Severe postpartum hemorrhage is a necessary"window phrase"during which patients progress toward critical illness or even death.Besides the amount of blood loss reaches a severe level，this phase triggers activation of compensatory mechanisms，leading to a cascade of clinical manifestations.If medical staff could observe carefully and survey these abnormal signs，correct diagnosis can be made and appropriate treatment can be initiated as early as possible.This proactive approach minimizes physical dysfunction and death caused by postpartum hemorrhage to the greatest extent.
Postpartum hemorrhage is a leading cause of maternal death in China.Early diagnosis and prompt initiation of shock resuscitation are key to restoring the maternal circulating blood volume and avoiding maternal mortality.Due to the physiological changes in circulating blood volume during pregnancy，the signs of shock in severe postpartum hemorrhage are no longer typical，which can easily be overlooked clinically，thus losing the best opportunity for rescue.Volume resuscitation is essential for maintaining maternal hemodynamic stability， including active resuscitation and restrictive fluid resuscitation.Clinically，restrictive fluid resuscitation should be chosen while actively clarifying the etiology of postpartum hemorrhage and preparing for blood or component transfusion.Transfusion should be initiated promptly following volume resuscitation to supplement red blood cells，coagulation factors，etc.，maximizing the resuscitation efficacy and minimizing side effects.This article discusses the volume resuscitation of postpartum hemorrhage from the following aspects：pathophysiological characteristics of postpartum hemorrhage，early treatment，volume resuscitation plans，types and selection of resuscitation fluids，and complications of resuscitation，aiming to provide more basis for the early diagnosis and rescue of postpartum hemorrhage，thereby reducing the risk of maternal death.
Postpartum hemorrhage is a serious complication during childbirth and one of the important factors leading to maternal mortality.Simulation training represents a highly effective strategy for enhancing healthcare teams'emergency response to postpartum hemorrhage，thereby reducing severe complications.This review details the development process，operating procedures，and effect evaluation of simulation training，including modalities such as sand table simulation，simulated delivery room，model drill，and stepped training.This paper analyzed the significant effects of simulation training in improving the skills of healthcare workers，enhancing teamwork，and optimizing the emergency process.Although studies have confirmed that simulation training can effectively reduce the incidence of severe postpartum hemorrhage complications，it is still imperative to further explore appropriate evaluation indicators and comprehensive evaluation systems.
To analyze the clinical characteristics，diagnosis and treatment methods，maternal-fetal outcomes in patients with hyper-triglyceridemic acute pancreatitis in pregnancy，and optimize the management of this disease during pregnancy and perinatal period.
Methods
The clinical data of 8 patients with hyper-triglyceridemic acute pancreatitis in pregnancy who were hospitalized and delivered in the First Affiliated Hospital of Sun Yat-sen University from January 1，2014 to December 31，2023 were retrospectively collected.The clinical characteristics，treatment methods，pregnancy outcomes and neonatal prognosis were summarized.
Results
1 in 8 patients had a twin pregnancy.All 8 patients had onset during the second and third trimesters of pregnancy.2 cases were complicated with pre-eclampsia，3 cases had abnormal blood glucose，2 cases were complicated with abnormal coagulation function，and 5 cases were complicated with hypokalemia.All underwent cesarean delivery，with 6 cases requiring ICU admission.Among 9 neonatal，8 survived and 1 died.
Conclusions
Hyper-triglyceridemic acute pancreatitis in pregnancy is a rare but life-threatening obstetric emergency characterized by rapid progression and high maternal-fetal mortality，necessitating multidisciplinary team management.
To analyze the clinical symptoms of patients with recurrent preeclampsia（PE）and explore the influencing factors of its onset，thereby providing a basis for the prevention and treatment of recurrent PE.
Methods
Complete data of 574 patients with PE admitted to the Third Affiliated Hospital of Guangzhou Medical University and Guangzhou Panyu District Maternal and Child Health Hospital from June 2010 to December 2021 were collected.Patients were divided into a recurrence group（132 cases）and a nonrecurrence group（442 cases）based on whether PE occurred during a second pregnancy.The clinical data and pregnancy characteristics of the two groups were compared using the chisquare test，t-test，or rank sum test.Logistic regression model was used to analyze the risk factors for PE recurrence.
