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Celikkan C, Ibanoglu MC, Engin-Ustun Y. Use of Shock Index, Modified Shock Index, and Age-Adjusted Shock Index for Detection of Postpartum Hemorrhage. Z Geburtshilfe Neonatol 2024; 228:370-376. [PMID: 38838714 DOI: 10.1055/a-2322-1861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
PURPOSE The aim of this study is to evaluate the role of shock index (SI), modified shock index (MSI), and delta shock index (ΔSI) in predicting postpartum hemorrhage (PPH) and adverse maternal outcomes. MATERIAL AND METHODS In this cross-sectional cohort study, a study group consisting of 416 pregnant women who delivered at our hospital and had postpartum hemorrhage was compared with 467 control patients with normal follow-up. SI (pulse/systolic blood pressure), MSI (pulse/mean arterial pressure), ΔSI (input SI - 2nd- or 6th-hour SI) values were calculated. RESULTS A total of 883 postpartum women were included in the study. The study group had higher peripartum, 2nd-hour, and 6th-hour SI values (p=0.011, p=0.001, p<0.001, respectively). Peripartum MSI values (p=0.004), 2nd-hour MSI values (p<0.001), and 6th-hour MSI values (p<0.001) were significantly lower in the control group than in the PPH group. When the groups were evaluated, the cut-off value of the 2nd-hour SI parameter was>0.8909 (sensitivity 30%, specificity 84%), and the 6th-hour SI parameter was>0.8909 (sensitivity 40%, specificity 80%) for predicting postpartum hemorrhage requiring blood transfusion and surgical intervention. The cut-off value of the 2nd-hour MSI parameter was>1.2 (sensitivity 34%, specificity 82%), and the cut-off value of the 6th-hour MSI parameter was>1.2652 (sensitivity 32%, specificity 90%). CONCLUSION The 2nd- and 6th-hour SI and 2nd- and 6th-hour MSI values were significantly higher in patients with postpartum hemorrhage. Values greater than 0.89 for SI and 1.2 for MSI were considered significant for predicting postpartum hemorrhage with maternal impairment.
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Affiliation(s)
- Cagla Celikkan
- Obstetrics and Gynecology, Ankara Etlik Zübeyde Hanım Kadın Hastalıkları Eğitim ve Araştırma Hastanesi, Ankara, Turkey
| | - Mujde Can Ibanoglu
- Obstetrics and Gynecology, Etlik İhtisas Eğitim ve Araştırma Hastanesi, Ankara, Turkey
- Obstetrics and Gynecology, Ankara Şehir Hastanesi Üniversiteler Mahallesi, Ankara, Turkey
| | - Yaprak Engin-Ustun
- Obstetrics and Gynecology, Ankara Etlik Zübeyde Hanım Kadın Hastalıkları Eğitim ve Araştırma Hastanesi, Ankara, Turkey
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Cahierc R, Debost-Legrand A, Lane S, Rouzaire M, Bonnin M, Delabaere A, Gallot D. [Evolution of the obstetrical Shock Index in postpartum haemorrhage according to the use of sulprostone]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2023; 51:448-454. [PMID: 37634804 DOI: 10.1016/j.gofs.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 06/30/2023] [Accepted: 08/08/2023] [Indexed: 08/29/2023]
Abstract
OBJECTIVES The Shock Index (SI) is used in emergency medicine to assess the severity of active bleeding and in the postpartum context for postpartum haemorrhage (PPH). We investigated the diagnostic value of haemodynamic parameters (SI, heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP)) in predicting subsequent use of uterotonic sulprostone treatment. METHODS This was a retrospective study including parturients with PPH ≥ 500mL between January 2017 and December 2018. Hemodynamic parameters at the diagnosis of PPH were compared according to whether the patient required subsequent sulprostone treatment (sulprostone(+) group) or not (sulprostone(-) group). RESULTS We included in the analysis 147 patients. The SI was significantly higher in the sulprostone(+) group (0.92±0.28 vs. 0.83±0.22; p=0.04). The SBP (107.2±17.5 vs. 113.8±17.7mmHg; p=0.03), DBP (56.8±12,2 vs. 61.5±13,2mmHg; p=0.04), MAP (73.6±12.6 vs. 78.5±13.4mmHg; p=0.03) were significantly lower in the same group. No difference between AUC of these parameters to predict the use of sulprostone was found (AUC between 0.59 and 0.61). No significant difference was found for the HR between the two groups. CONCLUSION The diagnostic value of SI appeared to be low and similar to other haemodynamic parameters in predicting the use of sulprostone.
