians while 18 (25 %) were on mixed diet. Patients presented with general weakness (66.7%), severe anorexia (60%), dyspnoea on exertion (40%), giddiness, tingling and numbness (33.3%), jaundice (20%), and ataxia (9.3%). Mean Hb was 6.14 g% (range 1.7-11.2 g%) with MCV of 111.37 fL (64.9-134 fL). The mean serum vitamin B12 level was 125.94 pg/ml, range 30-120 pg/ml. Inadequate dietary intake (nutrition) was the most common etiology seen in 48 patients (64%), followed by alcohol in 14 (18.7%) and pernicious anemia in 9 (12%) patients. Conclusion: We observed that vitamin B12 deficiency is commonly seen in our region, which might be due to insufficient dietary intake of vitamin B12 and can be described as a treatable disease with Nagaraj Kotli, Sagar Sourabh. Study to assess the etiology of vitamin b12 deficiency in patients of North Karnataka. IAIM, 2019; 6(5): 104-111. Page 105 good short and long term outcomes. Clinical signs and symptoms, etiology, in this study were similar to those of other studies.

Gastritis autoinmune: diagnóstico y manejo de una entidad subdiagnosticada / Autoimmune gastritis: diagnosis and management of an underdiagnosed disease

Autoimmune gastritis (AIG) or chronic atrophic gastritis type A, is a chronic inflammatory disease that affects the body and fundus mucosa of the stomach. It is an underdiagnosed entity, whose clinical presentation has a broad spectrum, which may include asymptomatic patients; hematological manifestations such as iron deficiency anemia, vitamin B12 deficiency anemia (so called pernicious); non-specific digestive symptoms like dyspepsia; neurological and psychiatric manifestations. AIG is associated with other autoimmune diseases, mainly hypothyroidism ("Tyrogastric Syndrome") and type 1 diabetes. It is characterized by the development of anti-parietal cell and anti-intrinsic factor antibodies, decrease in pepsinogen I (PGI) level with low PGI/PGII ratio (< 3), and high level of gastrin. Endoscopic findings are not sufficient for the diagnosis of gastric atrophy. The use of the Sydney pathological report protocol and the OLGA/OLGIM system to evaluate the severity of gastritis have improved their diagnosis and the possibility to establish the risk of developing gastric neoplasms. The importance of its diagnosis and surveillance is based on the development of type 1 neuroendocrine gastric neoplasms, in addition to an increased risk of the incidence of gastric adenocarcinoma. Currently, an individualized endoscopic surveillance seems reasonable, with a minimum interval of 3 years.

La gastritis autoinmune (GAI) o gastritis crónica atrófica tipo A, es una enfermedad inflamatoria crónica que afecta la mucosa del cuerpo y fondo del estómago. La GAI es una entidad subdiagnosticada, cuya presentación clínica es de amplio espectro, puede incluir pacientes asintomáticos; manifestaciones hematológicas, tales como anemia ferropriva, anemia por déficit de vitamina B12 (anemia perniciosa); digestivas inespecíficas tipo dispepsia; neurológicas y psiquiátricas. La GAI está asociada a otras enfermedades autoinmunes, principalmente hipotiroidismo ("síndrome tirogástrico") y diabetes tipo 1. Se caracteriza por el desarrollo de anticuerpos anti células parietales y anti factor intrínseco, bajo nivel de pepsinógeno I (PGI) con una baja relación PGI/PGII (< 3), e hipergastrinemia. Los hallazgos endoscópicos no son suficientes para el diagnóstico de atrofia gástrica. El uso de protocolo de Sydney de reporte patológico y sistema OLGA/OLGIM para evaluar la severidad de gastritis han mejorado su diagnóstico y objetivado su riesgo de desarrollar neoplasias gástricas. La importancia de su diagnóstico y seguimiento está basada en el desarrollo de neoplasias gástricas neuroendocrinas tipo 1, además de un riesgo incrementado de la incidencia de adenocarcinoma gástrico, entre otros. Actualmente, parece razonable un seguimiento endoscópico individualizado, siendo un intervalo mínimo de 3 años.

