Aged ; Female ; Humans ; Uterine Hemorrhage/etiology*

Gestational trophoblastic tumors (GTTs) are malignant lesions that often cause abnormal genital bleeding and may present with hemoptysis, intraperitoneal bleeding or acute neurologic deficits. GTTs are generally highly chemosensitive with more favorable outcomes than other comparable malignancies. Here we report a rare case of invasive mole (FIGO stage IV, WHO score16) presenting with renal subcapsular hematoma due to bleeding renal metastasis. The patient had a pretreatment β-human chorionic gonadotrophin (β-HCG) level of 462 047 mIU/ml and received combined chemotherapy with etoposide, methotrexate, actinomycin-D, cyclophosphamide and vincristine with also adjuvant surgeries including hysterectomy and nephrectomy. The patient recovered well and the tumor has remained in complete remission for one year and a half.
Antineoplastic Combined Chemotherapy Protocols ; Female ; Hemorrhage ; etiology ; Humans ; Hydatidiform Mole, Invasive ; complications ; Kidney ; pathology ; Pregnancy ; Uterine Neoplasms ; complications

Child, Preschool ; Diagnosis, Differential ; Female ; Gonadotropin-Releasing Hormone ; therapeutic use ; Humans ; Hysteroscopy ; Pediatrics ; Puberty, Precocious ; diagnosis ; therapy ; Uterine Hemorrhage ; diagnosis ; etiology ; therapy ; Vaginal Diseases ; diagnosis ; etiology ; therapy

OBJECTIVETo investigate major risk factors for childhood cerebral palsy (CP) during pregnancy and to provide evidence for the prevention of CP.

METHODSUsing the search terms of "cerebral palsy", "pregnancy", "risk factor", and "case-control", a search was performed to collect case-control studies on the risk factors for childhood CP from 1998 to 2011. The obtained data were subjected to metaanalysis using fixed effects model and DersimonionLaird random effects model to quantitatively evaluate risk factors for childhood CP during pregnancy.

RESULTSEighteen studies involving 11050 cases and 15941 controls were collected. The results of the multivariate analysis for risk factors of childhood CP during pregnancy were as follows: maternal age (≥35 years) (OR = 4.172, 95%CI = 1.670-10.426, P < 0.05), multiple pregnancy (OR = 8.402, 95% CI = 2.386-29.584, P < 0.05), medicine use in early pregnancy (OR = 3.974, 95% CI = 2.217-7.123, P < 0.05), harmful environment (OR = 3.299, 95% CI = 1.058-10.289, P < 0.05), recurrent vaginal bleeding during pregnancy (OR = 4.736, 95% CI = 1.792-12.517, P < 0.05), pregnancy infectious diseases (OR = 1.238, 95%CI: 0.284-5.395, P > 0.05), pregnancy induced hypertension (OR = 4.096, 95%CI: 2.246-7.469, P < 0.05), meat intake (OR = 1.436, 95%CI:0.382-5.393, P > 0.05), father smoking (OR = 2.376, 95%CI: 0.801-7.049, P > 0.05).

CONCLUSIONSThe major risk factors for childhood CP during pregnancy include advanced maternal age (≥35 years), multiple pregnancy, medicine use in early pregnancy, harmful environment, recurrent vaginal bleeding during pregnancy and pregnancy-induced hypertension.

Adult ; Case-Control Studies ; Cerebral Palsy ; etiology ; prevention & control ; Child ; Female ; Fetus ; drug effects ; Humans ; Hypertension, Pregnancy-Induced ; physiopathology ; Maternal Age ; Pregnancy ; Risk Factors ; Uterine Hemorrhage ; complications

