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Ishikawa S, Ishikawa H, Sato M, Nagasawa A, Suzuki Y, Okayama J, Nakada E, Omoto A, Shozu M, Koga K. Postpartum acute adrenal insufficiency of early-onset Sheehan syndrome: A case series study in a single center. J Obstet Gynaecol Res 2024; 50:205-211. [PMID: 37986644 DOI: 10.1111/jog.15838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 11/09/2023] [Indexed: 11/22/2023]
Abstract
AIM To identify the symptoms and relevant factors associated with acute adrenal insufficiency of early-onset Sheehan syndrome. METHODS We retrospectively reviewed the charts of 125 women admitted to our intensive care unit because of postpartum hemorrhage between January 2011 and December 2021. Three women developed acute adrenal insufficiency. We investigated the total blood loss, shock status, consciousness level upon arrival, and intensive care provided to the women. We also analyzed the symptoms and laboratory data that led to the diagnosis of acute adrenal insufficiency. Continuous variables were presented by median (minimum-maximum). RESULTS The medians and ranges of age, total blood loss, and shock index [heart rate/systolic blood pressure] on admission were 33.1 (17.2-45.3) years, 3351 (595-20 260) g, and 0.94 (0.55-2.94), respectively. Seven women were older than 40 years, 28 experienced >5000 g blood loss, 17 had shock index >1.5, 27 had impaired consciousness upon arrival, and 15 underwent hysterectomy. Women who developed acute adrenal insufficiency were <40 years old and had a bleeding volume of over 5000 g, impaired consciousness upon arrival, and had undergone hysterectomy. They had experienced lactation failure, presented with hyponatremia-related symptoms on postpartum days 8-9, experienced general malaise, headache, and impaired consciousness, and showed severe hyponatremia. CONCLUSIONS Massive postpartum hemorrhage over 5000 g, impaired consciousness upon arrival, and hysterectomy as a hemostatic measure were relevant factors associated with acute adrenal insufficiency of early-onset Sheehan syndrome. Hyponatremia-related symptoms occurring after lactation failure are indicative of the onset of acute adrenal insufficiency.
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Affiliation(s)
- Shota Ishikawa
- Department of Obstetrics and Gynecology, Chiba University Hospital, Chiba, Japan
| | - Hiroshi Ishikawa
- Department of Obstetrics and Gynecology, Chiba University Hospital, Chiba, Japan
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Mika Sato
- Department of Obstetrics and Gynecology, Chiba University Hospital, Chiba, Japan
| | - Akiko Nagasawa
- Department of Obstetrics and Gynecology, Chiba University Hospital, Chiba, Japan
| | - Yoshiya Suzuki
- Department of Obstetrics and Gynecology, Chiba University Hospital, Chiba, Japan
| | - Jun Okayama
- Department of Obstetrics and Gynecology, Chiba University Hospital, Chiba, Japan
| | - Emiri Nakada
- Department of Obstetrics and Gynecology, Chiba University Hospital, Chiba, Japan
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Akiko Omoto
- Department of Obstetrics and Gynecology, Chiba University Hospital, Chiba, Japan
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Makio Shozu
- Department of Obstetrics and Gynecology, Chiba University Hospital, Chiba, Japan
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Chiba University, Chiba, Japan
- Evolution and Reproductive Biology, Medical Mycology Research Center, Chiba University, Chiba, Japan
| | - Kaori Koga
- Department of Obstetrics and Gynecology, Chiba University Hospital, Chiba, Japan
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Chiba University, Chiba, Japan
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Bishop DG, Fernandes NL, Dyer RA, Sumikura H, Okada H, Suga Y, Shen F, Xu Z, Liu Z, Vasco M, George RB, Guasch E. Global issues in obstetric anaesthesia: perspectives from South Africa, Japan, China, Latin America and North America. Int J Obstet Anesth 2023; 54:103648. [PMID: 36930996 DOI: 10.1016/j.ijoa.2023.103648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 02/12/2023] [Accepted: 02/20/2023] [Indexed: 03/02/2023]
Abstract
South Africa is classified as a low- and middle-income country, with a complex mixture of resource-rich and resource-limited settings. In the major referral hospitals, the necessary skill level exists for the management of complex challenges. However, this contrasts with the frequently-inadequate skill levels of anaesthesia practitioners in resource-limited environments. In Japan, obstetricians administer anaesthesia for 40% of caesarean deliveries and 80% of labour analgesia. Centralisation of delivery facilities is now occurring and it is expected that obstetric anaesthesiologists will be available 24 h a day in centralised facilities in the future. In China, improvements in women's reproductive, maternal, neonatal, child, and adolescent health are critical government policies. Obstetric anaesthesia, especially labour analgesia, has received unprecedented attention. Chinese obstetric anaesthesiologists are passionate about clinical research, focusing on efficacy, safety, and topical issues. The Latin-American region has different landscapes, people, languages, and cultures, and is one of the world's regions with the most inequality. There are large gaps in research, knowledge, and health services, and the World Federation of Societies of Anaesthesiologists is committed to working with governmental and non-governmental organisations to improve patient care and access to safe anaesthesia. Anaesthesia workforce challenges, exacerbated by coronavirus disease 2019, beset North American healthcare. Pre-existing struggles by governments and decision-makers to improve health care access remain, partly due to unfamiliarity with the role of the anaesthesiologist. In addition to weaknesses in work environments and dated standards of work culture, the work-life balance demanded by new generations of anaesthesiologists must be acknowledged.
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Affiliation(s)
- D G Bishop
- Perioperative Research Group, Department of Anaesthetics, Critical Care and Pain Management, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | - N L Fernandes
- Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, South Africa
| | - R A Dyer
- Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, South Africa
| | - H Sumikura
- Department of Anesthesiology and Pain Medicine, Juntendo University, Japan
| | - H Okada
- Department of Anesthesiology and Pain Medicine, Juntendo University, Japan
| | - Y Suga
- Department of Anesthesiology and Pain Medicine, Juntendo University, Japan
| | - F Shen
- Department of Anaesthesiology, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynaecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Z Xu
- Department of Anaesthesiology, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynaecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Z Liu
- Department of Anaesthesiology, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynaecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - M Vasco
- Director of Clinical Simulation, Universidad CES, Medellín, Colombia
| | - R B George
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
| | - E Guasch
- Division Chief Obstetric Anaesthesia, Hospital Universitario La Paz, Madrid, Spain.
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Blandine M, Christian ZA. The Association Between Women's Empowerment and Reproductive Health Care Utilization in Cameroon. Int J Qual Health Care 2022; 34:6571666. [PMID: 35445256 DOI: 10.1093/intqhc/mzac032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 03/17/2022] [Accepted: 04/20/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The context related to maternal mortality has improved over the past decade in Cameroon. However, the demand for reproductive health care use remains insufficient with regard to public health policy targets, and women's empowerment is identified as a catalyst with a great potential. This study aims to analyse the association between the dimensions of women's empowerment and the utilization of adequate reproductive health care. METHOD The data comes from the fifth demographic and health survey of Cameroon carried out in 2018. Women's empowerment is measured through two indices: The economic status index and the decision-making index. Given the dichotomous nature of reproductive health outcomes, namely the use of at least four antenatal visits during pregnancy, the timing from the first antenatal visit and the place of delivery, a logistic regression model is adopted. RESULTS The results suggest that an increase in the decision-making index was significantly associated with higher chances of having at least four antenatal visits during pregnancy (OR: 1.25; 95% CI: 1.20, 1.29), of making the first prenatal visit during the first three months of pregnancy (OR: 1.03; 95% CI: 1.01, 1.07) and delivery in a hospital (OR: 1.34; 95% CI: 1.29, 1.39). However, a better economic status of the woman in the household was associated with lower chances of making the first prenatal visit during the first three months of pregnancy (OR: 0.65; 95% CI: 0.60, 0.71) and giving birth in a hospital (OR: 0.92; 95% CI: 0.83, 1.01); but no significant association was found with the number of antenatal visits. These different associations do not remain the same when mother and household characteristics are controlled. In addition, the results illustrate the key role that education, household wealth and media exposure played in the use of reproductive health care. CONCLUSION One of the strategic objectives of the Health Sector Strategy 2016-2027, the framework document for the public health policy in force, is to reduce maternal mortality rates by improving access to reproductive health care. To achieve this objective, this study suggests that policymakers should emphasize social policies favourable to women's empowerment in Cameroon, by pointing out access to income-generating activities and decision-making within the household.
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Affiliation(s)
- Mokam Blandine
- Faculty of Economics and Management, University of Yaoundé II, Cameroon
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Nivatpumin P, Lertbunnaphong T, Dittharuk D. A ten-year retrospective review of maternal cardiac arrest: Incidence, characteristics, causes, and outcomes in a tertiary-care hospital in a developing country. Taiwan J Obstet Gynecol 2021; 60:999-1004. [PMID: 34794763 DOI: 10.1016/j.tjog.2021.09.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2021] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE Maternal cardiac arrest is rare. We retrospectively reviewed and reported (1) the incidence of maternal cardiac arrests during admissions for delivery; (2) the characteristics and causes of cardiac arrest; and (3) the mortality rate and outcomes in a referral, single-university, teaching hospital in Thailand. MATERIALS AND METHODS Data on 23 cardiac arrests during admissions for delivery in the decade January 2006-December 2015 were retrospectively chart-reviewed. Patients with gestational ages under 24 weeks or cardiac arrests and death occurring before hospital arrival were excluded. The clinical characteristics of the arrests and outcomes were collected. RESULTS Of 89,368 deliveries during the decade, 23 women suffered cardiac arrest (incidence, 1:3885), with 3 of those arrests occurring before delivery (incidence, 1:29,789). One patient underwent a perimortem cesarean delivery in the operating theatre. The most common reasons for the arrests were hypertension during pregnancy and cardiovascular causes (30.4% and 21.7%, respectively). Amniotic fluid embolisms were suspected for 2 patients (8.7%) with unidentified causes. The incidence of maternal deaths in peripartum cardiac arrests was 20/23, representing 86.9% (95% CI, 67.9-95.5) or 1:4468 of deliveries. Three patients suffering cardiac arrests after delivery survived to discharge. CONCLUSIONS We found a high maternal mortality rate following cardiac arrests during hospitalization for delivery. To decrease the incidence of arrests during the peripartum period and diminish the maternal mortality rate, identification of the causes and precipitating factors is vital. High-risk pregnant women require multidisciplinary care to improve the survival-to-discharge rate.
