Severe postpartum hemorrhage (SPPH) is the main cause of maternal mortality or organ damage in pregnant women. SPPH combined with coagulation dysfunction increases the complexity and peril of the condition, exerting profoundly adverse effects on maternal and neonatal outcomes. This article elaborates on the pathogenesis, prevention strategies, diagnostic methods, and management measures of SPPH with coagulation dysfunction, aiming to provide academic guidance for enhancing the quality of obstetric care and reducing maternal mortality.

Postpartum hemorrhage (PPH) remains one of the leading cause of global maternal mortality. Oxytocin, as an effective classic uterotonic agent, plays a crucial role in both the prevention and treatment of PPH. This article systematically discusses the pharmacological properties of oxytocin and its clinical application in the management of PPH.

Postpartum hemorrhage (PPH) is the primary cause of maternal mortality in China. Exploring effective treatments for PPH is of great significance in reducing maternal mortality. Transcatheter Arterial Embolization (TAE) has become one of the crucial interventions for treating PPH. However, this technique requires a high level of operational experience from practitioners and comprehensive capabilities from medical institutions. Standardized referral processes and collaborative mechanisms among regional medical centers are essential for improving the prognosis of PPH. Therefore, it is vital for hospitals at all levels to master the indications, optimal surgical timing for TAE, and methods to prevent its complications. This article delves into the indications, application timing, and prevention of complications associated with TAE in cases of severe PPH.

Severe postpartum hemorrhage frequently leads to critical obstetric complications such as hemorrhagic shock, disseminated intravascular coagulation, renal failure, Sheehan syndrome, constituting a significant cause of maternal mortality.When severe postpartum hemorrhage occurs, all non-surgical treatment measures are ineffective, and the life safety of the mother is seriously threatened, hysterectomy becomes a life-saving intervention. This article discusses the indications, optimal timing and surgical procedures for hysterectomy in the context of severe postpartum hemorrhage.

To explore the clinical efficacy of the Bakri intrauterine balloon (BIUB) in preventing and treating postpartum hemorrhage(PPH) caused by different etiologies.

A retrospective study was conducted on 724 postpartum hemorrhage patients treated at 31 hospitals across 9 provinces in China from November 2018 to September 2019. Clinical data included age, height, pre-pregnancy weight, parity, gestational age at delivery, pregnancy complications and comorbidities was collected. Patients were divided into three groups based on PPH etiology: (1) Group A, with 308 cases of PPH caused by uterine atony; (2) Group B, 211 cases of PPH caused by placental factors; (3) Group C, 205 cases of PPH caused by coagulation dysfunction. General situation, bleeding volume before and after balloon placement, changes in related indicators of blood routine examination, and hemostatic efficacy of Bakri balloon were compared among groups.

(1) General situation: There were statistically significant differences in the average age [(31.43±4.95)years vs(32.27±4.82)years vs(33.17±5.07)years, P<0.001)], twin pregnancy [62 (20.13%) vs 11 (5.21%) vs 21 (10.24%), P<0.001], gestational weeks of delivery [(37.39±2.75)weeks vs (36.13±2.56)weeks vs (36.62±2.56) weeks, P<0.001], preterm delivery [76 (24.68%) vs 83 (39.34%) vs 79 (38.54%), P<0.001], cesarean delivery [215 (69.81%) vs 178 (84.36%) vs 150 (73.17%), P<0.001], prenatal red blood cell count [(3.92±0.63)×10¹²/L vs (3.74±0.69)×10¹²/L vs (3.79±0.67)×10¹²/L, P=0.007], hemoglobin [(111.98±16.18)g/L vs (108.66±15.92)g/L vs (107.00±19.76)g/L, P=0.006], hematocrit [(0.35±0.09)%vs (0.34±0.07)% vs(0.33±0.06)%, P=0.033], and mean corpuscular volume(MCV) levels [(86.46±11.20)fl vs (89.04±7.21)fl vs (85.55±11.97)fl, P=0.002] among the three groups of patients. No statistically significant difference were found in pre-pregnancy weight, parity, prenatal mean corpuscular hemoglobin(MCH), mean corpuscular hemoglobin concentration(MCHC), and pre-balloon hemorrhage (P>0.05). (2) Changes in blood routine related indicators: There were no statistically significant changes in red blood cell count, hemoglobin, hematocrit, average red blood cell volume, and average red blood cell hemoglobin concentration among the three groups of patients before and after balloon placement (P>0.05). (3) Hemostatic effect: hemostatic success rates after balloon placement were 98.05%, 97.63%, and 96.59%, respectively. There was no significant difference in the success rate and incidence of complications of Bakri balloon hemostasis among the three groups of patients (P>0.05).

