Objective To discuss appropriate management of postpartum hemorrhage(PPH). Material and Methods By means of hospital based data over 10 years, 15 cases of severe PPH were retrospectively analyzed about the clinical parameters and management. Results Among the 15 patients, 9 had hysterectomy, selective arterial embolization was carried out in 7 and 1 had focus clearance. The main causes of postpartum hemorrhage requiring operative management were: DIC, uterine arteriovenous fistula and malformation, placental abnormality, uterine myoma and laceration. Conclusion Upon recognition of postpartum hemorrhage, the most effective management should be initiated. Every effort should be made to stable patient, save life and maintain the reproductive capability.

Objective To evaluate the impact of carvedilol and metoprolol on left ventricular (LV)dyssynchrony in idiopathic dilated cardiomyopathy(IDC).Methods In this study,we randomly assigned 65 IDC patients from January 2009 to June 2011 to re-ceive carvedilol or metoprolol succinate.All patieats were divided in to carvedilol group(n=33)and metoprolol group(n=32)Echo-cardiographic measurements and N-terminal pro-brain natriuretic peptide levels were obtained at baseline and 6 month after thera-py.Then long-term follow up the survival rate of patients were observed.Results In carvedilol group,reduction in LVEDS and in-crease in LVEF was higher compared to metoprolol group.Also improvement in LV dyssynchrony achieved and survival rate with carvedilol was higher than metoprolol.However,Improvements in LV mechanical dyssynchrony was similar in two groups.Im-provements in LV mechanical dyssynchrony achived with both drugs were accompanied by reduction in NT-pro-BNP levels in both carvedilol and metoprolol groups(P >0.05).Conclusion Carvedilol is an effective drug improves the intraventricular dyssynchro-nyfor for IDC patients with left ventricular dyssynchrony,and could increasea the survival rate.

Objective:Surgery intervention and its effect on pregnancy heart disease were explored. Meth-ods:Retrospective review of 34 cases of pregnancy heart disease who needed surgery intervention from Jan, 2000 to Dec,2007 was done. Results:17 patients had percutaneous balloon mitral valve (PBMV) dilatation, the area of mitral valve enlarged markedly postoperatively ( P <0.01 ). 9 patients had open chest surgery un-der extracorpory circulation,7 of them had re-replacement mechanical valve due to mechanical valve throm-bosis. One patient had left atrium mucomamectomy. One patient had Wad's sinus breakout and repairmen. 5 patients had Radiofrequency catheter ablation (RFCA) for supraventricular tachycardia. 3 patients had int-racardiac device (ICD) for Ⅲ grade atrioventicular block. 22 patients had cardiac function as grade Ⅲ～Ⅳ and postoperatively recovered to grade Ⅰ～Ⅱ . All 34 patients were alive after treatment, 23 fetus were alive (67.6%), and no adverse results were found during the follow-up. Conclusions:When patients who had pregnancy heart disease need surgery intervention, individualized treatment plan should be made by multidis-cipline experienced doctors according to different heart disease and cardiac function.

BACKGROUND: The intelligence retardation in children refers to hypo-intelligence structure of full intelligence quotient(FIQ) composed of performance intelligence quotient(PIQ) and verbal intelligence quotient (VIQ) . It is verified in some researches that some of compound formulas provide better intervention on it.OBJECTIVE: To observe the effect of yizhi koufuye on intelligence structure in children with intelligence retardation.DESIGN: Homochronous controlled study based on children.SETTING: Pediatric department in a provincial college of traditional Chinese medicine and one provincial rehabilitation center.PARTICIPANTS: The cases were selected in Rehabilitative Central Hospital in Gansu Province and Clinic of the Hospital Affiliated to Gansu College of Traditional Chinese Medicine from January to July 2002. They were 74 students in Fudu Schools in Chenguan District, Lanzhou City, aged varied from 6 to 16 years, diagnosed as intelligence retardation according to CCMD-Ⅱ-R proposed Intelligence Retardation Diagnostic Standards, and they were able to accept medical and training treatment and were absent of congenital hereditary chromosome disorders. Of those, 47 cases were males and 27 cases females. They were divided into treatment group of 33 cases,the control of 20 cases and simple educational training group of 21 cases.METHODS: In treatment group of 33 cases, yizhi koufuye was administrated and was taken 15 mL each time for children younger than 10 years old, 20 mL for those between 10 to 14 years old and 25 mL for those over 14years old. In addition, the special educational training was applied. In the control of 20 cases, oral application of piracetam was prescribed, 0.4 g per time, 3 times a day and the special educational training was applied additionally. In simple educational training group of 21 cases, the children only received special education same as those in treatment group and the control. Three months made one session. Chinese-Wechsler Intelligence Scale for Children (C-WISC) and specific devices were used to assess FIQ and PIQ and VIQ in classified IQ in 3 groups before and after treatments, and the control comparisons were carried on among groups.MAIN OUTCOME MEASURES: Improvement of FIQ and improved values of VIQ and PIQ in 3 groups.RESULTS: Totally 74 cases were selected and no one lost. Improvement of FIQ: In treatment group, there were 44.7±9.8 and 51.8 ± 11.5 before and after treatment respectively, t = 2. 701, P ＜ 0.01; In the control, there were 43.8 ± 14.0 and 51.0 ± 13.6 before and after treatment respectively, t = 1. 680, P ＞ 0. 05; In simple educational training group, there were 41.6 ± 7.8 and 45.2 ± 10.6 before and after treatment respectively, t = 1. 561 and P ＞ 0.05. Improved values of VIQ: It was 8.1 ± 5.5 in treatment group, 5.3 ± 3.9 in the control and 4. 8 ± 4. 8 in simple educational training group. P ＜ 0.05 compared with the results in treatment group. Improved values of PIQ: It was 4.0 ± 3.6 in treatment group and P ＜ 0. 05 compared with 1.7± 2. 2 in the control and simple educational training group. Improving extent of VIQ was 8. 1 ± 5. 5 and of PIQ was 4.0 ± 3.6 in treatment group, P ＜ 0. 01.CONCLUSION: Yizhi koufuye improves markedly FIQ of children with intelligence retardation and for the classified IQ, the improving extent of VIQ is superior to that of PIQ.

