Cerebrovascular complications during pregnancy and postpartum: clinical and prognosis observations in 240 Hispanic women

Background and purpose: Although pregnancy and postpartum have long been associated with stroke, there is a dearth of information in Latino‐American populations. The aim of this study was to describe the cerebrovascular complications occurring during pregnancy/postpartum and compare the characteristics amongst stroke types occurring in this period in Hispanic women. Patients and methods: We studied 240 women with cerebrovascular complications during pregnancy and the first 5 weeks postpartum, from our stroke registry. Patients were classified into three groups: cerebral venous thrombosis (CVT), ischaemic stroke (IS), and intracerebral hemorrhage (ICH). For each group, clinical data, timing of the event, and outcome were analyzed. Results: Of the 240 women, 136 had CVT (56.7%), 64 IS (26.7%), and 40 ICH (16.6%). In 72 women (30%), the event occurred during pregnancy, in 153 (64%) during postpartum, and in 15 (6%) closely related to labor. CVT was more common in the first trimester of pregnancy and in the second and third weeks following delivery; whilst IS and ICH were seen mainly during pregnancy and the first 2 weeks following delivery. Pre‐eclampsia/eclampsia was more common in patients with ICH (57.5%) and IS (36%) than in those with CVT (9.6%) (P < 0.001). An excellent recovery (modified Rankin Scale: 0–1) was observed amongst women with CVT (64%) and IS (50%) compared to ICH (32%), (P = 0.004). Conclusions: Pre‐eclampsia/eclampsia is a frequent risk factor in patients with ICH and IS, but not in CVT. Stroke types clustered different within the pregnancy‐postpartum period. A good prognosis is observed in patients with CVT.     

Multisite Infective Endocarditis/Endarteritis in a Young Peripartum Patient with Patent Ductus Arteriosus and Rheumatic Heart Valve Disease: A Case Report

Infective endocarditis (IE) is rarely seen in pregnancy and puerperal period, and generally occurs in patients with preexisting heart disease or intravenous drug abuse. In this report, we describe a case of a 27‐year‐old patient with missed diagnosis of rheumatic heart disease and a moderate size patent ductus arteriosus, in whom multisite culture‐negative IE/pulmonary endarteritis developed after uncomplicated vaginal delivery. (Echocardiography 2010;27:466‐469)     

产后家庭访视质量标准的制订与应用

目的落实产后家庭访视举措,提高访视效果。方法由课题组成员在理论研究与实践调研的基础上初拟产后家庭访视质量标准(下称产后访视标准),采用德尔菲法对15名专家进行2轮咨询、筛选与论证;按出院日将产妇286人单号分为观察组(154人)、双号分为对照组(132人),分别行常规访视和采用产后访视标准访视,连续3次时评价效果。结果形成8个一级条目、45个二级条目的产后访视标准;2轮专家咨询问卷的回收率均为100%,专家的权威系数为0.81,第2轮的协调系数为0.567,一致性检验P<0.01。观察组健康教育、访视前后处理、整体服务效果得分显著高于对照组(均P<0.01)。结论产后访视标准内容合理,评分客观,用于产后家庭访视可提高访视效果。     

辅助生殖技术妊娠妇女产褥期知识需求调查分析

目的 探讨辅助生殖技术妊娠妇女产褥期对健康知识的需求,为辅助生殖技术妊娠妇女产褥期健康教育提供理论依据.方法 采用自行设计的调查问卷,对105例接受辅助生殖技术产妇进行问卷调查;并以年龄和孕次作为匹配变量收集同期的120例自然妊娠的产妇作对照.结果 两组产妇对饮食知识、卫生知识、用药指导、产褥期康复护理指导、母乳喂养知...     

Predisposing factors, diagnosis, treatment and prognosis of cerebral venous thrombosis during pregnancy and postpartum: a case-control study

Background  Previous investigations have demonstrated a relatively low incidence of stroke among young women, though both pregnancy and delivery can substantially increase the risk. Cerebral venous thrombosis may manifest different characteristics during pregnancy and postpartum as a result of their specific physiological statuses. This study aimed to identify the clinical manifestations, diagnosis, treatment, and prognosis of cerebral venous thrombosis during pregnancy and postpartum.

Methods  We conducted a retrospective analysis of 22 patients with cerebral venous thrombosis who were assigned to either group A (during pregnancy) or group B (during postpartum). The relevant risk factors, initiation and development of the disease, clinical presentations, diagnosis, treatment, and prognosis were compared between the two stages.