Comparative study of extra vascular occlusion of low abdominal aorta and low abdominal aortic balloon occlusion in the treatment of placenta previa with implantation / 实用医学杂志

Objective To compare the clinical efficacy of extra vascular occlusion of low abdominal aorta and low abdominal aorta balloon occlusion in the treatment of placenta previa with placenta previa.Methods From January 2014 to July 2017,68 implantable placenta previa patients were divided into two groups,elective cesarean section of extra vascular occlusion of low abdominal aorta in 34 cases(group A)and cesarean section on the lower abdominal aorta balloon occlusion in 34 cases(group B),and observation of pregnant women was compared between surgery of two groups. Results Operation time,complications of vascular injury and thrombosis,fetal radiation exposure in group A were significantly lower than that of group B(P<0.05);two groups of patients with sensory dysfunction incidence,cesarean operation time,intraoperative blood loss,blood transfusion rate,the uterus resection rate,hospitalization time had no statistically significant difference postoperatively(P > 0.05). Conclusion Two kinds of operation can safely and effectively reduce the bleeding during the treatment of placenta previa. While group A surgery operation time is short,without intraoperative and postoperative bleeding of the puncture site,without pelvic and lower extremity arterial thrombosis,without X-ray exposure,more safety of the womb and can be popularized in clinic.

Research on the influence of high quality nursing interventions in patients with pernicious placenta previa and the neonate's prognosis / 中国实用护理杂志

Objective To explore the influence of high quality nursing interventions in patients with pernicious placenta previa and the neonate's prognosis. Methods The clinical data about 28 patients with pernicious placenta previa treated from January 2016 to January 2017 were reviewed;the high quality nursing interventions were applied(study group). 30 patients with pernicious placenta previa treated from December 2014 to December 2015 were selected;the conventional nursing cares were applied (control group). After intervention, the clinical prognosis for the infants and mom was analyzed. Results At the time of admission, the research group of state anxiety and trait anxiety and depression scale scores were 58.42±3.61,55.57±2.69,55.06±2.67,before discharge,patients in the study group,state anxiety and trait anxiety and depression scale scores were 42.19 ±2.16,47.20±2.74 and 44.25± 4.36,the control group were respectively 58.96±3.35,55.27±2.75,55.23±3.12,before discharge respectively 44.35± 3.13, 49.35 ± 3.13, 48.67 ± 5.16, two groups were SAI, TAI and SDS score comparison no statistical significance (t=0.591, 0.420, 0.222, P > 0.05), the difference between the two groups before discharge compared with statistical significance (t=3.038, 2.775, 3.511, P<0.01);the time of termination of pregnancy, postpartum hemorrhage and neonatal postpartum 1min Apgar scores of the study group were 36.15± 0.77,1 000.19 ± 14.21,9.13± 0.10,the control group were 33.50±0.66,1 516.71 ±29.08,8.79± 0.50, and the difference was statistically significant (t=14.102, 32.490, 3.531, P<0.01);comparison of body mass in two groups showed no statistical significance (P>0.05);group of maternal and neonatal complications for a total of 7.14% (2/28), significantly lower than the control group 20.00%(6/30), the difference between significant(χ2=7.050,P<0.01);evaluation of nursing measures of maternal satisfaction in the study group(95.23+4.65)was higher than that of the control group(91.36±5.63),the difference was statistically significant correlation (t=2.842,P<0.05). Conclusions The high quality nursing interventions have an obvious effect in patients with pernicious placenta previa.It can relieve the negative emotions and improve the mom&infant's outcomes and the clinical satisfaction.

Perioperative nursing care of patients with pernicious placenta previa and placenta accreta treated with temporary ballon occlusion of the abdominal aorta / 中国实用护理杂志

Objective To study the nursing effect of temporary ballon occlusion of the abdominal aorta in the treatment of pernicious placenta previa and placenta accrete. Methods Nursing points and experience of 126 cases of pernicious placenta previa and placenta accreta using temporary ballon occlusion of the abdominal aorta to prevent intraoperative bleeding in caesarean section were retrospectively summarized. This paper introduced the method, safety and superiority of the way of temporary ballon occlusion of the abdominal aorta, and the method of nursing care of patients with temporary ballon occlusion of the abdominal aorta, and the methods of the observation and prevention of postoperative bleeding and the nursing of pain. Results Totally 126 patients successfully achieved hemostasis, no hysterectomy occurred. Conclusions Through effective nursing of temporary ballon occlusion of the abdominal aorta in the treatment of pernicious placenta previa and placenta accrete, the postpartum hemorrhage, blood transfusion and the risk of hysterectomy can be reduced.