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Affiliation(s)
- Patchareya Nivatpumin
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand.
| | - Tripop Lertbunnaphong
- Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
| | - Doungdalad Dittharuk
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
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Yu D, Zhang L, Yang S, Chen Q, Li Z. Trends, causes and solutions of maternal mortality in Jinan, China: the epidemiology of the MMR in 1991-2020. BMC Public Health 2021; 21:1792. [PMID: 34610806 PMCID: PMC8493743 DOI: 10.1186/s12889-021-11816-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 08/29/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND China was one of the few countries to achieve the Millennium Development Goals 5. China had taken many effective measures to reduce maternal mortality ratio (MMR) and has achieved encouraging progress. These measures were worth sharing for other countries to reduce the MMR, but the introduction of these measures from the national perspective was too grand, and the measures implemented in a city and the results achieved were more valuable. However, there were few studies on the prevalence and trends of prolonged maternal mortality in a city. In this study, we mainly introduced the prevalence of the MMR in Jinan,China from 1991 to 2020, analyzed the causes of trends and put forward some solutions to the difficulty existing in the process of reducing the MMR,hoping to serve as a model for some developing cities to reduce MMR. METHODS We collected maternal mortality data from paper records, electronic files and network platforms. The time trend of MMR was tested by Cochran-Armitage Test (CAT). We divided the study period into three stages with 10 years as a stage and the Chi-square test or Fisher's exact test was used to test the difference in MMR of different periods. RESULTS From 1991 to 2020, We counted 1,804,162 live births and 323 maternal deaths, and the MMR was 17.93 per 100,000 live births. The MMR declined from 44.06 per 100,000 live births in 1991 to 5.94 per 100,000 live births in 2020, with a total decline of 86.52% and an annual decline of 2.89%. The MMR declined by 88.54% in rural areas, with an average annual decline 2.95%, faster than that in urban areas (82.06, 2.73%). From 1991 to 2020, the top five causes of maternal deaths were obstetric haemorrhage (4.55 per 100,000 live births), amniotic fluid embolism (3.27 per 100,000 live births), pregnancy-induced hypertension (2.61 per 100,000 live births), heart disease (2.33 per 100,000 live births) and other medical complications (2.05 per 100,000 live births). Postpartum hemorrhage, amniotic fluid embolism, pregnancy-induced hypertension showed a downward trend (P < 0.05) and other medical complications showed an upward trend (P < 0.05). CONCLUSIONS Subsidy for hospitalized delivery of rural women, free prenatal check-ups for pregnant women and rapid referral system between hospitals have contributed to reducing MMR in Jinan. However, it was still necessary to strengthen the treatment of obstetric hemorrhage by ensuring blood supply, reduce the MMR due to medical complications by improving the skills of obstetricians to deal with medical diseases, and reduce the MMR by strengthening the allocation of emergency equipment in county hospitals and the skills training of doctors.
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Affiliation(s)
- Dafang Yu
- Department of Nursing, Jinan Maternity and Child Care Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Lihua Zhang
- Department of Medicine, Jinan Maternity and Child Care Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Shimin Yang
- Department of Public Health, Jinan Maternity and Child Care Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Qing Chen
- Department of Human Resources, Jinan Maternity and Child Care Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Zhongliang Li
- Department of Women Healthcare, Jinan Maternity and Child Care Hospital Affiliated to Shandong First Medical University, Jinan, 250012, People's Republic of China.
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Li D, Yu C, Song C, Ning W, Xu Y, Ge H, Lin S, Zhou W, Lu Y, Wang X, Hu Z, Lin Y, Wu J. Maternal mortality ratio in Jiangsu Province, China: recent trends and associated factors. BMC Pregnancy Childbirth 2021; 21:447. [PMID: 34172025 PMCID: PMC8235612 DOI: 10.1186/s12884-021-03897-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 05/17/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND In recent years, births to older mothers and multiparous mothers have increased rapidly with the change of birth policy in China. And mothers of advanced age are more likely to have maternal complications and poor birth outcomes. We aimed to estimate the recent trends and underlying risk factors of maternal mortality. METHODS In this systematic assessment, we used data from the National Maternal and Child Health Routine Reporting System (2013-2018), Jiangsu Provincial Maternal Mortality Surveillance System (2017-2018), the Integrated National Mortality Surveillance System (2018), City Statistical Yearbooks (2018), City Health Statistical Yearbooks (2018). The factors associated with maternal mortality ratio (MMR) were explored using the stepwise regression analysis and cluster analysis. RESULTS The MMR maintained at low levels between 2013 and 2016 and there was a slight increase in maternal mortality after 2016 in Jiangsu province. With the implementation of the China's universal two child policies, the percentage of multiparous mothers ascended from 34.2% (95% confidence interval (CI) = 34.1-34.3%) in 2013 to 51.4% (95% CI = 51.3-51.6%) in 2018 (beta = 3.88, P < 0.001). Consistently, the percentage of advanced maternal age (≥ 35) increased from 8.4% (95% CI = 8.4-8.5%) in 2013 to 10.4% (95% CI = 10.3-10.4%) in 2018 (beta = 0.50, P = 0.012). And we found that the percentage of multiparous mothers and advanced maternal age among maternal deaths were higher than all pregnant women (P < 0.001). In the stepwise regression analysis, four risk factors were significantly associated with maternal mortality ratio (primary industry of gross domestic product (GDP), rate of delivery in maternal and child health hospital, rate of cesarean section and rate of low birth weight). As the results derived from cluster analysis, the relatively developed regions had lower preventable maternal mortality ratio (43.5% (95% CI = 31.2-56.7%) vs. 62.6% (95% CI = 52.3-72.0%), P = 0.027). CONCLUSIONS Since the universal two child policy has been associated with changes in health related birth characteristics: women giving birth have been more likely to be multiparous, and more likely to be aged 35 and over. This somewhat magnifies the impact of differences in economic development and obstetric services on MMR. The findings based on prefecture level data suggest that interventions must target economic development, the health system and maternal risk factors in synergy. These approaches will be of great benefit to control or diminish environmental factors associated with preventable deaths and will effectively reduce MMR and narrow the gap among the different regions.
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Affiliation(s)
- Donghua Li
- State Key Laboratory of Reproductive Medicine, Department of Obstetrics and Gynecology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Jiangsu Women and Children Health Hospital, Nanjing, 210036, China
| | - Chengxiao Yu
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
- Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing Medical University, Nanjing, 211166, China
| | - Ci Song
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
- Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing Medical University, Nanjing, 211166, China
| | - Weiqing Ning
- State Key Laboratory of Reproductive Medicine, Department of Obstetrics and Gynecology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Jiangsu Women and Children Health Hospital, Nanjing, 210036, China
| | - Yan Xu
- Department of Women and Children, Jiangsu Provincial Commission of Health, Nanjing, 210008, China
| | - Huan Ge
- State Key Laboratory of Reproductive Medicine, Department of Obstetrics and Gynecology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Jiangsu Women and Children Health Hospital, Nanjing, 210036, China
| | - Song Lin
- State Key Laboratory of Reproductive Medicine, Department of Obstetrics and Gynecology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Jiangsu Women and Children Health Hospital, Nanjing, 210036, China
| | - Wenjie Zhou
- State Key Laboratory of Reproductive Medicine, Department of Obstetrics and Gynecology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Jiangsu Women and Children Health Hospital, Nanjing, 210036, China
| | - Yajun Lu
- State Key Laboratory of Reproductive Medicine, Department of Obstetrics and Gynecology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Jiangsu Women and Children Health Hospital, Nanjing, 210036, China
| | - Xudong Wang
- State Key Laboratory of Reproductive Medicine, Department of Obstetrics and Gynecology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Jiangsu Women and Children Health Hospital, Nanjing, 210036, China
| | - Zhibin Hu
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
- Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing Medical University, Nanjing, 211166, China
| | - Yuan Lin
- Department of Maternal, Child and Adolescent Health, School of Public Health, Nanjing Medical University, Nanjing, 211166, China.
| | - Jie Wu
- State Key Laboratory of Reproductive Medicine, Department of Obstetrics and Gynecology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Jiangsu Women and Children Health Hospital, Nanjing, 210036, China.
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Comprehensive pregnancy monitoring with a network of wireless, soft, and flexible sensors in high- and low-resource health settings. Proc Natl Acad Sci U S A 2021; 118:2100466118. [PMID: 33972445 PMCID: PMC8157941 DOI: 10.1073/pnas.2100466118] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Monitoring vital signs for laboring women and their fetuses is foundational to the delivery of obstetrical care; however, monitoring platforms for pregnancy have undergone little innovation over the last several decades with many low-income settings lacking basic access. We report a new time-synchronized, flexible, and wireless sensor system applicable across the entire continuum of antepartum and postpartum care that provides continuous, comprehensive, and noninvasive monitoring (heart rate, respiratory rate, and pulse oxygenation) compatible with a wide range of mobile devices. This system offers advanced features such as continuous blood pressure, uterine electrohysterography, and automated body position classification. We further demonstrate the performance of this new system among pregnant individuals (n = 576) in both high-resource settings and low-resource care settings. Vital signs monitoring is a fundamental component of ensuring the health and safety of women and newborns during pregnancy, labor, and childbirth. This monitoring is often the first step in early detection of pregnancy abnormalities, providing an opportunity for prompt, effective intervention to prevent maternal and neonatal morbidity and mortality. Contemporary pregnancy monitoring systems require numerous devices wired to large base units; at least five separate devices with distinct user interfaces are commonly used to detect uterine contractility, maternal blood oxygenation, temperature, heart rate, blood pressure, and fetal heart rate. Current monitoring technologies are expensive and complex with implementation challenges in low-resource settings where maternal morbidity and mortality is the greatest. We present an integrated monitoring platform leveraging advanced flexible electronics, wireless connectivity, and compatibility with a wide range of low-cost mobile devices. Three flexible, soft, and low-profile sensors offer comprehensive vital signs monitoring for both women and fetuses with time-synchronized operation, including advanced parameters such as continuous cuffless blood pressure, electrohysterography-derived uterine monitoring, and automated body position classification. Successful field trials of pregnant women between 25 and 41 wk of gestation in both high-resource settings (n = 91) and low-resource settings (n = 485) demonstrate the system’s performance, usability, and safety.
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Wakasa T, Ishibashi‐Ueda H, Takeuchi M. Maternal death analysis based on data from the nationwide registration system in Japan (2010-2018). Pathol Int 2021; 71:223-231. [PMID: 33559265 PMCID: PMC8248185 DOI: 10.1111/pin.13076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 01/19/2021] [Indexed: 12/12/2022]
Abstract
The maternal mortality rate in Japan was 3.5 per 100 000 live births in 2017, similar to that reported in other developed countries. To reduce the number of maternal deaths, a Japanese nationwide registration and analysis system was implemented in 2010. Between January 2010 and April 2018, 367 maternal deaths were reported. Among them, by reviewing 80 autopsy records, the direct obstetric causes of death were identified in 52 women. The major causes of deaths were amniotic fluid embolism and acute pulmonary thromboembolism. The other 26 maternal deaths were associated with indirect obstetric causes including invasive Group A Streptococcus infection, aortic dissection, cerebral stroke and cardiomyopathies. This review highlights the importance of autopsy in maternal deaths. On analyzing 42 autopsy specimens obtained from registered cases of maternal death during 2012-2015, the 36% of causes of death by autopsy were discordant with the clinical diagnosis. Moreover, of the 38% of non-autopsied maternal death, the cause of death could not be clarified from the clinical chart. We emphasized that detailed autopsies are necessary to clarify the precise pathologic evidence related to pregnancy and delivery, especially causes of unexpected death such as amniotic fluid embolism.
