<em>Background:</em> The diagnosis of placental abruption is primarily clinical, but findings from imaging, laboratory, and postpartum pathologic studies can be used to support the clinical diagnosis. In p...<em>Background:</em> The diagnosis of placental abruption is primarily clinical, but findings from imaging, laboratory, and postpartum pathologic studies can be used to support the clinical diagnosis. In patients with classic symptoms, fetal heart rate abnormalities, intrauterine fetal demise, and/or disseminated intravascular coagulation strongly support the clinical diagnosis and indicate extensive placental separation. In a few cases, placental separation has not been recognized and was only identified upon cesarean section as an incidental finding. <em>Objectives: </em>To describe the clinical presentations and pregnancy outcomes of placental abruption cases that are not diagnosed before cesarean delivery, termed “unpredictable placental abruption” and also cases diagnosed before cesarean delivery, termed “predictable placental abruption”.<em> Methods: </em>A retrospective analysis of 100 cases of placental abruption was identified by cesarean delivery at Tu Du hospital from September 2018 to May 2019. Clinical variables were compared between the unpredictable and predictable groups. The unpredictable group consists of cases that are not diagnosed before cesarean delivery, while the predictable cases were identified placental separation before cesarean delivery. The maternal and fetal outcomes were also studied. <em>Results:</em> In 100 cases of placental, abruption by gross clinical examination of the placenta at the time operation revealed that, 33% were unpredictable. Placental abruption attributed to maternal complications included one case of total hysterectomy (1%) with no cases of disseminated intravascular coagulation (DIC), shock or maternal death;specifically, this case of total hysterectomy appeared with predictable one. There were two cases of stillbirths. Among the 98 live neonates, 15 cases (14.7%) experienced severe birth asphyxia resulting in eight neonatal deaths;two of which were caused by heart disease and necrotizing enterocolitis. Sixty-three neonates were delivered prematurely (61.74%), with mean gestational age of 34.64 <span style="white-space:nowrap;">±</span> 3.32 weeks. Among the 33 unpredictable cases, there were no stillbirths but 60.6% and 12.1% experienced moderate and severe asphyxia, respectively. All unpredictable cases had obvious indications of cesarean section but the basic symptoms and signs of acute placental abruption included the onset of preterm labor, unspecified intrapartum hemorrhage, hypertonic uterine contractions and fetal distress for emergency caesarian section;however there were also cases where there were no symptoms and signs.<em> Conclusions: </em>Unpredictable placental abruption cases—not suspected of having abruption, termed—“concealed” or “chronic” placental abruption, may have variable clinical manifestations and better pregnancy outcomes.展开更多
Placental abruption(also termed accidental haemorrhage) refers to the separation of a normally sited placenta from the uterine wall resulting in maternal haemorrhage into the interventing space. If this space communic...Placental abruption(also termed accidental haemorrhage) refers to the separation of a normally sited placenta from the uterine wall resulting in maternal haemorrhage into the interventing space. If this space communicates with the external os of the cervix, the haemorrhage will be revealed. If not,the haemorrhage may result in delay in diagnosis, and underestimation of blood loss,which in turn increases the likelihood of coagulopathy and maternal morbidity. In the presence of massive abruption, blood tracks under pressure back into the myometrium, and may be visible beneath the uterine serosa at caesarean section. This appearance is referred to as a ’Couvelaire uterus’. Fetal bleeding can occur with placental abruption , though it is rare. It can be detected by a Kleihauer test which detects fetal haemoglobin in the maternal circulation and can be a clue to retroplacental bleeding in cases of trauma.展开更多
During human pregnancy, progesterone induced decidual cells protect against hemorrhage: 1) as endovascular trophoblast breech and remodel uterine blood vessels;and 2) in the third stage of labor following preterm and ...During human pregnancy, progesterone induced decidual cells protect against hemorrhage: 1) as endovascular trophoblast breech and remodel uterine blood vessels;and 2) in the third stage of labor following preterm and term delivery. De- cidual cells promote hemostasis through enhanced expression of tissue factor (TF), the primary initiator of hemostasis via thrombin generation, and plasminogen activator inhibitor-1, which inactivates tissue type plasminogen activator, the primary fibrinolytic agent. Abruptions (decidual hemorrhage) produce excess thrombin which acts as autocrine/paracrine inducer of decidual cell expressed matrix metalloproteinases and of neutrophil chemoattractant and activator, interleukin-8. The latter mediates aseptic abruption-related neutrophil infiltration. During abruptions, decidual cell and neutrophil-derived proteases effectively degrade the decidual and fetal membrane extracellular matrix to promote preterm premature rupture of the membranes and preterm delivery (PTD). Decidual cell-derived thrombin weakens the amniotic membrane and lowers decidual cell-expressed progesterone receptor levels by increasing phospho-ERK1/2 signaling. The resulting functional progesterone withdrawal accompanies PTD.展开更多
We consider that a low-frequency, sinusoidal rhythm detected by Electronic Fetal Monitoring (EFM) is a typical manifestation of a placental abruption. We present the case of a 26-year-old woman who was gestational 36 ...We consider that a low-frequency, sinusoidal rhythm detected by Electronic Fetal Monitoring (EFM) is a typical manifestation of a placental abruption. We present the case of a 26-year-old woman who was gestational 36 weeks. She had irregular contractions. The EFM showed a low-frequency, sinusoidal rhythm. The cycle of the sine curve increased in time from 90 seconds to 160 seconds gradually. A severely asphyxiated newborn was successfully resuscitated after an emergency Cesarean Section. The mother and child were discharged from our hospital in a good general condition seven days later. Upon examination it was proven that this was a case of a placental abruption. This is an original case study report about how to diagnose a placental abruption according to an EFM reading. We propose a definition of a low-frequency, sinusoidal rhythm having: 1) a stable baseline FHR (fetal heart rate) of 120 - 160 bpm;2) a possible variation of 20 - 30 bpm;3) a frequency of 90 - 160 seconds per cycle;4) fixed or flat short-term variability;5) oscillation of the sinusoidal wave from above and below a baseline;6) no areas of normal FHR variability or reactivity. What is more, the lengths of the fluctuation cycle and the greater the amplitude has a close relationship with the prognosis of both mother and child. This pre-partum, low-frequency, sinusoidal rhythm is an ominous sign of fetal jeopardy needing immediate intervention. The medical literature has never reported such an association. Therefore, our case study report is possibly the first to mention this observation.展开更多
