Background Although maternal deaths are rare in developed regions, the morbidity associated with severe postpartum hemorrhage (SPPH) remains a major problem. To determine the prevalence and risk factors of SPPH, we analyzed data of women who gave birth in Guangzhou Medical Centre for Critical Pregnant Women, which received a large quantity of critically ill obstetric patients who were transferred from other hospitals in Southern China. Methods In this study, we conducted a retrospective case-control study to determine the prevalence and risk factors for SPPH among a cohort of women who gave birth after 28 weeks of gestation between January 2015 and August 2019. SPPH was defined as an estimated blood loss ≥1000 mL and total blood transfusion≥4 units. Logistic regression analysis was used to identify independent risk factors for SPPH. Results SPPH was observed in 532 mothers (1.56%) among the total population of 34,178 mothers. Placenta-related problems (55.83%) were the major identified causes of SPPH, while uterine atony without associated retention of placental tissues accounted for 38.91%. The risk factors for SPPH were maternal age < 18 years (adjusted OR [aOR] = 11.52, 95% CI: 1.51–87.62), previous cesarean section (aOR = 2.57, 95% CI: 1.90–3.47), history of postpartum hemorrhage (aOR = 4.94, 95% CI: 2.63–9.29), conception through in vitro fertilization (aOR = 1.78, 95% CI: 1.31–2.43), pre-delivery anemia (aOR = 2.37, 95% CI: 1.88–3.00), stillbirth (aOR = 2.61, 95% CI: 1.02–6.69), prolonged labor (aOR = 5.24, 95% CI: 3.10–8.86), placenta previa (aOR = 9.75, 95% CI: 7.45–12.75), placenta abruption (aOR = 3.85, 95% CI: 1.91–7.76), placenta accrete spectrum (aOR = 8.00, 95% CI: 6.20–10.33), and macrosomia (aOR = 2.30, 95% CI: 1.38–3.83). Conclusion Maternal age < 18 years, previous cesarean section, history of PPH, conception through IVF, pre-delivery anemia, stillbirth, prolonged labor, placenta previa, placental abruption, PAS, and macrosomia were risk factors for SPPH. Extra vigilance during the antenatal and peripartum periods is needed to identify women who have risk factors and enable early intervention to prevent SPPH.

vNOTES is a feasible approach for sacrocolpopexy, with promising short-term efficacy and safety data. Larger studies across multiple sites and surgeons should evaluate the long-term efficacy and safety profile of vNOTES sacrocolpopexy.

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To demonstrate stepwise techniques for the successful use of the laparoscopic single-site technique for safely performing transvaginal sacrocolpopexy for pelvic organ prolapse. Design: Stepwise demonstration with narrated video footage (Canadian Task Force classification III). Setting: Academic tertiary care hospital. The patient, aged 69 years gravida 2 para 2-0-0-2 with a history of SVD £ 2, presented with symptomatic stage II anterior vaginal prolapse (Aa +1) and stage II posterior vaginal prolapse (Ap À1). The preoperative vaginal length was measured at 9 cm. Interventions: Laparoscopic transvaginal single-site sacrocolpopexy has been demonstrated to be feasible and safe in the surgical management of pelvic organ prolapse. However, the retroperitoneal dissection or suturing/knot tying can be technically challenging to perform, especially in the event of an anatomic variation of a deeply angled S1 vertebra. Wristed robotic instrumentation may overcome some of these obstacles and result in easier suturing and knot tying. Integration of a robotic platform for sacrocolpopexy is a novel alternative minimally invasive approach that is more cosmetic, safer, and effective. Several helpful techniques in robot-assisted transvaginal single-site include the following: (1)The use of a 30˚-angled scope alternating between "facing up" and "facing down" depending on the need for dissection or suturing. (2) The use of 3-dimensional visualization with a robotic camera that can highlight the depth of the surgical anatomy, therefore facilitating easier identification in the dissection of a surgical pedicle. (3) The use of wristed instruments that permit increased articulation and triangulation that are lacking in traditional laparoscopic single-site surgery, allowing for much easier and proficient suturing and knot tying. (4) Integration of the robotic platform that stabilizes the fine motor movement in a surgeon's hands improving the precision of the suturing and knot tying. The procedure was successfully performed in approximately 227 minutes with a measured postoperative vaginal length of 7 cm. The patient's postoperative pelvic organ prolapse quantification was stage 0. Conclusion: Robot-assisted transvaginal single-site sacrocolpopexy for pelvic organ prolapse is feasible, effective, and safe in patients with pelvic organ prolapse. Patients experience improved cosmesis, decreased postoperative pain, and faster recovery compared with abdominal sacrocolpopexy.

The total number of patients undergoing hysteroscopy and laparoscopy was 60. Patients with ovarian endometriosis (OE) (n = 25), retrocervical endometriosis (RE) (n = 6), adenomyosis (A) (n = 9), and peritoneal endometriosis (PE) (n = 20) underwent surgery for benign disease between 2016 and 2017. All patients underwent surgery after the end of menstrual bleeding; thus, most of our patients were in the proliferative phase. Interventions: Histological and immunohistochemical studies in paraffinembedded tissue samples were performed (LAMP 1 (1:100), LC3(1:50), NFkp (1:100) (Ventana, Roche) (ectopic and eutopic endometrium samples). Measurements/Results: All tested markers showed a significant downregulation of autophagy in ectopic endometrium (EO, RE, A and PE) compared with eutopic endometrium of affected women (p < .05). The most noticeable autophagy deficiency was registered in patients with RE, followed by A, OE, and PE, but the difference was statistically significant only between RE and A (p < .05). NF-kb expression was significantly higher in ectopic lesions compared with eutopic endometrium (p < .05), while the differences among the types of endometriosis were not statistically significant (with the most remarkable NF-kb expression in RE and A groups). Conclusions: The diminished autophagy observed in different types of endometriosis can be considered as a part of its pathogenesis, which can promote the survival of endometriotic cells and maintenance of lesions in ectopic sites. NF-kb activity may have direct involvement with this decreased autophagy in endometriotic lesions. Further investigations targeting the evaluation of the relationship between the inflammatory state of the tissue and decreased autophagy could be of significant benefit.