POSTPARTUM PHLEBECTOMY

Saphenous vein ligation and stripping was performed on 27 patients in the immediate postpartum period without complications. Doing the operation at this time saves time and money. Technically it is easier to do postpartum than during pregnancy, and the patients have less postoperative discomfort than is usual with phlebectomy at other times.     

缩宫素联合卡前列素氨丁三醇对产后出血患者凝血功能及血流动力学的影响

目的:探讨缩宫素联合卡前列素氨丁三醇对产后出血患者凝血功能及血流动力学的影响。方法:选取我院于2014年1月-2017年4月期间收治的产后出血患者126例,根据乱数表法分为对照组(n=63)与研究组(n=63),其中对照组给予缩宫素治疗,研究组则给予缩宫素联合卡前列素氨丁三醇治疗。观察并比较两组患者产后出血情况、凝血功能以及血流动力学各项指标,同时观察两组患者的生活质量及不良反应发生情况。结果:研究组患者产后出血发生率、产后2 h出血量以及产后24 h出血量均明显低于对照组(P0.05)。两组患者活化部分凝血活酶时间(APTT)、血浆凝血酶原时间(PT)、血浆凝血酶时间(TT)、纤维蛋白原(Fg)相比无统计学差异(P0.05)。治疗2 h后两组患者心率(HR)较治疗前升高,且对照组高于研究组,收缩压(SBP)、舒张压(DBP)较治疗前降低,且对照组低于研究组(P0.05);治疗24 h后研究组患者SBP高于对照组(P0.05);两组患者不同时间的血氧饱和度(SPO_2)比较均无统计学差异(P0.05)。研究组患者的躯体功能、精神健康、情感职能、社会活动以及社会功能得分均高于对照组(P0.05)。对照组患者不良反应发生率为7.94%,与研究组的6.35%比较无统计学差异(P0.05)。结论:缩宫素联合卡前列素氨丁三醇可有效减少患者产后出血发生率,维持患者血流动力学稳定,对患者凝血功能无影响,生活质量评分较高,值得临床推广。     

腹动脉球囊置入联合宫颈提拉缝合治疗凶险性前置胎盘产后大出血临床效果

摘要 目的：探讨腹动脉球囊置入联合宫颈提拉缝合治疗凶险性前置胎盘产后大出血的临床效果。方法：选取我院2019年1月到2021年12月收治的178例凶险性前置胎盘患者作为研究对象,所有患者均采取剖宫产手术,且术后出现产后大出血现象,将所有患者依照术中胎盘位置及植入情况治疗方式分为观察组（n=73）与对照组（n=105）。其中对照组产妇采取腹动脉球囊置入联合宫腔纱条填塞术,观察组采取腹动脉球囊置入联合宫颈提拉缝合治疗,对比两组产妇的剖宫产时间、术后24 h失血量、术中失血量以及总手术时间,相关临床指标,产后泌乳时间和产后1 d、2 d的泌乳量评分以及住院时间,并发症发生情况。结果：两组产妇剖宫产时间、球囊预置术时间对比无明显差异（P＞0.05）,观察组产妇术后24 h失血量、术中失血量、总手术时间明显低于对照组（P＜0.05）。手术前两组产妇凝血酶原时间（PT）、凝血活酶时间（APTT）、血小板（PLT）、纤维蛋白原（FIB）、一氧化氮（NO）、一氧化氮合酶（NOS）、D-二聚体（D-Dimer）无明显差异（P＞0.05）,治疗后两组产妇PT均升高,观察组高于对照组,PLT、NO、NOS均降低,观察组低于对照组;对照组APTT、FIB无明显变化,但观察组APTT高于对照组,FIB低于对照组;观察组D-Dimer无明显变化,但对照组升高（P＜0.05）。观察组产妇的产后1、2 d泌乳量评分明显高于对照组,泌乳时间、术后住院时间明显低于对照组（P＜0.05）。观察组产妇术后并发症发生率明显低于对照组（P＜0.05）。结论：对凶险性前置胎盘产后大出血患者采取腹动脉球囊置入联合宫颈提拉缝合治疗能够进一步减轻患者术后出血量,且改善患者凝血因子、一氧化氮、一氧化氮合酶、纤维蛋白原、D-二聚体水平,提升泌乳量,减少术后并发症发生率,值得临床应用推广。     