Background: Snakebite envenomation in pregnancy is uncommon. It can lead to a poor outcome in both the mother and the fetus. We describe our approach to envenomation in pregnancy based on the currently available evide...Background: Snakebite envenomation in pregnancy is uncommon. It can lead to a poor outcome in both the mother and the fetus. We describe our approach to envenomation in pregnancy based on the currently available evidence. Case: We reported two case of snakebite in the third trimester of pregnancy having caused placental abruption with expelling a fresh still born baby and a live baby. In both cases, consumption coagulopathy occurred. managed by polyvalent anti-snake and blood transfusion. Their investigations became normal and they were discharged of hospitalization. Conclusion: Snakebite envenomation in pregnant is a maternal and fetal emergency. Treatment must be quick and well adapted.展开更多
Objective: To describe the epidemiological, clinical and prognostic factors and assess treatment of placental abruption in the obstetrics gynecology department of the Dakar Principal Hospital. Patients and Method: We ...Objective: To describe the epidemiological, clinical and prognostic factors and assess treatment of placental abruption in the obstetrics gynecology department of the Dakar Principal Hospital. Patients and Method: We carried out a retrospective observational study of 130 successive cases of placental abruption, which occurred from January 2015 to December 2017 at the Level 3 Maternity Unit of the Dakar Principal Hospital. Data were collected from non-computerized obstetric records and analyzed using Excel and Epi info software. Results: There were 130 cases of placental abruption, that is a prevalence of 1.5%. The average age of onset of placental abruption was 30 years. The history of hypertension concerned 32.3% of patients, the average gestational age of 32.5 weeks at the time of diagnosis, grade 3 of Sher was found in 48.5% of cases. The outcome of the pregnancy was a caesarean section in 79.2% of cases, the average weight of newborns was 2058 g. The management of the complications required a blood transfusion and intensive care. A haemostasis hysterectomy was performed in 6.2% of cases. Stillbirth rate was 53.7% and maternal mortality was zero. Discussion and Conclusion: Placental abruption, a severe complication of pregnancy, is associated with high perinatal morbidity and mortality linked to the severity of the clinical picture, despite an improved maternal prognosis.展开更多
In the context of climate change,the acceleration of the global water cycle has led to the emergence of abrupt transitions between drought and flood events,presenting a new challenge for flood and drought disaster mit...In the context of climate change,the acceleration of the global water cycle has led to the emergence of abrupt transitions between drought and flood events,presenting a new challenge for flood and drought disaster mitigation.Abrupt transitions between drought and flood refer to a phenomenon in which an extreme drought event quickly shifts to an extreme flood event,or vice versa,within a relatively short time span.This phenomenon disrupts the traditional spatiotemporal distribution patterns of water-related disasters,reflecting not only the extreme unevenness in the distribution of water resources but also the rapid alternation of the water cycle's evolution(He et al.,2016).Moreover,due to its suddenness,extremity,and complexity,it poses severe threats to human societies and ecosystems.Scientifically addressing abrupt transitions between drought and flood has thus become a new challenge in flood and drought disaster prevention.展开更多
Critical for metering and protection in electric railway traction power supply systems(TPSSs),the measurement performance of voltage transformers(VTs)must be timely and reliably monitored.This paper outlines a three-s...Critical for metering and protection in electric railway traction power supply systems(TPSSs),the measurement performance of voltage transformers(VTs)must be timely and reliably monitored.This paper outlines a three-step,RMS data only method for evaluating VTs in TPSSs.First,a kernel principal component analysis approach is used to diagnose the VT exhibiting significant measurement deviations over time,mitigating the influence of stochastic fluctuations in traction loads.Second,a back propagation neural network is employed to continuously estimate the measurement deviations of the targeted VT.Third,a trend analysis method is developed to assess the evolution of the measurement performance of VTs.Case studies conducted on field data from an operational TPSS demonstrate the effectiveness of the proposed method in detecting VTs with measurement deviations exceeding 1%relative to their original accuracy levels.Additionally,the method accurately tracks deviation trends,enabling the identification of potential early-stage faults in VTs and helping prevent significant economic losses in TPSS operations.展开更多
In the summer of 2024, following a strong El Ni?o event in the preceding winter, the tropical Indian Ocean and tropical North Atlantic recorded their highest SSTs since 1961, along with a significant westward shift an...In the summer of 2024, following a strong El Ni?o event in the preceding winter, the tropical Indian Ocean and tropical North Atlantic recorded their highest SSTs since 1961, along with a significant westward shift and intensification of the western Pacific subtropical high(WPSH). Under these conditions, China experienced its hottest summer since 1961,and was hit by a series of high-impact extreme weather and climate events. From 9 June to 2 July, southern China experienced an unprecedented extreme precipitation event that exceeded the well-known 1998 summer precipitation event in both duration and impact scope, resulting in devastating floods in the Yangtze River basin. Subsequently, in early to midJuly, the Huanghe-Huaihe Basin suffered from a severe drought–flood abrupt alternation event, heavily affecting Henan and Shandong. Meanwhile, southern China underwent a widespread heatwave event lasting 74 days, ranking as the second most intense since 1961. From late July to the end of August, northern China faced unusually frequent heavy precipitation events, with cumulative precipitation reaching the second highest for the same period since 1961, causing floods in many rivers of northern China. This study provides a timely summary and assessment of the characteristics and impacts of these extreme events. It serves as a reference for climate change research, including mechanism analysis, numerical simulation,and climate event attribution, and also offers valuable insights for improving meteorological disaster prevention and mitigation strategies.展开更多
