Causes and trend of maternal death in a local obstetric unit in Hong Kong

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My biggest mistake：A lesson from a death

Neurocysticercosis is a major public health problem in manydeveloping countries in Asia and has a profound impact onproductivity,health,economy,and quality of life.It is endemicin Nepal and is the commonest parasitic infestation of the centralnervous system,caused by larvae of the tapewormTaeniasolium.Neurological manifestations vary from a simple chronicheadache to life threatening meningoencephalitis depending onthe location and number of the parasites in the brain.In August2000,I came fro…     

Preconception health and care (PHC)—a strategy for improved maternal and child health

Maternal health status before pregnancy is a decisive factor for pregnancy outcomes and for risk for maternal and infant complications. Still, maternity care does not start until the pregnancy is established and in most low-income settings not until more than half of the pregnancy has passed, which often is too late to impact outcomes. In Western societies preconception care (PCC) is widely recognized as a way to optimize women’s health through biomedical and behavioural changes prior to conception with the aim of improving pregnancy outcomes. But the content of PCC is inconsistent and limited to single interventions or preconception counselling to women with chronic illnesses. It has been suggested that PCC should be extended to preconception health and care (PHC), including interventions prior to pregnancy in order to optimize women’s health in general, and thereby subsequent pregnancy outcomes, the well-being of the family, and the health of the future child. With this definition, almost every activity that can improve the health of girls and women can be included in the concept. In the World Health Report of 2005 a longitudinal approach to women’s wellness and reproductive health was highlighted, and the World Health Organization has proposed a more comprehensive maternal and child health care, also including psychosocial issues and intimate partner violence. The present article gives an overview of the recent literature and discusses contents and delivery of PCC/PHC in Western as well as low-income countries. The article puts special emphasis on why violence against women is an issue for PHC.     

Influence of maternal body weight before pregnancy and maternal weight gain during pregnancy on pregnancy outcome

Influence of maternal body weight before pregnancy and maternal weight gain during pregnancy on pregnancy outcome@孙宝治@李娟@宋清萍@徐风森@修俊玲...     

Ethnic-specific splicing mutation of the carnitine-acylcarnitine translocase gene in a Chinese neonate presenting with sudden unexpected death

Carnitine acylcarnitinetranslocase (CACT )deficiency(OMIM 2 12 138)isanautosomalrecessivediseasecausedbymutationsoftheSLC2 5A2 0gene [solutecarrierfamily 2 5(carnitine/acylcarnitinetranslocase) ,member 2 0 ] Thegenehasanopenreadingframeof 90 3bp ,1mappedtochromosome 3p2 1 31byinsituhybridization ,2 　andencodesaproteinhavingthreerepeatedhomologousdomains,eachabout 10 0aminoacidsinlength—acharacteristicfeatureofmitochondrialtransportproteins 3,4　CACTisessentialinlong chainfattyacidoxida…     

Comparison of second-trimester maternal serum free-p-human chorionic gonadotropin and a-fetoprotein between normal singleton and twin pregnancies： a population-based study

Background The second-trimester maternal serum screening in twin pregnancy is still controversial, as the serum marker levels in twins are not as clear as those in singletons. This study aimed to evaluate the relationship between the levels of the second-trimester maternal serum free β-human chorionic gonadotropin （free β-HCG） and a-fetoprotein （AFP） in normal twin and singleton pregnancies and to estimate feasible analysis methods for utilizing these markers in second trimester screening for twin pregnancy. Methods On the basis of a prospective population-based study of second-trimester maternal serum screening, the concentrations of maternal serum AFP and free β-HCG of 195 normal twin pregnancy and 26 512 singleton controls at gestational weeks 15 to 20 were measured by time-resolved fluoroimmunoassay in one laboratory. The levels of markers were compared between the twins and singletons using weight-correction and gestational age-specific model. Results According to the research protocol, 95 communities were randomly sampled, which covered the whole Jiangsu province, the east of China. A total of 26 803 pregnant women （98%）, from the target population accepted prenatal screening for maternal serum AFP, β-HCG detection, and all babies were followed up for at least six months. There were 197 （0.73%） twin pregnancies, of which one case had fetal trisomy 18, and one case with fetal anencephaly. The others were normal twin pregnancy. From a total enrollment of 26 803 women participants, 26 512 women with normal singleton pregnancies were selected as the model controls. The other 291 pregnancies, including trisomy 21, neural tube defect （NTD）, trisomy 18, and other fetal abnormalities, were excluded. No significant differences were found in the medians of gestational age-specific maternal serum free β-hCG and AFP in normal twin pregnancy comparing with twice those in model controls with the exception of the medians for free β-hCG during the 16th gestational week （P=0.012）. Conclusion The weight-correction and gestational age-specific levels of Chinese Han population maternal serum free β-hCG and AFP in normal twins were twice the levels as those in the singleton controls during the 17-19 gestational weeks.     