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Affiliation(s)
- Tomoko Wakasa
- Department of Diagnostic Pathology, Nara HospitalKindai UniversityNaraJapan
| | | | - Makoto Takeuchi
- Department of PathologyOsaka Women's and Children's HospitalOsakaJapan
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Yamazaki T, Cerdeira AS, Agrawal S, Koh I, Sugimoto J, Vatish M, Kudo Y. Predictive Accuracy of Soluble FMS-Like Tyrosine Kinase-1/Placental Growth Factor Ratio for Preeclampsia in Japan: A Systematic Review. HYPERTENSION RESEARCH IN PREGNANCY 2021. [DOI: 10.14390/jsshp.hrp2020-012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Tomomi Yamazaki
- Department of Obstetrics and Gynecology, Graduate School of Biomedical Sciences, Hiroshima University
- equal contribution
| | - Ana Sofia Cerdeira
- Nuffield Department of Women’s Health and Reproductive Research, University of Oxford, Level 3, Women’s Center, John Radcliffe Oxford University Hospital Oxford
- equal contribution
| | - Swati Agrawal
- Department of Maternal-Fetal Medicine, University of Toronto
| | - Iemasa Koh
- Department of Obstetrics and Gynecology, Graduate School of Biomedical Sciences, Hiroshima University
| | - Jun Sugimoto
- Department of Obstetrics and Gynecology, Graduate School of Biomedical Sciences, Hiroshima University
| | - Manu Vatish
- Nuffield Department of Women’s Health and Reproductive Research, University of Oxford, Level 3, Women’s Center, John Radcliffe Oxford University Hospital Oxford
- equal contribution
| | - Yoshiki Kudo
- Department of Obstetrics and Gynecology, Graduate School of Biomedical Sciences, Hiroshima University
- equal contribution
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Toyokawa S, Hasegawa J, Ikenoue T, Asano Y, Jojima E, Satoh S, Ikeda T, Ichizuka K, Takeda S, Tamiya N, Nakai A, Fujimori K, Maeda T, Masuzaki H, Suzuki H, Ueda S. Weekend and off-hour effects on the incidence of cerebral palsy: contribution of consolidated perinatal care. Environ Health Prev Med 2020; 25:52. [PMID: 32912144 PMCID: PMC7488476 DOI: 10.1186/s12199-020-00889-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 08/27/2020] [Indexed: 11/25/2022] Open
Abstract
Objective This study estimated the effects of weekend and off-hour childbirth and the size of perinatal medical care center on the incidence of cerebral palsy. Methods The cases were all children with severe cerebral palsy born in Japan from 2009 to 2012 whose data were stored at the Japan Obstetric Compensation System for Cerebral Palsy database, a nationally representative database. The inclusion criteria were the following: neonates born between January 2009 and December 2012 who had a birth weight of at least 2000 g and gestational age of at least 33 weeks and who had severe disability resulting from cerebral palsy independent of congenital causes or factors during the neonatal period or thereafter. Study participants were restricted to singletons and controls without report of death, scheduled cesarean section, or ambulance transportation. The controls were newborns, randomly selected by year and type of delivery (normal spontaneous delivery without cesarean section and emergency cesarean section) using a 1:10 case to control ratio sampled from the nationwide Japan Society of Obstetrics and Gynecology database. Results A total of 90 cerebral palsy cases and 900 controls having normal spontaneous delivery without cesarean section were selected, as were 92 cerebral palsy cases and 920 controls with emergent cesarean section. A significantly higher risk for cerebral palsy was found among cases that underwent emergent cesarean section on weekends (odds ratio [OR] 1.72, 95% confidence interval [CI] 1.06–2.81) and during the night shift (OR 2.29, 95% CI 1.30–4.02). No significant risk was found among normal spontaneous deliveries on weekends (OR 1.63, 95% CI 0.97–2.73) or during the quasi-night shift (OR 1.26, 95% CI 0.70–2.27). Regional perinatal care centers showed significantly higher risk for cerebral palsy in both emergent cesarean section (OR 2.35, 95% CI 1.47–3.77) and normal spontaneous delivery (OR 2.92, 95% CI 1.76–4.84). Conclusion Labor on weekends, during the night shift, and at regional perinatal medical care centers was associated with significantly elevated risk for cerebral palsy in emergency cesarean section.
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Affiliation(s)
- Satoshi Toyokawa
- Department of Public Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan. .,Department of the Japan Obstetric Compensation System for Cerebral Palsy, Japan Council for Quality Health Care, Tokyo, Japan.
| | - Junichi Hasegawa
- Department of the Japan Obstetric Compensation System for Cerebral Palsy, Japan Council for Quality Health Care, Tokyo, Japan.,Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kanagawa, Japan
| | | | - Yuri Asano
- Department of the Japan Obstetric Compensation System for Cerebral Palsy, Japan Council for Quality Health Care, Tokyo, Japan
| | - Emi Jojima
- Department of the Japan Obstetric Compensation System for Cerebral Palsy, Japan Council for Quality Health Care, Tokyo, Japan
| | - Shoji Satoh
- Maternal and Perinatal Care Center, Oita Prefectural Hospital, Oita, Japan
| | - Tomoaki Ikeda
- Department of Obstetrics and Gynecology, Mie University Graduate School of Medicine, Mie, Japan
| | - Kiyotake Ichizuka
- Department of Obstetrics and Gynecology, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - Satoru Takeda
- Department of Obstetrics and Gynecology, Juntendo University, Tokyo, Japan
| | - Nanako Tamiya
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Akihito Nakai
- Department of Obstetrics and Gynecology, Nippon Medical School, Tokyo, Japan
| | - Keiya Fujimori
- Department of Obstetrics and Gynecology, Fukushima Medical University, Fukushima, Japan
| | | | - Hideaki Masuzaki
- Department of Obstetrics and Gynecology, University of Nagasaki, Nagasaki, Japan
| | - Hideaki Suzuki
- Department of the Japan Obstetric Compensation System for Cerebral Palsy, Japan Council for Quality Health Care, Tokyo, Japan
| | - Shigeru Ueda
- Department of the Japan Obstetric Compensation System for Cerebral Palsy, Japan Council for Quality Health Care, Tokyo, Japan
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11
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Hironaka K, Suzuki M, Tateyama K, Ozeki T, Adachi K, Morita A. Severe Aneurysmal Subarachnoid Hemorrhage after Warning Headache during Pregnancy: A Case Report. J NIPPON MED SCH 2020; 87:162-165. [PMID: 32655093 DOI: 10.1272/jnms.jnms.2020_87-308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Aneurysmal subarachnoid hemorrhage is a rare but important cause of maternal death during pregnancy. CASE DESCRIPTION A 34-year-old primigravida (31 weeks of pregnancy) with acute headache but no neurological deficits or neck stiffness was prescribed medication and returned home. Four weeks later she presented with severe headache and consciousness disturbance. She was admitted to our hospital, where she fell into a deep coma. Brain CT and three-dimensional CT angiography showed subarachnoid hemorrhage and a 5-mm right internal carotid-posterior communicating artery aneurysm. Fetal heart rate was 60 beats per minute. Emergent cesarean section and surgical clipping were performed. Intraoperative examination revealed that the aneurysm originated at the right posterior communicating artery. There were no postoperative neurological focal deficits. On postoperative day 13 she developed delayed cerebral ischemia of the right temporo-parieto-occipital lobe. She was discharged home 36 days after surgery with left hemianopsia. The infant was free of complications and was discharged at age 17 days. CONCLUSIONS A pregnant woman with severe headache should undergo brain CT or magnetic resonance imaging to rule out subarachnoid hemorrhage.
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Affiliation(s)
- Kohei Hironaka
- Department of Neurological Surgery, Nippon Medical School Musashi Kosugi Hospital
| | - Masanori Suzuki
- Department of Neurological Surgery, Nippon Medical School Musashi Kosugi Hospital
| | - Kojiro Tateyama
- Department of Neurological Surgery, Nippon Medical School Musashi Kosugi Hospital
| | - Tomohiro Ozeki
- Department of Neurological Surgery, Nippon Medical School Musashi Kosugi Hospital
| | - Koji Adachi
- Department of Neurological Surgery, Nippon Medical School Musashi Kosugi Hospital
| | - Akio Morita
- Department of Neurological Surgery, Nippon Medical School
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Hashii K, Yamahata Y, Suzuki T. Evaluation and care protocol for maternal emergencies: the basic J-CIMELS protocol derived from the Kyoto protocol. HYPERTENSION RESEARCH IN PREGNANCY 2020. [DOI: 10.14390/jsshp.hrp2019-018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Koji Hashii
- Department of Obstetrics and Gynecology, Hashii Clinic of Obstetrics and Gynecology
| | - Yoshihiro Yamahata
- Department of Emergency and Disaster Medicine, Kyoto Prefectural University of Medicine, Graduate School of Medical Science
| | - Takao Suzuki
- Department of Emergency and Critical Care Medicine, Hyogo Prefectural Amagasaki General Medical Center
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13
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Hasegawa J, Katsuragi S, Tanaka H, Kurasaki A, Nakamura M, Murakoshi T, Nakata M, Kanayama N, Sekizawa A, Isamu I, Kinoshita K, Ikeda T. Decline in maternal death due to obstetric haemorrhage between 2010 and 2017 in Japan. Sci Rep 2019; 9:11026. [PMID: 31363105 PMCID: PMC6667693 DOI: 10.1038/s41598-019-47378-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 07/16/2019] [Indexed: 11/16/2022] Open
Abstract
This descriptive study was based on the maternal death registration system established by the Japan Association of Obstetricians and Gynecologists and the Maternal Death Exploratory Committee (JMDEC). 361 women died during pregnancy or within 42 days after delivery between January 2010 and June 2017 throughout Japan were analysed, in order to investigate the trend in maternal deaths related to obstetric medical practice. Reports of maternal death were consistent, ranging from 45 cases in 2010 to 44 cases in 2017. Among all maternal deaths, the frequency of deaths due to obstetric haemorrhage ranged from 29% (2010) to 7% (2017) (p < 0.001). The causes of obstetric haemorrhage have progressively reduced, especially maternal deaths due to uterine inversion and laceration have not occurred since 2014. The remaining causes of obstetric haemorrhage-related maternal deaths were placenta accreta spectrum, placental abruption, and severe forms of uterine focused amniotic fluid embolism. We believe the activities of the JMDEC including annual recommendations and simulation programs are improving the medical practices of obstetric care providers in Japan, resulting in a reduction of maternal deaths due to obstetric haemorrhage.