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Affiliation(s)
- Romain Cahierc
- Obstetrics and Gynaecology Department, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France; Université Clermont Auvergne, CHU, CNRS, SIGMA Clermont, Institut Pascal, 63000 Clermont-Ferrand, France.
| | - Anne Debost-Legrand
- Université Clermont Auvergne, CHU, CNRS, SIGMA Clermont, Institut Pascal, 63000 Clermont-Ferrand, France
| | - Sophie Lane
- Medical School, université Clermont-Auvergne, 63000 Clermont-Ferrand, France
| | - Marion Rouzaire
- Obstetrics and Gynaecology Department, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Martine Bonnin
- Department of Anesthesia, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Amélie Delabaere
- Obstetrics and Gynaecology Department, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France; Université Clermont Auvergne, CHU, CNRS, SIGMA Clermont, Institut Pascal, 63000 Clermont-Ferrand, France
| | - Denis Gallot
- Obstetrics and Gynaecology Department, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France; Team "Translational approach to epithelial injury and repair", université Clermont-Auvergne, CNRS, Inserm, GReD, 63000 Clermont-Ferrand, France
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Kietaibl S, Ahmed A, Afshari A, Albaladejo P, Aldecoa C, Barauskas G, De Robertis E, Faraoni D, Filipescu DC, Fries D, Godier A, Haas T, Jacob M, Lancé MD, Llau JV, Meier J, Molnar Z, Mora L, Rahe-Meyer N, Samama CM, Scarlatescu E, Schlimp C, Wikkelsø AJ, Zacharowski K. Management of severe peri-operative bleeding: Guidelines from the European Society of Anaesthesiology and Intensive Care: Second update 2022. Eur J Anaesthesiol 2023; 40:226-304. [PMID: 36855941 DOI: 10.1097/eja.0000000000001803] [Citation(s) in RCA: 66] [Impact Index Per Article: 66.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
BACKGROUND Management of peri-operative bleeding is complex and involves multiple assessment tools and strategies to ensure optimal patient care with the goal of reducing morbidity and mortality. These updated guidelines from the European Society of Anaesthesiology and Intensive Care (ESAIC) aim to provide an evidence-based set of recommendations for healthcare professionals to help ensure improved clinical management. DESIGN A systematic literature search from 2015 to 2021 of several electronic databases was performed without language restrictions. Grading of Recommendations, Assessment, Development and Evaluation (GRADE) was used to assess the methodological quality of the included studies and to formulate recommendations. A Delphi methodology was used to prepare a clinical practice guideline. RESULTS These searches identified 137 999 articles. All articles were assessed, and the existing 2017 guidelines were revised to incorporate new evidence. Sixteen recommendations derived from the systematic literature search, and four clinical guidances retained from previous ESAIC guidelines were formulated. Using the Delphi process on 253 sentences of guidance, strong consensus (>90% agreement) was achieved in 97% and consensus (75 to 90% agreement) in 3%. DISCUSSION Peri-operative bleeding management encompasses the patient's journey from the pre-operative state through the postoperative period. Along this journey, many features of the patient's pre-operative coagulation status, underlying comorbidities, general health and the procedures that they are undergoing need to be taken into account. Due to the many important aspects in peri-operative nontrauma bleeding management, guidance as to how best approach and treat each individual patient are key. Understanding which therapeutic approaches are most valuable at each timepoint can only enhance patient care, ensuring the best outcomes by reducing blood loss and, therefore, overall morbidity and mortality. CONCLUSION All healthcare professionals involved in the management of patients at risk for surgical bleeding should be aware of the current therapeutic options and approaches that are available to them. These guidelines aim to provide specific guidance for bleeding management in a variety of clinical situations.
