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Zhong X, Zhang P. Analysis of risk factors associated with different degrees of postpartum hemorrhage in patients with pregnancy-induced hypertension and construction of a prediction model using line graph. J Matern Fetal Neonatal Med 2023; 36:2239983. [PMID: 37558281 DOI: 10.1080/14767058.2023.2239983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 07/05/2023] [Accepted: 07/18/2023] [Indexed: 08/11/2023]
Abstract
OBJECTIVE This study aims to analyze the risk factors associated with different degrees of postpartum hemorrhage in patients with pregnancy-induced hypertension and construct a prediction model using line graph. METHODS The patients who were treated in our hospital for pregnancy-induced hypertension from January 2021 to December 2022 were enrolled as the study subjects. Their clinical data were collected, and the risk factors associated with postpartum hemorrhage in patients with pregnancy-induced hypertension were analyzed by single-factor and multi-factor logistic regression. The nomogram prediction model was constructed and validated internally, and the discrimination and consistency of the model were verified by the ROC curve and calibration graph. RESULTS In this experiment, 125 out of the 482 patients with hypertensive disorder complicating pregnancy experienced different degrees of postpartum hemorrhage, with an incidence of 25.93%. Multivariate Logistic regression analysis showed that patients with severe disease (OR = 2.454), the degree of proteinuria +++ or ++++ (OR = 6.754, 7.206), fetal body mass ≥4000 g (OR = 5.972), uterine atony (OR = 11.789), abnormal HDL-C (OR = 3.174), abnormal LDL-C (OR = 8.812), and abnormal VEGF (OR = 7.702) had a higher risk of postpartum hemorrhage (p < .05). The risk of postpartum hemorrhage was lower in patients with onset gestational week ≥28 weeks (OR = 0.158, 0.025) and delivery gestational week ≥28 weeks (OR = 0.085, 0.152) (p < .05). Columnar line graph models for postpartum hemorrhage in patients with gestational hypertension were constructed based on nine independent risk factors, and the model differentiation (AUC 0.912 and 0.919, respectively) and precision (goodness of fit HL χ2 = 8.441, p = .392, χ2 = 7.741, p = .459) were better in the modeling and validation groups. CONCLUSION The severity of disease, the gestational week upon onset, the gestational week upon delivery, the degree of proteinuria, systolic blood pressure, diastolic blood pressure, uterine atony, HDL-C, LDL-C, VEGF are factors affecting the incidence of postpartum hemorrhage in patients with hypertensive disorder complicating pregnancy. The prediction model based on the above factors can accurately evaluate the risk of different degrees of postpartum hemorrhage in patients with hypertensive disorder complicating pregnancy.
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Affiliation(s)
- Xiwen Zhong
- Department of Gynaecology and Obstetrics, Wenzhou Central Hospital, Wenzhou City, China
| | - Pingping Zhang
- Department of Gynaecology and Obstetrics, Wenzhou Central Hospital, Wenzhou City, China
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Muñoz Olarte M, Gómez Valdemoro M, Sáenz Pascual M, Laguna Olmos M, Ruiz Peña A. Síndrome de Klippel-Trenaunay en la gestación: a propósito de un caso y revisión de literatura reciente. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2023. [DOI: 10.1016/j.gine.2022.100799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Hofmann K, Macchiella D, Kloeckner R, Hasenburg A. Pregnancy management for a woman with extensive vulvar and pelvic malformations caused by Klippel–Trénaunay syndrome. Clin Case Rep 2022; 10:e6130. [PMID: 35898753 PMCID: PMC9309614 DOI: 10.1002/ccr3.6130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/30/2022] [Accepted: 07/13/2022] [Indexed: 01/19/2023] Open
Abstract
Klippel–Trénaunay syndrome (KTS) is a rare congenital disorder defined by a triad of capillary malformation, venous malformation, and soft tissue or bone hypertrophy most commonly affecting unilateral lower limbs. Due to the rarity of KTS, evidence‐based guidelines for the management of pregnancy in people with KTS are still lacking. A 34‐year‐old woman (gravidity 1; parity 0) presented at 25 weeks of gestation with malformations of the right side of her body. The extent of the KTS affecting the vulva, pelvis, and right leg was remarkable. As the prenatal MRI showed massive vascular malformations of the pelvis and vulva, we performed an elective cesarean section to avoid severe perinatal hemorrhage during a vaginal delivery. Intraoperatively, we observed varices on the parietal peritoneum within the vesico‐uterine pouch and the isthmocervical transition of the uterus, which were not identifiable in the preoperative MRI. Although KTS patients have been discouraged from pregnancy in the past because of a high risk for complications, successful and uncomplicated pregnancies are possible. For this purpose, we believe a multidisciplinary strategy that is crucial. To lower the risk for complications in pregnancies for people with excessive KTS, a multidisciplinary strategy including prenatal consultations with radiology, anesthesia, hemostaseology, and pediatrics is crucial.
