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Kim SM, Sohn CH, Kwon H, Ryoo SM, Ahn S, Seo DW, Kim WY. Thromboelastography as an early prediction method for hypofibrinogenemia in emergency department patients with primary postpartum hemorrhage. Scand J Trauma Resusc Emerg Med 2024; 32:85. [PMID: 39272172 PMCID: PMC11401245 DOI: 10.1186/s13049-024-01263-5] [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: 05/13/2024] [Accepted: 09/06/2024] [Indexed: 09/15/2024] Open
Abstract
BACKGROUND Timely and accurate assessment of coagulopathy is crucial for the management of primary postpartum hemorrhage (PPH). Thromboelastography (TEG) provides a comprehensive assessment of coagulation status and is useful for guiding the treatment of hemorrhagic events in various diseases. This study aimed to evaluate the role of TEG in predicting hypofibrinogenemia in emergency department (ED) patients with primary PPH. METHODS We conducted a retrospective observational study in the ED of a university-affiliated tertiary hospital between November 2015 and August 2023. TEG was performed upon admission. The cutoff value for hypofibrinogenemia was 200 mg/dL. The primary outcome was the presence of hypofibrinogenemia. RESULTS Among the 174 patients, 73 (42.0%) had hypofibrinogenemia. The need for massive transfusion was higher in the hypofibrinogenemia group (37.0% vs. 5.0%, p < 0.001). Among the TEG parameters, all values were significantly different between the groups, except for lysis after 30 min, suggesting a tendency toward hypocoagulability. Multivariable analysis revealed that the alpha angle (odds ratio (OR) 0.924, 95% confidence interval (CI) 0.876-0.978) and maximum amplitude (MA) (OR 0.867, 95% CI 0.801-0.938) were independently associated with hypofibrinogenemia. The optimal cutoff values for the alpha angle and maximum amplitude (MA) for hypofibrinogenemia were 63.8 degrees and 56.1 mm, respectively. CONCLUSION Point-of-care TEG could be a valuable tool for the early identification of hypofibrinogenemia in ED patients with primary PPH.
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Affiliation(s)
- Sang-Min Kim
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Chang Hwan Sohn
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| | - Hyojeong Kwon
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seung Mok Ryoo
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Shin Ahn
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Dong Woo Seo
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Won Young Kim
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Hasegawa J, Sekizawa A, Tanaka H, Katsuragi S, Tanaka K, Nakata M, Hayata E, Murakoshi T, Ishiwata I, Ikeda T. Infection route associated with invasive group A streptococcal toxic shock syndrome in maternal deaths: Nationwide analysis of maternal mortalities in Japan. Int J Infect Dis 2024; 146:107154. [PMID: 38936654 DOI: 10.1016/j.ijid.2024.107154] [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: 05/08/2024] [Revised: 06/20/2024] [Accepted: 06/22/2024] [Indexed: 06/29/2024] Open
Abstract
OBJECTIVES To clarify the infection route in maternal death due to invasive group A streptococcal (GAS) infection and toxic shock syndrome (TSS). METHODS A retrospective study was conducted on maternal deaths due to GAS-TSS in Japan between January 2010 and March 2024. The final causal diagnosis of maternal death and the infection routes of GAS were analysed using medical records, laboratory data and autopsy findings. RESULTS Among the 616 maternal deaths during the study period, 48 (8%) involved infectious diseases. The most common infection was invasive GAS (56%, n = 27), 21 (78%) and six cases occurred during the antepartum and puerperium periods, respectively. In the GAS-TSS group, 71% (15/21) infections were originated the upper respiratory tract. However, in the puerperium cases, 67% (4/6) were infected from the genital tract. In addition, no maternal deaths due to GAS-TSS were reported during the COVID-19 pandemic period in Japan from 2020 to 2023. CONCLUSION Most antepartum GAS infections were from the upper respiratory tract. They may be reduced by preventive measures, including frequent disinfection, wearing masks and isolation from persons at high risk of carrying GAS, such as symptomatic children. On the other hand, GAS-TSS during puerperium infection via the genital tract.
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Affiliation(s)
- Junichi Hasegawa
- Department of Perinatal Developmental Pathophysiology, St. Marianna University Graduate School of Medicine, Kawasaki, Japan.