The Bakri balloon effectively achieves rapid hemostasis for PPH caused by uterine atony, placental factors, and coagulation dysfunction, demonstrating particular suitability for uterine atony. However, its efficacy is limited in cases of severe PPH.

To compare the differences in risk factors of postpartum hemorrhage (PPH) between patients conceiving via assisted reproductive technology (ART) and spontaneous conception, and to explore whether ART conception is an independent risk factor for PPH.

A retrospective cohort study was conducted involving 25 035 women aged 18-49 years with singleton vaginal deliveries at Peking University Third Hospital from January 2012 to December 2020. They were divided into ART group (2 003 cases, accounting for 8.0%) and natural pregnancy group (23 032 cases, accounting for 92.0%) based on whether ART conception occurred. The maternal age, gestational age at delivery, primiparous status, body mass index (BMI), pregnancy complications (pregnancy anemia, hypertensive disorders in pregnancy, gestational diabetes mellitus, macrosomia and placenta accreta spectrum) of the two groups were analyzed respectively. Chi-square and Mann-Whitney U tests were used to verify the correlation between ART and the incidence of PPH and blood loss. Furthermore, multivariate logistic regression was conducted.

The incidence of PPH in the ART group and non-ART group was 19.4% and 11.9%, respectively (P<0.001). After removing the confounding factors such as maternal age (34 years vs 31 years, P<0.001), gestational age (39 weeks vs 39 weeks, P=0.924), primiparous status (91.4% vs 76.7%, P<0.001), body mass index (BMI) (21.631 kg/m² vs 21.077 kg/m^2, P<0.001), pregnancy complications [pregnancy anemia (5.5% vs 6.0%, P=0.410), hypertensive disorders in pregnancy (8.0% vs 5.9%, P<0.001), gestational diabetes mellitus (33.5% vs 21.9%, P<0.001), macrosomia (3.1% vs 3.4%, P=0.482) and placenta accreta spectrum (4.0% vs 2.4%, P<0.001)], the incidence of PPH (OR=1.580, 95%CI: 1.382~1.806, P<0.001) and blood loss (β=47.526, 95%CI: 7.051~88.001, P=0.021) in the ART group was significantly higher than that in the non-ART group.

Compared with spontaneous conception, ART conception is associated with an increased risk of PPH during vaginal delivery, highlighting the need for enhanced risk management in ART pregnancies.

To investigate the predictive value of placental volume, placental area and cervical length for placenta accreta (PAS) in patients with complete placenta previa.

A retrospective study was conducted on 926 patients with complete placenta previa who received regular antenatal examination and delivered in the Affiliated Suzhou Hospital of Nanjing Medical University from January 2016 to December 2023. Among them, 90 patients meeting inclusion criteria with complete placenta previa and PAS were enrolled as the study group, and 90 patients with complete placenta previa without PAS were selected as controls. Maternal age, body mass index (BMI), gravidity and parity, placental area and volume measured by magnetic resonance imaging (MRI), cervical length, gestational age at delivery, intraoperative blood loss, and transfusion volume were compared between groups.