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Affiliation(s)
- Sibylle Kietaibl
- From the Department of Anaesthesiology & Intensive Care, Evangelical Hospital Vienna and Sigmund Freud Private University Vienna, Austria (SK), Department of Anaesthesia and Critical Care, University Hospitals of Leicester NHS Trust (AAh), Department of Cardiovascular Sciences, University of Leicester, UK (AAh), Department of Paediatric and Obstetric Anaesthesia, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (AAf), Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark (AAf), Department of Anaesthesiology & Critical Care, CNRS/TIMC-IMAG UMR 5525/Themas, Grenoble-Alpes University Hospital, Grenoble, France (PA), Department of Anaesthesiology & Intensive Care, Hospital Universitario Rio Hortega, Valladolid, Spain (CA), Department of Surgery, Lithuanian University of Health Sciences, Kaunas, Lithuania (GB), Division of Anaesthesia, Analgesia, and Intensive Care - Department of Medicine and Surgery, University of Perugia, Italy (EDR), Department of Anesthesiology, Perioperative and Pain Medicine, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA (DFa), University of Medicine and Pharmacy Carol Davila, Department of Anaesthesiology & Intensive Care, Emergency Institute for Cardiovascular Disease, Bucharest, Romania (DCF), Department of Anaesthesia and Critical Care Medicine, Medical University Innsbruck, Innsbruck, Austria (DFr), Department of Anaesthesiology & Critical Care, APHP, Université Paris Cité, Paris, France (AG), Department of Anesthesiology, University of Florida, College of Medicine, Gainesville, Florida, USA (TH), Department of Anaesthesiology, Intensive Care and Pain Medicine, St.-Elisabeth-Hospital Straubing, Straubing, Germany (MJ), Department of Anaesthesiology, Medical College East Africa, The Aga Khan University, Nairobi, Kenya (MDL), Department of Anaesthesiology & Post-Surgical Intensive Care, University Hospital Doctor Peset, Valencia, Spain (JVL), Department of Anaesthesiology & Intensive Care, Johannes Kepler University, Linz, Austria (JM), Department of Anesthesiology & Intensive Care, Semmelweis University, Budapest, Hungary (ZM), Department of Anaesthesiology & Post-Surgical Intensive Care, University Trauma Hospital Vall d'Hebron, Barcelona, Spain (LM), Department of Anaesthesiology & Intensive Care, Franziskus Hospital, Bielefeld, Germany (NRM), Department of Anaesthesia, Intensive Care and Perioperative Medicine, GHU AP-HP. Centre - Université Paris Cité - Cochin Hospital, Paris, France (CMS), Department of Anaesthesiology and Intensive Care, Fundeni Clinical Institute, Bucharest and University of Medicine and Pharmacy Carol Davila, Bucharest, Romania (ES), Department of Anaesthesiology and Intensive Care Medicine, AUVA Trauma Centre Linz and Ludwig Boltzmann-Institute for Traumatology, The Research Centre in Co-operation with AUVA, Vienna, Austria (CS), Department of Anaesthesia and Intensive Care Medicine, Zealand University Hospital, Roskilde, Denmark (AW) and Department of Anaesthesiology, Intensive Care Medicine & Pain Therapy, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany (KZ)
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Pregnancy-Related Hysterectomy for Peripartum Hemorrhage: A Literature Narrative Review of the Diagnosis, Management, and Techniques. BIOMED RESEARCH INTERNATIONAL 2021; 2021:9958073. [PMID: 34307683 PMCID: PMC8282389 DOI: 10.1155/2021/9958073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 06/21/2021] [Indexed: 12/14/2022]
Abstract
Postpartum hemorrhage is a life-threatening situation, in which hysterectomy can be performed to prevent maternal death. However, it is associated with high rates of maternal morbidity and mortality and permanent infertility. The incidence of pregnancy-related hysterectomy varies across countries, but its main indications are the following: uterine atony and placenta spectrum (PAS) disorders. PAS disorder prevalence is rising during the last years, mainly due to the increased number of cesarean sections. As a result, obstetricians should be aware of the difficulties of this emergent condition and improve its accurate antenatal diagnosis rates, as well as its modern management strategies. Of course, special skills are required during a pregnancy-related hysterectomy, so these patients should be referred to centers of excellence in antenatal care, where a multidisciplinary team approach is followed. This study is a narrative review of the literature of the last 5 years (PubMed, Cochrane) regarding postpartum hemorrhage to offer obstetricians up-to-date knowledge on this pregnancy-related life-threatening issue. However, there is a lack of available high-quality data, because most published papers are retrospective case series or observational cohorts.