Influence of pre- and post-partum nutrition on LH secretion in suckled postpartum beef heifers

The influence of nutrition during the last trimester of pregnancy and the early postpartum period on postpartum LH secretion was evaluated in two-year-old Hereford and Simmental heifers maintained on a high or low plane of nutrition (experiment 1) or in Hereford heifers fed a high or low energy (150% vs 100% NRC) ration (experiment 2). Amount of LH released with 10 mg estradiol benzoate (IM) at 14 and 28 days postpartum in experiment 1 or at 14,32,50 and 74 days postpartum in experiment 2 was less (P<.01) for heifers fed the low vs high plane or energy ration and less (P<.05) at 14 days postpartum than at subsequent postpartum periods. The interval from estradiol benzoate injection to the LH peak concentration was longer (P<.05) in Simmental than Hereford heifers, longer (P<.05) in heifers fed the low rather than high energy ration, and longer (P<.01) at 14 days postpartum than at subsequent postpartum periods. The amount of LH released was inversely related to the time required for initiation of the release (r = -.62). Tonic LH secretion was higher (P<.05) in heifers fed the high energy ration and was correlated with average daily gain (r = .75), but was unaffected (P.05) by days postapartum or breed of cattle. Results indicate that increased dietary energy intake increases LH secretion and shortens the anovulatory period in suckled postpartum beef heifers.     

卡贝缩宫素联合Bakri球囊压迫对宫缩乏力性产后出血患者卵巢功能和凝血功能的影响

目的:探讨卡贝缩宫素、Bakri球囊压迫联合治疗对宫缩乏力性产后出血患者卵巢功能以及凝血功能的影响。方法:选取2017年2月-2021年3月我院接诊治疗的86例宫缩乏力性产后出血患者,以随机数字表法分为对照组、研究组,分别给予Bakri球囊压迫单一治疗及卡贝缩宫素、Bakri球囊压迫联合治疗。检测对比患者的卵巢功能指标包括LH、FSH、E2水平,记录两组患者舒张压(DBP)、收缩压(SBP)、心率、出血量变化和止血起效时间,测定纤维蛋白原(FIB)、凝血酶原时间(PT)和活化部分凝血活酶时间(APTT),对比两组不良反应发生情况。结果:两组患者DBP、SBP及心率变化波动较小,治疗后数据显示差异无统计学意义(P>0.05);两组患者治疗后2 h、24 h出血量减少,且研究组治疗后2 h、24 h出血量及止血起效时间短于对照组(P<0.05);治疗后3 d,两组患者FIB水平降低,PT、APPT水平升高,且研究组FIB水平低于对照组,PT、APPT水平高于对照组(P<0.05);治疗后3 d,两组患者血清E₂水平升高,FSH、LH水平降低,且研究组血清E₂、FSH、LH水平优于对照组(P<0.05);研究组不良反应发生率(8.89%)高于对照组(4.88%),但是未见显著性差异(P>0.05)。结论:卡贝缩宫素联合Bakri球囊压迫可改善宫缩乏力性产后出血的卵巢功能及凝血功能,提升产后止血效果,增强患者子宫收缩能力。     

Glucocorticoid receptor gene polymorphisms and disease activity during pregnancy and the postpartum period in rheumatoid arthritis

Introduction

The mechanism underlying the spontaneous improvement of rheumatoid arthritis (RA) during pregnancy and the subsequent postpartum flare is incompletely understood, and the disease course varies widely between pregnant RA patients. In pregnancy, total and free levels of cortisol increase gradually, followed by a postpartum decrease to prepregnancy values. The glucocorticoid receptor (GR) polymorphisms BclI and N363S are associated with relatively increased glucocorticoid (GC) sensitivity, whereas the 9β and ER22/23EK polymorphisms of the GR gene are associated with a relatively decreased GC sensitivity. We examined the relation between the presence of these GR polymorphisms and level of disease activity and disease course of RA during pregnancy and postpartum.