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Affiliation(s)
- Konstantin Hofmann
- Department of Obstetrics and Gynecology University Medical Center of the Johannes Gutenberg‐University Mainz Mainz Germany
| | - Doris Macchiella
- Department of Obstetrics and Gynecology University Medical Center of the Johannes Gutenberg‐University Mainz Mainz Germany
| | - Roman Kloeckner
- Department of Diagnostic and Interventional Radiology University Medical Center of the Johannes Gutenberg‐University Mainz Mainz Germany
| | - Annette Hasenburg
- Department of Obstetrics and Gynecology University Medical Center of the Johannes Gutenberg‐University Mainz Mainz Germany
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Faisant MC, Legros L, Préaubert L, Forey PL, Blaise S, Equy V, Riethmuller D. [Management of pregnant woman with Klippel-Trenaunay syndrome: A rare and complex situation, about a case report]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2022; 50:563-565. [PMID: 35472443 DOI: 10.1016/j.gofs.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 02/27/2022] [Accepted: 04/02/2022] [Indexed: 06/14/2023]
Affiliation(s)
- M-C Faisant
- Département de gynécologie-obstétrique et médecine de la reproduction, CHU Grenoble-Alpes, Grenoble, France
| | - L Legros
- Département de gynécologie-obstétrique et médecine de la reproduction, CHU Grenoble-Alpes, Grenoble, France
| | - L Préaubert
- Département de gynécologie-obstétrique et médecine de la reproduction, CHU Grenoble-Alpes, Grenoble, France
| | - P-L Forey
- Département de gynécologie-obstétrique et médecine de la reproduction, CHU Grenoble-Alpes, Grenoble, France
| | - S Blaise
- Médecine vasculaire, CHU Grenoble-Alpes, Grenoble, France
| | - V Equy
- Département de gynécologie-obstétrique et médecine de la reproduction, CHU Grenoble-Alpes, Grenoble, France
| | - D Riethmuller
- Département de gynécologie-obstétrique et médecine de la reproduction, CHU Grenoble-Alpes, Grenoble, France.
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Cucinella G, Di Buono G, Geraci G, Ricupati F, Gullo G, Maienza E, Romano G, Bonventre G, Amato G, Romano G, Buscemi S, Agrusa A. Uterine Involvement in Klippel–Trenaunay Syndrome: A Rare But Relevant Event. Review of the Literature. Front Surg 2022; 9:893320. [PMID: 35647021 PMCID: PMC9133495 DOI: 10.3389/fsurg.2022.893320] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 04/18/2022] [Indexed: 01/19/2023] Open
Abstract
Introduction Klippel–Trenaunay syndrome (KTS) is a rare vascular congenital disorder characterized by the classical triad of port-wine stains, abnormal growth of soft tissues and bones, and vascular malformations. The involvement of the genitourinary tract and of the uterus in particular is extremely infrequent but relevant for possible consequences. Methods We performed an extensive review of the literature using the Pubmed, Scopus and ISI web of knowledge database to identify all cases of KTS with uterine involvement. The search was done using the MeSH term “Klippel–Trenaunay syndrome” AND “uterine” OR “uterus.” We considered publications only in the English language with no limits of time. We selected a total of 11 records of KTS with uterine involvement, including those affecting pregnant women. Results Klippel–Trenaunay syndrome was described for the first time in the year 1900 in two patients with hemangiomatous lesions of the skin associated with varicose veins and asymmetric soft tissue and bone hypertrophy. Uterine involvement is a rare condition and can cause severe menorrhagia. Diagnosis is based on physical signs and symptoms. CT scans and MRI are first-choice test procedures to evaluate both the extension of the lesion and the infiltration of deeper tissues before treatment. The management of Klippel–Trenaunay syndrome should be personalized using careful diagnosis, prevention and treatment of complications. Conclusion Klippel–Trenaunay syndrome is a rare vascular malformation with a wide variability of manifestations. There are no univocal and clear guidelines that suggest the most adequate monitoring of the possible complications of the disease. Treatment is generally conservative, but in case of recurrent bleeding, surgery may be needed.
