Objective: To investigate the clinical characteristics of induced labor in twin pregnancy and the related factors of induced labor failure. Methods: The clinical data of twin pregnant women who underwent induced labor in Peking University Third Hospital from January 2016 to December 2022 were retrospectively analyzed. According to whether they had labor or not after induction, pregnant women were divided into the success group (pregnant women who had labor after induction, 72 cases) and the failure group (pregnant women who did not have labor after induction, 30 cases). Logistic regression was used to analyze the related factors of induction failure in twin pregnant women. Results: The parity and cervical Bishop score in the failure group were significantly lower than those in the success group, while the proportion of dichorionic diamniotic twins, assisted reproductive technology pregnancy and cervical Bishop score <6, postpartum hospital stay and total hospital stay in the failure group were significantly higher than those in the success group (all P<0.05). The proportion of induced labor by artificial rupture of membranes ± oxytocin intravenous infusion in the success group was 72.2% (52/72), which was significantly higher than that in the failure group (46.7%, 14/30; P=0.030). There were no significant differences between the two groups in the gestational age at delivery, the incidence of severe postpartum hemorrhage and blood transfusion, the amount of postpartum hemorrhage, the neonatal weight of two fetuses, the incidence of neonatal asphyxia, and the proportion of neonates admitted to the neonatal intensive care unit (all P>0.05). There were no severe perineal laceration and hysterectomy in all pregnant women. Multivariate logistic regression analysis showed that primipara (OR=3.064, 95%CI: 1.112-8.443; P=0.030) and cervical Bishop score <6 (OR=5.208, 95%CI: 2.008-13.508; P=0.001) were the independent risk factors for induction failure in twin pregnancy. Conclusions: Elective induction of labor in twin pregnancy is safe and feasible. It is helpful to improve the success rate of induction of labor by strictly grasping the timing and indications of termination of pregnancy, choosing the appropriate method of induction according to the condition of the cervix, and actively promoting cervical ripening .
Infant, Newborn ; Pregnancy ; Female ; Humans ; Pregnancy Trimester, Third ; Pregnancy, Twin ; Postpartum Hemorrhage/etiology* ; Retrospective Studies ; Labor, Induced/methods* ; Cervical Ripening

Introduction: Obstetrical hemorrhage remains to be one of the most common causes of maternal morbidity and mortality. Postpartum hemorrhage occurs after delivery and is usually secondary to uterine atony, genital tract lacerations, and retained placental fragments. Case: A case of a 21-year old, primipara, presented with profuse vaginal bleeding and hemoptysis at 3 weeks' postpartum. A clinical diagnosis of gestational trophoblastic neoplasia was established after an elevated serum beta human chorionic gonadotropin was obtained and an intrauterine mass was seen on ultrasonography, including metastasis to the lungs and liver seen through imaging studies. Discussion Chemotherapy with etoposide, methotrexate, actinomycin D, cyclophosphamide and oncovin (EMACO) is the mainstay treatment for Stage IV disease. However, complications such as hemorrhage and tumor rupture are best managed surgically. Although rare, a diagnosis of choriocarcinoma should be considered in patients with persistent bleeding after a normal pregnancy to institute proper management and avoid associated complications of tumor progression.
Choriocarcinoma ; Gestational Trophoblastic Disease ; Postpartum Hemorrhage

Postpartum depression is a condition that is commonly experienced by postpartum women after childbirth. Determination and detection of factors influencing postpartum depression will help mothers explore evidence-based strategies for early prevention and treatment. A quantitative descriptive survey design was utilized in the study. Data was collected through stratified random sampling. The childbearing mothers in four selected communities of Bontoc, Mountain Province: upland, riverside, AlBaGo, and central Bontoc were the respondents of the study. Data gathered utilized a self-made questionnaire based on journals and research studies about postpartum depression. Results of the study showed that the respondents considered the impact on the extent of factors causing postpartum depression among child bearing mothers. There is a significant difference on the extent of factors influencing postpartum depression among child bearing mothers when grouped according to civil status but no significant difference when grouped according to age, educational attainment and employment status. The respondents ranked the suggested measures to prevent postpartum depression as: 1) psychological, 2) physical and;3) social. Promoting the mental health and well-being of mothers and families through implementation of an evidence-based strategy in the Municipal and Provincial health units can prevent or reduced Postpartum depression. Early interventions on postpartum depression promoted maternal recovery and strong foundations for postpartum mothers. This includes educating mothers, planning health education programs, focusing on early detection, and distributing behavioral change communications through flyers, brochures, and training materials.