| | - Akihiko Sekizawa
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Hiroaki Tanaka
- Department of Obstetrics and Gynecology, Kumamoto General Hospital, Kumamoto, Japan
| | - Shinji Katsuragi
- Department of Obstetrics and Gynaecology, Miyazaki University School of Medicine, Miyazaki, Japan
| | - Kayo Tanaka
- Department of Obstetrics and Gynecology, Kumamoto General Hospital, Kumamoto, Japan
| | - Masahiko Nakata
- Department of Obstetrics and Gynecology, Toho University Faculty of Medicine, Tokyo, Japan
| | - Eijiro Hayata
- Department of Obstetrics and Gynecology, Toho University Faculty of Medicine, Tokyo, Japan
| | - Takeshi Murakoshi
- Division of Perinatology, Maternal and Perinatal Care Center, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Isamu Ishiwata
- Ishiwata Obstetrics and Gynecology Hospital, Ibaraki, Japan
| | - Tomoaki Ikeda
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Mie, Japan
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Nakamura M, Sekizawa A, Hasegawa J, Nakata M, Katsuragi S, Tanaka H, Murakoshi T, Kanayama N, Ishiwata I, Ikeda T. Relationship between maternal mortality and ritodrine hydrochloride as a tocolytic agent in Japan. J Obstet Gynaecol Res 2024; 50:1111-1117. [PMID: 38627884 DOI: 10.1111/jog.15951] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 04/03/2024] [Indexed: 07/10/2024]
Abstract
AIM In Japan, unlike Western countries, tocolytic agents are administered in long-term protocols to treat threatened preterm labor. Evaluating the side effects of this practice is crucial. We examined whether ritodrine hydrochloride had been administered in cases of maternal death, aiming to investigate any relationship between ritodrine administration and maternal death. METHODS This retrospective cohort study used reports of maternal deaths from multiple institutions in Japan between 2010 and 2020. Data on the reported cases were retrospectively analyzed, and data on the route of administration, administered dose, and clinical findings, including causes of maternal death, were extracted. The amount of tocolytic agents was compared between maternal deaths with ritodrine administration and those without. RESULTS A total of 390 maternal deaths were reported to the Maternal Death Exploratory Committee in Japan during the study period. Ritodrine hydrochloride was administered in 32 of these cases. The frequencies (n) and median doses (range) of oral or intravenous ritodrine hydrochloride were 34.4% (11) and 945 (5-2100) mg and 84.4% (27) and 4032 (50-18 680) mg, respectively. Frequencies of perinatal cardiomyopathy, cerebral hemorrhage, diabetic ketoacidosis, and pulmonary edema as causes of maternal death were significantly higher with ritodrine administration than without it. CONCLUSIONS Our results suggest a relationship between long-term administration of ritodrine hydrochloride and an increased risk of maternal death due to perinatal cardiomyopathy, cerebral hemorrhage, diabetic ketoacidosis, and pulmonary edema. In cases where ritodrine should be administered to prevent preterm labor, careful management and monitoring of maternal symptoms are required.
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Affiliation(s)
- Masamitsu Nakamura
- Department of Obstetrics and Gynecology, Fujita Health University, Aichi, Japan
| | - Akihiko Sekizawa
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Junichi Hasegawa
- Department of Obstetrics and Gynecology, St. Marianna School of Medicine, Kanagawa, Japan
| | - Masahiko Nakata
- Department of Obstetrics and Gynecology, Toho University School of Medicine, Tokyo, Japan
| | - Shinji Katsuragi
- Department of Obstetrics and Gynecology, Miyazaki University, Miyazaki, Japan
| | - Hiroaki Tanaka
- Department of Obstetrics and Gynecology, Mie University, Mie, Japan
| | - Takeshi Murakoshi
- Division of Perinatology, Maternal and Perinatal Care Center, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Naohiro Kanayama
- University President, Shizuoka College of Medical Science, Hamamatsu, Japan
| | - Isamu Ishiwata
- Ishiwata Obstetrics and Gynecologic Hospital, Ibaraki, Japan
| | - Tomoaki Ikeda
- Department of Obstetrics and Gynecology, Mie University, Mie, Japan
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Kim SM, Sohn CH, Kwon H, Ryoo SM, Ahn S, Seo DW, Kim WY. Prognostic Role of Initial Thromboelastography in Emergency Department Patients with Primary Postpartum Hemorrhage: Association with Massive Transfusion. J Pers Med 2024; 14:422. [PMID: 38673049 PMCID: PMC11050950 DOI: 10.3390/jpm14040422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 04/14/2024] [Accepted: 04/15/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND The early prediction of the need for massive transfusions (MTs) and the preparation of blood products are essential for managing patients with primary postpartum hemorrhage (PPH). Thromboelastography (TEG) enables a thorough evaluation of coagulation status and is useful for guiding the treatment of hemorrhagic events in various diseases. We investigated the role of TEG in predicting the need for MT in patients with primary PPH. METHODS A retrospective observational study was conducted in the emergency department (ED) of a university-affiliated, tertiary referral center between November 2015 and August 2023. TEG was performed upon admission. We defined MT as the requirement for transfusion of more than 10 units of packed red blood cells within the first 24 h. The primary outcome was the need for MT. RESULTS Among the 184 patients with initial TEG, 34 (18.5%) required MT. Except for lysis after 30 min, the MT and non-MT groups had significantly different TEG values. Based on multivariate analysis, an angle < 60 was an independent predictor of MT (odds ratio (OR) 7.769; 95% confidence interval (CI), 2.736-22.062), along with lactate (OR, 1.674; 95% CI, 1.218-2.300) and shock index > 0.9 (OR, 4.638; 95% CI, 1.784-12.056). Alpha angle < 60 degrees indicated the need for MT with 73.5% sensitivity, 72.0% specificity, and 92.3% negative predictive value. CONCLUSIONS Point-of-care testing of TEG has the potential to be a useful tool in accurately predicting the necessity for MT in ED patients with primary PPH at an early stage.