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Affiliation(s)
- Gaspare Cucinella
- Obstetrics and Gynecology, “Villa Sofia Cervello” Hospital, University of Palermo, Palermo, Italy
| | - Giuseppe Di Buono
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
- Correspondence: Giuseppe Di Buono
| | - Girolamo Geraci
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Federica Ricupati
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Giuseppe Gullo
- Obstetrics and Gynecology, “Villa Sofia Cervello” Hospital, University of Palermo, Palermo, Italy
| | - Elisa Maienza
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Giorgio Romano
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Giulia Bonventre
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Giuseppe Amato
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Giorgio Romano
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Salvatore Buscemi
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Antonino Agrusa
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
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Benson E, Chen H, Nakhosteen A, Yoong W. Management of postpartum haemorrhage in a patient with Klippel-Trènaunay syndrome. BMJ Case Rep 2022; 15:e246601. [PMID: 35131786 PMCID: PMC8823054 DOI: 10.1136/bcr-2021-246601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2022] [Indexed: 01/19/2023] Open
Abstract
Klippel-Trènaunay syndrome is a rare congenital disorder characterised by vascular malformations, which may be exacerbated during pregnancy and pose considerable thromboembolic and haemorrhagic risk for obstetric patients. We report on a patient with this syndrome who underwent elective caesarean section which was indicated due to previous obstetric anal sphincter injury. We describe her multidisciplinary preoperative planning and successful management of major postpartum haemorrhage with uterine compression sutures and intrauterine balloon tamponade ('uterine sandwich').
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Affiliation(s)
- Emily Benson
- Obstetrics and Gynaecology, North Middlesex University Hospital NHS Trust Ferriman Information and Library Service, London, UK
| | - Huigen Chen
- St George's International School of Medicine, Grenada, UK
- North Middlesex University Hospital NHS Trust Ferriman Information and Library Service, London, UK
| | - Ali Nakhosteen
- Department of Radiology, North Middlesex University Hospital NHS Trust, London, UK
| | - Wai Yoong
- Obstetrics and Gynaecology, North Middlesex University Hospital NHS Trust Ferriman Information and Library Service, London, UK
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Yang H, Du B, Liu H, Yao Y, Li C. Case Report: Life-Threatening Post-operative Hemorrhage in Klippel-Trenaunay Syndrome Associated With Hypofibrinogenemia. Front Med (Lausanne) 2021; 8:669793. [PMID: 34434940 PMCID: PMC8380826 DOI: 10.3389/fmed.2021.669793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 07/12/2021] [Indexed: 01/19/2023] Open
Abstract
Klippel–Trenaunay Syndrome (KTS) is a rare congenital disorder, characterized by venous and lymphatic malformations of the skin, soft tissue, and bone, causing limb hypertrophy. Although, a ruptured hemorrhagic corpus luteum is a rare condition in women of reproductive age, it can result in lethal outcomes. Here, we have described a patient with KTS and hypofibrinogenemia who went through recurrent lethal postoperative bleeding due to a ruptured hemorrhagic corpus luteum. This case suggested that conservative therapy might be the first choice and effective therapy for the patients with KTS, who suffered from bleeding complications of surgical therapy.