Methods

We studied 147 participants of the PARA study (Pregnancy-Induced Amelioration of Rheumatoid Arthritis study), a prospective study investigating the natural improvement during pregnancy and the postpartum flare in women with RA. Patients were visited, preferably before pregnancy, at each trimester and at three postpartum time points. On all occasions, disease activity was scored by using DAS28. All patients were genotyped for the GR polymorphisms BclI, N363S, 9β, and ER22/23EK and divided in groups harboring either polymorphisms conferring increased GC sensitivity (BclI and N363S; GC-S patients) or polymorphisms conferring decreased GC sensitivity (9β or 9β + ER22/23EK; GC-I patients). Data were analyzed by using a mixed linear model, comparing GC-S patients with GC-I patients with respect to improvement during pregnancy and the postpartum flare. The cumulative disease activity was calculated by using time-integrated values (area under the curve, AUC) of DAS28 in GC-I patients versus GC-S patients. Separate analyses were performed according to the state of GC use.

Results

GC-S patients treated with GC had a significantly lower AUC of DAS28 in the postpartum period than did GC-I patients. This difference was not observed in patients who were not treated with GCs. During pregnancy, GC-S and GC-I patients had comparable levels of disease activity and course of disease.

Conclusions

Differences in relative GC sensitivity, as determined by GR polymorphisms, are associated with the level of disease activity in the postpartum period in GC-treated patients, but they do not seem to influence the course of the disease per se.     

Influence of bull biostimulation, season and parity on resumption of ovarian activity of zebu (Bos indicus) cattle following parturition

A total of 135 postpartum suckled zebu cows were assigned randomly at calving to two treatments: cows exposed to vasectomised bulls (Mature Bull Exposure, MBE) and cows not exposed to bulls (No Bull Exposure, NBE) for a period of 150 days postpartum. This study was conducted to determine the influence of bull biostimulation, season and parity on postpartum reproductive performance of Bos indicus cattle. The trials were conducted in two seasons: cows calving in the dry season and cows calving in the rainy season. Cows with an increase in serum progesterone (P(4)) concentration of >1 ng/ml from the weekly blood samples were used to analyse the number of days from calving to the time of resumption of ovarian activity. The introduction of vasectomised bulls shortened the postpartum anoestrus in cattle following calving. Mean interval from calving to resumption of ovarian activity for the MBE cows was 71.7 days, which was significantly earlier following calving than the NBE cows with a duration of 77.8 days. By 60 to 80 days postpartum, the proportion of cows at resumption of postpartum activity for MBE cows was greater than for the NBE cows.Mean interval from calving to resumption of ovarian activity for cows that calved in the dry season was 71.3 days, which was significantly earlier than for cows that calved in the rainy season (78.6 days). At 60 days postpartum, the proportion of cows at resumption of postpartum ovarin activity for cows that calved in the dry season was greater than the cows that calved in the rainy season. Mean interval from parturition to resumption of ovarian activity for cows with three to five calvings was 65.1 days, which was significantly earlier than the value of 71. 2 days for cows with one to two calvings. By 60 to 80 days postpartum, the proportion of cows at onset of ovarian activity for cows with three to five calvings was greater than those cows with one to two calvings. Cows that calved in the dry season completed uterine involution by 24.4 days, which was significantly shorter than the duration of 26.5 days for cows that calved in the rainy season. Cows with three to five calvings completed uterine involution earlier than those with one to two calvings. It is concluded that bull-cow biostimulation influences reproductive activity in the cow possibly through olfactory cues (pheromones).     

