OBJECTIVES: There is a high coagulation state in pregnant women, which is prone to coagulation and fibrinolysis system dysfunction. This study aims to explore the latest coagulation markers-thrombomodulin (TM), thrombin-antithrombin complex (TAT), plasmin-α2 plasmin inhibitor complex (PIC), and tissue plasminogen activator/plasminogen activator inhibitor compound (tPAI-C) in different stages of pregnancy, establish reference intervals (RIs) for healthy pregnant women of Chinese population, and to provide an effective and reliable reference for clinicians. METHODS: A total of 492 healthy pregnant women, who underwent pregnancy examination and delivery in the Department of Obstetrics, Second Xiangya Hospital of Central South University from October 2019 to October 2020, were enrolled for this study. They were assigned into the first trimester group, the second trimester group, the third trimester group, and the puerperium group according to the pregnancy period, and 123 healthy non-pregnant women were selected as the controls. Plasma levels of TM, TAT, PIC and tPAI-C were analyzed by automatic chemiluminescence immunoassay analyzer. The RIs for TM, TAT, PIC, and tPAI-C were defined using non-parametric 95% intervals, determined following Clinical and Laboratory Standards Institute Document C28-A3c (CLSI C28-A3c), and Formulation of Reference Intervals for the Clinical Laboratory Test Items (WS/T402-2012). RESULTS: TM and TAT levels increased gradually in the first, second, and third trimester women and decreased in the puerperium women (P<0.05 or P<0.01). PIC level of healthy non-pregnant women was lower than that of pregnant women (P<0.05 or P<0.01), but PIC level of pregnant and puerperium women did not differ significantly (P>0.05). tPAI-C level in healthy non-pregnant women was lower than that of pregnant women (P<0.05 or P<0.01), and tPAI-C level was significantly decreases in the puerperium women (P<0.01). The RIs for TM were as follows: Healthy non-pregnant women at 3.20-4.60 TU/mL, the first and second trimester at 3.12-7.90 TU/mL, the third trimester at 3.42-8.29 TU/mL, puerperium at 2.70-6.40 TU/mL. The RIs for TAT were as follows: Healthy non-pregnant women at 0.50-1.64 ng/mL, the first and second trimester at 0.52-6.91 ng/mL, the third trimester at 0.96-12.92 ng/mL, puerperium at 0.82-3.75 ng/mL. The RIs for PIC were as follows: Healthy non-pregnant women at 0.160-0.519 ng/mL, pregnant women at 0.162-0.770 μg/mL. The RIs for tPAI-C were as follows: Healthy non-pregnant women at 1.90-4.80 ng/mL, the first and second trimester at 2.03-9.33 ng/mL, the third trimester at 2.80-14.20 ng/mL, puerperium at 1.10-8.40 ng/mL. CONCLUSIONS The levels of 4 new coagulation markers TM, TAT, PIC, and tPAI-C in pregnant women are increased significantly during pregnancy and gradually return to normal after delivery. The RIs for TM, TAT, PIC, and tPAI-C in pregnant women by trimester are established according to CLSI C28-A3c, thus providing a clinical reference for clinician in judgement of thrombotic risk.
Biomarkers/blood* ; Blood Coagulation ; Female ; Humans ; Postpartum Period ; Pregnancy ; Reference Values

Postpartum depression(PPD) is a common emotional disorder in the puerperium, which has negative impact on women, infants and family. There is growing evidence that abnormal concentration of a number of nutrients (including polyunsaturated fatty acids, vitamin D and homocysteine) is associated with depression in postpartum population. Further studies on the mechanisms for the functions of nutrients and regulation of nutritional states in the puerperium will be of great value in the prevention, early diagnosis and treatment of PPD.
Depression, Postpartum ; blood ; physiopathology ; Fatty Acids, Unsaturated ; blood ; physiology ; Female ; Homocysteine ; blood ; physiology ; Humans ; Nutritional Status ; Postpartum Period ; physiology ; Vitamin D ; blood ; physiology