The application of prophylactic abdominal aorta balloon occlusion with Fogarty catheter in treating patients with pernicious placenta previa / 介入放射学杂志

Objective To discuss the clinical effect of prophylactic abdominal aorta balloon occlusion with Fogarty catheter before cesarean section in treating delivery woman with pernicious placenta previa.Methods The clinical data of 12 delivery women with pernicious placenta previa,who received prophylactic abdominal aorta balloon occlusion with Fogarty catheter before cesarean section,were retrospectively analyzed.The curative effect was evaluated.Results The average intraoperative blood loss in the 12 patients was (1256±318) ml.The uterus was successfully retained in 9 patients.Hysterectomy had to be carried out in 3 patients because of refractory hemorrhage;one of them had to receive total hysterectomy together with bladder repair as the placenta had penetrated into the bladder wall.After delivery no complications,such as infection,delayed hemorrhage,lower limb thrombosis,etc.,occurred.All 12 neonates were born smoothly.Conclusion Prophylactic abdominal aorta balloon occlusion with Fogarty catheter before cesarean section can effectively reduce intraoperative blood loss and help save the uterus.Therefore,it is a safe and effective therapeutic means for delivery woman with pernicious placenta previa before the performance of cesarean section.

Pancitopenia em pacientes com anemia perniciosa. Estudo descritivo de 33 casos. / Pancytopenia in patients with pernicious anemia. Descriptive study of 33 cases.

Objetivo: Discriminar as variáveis de sexo e idade nos pacientes com anemia perniciosa; estudar seu perfil hematimétrico; verificar a prevalência de outras doenças autoimunes e anemia perniciosa; analisar a incidência da pancitopenia e sua relação com alterações laboratoriais comum na doença; e avaliar a frequência dos autoanticorpos anticélulas parietais e antifator intrínseco. Métodos: Estudo transversal descritivo, de base clínica e laboratorial, de 33 prontuários de pacientes com anemia perniciosa, diagnosticados em um ambulatório de hospital terciário de atenção à saúde, no período de junho de 2009 a junho de 2014. Para analisar a relação da presença e da ausência de pancitopenia com os níveis da enzima lactato desidrogenase e vitamina B12, foi utilizado o teste qui quadrado. O programa utilizado foi o software Epi Info, versão 7. Resultados: Na amostra, 63,6% eram mulheres, e a idade média geral foi de 47,3 anos. Doenças autoimunes estavam associadas em 30,3% dos pacientes. A pancitopenia esteve presente em 39,4% dos pacientes. Houve significância estatística na relação da pancitopenia com os níveis de enzima lactato desidrogenase (p<0,05). A prevalência do antifator intrínseco foi de 69,7% e dos autoanticorpos anticélulas parietais foi de 72,7%. Conclusão: A pancitopenia mostrou-se um achado significante na população com anemia perniciosa, assim como níveis elevado de LDH, acrescentando a anemia perniciosa como um diagnóstico diferencial de tais alterações laboratoriais.(AU)

Objective: To discriminate the gender and age variables in patients with pernicious anemia; to study erythrocyte profile; to check the prevalence of other autoimmune diseases and pernicious anemia; to analyze the incidence of pancytopenia and its relationship with common laboratory abnormalities in the disease; to evaluate the frequency of anti-gastric parietal cell antibodies, and anti-intrinsic factor antibodies. Methods: Descriptive, cross-sectional study of clinical and laboratorybased medical records of 33 patients with pernicious anemia diagnosed in an outpatient's department of a tertiary healthcare center, in the period between June 2009 and June 2014. To analyze the relationship between the presence and absence of pancytopenia with levels of lactate dehydrogenase enzyme and levels of Vitamin B12 we used the chi-squared test. The software used was Epininfo version 7. Results: The sample showed 63.6% women and 36.4% men with a mean age of 47.3 years. Autoimmune diseases were associated in 30.3% of the patients. Pancytopenia was present in 39.4% of patients. There was statistically significant relationship of pancytopenia with lactate dehydrogenase enzyme levels (p <0.05). The frequency of anti-intrinsic factor antibodies was 69.7%, and the antigastric parietal cell antibodies was 72.7%. Conclusion: Pancytopenia proved to be a significant finding among the population with pernicious anemia and high levels of LDH, which includes pernicious anemia as a differential diagnosis of such laboratory alterations.(AU)