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Affiliation(s)
- Hongna Yang
- Department of Critical-Care Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Binfeng Du
- Department of Critical-Care Medicine, Qilu Hospital of Shandong University, Shandong University, Jinan, China
| | - Han Liu
- Department of Critical-Care Medicine, Qilu Hospital of Shandong University, Shandong University, Jinan, China
| | - Yong Yao
- Department of Critical-Care Medicine, Qilu Hospital of Shandong University, Shandong University, Jinan, China
| | - Chen Li
- Department of Critical-Care Medicine, Qilu Hospital of Shandong University, Shandong University, Jinan, China
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Abstract
Vascular anomalies, comprised of vascular tumors and malformations, are frequently associated with coagulopathy. Recognition of and familiarity with these vascular anomaly-associated hematologic abnormalities prior to surgery or interventional procedures is essential for pre-operative pre-operative planning. Complicated coagulopathies present within the framework of either Kasabach-Merritt phenomenon (KMP) or localized intravascular coagulopathy (LIC), and their management benefits from the expertise of a hematologist for optimal intra- and peri‑operative care. Furthermore, with the recent broadening of understanding of vascular anomalies and the addition of new classification sub-groups, distinctions of these two classic coagulopathy phenotypes have been recognized. This review summarizes the main features of these coagulopathies, described according to their vascular anomaly type, highlighting clinical aspects relevant to surgical management.
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Affiliation(s)
- Kiersten W Ricci
- Hemangioma and Vascular Malformation Center, Division of Hematology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue, MLC 7015, Cincinnati 45229, OH, United States.
| | - Leonardo R Brandão
- The Hospital for Sick Children, Division of Haematology-Oncology, Toronto, Ontario, Canada
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Fang X, Zhang W, Yu Z, Kuang F, Huang B, Duan H. Periosteal new bone formation in Klippel-Trénaunay syndrome: a case report. BMC Pediatr 2020; 20:388. [PMID: 32814548 PMCID: PMC7437036 DOI: 10.1186/s12887-020-02298-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 08/13/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Klippel-Trénaunay syndrome (KTS) is a complex congenital vascular disorder, typically accompanied by port-wine stains, varicose veins, and limb hypertrophy. This paper reports a rare and unusual clinical condition of periosteal reaction in a pediatric case of KTS. Although periosteal new bone formation is not rare in children, as is KTS, their dual occurrence or the presentation of the former due to KTS has not been previously documented. Our objective in this study is to highlight the potential association between periosteal new bone formation and KTS, as well as to help physicians consider this association when bone neoplasm has been ruled out. CASE PRESENTATION A 7-year old girl, initially presented with a persistent mild swelling in her left shank, with no abnormalities in the X-ray of the tibiofibular. However, after a few consults and examinations, 7 weeks later, a 17 cm-long periosteal new bone formation along the left tibia and diffused dilated vessels in the left shank were revealed by the radiological examination. Not knowing the true nature of the fast-growing lesion in a typical case of KTS was worrying. Therefore, a core needle biopsy was performed. The test demonstrated a possible parosteal hemangioma. Following further investigation through an excisional biopsy, and a pathological analysis, hyperplasia of the bone tissues with no tumor cells was revealed. Thereafter, an elastic stocking treatment was prescribed. During the first two-year follow-up, recurrence of the mass or sign of progression of KTS was not observed. CONCLUSIONS Periosteal new bone formation is a potential manifestation of KTS. Based on the conclusive pathological results of the excisional biopsy, invasive examinations and surgeries could be avoided in future KTS-subperiosteal lesion manifestations.
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Affiliation(s)
- Xiang Fang
- Department of Orthopedics, West China Hospital, Sichuan University, 37 Guo Xue Lane, 610064, Chengdu, Sichuan, People's Republic of China
| | - Wenli Zhang
- Department of Orthopedics, West China Hospital, Sichuan University, 37 Guo Xue Lane, 610064, Chengdu, Sichuan, People's Republic of China
| | - Zeping Yu
- Department of Orthopedics, West China Hospital, Sichuan University, 37 Guo Xue Lane, 610064, Chengdu, Sichuan, People's Republic of China
| | - Fuguo Kuang
- Department of Orthopedics, People's Fourth Hospital of Sichuan Province, Chengdu, Sichuan, People's Republic of China
| | - Bin Huang
- Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Hong Duan
- Department of Orthopedics, West China Hospital, Sichuan University, 37 Guo Xue Lane, 610064, Chengdu, Sichuan, People's Republic of China.
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