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Attali E, Many A, Kern G, Reicher L, Kahana A, Shemer A, Kagan G, Gamzu R, Yogev Y, Zakar L. Predicting the need for blood transfusion requirement in postpartum hemorrhage. J Matern Fetal Neonatal Med 2021; 35:7911-7916. [PMID: 34107848 DOI: 10.1080/14767058.2021.1937992] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE We aimed to assess the role of lactate and hemoglobin levels as predictors for the need for blood transfusion in post-partum hemorrhage (PPH). METHODS A retrospective cohort study of women with PPH in a single university-affiliated tertiary medical center between August 2018 and June 2020. PPH was defined as an estimated excessive blood loss (of more than 500 ml following vaginal delivery and 1000 ml following a cesarean delivery) requiring at least one uterotonic drug and fluid resuscitation. Women were stratified by the need of requiring blood transfusion due to hemorrhage. The criteria for blood transfusion were: (1) clinically severe uncontrollable ongoing hemorrhage; (2) symptomatic anemia (maternal tachycardia >110 beats per minute, dizziness, syncope or presyncope) in the presence of Hb 7-8 g/dL; or (3) postpartum Hb level < 7 g/dL regardless of maternal symptoms or signs of anemia. Demographic, labor characteristics as well as laboratory data were collected. For all women the Shock Index (SI: heart rate divided by systolic blood pressure) was calculated. Women without available data on immediate (more than 15 min from the bleeding initiation) hemoglobin (Hb) level and lactate concentrations were excluded. RESULTS Overall, out of 22,241 deliveries during the study, 94 women were included, of them 26 (23.4%) required blood transfusion. The antepartum Hb level was lower in the transfused group (11.7 ± vs 12.4 ± 1.0 re/dL, p = .01). No significant differences were found in demographic and labor characteristics. In multivariate logistic regression analysis, a lower immediate postpartum Hb and a higher SI higher were associated with blood transfusion requirement (adjusted odds ratio (aOR) 3.45 [CI] 1.82-7.69, p < .001] and aOR 1.25 [CI 1.03-1.55, p = .03], respectively). The combination of SI, immediate postpartum Hb and lactate concentration provided the best integration, with an area under the curve of 0.86, sensitivity 92.65%, specificity 61.54%, positive and negative predictive values of 86.3% and 76.2%, respectively. CONCLUSION The combination of SI, immediate postpartum Hb and lactate levels is a good predictor for the need of blood requirement in PPH.
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Affiliation(s)
- Emmanuel Attali
- Lis Hospital for Women, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ariel Many
- Lis Hospital for Women, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Guy Kern
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lee Reicher
- Lis Hospital for Women, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adiel Kahana
- Lis Hospital for Women, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Asaf Shemer
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Georgy Kagan
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Division of Anesthesiology, Pain and Critical Care, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Ronni Gamzu
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Yariv Yogev
- Lis Hospital for Women, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Liat Zakar
- Lis Hospital for Women, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Morau E, Ducloy JC, Le Roux S, Weber P, Dreyfus M. [Maternal deaths due to haemorrhage in France 2013-2015]. ACTA ACUST UNITED AC 2020; 49:60-66. [PMID: 33166700 DOI: 10.1016/j.gofs.2020.11.011] [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: 10/23/2022]
Abstract
Maternal death from haemorrhage is decreasing: in the last 15 years the number of deaths has been halved. This improvement demonstrates the progress made in hemorrhage management as a result of collective efforts. The number of deaths in this triennium is 22, representing 8.4% of maternal deaths and a maternal mortality ratio by haemorrhage of 1.0/100,000 live births. Nevertheless, there is a worrying proportion of deaths from occult haemorrhage. These occult haemorrhages most often occurred after caesarean sections. A lack of surveillance in the immediate follow-up was generally associated. One or more factors of sub-optimal care were present in 84% of the cases, and 88.9% of deaths were considered possibly or probably preventable. Delay in the diagnosis of haemorrhage, delay in surgical treatment, an insufficient transfusion strategy and inappropriate locations of care were the most frequently reported factors. The experts suggest that risk factors for haemorrhage should be identified in order to propose the most appropriate facility for childbirth. They encourage the strategies for early diagnosis of haemorrhage (attentive and regular monitoring, rapid haemoglobin measurement, abdominal ultrasound) and surgical intervention in case of hemoperitoneum.