Spontaneous remission of acute leukemia is a rare event and has been documented in cases of systemic infection and blood transfusion. Furthermore spontaneous remission in association with the termination of pregnancy is also rare and hormonal effects during the puerperium have been implicated. We report here a case of acute myelogenous leukemia (AML, M5) diagnosed in a young woman after Cesarean section delivery who acheived spontaneous remission and relapsed 2 weeks later with leukemia cutis.
Blood Transfusion ; Cesarean Section ; Female ; Humans ; Leukemia ; Leukemia, Myeloid, Acute* ; Postpartum Period ; Pregnancy* ; Remission, Spontaneous* ; Skin*

Plasmapheresis has been used for some conditions during pregnancy and puerperium, such as hemolysis, elevated liver enzymes, and low platelet (HELLP) syndrome. We present one case of the HELLP syndrome which was treated with plasmapheresis and also review the indications, complications and guidelines for repetitive plasma exchange.
Blood Platelets ; Female ; HELLP Syndrome* ; Hemolysis ; Liver ; Plasma Exchange ; Plasmapheresis* ; Postpartum Period* ; Pregnancy

Cerebrovascular disease refers to disorder of one or more blood vessels of the brain, and the majority of lesions that arise from these are from arterial diseases. The occurrence of cerebral venous thrombosis is clearly linked to the puerperal state, and pregnancy may increase the risk of subarachnoid hemorrhage. The most common cause is rupture of arterial aneurism. Hemodynamic, hormonal or other physiological changes of pregnancy may play a role in aneurysmal rupture. We report two cases of cerebrovascular diseases in the puerperium with a brief review of concerned literatures
Aneurysm ; Blood Vessels ; Brain ; Hemodynamics ; Postpartum Period* ; Pregnancy ; Rupture ; Subarachnoid Hemorrhage ; Venous Thrombosis

PURPOSE: There is increasing necessity of using cord blood cell worldwide. In order to improve the effectiveness of cord blood's usage in Korea, the study of knowledge and attitude regarding cord blood is needed. METHODS: As descriptive correlation study, data was collected from 212 early postpartum women who stored or donated cord blood from 2007 April to July. Data was analyzed using chi-square-test, t-test, ANOVA, and logistic regression. RESULTS: Total score of knowledge and attitude of early postpartum women who donated cord blood was higher than who stored. According to the source of education and the source of influence toward decision of using cord blood, early postpartum women who educated or influenced by mass media showed difference in attitude. Job status and income, and attitude of cord blood were the predictor of cord blood donation. CONCLUSION: Attitude regard to cord blood affect to usage of cord blood, and the attitude and knowledge of cord blood in early postpartum women who donated it higher than who stored.
Fetal Blood ; Korea ; Logistic Models ; Mass Media ; Postpartum Period ; Statistics as Topic

PURPOSE: To identify the effects of foot reflexology massage on fatigue, stress and depression of postpartum women. METHODS: A nonequivalent control group pre-post design was used. A total of 70 women in a postpartum care center were recruited and were assigned to the experimental group (35) or control group (35). Foot reflexology massage was provided to the experimental group once a day for three days. Data were collected before and after the intervention program which was carried out from December, 2013 to February, 2014. Data were analyzed using Chi-square test, Fisher's exact test, and t-test. RESULTS: The level of fatigue in the experimental group was significantly lower than the control group (t= - 2.74, p =.008). The level of cortisol in the urine of women in the experimental group was significantly lower than the control group (t= - 2.19, p =.032). The level of depression in the experimental group was significantly lower than the control group (t= - 3.00, p =.004). CONCLUSION: The results show that the foot reflexology massage is an effective nursing intervention to relieve fatigue, stress, and depression for postpartum women.
Adult ; Depression, Postpartum/*prevention & control ; *Fatigue ; Female ; Foot ; Humans ; Hydrocortisone/blood ; Infant, Newborn ; Male ; *Massage ; Postpartum Period/*psychology ; *Stress, Psychological ; Surveys and Questionnaires