Since the 21st century,the Huang–Huai–Hai River Basin(HHHRB)in China has experienced increased frequency and severity of drought–flood abrupt alternation(DFAA)events during early summer,characterized by droughts in...Since the 21st century,the Huang–Huai–Hai River Basin(HHHRB)in China has experienced increased frequency and severity of drought–flood abrupt alternation(DFAA)events during early summer,characterized by droughts in June followed by floods in July.The 2024 event was the most severe since 1981.This study demonstrates that such compound extreme events are closely linked to anomalous subseasonal evolution of large-scale atmospheric circulation.During the drought phase,the East Asian subtropical westerly jet(EAJ)shifts southward,and the western Pacific subtropical high(WPSH)exhibits anomalous strengthening with its western ridge line displaced southward.The flood phase is characterized by acceleration of the EAJ,westward extension of the WPSH,and enhanced southwestern moisture transport from the western Pacific.Beyond these typical features,the 2024 early summer circulation exhibited unique characteristics:Anomalous northeastward intensification of the WPSH facilitated merged moisture influx from both the Indian Ocean and the western Pacific along the southeast pathway into the HHHRB in July,resulting in the highest net moisture inflow at the southern boundary of the HHHRB since 1981.The synergistic effects of multiple factors primarily explain the exceptionally intense DFAA event in 2024.展开更多
It is an objective fact that the weather is unpredictable.Even the famous meteorologist,Academician Chu Ko Chen,has only a partial understanding of the changing laws of wind and rain.Even though ancient people summari...It is an objective fact that the weather is unpredictable.Even the famous meteorologist,Academician Chu Ko Chen,has only a partial understanding of the changing laws of wind and rain.Even though ancient people summarized the 24 solar terms by observing the annual activities of the sun for a long time,because they ignored the impact of the activities of the moon on the Earth’s climate change on a small scale,the 24 solar terms they summarized often could not accurately predict the change of the Earth’s climate.Therefore,the author studied the influence of lunar activities on the Earth’s climate change,finds out the law of the influence of lunar activities on the Earth’s climate change on a small scale,and summarizes the eternal climate change pattern determined by the activities of the sun and the moon.In addition,the author also reveals the causes and countermeasures of global warming and the frequent occurrence of extreme weather as well as environmental change.展开更多
Climate change is the phrase used to describe long-term changes in temperatures and weather patterns. Changes in the atmosphere and their interactions with diverse geologic, chemical, biological, and geographic variab...Climate change is the phrase used to describe long-term changes in temperatures and weather patterns. Changes in the atmosphere and their interactions with diverse geologic, chemical, biological, and geographic variables are the main contributors to this cyclical adjustment of the Earth’s climate. Such changes may be induced purposefully, because of burning fossil fuels, clearing forests, and raising animals, or they may be natural, brought on by significant volcanic eruptions or variations in the sun’s activity. By significantly increasing the amount of greenhouse gases already in the atmosphere, this heightens the greenhouse effect and contributes to global warming. This work includes several additional theoretical and practical explanations of sustainable development. The theoretical work encompasses hundreds of researches that identify requirements for how development routes might satisfy sustainable development (SD) criteria using economic theory, complex systems approach, ecological science, and other techniques. The agreements made by the Parties in various nations across the world will consider a wide range of perspectives about what would be considered undesirable effects on the environment, the climate system, sustainability, economic growth, or food production.展开更多
The effect of pruning severity on tree growth was analyzed by change point detection using segmented regression. The present study applied this analysis to a well-known published data set including diameter growth res...The effect of pruning severity on tree growth was analyzed by change point detection using segmented regression. The present study applied this analysis to a well-known published data set including diameter growth response, tree age, pruning severity and pretreatment crown size. First, multiple regression analysis was performed to assess the effect of tree age, pruning severity and pretreatment crown size on diameter growth response. Next, segmented regression analysis was performed to assess the effect of pruning severity on diameter growth response. The results of the multiple regression showed that diameter growth response was significantly influenced by pruning severity and pretreatment crown size. The results of the segmented regression showed that in the whole data set, an abrupt change toward a decrease in diameter growth response was detected at 25% of the live crown removed. However, in the group of fully crowned and open-grown, diameter growth response continuously decreased with increasing pruning severity with no significant abrupt change, whereas in the group of 70% - 90% live crown, diameter growth response did not significantly decrease up to the break point (53% crown removed) and then abruptly decreased. This may be the first study to show the numerical evaluation of the effect of pruning severity on tree growth by change point analysis.展开更多
Based on the monthly precipitation data from 43 stations in North China from 1979 to 2008,the variation characteristics of precipitation in North China in recent 30 years were analyzed by means of empirical orthogonal...Based on the monthly precipitation data from 43 stations in North China from 1979 to 2008,the variation characteristics of precipitation in North China in recent 30 years were analyzed by means of empirical orthogonal function(EOF)decomposition,Morlet wavelet transform and Mann-Kendall test.The results showed that the spatial distribution of annual and seasonal precipitation was basically identical in North China,while the annual and summer precipitation from the middle of 1980s to the middle of 1990s were obviously more than these in other periods,and there was great annual variation in spring precipitation in 1990s,while autumn precipitation was higher from 1980s to 1990s and then went down after the beginning of 21st century,which was opposite to winter precipitation,namely there was more winter precipitation from 1980s to 1990s and fewer winter precipitation after the beginning of 21st century.In addition,the annual and summer precipitation changed abruptly in 1997,and there was no obvious change in spring precipitation and autumn precipitation,while winter precipitation had an abrupt change in 2000.Meanwhile,wavelet analysis revealed that the variation period of annual and seasonal precipitation was 3-4 years.展开更多