Chronic Myeloid Leukemia, a chronic hematopoietic stem cell disorder, is uncommon among younger age group such as pregnant patients. Due to the rarity of this condition in pregnancy, there are no randomized controlled trials to address the optimal management of this condition. We are presented with a 26 year old patient, who had an unplanned pregnancy in the advanced phase of the disease. Due to the risk to the mother in delaying treatment, she was continued on Imatinib, a tyrosine kinase inhibitor, which is a known fetal teratogen. Her pregnancy was carried to term. The patient delivered via spontaneous vaginal delivery to a live, neonate, with findings of hydrocele and syndactyly on the 4" and 5™ digit of the right foot. Due to the maternal disease progression, she presented with postpartum hemorrhage, in contrast to an augmented procoagulant state among normal pregnancies. Obstetric adjunctive measures, such as intrauterine balloon tamponade and uterine artery ligation, were done. The patient was discharged stable.
Leukemia, Myelogenous, Chronic, BCR-ABL Positive ; Imatinib Mesylate ; Postpartum Hemorrhage ; Pregnancy

BACKGROUND

Postpartum depression (PPD) is the most common perinatal psychiatric disorder and women are at greatest risk of developing this during their first postpartum year. Extraneous factors and events indirectly related to maternity like the quarantine measures imposed during the COVID-19 pandemic can add to the already burdensome mental effects of pregnancy.

The aim of the study is to determine the prevalence of and possible risk factors for PPD during the COVID-19 pandemic using the Edinburgh Postnatal Depression Scale in Filipino (EPDS-F) in a tertiary government hospital.

This is a cross-sectional study involving patients 18 years of age and above who delivered vaginally or through cesarean section to a live or dead fetus more than 20 weeks age of gestation and more than 500 g, preterm or term during the pandemic. Patients included were those who tested positive for COVID 19 infection who delivered 48 h up to 8 week postpartum. All the patients who consented and fulfilled the inclusion criteria answered the EPDS-F questionnaire to determine the prevalence rate of PPD. A score of 13 or greater suggests the presence of major depressive symptoms.

There was a total of 61 postpartum patients who were delivered in a tertiary hospital from September 2022 to October 2022. Out of 61 patients, 20 scored 13 points and above in the EPDS-F questionnaire showing a PPD prevalence of 32.8%. Patient’s age showed a statistically significant association with the likelihood of having PPD (P = 0.0148), the highest prevalence observed at an average age of 25 and a lower prevalence at 29 years old.

Although age seems to have a significant association with PPD, direct causality is difficult to establish as the likelihood of having PPD depends on the mother’s personal qualities and traits, the societal background, and her coping mechanisms during an extraordinary circumstance such as this global COVID-19 pandemic.

Objective: To analyze associated factors and adverse pregnancy outcomes of postpartum hemorrhage in the caesarean section of puerperae with different types of placenta previa. Methods: This retrospective research was a case-control study. Puerperae with cesarean section of placenta previa from January 2019 to December 2020 in Women's Hospital, School of Medicine, Zhejiang University were collected and divided into the<1 000 ml control group or ≥1 000 ml postpartum hemorrhage group according to the amount of blood loss during cesarean section. Differences in continuous variables were analyzed by t-test and categorical variables were analyzed by χ² test. The risk factors of postpartum hemorrhage were analyzed by logistic multivariate regression. Results: A total of 962 puerperae were enrolled with 773 cases in the control group and 189 cases in the postpartum hemorrhage group. The incidence of gestational weeks, gravidity, parity, induced abortion, placental accreta and preoperative hemoglobin<110 g/L was significantly different between two groups in different types of placenta previa (P<0.001). Logistic multivariate regression model analysis showed that the independent risk factors of postpartum hemorrhage in the caesarean section of low-lying placenta included placental accreta (OR=12.713, 95%CI: 4.296-37.625), preoperative hemoglobin<110 g/L (OR=2.377, 95%CI: 1.062-5.321), and prenatal vaginal bleeding (OR=4.244, 95%CI: 1.865-9.656). The independent risk factors of postpartum hemorrhage in the caesarean section of placenta previa included once induced abortion (OR=2.789, 95%CI:1.189-6.544), induced abortion≥2 (OR=2.843, 95%CI:1.101-7.339), placental accreta (OR=6.079, 95%CI:3.697-9.996), HBsAg positive (OR=3.891, 95%CI:1.385-10.929), and placental attachment to the anterior uterine wall (OR=2.307, 95%CI:1.285-4.142). The rate of postpartum hemorrhage and premature delivery in puerperae with placenta previa was higher than that in puerperae with low-lying placenta (P<0.001). Conclusions: The associated factors of postpartum hemorrhage in puerperae with different types of placenta previa are different. Placenta accreta is the common risk factor of postpartum hemorrhage in puerperae with low-lying placenta and placenta previa.
Female ; Pregnancy ; Humans ; Cesarean Section ; Postpartum Hemorrhage/surgery* ; Pregnancy Outcome ; Retrospective Studies ; Case-Control Studies ; Placenta Previa/surgery* ; Placenta ; Risk Factors

