Anxiety and first-time mothers

Whereas the child's need for mothering is absolute, the need for an adult woman to mother is relative. During pregnancy and subsequent child development, the mother unconsciously relives her own infantile and childhood experiences. Psychiatric disturbance is common in pregnancy and anxiety may be normal or pathological. ‘State’ or ‘trait’ anxiety need to be differentiated in order to consider treatment interventions. High anxiety levels may exert a number of adverse effects on mother and child alike. Adequate social support is important and intervention should be considered on humane grounds at the very least.     

妇产科患者静脉血栓栓塞症风险评估模型的研究现状

静脉血栓栓塞症(VTE)是指静脉血管管腔内血液异常凝结,形成血栓而使血管完全或部分阻塞引起血液循环障碍,由此导致的一系列相关病理生理改变的临床疾病。VTE主要包括深静脉血栓形成(DVT)和肺栓塞。妊娠期VTE是一种非常严重的,具有潜在致死性的妊娠并发症。VTE是可预防性疾病,早预防、早发现、早治疗是避免VTE严重后果的重要原则。对妇产科患者利用VTE风险评估模型进行评估,可科学、有效、及时鉴别诊断VTE高危患者,而对其及时采取个性化预防措施,可降低女性患者VTE发生率。目前在妇产科领域研究和应用较为广泛的VTE风险评估模型包括:Caprini、Rogers、Autar及Khorana风险评估模型等。笔者分别拟就妇科与产科领域常用VTE风险评估模型的研究现状进行阐述,旨在为妇产科医师对VTE高危患者的评估提供参考。     

Discovering the Holy Grail in Postpartum Uterine Involution

Abstract: A Swiss study attempted to establish normal values for the uterine involution expected during the first 5 days postpartum. Two methods were used, apparently independently and without validation. One, named the finger method, consisted of estimating the height of the uterine fundus in finger breadths above or below the umbilicus. The other, the tape method, consisted of marking the distance between the uterine fundus and the pubic symphysis on a blank tape, which was subsequently read in centimeters against a measuring tape. The authors contend that normal uterine involution postpartum is governed by different factors according to whether it is measured by fingers or by tape. Thus, gestational age affected uterine involution when measured with fingers, but not when measured with a tape, whereas maternal age did the reverse. Apart from being based on a study population that defies any criteria of normality, a comparison of the results from finger and tape methods shows data that are incompatible with the anatomy of human fingers and the uterus postpartum. Yet, the authors suggest that these data should be used to differentiate electronically between normal and abnormal uterine involution, without considering what the consequences of such nonvalidated programming might be. (BIRTH 38:1 March 2011)     

产褥期妇女乳头皲裂发病原因及对策

综述了乳头皲裂的现状、发病原因及防治方法,为进一步制定预防乳头皲裂的干预措施提供参考依据。     

孕产妇静脉血栓栓塞症相关风险因素分析

目的：探讨孕产妇发生静脉血栓栓塞症（venous thromboembolism，VTE）的相关危险因素。方法：采用回顾性病例对照研究，选取我院2010-2020年收治的38例发生VTE的孕产妇作为观察组，同时随机选取同时段我院199例未发生VTE的孕产妇作为对照组。将两组患者的高危因素、Caprini评分及《产科静脉血栓栓塞症综合防治上海共识》中孕产妇静脉血栓栓塞风险因素评分（简称孕产妇VTE评分）、实验室指标等因素纳入统计学分析。结果：产褥期发生VTE的比例最高(65.79%,25/38)。发生类型最高的为下肢深静脉血栓形成，其次为颅内静脉血栓形成。其中2例死亡原因为广泛颅内静脉血栓形成伴脑梗死出血转化，1例为晚期乳腺癌并发肺栓塞形成。logistic回归单因素分析显示剖宫产、孕产妇VTE风险评分、血红蛋白、血小板计数、D-二聚体、凝血酶原时间、活化部分凝血酶原时间有统计学差异（P＜0.05）。多因素回归分析结果显示孕产妇VTE风险评分、D-二聚体、凝血酶原时间、活化部分凝血酶原时间为孕产妇发生VTE的独立危险因素（P＜0.05）。结论:上海共识孕产妇VTE风险评分、D-二聚体、凝血酶原时间、活化部分凝血酶原时间为孕产妇发生VTE的独立危险因素。VTE的发生重在预防，专科VTE评分对孕产妇预防静脉血栓形成有临床意义。一旦发生VTE，结合实验室指标及必要的影像学指标早期诊断和治疗。     

Off-pump coronary artery bypass grafting for spontaneous coronary dissection in a 26-year-old patient two weeks post-partum: a case report and review

Spontaneous coronary artery dissections are an infrequent cause of myocardial infarction and have been reported in late stages of pregnancy and in the puerperium phase. We report a case of a 26-year-old post-partum woman who was diagnosed with a spiral coronary dissection of the left anterior descending artery, with a compromised diagonal branch. She underwent an emergent surgical revascularization without the use of cardiopulmonary bypass. The patient's in-hospital clinical course, prognosis, treatment, and potential etiologies are discussed.     