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Affiliation(s)
| | - Chang Hwan Sohn
- Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05519, Republic of Korea; (S.M.K.); (H.K.); (S.M.R.); (S.A.); (D.W.S.); (W.Y.K.)
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Miyamoto K, Komatsu H, Okawa M, Iida Y, Osaku D, Azuma Y, Tsuneto T, Harada T, Taniguchi F, Harada T. D-dimer level significance for deep vein thrombosis screening in the third trimester: a retrospective study. BMC Pregnancy Childbirth 2022; 22:21. [PMID: 34996371 PMCID: PMC8742329 DOI: 10.1186/s12884-021-04353-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 12/20/2021] [Indexed: 12/01/2022] Open
Abstract
Background Venous thromboembolism often develops after surgery and childbirth, resulting in death in some cases. Although early deep vein thrombosis (DVT) detection can predict pulmonary thromboembolism, there is no early screening method for DVT in pregnant women. Lack of consensus regarding significance or setting and cut-off value interpretation of D-dimer levels further impedes venous thromboembolism screening in pregnant women. This study aimed to examine the utility of third-trimester serum D-dimer levels as a screening test for DVT during pregnancy and to determine the frequency of asymptomatic DVT using lower-limb compression ultrasonography. Methods This single-center retrospective study included 497 pregnant women who underwent elective cesarean section at term in our hospital between January 2013 and December 2019. Serum D-dimer levels were preoperatively measured at 32–37 weeks’ gestation. The presence or absence of DVT in patients with serum D-dimer levels ≥ 3.0 µg/ml, the cut-off value, was examined using compression ultrasonography. In all patients, the presence or absence of clinical venous thrombosis (symptoms such as lower-limb pain, swelling, and heat sensation) was examined within 4 postoperative weeks. The Royal College of Obstetricians and Gynecologists Guideline 2015 was referred to determine risk factors for the onset of venous thrombosis during pregnancy. Among those, we examined the risk factors for DVT that result in high D-dimer levels during pregnancy. Results The median age and body mass index were 35 (20–47) years and 21.2 (16.4–41.1) kg/m2, respectively. Further, the median gestational age and D-dimer levels were 37 weeks and 2.1 (0.2–16.0) µg/ml, respectively. Compression ultrasonography was performed on 135 (26.5%) patients with a D-dimer level ≥ 3.0 µg/ml, with none of the patients showing DVT. All patients were followed up for 4 postoperative weeks, with none presenting with venous thromboembolism. Multivariate analysis showed that hypertensive disorders of pregnancy are an independent risk factor for venous thromboembolism that causes high D-dimer levels (odds ratio: 2.48, 95% confidence interval: 1.05–6.50, P = 0.04). Conclusion There may be low utility in screening for DVT using D-dimer levels in the third trimester. Further, prepartum asymptomatic DVT has a low frequency, indicating the low utility of compression ultrasonography. Trial registration Institutional Review Board of Tottori University Hospital (IRB no. 20A149).
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Affiliation(s)
- Keisuke Miyamoto
- Department of Obstetrics and Gynecology, Tottori University School of Medicine, 36-1 Nishicho, 683-8504, Tottori Prefecture, Yonago, Japan
| | - Hiroaki Komatsu
- Department of Obstetrics and Gynecology, Tottori University School of Medicine, 36-1 Nishicho, 683-8504, Tottori Prefecture, Yonago, Japan.