Objective To explore the effect of insight education and self-confidence training on the quality of life and well-being rating of first episode schizophrenia. Methods 96 inpatients with first episode schizophrenia were randomly divided into the observed group (48 cases) in which patients were treated with risperidone plus insight education and self-confidence training and the control group (48 cases) in which patients were treated with risperidone only. These patients had been treated for 8 weeks and followed up for 0.5 year after discharged. The assessments included the Positive and Negative Symptoms Scale (PANSS),WHO QOL-100,General Well-Being Schedule (GWB) and the Self-Esteem Scale (SES) before the treatment and at the end of the following-up. Results The scores of PANSS, QOL-100, GWB and SES in both groups didn't show significant difference before the treatment (P>0.05). At the end of following-up, the total score, negative score and positive score of PANSS in the observed group were lower than that in the control group (P<0.01), while the total score of QOL-100, areas of mentality, dependence, social relation factor scores, the scores of GWB and SES in the observed group were higher than that in the control group(P<0.05 or P<0.01). Conclusion The insight education and self-confidence training can help to improve the symptom of first episode schizophrenia and enhance their quality of life and well-being rating.

Objective To explore the effects of delivery classification scale for fetal cardiac disease on the prenatal and postnatal integrated treatment strategies.Methods Delivery classification scale for fetal cardiac disease included:grade Ⅰ,no hemodynamics instability; grade Ⅱ,ducted-dependent lesions,stable hemodynamics anticipated;grade Ⅲ,possibility or likelihood of hemodynamic instability; IMPACT(delivery immediately heart intervention) level,hemodynamic instability is anticipated at separation from placental circulation.During August 2006 to May 2010,a retrospective study of 46 cases of prenatal diagnosis of congenital heart disease and delivery in one cardiac center was taken,in which 33 in grade Ⅰ,9 in grade Ⅱ,4 in grade Ⅲ,and no IMPACT.Results Thirty-nine boys and 7 girls were born at (38.0 ± 1.4) weeks of gestation and had consistent fetal diagnoses of mainly cardiac abnormalities with postnatal screen.Thirteen neonates underwent cardiac intervention within one week after birth with one death,including 2 in grade Ⅰ,7 in grade Ⅱ,4 in grade Ⅲ,of them 1 death.Seven infants including 5 in grade Ⅰ and 2 in grade Ⅱ underwent cardiac intervention with one death.The remaining 26 children in grade Ⅰ had uneventfully outcomes,in which 7 cases of surgical operation,17 cases of interventional therapy,2 cases of spontaneous healing.Conclusion Delivery classification scale for fetal cardiac disease should have some guiding significance for early treatment strategies and could enhance closely integration of prenatal diagnosis and postnatal treatment.The most fetuses in grade Ⅰ need not undergo cardiac interventions in neonatal stage.However,early cardiac intervention for fetuses in grade Ⅱ and Ⅲ should be carried out postnatally with the help of neonatologists.

Objective To summarize primary experiences of integrated fetal diagnosis and postnatal treatment for the transposition of the great arteries (TGA). Methods Five fetus were diagnozed as TGA at(28.4 ±4.4) weeks of gestation via fetal echocardiography. The mean age of the pregnant women was (28.4 ±3.0) years old. Delivers were taken by caesarean at (36.5 ±1.8) weeks of gestation. The body weight of neonates was (2468 ±442) grams. All neonates were transported to the department of neonatology and re-checked by echocardiography. 3 cases were TGA with intact ventricular septum, 2 cases were TGA with ventricular septal defect. Prostaglandin and mechanical ventilation were applied if oxygen saturation was lower. The standard arterial switch procedure was performed under cardiopulmonary bypass with moderate hypothermia. Results The mean age for patients at surgery was (9. 0 ±6. 2) days ( ranged 2-19 days). Three neonates survived, 2 preterm neonates died. One with body weight 1770 g, 2 days after operation was died of sudden heart arrest and failure of resuscitation. Another was treated by mechanical ventilation and prostaglandin after delivery and underwent operation at the second postnatal day, the neonate appeared low cardiac output and high serum lactate postoperatively and died in the third day. Conclusion The integrated fetal diagnosis and postnatal treatment for TGA could prevent severe cyanosis and emergency transportation after parturition. The lack of any link in the cooperation among the multidisciplinary team could affect the benefits for the TGA neonates provided by prenatal diagnosis.