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Affiliation(s)
- Junichi Hasegawa
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kanagawa, Japan.
| | - Shinji Katsuragi
- Department of Obstetrics and Gynecology, Sakakibara Heart Institute, Tokyo, Japan
| | - Hiroaki Tanaka
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Mie, Japan
| | - Akiko Kurasaki
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Masamitsu Nakamura
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Takeshi Murakoshi
- Division of Perinatology, Maternal and Perinatal Care Center, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Masahiko Nakata
- Department of Obstetrics and Gynecology, Toho University School of Medicine, Tokyo, Japan
| | - Naohiro Kanayama
- Department of Obstetrics and Gynaecology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Akihiko Sekizawa
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Ishiwata Isamu
- Ishiwata Obstetrics and Gynecology Hospital, Ibaraki, Japan
| | | | - Tomoaki Ikeda
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Mie, Japan
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14
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Challenges and hurdles for patient safety in obstetric anesthesia in Japan. J Anesth 2018; 32:901-907. [DOI: 10.1007/s00540-018-2571-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 10/18/2018] [Indexed: 10/28/2022]
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16
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Suzuki H, Hirashima C, Nagayama S, Takahashi K, Yamamoto T, Matsubara S, Ohkuchi A. Increased serum levels of sFlt-1/PlGF ratio in preeclamptic women with onset at <32 weeks compared with ≥32 weeks. Pregnancy Hypertens 2018; 12:96-103. [DOI: 10.1016/j.preghy.2018.03.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 03/15/2018] [Accepted: 03/18/2018] [Indexed: 11/29/2022]
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17
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Brüggmann D, Kollascheck J, Quarcoo D, Bendels MH, Klingelhöfer D, Louwen F, Jaque JM, Groneberg DA. Ectopic pregnancy: exploration of its global research architecture using density-equalising mapping and socioeconomic benchmarks. BMJ Open 2017; 7:e018394. [PMID: 29025848 PMCID: PMC5652463 DOI: 10.1136/bmjopen-2017-018394] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE About 2% of all pregnancies are complicated by the implantation of the zygote outside the uterine cavity and termed ectopic pregnancy. Whereas a multitude of guidelines exists and related research is constantly growing, no thorough assessment of the global research architecture has been performed yet. Hence, we aim to assess the associated scientific activities in relation to geographical and chronological developments, existing research networks and socioeconomic parameters. DESIGN Retrospective, descriptive study. SETTING On the basis of the NewQIS platform, scientometric methods were combined with novel visualising techniques such as density-equalising mapping to assess the scientific output on ectopic pregnancy. Using the Web of Science, we identified all related entries from 1900 to 2012. RESULTS 8040 publications were analysed. The USA and the UK were dominating the field in regard to overall research activity (2612 and 723 publications), overall citation numbers and country-specific H-Indices (US: 80, UK: 42). Comparison to economic power of the most productive countries demonstrated that Israel invested more resources in ectopic pregnancy-related research than other nations (853.41 ectopic pregnancy-specific publications per 1000 billlion US$ gross domestic product (GDP)), followed by the UK (269.97). Relation to the GDP per capita index revealed 49.3 ectopic pregnancy-specific publications per US$1000 GDP per capita for the USA in contrast to 17.31 for the UK. Semiqualitative indices such as country-specific citation rates ranked Switzerland first (24.7 citations per ectopic pregnancy-specific publication), followed by the Scandinavian countries Finland and Sweden. Low-income countries did not exhibit significant research activities. CONCLUSIONS This is the first in-depth analysis of global ectopic pregnancy research since 1900. It offers unique insights into the global scientific landscape. Besides the USA and the UK, Scandinavian countries and Switzerland can also be regarded as leading nations with regard to their relative socioeconomic input.
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Affiliation(s)
- Dörthe Brüggmann
- Department of Obstetrics and Gynecology, Keck School of Medicine of USC, Los Angeles, California, USA
- Division of Female Health and Preventive Medicine, Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University, Frankfurt
- Department of Gynecology and Obstetrics, Goethe-University, Frankfurt, Germany
| | - Jana Kollascheck
- Division of Female Health and Preventive Medicine, Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University, Frankfurt
| | - David Quarcoo
- Division of Female Health and Preventive Medicine, Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University, Frankfurt
| | - Michael H Bendels
- Division of Female Health and Preventive Medicine, Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University, Frankfurt
| | - Doris Klingelhöfer
- Division of Female Health and Preventive Medicine, Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University, Frankfurt
| | - Frank Louwen
- Department of Gynecology and Obstetrics, Goethe-University, Frankfurt, Germany
| | - Jenny M Jaque
- Department of Obstetrics and Gynecology, Keck School of Medicine of USC, Los Angeles, California, USA
| | - David A Groneberg
- Division of Female Health and Preventive Medicine, Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University, Frankfurt
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Galectin-1 as a novel risk factor for both gestational hypertension and preeclampsia, specifially its expression at a low level in the second trimester and a high level after onset. Hypertens Res 2017; 41:45-52. [PMID: 28978981 DOI: 10.1038/hr.2017.85] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 04/10/2017] [Accepted: 05/07/2017] [Indexed: 12/18/2022]
Abstract
Our aim was to evaluate whether the serum level of galectin-1 (Gal-1) at 18-24 and 27-31 weeks of gestation is a risk factor for predicting the later occurrence of not only preeclampsia (PE) but also gestational hypertension (GH). We measured serum levels of soluble fms-like tyrosine kinase 1 (sFlt-1), placental growth factor (PlGF), and Gal-1 using an enzyme-linked immunosorbent assay in 81 and 73 normal pregnant women, 22 and 16 women with a later onset of GH, and 37 and 29 women with a later onset of PE at 18-24 and 27-31 weeks, respectively. We also measured Gal-1 in 33 women with GH and 78 women with PE after the onset. The levels of Gal-1 after the onset of GH, late-onset PE (onset at ⩾34 weeks), and early-onset PE (onset at <34 weeks) were significantly higher than those in normal pregnant women at 27-31 weeks. However, the low levels of Gal-1 (<8.1 ng ml-1) at 18-24 weeks, but not at 27-31 weeks, predicted the later occurrence of not only early-onset PE and late-onset PE but also GH. The low level of Gal-1 at 18-24 weeks was an independent risk factor for the later occurrence of GH and PE, after adjusting for the effects of a high BP and increased sFlt-1/PlGF ratio at 18-24 weeks. In conclusion, the serum level of Gal-1 is a novel risk factor for both GH and PE, specifically its expression at a low level in the second trimester and a high level after onset.
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Hasegawa J, Ikeda T, Sekizawa A, Tanaka H, Nakamura M, Katsuragi S, Osato K, Tanaka K, Murakoshi T, Nakata M, Ishiwata I. Recommendations for saving mothers' lives in Japan: Report from the Maternal Death Exploratory Committee (2010-2014). J Obstet Gynaecol Res 2016; 42:1637-1643. [PMID: 27718278 DOI: 10.1111/jog.13136] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 07/17/2016] [Indexed: 11/28/2022]
Abstract
To make recommendations for saving mothers' lives, issues related to maternal deaths including diseases, causes, treatments, and hospital and regional systems are analyzed by the Maternal Death Exploratory Committee in Japan. In this report, we present ten clinical important recommendations based on the analysis of maternal deaths between 2010 and 2014 in Japan.
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Affiliation(s)
- Junichi Hasegawa
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Tomoaki Ikeda
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Mie, Japan
| | - Akihiko Sekizawa
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Hiroaki Tanaka
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Mie, Japan
| | - Masamitsu Nakamura
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Shinji Katsuragi
- Department of Obstetrics and Gynecology, Sakakibara Heart Institute, Tokyo, Japan
| | - Kazuhiro Osato
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Mie, Japan
| | - Kayo Tanaka
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Mie, Japan
| | - Takeshi Murakoshi
- Obstetrics and Gynecology, Maternal and Perinatal Care Center, Seirei Hamamatsu General Hospital, Shizuoka, Japan
| | - Masahiko Nakata
- Department of Obstetrics and Gynecology, Toho University, Tokyo, Japan
| | - Isamu Ishiwata
- Ishiwata Obstetrics and Gynecology Hospital, Ibaraki, Japan
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20
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Ohkuchi A, Hirashima C, Takahashi K, Suzuki H, Matsubara S. Prediction and prevention of hypertensive disorders of pregnancy. Hypertens Res 2016; 40:5-14. [PMID: 27534740 DOI: 10.1038/hr.2016.107] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 07/06/2016] [Accepted: 07/09/2016] [Indexed: 12/24/2022]
Abstract
The most common classifications of hypertensive disorders of pregnancy consist of chronic hypertension, gestational hypertension, preeclampsia (PE) and superimposed PE. A common final pathophysiology of PE is endothelial dysfunction. The most successful translational research model for explaining the cause-effect relationship in the genesis of PE is the angiogenic/angiostatic balance theory, involving soluble fms-like tyrosine kinase 1 (sFlt-1), placental growth factor (PlGF) and soluble endoglin (sEng). In a systematic review of articles on the prediction of early-onset PE using angiogenesis-related factors, we revealed that the prediction of early-onset PE in the first trimester is clinically possible, but the prediction of early-onset PE in the early third trimester might be ideal. In addition, an onset threshold or a serial approach appeared to be clinically useful for predicting the imminent onset of PE, with onset at <4 weeks after blood sampling in the second and early third trimesters, because the positive likelihood ratio was >10 and the positive predictive value was >20%. The National Institute for Health and Care Excellence guidelines state that the Triage PlGF testing and Elecsys immunoassay for the sFlt-1/PlGF ratio could help to exclude PE in women with suspected PE at 20-34 weeks of gestation. Until now, we have not found any effective therapies to prevent PE. However, low-dose aspirin treatment starting at ⩽16 weeks of gestation might be associated with a marked reduction in PE. In addition, early statin treatment might prevent the occurrence of PE. Currently, a clinical trial using pravastatin for the prevention of PE is ongoing.
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Affiliation(s)
- Akihide Ohkuchi
- Department of Obstetrics and Gynecology, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Chikako Hirashima
- Department of Obstetrics and Gynecology, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Kayo Takahashi
- Department of Obstetrics and Gynecology, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Hirotada Suzuki
- Department of Obstetrics and Gynecology, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Shigeki Matsubara
- Department of Obstetrics and Gynecology, Jichi Medical University School of Medicine, Tochigi, Japan
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Koroukian SM. Relative Risk of Postpartum Complications in the Ohio Medicaid Population: Vaginal Versus Cesarean Delivery. Med Care Res Rev 2016; 61:203-24. [PMID: 15155052 DOI: 10.1177/1077558703260123] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The objective of this study was to estimate the relative risk of postpartum complication by type of delivery among Ohio Medicaid beneficiaries. The study uses the linked Medicaid and Ohio birth certificate data for births occurring from July 1991 through April 1996 (N = 168,736). The results indicate that the incidence of major puerperal infection, thromboembolic events, anesthetic complications, and obstetrical surgical wound infection was higher among women undergoing a C-section as compared to those with vaginal delivery, even after limiting the analysis to elective cesarean deliveries and uncomplicated vaginal deliveries. On the other hand, women with C-sections were less likely to experience obstetrical trauma, and results on postpartum hemorrhage were inconclusive. Aside from obstetrical trauma, the relative risk of postpartum complications remains significantly higher among women undergoing C-section. These findings are of particular relevance in light of the substantial proportion of repeat C-sections performed on an elective basis.