| | - Masayo Okawa
- Department of Obstetrics and Gynecology, Tottori University School of Medicine, 36-1 Nishicho, 683-8504, Tottori Prefecture, Yonago, Japan
| | - Yuki Iida
- Department of Obstetrics and Gynecology, Tottori University School of Medicine, 36-1 Nishicho, 683-8504, Tottori Prefecture, Yonago, Japan
| | - Daiken Osaku
- Department of Obstetrics and Gynecology, Tottori University School of Medicine, 36-1 Nishicho, 683-8504, Tottori Prefecture, Yonago, Japan
| | - Yukihiro Azuma
- Department of Obstetrics and Gynecology, Tottori University School of Medicine, 36-1 Nishicho, 683-8504, Tottori Prefecture, Yonago, Japan
| | - Takako Tsuneto
- Department of Obstetrics and Gynecology, Tottori University School of Medicine, 36-1 Nishicho, 683-8504, Tottori Prefecture, Yonago, Japan
| | - Takashi Harada
- Department of Obstetrics and Gynecology, Tottori University School of Medicine, 36-1 Nishicho, 683-8504, Tottori Prefecture, Yonago, Japan
| | - Fuminori Taniguchi
- Department of Obstetrics and Gynecology, Tottori University School of Medicine, 36-1 Nishicho, 683-8504, Tottori Prefecture, Yonago, Japan
| | - Tasuku Harada
- Department of Obstetrics and Gynecology, Tottori University School of Medicine, 36-1 Nishicho, 683-8504, Tottori Prefecture, Yonago, Japan
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Takahashi M, Takeda J, Haneda S, Ishii S, Shinohara M, Yoshida E, Sato A, Makino S, Itakura A. "Step-by-Step" Minimally Invasive Hemostatic Technique Using Intrauterine Double-Balloon Tamponade Combined with Uterine Isthmus Vertical Compression Suture for the Control of Placenta Accreta and Severe Atonic Hemorrhage during a Cesarean Section. Surg J (N Y) 2021; 7:e216-e221. [PMID: 34466659 PMCID: PMC8390297 DOI: 10.1055/s-0041-1733990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 06/28/2021] [Indexed: 11/30/2022] Open
Abstract
A sudden onset of postpartum hemorrhage (PPH) during a cesarean delivery requires urgent hemostasis procedures, such as the B-Lynch, Hayman, or double-vertical compression sutures, when bimanual compression, uterotonic agent administration, and intrauterine balloon tamponade had failed to achieve sufficient hemostasis. However, after invasive hemostatic procedures, postoperative complications, including subsequent synechiae and infection followed by ischemia, have been reported to occur even in successful cases. To avoid these complications, we devised and performed a minimally invasive combined technique based on a “step-by-step” minimally invasive hemostatic protocol for a case of placenta accreta and severe atonic hemorrhage during a cesarean delivery. A nullipara woman with a history of systemic lupus erythematosus and treatment with prednisolone and tacrolimus underwent a cesarean section because of a nonreassuring fetal status. Severe atonic hemorrhage and placenta accreta were observed which did not respond to bimanual compression and uterotonics. Because severe uterine atony and continuous bleeding from the placental attachment area were observed even with intrauterine balloon tamponade, vertical compression sutures were placed in the uterine isthmus. However, severe uterine atony and atonic bleeding from the uterine corpus persisted; thus, a second balloon was inserted into the uterine corpus. Hemostasis was accomplished with a combination of isthmus vertical compression sutures and double balloons which is a less-invasive approach than existing compression techniques. No complications related to these procedures were observed. This step-by-step minimally invasive hemostatic technique has the potential to control PPH with less complications, especially in immunocompromised patients.
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Affiliation(s)
- Masaya Takahashi
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Jun Takeda
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Sumie Haneda
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Sumire Ishii
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Mitsuko Shinohara
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Emiko Yoshida
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Anna Sato
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Shintaro Makino
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Atsuo Itakura
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
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Donders G, Greenhouse P, Donders F, Engel U, Paavonen J, Mendling W. Genital Tract GAS Infection ISIDOG Guidelines. J Clin Med 2021; 10:jcm10092043. [PMID: 34068785 PMCID: PMC8126195 DOI: 10.3390/jcm10092043] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 04/18/2021] [Accepted: 04/23/2021] [Indexed: 02/07/2023] Open
Abstract
There has been an increasing worldwide incidence of invasive group A streptococcal (GAS) disease in pregnancy and in the puerperal period over the past 30 years. Postpartum Group A streptococci infection, and in particular streptococcal toxic shock syndrome (TSS) and necrotizing fasciitis, can be life threatening and difficult to treat. Despite antibiotics and supportive therapy, and in some cases advanced extensive surgery, mortality associated with invasive group A streptococcal postpartum endometritis, necrotizing fasciitis, and toxic shock syndrome remains high, up to 40% of postpartum septic deaths. It now accounts for more than 75,000 deaths worldwide every year. Postpartum women have a 20-fold increased incidence of GAS disease compared to non-pregnant women. Despite the high incidence, many invasive GAS infections are not diagnosed in a timely manner, resulting in potentially preventable maternal and neonatal deaths. In this paper the specific characteristics of GAS infection in the field of Ob/Gyn are brought to our attention, resulting in guidelines to improve our awareness, early recognition and timely treatment of the disease. New European prevalence data of vaginal GAS colonization are presented, alongside two original case histories. Additionally, aerobic vaginitis is proposed as a supplementary risk factor for invasive GAS diseases.