Design: Retrospective analysis. Setting: East London Hospital. Subjects: 724 women who had maternal serum alphafetoprotein levels measured between 15 to 19 weeks gestation. Main outcome measure: The main outcome measu...Design: Retrospective analysis. Setting: East London Hospital. Subjects: 724 women who had maternal serum alphafetoprotein levels measured between 15 to 19 weeks gestation. Main outcome measure: The main outcome measures were defined as any case of preeclampsia, small-for-gestational age (SGA) birth- weight th centile, placental abruption, stillbirth or early neonatal death. Methods: Women with MSAFP > 2.0 Multiples of Median (MoM) were classified as screen positive. Results: 41 (5.7%) women developed preeclampsia. Women with MSAFP > 2.0 Multiples of the Median (MoM) were significantly more likely to develop preeclampsia (p th centile展开更多
[Objective] The change law and meteorological factor of sunshine duration in Dalian in recent 60 years were studied.[Method] Based on the statistical data of sunshine duration from base station in Dalian City from 195...[Objective] The change law and meteorological factor of sunshine duration in Dalian in recent 60 years were studied.[Method] Based on the statistical data of sunshine duration from base station in Dalian City from 1951 to 2009,the annual,seasonal,and monthly variation of sunshine duration in recent 60 years were analyzed,as well as its relationship with meteorological factors,and sunshine duration was detected by means of climate mutation theory.[Result] Annual sunshine duration in Dalian in recent 60 years showed decrease trend on the whole,and its climatic variation rate was-3.31 h/a,with larger annual variation,namely the difference between maximum value(1978) and minimum value(2003) reached 681 h;there was obvious seasonal variation in sunshine duration,with the order of autumn>summer>winter>spring,and their climatic variation rate were-1.18,-1.15,-0.91 and-0.62 h/a;except for March,sunshine duration in each month went down,especially October,while there was slight increase in March;sunshine percentage had inverse correlation relationship with total cloudiness,relative humidity and heavy fog days;annual sunshine duration reduced abruptly around 1983.[Conclusion] Our study could provide scientific foundation for the development of agriculture and forestry in Dalian City.展开更多
Thyroid hormones are critical for foetal neurological development and maternal health. Maternal hypothyroidism during pregnancy is associated with adverse impact on health of the mother as well as the progeny. Reduced...Thyroid hormones are critical for foetal neurological development and maternal health. Maternal hypothyroidism during pregnancy is associated with adverse impact on health of the mother as well as the progeny. Reduced thyroid hormone levels predispose the child to develop mental retardation and cognitive delay in early life. In the mother, hypothyroidism during pregnancy is associated with spontaneous abortion, placental abruption, preterm delivery and hypertensive disorders. Therefore, screening and therapeutic intervention is justified to prevent foetal as well as maternal co-morbidities. In view of impact of such a large-scale screening and intervention program on limited healthcare resources, it is debatable if a targeted rather than universal screening program will result in comparable outcomes. In addition, there is an ongoing debate regarding best evidence-based practice for the management of isolated hypothyroxinaemia, subclinical hypothyroidism and euthyroid women with autoimmune hypothyroidism. We have carried out a review of the literature; firstly, to determine whether universal screening for asymptomatic women in early pregnancy would be cost-effective. Secondly, we have retrospectively reviewed the literature to analyse the evidence regarding the impact of therapeutic intervention in women with subclinical hypothyroidism.展开更多
Two pregnant women who initially developed proteinuria alone followed by serious preeclampsia are presented to emphasize that there is no adequate technical term to express the period of proteinuria alone based on the...Two pregnant women who initially developed proteinuria alone followed by serious preeclampsia are presented to emphasize that there is no adequate technical term to express the period of proteinuria alone based on the current criteria of pregnancy-induced hypertension. Case 1 exhibited a urinary protein concentration of 46 mg/dL in the absence of hypertension, and abdominal pain due to placental abruption with hypertension at gestational week (GW) 29–3/7 and 29–4/7, respectively. Case 2 exhibited a urinary protein/creatinine ratio of 2.67, developed hypertension, required cesarean section, and developed posterior reversible encephalopathy syndrome at GW 28–1/7, 29–6/7, and 32–0/7, and on postpartum day 2, respectively. As women with proteinuria alone are not diagnosed as having preeclampsia and as a diagnosis of gestational proteinuria can be made only at 12 weeks postpartum, a prospective technical term applicable to the condition of proteinuria alone is needed to increase physicians’ attention to this condition.展开更多
OBJECTIVES: In the very high risk obstetric cases of placental abruption, expediting delivery is of utmost urgency, since the complications are related to the abruption delivery interval. Before the introduction of pr...OBJECTIVES: In the very high risk obstetric cases of placental abruption, expediting delivery is of utmost urgency, since the complications are related to the abruption delivery interval. Before the introduction of prostaglandins for labor induction, it was a routine practice to do amniotomy and use oxytocin drip to accelerate labor when vaginal delivery was contemplated. We present 116 cases of placental abruption, including the severe cases, managed in the year 2006 during a period of 8 months, at Modern Government Maternity Hospital, which was the biggest maternity hospital in the combined state of Andhra Pradesh, and is the biggest in the state of Telangana, attached to Osmania Medical College. The role of prostaglandin E1 (PGE1), for cervical ripening and labor induction/augmentation has been analyzed in this observational study. A variety of variables including age, parity, gestational age, severity of abruption and maternal and fetal status, associated preeclampsia, Bishop score, availability of blood and blood products, associated complications, all factors influence the management adopted. MATERIAL METHODS: The response to PGE1 induction has been studied in terms of efficacy, the total number of doses of vaginal PGE1 in relation to parity, induction delivery interval, successful vaginal delivery rate, the indications for caesarean delivery, perinatal outcome and complications. A decision was made for either abdominal delivery or vaginal delivery on a case to case basis. A routine amniotomy was performed when the cervical os was open, both for confirmation of diagnosis and to release intra uterine pressure, and also it would