Maternal brain death — an Irish perspective

Background  

Brainstem death is a concept used in cases in which life-support equipment obscures the conventional cardiopulmonary criteria of death. Brainstem death during pregnancy is an occasional and tragic occurrence.     

Does olw dose radiation increase thymocyte death

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Current status of maternal health care in China.

For the protection of the health of mothers and children, Chinese government has paid much attention to maternal and child health (MCH) after the founding of the People's Republic of China in 1949. MCH, preventive and curative medicine are considered the three major tasks of China's health work. Safe motherhood and decrease of maternal and infant mortality have been particularly marked since 1949. Maternal mortality has dropped from 1500/100000 in 1949 to 94.7/100000 in 1989 and infant mortality dropped from 200‰ to 51.1‰ in 1986. With the reform of economic System and open policy in the recent 10 years, maternal health care has been greatly improved.     

Moving from death sentence to chronic disease management

In Europe today, HIV/AIDS prevention, treatment and care are needed more than ever. HIV incidence steady in western and central Europe, and dramatically increasing in eastern Europe remains a major challenge to public health in the 21st century. With more than two million people living with HIV/AIDS in the WHO European Region, no country has been spared.This book tells the story of HIV/AIDS in Europe from a broad variety of perspectives: biomedical, social, cultural, economic and …     

Should individuals choose their definition of death?

Alireza Bagheri supports a policy on organ procurement where individuals could choose their own definition of death between two or more socially accepted alternatives. First, we claim that such a policy, without any criterion to distinguish accepted from acceptable definitions, easily leads to the slippery slope that Bagheri tries to avoid. Second, we suggest that a public discussion about the circumstances under which the dead donor rule could be violated is more productive of social trust than constantly moving the line between life and death.     

More fiddling with the definition of death?

Stanley contends that G.R. Gillett, in the last paragraph of an otherwise excellent article, "Why let people die?" (Journal of Medical Ethics 1986 Jun; 12(2): 83-86), is "fiddling about" with the definition of death when he argues that the patient in a persistent vegetative state is, in an ethical sense, no longer alive as a person; that what remains is a body in which the former patient has no futher interest. Stanley maintains that the determination of the nonreversibility of decortication is uncertain while brain stem death is not reversible. Furthermore, decorticate patients are still biologically alive and decisions concerning their treatment and who makes the decisions are important questions for the medical profession and for society to address. The author concludes that these problems should not be solved by extending the definition of death to include neocortical death.     

Effects of Danshensu on maternal syndrome in phosphatidyleserine/ phosphatidylcholine microvesicle induced-mouse model: is it a candidate for preeclampsia remedy?

Backgroud Up to date, there is few satisfactory pharmacotherapy, except for aspirin and heparin, to stop the preeclampsia progression. Although the mechanism of preeclampsia is poorly understood, it has been proven to be associated with coagulation activation. Researches on prophylactic and therapeutic application of anticoagulants may benefit the clinical aspects of preeclampsia individuals. This study aimed to evaluate the effects of Danshensu on maternal syndrome in phosphatidylserine/phosphatidylcholine （PS/PC） microvesicle induced-mouse model. Methods Sixty-six preeclampsia-like pregnant mice, induced by PS/PC microvesicle administration, were randomly divided into six groups. From days 5.5 to 16.5 of pregnancy, each group was respectively treated as follows： a） mice in group C （n=12, control group） were injected with 100 μl of filtered phosphate-buffered saline into the tail vein every day; b） group PE （n=15, preeclampsia model group） were injected in the same way with 100 μl of filtered PS/PC vesicle suspension; c） group H （n=9, group treated with heparin） were injected with 1 unit heparin together with PS/PC vesicle suspension; d） group A （n=10, group treated with aspirin） were injected with 20 μg/g aspirin-DL lysine as well; e） group LD （n=10, group treated with low-dose Danshensu） were injected with 10 μg/g Danshensu; and f） group HD （n=10, group treated with high-dose Danshensu） were injected with 30 μg/g Danshensu. Systolic blood pressure, total urinary protein levels, blood tests for some hemostatic function parameters （mean platelet counts, plasma antithrombin III activity （AT-Ⅲ）, D-D dimmer levels, and thrombin time）, fibrin deposition by phosphotungstic acid hematoxylin staining, and thrombomodulin expression by immunohistochemistry staining in placentas were examined as indices for maternal syndrome. Results Heparin showed significant effects on maternal syndrome of preeclampsia such as hypertension and proteinuria, and different doses of Danshensu also presented the certain effects. High-dose Danshensu and aspirin all demonstrated better effects than low-dose Danshensu on decreasing blood pressure to normal level, while high-dose Danshensu demonstrated better effects than aspirin and low-dose Danshensu on decreasing proteinuria to normal level. As to Danshensu＇s effects on hemostatic function, high- and low-dose Danshensu＇s marked effects on increasing the plasma AT-III activity were the same as that of aspirin and inferior to that of heparin. High-dose Danshensu＇s better effect on elevating the platelet counts was superior to low-dose Danshensu and aspirin. Low-dose Danshensu＇s obvious effect on decreasing D-D levels was close to heparin and superior to high-dose Danshensu and aspirin. High- and low-dose Danshensu＇s significant effects on reduced thrombin time level are same to heparin. Different anticoagulants all played improvement roles in placental fibrin depositions, but heparin and high-dose Danshensu＇s roles on lowering thrombomodulin expression in placentas were superior to low-dose Danshensu and aspirin. However, anticoagulant function of high-dose Danshensu was still inferior to heparin. We found long-term use of heparin and aspirin, in spite of low-dose administration, could raise the risk of bleeding such as placental abruption and intestinal hemorrhage. But no any side effect was observed in mice treated with different doses of Danshensu in our study.Conclusions Danshensu has proven to be effective and safe in ameliorating the prognosis of maternal syndrome in a preeclampsia mouse model. We suggest long-term provision of low-dose Danshensu in pregnancy, leading to an improvement of preeclampsia syndrome with considerable maternal safety.     