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Affiliation(s)
- Gilbert Donders
- Femicare, Clinical Research for Women, 3300 Tienen, Belgium;
- Department of Obstetrics and Gynecology, University Hospital Antwerp, 2000 Antwerp, Belgium
- Regional Hospital H Hart, 3300 Tienen, Belgium
- Correspondence: ; Tel.: +32-38-214413
| | | | | | - Ulrike Engel
- Department of Ob/Gyn Maternité, Centre Hospitalier, 1210 Luxembourg, Luxembourg;
| | - Jorma Paavonen
- Department of Obstetrics and Gynecology, Helsinki University Hospital, 00260 Helsinki, Finland;
| | - Werner Mendling
- German Centre for Infections in Gynaecology and Obstetrics, St. Anna Hospital, 42109 Wuppertal, Germany;
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Wakasa T, Ishibashi‐Ueda H, Takeuchi M. Maternal death analysis based on data from the nationwide registration system in Japan (2010-2018). Pathol Int 2021; 71:223-231. [PMID: 33559265 PMCID: PMC8248185 DOI: 10.1111/pin.13076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 01/19/2021] [Indexed: 12/12/2022]
Abstract
The maternal mortality rate in Japan was 3.5 per 100 000 live births in 2017, similar to that reported in other developed countries. To reduce the number of maternal deaths, a Japanese nationwide registration and analysis system was implemented in 2010. Between January 2010 and April 2018, 367 maternal deaths were reported. Among them, by reviewing 80 autopsy records, the direct obstetric causes of death were identified in 52 women. The major causes of deaths were amniotic fluid embolism and acute pulmonary thromboembolism. The other 26 maternal deaths were associated with indirect obstetric causes including invasive Group A Streptococcus infection, aortic dissection, cerebral stroke and cardiomyopathies. This review highlights the importance of autopsy in maternal deaths. On analyzing 42 autopsy specimens obtained from registered cases of maternal death during 2012-2015, the 36% of causes of death by autopsy were discordant with the clinical diagnosis. Moreover, of the 38% of non-autopsied maternal death, the cause of death could not be clarified from the clinical chart. We emphasized that detailed autopsies are necessary to clarify the precise pathologic evidence related to pregnancy and delivery, especially causes of unexpected death such as amniotic fluid embolism.
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Affiliation(s)
- Tomoko Wakasa
- Department of Diagnostic Pathology, Nara HospitalKindai UniversityNaraJapan
| | | | - Makoto Takeuchi
- Department of PathologyOsaka Women's and Children's HospitalOsakaJapan
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Hashii K, Yamahata Y, Suzuki T. Evaluation and care protocol for maternal emergencies: the basic J-CIMELS protocol derived from the Kyoto protocol. HYPERTENSION RESEARCH IN PREGNANCY 2020. [DOI: 10.14390/jsshp.hrp2019-018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Koji Hashii
- Department of Obstetrics and Gynecology, Hashii Clinic of Obstetrics and Gynecology
| | - Yoshihiro Yamahata
- Department of Emergency and Disaster Medicine, Kyoto Prefectural University of Medicine, Graduate School of Medical Science
| | - Takao Suzuki
- Department of Emergency and Critical Care Medicine, Hyogo Prefectural Amagasaki General Medical Center
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10
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Okada A, Okada Y, Inoue M, Narumiya H, Nakamoto O. Lactate and fibrinogen as good predictors of massive transfusion in postpartum hemorrhage. Acute Med Surg 2019; 7:e453. [PMID: 31988765 PMCID: PMC6971467 DOI: 10.1002/ams2.453] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 07/30/2019] [Indexed: 11/12/2022] Open
Abstract
Aim This study aims to identify the clinical factors that can predict the requirement of massive transfusion among patients with postpartum hemorrhage (PPH). Methods Consecutive anonymized patients with PPH who were treated at the emergency department of our perinatal medical center were examined. Patients who had received transfusions before admission, those who had cardiac arrest on arrival, and those without history of blood gas analysis were excluded. Our primary outcome was the requirement of massive transfusion defined as packed red blood cells of ≥10 units/24 h. Univariable logistic analysis was carried out to identify the odds ratio and 95% confidence interval (CI) of the explanatory variables for the outcome. Results A total of 31 patients (massive transfusion, n = 19) were included in the main analysis. The crude odds ratio for fibrinogen per mg/dL and lactate per mmol/L were calculated as 0.98 (95% CI, 0.97–0.99) and 1.62 (95% CI, 1.08–3.02), respectively. The area under the curves for fibrinogen and lactate were 0.814 and 0.734, respectively, and optimal cut‐off values for fibrinogen and lactate were 211 mg/dL and 4 mmol/L, respectively. Conclusion These findings suggest that lactate and fibrinogen can be predictors for the requirement of massive transfusion in patients with PPH.