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Hasegawa J, Sekizawa A, Tanaka H, Katsuragi S, Osato K, Murakoshi T, Nakata M, Nakamura M, Yoshimatsu J, Sadahiro T, Kanayama N, Ishiwata I, Kinoshita K, Ikeda T. Current status of pregnancy-related maternal mortality in Japan: a report from the Maternal Death Exploratory Committee in Japan. BMJ Open 2016; 6:e010304. [PMID: 27000786 PMCID: PMC4809072 DOI: 10.1136/bmjopen-2015-010304] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To clarify the problems related to maternal deaths in Japan, including the diseases themselves, causes, treatments and the hospital or regional systems. DESIGN Descriptive study. SETTING Maternal death registration system established by the Japan Association of Obstetricians and Gynecologists (JAOG). PARTICIPANTS Women who died during pregnancy or within a year after delivery, from 2010 to 2014, throughout Japan (N=213). MAIN OUTCOME MEASURES The preventability and problems in each maternal death. RESULTS Maternal deaths were frequently caused by obstetric haemorrhage (23%), brain disease (16%), amniotic fluid embolism (12%), cardiovascular disease (8%) and pulmonary disease (8%). The Committee considered that it was impossible to prevent death in 51% of the cases, whereas they considered prevention in 26%, 15% and 7% of the cases to be slightly, moderately and highly possible, respectively. It was difficult to prevent maternal deaths due to amniotic fluid embolism and brain disease. In contrast, half of the deaths due to obstetric haemorrhage were considered preventable, because the peak duration between the initial symptoms and initial cardiopulmonary arrest was 1-3 h. CONCLUSIONS A range of measures, including individual education and the construction of good relationships among regional hospitals, should be established in the near future, to improve primary care for patients with maternal haemorrhage and to save the lives of mothers in Japan.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Jun Yoshimatsu
- National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Tomohito Sadahiro
- Tokyo Women's Medical University Yachiyo Medical Center, Chiba, Japan
| | | | - Isamu Ishiwata
- Ishiwata Obstetrics and Gynecology Hospital, Ibaraki, Japan
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Tanaka H, Katsuragi S, Tanaka K, Kawamura T, Nii M, Kubo M, Osato K, Sasaki Y, Ikeda T. Application of the perfusion index in obstetric bleeding. J Matern Fetal Neonatal Med 2016; 29:3812-4. [PMID: 26820698 DOI: 10.3109/14767058.2016.1147552] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE We assessed the utility of the pulse oximeter perfusion index (PI) in maternal monitoring immediately after delivery. METHODS We examined 30 pregnant women without any complications using the Rad7 device at delivery. The correlations between heart rate (HR), systolic blood pressure (BP), oxygen saturation SpO2, PI, Pleth variability index (PVI), shock index and blood loss were assessed. RESULTS Blood loss at 20-min postpartum was not correlated with the difference in heart rate, systolic BP, SpO2, shock index or PVI taken immediately after delivery and at 20-min postpartum, but showed a strong negative correlation with the difference in the PI taken immediately after delivery and at 20-min postpartum (r = -0.70). CONCLUSION PI changes were correlated with post-delivery blood loss and can be used for maternal monitoring at delivery.
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Affiliation(s)
- Hiroaki Tanaka
- a Department of Obstetrics and Gynecology , Mie University School of Medicine , Mie , Japan .,b Department of Obstetrics and Gynecology , Kuwana City Medical Center , Kuwana , Japan , and
| | - Shinji Katsuragi
- c Department of Obstetrics and Gynecology , Sakakibara Heart Institute , Tokyo , Japan
| | - Kayo Tanaka
- a Department of Obstetrics and Gynecology , Mie University School of Medicine , Mie , Japan
| | - Takuya Kawamura
- a Department of Obstetrics and Gynecology , Mie University School of Medicine , Mie , Japan
| | - Masafumi Nii
- a Department of Obstetrics and Gynecology , Mie University School of Medicine , Mie , Japan
| | - Michiko Kubo
- a Department of Obstetrics and Gynecology , Mie University School of Medicine , Mie , Japan
| | - Kazuhiro Osato
- a Department of Obstetrics and Gynecology , Mie University School of Medicine , Mie , Japan
| | - Yoshihito Sasaki
- b Department of Obstetrics and Gynecology , Kuwana City Medical Center , Kuwana , Japan , and
| | - Tomoaki Ikeda
- a Department of Obstetrics and Gynecology , Mie University School of Medicine , Mie , Japan
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Tanaka H, Katsuragi S, Osato K, Hasegawa J, Nakata M, Murakoshi T, Yoshimatsu J, Sekizawa A, Kanayama N, Ishiwata I, Ikeda T. The increase in the rate of maternal deaths related to cardiovascular disease in Japan from 1991-1992 to 2010-2012. J Cardiol 2016; 69:74-78. [PMID: 26899278 DOI: 10.1016/j.jjcc.2016.01.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 12/30/2015] [Accepted: 01/10/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cardiovascular diseases (CVD), both genetic and acquired, increase the risk of maternal death (MD) unless proper genetic/clinical counseling is provided and a multidisciplinary approach is adopted during pregnancy. In recent decades, there has been a significant increase in the number of women with CVD of child-bearing age and in the incidence of pregnancy among relatively older women. However, the impact of this phenomenon on MD has not been carefully investigated. METHODS This retrospective study compares the incidence and etiology of maternal deaths related to cardiovascular disease (MD-CVD) in Japan in 2010-2012 to that seen in 1991-1992. RESULTS Seven cases of MD-CVD were reported in 1991-1992, compared to 15 in 2010-2012. In 2010-2012, the causes included aortic dissection (n=5), peripartum cardiomyopathy (n=3), sudden adult/arrhythmic death syndrome (n=2), acute cardiomyopathy (n=2), pulmonary hypertension (n=2), and myocardial infarction (n=1), and four of these causes were not encountered in 1991-1992. The incidence of MD over the total number of pregnancies decreased from 9.4 per 100,000 cases in 1990-1992 to 4.6 per 100,000 cases in 2010-2012 (p<0.05). However, the incidence of MD-CVD over the number of cases of MD increased from 2.9% in 1991-1992 to 9.7% in 2010-2012 (p<0.05). CONCLUSIONS The present study demonstrates that the rate of MD-CVD among the cases of MD has increased 3-fold in Japan over the past 20 years. Thus, it is of critical importance to better understand the etiologies and early signs of MD-CVD and to devise an effective management program for pregnancies complicated by CVD.
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Affiliation(s)
- Hiroaki Tanaka
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Mie, Japan.
| | - Shinji Katsuragi
- Department of Obstetrics and Gynecology, Sakakibara Heart Institute, Tokyo, Japan
| | - Kazuhiro Osato
- Department of Obstetrics and Gynecology, Ise Red Cross Hospital, Mie, Japan
| | - Junichi Hasegawa
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Masahiko Nakata
- Department of Obstetrics and Gynecology, Toho University Omori Medical Center, Tokyo, Japan
| | - Takeshi Murakoshi
- Division of Perinatology, Maternal and Perinatal Care Center, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Jun Yoshimatsu
- Division of Maternal Fetal Medicine and Gynecology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Akihiko Sekizawa
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Naohiro Kanayama
- Department of Obstetrics and Gynecology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Isamu Ishiwata
- Ishiwata Obstetrics and Gynecology Hospital, Ibaraki, Japan
| | - Tomoaki Ikeda
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Mie, Japan
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The effect of concentrating obstetrics services in fewer hospitals on patient access: a simulation. Int J Health Geogr 2016; 15:4. [PMID: 26800889 PMCID: PMC4724143 DOI: 10.1186/s12942-016-0035-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 01/14/2016] [Indexed: 11/10/2022] Open
Abstract
Background In Japan, the number of obstetrics facilities has steadily decreased and the selection and concentration of obstetrics facilities is progressing rapidly. Obstetrics services should be concentrated in fewer hospitals to improve quality of care and reduce the workload of obstetricians. However, the impact of this intensification of services on access to obstetrics hospitals is not known. We undertook a simulation to examine how the intensification of obstetrics services would affect access to hospitals based on a variety of scenarios, and the implications for health policy. Methods The female population aged between 15 and 49 living within a 30-min drive of an obstetrics hospital was calculated using a Geographic Information System for three possible intensification scenarios: Scenario 1 retained facilities with a higher volume of deliveries without considering the geographic boundaries of Medical Service Areas (MSAs, zones of healthcare administration and management); Scenario 2 prioritized retaining at least one hospital in each MSA and then retained higher delivery volume institutions, while Scenario 3 retained facilities to maximize population coverage using location-allocation modeling. We also assessed the impact of concentrating services in academic hospitals and specialist perinatal medical centers (PMCs) alone. Results In 2011, 95.0 % of women aged 15–49 years lived within a 30-min drive of one of 1075 obstetrics hospitals. This would fall to 82.7 % if obstetrics services were intensified into academic hospitals and general and regional PMCs. If 55.0 % of institutions provided obstetrics services, the coverage would be 87.6 % in Scenario 1, whereas intensification based on access would achieve over 90.5 % coverage in Scenario 2 and 93.9 % in Scenario 3. Conclusions Intensification of obstetrics facilities impairs access, but a greater caseload and better staffing have the potential advantages of better clinical outcomes and reduced costs. It is essential to consult residents of hospital catchment areas when reorganizing clinical services; a simulation is a useful means of informing these important discussions.
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Hirose N, Ohkuchi A, Baba Y, Usui R, Hirashima C, Watanabe T, Matsubara S. Mismatch between estimated blood loss and shock index in transferred women with postpartum hemorrhage. HYPERTENSION RESEARCH IN PREGNANCY 2016. [DOI: 10.14390/jsshp.hrp2015-014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Noriko Hirose
- Department of Obstetrics and Gynecology, Jichi Medical University School of Medicine
| | - Akihide Ohkuchi
- Department of Obstetrics and Gynecology, Jichi Medical University School of Medicine
| | - Yosuke Baba
- Department of Obstetrics and Gynecology, Jichi Medical University School of Medicine
| | - Rie Usui
- Department of Obstetrics and Gynecology, Jichi Medical University School of Medicine
| | - Chikako Hirashima
- Department of Obstetrics and Gynecology, Jichi Medical University School of Medicine
| | - Takashi Watanabe
- Department of Obstetrics and Gynecology, Jichi Medical University School of Medicine
| | - Shigeki Matsubara
- Department of Obstetrics and Gynecology, Jichi Medical University School of Medicine
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The Importance of the Monitoring of Resuscitation with Blood Transfusion for Uterine Inversion in Obstetrical Hemorrhage. Obstet Gynecol Int 2015; 2015:269156. [PMID: 26491450 PMCID: PMC4605367 DOI: 10.1155/2015/269156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Revised: 09/14/2015] [Accepted: 09/17/2015] [Indexed: 11/20/2022] Open
Abstract
Objective. The aim of this study was to describe critical care for obstetrical hemorrhage, especially in cases of uterine inversion. Study Design. We extracted data for six patients diagnosed with uterine inversion concerning resuscitation. Results. The shock index on admission of the six patients was 1.6 or more on admission. Four of the six experienced delay in diagnosis and received inadequate fluid replacement. Five of the six experienced delay in transfer. Five of the six underwent simultaneous blood transfusion on admission, and the remaining patient experienced a delay of 30 minutes. All six patients successfully underwent uterine replacement soon after admission. One maternal death occurred due to inappropriate practices that included delay in diagnosis, delay in transfer, inadequate fluid replacement, and delayed transfusion. Two patients experiencing inappropriate practices involving delay in diagnosis, delay in transfer, and inadequate fluid replacement survived. Conclusion. If a delay in diagnosis occurs simultaneously with a delay in transfer and inadequate fluid replacement, failure in providing a prompt blood transfusion may be critical and result in maternal death. The monitoring of resuscitation with blood transfusion for uterine inversion is essential for the improvement of obstetrical care.