Haemostatic changes in the puerperium '6 weeks postpartum' (HIP Study) — implication for maternal thromboembolism

Objective  We aim to measure the thrombotic changes during the postnatal period up to 6 weeks after delivery and assess the extent of the risk period.
Design  Prospective observational study.
Setting  Queen Elizabeth II, an acute District General Hospital, Hertfordshire.
Population  Women booked at the antenatal clinic and prepared to deliver at the hospital.
Methods  We assessed the haemoglobin, platelet count and function, fibrinogen, prothrombin time, activated partial thromboplastin time, protein C, S and antithrombin level and as well as rotational thromboelastometry (ROTEM) from predelivery till 6 weeks postpartum.
Results  A total 50 women were recruited of which four dropped out. Results compared against the finding at 6 weeks after delivery. Platelet was significantly elevated on day 19 compared to day 42 ( P  < 0.001). Fibrinogen was elevated from predelivery till day 15 after delivery ( P  < 0.01). Prothrombin time (PT) was low till day 15 ( P  < 0.05) and activated partial thromboplastin time (APTT) was significantly lower till day 3 after delivery ( P  < 0.001). ROTEM revealed low clotting time (CT) at predelivery and continued to be low till day 7. Clot formation time (CFT) significantly low till day 25 ( P  < 0.05). Maximum clot firmness, alpha angle and amplitude at 20 minutes were raised till day 19 ( P  < 0.001, P  < 0.01 and P  < 0.001 respectively). While, comparing vaginal delivery against caesarean section there were nonsignificant increase in thrombotic parameters in caesarean section.
Conclusion  Coagulation screens as well as thomboelastometry suggest a persistent hypercoagulation during the first 3 weeks after delivery.     

新型产褥期护理管理模式与高危妊娠剖宫产术后DVT发生的相关研究

目的 探讨新型产褥期护理管理模式对高危妊娠剖宫产术后发生DVT的影响.方法 采用随机对照研究,选取2015年2至10月在广东省妇幼保健院及广州市增城区妇幼保健院剖宫产的孕妇240例作为研究对象,随机分为试验组及对照组;试验组采用新型产褥期护理管理模式,对照组采用常规产褥期护理模式;比较两组孕妇DVT的发生率.结果 两组年龄和BMI比较差异无统计学意义(t=1.787、1.933,P＞0.05),试验组孕妇中有2例发生DVT,发生率为1.67％;对照组孕妇中10例发生DVT,发生率为8.33％,试验组DVT发生率明显低于对照组,差异有统计学意义(P＜0.05).结论 研究显示试验组孕妇DVT的发生率明显低于对照组,提示对高危妊娠剖宫产术后孕妇采用新型产褥期护理管理模式可有效减少DVT的发生.     

Neurosurgical interventions during pregnancy and the puerperium: clinical considerations and management

Summary. Neurosurgical interventions during pregnancy represent a special clinical challenge and require a meticulously selected treatment strategy. A thorough understanding of the underlying pathophysiological mechanisms involving mother and fetus is mandatory. We report our experience with neurosurgical procedures during pregnancy and the puerperium and summarize the difficulties encountered. The emerging diagnostic as well as therapeutic implications in these complex cases are also discussed.     

Ultrasound assessment of bladder volume: is it valid after delivery?

AIM: To assess the validity of a commercially available bladder volume scanner in the puerperium. METHODS: A prospective blinded comparison of bladder volume measurement after vaginal delivery using the BladderScan bladder volume instrument (BVI) 3000 and Foley catheter; comparison using the intraclass correlation coefficient. RESULTS: The mean difference between the two measurements was a 130-mL over-measurement by the bladder scanner (range: -156 mL to +422 mL). The intraclass correlation coefficient was 0.23 (95% confidence interval 0.00, 0.59). CONCLUSIONS: The BladderScan BVI 3000 is not an accurate instrument to assess bladder volume the day after vaginal delivery. Some of the discrepancy might relate to use of the Foley catheter as the reference standard. Further comparison between the BladderScan and a short female catheter or real time ultrasound is indicated.