Objective To investigate the effect of collaborative ward rounds of doctors and nurses.Methods The department of cardiovascular diseases was involved in the trial. The conventional nursing ward rounds from January to June 2012 were set as control group(before collaborative ward rounds)and the collaborative rounds were as the experiment group from July to December 2012(after collaborative ward rounds). The degree of satisfaction of doctors and patients with nurses in the department was investigated before and after the implementation.Result The level of satisfaction of doctors and patients with nurses after the implementation was significantly higher than that before the implementation(P<0.05).Conclusion Collaborative clinical rounds can improve the quality of holistic nursing and raise the level of satisfaction of doctors and patients with nurses.

Facing the current situation of cultivation of humanistic quality of medical students,the affiliated hospital has the necessity and possibility to deeply involve the cultivation of medical students' humanistic quality.Its profound historical and cultural accumulation,a large number of advanced figures and humanistic care system are conducive to the cultivation of humanistic quality of medical students.This paper put forward the establishment of the working group on the cultivation of humanistic quality,the multi-level humanistic curriculum teaching,the motivation of teachers in hospital,the evaluation and assessment of medical students' humanistic quality,and the formation of the combination mode of hospital and medical college in the cultivation of medical student's humanistic quality,are the effective way of strengthening the deep involvement of affiliated hospital in the cultivation of medical students' humanistic quality.

Objective To investigate the perinatal outcomes of pregnancies complicated with varying degrees of thrombocytopenia.Methods Clinical data of 305 pregnant women with thrombocytopenia,who admitted to Peking University People's Hospital from January 1,2000 to January 31,2010 were retrospectively analyzed.The etiological diagnosis of them were gestational thrombocytopenia (GT),idiopathic thrombocytopenic purpura (ITP) or undetermined.The patients were divided into 4 groups according to the minimal level of platelets in pregnancy ( platelets count was lower than 100 ×109/L at least twice) : groupⅠ,(50-100) ×109/L (n=101) ; group Ⅱ,(30-50) × 109/L (n = 85); group Ⅲ,(10-30) × 109/L (n = 87); group Ⅳ,< 10 × 109/L (n = 32).Demographic data such as pregnancy complications,treatment,neonates and follow-up results of the patients in each group were compared with ANOVA,Spearman rank correlation analysis,Chirsquare test and Chi-square trend test in SPSS 17.0.Results Medical complications in pregnancy of these patients included hypertensive disorder complicating (n = 35,11.48%) and abnormal glucose metabolism (n=23,7.54%),no difference was found in the incidence of these diseases among the four groups.There were 68 patients complicated with anemia (22.30%),40 preterm delivery (13.11%),60 postpartum hemorrhage (19.67%); there were significant differences in the incidence among the four groups (P＜0.05),the incidence increased with the aggravation of thrombocytopenia (P＜0.05).There were 2 cases of puerperal infection (0.66%),no maternal deaths.Fifty-one patients (16.72%) accepted treatment of corticosteroids or Gamma globulin during pregnancy.There were 116 cases (38.03%) of vaginal delivery and 189 cases (61.97%) of cesarean section.The postpartum bleeding amount within 24 hours increased with the aggravation of thrombocytopenia.Two hundred and eleven (69.18%) patients were followed up and platelet count regained normal,among which 152 cases recovered within six months after delivery.The recovery rates were 90.59% (77/85),82.36% (42/51),46.16% (24/52) and 39.13% (9/23) from group Ⅰ to group Ⅳ,as declined with the aggravation of thrombocytopenia in pregnancy ( x2trend = 42.616,Ptrend =0.000).Among the 306 perinatal fetuses,neonatal outcomes included 301 live births,5 fetal deaths,4 early neonatal deaths,4 low birth-weight infants after term birth,1 intracranial hemorrhage and 18 (5.98%) neonatal thrombocytopenia cases.Incidence of neonatal thrombocytopenia increased with the aggravation of maternal thrombocytopenia.Sixteen cases of neonatal thrombocytopenia recovered at 3-8 weeks after birth,but two cases did not recover within three years during followed up.Conclusions The perinatal outcomes are different in pregnancies complicated with varying degrees of thrombocytopenia.As thrombocytopenia in pregnancy become worse,the risk of anemia,premature delivery,postpartum hemorrhage and neonatal thrombocytopenia increases.While,perinatal outcomes may be better under close perinatal care.