Results
（1）The recurrence rate of PE was 23.0%；（2）The age of pregnancy in the recurrent group was higher than that in the non recurrent group［（32.92±4.14）years vs（30.81±4.29）years，t= -4.982］，while the gestational weeks at admission［（36.36±3.12）weeks vs（37.96±2.25）weeks，t=6.493］and delivery［（36.73±2.87）weeks vs（38.19±2.10）weeks，t=6.377］were lower than those in the non-recurrent group，with statistical significance（P＜0.05）；The vaginal delivery rates were 31.8% vs.43.1%，and cesarean delivery rates were 68.2% vs.56.9% in the two groups，respectively（χ2=5.355），demonstrating statistically significant differences（P＜0.05）.（3）The recurrence group demonstrated significantly higher incidences of both ascites（4.5% vs 0.2%，χ2=15.706）and epigastric discomfort（2.3% vs 0.2%，χ2=6.143），with all differences being statistically significant（P＜0.05）.（4）The white blood cell count in the recurrent group was higher than that in the non-recurrent group［（9.85±2.14）×109/L vs（9.2±2.2）×109/L，t= -2.122］，and the difference was statistically significant（P＜0.05）.（5）The birth weight［（2 760.0±830.0）g vs（3 120.0±540.0）g，t=5.867］and Apgar score of newborns［1 min：（9.51±1.56）vs（9.79±1.11），t=2.299；5 min：（9.70±1.35）vs（9.88±0.97），t=1.697］in the recurrent group were significantly lower than those in the non-recurrent group，and the incidence of fetal growth restriction was higher（6.9%vs2.0%，χ2=7.738），with statistical significance（P＜0.05）.The neonatal mortality rate was significantly higher than that of the non-recurrence group（9.1% vs 3.8%）.（6）The recurrence group had an increase in blood pressure in the previous pregnancy［（33.85±5.35）weeks vs（36.64±3.83）weeks，t=36.531］and the gestational age at admission［（35.56±4.46）weeks vs（37.44±3.04）weeks，t=42.792）］was earlier than the non-recurrence group，while the highest systolic blood pressure［（165.1±13.8）mmHg vs（156.1±13.4）mmHg，t= -5.508］and maximum diastolic blood pressure［（106.2±11.9）mmHg vs（100.4±10.4）mmHg，t= -4.463］was higher than that of the nonrecurrence group，and the proportion of non-first pregnancies（46.2% vs 36.7%，t=7.66）was significantly higher than that of the non-recurrence group（P＜0.05）.（7）Logistic regression analysis showed that age（OR=1.18，95%CI：1.03～1.35），highest systolic blood pressure during the previous pregnancy（OR=1.05，95%CI：1.01～1.08，P＜0.05），age of the previous pregnancy（OR=1.23，95%CI：1.16～1.37，P＜0.05），gestational age of the previous delivery（OR=1.32，95%CI：1.23～1.39，P＜0.05），and urinary protein during the previous pregnancy（OR=2.59，95%CI：1.01～6.64，P＜0.05）were risk factors for PE recurrence in pregnant women.The starting gestational age of the previous increase in blood pressure（OR=0.89，95%CI：0.82～0.97，P＜0.05）was a protective factor for PE recurrence.
Conclusions
Recurrent PE has certain clinical characteristics.The maternal age，highest systolic blood pressure during the previous pregnancy，age of the previous pregnancy，gestational age of the previous pregnancy，and urinary protein during the previous pregnancy are risk factors for recurrent PE.The initial gestational age of the previous pregnancy with elevated blood pressure is a protective factor for recurrent PE.
To analyze the clinical manifestations，diagnosis and treatment process，maternal and fetal prognosis of spontaneous splenic rupture in pregnancy，and to summarize treatment experience.
Methods
A retrospective analysis was conducted on 5 pregnant patients with spontaneous splenic rupture who were registered and underwent routine prenatal examinations in our hospital from January 2018 to December 2023.Clinical parameters recorded and analyzed included：maternal age，gestational age at the time of splenic rupture，parity，medical history，pregnancy complications，previous delivery mode，presence of underlying diseases，clinical manifestations and auxiliary examination results，treatment process，and prognosis，respectively.
Results
Splenic rupture occurs in the second and third trimester of pregnancy，with sudden abdominal pain as the main symptom，and soon leading to varying degrees of shock.All 5 patients underwent emergency splenectomy and recovered well after surgery.Four cases underwent splenectomy and cesarean section simultaneously，of which one fetus died in the uterus.One case underwent simple splenectomy，and the fetus was delivered by cesarean section after full term pregnancy.
Conclusions
Spontaneous splenic rupture of pregnancy is prone to misdiagnosis.Pregnant women with a history of abdominal surgery in the second and third trimester of pregnancy exhibiting acute abdomen are demanded to consider the possibility of spontaneous splenic rupture.Treating shock promptly while exploring laparotomy urgently and splenectomy are performed to avoid maternal and fetal adverse prognosis.