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Nagayama S, Ohkuchi A, Shirasuna K, Takahashi K, Suzuki H, Hirashima C, Sakata A, Nishimura S, Takahashi M, Matsubara S. The Frequency of Peripheral Blood CD4 +FoxP3 + Regulatory T Cells in Women With Pre-eclampsia and Those With High-risk Factors for Pre-eclampsia. Hypertens Pregnancy 2015; 34:443-455. [PMID: 26362262 DOI: 10.3109/10641955.2015.1065884] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE We compared the frequency of peripheral blood Treg cells in women with pre-eclampsia (PE) and in those without, and investigated whether the frequency of Treg cells in women with high-risk factor for PE changed during pregnancy. METHODS We examined the frequency of CD4+FoxP3+ Treg cells in the peripheral blood using flow cytometry. Eleven women with PE and 10 women without PE (controls) were included. Every control had any risk factors for PE, such as high blood pressure, bilateral notching or a past history of PE or gestational hypertension. Blood sampling was conducted 1-3 times in the controls. RESULTS No significant differences were observed in the frequency of Treg cells between women with PE and the controls [mean ± SE (%): 5.74 ± 0.91 versus 5.48 ± 0.94, p = 0.843]. In five controls with serial sampling, the frequency of Treg cells significantly decreased from 5.83 ± 1.20 to 2.99 ± 0.54 (p = 0.046) (week of the first sampling to that of the last sampling [mean ± SD]: 21.5 ± 1.6 weeks to 31.2 ± 2.5 weeks). CONCLUSION The frequency of Treg cells in women with PE was almost identical to that in the controls. The frequency of Treg cells in the controls was reduced by half from the second trimester to the third trimester. These results suggested that the levels of Treg cells in a high-risk pregnant cohort were decreased to those in women with PE in the third trimester irrespective of the occurrence of PE.
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Affiliation(s)
- Shiho Nagayama
- a Department of Obstetrics and Gynecology , Jichi Medical University School of Medicine , Tochigi , Japan
| | - Akihide Ohkuchi
- a Department of Obstetrics and Gynecology , Jichi Medical University School of Medicine , Tochigi , Japan
| | - Koumei Shirasuna
- b Division of Inflammation Research , Center for Molecular Medicine, Jichi Medical University, Shimotsuke , Tochigi , Japan .,c Laboratory of Animal Reproduction, Department of Agriculture , Tokyo University of Agriculture , Atsugi , Kanagawa , Japan , and
| | - Kayo Takahashi
- a Department of Obstetrics and Gynecology , Jichi Medical University School of Medicine , Tochigi , Japan
| | - Hirotada Suzuki
- a Department of Obstetrics and Gynecology , Jichi Medical University School of Medicine , Tochigi , Japan
| | - Chikako Hirashima
- a Department of Obstetrics and Gynecology , Jichi Medical University School of Medicine , Tochigi , Japan
| | - Asuka Sakata
- d Division of Cell and Molecular Medicine, Center for Molecular Medicine , Jichi Medical University , Tochigi , Japan
| | - Satoshi Nishimura
- d Division of Cell and Molecular Medicine, Center for Molecular Medicine , Jichi Medical University , Tochigi , Japan
| | - Masafumi Takahashi
- b Division of Inflammation Research , Center for Molecular Medicine, Jichi Medical University, Shimotsuke , Tochigi , Japan
| | - Shigeki Matsubara
- a Department of Obstetrics and Gynecology , Jichi Medical University School of Medicine , Tochigi , Japan
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Tanaka H, Katsuragi S, Osato K, Hasegawa J, Nakata M, Murakoshi T, Yoshimatsu J, Sekizawa A, Kanayama N, Ishiwata I, Ikeda T. Increase in maternal death-related venous thromboembolism during pregnancy in Japan (2010-2013). Circ J 2015; 79:1357-62. [PMID: 25766273 DOI: 10.1253/circj.cj-14-1228] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The aim of the present work was to understand the current circumstances of maternal-death-related venous thromboembolism (MD-VTE) in Japan. We retrospectively investigated the characteristics of cases of MD-VTE, and compared past and present rates of occurrence. METHODS AND RESULTS We examined the Japanese data for MD-VTE in 2010-2013, and compared it with that from 1991-1992. MD-VTE occurred in 17 women in 1991-1992, and in 13 women in 2010-2013. The maternal mortality ratio of MD-VTE was 0.7 per 100,000 in 1991-1992 and 0.4 per 100,000 in 2010-2013. Both the maternal mortality ratio and rate of MD-VTE in 2010-2013 deceased significantly compared with 1991-1992 (P<0.05). However, the number of cases of MD-VTE during pregnancy was 6 among 13 women (41%) in 2010-2013, but 1 in 17 women (6%) in 1991-1992, showing an increase (P<0.05). In the present study, cesarean delivery was more frequently associated with MD-VTE. CONCLUSIONS MD-VTE overall has decreased within the past 20 years in Japan. But, MD-VTE during pregnancy in 2010-2013 increased relative to 1991-1992. Future guidelines for prevention of VTE may need to extend beyond the perioperative period to decrease the incidence of MD-VTE.
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Affiliation(s)
- Hiroaki Tanaka
- Department of Obstetrics and Gynecology, Mie University School of Medicine
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Farzianpour F, Foroushani AR, Changizi N, Ramezani K. Assessing Demographic Factors Related to Maternal Mortality in Tehran Province, Iran from 2008 to 2011. Health (London) 2015. [DOI: 10.4236/health.2015.73035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Ohkuchi A, Hirashima C, Takahashi K, Shirasuna K, Suzuki H, Ariga H, Kobayashi M, Hirose N, Matsubara S, Suzuki M. A trio of risk factors for the onset of preeclampsia in the second and early third trimesters. Pregnancy Hypertens 2014; 4:224-30. [DOI: 10.1016/j.preghy.2014.04.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Revised: 03/10/2014] [Accepted: 04/06/2014] [Indexed: 11/28/2022]
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Yoshimatsu J, Ikeda T, Katsuragi S, Minematsu K, Toyoda K, Nagatsuka K, Naritomi H, Miyamoto S, Iihara K, Yamamoto H, Ohno Y. Factors contributing to mortality and morbidity in pregnancy-associated intracerebral hemorrhage in Japan. J Obstet Gynaecol Res 2014; 40:1267-73. [DOI: 10.1111/jog.12336] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Accepted: 10/25/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Jun Yoshimatsu
- Department of Perinatology and Gynecology; National Cerebral and Cardiovascular Center; Osaka Japan
| | - Tomoaki Ikeda
- Department of Obstetrics and Gynecology; Mie University; Osaka Japan
| | - Shinji Katsuragi
- Department of Obstetrics and Gynecology; Sakakibara Heart Institute; Tokyo Japan
| | - Kazuo Minematsu
- Department of Cerebrovascular Medicine; National Cerebral and Cardiovascular Center; Suita Japan
| | - Kazunori Toyoda
- Department of Cerebrovascular Medicine; National Cerebral and Cardiovascular Center; Suita Japan
| | - Kazuyuki Nagatsuka
- Department of Neurology; National Cerebral and Cardiovascular Center; Suita Japan
| | - Hiroaki Naritomi
- Department of Neurology; National Cerebral and Cardiovascular Center; Suita Japan
| | - Susumu Miyamoto
- Department of Neurosurgery; National Cerebral and Cardiovascular Center; Suita Japan
| | - Koji Iihara
- Department of Neurosurgery; National Cerebral and Cardiovascular Center; Suita Japan
| | - Haruko Yamamoto
- Advanced Medical Technology Development; National Cerebral and Cardiovascular Center; Suita Japan
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A novel three-step approach for predicting the imminent onset of preeclampsia within 4 weeks after blood sampling at 19–31 weeks of gestation. Hypertens Res 2014; 37:519-25. [DOI: 10.1038/hr.2014.31] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Revised: 10/20/2013] [Accepted: 10/23/2013] [Indexed: 11/08/2022]
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Yoshida A, Saito K, Ishii K, Azuma I, Sasa H, Furuya K. Assessment of noninvasive, percutaneous hemoglobin measurement in pregnant and early postpartum women. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2014; 7:11-6. [PMID: 24470779 PMCID: PMC3896274 DOI: 10.2147/mder.s54696] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Using the Pronto-7® analyzer, we measured percutaneous hemoglobin (SpHb) noninvasively in pregnant and early postpartum women, and assessed the accuracy of the measurements by comparing them with laboratory measurements of hemoglobin. METHODS We obtained SpHb measurements from 193 pregnant women, 269 early postpartum women, and 76 nonpregnant women. A laboratory total hemoglobin (tHb) measurement, from venous blood sampling, was obtained immediately prior to the SpHb measurement. The total number of measurements obtained from the nonpregnant, pregnant, and postpartum women was 76, 438, and 347, respectively. RESULTS The mean biases (SpHb - tHb) among the nonpregnant, first trimester, second trimester, third trimester, and early postpartum women were -0.20, 0.19, 1.01, 1.32, and 1.10 g/dL, respectively. The Bland-Altman comparison showed neither the tendency of a fixed bias nor proportional biases among the measurements in the category of nonpregnant and first trimester women. But in the second and third trimester and postpartum category, a significant fixed bias was noted, without any tendencies of proportional bias. CONCLUSION In this study, we found higher hemoglobin values with the Pronto-7 analyzer than were measured in the laboratory. We consider that the device has certain limitations in obstetrical utility and requires further modifications for use in the perinatal period.
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Affiliation(s)
- Atsushi Yoshida
- Department of Obstetrics and Gynecology, National Defense Medical College, Tokorozawa, Japan
| | - Keiko Saito
- Department of Obstetrics and Gynecology, Nishisaitama-Chuo National Hospital, Tokorozawa, Japan
| | - Kenji Ishii
- Department of Obstetrics and Gynecology, Nishisaitama-Chuo National Hospital, Tokorozawa, Japan
| | - Isao Azuma
- Department of Obstetrics and Gynecology, Nishisaitama-Chuo National Hospital, Tokorozawa, Japan
| | - Hidenori Sasa
- Department of Obstetrics and Gynecology, National Defense Medical College, Tokorozawa, Japan
| | - Kenichi Furuya
- Department of Obstetrics and Gynecology, National Defense Medical College, Tokorozawa, Japan
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Morikawa M, Yamada T, Cho K, Yamada T, Sato S, Minakami H. Prospective risk of abruptio placentae. J Obstet Gynaecol Res 2013; 40:369-74. [PMID: 24245905 DOI: 10.1111/jog.12175] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Accepted: 05/03/2013] [Indexed: 11/29/2022]
Abstract
AIM The aim of this study was to better characterize the nature of abruptio placentae (AP) with regard to the timing of onset. MATERIAL AND METHODS Prevalence and prospective risk of AP according to gestational week (GW) were determined among 293,899 women who gave birth to singleton infants at and after GW 30. The prospective risk of AP at gestational week N was defined as the number of all women who experienced an AP at ≥GW N divided by the number of all women who gave birth at ≥GW N. RESULTS AP developed in 2649 (0.90%) women. The prevalence of AP (6.7% among women who gave birth at GW 30-33) sharply decreased with advancing GW at delivery to 0.9% for GW 37 and 0.1% for ≥GW 42. The highest prospective risk of AP, 9 per 1000 women at GW 30, decreased linearly with advancing gestation to 1 per 1000 women at ≥GW 42. AP accounted for 4.7% (1591/33,725) of all preterm births at GW <37, while prevalence of AP was 0.41% (1058/260,174) among term births. Preterm AP accounted for 60.1% (1591/2649) of all AP. CONCLUSION Our figures indicate that AP is more common in preterm births than in term birth and may be helpful for better understanding the epidemiology of this condition.