Relationship Factors and Trajectories of Intimate Partner Violence among South African Women during Pregnancy and the Postpartum Period

Intimate partner violence (IPV) is a significant public health problem in South Africa. However, there is limited research on whether and how IPV changes during pregnancy and the postpartum period and on the factors that might affect women''s risk during this time. In this study, we describe the mean trajectories of physical and psychological IPV during pregnancy and the postpartum period and examine whether relationship power, partner social support, and relationship stress are associated with women''s trajectories of IPV. Data come from a longitudinal study with 1,480 women recruited during pregnancy between May 2008 and June 2010 at a public clinic in Durban. Women completed behavioral assessments at their first antenatal visit, at fourteen weeks and at nine months postpartum. Women''s experiences of IPV were measured at all three time points and relationship power, partner social support and relationship stress were each measured at the baseline assessment. We used multilevel random coefficients growth modeling to build our models. The mean trajectory for both types of IPV was flat which means that, on average, there was not significant change in levels of IPV over pregnancy and the postpartum period. However, there was significant individual variability in trajectories of IPV over the study period. Women who had higher relationship power had lower levels of physical and psychological IPV over time than women with lower relationship power. Additionally, women with higher relationship stress and lower partner support had higher levels of psychological IPV at pregnancy. Interventions that maximize women''s relationship power and partner social support and minimize relationship stress during this transformative time are needed.     

Influence of metabolic status on oocyte quality and follicular characteristics at different postpartum periods in primiparous rabbit does

Low reproductive performance of high-yield primiparous animals is closely associated with the metabolic stress caused by a simultaneous gestation and lactation. The aim of this work was (1) to analyze body composition and metabolic environment at three time points along lactation (at parturition time; in the lactation period [Day 11 postpartum]; and in the postweaning period [Day 32 postpartum]) of primiparous rabbit does (Oryctolagus cuniculus) and (2) to investigate the ovarian status at insemination time and the possible link with metabolic environment and with their reproductive performance. To this end, does were either submitted to a semi-intensive reproductive rhythm (Group S, inseminated on Day 11 postpartum) or an extensive rhythm (Group E, inseminated on Day 32 postpartum). Body energy (P < 0.05) and protein content (P < 0.001) as well as serum leptin (P < 0.05) and protein concentrations (P < 0.001) increased significantly along the postpartum period. At parturition, body lipid content was significantly lower and serum nonesterified fatty acids concentrations were significantly higher than that on Days 11 postpartum and 32 postpartum. Concerning ovarian status at insemination time, no significant differences were found in mean follicular stages, serum estradiol, progesterone, and prolactin (PRL) concentrations or in prolactin receptor (PRL-R) immunostaining. However, follicles in Group S showed a significantly higher apoptosis index than that of Group E (P < 0.001). The nuclear and cytoplasmic oocyte maturation rates of Group S were also significantly lower than that in Group E. In addition, conception rate and prolificacy were improved in Group E (P < 0.001 and P < 0.05, respectively). In conclusion, in the early postpartum period, metabolic status seems to impact negatively on ovarian follicle and oocyte quality leading to a poor reproductive outcome in primiparous rabbit does.     

Influence of parity on follicular dynamics and resumption of ovarian cycle in postpartum dairy cows