Anemia perniciosa en una paciente con artritis reumatoide y vitíligo / Pernicious anemia in a female patient with rheumatoid arthritis and vitiligo

Resumen: Comunicamos el caso de una mujer en la cuarta década de la vida con antecedentes personales de artritis reumatoide y vitíligo, quien acudió a consulta por síndrome anémico. En su abordaje diagnóstico encontramos concentraciones bajas de vitamina B12 y anticuerpos contra factor intrínseco positivos con lo que llegamos al diagnóstico de anemia perniciosa. Este caso apoya la definición del término de síndrome de poliautoinmunidad en el que existe asociación entre diferentes enfermedades autoinmunitarias sin relación comprobada previamente.

Abstract: We report the case of a woman in the fourth decade of life with previous medical history of rheumatoid arthritis and vitiligo who presented with anemic syndrome. In the diagnostic workup we found low levels of vitamin B12 and positive intrinsic factor antibodies that corroborate the diagnosis of pernicious anemia. This clinical case supports the definition of polyautoimmune syndrome in which there is a link between different autoimmune diseases without a previous known relation.

Demencia reversible por déficit de vitamina B12 en un adulto mayor / Reversible dementia caused by vitamin B12 deficiency in an older adult

Se presenta el caso de un paciente adulto mayor con antecedente de haber presentado úlcera gástrica hace 40 años, cuyos familiares observaron desde hace dos meses cambios en el comportamiento, los cuales incluyeron progresivamente desorientación, agitación psicomotriz, negativismo, delirio de persecución, lo que motivó ser traído al servicio de emergencia. Así mismo presentó palidez marcada y equimosis múltiple, por lo cual fue admitido posteriormente en nuestro servicio y diagnosticado de demencia reversible por anemia perniciosa. También se le detectó pancitopenia y cambios neurológicos. El paciente respondió favorablemente a la administración de vitamina B12.

This is the case of an elderly patient with a 40-year history of stomach ulcer, whose relatives perceived behavioral changes for the last two months. Those changes progressively included disorientation, psychomotor agitation, negativism and delirium of persecution, which caused him to be brought to the emergency room. He also showed marked pallor and multiple ecchymosis, due to which he was hospitalized in our service and diagnosed with reversible dementia caused by pernicious anemia. Pancytopenia and neurological changes were also found. The patient responded favorably to the administration of vitamin B12.

Application of ultrasound-guided temporary balloon occlusion in performing cesarean section for patients with pernicious placenta previa: initial results in 13 cases / 介入放射学杂志

Objective To discuss the clinical application of ultrasound-guided temporary balloon occlusion in performing cesarean section for patients with pernicious placenta previa.Methods At Qujing Municipal First People's Hospital,the Interventional Department and Ultrasonography Department assisted the Obstetrics Department to accomplished cesarean section for 13 patients with pernicious placenta previa.The diagnosis of central placenta previa was confirmed by both color ultrasound and MRI in all the 13 patients.Before cesarean section,the balloons were placed in bilateral common iliac arteries or in abdominal aorta,and the balloons were inflated at the same time when the fetus was delivered so as to temporarily obstruct the target vessels.Based on the hemostatic condition,the balloon was timely withdrawn.Results Among the 13 patients,temporary abdominal aorta occlusion was employed in one and temporary bilateral common iliac artery occlusion in 12.Ultrasound-guided occlusion was successfully accomplished in 12 patients,and the average blocking time was ＜15 min.The amount of intraoperative blood loss was 800-1500 ml.Conclusion Ultrasound-guided temporary balloon occlusion before cesarean section is safe with reliable effect in treating pernicious placenta previa,it can remarkably reduce the amount of intraoperative blood loos,and it has no X-ray radiation damage,therefore,this technique is worthy of clinical application.