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Affiliation(s)
- Asami Okada
- Department of Emergency Medicine and Clinical Care Japanese Red Cross Society Kyoto Daini Red Cross Hospital Kyoto Japan.,Department of Obstetrics Osaka City General Hospital Osaka-shi Japan
| | - Yohei Okada
- Department of Emergency Medicine and Clinical Care Japanese Red Cross Society Kyoto Daini Red Cross Hospital Kyoto Japan
| | - Motoi Inoue
- Department of Obstetrics Osaka City General Hospital Osaka-shi Japan
| | - Hiromichi Narumiya
- Department of Emergency Medicine and Clinical Care Japanese Red Cross Society Kyoto Daini Red Cross Hospital Kyoto Japan
| | - Osamu Nakamoto
- Department of Obstetrics Osaka City General Hospital Osaka-shi Japan
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11
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Takeda J, Takeda S. Adding "pregnancy" to the Centor score, aim to reduce maternal death. J Infect Chemother 2019; 25:835. [PMID: 31358434 DOI: 10.1016/j.jiac.2019.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 07/11/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Jun Takeda
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan.
| | - Satoru Takeda
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
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12
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Hasegawa J, Katsuragi S, Tanaka H, Kurasaki A, Nakamura M, Murakoshi T, Nakata M, Kanayama N, Sekizawa A, Isamu I, Kinoshita K, Ikeda T. Decline in maternal death due to obstetric haemorrhage between 2010 and 2017 in Japan. Sci Rep 2019; 9:11026. [PMID: 31363105 PMCID: PMC6667693 DOI: 10.1038/s41598-019-47378-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 07/16/2019] [Indexed: 11/16/2022] Open
Abstract
This descriptive study was based on the maternal death registration system established by the Japan Association of Obstetricians and Gynecologists and the Maternal Death Exploratory Committee (JMDEC). 361 women died during pregnancy or within 42 days after delivery between January 2010 and June 2017 throughout Japan were analysed, in order to investigate the trend in maternal deaths related to obstetric medical practice. Reports of maternal death were consistent, ranging from 45 cases in 2010 to 44 cases in 2017. Among all maternal deaths, the frequency of deaths due to obstetric haemorrhage ranged from 29% (2010) to 7% (2017) (p < 0.001). The causes of obstetric haemorrhage have progressively reduced, especially maternal deaths due to uterine inversion and laceration have not occurred since 2014. The remaining causes of obstetric haemorrhage-related maternal deaths were placenta accreta spectrum, placental abruption, and severe forms of uterine focused amniotic fluid embolism. We believe the activities of the JMDEC including annual recommendations and simulation programs are improving the medical practices of obstetric care providers in Japan, resulting in a reduction of maternal deaths due to obstetric haemorrhage.
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Affiliation(s)
- Junichi Hasegawa
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kanagawa, Japan.
| | - Shinji Katsuragi
- Department of Obstetrics and Gynecology, Sakakibara Heart Institute, Tokyo, Japan
| | - Hiroaki Tanaka
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Mie, Japan
| | - Akiko Kurasaki
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Masamitsu Nakamura
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Takeshi Murakoshi
- Division of Perinatology, Maternal and Perinatal Care Center, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Masahiko Nakata
- Department of Obstetrics and Gynecology, Toho University School of Medicine, Tokyo, Japan
| | - Naohiro Kanayama
- Department of Obstetrics and Gynaecology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Akihiko Sekizawa
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Ishiwata Isamu
- Ishiwata Obstetrics and Gynecology Hospital, Ibaraki, Japan
| | | | - Tomoaki Ikeda
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Mie, Japan
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13
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Furukawa S, Fujisaki M, Maki Y, Oohashi M, Doi K, Sameshima H. Manual removal of placenta in women having unpredictable adherent placenta. J Obstet Gynaecol Res 2018; 45:141-147. [PMID: 30230145 DOI: 10.1111/jog.13805] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 08/10/2018] [Indexed: 11/30/2022]
Abstract
AIM Our aim is to provide expected outcomes for undergoing manual removal of placenta (MROP) following vaginal delivery in women having an unpredictable adherent placenta (AP). METHODS The data were obtained from four hospitals in Miyazaki Prefecture, Japan. We used propensity score-matched (1:1) analysis to match women who underwent MROP with women who did not undergo MROP (control). Total blood loss and hemorrhagic rate used as a ratio of women who reached a certain amount of blood loss were compared. Subgroup analysis was undertaken and was dependent on the presence of AP. We found the cut-off value of blood loss for detecting AP. RESULTS Thirty-seven MROP cases were identified. Total blood loss and hemorrhagic rate differed significantly between MROP cases and controls; 95% of controls had blood loss of 1000 mL or less, whereas for the MROP cases, it was 14%. Fourteen MROP cases were diagnosed with AP. The hemorrhagic rate differed significantly between MROP cases with and without AP (n = 19); 79% of MROP cases without AP had blood loss of 2000 mL or less, whereas for the MROP cases with AP, it was 7%. There were seven incidents of hysterectomy and two of arterial embolization in MROP cases with AP. Through receiver operating characteristic curve analysis, 2035 mL of blood loss was determined to be the optimal cut-off value for detecting AP. CONCLUSION The incidence of unpredictable AP in MROP cases was as high as 38%. The morbidity of MROP cases with unpredictable AP was severe. MROP should be prohibited in the absence of appropriate hemostatic preparations.