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Affiliation(s)
- E Morau
- Service d'anesthésie-réanimation, CHU de Nîmes, place du Pr. Robert-Debré, 30029 Nîmes, France.
| | - J C Ducloy
- Hôpital privé Villeneuve d'Ascq, 20, avenue de la Reconnaissance, 59491 Villeneuve d'Ascq, France
| | - S Le Roux
- Maternité, CH Annecy-Genevois, 1, avenue de l'Hôpital, 74370 Epagny Metz-Tessy, France
| | - P Weber
- Service de gynéco-obstétrique, CHR Mulhouse Sud-Alsace, 87, avenue d'Altkirch, 68051 Mulhouse, France
| | - M Dreyfus
- Service gynécologie obstétrique et médecine de la reproduction, université de Caen, CHU de Caen, avenue Côte-de-Nacre, 14033 Caen cedex 09, France
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Peng Y, Jiang L, Peng C, Wu D, Chen L. The application of prophylactic balloon occlusion of the internal iliac artery for the treatment of placenta accreta spectrum with placenta previa: a retrospective case-control study. BMC Pregnancy Childbirth 2020; 20:349. [PMID: 32513127 PMCID: PMC7282070 DOI: 10.1186/s12884-020-03041-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 05/29/2020] [Indexed: 02/02/2023] Open
Abstract
Background Severe obstetric haemorrhage caused by placenta accreta spectrum (PAS) results in significant maternal morbidity and mortality. The effectiveness of prophylactic balloon occlusion of the internal iliac artery in PAS patients remains controversial. Therefore, we conducted a retrospective case-control study to investigate the clinical effectiveness of this treatment. Methods The clinical data of 104 patients with PAS complicated with placenta previa who delivered by caesarean section between January 2016 and January 2019 were collected, and the patients were divided into two groups. The study group (48 cases) underwent internal iliac artery preset balloon occlusion before caesarean section and uterine artery embolisation according to the bleeding status after surgery, while the control group (56 cases) did not undergo internal iliac artery preset balloon occlusion before caesarean section. Results The operation and hospitalisation times in the study group were longer than those in the control group. Additionally, the hysterectomy rate in the study group was significantly higher than that in the control group. No significant differences in blood loss, blood transfusion volume, urinary system injury, postoperative ICU transfer rate, or neonatal scores were identified between the groups. Among the patients without invasive placenta (placenta increta and percreta), blood loss was lower in the study group, and the caesarean hysterectomy rate did not significantly differ between the groups. Among the patients with invasive placenta, blood loss and the caesarean hysterectomy rate did not significantly differ between the groups. The risk of hysterectomy in the study group was related to invasive placenta penetration, a large area of placental invasion, or abnormal vascular filling. One patient in the study group had a thrombus in the left lower extremity artery. Conclusions Balloon occlusion of the internal iliac artery is effective for haemostasis of placenta previa in the absence of invasive placenta. For patients with invasive placenta, especially placenta percreta, a large area of placental invasion or abnormal vascular filling suggests the need for hysterectomy. The risks of the prophylactic use of internal iliac artery balloon occlusion include vascular injury and thrombus formation.
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Affiliation(s)
- Ying Peng
- Department of Obstetrics and Gynecology, First Affiliated Hospital of University of Science and Technology of China (Anhui Provincial Hospital, China), Hefei, 230001, Anhui Province, China.
| | - Lai Jiang
- Department of Obstetrics and Gynecology, First Affiliated Hospital of University of Science and Technology of China (Anhui Provincial Hospital, China), Hefei, 230001, Anhui Province, China
| | - Cheng Peng
- Department of Obstetrics and Gynecology, First Affiliated Hospital of University of Science and Technology of China (Anhui Provincial Hospital, China), Hefei, 230001, Anhui Province, China
| | - Dabao Wu
- Department of Obstetrics and Gynecology, First Affiliated Hospital of University of Science and Technology of China (Anhui Provincial Hospital, China), Hefei, 230001, Anhui Province, China
| | - Ling Chen
- Department of Obstetrics and Gynecology, First Affiliated Hospital of University of Science and Technology of China (Anhui Provincial Hospital, China), Hefei, 230001, Anhui Province, China
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