Objective To investigate the mechanism of anticoagulant proteins defect in patients with unexplained miscarriage. Methods Fifty-seven patients with a history of unexplained abortion in Peking union hospital during may. 1999 to April 2000. were tested for protein S, protein C, and antithrombin(AT)Ⅲ, activated protein C resistance(APC-R).The control group consisted of 50 healthy women with a history of normal pregnancy and delivery. Blood samples were taken for measuring protein S, protein C, AT-Ⅲ and APC-R. Patients with APC-R positive were measured for FV Leiden gene mutation by PCR-RFLP method. Results Of the 57 patients, there were 21.1%?1.8% and 8.8% with protein S?protein C and AT-Ⅲ deficiency respectively. For APC-R 22.8% of the 57 patients were positive .In control group, 4.0% were protein S deficiency; None was protein C and AT-Ⅲ deficiency ; 6.0% were positive for APC-R .No FV Leiden gene mutation was found in all the patients with APC-R positive .The incidence of anticoagulant proteins defect is higher in late spontaneous abortion group than that in early abortion group. Conclusions This study demonstrate that anticoagulant protein defects may be associated with pregnancy loss, especially the late spontaneous abortion.

Objective To summarize the common causes of fetal arrhythmia and explore its clinical significance and correlation with fetal prognosis. Methods The clinical situation and diagnostic procedure as well as the results of long-term follow-up of 26 cases of fetal arrthythmias were analyzed retrospectively. Results The incidence of fetal arrhythmias is 0.2%. 11.5%(3/26) of them were diagnosed fetal tachycardia, 15.4% (4/26) of them were diagnosed fetal bradycardia and 73.1% (19/26)were diagnosed irregular fetal cardiac rhythm . The average gestational age they were diagnosed was 35 +2 weeks (15 weeks to 41 +1weeks). Twenty-two cases were diagnosed by antenatal auscultation, 1 case was diagnosed by ultrasonography at 15 weeks' gestation, 3 cases were diagnosed by fetal heart monitoring. We performed fetal echocardiograms on 17 fetuses, 6 cases (35.3%)showed that premature atrial contraction with normal structure of fetal heart. All of the neonates survived postnatally and 24 of them (92.3%) accepted follow-up. Echocardiograms for16 neonates were performed and 2 of them were identified as atrial septal defects with normal heart rhythms. The incidence of structure heart disease in fetal arrhythmia is 7.7%. Conclusion The prognosis is well for most of the fetuses with arrhythmias, the incidence of heart structure disease is very low among them. We should pay attention to diagnose the fetus of heart structure disease with persistant bradycardia. Temporization for the management of arrhythmiatic fetuses should be accepted and the decision for termination of pregnancy should be made according to obstetric indication.

OBJECTIVETo investigate the high risk factors, clinical features, diagnosis and treatment of pulmonary embolism (PE) during pregnancy and the postpartum period.

METHODSTwo cases of PE during pregnancy and postpartum period were reported retrospectively.

RESULTSThe first case was a pregnant woman with congenital heart disease at 39-week gestation. She underwent a successful cesarean section (CS) because of heart disease, but she manifested tachycardia, tachypnea, cyanosis, and dyspnea suddenly on the 10th day after CS and died soon after the onset of these symptoms. The diagnosis of PE was highly suspected clinically. The second case was a twin-pregnancy woman at 35-week gestation. Because of severe perinatal myocardiopathy, cesarean section was performed. Unfortunately, the patient died abruptly on the operation table. The diagnosis of PE was confirmed by autopsy.

CONCLUSIONSThe maternal mortality of PE during pregnancy and postpartum period is quite high. Whenever there is any doubt, objective examinations for PE should be started early in order to strive for the chances of the anticoagulant therapy.

Adult ; Cesarean Section ; Female ; Humans ; Pregnancy ; Pregnancy Complications, Cardiovascular ; diagnosis ; Puerperal Disorders ; diagnosis ; Pulmonary Embolism ; diagnosis ; Risk Factors

OBJECTIVETo discuss the diagnosis of and conservative management for lower uterine segment pregnancy with placenta increta complicating first trimester abortion.

METHODSFour patients with previous caesarean section and severe hemorrhage in induced abortion in the first trimester were studied. Uterine artery embolization (UAE) was used to control bleeding and preserve the uterus.

RESULTSUAE controlled heavy uterine bleeding satisfactorily. One of the four patients asked for a hysterectomy after UAE, and her pathology report confirmed "lower uterine segment pregnancy with placenta increta".

CONCLUSIONPrevious caesarean section is a risk factor for lower uterine segment pregnancy with placenta increta. UAE is one of the best conservative management methods for heavy hemorrhage, especially for women who desire future fertility.

Abortion, Induced ; adverse effects ; Adult ; Embolization, Therapeutic ; Female ; Humans ; Placenta Accreta ; diagnosis ; therapy ; Pregnancy ; Pregnancy Trimester, First ; Uterine Hemorrhage ; etiology ; therapy ; Uterus ; pathology

Objective To evaluate the effect of traditional Chinese herbal medicine on the prevention of hemolytic disease caused by maternal-fetal blood group incompatibility.Methods A total of 126 Chinese patients with maternal-fetal blood group incompatibility were studied, including 105 cases of ABO type and 21 cases of Rh type incompatibility. The traditional Chinese herbal medicine was used for preventative treatment in 79 cases, and 47 cases served as controls. The prescription consisted of Herba leonuri 500 g, white peony root 180 g, Banksia rose 12 g, root of Chinese angelica 150 g and Rhizomal ligustica 150 g.Results Preventative treatment with traditional Chinese herbal medicine significantly reduced the perinatal mortality rate in cases of Rh type incompatibility, from 50.0% in the control group to 7.7% in the treatment group (P<0.05). There was no death in the cases of ABO incompatibility. The traditional Chinese herbal medicine also decreased the degree of hemolysis. The percentage of severe cases in the control group was 29.8%, while it was 15.2% in the treatment group (P=0.05). The duration of treatment was closely related to the outcomes. In patients who used traditional Chinese herbal medicine for more than 10 weeks, the incidence of severe hemolysis was 8.2%, compared with 38.9% in those treated for less than 10 weeks (P<0.05). The change of serum immune antibody (A and /or B) titers during the treatment was a very important predictive factor for the outcome of the pregnancy.Conclusion Traditional Chinese herbal medicine is effective not only for ABO type but also for Rh type maternal-fetal blood group incompatibility, with no side effects.