Objective To study the MRI findings and pathologic characteristics of cesarean scar pregnancy during the first-trimes-ter.Methods Clinical data,MRI findings and pathologic manifestations of 23 CSP patients confirmed by surgery and pathology were analyzed retrospectively.Results On pathologic specimens by the microscope,villi and decidua tissue were found in the myometrium of all 23 cases (100%),and smooth muscle tissue in the uterus scar was incomplete in 12 cases (52.2%).The incision scars were found in the uterine lower antetheca in 21 cases,which showed low signal on T1 WI and T2 WI.A majority of the gestational sac pro-truded into intrauterine in 12 cases.The gestational sac located in the scar of lower uterine antetheca in 10 cases and in the myometri-um around the scar in 1 case.The gestational sac of 22 cases were quasi-round with the size between 1.8 cm×1.2 cm and 6.4 cm× 2.7 cm.The gestational sacs showed homogeneous low signal on T1 WI and high signal on T2 WI in 8 cases,heterogeneous high signal on T2 WI and STIR sequence in 1 5 cases,a little short T1 signal of bleeding in 9 cases,and heterogeneous high signal on DWI sequence in 3 cases.The gestational sac borders were well-defined in 18 cases and blurred in 5 cases.Among 5 cases performed by enhanced MRI,there were 3 cases which gestational sac walls were ring-shaped enhanced.Conclusion MRI findings of CSP had certain char-acteristics and could reflect the pathological characteristics of CSP.MRI had important reference value in early diagnosis of CSP and the choice of treatment.

PurposeTo evaluate multislice spiral CT (MSCT) in diagnosing abdominal anaphylactoid purpura (AAP), and to explore its role in treatment follow-up.Materials and Methods Clinical and MSCT data of 13 patients with confirmed AAP were retrospectively analyzed. All patients underwent abdominal CT scan and thin layer reconstruction. Upper endoscopy was performed in 8 patients prior to treatment. MSCT was performed in 10 patients and endoscopy in 4 patients posttreatment, then clinical and CT features were compared to pretreatment findings.Results In pretreatment CT scan, single segment bowel involvement was found in 2 cases, multisegmental bowel involvement in 10 cases, and no positive finding in 1 patient. The duodenum and jejunum were involved in 8 patients and stomach in 5 patients. The diseased bowel wall showed swelling and thickening with decreased attenuation and homogeneous luminal narrowing with equivocal lining and double loop sign. Infiltration was found in 10 patients, small ascites in 3 patients. Patients were misdiagnosed as acute pancreatitis in 2 cases, acute cholecystitis, small bowel obstruction and peritonitis in 1 case respectively. Of 13 patients, five patients were cured, and the other 8 patients were improved. The clinical symptoms including rash, abdominal pain, occult blood, leukocytosis, vomiting, melena, urine occult blood were improved (χ2=5.59-18.33,P<0.05 orP<0.01). Post treatment CT showed significant improvement of bowel edema and infiltration (P<0.01). There was no statistically significant difference in change of ascites (P>0.05).Conclusion MSCT findings of AAP are nonspecific. CT diagnosis is difficult before skin rash. Combining CT characteristics of multisegmental bowel edema and clinical manifestations is helpful. CT examination can effectively follow up treatment response.

Objective To compare the value of transvaginal ultrasound and MRI in diagnosis of the first-trimester cesarean scar pregnancy (CSP).Methods The transvaginal ultrasound and MRI data of 28 patients who were initially diagnosed as CSP were analyzed. Regarding the surgery and postoperative pathology as a gold standard,the differences between transvaginal ultrasound and MRI were compared in the sensitivity,specificity,diagnostic coincidence rate and the ability in showing the internal structure of gestational sac and its relationship with the surrounding tissue.Results 22 CSP patients were confirmed by surgical pathology in a total of 28 patients,while 20 CSP patients using transvaginal ultrasound and 1 9 using MRI were correctly diagnosed respectively,and the sensitivity,specificity and diagnostic coincidence rate were 90.9%,50.0%,82.1% vs 86.4%,83.3%,85.7%,respectively,exhibiting no statistical difference in the coincidence rates between two methods (χ2 =0.132,P=0.72 ).The pregnant bursa in 20 patients was found by pathology in 22 CSP patients,and 19 pregnant bursa with transvaginal ultrasound and 17 with MRI were confirmed respectively,exhibiting no statistical difference between two methods (χ2 =1.11,P =0.29).The yolk sac in 12 patients,embryos in 8,original heart tube in 5 and local scar pregnancy sac infiltration in 3 were found with transvaginal ultrasound,meanwhile those in 2,2,0 and 9 respectively were also found with MRI,exhibiting significant differences between the two methods (χ2 =13.8,P =0.000;χ2 =7.7,P =0.006;χ2 =7.2,P =0.007;χ2 =7.1,P=0.008).The pregnancy capsule hemorrhage in 7 patients and hemorrhage in uterine cavity in 9 were found with transvaginal ultrasound, meanwhile those in 14 and 1 5 were found with MRI,exhibiting significant differences (χ2 =6.6,P =0.01;χ2 =5.0,P =0.026). Conclusion The coincidence rate in diagnosis of CSP using transvaginal ultrasound or MRI is higher.Transvaginal ultrasound is superior to MRI in showing the yolk sac,embryos and original heart tube,while MRI is better than transvaginal ultrasound in showing the hemorrhage of uterine cavity or gestational sac and the relationship between pregnant bursa and the surrounding tissue.Combination of the two methods shows more value in early diagnosis of CSP.

Objective: To study the related factors of postpartum posttraumatic stress disorder. Methods: Perinatal posttraumatic stress disorder questionnaire-Chinese edition(PPQ-C) was used to measure the symptoms of 1 160 puerpera in maternal and child health hospital of Hubei Province.Chi-square test was used to evaluate the differences of positive and negative symptom group in living area (urban or rural), employment status (employment or unemployment), medical insurance status (with or without medical insurance), parity (primiparity or multiparity), mode of delivery (natural labor or cesarean section). Logistic regression analysis was used to discuss the influencing factors of postpartum PTSD. Results: In all 1 160, there were 188 puerpera meet the positive standard postpartum PTSD(16.2%), and the average score of PPQ-C of this 188 puerpera was (25.71±6.22). Women who were unemployed(OR=0.64, 95%CI: 0.46-0.89, P=0.01), who had no medical insurance (OR=0.60, 95%CI: 0.43-0.82, P<0.01), who gave birth by cesarean section(OR=1.47, 95%CI: 1.06-2.03, P=0.02) and who had pregnancy complications (OR=1.47, 95%CI: 1.06-2.03, P=0.03) were at higher risk of postpartum PTSD. Conclusion Medical insurance status and employment status were important factors affecting postpartum PTSD.Delivery mode and pregnancy complications are important factors affecting the occurrence and development of postpartum PTSD symptoms, and abnormal results of pregnancy examination which related to pregnancy complications are important stressor for postpartum PTSD symptoms.