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Affiliation(s)
- Mamoru Morikawa
- Department of Obstetrics, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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Onset threshold of the plasma levels of soluble fms-like tyrosine kinase 1/placental growth factor ratio for predicting the imminent onset of preeclampsia within 4 weeks after blood sampling at 19–31 weeks of gestation. Hypertens Res 2013; 36:1073-80. [DOI: 10.1038/hr.2013.95] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2013] [Revised: 04/19/2013] [Accepted: 05/19/2013] [Indexed: 11/08/2022]
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Abstract
Obstetrical critical care has not been able to achieve the same level of peaks in developing nations like India, as in the western countries. Numerous factors, including clinical and economical, have played a major role in widening the gap of quality care delivery in severely ill obstetric patients, between the two extreme worlds. Moreover, this wide gap can be, to a large extent, attributable to the lower literacy rates, paucity of research in obstetrical critical care, poverty, lack of awareness, and the sociocultural and behavioral factors prevalent in these developing nations. The most common indication for Intensive Care Unit (ICU) admission of such patients throughout the world is hemorrhage, both antepartum and postpartum. Hypertensive disorders, pre-eclampsia, and its related complications are also major contributory factors for such admissions. The pattern of the disease necessitating such admissions influences maternal mortality to a great extent. The present article reviews the most common indications of obstetrical admissions to the ICU, the challenges and obstacles in the treatment of severely ill obstetric patients, their possible outcome in the developing nations, room for improvement, and the need for a change in the system for better delivery of critical care obstetrical services.
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Affiliation(s)
- Sukhwinder Kaur Bajwa
- Department of Obstetrics and Gynaecology, Gian Sagar Medical College and Hospital, Ram Nagar, Banur, Punjab, India
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The etiology of maternal mortality in developed countries: a systematic review of literature. Arch Gynecol Obstet 2012; 285:1499-503. [PMID: 22454216 DOI: 10.1007/s00404-012-2301-y] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Accepted: 03/14/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE To review the literature about MD in developed countries. METHODS A search in PubMed, EMBASE, Medline and reference lists was performed. Key words: maternal death/mortality, pregnancy death and obstetric/maternity care. Articles were selected if they reported the cause of death per livebirths, were performed in developed countries and unselected population, classified MD by the World Health Organization. Maternal age, cause of MD, time of MD (antepartum, intrapartum, postpartum) and delivery mode were abstracted. MD was expressed as maternal mortality ratio (MMR). PRISMA guidelines were followed. RESULTS Twelve articles provided data from 1980 to 2007. The MD rate was 9,750 in 75,560,683 livebirths (MMR: 12.90). MD was direct in 6,791 women (MMR: 8.98), being postpartum hemorrhage the leading cause, and indirect in 2,786 women (MMR: 3.68), with cardiovascular disease as the main cause. The remaining 173 deaths (MMR: 0.22) were unexplained. Maternal age >45 years, vaginal delivery, postpartum period increased the risk of MD. MD reduced over time in all countries except in the Netherlands and USA. CONCLUSIONS Conditions leading to hemorrhage warrant strict management. The risk of an apparently healthy woman to die during motherhood is 0.22 out of 100,000 livebirths.
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Yoshioka T, Yeo S, Fetters MD. Experiences with epidural anesthesia of Japanese women who had childbirth in the United States. J Anesth 2012; 26:326-33. [PMID: 22327144 DOI: 10.1007/s00540-012-1328-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2010] [Accepted: 01/06/2012] [Indexed: 11/26/2022]
Abstract
PURPOSE Cultural views are purported to be critical barriers to the use of epidural anesthesia during childbirth in Japan, even though it is not routinely available. We sought to understand the importance of the asserted cultural barriers for Japanese women living in Michigan in the United States where access to epidural anesthesia is routine. METHODS We used a mixed-methods approach including self-administered, cross-sectional mail surveys and semi-structured qualitative interviews. Participants were Japanese women who received prenatal care at the University of Michigan Japanese Family Health Program. RESULTS Of 78 participants in the mail survey, 63% used epidural anesthesia. Positive influences to have epidural anesthesia came from friends (58%), husbands (42%), and knowledge of the epidural anesthesia experiences of others (50%). Seventeen respondents participated in qualitative interviews. Most had learned little about epidural anesthesia while living in Japan, and some respondents had heard unsettling rumors. Many mentioned obtaining their first detailed knowledge about epidural anesthesia from friends in the United States, and expressed fear or concerns about the side effects of anesthesia. Thirteen out of fourteen interviewed participants who used or wanted epidural anesthesia expressed a desire to use it for the next childbirth. CONCLUSIONS While Japanese women in this United States setting considered previously reported cultural barriers to epidural anesthesia for birth pain, many chose to have it during their labor. This finding implicates limited access as a barrier at least as important as cultural barriers to epidural anesthesia use in Japan.
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Affiliation(s)
- Tetsuya Yoshioka
- Keiju General Hospital, Family Medicine Center, Ishikawa, Japan.
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Ohkuchi A, Hirashima C, Matsubara S, Takahashi K, Matsuda Y, Suzuki M. Threshold of soluble fms-like tyrosine kinase 1/placental growth factor ratio for the imminent onset of preeclampsia. Hypertension 2011; 58:859-66. [PMID: 21947468 DOI: 10.1161/hypertensionaha.111.174417] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
It has not been clarified whether thresholds of soluble fms-like tyrosine kinase 1 (sFlt-1), placental growth factor (PlGF), soluble endoglin, and the sFlt-1/PlGF ratio for the imminent onset of preeclampsia (PE) exist. We hypothesized that onset thresholds for the imminent onset of PE could be determined by the distributions of these 4 markers just after the onset of PE. Study subjects were 51 PE after the onset of PE; 36 of PE, 20 of gestational hypertension, 142 of a small-for-gestational-age infant, and 400 of normal pregnant controls at 19 to 25 and 27 to 31 weeks of gestation in a prospective cohort study. The current data supported our hypothesis that onset thresholds of sFlt-1 and the sFlt-1/PlGF ratio exist. The onset thresholds of the sFlt-1/PlGF at 26 to 31 weeks of gestation were useful for detecting imminent PE with the onset at <36 weeks of gestation, showing sensitivity of 0.36 and a positive likelihood ratio and 95th percent CIs of 38 (11-132); when positive, PE occurred at 2.2±0.6 weeks (range: 1.4-3.0 weeks) after the measurement of the sFlt-1/PlGF ratio. The combination of sFlt-1 at 26 to 31 weeks of gestation, past history of gestational hypertension or PE, prepregnancy body mass index, and mean blood pressure at 16 to 23 weeks of gestation was useful for detecting PE with onset of <36 weeks of gestation, showing sensitivity of 0.82, and a positive likelihood ratio (95% CI) of 42 (20-88). In conclusion, the onset threshold of sFlt-1/PlGF existed and might be useful for detecting the imminent onset of PE.
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Affiliation(s)
- Akihide Ohkuchi
- Department of Obstetrics and Gynecology, Jichi Medical University School of Medicine, Tochigi 329-0498, Japan.
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Liang J, Dai L, Zhu J, Li X, Zeng W, Wang H, Li Q, Li M, Zhou R, Wang Y. Preventable maternal mortality: geographic/rural-urban differences and associated factors from the population-based Maternal Mortality Surveillance System in China. BMC Public Health 2011; 11:243. [PMID: 21501529 PMCID: PMC3108316 DOI: 10.1186/1471-2458-11-243] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2010] [Accepted: 04/19/2011] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Most maternal deaths in developing countries can be prevented. China is among the 13 countries with the most maternal deaths; however, there has been a marked decrease in the maternal mortality ratio (MMR) over the last 3 decades. China's reduction in the MMR has contributed significantly to the global decline of the MMR. This study examined the geographic and rural-urban differences, time trends and related factors in preventable maternal deaths in China during 1996-2005, with the aim of providing reliable evidence for effective interventions. METHODS Data were retrieved from the population-based maternal mortality surveillance system in China. Each death was reviewed by three committees to determine whether it was avoidable. The preventable maternal mortality ratio (PMMR), the ratios of PMMR (risk ratio, RR) and 95% confidence intervals (CI) were used to analyze regional disparities (coastal, inland and remote regions) and rural-urban variations. Time trends in the MMR, along with underlying causes and associated factors of death, were also analysed. RESULTS Overall, 86.1% of maternal mortality was preventable. The RR of preventable maternal mortality adjusted by region was 2.79 (95% CI 2.42-3.21) and 2.38 (95% CI: 2.01-2.81) in rural areas compared to urban areas during the 1996-2000 and 2001-2005 periods, respectively. Meanwhile, the RR was the highest in remote areas, which was 4.80(95%CI: 4.10-5.61) and 4.74(95%CI: 3.86-5.83) times as much as that of coastal areas. Obstetric haemorrhage accounted for over 50% of preventable deaths during the 2001-2005 period. Insufficient information about pregnancy among women in remote areas and out-of-date knowledge and skills of health professionals and substandard obstetric services in coastal regions were the factors frequently associated with MMR. CONCLUSIONS Preventable maternal mortality and the distribution of its associated factors in China revealed obvious regional differences. The PMMR was higher in underdeveloped regions. In future interventions in remote and inland areas, more emphasis should be placed on improving women's ability to utilize healthcare services, enhancing the service capability of health institutions, and increasing the accessibility of obstetric services. These approaches will effectively lower PMMR in those regions and narrow the gap among the different regions.
