RESUMO
The survival rate of adult patients with congenital heart disease(CHD)has increased during the last few decades as a result of significant improvement in diagnosis and treatment.Women with CHD are therefore more likely to live to childbearing age,and to decide to have children.Compared with the general parturients,maternal risk and neonatal complications such as prematurity,intra-uterine fetal growth restriction,fetal demise,or neonatal mortality,are increased in pregnant women with CHD.How can we minimize the maternal mortality and morbidity risk and improve perinatal outcome?We retrospectively reviewed articles and documents about pregnancy with congenital heart disease,and tried to discuss it in this article.
RESUMO
Postpartum hemorrhage,a frequent emergency in obstetrics,is the first reason for maternal mortality in China and worldwide.The contributors to adverse outcome included delayed treatment because of underestimation of blood loss,lack of blood products,lack of treatment algorithms,lack of knowledge and training,insufficient interdisciplinary communication and inadequate management.Therefore,it is essential to improve the management of medical institutions and set up a protocol for emergency situations.Meanwhile,the key point in rescue postpartum hemorrhage is the teamwork with efficient training and cooperation.This article made a review on the management of postparttum hemorrhage,establishment of emergengy protocol and risk assessment and team cooperation based on guidelines and recommendations published by main authorities and the latest studies.The goal of the article is to provide some ideas to reduce the frequency of severe hemorrhages after delivery and improve maternal outcomes.
RESUMO
Objective·To investigate the effect of recombinant adiponectin on the pregnancy outcome and the balance of Th 17/regulatory T cell (Treg) in spontaneous abortion murine model.Methods· CBA/J(♀)×DBA/2(♂) mating was used as a spontaneous abortion model,while CBA/J(♀)×BALB/c(♂) mating as a normal pregnancy model.CBA/J female mice were intraperitoneal injected with 10 μg/(kg·d) recombinant adiponectin for 9 d from day 5 of gestation.The control group received equal volumes of PBS each day.On day 14 of gestation,the mice were killed.The embryo resorption rate was calculated.The levels of serum adiponectin,IL-17 and TGF-β were detected by ELISA.Spleen lymphocytes were isolated.The ratios of Thl 7/Treg were counted by flow cytometry(FCM).Results· Recombinant adiponectin administration had no obvious effect on the embryo resorption rate of the normal pregnancy model,while it significantly reduced the embryo resorption rate from 32.2％ to 13.3％ (P=0.039) of the spontaneous abortion model.ELISA showed that recombinant adiponectin increased the serum adiponectin and TGF-β levels,and reduced the IL-17 level of the spontaneous abortion model (P＜ 0.01).FCM showed that adiponectin administraion could reduce the ratio of Th 17/CD4+ T cells,increase the ratio of Treg/CD4+ T cells and reverse the ratio of Th 17/Treg in abortion mice.Conclusion · Intraperitoneal administration of recombinant adiponectin in early gestation can improve pregnancy outcome in a murine model of abortion maybe through regulating the balance of Th 17/Treg.