(1) The gravidity [3(3, 4) vs 3(2, 4), Z=2.13] and parity [2(1, 2) vs 2(1, 2), Z=3.06] in the study group was higher than that in the control group, and the difference was statistically significant (P<0.05). The gestational age of delivery in the study group was smaller than that in the control group [(35.51±1.45) weeks vs (36.35±1.77) weeks, t=3.48], and the difference was statistically significant (P<0.05). (2)The operation time [(94.27±33.57) min vs (63.04±27.58) min, t=6.82], blood loss [(2 358.46±537.29)ml vs(1 350.27±364.22)ml, t=14.74] and blood transfusion [(1 725.27±410.55)ml vs (836.58±357.29)ml, t=15.49] in the study group were higher than those in the control group, and the differences were statistically significant(P<0.01). (3)The uterine artery embolization rate (23.22% vs 3.33%, χ²=4.96) in the study group was higher than those in the control group, the difference was statistically significant (P<0.05). The neonatal weight of the study group was lower than that of the control group [(2 419.52±410.27)g vs (2 715.26±385.17) g, t=4.99], and the difference was statistically significant (P<0.05). (4) The placental area [(82.52±12.95) cm² vs (63.50±13.55)cm², t=9.63] and placental volume [(1 003.68±211.52)cm³ vs (812.66±219.50)cm^3, t=5.95] of the study group were higher than those of the control group, and the difference was statistically significant (P<0.05). The cervical length of the study group was smaller than that of the control group [(1.89±0.49) cm vs (2.76±0.54) cm, t=11.32], and the difference was statistically significant (P<0.05). (5) The MRI features of placenta volume, placenta area and cervical length included in this study have certain predictive value for whether patients with placenta accreta, and the AUC of the three MRI features were all >0.80, and the diagnostic value of placenta volume was the largest (AUC=0.88). The combination of three MRI features had high value in the prediction of placenta accreta in placenta previa (AUC=0.93).

The placental volume, placental area and cervical length are effective predictors of PAS in patients with complete placenta previa, aiding obstetricians in preoperative preparation and improve maternal outcomes.

To investigate the effect of a Macy model-based communication training program on doctor-patient communication in critically ill pregnant women.

A prospective study was conducted, involving 198 critically ill pregnant women and 32 healthcare providers admitted to the Intensive Care Unit (ICU) of our hospital from January 2023 to June 2024. Participants were divided into two groups based on different training periods: a control group (16 healthcare providers and 102 pregnant women, trained from January 2023 to September 2023) and an observation group (16 healthcare providers and 96 pregnant women, trained from October 2023 to June 2024). Medical staff in the control group received conventional doctor-patient communication training, while those in the observation group underwent Macy model-based communication training, focusing on ″eliciting patient perspectives, patient education, and treatment plan negotiation.″ The training outcomes of medical staff in both groups were compared before and after training. Additionally, the satisfaction feedback from the 198 critically ill pregnant women regarding the communication with medical staff after training was compared between the two groups after training.

After the training, the scores of the observation group in ″eliciting and understanding the patient′s perspective, ″ ″shared decision-making, ″ and ″patient education″ were (3.50±0.42), (3.49±0.42), and (3.30±0.56) points, respectively. In comparison, the control group scored (3.11±0.64), (3.02±0.62), and (2.90±0.52) points in the corresponding domains. The post-training scores in these three aspects were significantly higher in the observation group than in the control group, with statistically significant differences (t=2.038, 2.094, 2.511; P<0.05). However, no statistically significant differences were found between the two groups after training in the domains of preparation and assessment, information gathering, patient evaluation, communication during physical examination, and closing the consultation (P>0.05). Moreover, the satisfaction rate of critically ill obstetric patients in the observation group was 93.80%, significantly higher than that in the control group (75.5%), with a statistically significant difference ( χ²=11.245, P<0.05).

The communication training program based on the Macy model effectively enhances the communication skills of healthcare providers, and critically ill pregnant women showed high satisfaction with this communication approach.