Objective To summarize the clinical experience of surgical intervention for cardiac neoplasm in a fetus . Methods A 32-year-old pregnant woman was admitted to our hospital for complaint of fetal cardiac neoplasm .A separated het-erogenic cardiac occupying lesion was identigied at right atrium of the fetus by echocardiography , whose size is 2.85 cm ×2.25 cm, but the pathogenic origin still remained uncertain, maybe originate from ether pericardium or atrium.The annulus of tri-cuspid valve was compressed nearly 50% with the presence of amount of pericardial effusion.The fetal heart rate decreased at some fetal position resulting in the compression to the heart.So an Ex-utero Intrapartum Therapy(EXIT) procedure was per-formed under the supply of placenta at the 32 weeks of pregnancy.Cesarean section was performed with intact umbilicus and fe-tal circulation by obstetricians.Consequently, the median sternotomy of this fetus and pericardiotomy were performed , with 30 ml clear pericardial effusion drained .The tumor was confirmed to be giant right atrial neoplasm after the intraoperative explora-tion.Considering on the high risk of the cardiopulmonary bypass and limited time for EXIT , the giant atrial neoplasm was left alone with delayed sternum closure after the effectively decompression of the heart .The omphalotomy was successfully per-formed after the EXIT surgery.The neoplasm resection and the repair for its defect on right atrium were performed with cardiop-ulmonary bypass 2 days later.Results Convalesce of this mother was quite good after cesarean resetion .Hemodynamics of the premature baby was satisfatory after the resection of right atrial neoplasm which pathological report was benign hemangioma . Conclusion Via multiple disciplines collaboration , EXIT intervention for fetus is feasible and safe under adequate prepara-tion.

Objective To retrospectively analyze the diagnosis and perinatal management of fetal congenital heart disease ( CHD) in our hospital during the past eight years.Methods A retrospective analysis of 358 cases of CHD diagnosed by fetal echocardiography prenatal and/or postnatal was done in Guangdong General Hospital from Jan 2006 to Dec 2013,the delivery conditions of these fetus were analyzed.Results Incidence of CHD was 1.85％(358/19338), 297 cases were prenatal diag-nosed, 61 cases were postnatal diagnosed.In the prenatal diagnosed group, 60.6％(180/297) were complex CHD.In the postnatal diagnosed group, 90.2％(55/61) were simple CHD.In the complex CHD, 96.8％(180/186) were prenatal diag-nosed.In the prenatal diagnosed group, the survival rate was 68.35％(203/297), of which the simple CHD was 93.16％(109/117), the complex CHD was 52.22％(94/180).The vaginal delivery rate(46.3％ vs 42.6％) in the prenatal diag-nosed group was higher than the postnatal diagnosed group, the difference was significant(P<0.001).Conclusion Through standardized screening and diagnosis methods, most of the complex CHD and part of simple CHD can be prenatal diagnosed . Except for obstetric indications, vaginal delivery was suggested for all of CHD, delivery way did not affect the prognosis.Most of postnatal diagnosed CHD were simple CHD, the prognosis was good.Integrated pattern of prenatal diagnosis and postnatal treatment was completely feasible .

Objective:To investigate the feasibility of echocardiography-guided transcatheter closure of atrial septal defect (ASD) during pregnancy and summarize the multidisciplinary treatment experience for such women.Methods:A retrospective analysis was performed on three women receiving echocardiography-guided secondum ASD closure during pregnancy in Guangdong Provincial People's Hospital from January 2018 to October 2021. Perioperative and perinatal multidisciplinary treatment and prognosis were described.Results:All three patients underwent cardiac ultrasonography due to abnormal electrocardiogram during routine prenatal examination and were diagnosed with secondum ASD. Progressive cardiac dysfunction was found during close follow-ups and all cases met the criteria for ASD closure during pregnancy after multidisciplinary evaluation. Echocardiography-guided ASD closure was successfully performed in all patients. Pulmonary arterial pressure was significantly reduced and the cardiac function was stable after the operation. All patients delivered vaginally at term without complications such as miscarriage, premature birth, postpartum hemorrhage or fetal growth restriction and had their cardiac function recovered during postpartum follow-up.Conclusions:Echocardiography-guided ASD closure during pregnancy is technically feasible. Good maternal and fetal outcomes can be obtained through multidisciplinary and close monitoring and treatment during perioperative and perinatal periods.