help in the acceleration of labor. When the Bishop score was more than six, amniotomy was performed and an oxytocin intravenous drip was started. If the Bishop score was less than six, 25/50 mcg. Misoprostol (PGE1) was placed high in the vagina. OBSERVATIONS: Primies that had abruption were 27/116 = 23.27% and multies were 89/116 = 76.72%. In our study 68/116, (58.62%) had preeclamsia. In our series, gestational age at abruption was less than 36 weeks in 89/116, (76.72%) and >36 weeks in 27/116 (23.27%) at presentation. It is significant to note that 100/116 (86.2%) were unbooked and 16/116 (13.79%) were booked cases at our institute. Vaginal deliveries were 84 (74.2%) and caesarean deliveries were 30 (25.8%) in 116 placental abruptions. There were four maternal deaths 3.4%, two died undelivered. Perinatal mortality in our series was 92/116 (79.3%). PGE1 induced labours—49: When PGE1 was used for labor induction in 49 women, 40 (81.63%) had vaginal delivery and caesarean delivery was done in 9 (18.36%) cases for non progress of labor. Induction delivery interval was less than 12 hours in 45 (91.83%), more than 12 hours in 4 (8.1%). Preterm delivery in PGE1 induced cases was 40/49 = 81.63% versus preterm in 116 cases, 76.72%. This indicates that more numbers of preterm deliveries were allowed vaginal delivery. DISCUSSION: Maternal mortality: Better facilities of transfusion of blood products may have reduced maternal mortality in our series. Government maternity hospital is a public sector tertiary health facility providing free treatment. Early referral would make some difference. Acute defibrination leading to disseminated intravascular cougulation was the cause of three deaths, irreversible haemorrhagic shock in another. CONCLUSION: Induction of labor with PGE1 was useful and effective when cervix was unfavorable and Bishop score was less than six. With PGE1 induction (49) 91.83% delivered in less than 12 hours. There were no maternal deaths and PPH in 49 women induced with PGE1. Hence PGE1 was safe to use in these emergency high-risk obstetric patients. PGE1 usage to expedite delivery can reduce Caesarean section rate.展开更多
文摘<em>Background:</em> The diagnosis of placental abruption is primarily clinical, but findings from imaging, laboratory, and postpartum pathologic studies can be used to support the clinical diagnosis. In patients with classic symptoms, fetal heart rate abnormalities, intrauterine fetal demise, and/or disseminated intravascular coagulation strongly support the clinical diagnosis and indicate extensive placental separation. In a few cases, placental separation has not been recognized and was only identified upon cesarean section as an incidental finding. <em>Objectives: </em>To describe the clinical presentations and pregnancy outcomes of placental abruption cases that are not diagnosed before cesarean delivery, termed “unpredictable placental abruption” and also cases diagnosed before cesarean delivery, termed “predictable placental abruption”.<em> Methods: </em>A retrospective analysis of 100 cases of placental abruption was identified by cesarean delivery at Tu Du hospital from September 2018 to May 2019. Clinical variables were compared between the unpredictable and predictable groups. The unpredictable group consists of cases that are not diagnosed before cesarean delivery, while the predictable cases were identified placental separation before cesarean delivery. The maternal and fetal outcomes were also studied. <em>Results:</em> In 100 cases of placental, abruption by gross clinical examination of the placenta at the time operation revealed that, 33% were unpredictable. Placental abruption attributed to maternal complications included one case of total hysterectomy (1%) with no cases of disseminated intravascular coagulation (DIC), shock or maternal death;specifically, this case of total hysterectomy appeared with predictable one. There were two cases of stillbirths. Among the 98 live neonates, 15 cases (14.7%) experienced severe birth asphyxia resulting in eight neonatal deaths;two of which were caused by heart disease and necrotizing enterocolitis. Sixty-three neonates were delivered prematurely (61.74%), with mean gestational age of 34.64 <span style="white-space:nowrap;">±</span> 3.32 weeks. Among the 33 unpredictable cases, there were no stillbirths but 60.6% and 12.1% experienced moderate and severe asphyxia, respectively. All unpredictable cases had obvious indications of cesarean section but the basic symptoms and signs of acute placental abruption included the onset of preterm labor, unspecified intrapartum hemorrhage, hypertonic uterine contractions and fetal distress for emergency caesarian section;however there were also cases where there were no symptoms and signs.<em> Conclusions: </em>Unpredictable placental abruption cases—not suspected of having abruption, termed—“concealed” or “chronic” placental abruption, may have variable clinical manifestations and better pregnancy outcomes.
文摘Placental abruption(also termed accidental haemorrhage) refers to the separation of a normally sited placenta from the uterine wall resulting in maternal haemorrhage into the interventing space. If this space communicates with the external os of the cervix, the haemorrhage will be revealed. If not,the haemorrhage may result in delay in diagnosis, and underestimation of blood loss,which in turn increases the likelihood of coagulopathy and maternal morbidity. In the presence of massive abruption, blood tracks under pressure back into the myometrium, and may be visible beneath the uterine serosa at caesarean section. This appearance is referred to as a ’Couvelaire uterus’. Fetal bleeding can occur with placental abruption , though it is rare. It can be detected by a Kleihauer test which detects fetal haemoglobin in the maternal circulation and can be a clue to retroplacental bleeding in cases of trauma.
文摘During human pregnancy, progesterone induced decidual cells protect against hemorrhage: 1) as endovascular trophoblast breech and remodel uterine blood vessels;and 2) in the third stage of labor following preterm and term delivery. De- cidual cells promote hemostasis through enhanced expression of tissue factor (TF), the primary initiator of hemostasis via thrombin generation, and plasminogen activator inhibitor-1, which inactivates tissue type plasminogen activator, the primary fibrinolytic agent. Abruptions (decidual hemorrhage) produce excess thrombin which acts as autocrine/paracrine inducer of decidual cell expressed matrix metalloproteinases and of neutrophil chemoattractant and activator, interleukin-8. The latter mediates aseptic abruption-related neutrophil infiltration. During abruptions, decidual cell and neutrophil-derived proteases effectively degrade the decidual and fetal membrane extracellular matrix to promote preterm premature rupture of the membranes and preterm delivery (PTD). Decidual cell-derived thrombin weakens the amniotic membrane and lowers decidual cell-expressed progesterone receptor levels by increasing phospho-ERK1/2 signaling. The resulting functional progesterone withdrawal accompanies PTD.