Pregnancy ; Female ; Humans ; Postpartum Hemorrhage/prevention & control* ; Oxytocics

Female ; Humans ; Infant ; Mothers ; Serotonin ; Object Attachment ; Surveys and Questionnaires ; Depression, Postpartum

In order to prevent the maternal immune defenses to the semi-allogeneic fetus, the maternal body will present a special adaptive immune system change represented by acute thymic involution(ATI) during pregnancy, which can be quickly regenerated after delivery. The ATI during pregnancy is related to the level of sex hormones, which is mainly caused by progesterone. Pregnancy-induced ATI is manifested as the continuous shrinkage of thymus volume, especially the cortex, and the wrinkle and phagocytosis of the subcapsular cortical thymic epithelial cells(cTECs), while other thymic epithelial cells(TECs) remain unchanged. The postpartum thymus is regenerated by the co-mediation of forkhead box N1(FOXN1) as well as its target genes chemokine(C-C motif) ligand 25(CCL25), chemokine(C-X-C motif) ligand 12(CXCL12), δ-like ligand 4(DLL4), cathepsin L(CTSL), and serine protease 16(PRSS16). Once the postpartum thymus is poorly repaired, immune dysfunction of the maternal body and several puerperal diseases will be induced, seriously endangering the survival of the mother and the newborn. In traditional Chinese medicine(TCM), Qi and blood are the cornerstone of pregnancy, and the thymus plays a key role in regulating Qi and blood. The deficiency of Qi and blood during pregnancy and childbirth is closely related to the abnormal ATI during pregnancy and the poor regeneration of the postpartum thymus. Based on this theory, TCM has profound academic ideas and rich clinical experience in postpartum recuperation. Based on the systematic description of the mechanism of ATI regeneration during pregnancy, as well as data mining and analysis of two classic gynecological works of TCM, Wan's Gynecology and Fu Qing-zhu's Treatise on Gynecology, this study found that the commonly used TCM for postpartum included Angelicae Sinensis Radix, Ginseng Radix et Rhizoma, Glycyrrhizae Radix et Rhizoma, and Chuanxiong Rhizoma. Among them, Ginseng Radix et Rhizoma, Angelicae Sinensis Radix, and Chuanxiong Rhizoma are high-frequency TCMs with positive effects on postpartum recovery.However, the mechanism of these TCMs in promoting postpartum thymus regeneration needs further investigation.
Female ; Infant, Newborn ; Humans ; Pregnancy ; Ligands ; Drugs, Chinese Herbal/pharmacology* ; Medicine, Chinese Traditional ; Prescriptions ; Postpartum Period ; Chemokines

Polymorphic eruption in pregnancy (PEP), formerly known as pruritic urticarial papules and plaques of pregnancy, is a common gestational dermatosis. It rarely manifests in the early trimester of pregnancy and hardly persists in the postpartum period especially in multigravid patients. PEP usually appears late in the third trimester of a first pregnancy, and less frequently in the immediate postpartum period. It occurs almost exclusively in primigravid mothers and is more common in multiple pregnancies.1 2 3 Recurrence in subsequent pregnancies is extremely rare.3 4 The cause of PEP is still unknown, although various theories have been proposed, including increased skin distention, deposition of fetal DNA in skin lesions, high levels of progesterone, and increased progesterone receptor immunoreactivity in patients with PEP.
Pruritic urticarial papules plaques of pregnancy ; Postpartum Period