Objective To investigate the etiology and perinatal outcome of pregnancies complicated with extremely severe thrombocytopenia [ at least two times of platelets count (PLT) < 10 × 109/L during pregnancy]. Methods Clinical data, including basic information, etiology, management and outcomes of pregnant women with extremely severe thrombocytopenia, admitted to Peking University People's Hospital from January 2004 to March 2009, were retrospectively collected. The management of these cases varied according to different etiology and the symptoms: (1) PLT were maitained > 20 × 109/L and hemoglobulin> 70 g/L in those women without spontaneous bleeding; (2) PLT transfusion would be required when PLT< 10 × 109/L or bleeding occur and RBC would be supplied when hematocrit <25% and hemoglobulin <70g/L; (3) Hemoglobulin should be > 70 g/L and PLT >30 × 109/L before cesarean section or delivery;(4) Predinisone and/or intravenous immunoglobulin G (IVIG) would be given in women complicated with idiopathic thrombocytopenic purpura (ITP) when PLT < (20-30) × 109/L or bleeding. PLT would be given if all the above management were failed, or PLT < 10 × 109/L, or bleeding. Women without bleeding would be closely monitored and delivery would be planned. Results (1) Twenty-six cases were identified among 9302 deliveries during the study period (0.28%), with an average of maternal age of 29. Seventeen were diagnosed before conception and 9 during pregnancy. Among the 26 women, half received regular prenatal check in our hospital and the average gestations at diagnosis was 24 weeks and the other half without regular prenatal visits and the average gestations at diagnosis was 32 weeks. Etiology was identified in 24 out of the 26 women, including 14(54%) ITP, 5 myelodysplastic syndrome (MDS), 4 chronic aplastic anaemia(CAA) and 1 systemic lupus erythematosus (SLE). (2) Management: All of the 26 women received blood products. Among the 14 ITP cases, 6 received predinisone and IVIG and 8 only took predinisone. Nine of the 26 patients (35%) had pregnant complications, among which 6 (6/9) were preeclampsia. The overall average gestation at delivery was 36 weeks. Only 2 delivered vaginally with the average blood loss of 83 ml and 23 cesarean sections were performed with the average blood loss of 410 ml. (3) Perinatal outcomes:There were 26 perinatal babies, among which 1 died intrauterine and 25 were born alive (12 preterm infants). The average birth weight was 2877 g. Neonatal severe thrombocytopenia presented in 2 newborns whose mother complicated with ITP. Conclusions The main cause of extremely severe thrombocytopenia during pregnancy is ITP, managed mainly by predinisone and IVIG, followed by CAA and MDS, which may require supportive treatment. Pregnancy complicated with extremely severe thrombocytopenia is not an indication of termination. Better maternal and fetal outcomes can be achieved through proper treatment based on the etiology, intensive care in prevention and management of complications and cesarean section.

Objectives To summarize the maternal and fetal outcomes of patients with essential thrombocythemia (ET), and tentatively propose possible solutions for different clinical scenarios.Methods We retrospectively studied the clinical data, treatment, outcomes and follow-up status in 18 consecutive cases of young women with ET visited Peking University People's Hospital, among whom 22 pregnancies occurred from March 2005 to January 2015.Rank-sum test, Chi-square test or Fisher exact test were applied for statistics.Results (1) Out of the total 22 pregnancies, 17 (77％) were successful (term live births) and five (23％) ended in miscarriages, among which four were spontaneous abortion in first trimester.(2) Six pregnancies did not received any therapy, while 16 received various treatments before and/or during pregnancy, including oral Aspirin(single/joint), Hydroxyurea, Interferon-α (IFN-α) and platelet apheresis.(3) Treatments before/during pregnancy improved the live birth rate significantly (15/16 vs 2/6, P=0.009).Platelet (PLT) count of the newborns were all normal till the time at follow-up.(4) The median PLT count in those patients before Aspirin therapy was 761 × 109/L[(448-1 213) × 109/L, and 639× 109/L[(283-1 908) × 109/L] thereafter, which showed no significant difference (Z=-0.405, P=0.686).(5) The PLT counts in those patients before combination therapy of Aspirin and IFN-α was 989 × 109/L[(435-1 504) × 109/L], and 498 × 109/L[(186-559) × 109/L] thereafter, which decreased significantly (Z=-2.366, P=0.018).Conclusions (1) First-trimester spontaneous abortion is the most common complication of ET in pregnancy.(2) A specific treatment strategy may improve the pregnant outcomes without long-term harmful effect up to now.(3) IFN-α and/or Aspirin might be the first-line therapy in women with ET during pregnancy.