文摘We consider that a low-frequency, sinusoidal rhythm detected by Electronic Fetal Monitoring (EFM) is a typical manifestation of a placental abruption. We present the case of a 26-year-old woman who was gestational 36 weeks. She had irregular contractions. The EFM showed a low-frequency, sinusoidal rhythm. The cycle of the sine curve increased in time from 90 seconds to 160 seconds gradually. A severely asphyxiated newborn was successfully resuscitated after an emergency Cesarean Section. The mother and child were discharged from our hospital in a good general condition seven days later. Upon examination it was proven that this was a case of a placental abruption. This is an original case study report about how to diagnose a placental abruption according to an EFM reading. We propose a definition of a low-frequency, sinusoidal rhythm having: 1) a stable baseline FHR (fetal heart rate) of 120 - 160 bpm;2) a possible variation of 20 - 30 bpm;3) a frequency of 90 - 160 seconds per cycle;4) fixed or flat short-term variability;5) oscillation of the sinusoidal wave from above and below a baseline;6) no areas of normal FHR variability or reactivity. What is more, the lengths of the fluctuation cycle and the greater the amplitude has a close relationship with the prognosis of both mother and child. This pre-partum, low-frequency, sinusoidal rhythm is an ominous sign of fetal jeopardy needing immediate intervention. The medical literature has never reported such an association. Therefore, our case study report is possibly the first to mention this observation.
文摘Background: Snakebite envenomation in pregnancy is uncommon. It can lead to a poor outcome in both the mother and the fetus. We describe our approach to envenomation in pregnancy based on the currently available evidence. Case: We reported two case of snakebite in the third trimester of pregnancy having caused placental abruption with expelling a fresh still born baby and a live baby. In both cases, consumption coagulopathy occurred. managed by polyvalent anti-snake and blood transfusion. Their investigations became normal and they were discharged of hospitalization. Conclusion: Snakebite envenomation in pregnant is a maternal and fetal emergency. Treatment must be quick and well adapted.
文摘Objective: To describe the epidemiological, clinical and prognostic factors and assess treatment of placental abruption in the obstetrics gynecology department of the Dakar Principal Hospital. Patients and Method: We carried out a retrospective observational study of 130 successive cases of placental abruption, which occurred from January 2015 to December 2017 at the Level 3 Maternity Unit of the Dakar Principal Hospital. Data were collected from non-computerized obstetric records and analyzed using Excel and Epi info software. Results: There were 130 cases of placental abruption, that is a prevalence of 1.5%. The average age of onset of placental abruption was 30 years. The history of hypertension concerned 32.3% of patients, the average gestational age of 32.5 weeks at the time of diagnosis, grade 3 of Sher was found in 48.5% of cases. The outcome of the pregnancy was a caesarean section in 79.2% of cases, the average weight of newborns was 2058 g. The management of the complications required a blood transfusion and intensive care. A haemostasis hysterectomy was performed in 6.2% of cases. Stillbirth rate was 53.7% and maternal mortality was zero. Discussion and Conclusion: Placental abruption, a severe complication of pregnancy, is associated with high perinatal morbidity and mortality linked to the severity of the clinical picture, despite an improved maternal prognosis.
基金supported by the National Key Research and Development Program of China(Grant No.2023YFC3209800)the National Natural Science Foundation of China(Grant No.52279011).
文摘In the context of climate change,the acceleration of the global water cycle has led to the emergence of abrupt transitions between drought and flood events,presenting a new challenge for flood and drought disaster mitigation.Abrupt transitions between drought and flood refer to a phenomenon in which an extreme drought event quickly shifts to an extreme flood event,or vice versa,within a relatively short time span.This phenomenon disrupts the traditional spatiotemporal distribution patterns of water-related disasters,reflecting not only the extreme unevenness in the distribution of water resources but also the rapid alternation of the water cycle's evolution(He et al.,2016).Moreover,due to its suddenness,extremity,and complexity,it poses severe threats to human societies and ecosystems.Scientifically addressing abrupt transitions between drought and flood has thus become a new challenge in flood and drought disaster prevention.
基金supported by the National Natural Science Foundation of China(No.52107125)Applied Basic Research Project of Sichuan Province(No.2022NSFSC0250)Chengdu Guojia Electrical Engineering Co.,Ltd.(No.KYL202312-0043).
文摘Critical for metering and protection in electric railway traction power supply systems(TPSSs),the measurement performance of voltage transformers(VTs)must be timely and reliably monitored.This paper outlines a three-step,RMS data only method for evaluating VTs in TPSSs.First,a kernel principal component analysis approach is used to diagnose the VT exhibiting significant measurement deviations over time,mitigating the influence of stochastic fluctuations in traction loads.Second,a back propagation neural network is employed to continuously estimate the measurement deviations of the targeted VT.Third,a trend analysis method is developed to assess the evolution of the measurement performance of VTs.Case studies conducted on field data from an operational TPSS demonstrate the effectiveness of the proposed method in detecting VTs with measurement deviations exceeding 1%relative to their original accuracy levels.Additionally,the method accurately tracks deviation trends,enabling the identification of potential early-stage faults in VTs and helping prevent significant economic losses in TPSS operations.
基金supported by the National Natural Science Foundation of China (Grant Nos.42005029 and 41701103)the China Meteorological Administration Special Foundation for Innovation and Development (Grant No.CXFZ2024Q007)。
文摘In the summer of 2024, following a strong El Ni?o event in the preceding winter, the tropical Indian Ocean and tropical North Atlantic recorded their highest SSTs since 1961, along with a significant westward shift and intensification of the western Pacific subtropical high(WPSH). Under these conditions, China experienced its hottest summer since 1961,and was hit by a series of high-impact extreme weather and climate events. From 9 June to 2 July, southern China experienced an unprecedented extreme precipitation event that exceeded the well-known 1998 summer precipitation event in both duration and impact scope, resulting in devastating floods in the Yangtze River basin. Subsequently, in early to midJuly, the Huanghe-Huaihe Basin suffered from a severe drought–flood abrupt alternation event, heavily affecting Henan and Shandong. Meanwhile, southern China underwent a widespread heatwave event lasting 74 days, ranking as the second most intense since 1961. From late July to the end of August, northern China faced unusually frequent heavy precipitation events, with cumulative precipitation reaching the second highest for the same period since 1961, causing floods in many rivers of northern China. This study provides a timely summary and assessment of the characteristics and impacts of these extreme events. It serves as a reference for climate change research, including mechanism analysis, numerical simulation,and climate event attribution, and also offers valuable insights for improving meteorological disaster prevention and mitigation strategies.
基金supported by the National Natural Science Foundation of China[grant numbers U2142207 and U2342205]the National Key R&D Program of China[grant number 2024YFC3013100]China Meteorological Administration(CMA)Youth Innovation Team[CMA2024QN06].