The present study examined ovarian changes preceding the resumption of the ovarian cycle in postpartum dairy cows with different parities under similar body nutritional conditions. In postpartum primi- (n=6), bi- (n=4), and multiparous (n=6) Holstein dairy cows, ovarian ultrasonographic observations starting at 7 days after calving were performed every other day and then daily after the confirmation of clinical signs of oestrus for the detection of postpartum first ovulation. Blood samples were collected at the same time as ultrasonography and analyzed for oestradiol and progesterone to monitor ovarian activity. To evaluate the nutritional condition of the cows, body weight and body condition score (BCS, 1=emaciated to 5=obese) were measured weekly and blood samples for the analysis of glucose, insulin, and non-esterified fatty acid (NEFA) were collected at the same time until postpartum second ovulation. Dominant follicles (>8mm in diameter) of the first follicular wave were detected at 7 days after calving in all cows. The first wave follicle ovulated in five of six multiparous cows, whereas no first wave follicle ovulated in any of the primiparous cows. The days to first ovulation after calving in primiparous cows (31.8+/-8.3 days) were significantly greater (p<0.05) than those in multiparous cows (17.3+/-6.3 days), but were not significantly different from biparous cows (28.8+/-8.6 days). There was a significant relationship between parity and days to first ovulation after calving (p<0.05). BCS was maintained at a level of more than 2.5 during the postpartum period in all cows and there was no influence of parity on postpartum changes in BCS, glucose, insulin, or NEFA throughout the experiment. The present study demonstrated a negative relationship between parity and number of days from calving to first ovulation in dairy cows under similar body nutritional conditions. It is possible that the influence of parity on the resumption of ovarian cycle is modulated by the factors different from the nutrition-related changes during the postpartum period in dairy cows.     

Pregnancy-Associated Breast Cancer in Taiwanese Women: Potential Treatment Delay and Impact on Survival

This study investigated the clinicopathologic characteristics and survival of women diagnosed with pregnancy-associated breast cancer (PABC) in Taiwan. PABC is defined as breast cancer diagnosed during pregnancy or within 1 year after obstetric delivery. Our sample of PABC patients (N = 26) included all patients diagnosed at a major medical center in northern Taiwan from 1984 through 2009. Among these patients, 15 were diagnosed during pregnancy and 11 were diagnosed within 1 year after delivery. The comparison group included 104 patients within the same age range as the PABC patients and diagnosed with breast cancer not associated with pregnancy from 2004 through 2009 at the same hospital. Patients'' initiating treatment delayed, 5-year and 10-year overall survival were delineated by stratified Kaplan-Meier estimates. Patients'' characteristics were associated with initiating treatment delayed was evaluated with multivariate proportional hazards modeling. Antepartum PABC patients were younger and had longer time between diagnosis and treatment initiation than postpartum PABC patients. The predictor of treatment delayed was including birth parity, cancer stage, and pregnancy. The PABC group had larger tumors, more advanced cancer stage, and tumors with less progesterone receptor than the comparison group. The antepartum PABC patients had higher mortality than postpartum PABC and comparison groups within 5 years after diagnosis. Based on these results, we confirmed that pregnant women with breast cancer were more likely to delay treatment. Therefore, we recommend that breast cancer screening should be integrated into the prenatal and postnatal routine visits for early detection of the women''s breast problems.     

Resumption of menstruation among urban post-partum women in Bangladesh.

To investigate the return of menstruation among postpartum women in Dacca, a random sample of 360 women (1-12 months postpartum) was selected from 4 Dacca hospitals for a cross-sectional study; another random sample of 200 women ( 1 month postpartum at time of interview) was selected from the same hospitals for prospective follow up. Many of the women were from rural areas who left the city after delivering their babies; most were under 25 years old at the time of interview. Results of the cross sectional study showed that 63% started menstruating by the 6th postpartum month; 10% were still amenorrhoeic by the 12th postpartum month; 46% were breastfeeding their infants by the 4th month; 90% resumed sexual relations, and 48% were using contraceptives, by the 6th month. Results of the prospective study showed that slightly more than half of the women started menstruating by the end of the 5th postpartum month; almost half stopped breastfeeding by the 5th month, 88.8% were having sexual relations with their husbands, and about 50.5% were on some form of birth control. The findings suggest a much shorter duration of lactational amenorrhea than has been claimed for a rural area of Bangladesh; they also suggest that urban women start menstruating earlier because of their primary reliance on supplementary feeding. The contraceptive effectiveness, as well as health benefits to infants, of prolonged and intensive lactation should be promoted to urban mothers.     