The clinical application of balloon occlusion technique in treating obstetric hemorrhage / 介入放射学杂志

Objective To discuss the clinical efficacy of balloon occlusion technique in treating pernicious placenta previa.Methods Between January 2015 and March 2016,a total of 16 matcrnal patients with pernicious placenta previa,who were admitted to the Interventional Department of Qujing Municipal First People's Hospital,received balloon occlusion management to assist obstetrician in dealing with placenta previa.Central type of placenta previa with highly suspected placenta implantation were diagnosed in 15 patients by color ultrasound or MRI.Balloon catheters were placed in bilateral internal iliac arteries before cesarean section was carried out,and immediately after the fetus was taken out the balloons were inflated to temporary occlude the targeted arteries.Based on the hemostatic status the balloon catheters were timely retrieved.One patient received emergency temporary balloon occlusion of abdominal aorta,and laparotomy revealed that the placenta had penetrated to the subserosa of uterine anterior wall,and total hysterectomy had to be carried out.Results Successful balloon occlusion was achieved in all 16 patients.The mean blocking time of the artery was 15 minutes and the amount of blood loss was 300-1200 ml.Conclusion In treating pernicious placenta previa,balloon occlusion treatment before cesarean section is safe and reliable,it can significantly reduce the amount of blood loss during surgery,make quick and effective hemostasis,provide a clear surgical field for the performance of cesarean section,and,more important,save the maternal life.This effective technique has fully showed the necessity of multidisciplinary collaboration,including obstetrics,interventional radiology,etc.

The application of temporary balloon occlusion technique in performing cesarean section for patients with pernicious placenta previa / 介入放射学杂志

Objective To compare the safety and effectiveness of temporary occlusion techniques with different balloons in performing cesarean section for patients with pernicious placenta previa.Methods The clinical data of 15 patients with pernicious placenta previa,who received cesarean section during the period from March 2014 to April 2016,were retrospectively analyzed.In order to reduce bleeding during operation and to preserve the uterus as far as possible,temporary occlusion of abdominal aorta with balloon was adopted in 7 patients (group A),and temporary balloon occlusion of bilateral internal iliac arteries was employed in 8 patients (group B).The intraoperative radiation dose,the amount of blood loss and blood transfusion during cesarean section,the hysterectomy rate,the postoperative hospitalization days,and the intervention-related complications were documented,and the results were compared between the two groups.Results All the 15 patients were suffered from central type of placenta praevia complicated by extensive placenta accreta.With the help of temporary balloon occlusion technique,the cesarean section was successfully accomplished in all 15 patients.Subtotal hysterectomy had to be done in 7 patients,including 4 patients of group A and 3 patients of group B,and every one patient from each group developed arterial thrombosis of lower limb.The intraoperative radiation dose of group A was significantly lower than that of group B (P＜0.01),besides the amount of blood loss and blood transfusion during cesarean section,the hysterectomy rate,the postoperative hospitalization days,and the intervention-related complications of group A were all lower than those of group B,but because of the limited number of cases these differences were not statistically significant (P＞0.05).Conclusion For the treatment of pernicious placenta previa,temporary balloon occlusion technique-assisted cesarean section is safe and effective.The intraoperative radiation dose in the group using temporary balloon occlusion of abdominal aorta is remarkably lower than that in the group using temporary balloon occlusion of bilateral internal iliac arteries.

Application of one-stage hybrid technique in treatment of pernicious placenta previa / 实用医学杂志

Objective To assess the value of one-stage hybrid technique for treatment of pernicious placenta previa. Methods 12 patients with pernicious placenta previa who had received simultaneously Cesarean section and temporary balloon occlusion of abdominal aorta or internal iliac artery in the hybrid operation room were included in this study. 12 patients with pernicious placenta previa who had preserved balloon ducts in internal iliac artery before Cesarean section were chosen as a control group. Balloons were filled to control hemorrhage during the procedure. The hemodynamic parameters including blood pressure and heart rate were monitored during the opera-tion. Surgical duration ,amount of blood loss ,amount of blood transfusion ,volume of infusion ,urine volume during the procedure,postoperative volume of blood loss within 24 hours,uterine hysterectomy rate and neonatal conditions were compared between the two groups. Results During the operation,the blood pressure and heart rate in hybrid group were more stable. The mean surgical duration was(72 ± 8)min,the intraoperative mean amount of blood loss was(620 ± 95)mL,the mean amount of blood transfusion was(550 ± 40)mL,the mean volume of infusion was(1850 ± 160)mL,the mean amount of blood loss in 24 h after the operation was(75 ± 9) mL in the hybrid group,which were significantly lower than those in the control group(P<0.05 for all comparisons). No serious complications occurred in any of the two groups after the operation. There were no significant differences in neonatal conditions between the two groups. Conclusions One-stage hybrid technique has an obvious effect in the control of intraoperative bleeding in patients with pernicious placenta previa. It is worth popularizing in the hospital whose conditions are permitted.