The management of postpartum hemorrhage remains one of the significant challenges to clinical practitioners of obstetrics. Massive postpartum hemorrhage is a major cause of maternal death and morbidity. Early postpartum hemorrhage refers to bleeding within the first 24 hours after delivery; late of delayed postpartum hemorrhage occurs more than 24 hours but less than six weeks after delivery. Uterine atony remains the most common cause with many patients presenting with no known risk factors. Postpartum bleeding can result from uterine atony, genital tract lacerations or hematomas, retained placenta, uterine inversion and acquired or inherited coagulopathies. Every obstetrics unit should have protocols available to deal with hemorrhage and have specific guidelines for patients who object to blood transfusions for various reasons. Placement and utilization of arterial catheters for uterine artery embolization is becoming more widespread. Timely hysterectomy should be performed for signs of refractory bleeding. Application of medical and surgical principles combined with recent new technologic advances will help the obstetrician avoid disastrous outcomes for both mother and fetus.
Blood Transfusion ; Catheters ; Fetus ; Hematoma ; Hemorrhage ; Humans ; Hysterectomy ; Lacerations ; Maternal Death ; Mothers ; Obstetrics ; Placenta, Retained ; Postpartum Hemorrhage* ; Postpartum Period* ; Risk Factors ; Uterine Artery Embolization ; Uterine Inertia ; Uterine Inversion

Ammiotic fluid embolism(AFE) is an often-devastating condition of pregnancy with high mortality. The diagnosis of amniotic fluid embolism is generally made postmortem and rests upon the morphological demonstration of amniotic fluid debris including fetal epithelial squames and hair in the pulmonary vasculature. We have made the diagnosis of amniotic fluid embolism by detection of amniotic fluid debris in cervical blood vessels ension with profuse postpartum hemorrhage and evidence of disseminated intravascular coagulation, cervical laceration after uneventful delivery. Amniotic fluid debris were only demonstrated in the blood vessels of cervical laceration site. We present a case of amniotic fluid embolism which was diagnosed at postpartum hysterectomy specimen via thorough histological examination.
Amniotic Fluid ; Blood Vessels ; Diagnosis ; Disseminated Intravascular Coagulation ; Embolism* ; Embolism, Amniotic Fluid ; Female ; Hair ; Hysterectomy ; Lacerations ; Mortality ; Postpartum Hemorrhage ; Postpartum Period ; Pregnancy

PURPOSE: To examine effects of a postnatal care program on self-efficacy, self-management, and glycemic control in women with gestational diabetes mellitus (GDM). METHODS: A non-equivalent control group non-synchronized quasi-experimental design was used. Sixty-two women with GDM were enrolled and assigned to either an experimental group (n=30) or a control group (n=32). The experimental group received an intervention which was postnatal care program for women with GDM. The postnatal care program for GDM included an individual education with leaflet and mobile web-based video with three times of telephone counseling. Effects of the intervention were measured with self-efficacy, self-management questionnaire, and a 75 g oral glucose tolerance test (75g OGTT). Statistical significance was examined using independent t-test and χ2-test. RESULTS: Although there was no significant difference in 75g OGTT (χ2=.11, p=.748) or self-management (t=−1.28, p=.206), there was a statistically significant increase in self-efficacy (t=−2.02, p=.048) in the experimental group compared to that in the control group. CONCLUSION: A postnatal care program is needed for women with GDM to improve their self-efficacy. Further studies are warranted to improve self-management and glycemic control through tailored education for GDM postpartum women.
Blood Glucose ; Counseling ; Diabetes, Gestational* ; Education ; Female ; Glucose Tolerance Test ; Humans ; Postnatal Care* ; Postpartum Period ; Pregnancy ; Self Care* ; Telephone