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Affiliation(s)
- Seishi Furukawa
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Midori Fujisaki
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Yohei Maki
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Masanao Oohashi
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Koutarou Doi
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Hiroshi Sameshima
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
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14
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Tanaka H, Katsuragi S, Hasegawa J, Osato K, Nakata M, Murakoshi T, Sekizawa A, Kanayama N, Ishiwata I, Ikeda T. Relationship between reproductive medicine for women with severe complications and maternal death in Japan. J Obstet Gynaecol Res 2018; 45:164-167. [PMID: 30117233 DOI: 10.1111/jog.13787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 07/20/2018] [Indexed: 11/29/2022]
Abstract
AIM To investigate the influence of reproductive medicine in maternal death cases in Japan. METHODS This retrospective study investigated the incidence of maternal deaths related to reproductive medicine in Japan from 2013 to 2015, and the relationship between fertility treatment and maternal death. RESULTS Fifteen out of 134 women (11.2%) involved in this study who underwent treatment for infertility died. Four experienced pregnancy with severe maternal complications (26.6%). The complications were active systemic lupus erythematosus, exacerbated depression, uncontrolled arrhythmia and uncontrolled type 2 diabetes mellitus. At least three of these four died due to these complications. CONCLUSION The maternal death rate of women who have undergone fertility treatment is similar to the birth rate due to assisted reproductive technology in Japan. Some maternal death cases involve severe uncontrolled complications. Therefore, medical histories should be evaluated before fertility treatment.
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Affiliation(s)
- Hiroaki Tanaka
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Mie, Japan
| | - Shinji Katsuragi
- Department of Obstetrics and Gynecology, Sakakibara Heart Institute, Tokyo, Japan
| | - Junichi Hasegawa
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Kazuhiro Osato
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Mie, Japan
| | - Masahiko Nakata
- Department of Obstetrics and Gynecology, Toho University Omori Medical Center, Tokyo, Japan
| | - Takeshi Murakoshi
- Division of Perinatology, Maternal and Perinatal Care Center, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Akihiko Sekizawa
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Naohiro Kanayama
- Department of Obstetrics and Gynecology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Isamu Ishiwata
- Ishiwata Obstetrics and Gynecology Hospital, Ibaraki, Japan
| | - Tomoaki Ikeda
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Mie, Japan
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15
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Takeda S. Education and training approaches for reducing maternal deaths in Japan. HYPERTENSION RESEARCH IN PREGNANCY 2018. [DOI: 10.14390/jsshp.hrp2018-007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Satoru Takeda
- Department of Obstetrics and Gynecology, Faculty of Medicine, Juntendo University
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16
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Leal AF, Lui L. Instituições participativas e seus efeitos nas políticas públicas: estudo do Comitê de Mortalidade por Aids de Porto Alegre. SAUDE E SOCIEDADE 2018. [DOI: 10.1590/s0104-12902018170425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Este estudo se insere no contexto das discussões sobre os efeitos das instituições participativas sobre políticas públicas. O objetivo foi conhecer a percepção dos membros do Comitê Municipal de Mortalidade por Aids de Porto Alegre sobre como essa instituição participativa tem consequências na melhoria do atendimento às pessoas que vivem com HIV/aids. Trata-se de pesquisa qualitativa, com método de estudo de caso, realizada com 17 membros do referido comitê. Suas reuniões mensais foram acompanhadas, quando se realizou observação de cunho etnográfico; realizou-se, também, entrevistas a partir de um roteiro semiestruturado, empregando-se o referencial da Teoria das Instituições Participativas. Identificou-se que o comitê é capaz de diagnosticar inúmeros problemas no sistema de saúde da cidade e apontar as fragilidades dos serviços de atendimento. Todavia, ainda não consegue assegurar que as propostas sugeridas sejam implementadas nos serviços a fim de resolver os problemas identificados e, por conseguinte, melhorar a qualidade dos serviços de atendimento às pessoas com HIV/aids.
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Affiliation(s)
| | - Lizandro Lui
- Universidade Federal do Rio Grande do Sul, Brazil
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17
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Ayyalil F, Irwin G, Ross B, Manolis M, Enjeti AK. Zeroing in on red blood cell unit expiry. Transfusion 2017; 57:2870-2877. [PMID: 28940216 DOI: 10.1111/trf.14321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Revised: 07/03/2017] [Accepted: 07/25/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Expiry of red blood cell (RBC) units is a significant contributor to wastage of precious voluntary donations. Effective strategies aimed at optimal resource utilization are required to minimize wastage. STUDY DESIGN AND METHODS This retrospective study analyzed the strategic measures implemented to reduce expiry of RBC units in an Australian tertiary regional hospital. The measures, which included inventory rearrangement, effective stock rotation, and the number of emergency courier services required during a 24-month period, were evaluated. RESULTS There was no wastage of RBC units due to expiry over the 12 months after policy changes. Before these changes, approximately half of RBC wastage (261/511) was due to expiry. The total number of transfusions remained constant in this period and there was no increase in the use of emergency couriers. Policy changes implemented were decreasing the RBC inventory level by one-third and effective stock rotation and using a computerized system to link the transfusion services across the area. Effective stock rotation resulted in a reduction in older blood (>28 days) received in the main laboratory rotated from peripheral hospitals, down from 6%-41% to 0%-2.5%. CONCLUSION Age-related expiry of blood products is preventable and can be significantly reduced by improving practices in the pathology service. This study provides proof of principle for "zero tolerance for RBC unit expiry" across a large networked blood banking service.