Postpartum uterine motility measurements in dairy cows retaining their fetal membranes

Postpartum uterine contraction variables were measured in 15 parturient Holstein dairy cows and heifers: 8 assigned to dexamethasone (DEX) treatment and 7 to control (CON) treatment. The DEX animals were induced to calve early with an injection of dexamethasone and estradiol benzoate, administered on days 270 to 274 of gestation. At this time, the CON animals were injected with sterile saline and allowed to calve at term. Six of the eight DEX animals and one of the seven CON animals retained their fetal membranes longer than 12 hours postpartum. The uterine contraction variables determined were: the number of contractions over a 10 minute period (C 10 ), the average amplitude of contractions (AMP), the average duration of contractions (DUR), Montevideo units (MONT) and Alexandria units (ALEX). Recordings were taken at 1 hour, 6 hours and 48 hours postpartum, for a period of 20 minutes each. The contraction variables were measured using a catheter which was fluid-filled and inserted into the pregnant horn and connected to a pressure transducer, amplifier and recorder. The data were analyzed in terms of DEX vs. CON animals and animals with retained fetal membranes (RET) vs. animals with a normal release (NRET). Treatment with dexamethasone and estradiol benzoate resulted in an increase in C 10 at 48 hours (P < .05). The AMP, MONT and ALEX variables were also higher in the DEX animals, as compared to controls at that time. Significant differences (P < .01) were observed at 48 hours postpartum between the RET and NRET animals in terms of AMP, MONT and ALEX variables, and at that time the RET animals had a higher rate of uterine contractility than the NRET animals. No significant differences in the amount of uterine work between either the DEX and CON animals or the RET and NRET animals were observed, at 1 and 6 hours postpartum. The treatment with dexamethasone and estradiol benzoate prolonged uterine motility up to 48 hours postpartum, and the retention of the fetal membranes was not a result of the lack of uterine contractility during the early stages postpartum.     

Inflammatory cytokine concentrations in uterine flush and serum samples from dairy cows with clinical or subclinical endometritis

The objective of this study was to compare the concentrations of inflammatory cytokines in uterine flush and serum from healthy postpartum dairy cows and cows with clinical or subclinical endometritis. Clinical endometritis was diagnosed by observation of vaginal discharges (>50% pus) and subclinical endometritis was diagnosed by evaluation of uterine cytology (neutrophils >18%) at 4 weeks postpartum. Uterine flush was obtained from 48 cows at 4, 6, and 8 weeks postpartum for evaluation of tumor necrosis factor-α (TNF-α), interleukin (IL)-1β, IL-6, IL-8, and IL-10 concentrations. Serum samples were obtained from 34 cows just after calving and at 1, 2, 4, 6, and 8 weeks postpartum for evaluation of TNF-α, IL-1β, and IL-6 concentrations. Concentrations of TNF-α, IL-6, and IL-10 were greater (P < 0.05) in cows with clinical endometritis than in cows with subclinical endometritis and healthy controls, whereas concentrations of IL-8 in both cows with clinical and subclinical endometritis were greater (P < 0.005) than in controls. Overall, IL-6 and IL-10 concentrations decreased during the postpartum period. IL-1β concentrations in cows with clinical endometritis decreased (P < 0.0005) during the postpartum, whereas concentrations in cows with subclinical endometritis and controls did not change significantly with time; at 4 weeks postpartum, concentrations were greater (P < 0.0001) in cows with clinical endometritis. There were no significant effects of group, sampling time, or interaction on serum cytokine concentrations. In conclusion, cows with endometritis have greater inflammatory cytokine concentrations in uterine flush than healthy cows, but no differences were observed in serum.     