Cervical stenosis is a challenging condition that often recurs despite intervention. Multiple therapeutic options have been described, but a clearly effective and reliable treatment method has yet to be identified. Patients with recurrent stenosis are at risk of developing severe complications such as chronic pelvic pain and infertility. We describe a case of congenital cervical stenosis with secondary haematometra in which repeated cervical dilatation, hysteroscopic canalisation and administration of medications to retard endometrial development were unsuccessful in relieving the obstruction and preventing re-accumulation of menstrual blood. Total hysterectomy was eventually mandated by spontaneous rupture of the haematometra.
Adult ; Constriction, Pathologic ; complications ; diagnosis ; Endometrium ; pathology ; Female ; Hematometra ; complications ; diagnostic imaging ; surgery ; Humans ; Infertility ; Pelvic Pain ; Recurrence ; Risk ; Rupture, Spontaneous ; complications ; Tomography, X-Ray Computed ; Uterine Cervical Diseases ; complications ; diagnosis ; Uterine Diseases ; complications ; diagnosis ; Uterine Hemorrhage ; complications ; diagnosis ; Uterine Rupture ; diagnostic imaging ; etiology ; surgery

INTRODUCTIONThis study aimed to assess maternal and perinatal outcomes following second stage Caesarean sections.

METHODSA retrospective study was conducted in a Singapore-based tertiary referral centre from January 1, 2009 to December 31, 2009. The medical records of all the women who underwent emergency Caesarean sections in the second stage of labour were reviewed.

RESULTSOut of 2,501 emergency Caesarean sections performed, 116 were Caesarean sections in the second stage of labour. Women with non-vertex, twins and preterm deliveries were excluded, and 110 (4.4%, 110/2,501) Caesarean sections were recruited. The majority of the Caesarean sections were determined and performed by registrars or consultants. With regard to maternal outcome, 2.7% (3/110) of patients had primary postpartum haemorrhage and 4.5% (5/110) of patients had vertical or lateral lower uterine segment tears. As for neonatal outcome, although the Apgar scores of newborns were low at birth for 8.2% (9/110) of patients, the Apgar score was > 4 at 5 minutes for all patients.

CONCLUSIONOverall, there was no statistically significant adverse maternal or perinatal outcome.

Adult ; Apgar Score ; Cesarean Section ; adverse effects ; mortality ; Emergency Treatment ; Female ; Humans ; Infant Mortality ; Infant, Newborn ; Labor Stage, First ; Labor, Obstetric ; Postpartum Hemorrhage ; etiology ; Pregnancy ; Pregnancy Outcome ; epidemiology ; Retrospective Studies ; Singapore ; epidemiology ; Uterine Rupture ; etiology

OBJECTIVETo verify the efficacy of moxibustion at Guanyuan (CV 4) and Shenque (CV 8) on the duration of vaginal bleeding for patients with midtrimester induction of labor and explore its mechanism.

METHODSOne hundred cases of midtrimester induction of labor were divided randomly into an observation group (50 cases) and a control group (50 cases). In control group, on the day of labor induction, Mifepristone was taken orally and intraamnionic injection of Rivanol was administered in the morning. In the morning on the second day, Misoprostol was taken orally. After delivery, the uterine curettage was given and 10 U Oxytocin was injected intramuscularly. In observation group, on the basis of the treatment as control group, moxibustion was given in combination. After Rivanol injection, moxibustion was applied to Shenque (CV 8) and Guanyuan (CV 4), for 15 min each time, once every 8 h. Totally, 4 treatments were required. The mean duration of vaginal bleeding was observed and the levels of serum estradiol (E2) and progesterone (P) were determined before and after treatment in two groups.

RESULTSThe mean duration of vaginal bleeding was (8.82 +/- 2.98) days in observation group, which was shortened apparently as compared with (10.59 +/- 3.46) days in control group (P < 0.05). After treatment, the level of serum E2 increased and that of P decreased in either group (all P < 0.01). The increase of E2 in observation group was superior to that in control group (P < 0.05).

CONCLUSIONMoxibustion at Guanyuan (CV 4) and Shenque (CV 8) may shorten the duration of vaginal bleeding for patients with midtrimester induction of labor. Probably through the increase of serum E2 level and the decrease of P level, the uterine contraction is effectively enhanced and the excretion of placental villi and deciduas is promoted. As a result, endometrial repair occurs rapidly.