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Affiliation(s)
- Fathima Ayyalil
- Pathology North-Hunter, Hunter Area Pathology Service, John Hunter Hospital, New Lambton, NSW, Australia.,Haematology Department, Calvary Mater Newcastle, Waratah, NSW, Australia
| | - Greg Irwin
- Pathology North-Hunter, Hunter Area Pathology Service, John Hunter Hospital, New Lambton, NSW, Australia
| | - Bryony Ross
- Pathology North-Hunter, Hunter Area Pathology Service, John Hunter Hospital, New Lambton, NSW, Australia.,Haematology Department, Calvary Mater Newcastle, Waratah, NSW, Australia.,University of Newcastle, Callaghan Campus, Callaghan, NSW, Australia
| | - Michael Manolis
- Pathology North-Hunter, Hunter Area Pathology Service, John Hunter Hospital, New Lambton, NSW, Australia
| | - Anoop K Enjeti
- Pathology North-Hunter, Hunter Area Pathology Service, John Hunter Hospital, New Lambton, NSW, Australia.,Haematology Department, Calvary Mater Newcastle, Waratah, NSW, Australia.,University of Newcastle, Callaghan Campus, Callaghan, NSW, Australia.,Hunter Cancer Research Alliance, Callaghan, NSW, Australia
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18
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Okada A, Nakamoto O, Komori M, Arimoto H, Rinka H, Nakamura H. Resuscitative endovascular balloon occlusion of the aorta as an adjunct for hemorrhagic shock due to uterine rupture: a case report. Clin Case Rep 2017; 5:1565-1568. [PMID: 29026545 PMCID: PMC5628233 DOI: 10.1002/ccr3.1126] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 07/08/2017] [Accepted: 07/21/2017] [Indexed: 11/17/2022] Open
Abstract
Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a life‐saving procedure used to control bleeding and maintain blood pressure temporarily in traumatic hemorrhagic shock. Uterine rupture and placenta accreta provoke uncontrollable massive hemorrhaging. REBOA may be useful for hemodynamic stabilization to prevent cardiac arrest in high‐risk pregnancy.
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Affiliation(s)
- Asami Okada
- Department of Obstetrics and Gynecology Osaka City General Hospital 2-13-22 Miyakojimahondori Miyakojima-ku Osaka Japan
| | - Osamu Nakamoto
- Department of Obstetrics and Gynecology Osaka City General Hospital 2-13-22 Miyakojimahondori Miyakojima-ku Osaka Japan
| | - Maya Komori
- Department of Obstetrics and Gynecology Osaka City General Hospital 2-13-22 Miyakojimahondori Miyakojima-ku Osaka Japan
| | - Hideki Arimoto
- Department of Emergency and Critical Care Medical Center Osaka City General Hospital 2-13-22 Miyakojimahondori Miyakojima-ku Osaka Japan
| | - Hiroshi Rinka
- Department of Emergency and Critical Care Medical Center Osaka City General Hospital 2-13-22 Miyakojimahondori Miyakojima-ku Osaka Japan
| | - Hiroaki Nakamura
- Department of Obstetrics and Gynecology Osaka City General Hospital 2-13-22 Miyakojimahondori Miyakojima-ku Osaka Japan
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19
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Tamura N, Farhana M, Oda T, Itoh H, Kanayama N. Amniotic fluid embolism: Pathophysiology from the perspective of pathology. J Obstet Gynaecol Res 2017; 43:627-632. [DOI: 10.1111/jog.13284] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 11/14/2016] [Accepted: 12/19/2016] [Indexed: 12/14/2022]
Affiliation(s)
- Naoaki Tamura
- Department of Obstetrics & Gynaecology; Hamamatsu University School of Medicine; Hamamatsu Japan
| | - Mustari Farhana
- Department of Obstetrics & Gynaecology; Hamamatsu University School of Medicine; Hamamatsu Japan
| | - Tomoaki Oda
- Department of Obstetrics & Gynaecology; Hamamatsu University School of Medicine; Hamamatsu Japan
| | - Hiroaki Itoh
- Department of Obstetrics & Gynaecology; Hamamatsu University School of Medicine; Hamamatsu Japan
| | - Naohiro Kanayama
- Department of Obstetrics & Gynaecology; Hamamatsu University School of Medicine; Hamamatsu Japan
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