Postpartum recuperation in primiparous rhesus macaques and development of their infants

Female primates endure great costs during pregnancy and lactation. Some studies have been conducted on exploring these; however, information on how maternal condition before conception influences maternal postpartum recuperation and infant development are not well known, especially in primipares. This 2-year investigation explored how maternal condition, maternal foraging time and alert time, and infants' time on nipple influenced postpartum recovery of primiparous rhesus macaques, as well as their infant's development during the first 3 months postpartum. The study was conducted on 11 female rhesus macaques (Macaca mulatta) living at the Caribbean Primate Research Center, Sabana Seca Field Station, Puerto Rico. Infant survivorship and development were not influenced by maternal age at first parturition or by the infants' time on the nipple. Infant development and maternal recovery were influenced by maternal condition before conception. Older primipares demonstrated greater postpartum recuperation. Maternal postpartum recuperation was not influenced by maternal feeding time or time the infant spent on the nipple. Maternal recuperation was negatively correlated with increased vigilance (alert time).     

GnRH induced LH release in suckled beef cows. 1. The effects of days postpartum and estradiol-17beta concentrations on the release of LH following administration of GnRH

Twenty suckled CharloixxHereford beef cows (5 cows/group) were assigned at random to receive 100 microg GnRH (IM) at either 2 to 3, 7 to 8, 15 to 16, or 31 to 32 days postpartum, Groups 1 through 4, respectively. Blood samples for hormone determinations were collected at time 0 (pre-GnRH), every half hr for 3 hr, and at 4.0 hr and 6.0 hr post-GnRH. Mean plasma LH, estradiol-17beta, or progesterone concentrations were not different among groups prior to GnRH. Plasma LH increased (P<.05) following GnRH in Groups 2, 3 and 4, but not in Group 1. Peak GnRH induced LH release was greater (P<.05) in Groups 3 and 4 than in Groups 1 or 2. Correlation coefficients between days postpartum and peak LH release (r=.72), and estradiol-17beta concentrations and time of LH peak (r=-.42) were significant (P<.05). These data indicate that LH release in response to GnRH, in suckled beef cows is not fully restored until 15 to 16 days postpartum.     

Cook双球囊联合改良B-Lynch缝合术对产后出血的治疗效果观察

目的:探讨Cook双球囊联合改良B-Lynch缝合术对产后出血的治疗效果。方法:选取2015年6月～2018年6月在我院经剖宫产术分娩并发生产后出血的产妇81例进行回顾性分析。根据术中止血方法的不同分为两组,对照组40例采用Cook双球囊进行止血,观察组41例在对照组的基础上应用改良B-Lynch缝合术进行止血。对两组患者的手术相关指标、止血成功率、子宫切除率、术后恢复情况和并发症发生情况进行比较。结果:观察组的术中出血量、术后24 h出血量和输血量显著低于对照组(P0.05),止血时间显著短于对照组(P0.05);观察组患者的止血成功率显著高于对照组(P0.05),子宫切除率和切口恢复时间显著低于对照组(P0.05),两组患者的住院时间和并发症发生率比较无统计学差异(P0.05)。结论:Cook双球囊联合改良B-Lynch缝合术对剖宫产产后出血患者的临床效果显著优于单用Cook双球囊,且安全性较高。     

Peripartum changes in the bovine placenta related to fetal membrane retention

To understand fetal membrane retention in dairy cattle, we examined these tissues in the immediate peripartum period before tissue separation. Placentomes were collected at 270-280 d of gestation from pre-partum Holstein cows (n = 5) and at 1, 3, 6, and 12 h postpartum from a) cows releasing fetal membranes in less than 12 h (n = 7), b) cows retaining fetal membranes for more than 12 h (n = 5), and c) cows induced to calve with dexamethasone (releasing membranes in more than 12 h; n = 5). Subjective evaluations of necrosis, distribution, and condition of binucleate giant and of principal cells were made. Necrotic foci and binucleate giant cells were counted for each interval for which tissue was available. Necrosis, existing prepartum, was identical to that observed at 1 h postpartum in all treatment groups (P > 0.05). Necrosis gradually increased in all treatment groups with time (P < 0.05); thus necrosis is unrelated to initiation of calving and is indirectly related to fetal membrane retention. Many binucleate giant cells were observed prepartum. In cows releasing fetal membranes normally, a significant (P < 0.05) decline in these cell numbers had occurred by 1 h postpartum. When fetal membrane retention occurred, no such decrease in binucleate giant cells was observed before 12 h postpartum. Loss of binucleate giant cells appears necessary for, or must occur with, separation of fetal membranes.     