Objective To evaluate the diagnosis and the optimal management of idiopathic thrombocytopenic purpura(ITP) with pregnancy and the related high risk factors with neonatal passive immune thrombocytopenia(PIT) occurring in infants born to mothers with ITP. Methods Medical records of 40 pregnant women with ITP and their neonatal outcomes were reviewed retrospectively from 1992.2 to 2001.8 in our hospital. Results The incidence of pregnancy with ITP was 3.4‰. The maternal complications included pregnancy-induced hypertension syndrome (17.5%), postpartum hemorrhage (15%), preterm labor (12.5%), gestational diabetes(7.5%) and FGR (7.5% ). One mother died at 36 weeks of gestational age. There were 13 cases delivered by vagina and 27 cases delivered by cesarean section. Nine neonates(28.1%)had neonatal PIT, Among them three neonates (9.3%) had severe PIT, One neonate(2.5%) had an intracranial hemorrhage(ICH) and two perinatal death (5%)occured in 40 neonates. No significant correlation was found between neonatal platelet counts and maternal platelet counts, maternal PAIgG values and maternal treatments respectively. Conclusion The prognosis of mothers and neonates in pregnancy with ITP are better. The incidence of severe fetal or neonatal PIT is low and not related to maternal platelet counts, maternal treatments and PAIgG values.

Objective To investigate the pregnancy opportunity and outcome of patients with sysmetic lupus erythematosus (SLE).Methods We carried out a retrospective analysis of the clinical information of patients who suffered from SLE complicated with pregnancy and were hospitalized to People's Hospital of Peking University from December of 1992 to February of 2012.Chi-square test were used for statistical analysis.Results Forty-nine cases of patients with SLE complicated with pregnancy had 52 pregnancies in total.In 27 cases of planned pregnancies,24 cases(89％ )resulted in live births and 5 cases( 18％ ) had flares during pregnancy.Of the 24 live births,3 cases( 12％)were premature deliveries and 4 cases(17％) had low birth weight infants.In 25 cases of unplanned pregnancies,12 cases (48％) resulted in live births and 20 cases (80％) had flares during pregnancy.Of the 12 live births,6 cases(50％ ) were premature deliveries and 6 cases (50％) were low birth weight infants.The patients in the planned pregnancy group tended to have flares during pregnancy more frequently than those in the unplanned group (P＜0.01),the former were more likely to have live births than the latter (P＜0.01) and were less likely to have premature delivery (P＜0.05).Conclusion Patients with SLE should have planned pregnancy and need collaborative supervision of both rheumatology and immunology department and obstetric department to improve live birth rate,decrease premature delivery and the activity of SLE during pregnancy.

Objective To investigate the effect of general anesthesia on pregnancy women with thrombocytopenia and neonate during cesarean section(CS). Methods Sixty-five singleton pregnant women with low platelet count (<50×10~9/L) and gestation >35 weeks were allocated into general anesthesia group (35 cases) and local anesthesia group (30 cases) randomly. The time from skin incision to fetal delivery, the oxyhemoglobin saturation(SO_2) before and after anesthesia, the blood loss during operation, Apgar scores at 1 min, birth weight, umbilical cord blood gas analysis were recorded. Results The mean time from anesthesia induction to fetal delivery was (9.7±3.5) minutes in general anesthesia group. The time from skin incision to fetal delivery in general anesthesia group [(7.7±2.5) minutes] was shorter than that in local anesthesia group [(12.5±3.0) minutes, P<0.01], while the operation time had no significant differences. There were no significant difference for the value of SO_2 before and after general anesthesia or local anesthesia(P>0.05). There was no significant difference for the blood loss [(471±245)ml vs. (452±213 )ml, P>0.05], Apgar scores at 1 minute, birth weight and umbilical cord blood gas analysis between the two groups (P>0.05). There had two infants with blue asphyxia in local anesthesia group while no infant with asphyxia in general anesthesia group. Conclusion General anesthesia is safe to pregnant women with thrombocytopenia during CS.