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Affiliation(s)
- Juan Liang
- National Office for Maternal and Child Health Surveillance, West China Second University Hospital, Sichuan University, No 17, section 3, Ren Min Nan Lu, Chengdu, Sichuan, China
| | - Li Dai
- National Center for Birth Defects Monitoring, West China Second University Hospital, Sichuan University, No 17, section 3, Ren Min Nan Lu, Chengdu, Sichuan, China
| | - Jun Zhu
- National Center for Birth Defects Monitoring, West China Second University Hospital, Sichuan University, No 17, section 3, Ren Min Nan Lu, Chengdu, Sichuan, China
| | - Xiaohong Li
- National Center for Birth Defects Monitoring, West China Second University Hospital, Sichuan University, No 17, section 3, Ren Min Nan Lu, Chengdu, Sichuan, China
| | - Weiyue Zeng
- Obstetric and Gynecologic Department, West China Second University Hospital, Sichuan University, No 17, section 3, Ren Min Nan Lu, Chengdu, Sichuan, China
| | - He Wang
- Obstetric and Gynecologic Department, West China Second University Hospital, Sichuan University, No 17, section 3, Ren Min Nan Lu, Chengdu, Sichuan, China
| | - Qi Li
- National Office for Maternal and Child Health Surveillance, West China Second University Hospital, Sichuan University, No 17, section 3, Ren Min Nan Lu, Chengdu, Sichuan, China
| | - Mingrong Li
- National Office for Maternal and Child Health Surveillance, West China Second University Hospital, Sichuan University, No 17, section 3, Ren Min Nan Lu, Chengdu, Sichuan, China
| | - Rong Zhou
- Obstetric and Gynecologic Department, West China Second University Hospital, Sichuan University, No 17, section 3, Ren Min Nan Lu, Chengdu, Sichuan, China
| | - Yanping Wang
- National Office for Maternal and Child Health Surveillance, West China Second University Hospital, Sichuan University, No 17, section 3, Ren Min Nan Lu, Chengdu, Sichuan, China
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Pronovost PJ, Lilford R. A Road Map For Improving The Performance Of Performance Measures. Health Aff (Millwood) 2011; 30:569-73. [DOI: 10.1377/hlthaff.2011.0049] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Peter J. Pronovost
- Peter J. Pronovost is a professor of anesthesiology and critical care medicine, surgery, and health policy and management at the Johns Hopkins University, in Baltimore, Maryland. He is also the director of the Quality and Safety Research Group and the director of Adult Critical Care Medicine
| | - Richard Lilford
- Richard Lilford is a professor of clinical epidemiology at the University of Birmingham, in England. He is vice dean for applied health research and director of the Birmingham Clinical Research Academy
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Irita K. Risk and crisis management in intraoperative hemorrhage: Human factors in hemorrhagic critical events. Korean J Anesthesiol 2011; 60:151-60. [PMID: 21490815 PMCID: PMC3071477 DOI: 10.4097/kjae.2011.60.3.151] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2010] [Revised: 09/27/2010] [Accepted: 09/27/2010] [Indexed: 12/11/2022] Open
Abstract
Hemorrhage is the major cause of cardiac arrest developing in the operating room. Many human factors including surgical procedures, transfusion practices, blood supply, and anesthetic management are involved in the process that leads to hemorrhage developing into a critical situation. It is desirable for hospital transfusion committees to prepare hospital regulations on 'actions to be taken to manage critical hemorrhage', and practice the implementation of these regulations by simulated drills. If intraoperative hemorrhage seems to be critical, a state of emergency should immediately be declared to the operating room staff, the blood transfusion service staff, and blood bank staff in order to organize a systematic approach to the ongoing problem and keep all responsible staff working outside the operating room informed of events developing in the operating room. To rapidly deal with critical hemorrhage, not only cooperation between anesthesiologists and surgeons but also linkage of operating rooms with blood transfusion services and a blood bank are important. When time is short, cross-matching tests are omitted, and ABO-identical red blood cells are used. When supplies of ABO-identical red blood cells are not available, ABO-compatible, non-identical red blood cells are used. Because a systematic, not individual, approach is required to prevent and manage critical hemorrhage, whether a hospital can establish a procedure to deal with it or not depends on the overall capability of critical and crisis management of the hospital.
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Affiliation(s)
- Kazuo Irita
- Department of Anesthesiology and Critical Care Medicine, Kyushu University Hospital, Fukuoka, Japan
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Yamada T, Yamada T, Morikawa M, Takeda M, Akaishi R, Nishida R, Araki N, Koyama T, Minakami H. Do uterotrophic drugs increase the risk of fatal hemorrhagic brain stroke? J Perinat Med 2011; 39:23-6. [PMID: 20954850 DOI: 10.1515/jpm.2010.116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To evaluate whether uterotrophic agents increase the risk of fatal hemorrhagic brain stroke. METHODS Between 1991 and 1992, there were 230 maternal deaths among 2,420,000 pregnant women in Japan and the causes of these deaths was investigated in 1994. Using information provided in this report, we identified 35 women who died from or were assumed to die from hemorrhagic brain stroke. We assumed that 93% of women would have tried vaginal delivery. The risk of fatal hemorrhagic brain stroke after uterotrophic agent use was calculated according to the assumption that 5.0-40% of women received uterotrophic agents. RESULTS Use of uterotrophic agents for induction/augmentation of labor was confirmed in five (14.3%) of the 35 women who died from hemorrhagic brain stroke. The incidence of fatal brain stroke after the use of uterotrophic agents was only significantly higher than that for spontaneous hemorrhagic brain stroke if these agents were administered in ≤ 6.0% of women. CONCLUSIONS Because more than 6.0% of women received uterotrophic agents, these agents are unlikely to increase the risk of fatal hemorrhagic brain stroke.
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Affiliation(s)
- Takashi Yamada
- Department of Obstetrics, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
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Obstetric admissions to the intensive care unit in a tertiary referral hospital. J Crit Care 2010; 25:628-33. [PMID: 20381297 DOI: 10.1016/j.jcrc.2010.02.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2009] [Revised: 01/31/2010] [Accepted: 02/26/2010] [Indexed: 11/21/2022]
Abstract
PURPOSE The present study was conducted to evaluate the obstetric admissions to the intensive care unit (ICU) in the setting of a tertiary referral hospital in an attempt to identify the risk factors influencing maternal outcome. MATERIALS AND METHODS All of the obstetric patients who seeked care for delivery at the emergency department and who were admitted to the ICU between January 2006 to July 2009 were retrospectively identified. The Simplified Acute Physiology Score (SAPS II) was calculated and the maternal mortality rate was estimated for each patient. The mean SAPS II scores and the mean estimated maternal mortality rates for the surviving patients and the nonsurviving patients were compared. RESULTS Seventy-three obstetric patients were admitted to the ICU. There were 9 maternal deaths and 24 fetal deaths. For the surviving group of patients, the mean SAPS II score was 34 and estimated maternal mortality rate was 20%, whereas for the nonsurviving group of patients, the SAPS II score was 64 and estimated maternal mortality rate was 73%. The difference between the surviving group of patients and the nonsurviving group of patients was statistically significant regarding both the mean SAPS II scores and the mean estimated maternal mortality rates. CONCLUSIONS Pregnancy-induced hypertensive disorders and hemorrhage appear as the major risk factors influencing maternal outcome in obstetric patients. Considering that the use of the SAPS II scores have enabled the reliable estimation of the mortality rates in the present study, the attempts at defining the focus of care for the obstetric patients who bear the major risk factors and who are admitted to the ICU should be carried out under the guidance of the ICU scoring systems such as the SAPS II.
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Koike S, Matsumoto S, Kodama T, Ide H, Yasunaga H, Imamura T. Estimation of physician supply by specialty and the distribution impact of increasing female physicians in Japan. BMC Health Serv Res 2009; 9:180. [PMID: 19811625 PMCID: PMC2761900 DOI: 10.1186/1472-6963-9-180] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2009] [Accepted: 10/07/2009] [Indexed: 11/13/2022] Open
Abstract
Background Japan has experienced two large changes which affect the supply and distribution of physicians. They are increases in medical school enrollment capacity and in the proportion of female physicians. The purpose of this study is to estimate the future supply of physicians by specialty and to predict the associated impact of increased female physicians, as well as to discuss the possible policy implications. Methods Based on data from the 2004 and 2006 National Survey of Physicians, Dentists and Pharmacists, we estimated the future supply of physicians by specialty, using multistate life tables. Based on possible scenarios of the future increase in female physicians, we also estimated the supply of physicians by specialty. Results Even if Japan's current medical school enrollment capacity is maintained in subsequent years, the number of physicians per 1000 population is expected to increase from 2.2 in 2006 to 3.2 in 2036, which is a 46% increase from the current level. The numbers of obstetrician/gynecologists (OB/GYNs) and surgeons are expected to temporarily decline from their current level, whereas the number of OB/GYNs per 1000 births will still increase because of the declining number of births. The number of surgeons per 1000 population, even with the decreasing population, will decline temporarily over the next few years. If the percentage of female physicians continues to increase, the overall number of physicians will not be significantly affected, but in specialties with current very low female physician participation rates, such as surgery, the total number of physicians is expected to decline significantly. Conclusion At the current medical school enrollment capacity, the number of physicians per population is expected to continue to increase because of the skewed age distribution of physicians and the declining population in Japan. However, with changes in young physicians' choices of medical specialties and as the percentage of female physicians increases, patterns of physician supply will vary between specialties. Specialties less often chosen by young physicians and where males have dominated will face a decline in physician supply. These results highlight the necessity for developing a work environment that attracts female physicians to these types of specialties. This will also lead to improved gender equality in the workforce and more effective use of human resources.
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Affiliation(s)
- Soichi Koike
- Department of Planning, Information and Management, University of Tokyo Hospital, Tokyo, Japan.
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Suzuki H, Ohkuchi A, Matsubara S, Takei Y, Murakami M, Shibuya M, Suzuki M, Sato Y. Effect of recombinant placental growth factor 2 on hypertension induced by full-length mouse soluble fms-like tyrosine kinase 1 adenoviral vector in pregnant mice. Hypertension 2009; 54:1129-35. [PMID: 19786649 DOI: 10.1161/hypertensionaha.109.134668] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The first aim of our study was to develop a pregnant mouse model for preeclampsia using adenoviral vector containing mouse full-length soluble fms-like tyrosine kinase 1 (sFlt-1) but not truncated sFlt-1. The second aim was to evaluate effects of recombinant mouse (rm) vascular endothelial growth factor (VEGF) and rm placental growth factor (PlGF) on a preeclampsia model induced by adenoviral vector containing mouse full-length sFlt-1. We injected adenoviral vector containing mouse full-length sFlt-1 on day 8.5 or 9.5 of gestation into pregnant Institute of Cancer Research mice, resulting in hypertension, proteinuria, and similar glomerular histological changes as those seen in human preeclamptic women with glomerular endotheliosis on day 16.5 or 17.5 of gestation. The preeclampsia models were treated with 100 microg/kg of rmVEGF164 (n=5), 100 microg/kg of rmPlGF-2 (n=5), or vehicle (n=7) twice a day for 2 days IP. The rmVEGF164 treatment significantly decreased the mean blood pressure on day 16.5 or 17.5 of gestation compared with the vehicle treatment (85+/-4 versus 97+/-2 mm Hg; P=0.018). The rmPlGF-2 treatment also significantly decreased the mean blood pressure on day 16.5 or 17.5 of gestation compared with the vehicle treatment (86+/-3 versus 97+/-2 mm Hg; P=0.018). However, proteinuria was not affected by either rmVEGF164 or rmPlGF-2. In conclusion, we, for the first time, created a mouse preeclampsia model using mouse full-length sFlt-1. VEGF and PlGF may be promising for ameliorating hypertension in women with preeclampsia. Additional study of PlGF as a potential drug for preeclampsia is warranted.
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Affiliation(s)
- Hirotada Suzuki
- Department of Obstetrics and Gynecology, Jichi Medical University School of Medicine, Tochigi, Japan
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Drife J. Maternal mortality in well-resourced countries: is there still a need for confidential enquiries? Best Pract Res Clin Obstet Gynaecol 2008; 22:501-15. [DOI: 10.1016/j.bpobgyn.2007.10.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Has R, Topuz S, Kalelioglu I, Tagrikulu D. Imaging features of postpartum uterine rupture: a case report. ACTA ACUST UNITED AC 2008; 33:101-3. [PMID: 17435984 DOI: 10.1007/s00261-007-9206-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
We present a case report on a postpartum uterine rupture with the history of a previous cesarean section. During the diagnosis of rupture, ultrasound, computerized tomography (CT) and magnetic resonance imaging of the uterus were obtained. Ultrasound examination did not result in substantial information. CT and magnetic resonance imaging established the correct diagnosis. The patient underwent exploratory laparotomy, and the diagnosis was confirmed. Diagnostic qualifications of these three instruments were compared.
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Affiliation(s)
- Recep Has
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Istanbul, Istanbul, Turkey
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