Adolescent ; Adult ; Estradiol ; blood ; Female ; Humans ; Labor, Induced ; Medicine, Chinese Traditional ; Moxibustion ; Pregnancy ; Pregnancy Trimester, Second ; Progesterone ; blood ; Time Factors ; Uterine Hemorrhage ; etiology

OBJECTIVE: To analyze the pathological characteristics and the death reasons due to postpartum hemorrhage, and to help to deal with the obstetrical medical tangles. METHODS: Thirty-two cases of death caused by postpartum hemorrhage encountered in our department since 1995 had been collected and retrospectively analyzed. RESULTS: Death caused by postpartum hemorrhage could be divided into single factor and multi-factor, with 81.25% due to single factor, 12.50% multi-factor, and 6.25% unknown reason. The single factors included uterine atony, retained placenta, placenta increta, laceration of the lower genital tract, and coagulation defects. The multi-factor included a combination of two or more factors mentioned above. CONCLUSION The causes of death due to postpartum hemorrhage should be analyzed according to the clinical characteristics of the postpartum hemorrhage and the autopsy examination.
Autopsy ; Blood Coagulation Disorders/complications* ; Cause of Death ; Female ; Forensic Pathology ; Humans ; Placenta, Retained ; Postpartum Hemorrhage/etiology* ; Pregnancy ; Retrospective Studies ; Uterine Inertia

INTRODUCTIONPathologically adherent placentas occur when there is a defect of the decidua basalis, typically arising from previous caesarean section, resulting in abnormally invasive implantation of the placenta. The depth of placental invasion varies from the superficial (accreta), to transmural and possibly beyond (percreta).

CLINICAL PICTUREWe report on 2 cases, one treated "conservatively", the other with a caesarean hysterectomy, both of which led to a safe outcome for both mother and baby.

CONCLUSIONSManagement relies on accurate early diagnosis with appropriate perioperative multidisciplinary planning to anticipate and avoid massive obstetric haemorrhage at delivery.

Adult ; Cesarean Section ; adverse effects ; utilization ; Decidua ; abnormalities ; Female ; Humans ; Hysterectomy ; Incidence ; Magnetic Resonance Imaging ; Placenta ; abnormalities ; diagnostic imaging ; Placenta Accreta ; diagnosis ; epidemiology ; etiology ; physiopathology ; Pregnancy ; Thailand ; epidemiology ; Ultrasonography ; Uterine Hemorrhage ; etiology

OBJECTIVETo investigate the clinical efficacy of estrogen in preventing postpartum hemorrhage and shortening the birth process during induced abortion.

METHODSTotally 320 puerperants for termination of pregnancy for medical reasons were randomly assigned into 2 groups, the estrogen group (n=175) and the control group (n=145), and the former were given oral estrostilben 3 mg thrice a day from the day before acrinol injection to the end of delivery. The amount of blood loss 2 h after delivery, cases of postpartum hemorrhage, and the duration of total birth process were recorded.

RESULTSSignificant differences were noted in blood loss 2 h after delivery between estrodiol and control groups (123.3-/+81.8 vs 206.3-/+114.4 ml). Two cases of postpartum hemorrhage were found in estrogen group and 10 in control group. The duration from acrinol injection to delivery was similar between the two groups (31-/+11 vs 33-/+12 h), but the former had significant shorter duration from contraction onset to delivery than the latter (6.03-/+3.19 vs 9.7-/+5.9 h). No side-effects were found in either group.

CONCLUSIONEstrogen given before delivery can be effective in stimulating uterine contraction for preventing postpartum hemorrhage and shortening the birth process in women undergoing induced abortion.

Abortion, Induced ; adverse effects ; Adult ; Estrogens ; therapeutic use ; Female ; Humans ; Labor Onset ; drug effects ; Postpartum Hemorrhage ; etiology ; prevention & control ; Pregnancy ; Time Factors ; Treatment Outcome ; Uterine Contraction ; drug effects