Objective To investigate the clinical characteristics, the antenatal management, the outcome and prognosis of chronic myeloproliferative disorders (CMPD) complicating pregnancy. Methods Retrospectively analyze the clinical data of eleven patients with CMPD complicating pregnancy hospitalized in Peking University People' s Hospital from 2000 to 2009, including five patients with essential thrombocythemia, one with primary myelofibrosis and five with chronic myeloid leukemia. Results (1)Five pregnancies had periodic antenatal care and laboratory monitorings like full blood count. Reasonable anti-coagulation therapy was given to prevent the complications. One patient with PMF diagnosed before conception had her first pregnancy ended with mild pre-eclampsia and intrauterine death at the gestational age of 32 weeks. During the first trimester of her second pregnancy two years later, the test for anti-β2 glycoprotein antibody was positive. She received low-dose aspirin and low-molecular-weight heparin as anticoagulants. An uneventful course was obtained and she delivered a healthy term infant. (2) Five pregnancies had occasional antenatal examination, including two patients with ET and three patients with CML One patient with ET developed severe pre-eclampsia at the gestational age of 25 weeks. Umbilical artery Doppler showed reversed end-diastolic velocity. The management with anti-convulsants, antihypertensives and anti-coagulants showed no effect. An emergency cesarean section had to be performed because of the aggressive hypertension and placental abruption, with still birth as a result. Two pregnancies never had an antenatal care. Both of them were admitted on labor and the diagnoses of CML were made. (3)Four pregnancies developed oligohydramnios and three developed preelampsia(two severe pre-eclampsia and one mild pre-eclampsia). There was no other hemorrhage and thrombosis event. (4) Eight pregnancies reached full-term with four cesarean sections and four vaginal births. Two preterm cesarean sections were performed because of a progressive oligohydramnios. The ten live neonates weighed 1820 - 3600 g. All were appropriate for gestational age, except one fetal growth retardation (FGR) developed in one patient with severe pre-eclampsia. (5) As for the CMPD, the eleven patients were all in stable conditions. Three patients with CML received hydroxyurea in the third trimester, four with ET and one with CML had plateletpheresis before delivery with favorable effect. All patients were uneventful postpartum, except one with CML who died in 5 months after childbirth. Conclusions The pregnancy outcomes for patients with CMPD are mostly good. However, antenatal care should pay more attention to the complications such as thromboembolic accidents, pre-eclampsia, still birth and fetal growth retardation. Management including reasonable anticoagulation therapy should be considered, which may help improve the prognosis.

Objective To investigate the perinatal outcomes of pregnancy with chronic myeloid leukemia (CML) and how to manage it during pregnancy. Methods To retrospectively analyse the clinical datas about the perinatal outcome and the obstetric management of the 16 cases of pregnancy with CML during the last 30 years in a single center. Results ( 1 ) Management ang perinatal outcomes: among the 16 pregnancies nine ended with therapeutic abortion during the first or second trimester and no CML complications were observed. The average gestation week was 7 weeks(5 - 13 weeks)when they came to our hospital. Seven pregnancies gave birth, among which CML was diagnosed during pregnancy in four patients and pregnancy was confirmed during CML in three patients. The average gestation week was 36 weeks (27 -40 weeks +2)when they came to our hospital. Among the seven women three were treated with hydroxyurea (one became pregnant while she was on hydroxyurea and she elected to continue her pregnancy and continued to use hydroxyurea), one with leukapheresis twice after her 40 weeks of gestation, one with plateletpheresis and three hadn't any treatment. In the seven pregnacies three developed severe preeclampsias, including the two had hydroxyurea during the gestation. The average delivery gestational week was 38 weeks (33 weeks +4 -41 weeks), two were premature birth. Two caesarean sections, three vaginal deliveries and two forceps deliveries. There were two postpartum hemorrhage, during the 24 hours the amount of bleeding was 1500 - 1800 ml and secondary disseminated intravascular coagulation happened. Seven patients gave birth to seven infants whose average birth weight was 2469 g( 1820 - 2810 g), of whom two were premature infants, two low birth weight infants, one had congenital malformation and two had abnormal blood routine examinations. (2) Management after delivery and prognosis: during the nine patients who ended pregnancy with therapeutic abortion during the first or second trimester four withdraw, one died whose course of disease was 3 years and the other four were alive during 5 months to 72 months, among which one had stem cell transplantation, two are taking imatinib mesylate and one takes hydroxyurea. Among the seven patients who deliveried two withdraw, two died and three are alive. Among the seven infants two withdraw,the other five have normal development following 4 months to 9 years. Conclusions CML patient may have successful pregnancy and delivery, and it is not the absolute indication for terminating pregnancy. On the other hand, CML and the treatment during pregnancy can have side effect on the mother and the fetus, so the patients should be monitored and treated in tertiary hospitals.