Comparison of second-trimester maternal serum free-β-human chorionic gonadotropin and α-fetoprotein between normal singleton and twin pregnancies: a population-based study

Background  The second-trimester maternal serum screening in twin pregnancy is still controversial, as the serum marker levels in twins are not as clear as those in singletons. This study aimed to evaluate the relationship between the levels of the second-trimester maternal serum free β-human chorionic gonadotropin (free β-HCG) and α-fetoprotein (AFP) in normal twin and singleton pregnancies and to estimate feasible analysis methods for utilizing these markers in second trimester screening for twin pregnancy.
Methods  On the basis of a prospective population-based study of second-trimester maternal serum screening, the concentrations of maternal serum AFP and free β-HCG of 195 normal twin pregnancy and 26 512 singleton controls at gestational weeks 15 to 20 were measured by time-resolved fluoroimmunoassay in one laboratory. The levels of markers were compared between the twins and singletons using weight-correction and gestational age-specific model.
Results  According to the research protocol, 95 communities were randomly sampled, which covered the whole Jiangsu province, the east of China. A total of 26 803 pregnant women (98%), from the target population accepted prenatal screening for maternal serum AFP, β-HCG detection, and all babies were followed up for at least six months. There were 197 (0.73%) twin pregnancies, of which one case had fetal trisomy 18, and one case with fetal anencephaly. The others were normal twin pregnancy. From a total enrollment of 26 803 women participants, 26 512 women with normal singleton pregnancies were selected as the model controls. The other 291 pregnancies, including trisomy 21, neural tube defect (NTD), trisomy 18, and other fetal abnormalities, were excluded. No significant differences were found in the medians of gestational age-specific maternal serum free β-hCG and AFP in normal twin pregnancy comparing with twice those in model controls with the exception of the medians for free β-hCG during the 16th gestational week (P=0.012).
Conclusion  The weight-correction and gestational age-specific levels of Chinese Han population maternal serum free β-hCG and AFP in normal twins were twice the levels as those in the singleton controls during the 17–19 gestational weeks.

     

Analysis of 176 cases of death from kidney transplantation

Objective To review the cadaveric kidney transplantations at our center in the past 22 years and to analyze the causes and the influencing factors on death in 176 patients who died after renal transplantation. Methods A total of 1 039 patients received cadaveric kidney graftings between October 1977 and June 1999. Patient' s mortality was calculated by the Kaplan-Meier method. The factors which might lead to patients' death,including age and sex of the donors and recipients, frequency of transplantation, dialysis time and transfusion volume before transplantation, cold ischemic time(CIT),delayed graft function(DGF),rejection, immunosuppressive regimen, and post-transplant complications, were analyzed by log-rank and Cox model. Results Total mortalities of the patient at 1 - ,5 - , 10 - , and 15-year were 6.9%, 19.7%, 32.1% and 34.7%, respectively. The leading causes of patients' death were infection, cardiocerebral vascular diseases, and hepatic failure. The factors of transplant times, dialysis time be