Observation on the curative effect of carboprost tromethamine combined with mifepristone on the treatment of the patients with risky placenta previa / 中国生化药物杂志

Objective Onto observe the curative effect of carboprost tromethamine injection combined with mifepristone on the treatment of the patients with risky placenta previa. Methods 66 cases with placenta previa during mid pregnancy from January 2016 to December 2016 in Dingbian county people's hospital were randomly divided into two groups, 33 cases in the control group and 33 cases in the observation group. All patients were received cesarean section and traditional treatments such as oxytocin and gauze filling. Hemostatic effect, prognosis and incidence of adverse reactions in the two groups were compared. Results The intraoperative bleeding volume, the amount of vaginal bleeding 2 hours after operation and the amount of vaginal bleeding 2 to 24 hours after operation in the observation group were less than those in the control group (P<0.05). The rate of postpartum hemorrhage, the rate of disseminated intravascular coagulation and the incidence of puerperal disease in the observation group were significantly less than those in the control group (P<0.05). The sanguinous lochia time and menstrual recovery time in the observation group were better than those in the control group (P<0.05). There was no significant difference in the rate of hysterectomy and adverse reactions between the two groups. Conclusion Carboprost Tromethamine Injection combined with mifepristone in the treatment of pernicious placenta previa can effectively reduce the bleeding rate and promote the rehabilitation of pregnant women. It is safe and has no obvious adverse reactions. It is worthy of clinical application.

A successful experience of using recombinant human coagulation factor Ⅶ a for treatment of a patient with pernicious placenta previa and massive postpartum hemorrhage / 中国中西医结合急救杂志

Massive postpartum hemorrhage is one of the most severe complications of pregnant women during deliveries, especially, on the basis of a scarred uterus with placenta previa and placenta implantation, the risk of occurrence of massive hemorrhage after delivery will be obviously increased. The recombinant human coagulation factorⅦa (rFⅦa) can be used to significantly reduce the incidence of delutional coagulopathy and the necessary amount of blood products in patients after major abdominal surgery. One patient with massive postpartum hemorrhage resulted from scarred uterus with placenta previa and previa accreta was administered into Guizhou Medical University Affiliated Hospital, whose hemorrhage was successfully stopped by using rFⅦa in case of surgical indication being excluded. It is suggested that rFⅦa can be regarded as an effective drug for postpartum hemorrhage on the basis of indication being strictly controlled.

Efficacy and Influence of Ovarian Function after Multiple Cervical Suture for Pernicious Placenta Previa / 医学研究杂志

Objective To investigate the efficacy and influence of ovarian function after multiple cervical suture for pernicious placenta previa.Methods A reteospective analysis was performed in 107 patients who underwent ineffective conservative treatment for PPP,indcluding 41 patients who underwent multiple cervical suture and 66 pantiets who underwent uterine packing.The clinical effects of the two groups were observed.The menstrual status and ovarian function were followed up.Results The significant difference of amount of blood loss during operation,transfusion volume,0peration time,hysterectomy rate,ICU stay days,hemostatic time and 24-hour postoperative vaginal bleeding amount,postoperative fever,continuance times of lochia was comporred (P ＜ 0.05).There were no significant differences in uterine insrauration rate,menstruation recovery and basic sex hormone levels between the two groups (P ＞ 0.05).Conclusion Multiple cervical suture for patients with pernicious placenta previa was effective,and worthy of clinical promotion and application.

A successful experience of using recombinant human coagulation factor Ⅶ a for treatment of a patient with pernicious placenta previa and massive postpartum hemorrhage / 中国中西医结合急救杂志

Massive postpartum hemorrhage is one of the most severe complications of pregnant women during deliveries, especially, on the basis of a scarred uterus with placenta previa and placenta implantation, the risk of occurrence of massive hemorrhage after delivery will be obviously increased. The recombinant human coagulation factorⅦa (rFⅦa) can be used to significantly reduce the incidence of delutional coagulopathy and the necessary amount of blood products in patients after major abdominal surgery. One patient with massive postpartum hemorrhage resulted from scarred uterus with placenta previa and previa accreta was administered into Guizhou Medical University Affiliated Hospital, whose hemorrhage was successfully stopped by using rFⅦa in case of surgical indication being excluded. It is suggested that rFⅦa can be regarded as an effective drug for postpartum hemorrhage on the basis of indication being strictly controlled.