Background: Most maternal deaths in developing countries can be prevented. China is among the 13 countries with the most maternal deaths; however, there has been a marked decrease in the maternal mortality ratio (MMR) over the last 3 decades. China's reduction in the MMR has contributed significantly to the global decline of the MMR. This study examined the geographic and rural-urban differences, time trends and related factors in preventable maternal deaths in China during 1996-2005, with the aim of providing reliable evidence for effective interventions.;Methods: Data were retrieved from the population-based maternal mortality surveillance system in China. Each death was reviewed by three committees to determine whether it was avoidable. The preventable maternal mortality ratio (PMMR), the ratios of PMMR (risk ratio, RR) and 95% confidence intervals (CI) were used to analyze regional disparities (coastal, inland and remote regions) and rural-urban variations. Time trends in the MMR, along with underlying causes and associated factors of death, were also analysed.;Results: Overall, 86.1% of maternal mortality was preventable. The RR of preventable maternal mortality adjusted by region was 2.79 (95% CI 2.42-3.21) and 2.38 (95% CI: 2.01-2.81) in rural areas compared to urban areas during the 1996-2000 and 2001-2005 periods, respectively. Meanwhile, the RR was the highest in remote areas, which was 4.80(95% CI: 4.10-5.61) and 4.74(95% CI: 3.86-5.83) times as much as that of coastal areas. Obstetric haemorrhage accounted for over 50% of preventable deaths during the 2001-2005 period. Insufficient information about pregnancy among women in remote areas and out-of-date knowledge and skills of health professionals and substandard obstetric services in coastal regions were the factors frequently associated with MMR.;Conclusions: Preventable maternal mortality and the distribution of its associated factors in China revealed obvious regional differences. The PMMR was higher in underdeveloped regions. In future interventions in remote and inland areas, more emphasis should be placed on improving women's ability to utilize healthcare services, enhancing the service capability of health institutions, and increasing the accessibility of obstetric services. These approaches will effectively lower PMMR in those regions and narrow the gap among the different regions.

Uterine arteries are the main vessels supplying blood to the uterus. Mainly, they originate from the anterior trunk of the internal iliac artery. Uterine arteries play an important role in pregnancy as well as transcatheter arterial embolization for postpartum hemorrhage and uterine fibroid management. This is a review of the English literature in the PubMed database of the anatomic variety on the origin of uterine arteries and their clinical significance. Eleven studies describe the origin of the uterine arteries and their variations in the literature. In six studies, the uterine artery emerged from internal iliac artery in the majority of the cases, either as a separate branch, or as a bifurcation with the inferior gluteal artery, or trifurcation with superior and inferior gluteal artery. In two studies, the inferior gluteal artery manifested as the main source of the uterine artery, whereas in three studies, the umbilical artery posed as its main origin. Internal iliac artery is described as the most common vascular origin of uterine artery. However, this review highlights that the main vessels of origin for uterine arteries are internal iliac, umbilical and inferior gluteal artery. Nevertheless, classification and further research for this peculiar anatomic structure is fundamental in the future.©Copyright 2020 by Turkish Society of Obstetrics and Gynecology | Turkish Journal of Obstetrics and Gynecology published by Galenos Publishing House.

Ovarian arteries generally arise from the anterolateral (or lateral) aspect of the abdominal aorta caudal to the origin of the renal arteries at the level of L2 vertebra. The ovarian arteries may arise from the renal, suprarenal, inferior phrenic, superior mesenteric, lumbar, common iliac, or internal iliac arteries. This was a unique case, in which both ovarian arteries originated from 2 differently-originating bilateral accessory renal arteries. This unique variation may provide significant information to surgeons and gynecologists dissecting the abdominal cavity. The case was found in a female cadaver aged 55 years during routine dissection in the Anatomy Department, College of Medicine, University of Dammam, Kingdom of Saudi Arabia in 2009. The subject had an average built without any abnormal external features. Both right and left ovarian arteries arose from the bilateral accessory renal arteries. Knowledge of ovarian arteries and their definitive course to the ovaries is of great interest to the anatomists, surgeons, radiologists, urologists, and gynecologists to avoid clinical complications during surgical interference, or radiological examination of this region.

To prospectively study and classify the anastomoses between the ovarian and uterine arteries in women undergoing uterine fibroid embolization, and to compare the presence of such with procedural failures and premature menopause.Angiographic ovarian artery-to-uterine artery anastomoses were studied in 76 consecutive patients undergoing uterine fibroid embolization. Mean patient age was 44.7 years (range, 29-56 years). Clinical follow-up consisted of a standard questionnaire. Procedural failure and complications were compared with the presence of various types of ovarian artery-to-uterine artery connections.Three types of anastomoses were identified. In type I (33 [21.7%] of 152 arteries), flow from the ovarian artery to the uterus was through anastomoses with the main uterine artery. In type II (six arteries [3.9%]), the ovarian artery supplied the fibroids directly. In type III (10 arteries [6.6%]), the major blood supply to the ovary was from the uterine artery. Seven patients (9%) were considered to have clinical failure, with three of the six women with type II anastomoses being in this group. Three of the five women who experienced menopause after fibroid embolization had bilateral ovarian artery-to-uterine artery anastomoses that were classified as high risk.Delineation of ovarian artery-to-uterine artery anastomosis is of practical relevance in avoiding nontarget ovarian embolization, in identification of those who would be at risk of uterine artery embolization or ovarian failure, and in those in whom the ovarian artery can be embolized safely.Copyright RSNA, 2002

To further evaluate relationships of the pelvic ureter to clinically relevant structures and to characterize the anatomy, histology, and nerve density of the distal ureter.In this observational cadaveric study, 35 female cadavers were examined, 30 by gross dissections and five microscopically. Ureter length and segments of pelvic ureter were measured. Closest distances between the ureter and clinically relevant points were recorded. The distal pelvic ureter and surrounding parametrium were evaluated microscopically. Nerve density was analyzed using automated quantification of peripheral nerve immunostaining. Average measurements of nerve density in the anterior and posterior quadrants surrounding the ureter were statistically compared using a two-tailed t test. Descriptive statistics were used for analyses with distances reported as mean±SD (range).Gross dissections revealed ureter length of 26.3±1.4 (range 24-29) cm (right), 27.6±1.6 (25-30.5) cm (left). Lengths of ureter from pelvic brim to uterine artery crossover were 8.2±1.9 (4.4-11.5) cm (right), 8.5±1.5 (4.5-11.5) cm (left) and from crossover to bladder wall 3.3±0.7 (2.4-5.8) cm (right), 3.2±0.4 (2.6-4.1) cm (left). Intramural ureter length was 1.5±0.3 (1-2.2) cm (right) and 1.7±1.2 (0.8-2.5) cm (left). Distances from the ureter to uterine isthmus: median 1.7 (range 1-3.0) cm (right) and 1.7 (1.0-2.9) cm (left); lateral anterior vaginal fornix 1.5 (1.0-3.1) cm (right) and 1.7 (0.8-3.2) cm (left); lateral vaginal apex 1.3 (1.0-2.6) cm (right) and 1.2 (1.1-2.2) cm (left) were recorded. Microscopy demonstrated denser fibrovascularity posteromedial to the ureter. Peripheral nerve immunostaining revealed greater nerve density posterior to the distal ureter.Proximity of the ureter to the uterine isthmus and lateral anterior vagina mandates careful surgical technique and identification. The intricacy of tissue surrounding the distal ureter within the parametrium and the increased nerve density along the posterior distal ureter emphasizes the importance of avoiding extensive ureterolysis in this region.