Gonadotropin-releasing hormone secretion during the postpartum anestrous period of the ewe

An increase in episodic release of LH is putatively the initial event leading to the onset of postpartum ovarian cyclicity in ewes. This experiment was conducted to determine the relationship between hypothalamic release of GnRH and onset of pulsatile secretion of LH during postpartum anestrus. Control ewes (n = 7) were monitored during the postpartum period to determine when normal estrous cycles resumed. In controls, the mean interval from parturition to the first postpartum estrus as indicated by a rise in serum progesterone greater than 1 ng/mg was 25.8 +/- 0.6 days. Additional ewes (n = 4-5) at 3, 7, 14, and 21 days postpartum (+/- 1 day) were surgically fitted with cannula for collection of hypophyseal-portal blood. Hypophyseal-portal and jugular blood samples were collected over a 6- to 7-h period at 10-min intervals. The number of GnRH pulses/6 h increased (p less than 0.05) from Day 3 postpartum (2.2 +/- 0.5) to Days 7 and 14 (3.6 +/- 0.2 and 3.9 +/- 0.4, respectively). A further increase (p less than 0.05) in GnRH pulse frequency was observed at Day 21 postpartum (6.4 +/- 0.4 pulses/6 h). Changes in pulsatile LH release paralleled changes observed in pulsatile GnRH release over Days 3, 7, 14, and 21 postpartum (0.83 +/- 0.3, 2.8 +/- 0.4, 2.9 +/- 0.6, and 4.0 +/- 1.1 pulses/6 h, respectively). GnRH pulse amplitude was higher at Day 21 than at Days 3, 7, or 14 postpartum. These findings suggest that an increase in the frequency of GnRH release promotes the onset of pulsatile LH release during postpartum anestrus in ewes.     

Physiological Reduction in Left Ventricular Contractile Function in Healthy Postpartum Women: Potential Overlap with Peripartum Cardiomyopathy

Aims

Peripartum cardiomyopathy is a potentially life-threatening cause of heart failure, commoner in Afro-Caribbean than Caucasian women. Its diagnosis can be challenging due to physiological changes in cardiac function that also occur in healthy women during the early postpartum period. This study aimed to (i) establish the overlap between normal cardiac physiology in the immediate postpartum period and pathological changes in peripartum cardiomyopathy ii) identify any ethnicity-specific changes in cardiac function and cardiac biomarkers in healthy postpartum women.

Methods and Results

We conducted a cross-sectional study of 58 healthy postpartum women within 48 hours of delivery and 18 matched non-pregnant controls. Participants underwent cardiac assessment by echocardiography and strain analysis, including 3D echocardiography in 40 postpartum women. Results were compared with 12 retrospectively studied peripartum cardiomyopathy patients. Healthy postpartum women had significantly higher left ventricular volumes and mass, and lower ejection fraction and global longitudinal strain than non-pregnant controls. These parameters were significantly more impaired in peripartum cardiomyopathy patients but with overlapping ranges of values. Healthy postpartum women had higher levels of adrenomedullin, placental growth factor (PlGF) and soluble fms-like tyrosine kinase-1 (sFlt1) compared to controls. The postpartum state, adrenomedullin, sFlt1 and the sFlt1:PlGF ratio were independent predictors of LV remodelling and function in healthy postpartum women.

Conclusion

Healthy postpartum women demonstrate several echocardiographic indicators of left ventricular remodelling and reduced function, which are associated with altered levels of angiogenic and cardiac biomarkers.