文摘Since the 21st century,the Huang–Huai–Hai River Basin(HHHRB)in China has experienced increased frequency and severity of drought–flood abrupt alternation(DFAA)events during early summer,characterized by droughts in June followed by floods in July.The 2024 event was the most severe since 1981.This study demonstrates that such compound extreme events are closely linked to anomalous subseasonal evolution of large-scale atmospheric circulation.During the drought phase,the East Asian subtropical westerly jet(EAJ)shifts southward,and the western Pacific subtropical high(WPSH)exhibits anomalous strengthening with its western ridge line displaced southward.The flood phase is characterized by acceleration of the EAJ,westward extension of the WPSH,and enhanced southwestern moisture transport from the western Pacific.Beyond these typical features,the 2024 early summer circulation exhibited unique characteristics:Anomalous northeastward intensification of the WPSH facilitated merged moisture influx from both the Indian Ocean and the western Pacific along the southeast pathway into the HHHRB in July,resulting in the highest net moisture inflow at the southern boundary of the HHHRB since 1981.The synergistic effects of multiple factors primarily explain the exceptionally intense DFAA event in 2024.
文摘It is an objective fact that the weather is unpredictable.Even the famous meteorologist,Academician Chu Ko Chen,has only a partial understanding of the changing laws of wind and rain.Even though ancient people summarized the 24 solar terms by observing the annual activities of the sun for a long time,because they ignored the impact of the activities of the moon on the Earth’s climate change on a small scale,the 24 solar terms they summarized often could not accurately predict the change of the Earth’s climate.Therefore,the author studied the influence of lunar activities on the Earth’s climate change,finds out the law of the influence of lunar activities on the Earth’s climate change on a small scale,and summarizes the eternal climate change pattern determined by the activities of the sun and the moon.In addition,the author also reveals the causes and countermeasures of global warming and the frequent occurrence of extreme weather as well as environmental change.
文摘Climate change is the phrase used to describe long-term changes in temperatures and weather patterns. Changes in the atmosphere and their interactions with diverse geologic, chemical, biological, and geographic variables are the main contributors to this cyclical adjustment of the Earth’s climate. Such changes may be induced purposefully, because of burning fossil fuels, clearing forests, and raising animals, or they may be natural, brought on by significant volcanic eruptions or variations in the sun’s activity. By significantly increasing the amount of greenhouse gases already in the atmosphere, this heightens the greenhouse effect and contributes to global warming. This work includes several additional theoretical and practical explanations of sustainable development. The theoretical work encompasses hundreds of researches that identify requirements for how development routes might satisfy sustainable development (SD) criteria using economic theory, complex systems approach, ecological science, and other techniques. The agreements made by the Parties in various nations across the world will consider a wide range of perspectives about what would be considered undesirable effects on the environment, the climate system, sustainability, economic growth, or food production.
文摘The effect of pruning severity on tree growth was analyzed by change point detection using segmented regression. The present study applied this analysis to a well-known published data set including diameter growth response, tree age, pruning severity and pretreatment crown size. First, multiple regression analysis was performed to assess the effect of tree age, pruning severity and pretreatment crown size on diameter growth response. Next, segmented regression analysis was performed to assess the effect of pruning severity on diameter growth response. The results of the multiple regression showed that diameter growth response was significantly influenced by pruning severity and pretreatment crown size. The results of the segmented regression showed that in the whole data set, an abrupt change toward a decrease in diameter growth response was detected at 25% of the live crown removed. However, in the group of fully crowned and open-grown, diameter growth response continuously decreased with increasing pruning severity with no significant abrupt change, whereas in the group of 70% - 90% live crown, diameter growth response did not significantly decrease up to the break point (53% crown removed) and then abruptly decreased. This may be the first study to show the numerical evaluation of the effect of pruning severity on tree growth by change point analysis.
基金Supported by National Key Technology R&D Program(2007BAC-29B02)
文摘Based on the monthly precipitation data from 43 stations in North China from 1979 to 2008,the variation characteristics of precipitation in North China in recent 30 years were analyzed by means of empirical orthogonal function(EOF)decomposition,Morlet wavelet transform and Mann-Kendall test.The results showed that the spatial distribution of annual and seasonal precipitation was basically identical in North China,while the annual and summer precipitation from the middle of 1980s to the middle of 1990s were obviously more than these in other periods,and there was great annual variation in spring precipitation in 1990s,while autumn precipitation was higher from 1980s to 1990s and then went down after the beginning of 21st century,which was opposite to winter precipitation,namely there was more winter precipitation from 1980s to 1990s and fewer winter precipitation after the beginning of 21st century.In addition,the annual and summer precipitation changed abruptly in 1997,and there was no obvious change in spring precipitation and autumn precipitation,while winter precipitation had an abrupt change in 2000.Meanwhile,wavelet analysis revealed that the variation period of annual and seasonal precipitation was 3-4 years.
文摘Design: Retrospective analysis. Setting: East London Hospital. Subjects: 724 women who had maternal serum alphafetoprotein levels measured between 15 to 19 weeks gestation. Main outcome measure: The main outcome measures were defined as any case of preeclampsia, small-for-gestational age (SGA) birth- weight th centile, placental abruption, stillbirth or early neonatal death. Methods: Women with MSAFP > 2.0 Multiples of Median (MoM) were classified as screen positive. Results: 41 (5.7%) women developed preeclampsia. Women with MSAFP > 2.0 Multiples of the Median (MoM) were significantly more likely to develop preeclampsia (p th centile
基金Supported by National Natural Science Foundation of China (40971294)Science and Technology Planning Project of Dalian Science and Technology Bureau(2009E11SF230)~~
文摘[Objective] The change law and meteorological factor of sunshine duration in Dalian in recent 60 years were studied.[Method] Based on the statistical data of sunshine duration from base station in Dalian City from 1951 to 2009,the annual,seasonal,and monthly variation of sunshine duration in recent 60 years were analyzed,as well as its relationship with meteorological factors,and sunshine duration was detected by means of climate mutation theory.[Result] Annual sunshine duration in Dalian in recent 60 years showed decrease trend on the whole,and its climatic variation rate was-3.31 h/a,with larger annual variation,namely the difference between maximum value(1978) and minimum value(2003) reached 681 h;there was obvious seasonal variation in sunshine duration,with the order of autumn>summer>winter>spring,and their climatic variation rate were-1.18,-1.15,-0.91 and-0.62 h/a;except for March,sunshine duration in each month went down,especially October,while there was slight increase in March;sunshine percentage had inverse correlation relationship with total cloudiness,relative humidity and heavy fog days;annual sunshine duration reduced abruptly around 1983.[Conclusion] Our study could provide scientific foundation for the development of agriculture and forestry in Dalian City.