Results  Cerebral venous thrombosis occurred during both pregnancy and postpartum, but was more common postpartum. Patients in group A had a longer hospitalization period than those in group B. Confirmed predisposing factors in 85.7% of patients of group A were dehydration, infection, and underlying cerebrovascular disorders. No obvious predisposing factors were identified in group B. The most frequent symptom was headache, with epileptic seizures, hemiparalysis and aphasia being less frequent symptoms. Focal neurological symptoms (P=0.022) and cerebral infarction (P=0.014) occurred more frequently in group A than in group B. Anticoagulation therapy proved to be safe for cerebral venous thrombosis patients during puerperium, regardless of parenchymal hemorrhage. However, more attention should be paid to spontaneous in-site placental hemorrhage in pregnant patients. Both groups had similar prognoses (P=1.000), with 36.3% patients suffering from consequential dysfunction or recurrent intracranial hypertension. Delayed diagnosis was associated with a poorer prognosis.

Conclusions  Cerebral venous thrombosis manifests different clinical characteristics during pregnancy and postpartum, though both have a good prognosis. Early diagnosis and prompt anticoagulation therapy are essential.

     

孕产妇甲流感患者血清DD、PCT、LTB4、TNF—α的测定及意义

目的探讨孕产妇甲流感患者血清中DD、PCT、LTB4和TNF-α各细胞因子在甲流感感染中的作用。方法采用酶联免疫吸附法（ELISA）测定24例甲流感孕产妇患者血清二聚体（DD）、血清降钙素原（PCT）、白三烯B4（LTB4）、肿瘤坏死因子-α（TNF-α）的水平。结果TNF-α在重症组于入院第1天时达峰值,随着抗病毒的有效治疗,其值逐渐下降;危重组第1天明显升高,未见其出现峰值,而是呈现逐渐上升的趋势。重症组、危重症组比较,在同一时间点TNF-α水平与疾病严重程度并非一定成正比。重症组、危重症组PCT于入院第1天时达峰值,以后迅速下降,逐渐恢复趋于正常水平,但仍明显高于对照组（P〈0．01）;DD于入院第1天达峰值,第3天和第5天有所下降,但一直处于较高水平（P〈0．05）;LTIM一直处于较高水平,在第3天、第5天明显升高,第5天最高。血清TNF-α与PCT、LTB4存在一定程度的正相关,但与DD相关性差异无统计学意义。结论孕产妇甲流感患者血清中DD、PCT及LTIM与TNF-α的指标的动态检测,我们发现这些指标与甲流感重症、危重症的发生有密切联系,故可将它们联合起来诊断和干预孕产妇甲流感重症、危重,从而降低其发生率和病死率。     

Incidence of venous thromboembolism during pregnancy and the puerperium: a systematic review and meta-analysis

Objective: Women during pregnancy or puerperium have a higher risk of venous thromboembolism (VTE). The reported incidence of pregnancy-associated VTE from literature varied considerably. To summarize the overall incidence of the disease, we conducted this meta-analysis.

Methods: We searched PubMed, EMBase and CNKI (China National Knowledge Infrastructure) for studies that reported the incidence of VTE during pregnancy or puerperium. The quality of included studies was assessed using the Newcastle–Ottawa scale and the meta-analysis was conducted using R software and Meta analyst Beta 3.13. Sensitivity analyses were performed to analyze the robustness of the results and publication bias was assessed using Egger's test.

Results: Twenty-seven articles met the inclusion criteria. The pooled incidence rate was 1.4‰ (1.0–1.8‰) for VTE, 1.1‰ (1.0–1.3‰) for deep vein thrombosis (DVT) and 0.3‰ (0.2–0.4‰) for pulmonary embolism (PE). The weighted proportion of VTE postpartum was 57.5% and the pooled proportion of right-sided DVT was 27.9%. We noted substantial heterogeneity among individual studies.

Conclusions: Women during pregnancy or puerperium are associated with a higher morbidity of VTE. Physicians should be of high vigilance to pregnancy-associated VTE, especially for women postpartum.     

精神分裂症孕产妇临床护理干预

通过对精神分裂症孕产妇患者采取细致、特殊的护理,配合安全有效的药物治疗,可以取得理想的治疗效果,使其顺利度过产褥期。     

产褥早期中医护理方案的应用及效果评价

目的:探索适用于产褥早期妇女的中医护理方案,促进产褥期产妇恢复。方法:将300例产妇随机分为实验组与对照组各150例,两组均予常规护理;实验组在常规护理的基础上给予产后中医护理,观察两组在子宫复旧、产后恶露、乳房硬结、乳汁分泌、睡眠、活动、情志等方面的护理效果。结果:实验组的效果明显优于对照组,差异有统计学意义(P﹤0.05)。结论:对产褥早期妇女实施中医护理方案能有效促进产妇的恢复,具有操作简单和使用方便等优点。     

Aminoglycoside dosing in obese puerperal women

We compared serum aminoglycoside levels in two groups of obese puerperal women being treated for endometritis. In these obese puerperal women (weights as much as 100 kg), the aminoglycoside dose did not have to be adjusted for excess weight initially, but it seems that determination of antibiotic levels should be performed in view of the large doses.