文摘Thyroid hormones are critical for foetal neurological development and maternal health. Maternal hypothyroidism during pregnancy is associated with adverse impact on health of the mother as well as the progeny. Reduced thyroid hormone levels predispose the child to develop mental retardation and cognitive delay in early life. In the mother, hypothyroidism during pregnancy is associated with spontaneous abortion, placental abruption, preterm delivery and hypertensive disorders. Therefore, screening and therapeutic intervention is justified to prevent foetal as well as maternal co-morbidities. In view of impact of such a large-scale screening and intervention program on limited healthcare resources, it is debatable if a targeted rather than universal screening program will result in comparable outcomes. In addition, there is an ongoing debate regarding best evidence-based practice for the management of isolated hypothyroxinaemia, subclinical hypothyroidism and euthyroid women with autoimmune hypothyroidism. We have carried out a review of the literature; firstly, to determine whether universal screening for asymptomatic women in early pregnancy would be cost-effective. Secondly, we have retrospectively reviewed the literature to analyse the evidence regarding the impact of therapeutic intervention in women with subclinical hypothyroidism.
文摘Two pregnant women who initially developed proteinuria alone followed by serious preeclampsia are presented to emphasize that there is no adequate technical term to express the period of proteinuria alone based on the current criteria of pregnancy-induced hypertension. Case 1 exhibited a urinary protein concentration of 46 mg/dL in the absence of hypertension, and abdominal pain due to placental abruption with hypertension at gestational week (GW) 29–3/7 and 29–4/7, respectively. Case 2 exhibited a urinary protein/creatinine ratio of 2.67, developed hypertension, required cesarean section, and developed posterior reversible encephalopathy syndrome at GW 28–1/7, 29–6/7, and 32–0/7, and on postpartum day 2, respectively. As women with proteinuria alone are not diagnosed as having preeclampsia and as a diagnosis of gestational proteinuria can be made only at 12 weeks postpartum, a prospective technical term applicable to the condition of proteinuria alone is needed to increase physicians’ attention to this condition.
文摘OBJECTIVES: In the very high risk obstetric cases of placental abruption, expediting delivery is of utmost urgency, since the complications are related to the abruption delivery interval. Before the introduction of prostaglandins for labor induction, it was a routine practice to do amniotomy and use oxytocin drip to accelerate labor when vaginal delivery was contemplated. We present 116 cases of placental abruption, including the severe cases, managed in the year 2006 during a period of 8 months, at Modern Government Maternity Hospital, which was the biggest maternity hospital in the combined state of Andhra Pradesh, and is the biggest in the state of Telangana, attached to Osmania Medical College. The role of prostaglandin E1 (PGE1), for cervical ripening and labor induction/augmentation has been analyzed in this observational study. A variety of variables including age, parity, gestational age, severity of abruption and maternal and fetal status, associated preeclampsia, Bishop score, availability of blood and blood products, associated complications, all factors influence the management adopted. MATERIAL METHODS: The response to PGE1 induction has been studied in terms of efficacy, the total number of doses of vaginal PGE1 in relation to parity, induction delivery interval, successful vaginal delivery rate, the indications for caesarean delivery, perinatal outcome and complications. A decision was made for either abdominal delivery or vaginal delivery on a case to case basis. A routine amniotomy was performed when the cervical os was open, both for confirmation of diagnosis and to release intra uterine pressure, and also it would help in the acceleration of labor. When the Bishop score was more than six, amniotomy was performed and an oxytocin intravenous drip was started. If the Bishop score was less than six, 25/50 mcg. Misoprostol (PGE1) was placed high in the vagina. OBSERVATIONS: Primies that had abruption were 27/116 = 23.27% and multies were 89/116 = 76.72%. In our study 68/116, (58.62%) had preeclamsia. In our series, gestational age at abruption was less than 36 weeks in 89/116, (76.72%) and >36 weeks in 27/116 (23.27%) at presentation. It is significant to note that 100/116 (86.2%) were unbooked and 16/116 (13.79%) were booked cases at our institute. Vaginal deliveries were 84 (74.2%) and caesarean deliveries were 30 (25.8%) in 116 placental abruptions. There were four maternal deaths 3.4%, two died undelivered. Perinatal mortality in our series was 92/116 (79.3%). PGE1 induced labours—49: When PGE1 was used for labor induction in 49 women, 40 (81.63%) had vaginal delivery and caesarean delivery was done in 9 (18.36%) cases for non progress of labor. Induction delivery interval was less than 12 hours in 45 (91.83%), more than 12 hours in 4 (8.1%). Preterm delivery in PGE1 induced cases was 40/49 = 81.63% versus preterm in 116 cases, 76.72%. This indicates that more numbers of preterm deliveries were allowed vaginal delivery. DISCUSSION: Maternal mortality: Better facilities of transfusion of blood products may have reduced maternal mortality in our series. Government maternity hospital is a public sector tertiary health facility providing free treatment. Early referral would make some difference. Acute defibrination leading to disseminated intravascular cougulation was the cause of three deaths, irreversible haemorrhagic shock in another. CONCLUSION: Induction of labor with PGE1 was useful and effective when cervix was unfavorable and Bishop score was less than six. With PGE1 induction (49) 91.83% delivered in less than 12 hours. There were no maternal deaths and PPH in 49 women induced with PGE1. Hence PGE1 was safe to use in these emergency high-risk obstetric patients. PGE1 usage to expedite delivery can reduce Caesarean section rate.
