Adverse Outcome of Cesarean Scar Pregnancy Managed Expectantly / 中山大学学报(医学科学版)

@#：【Objective】Toprovidefurtherevidenceoftheassociationbetweencesareanscarpregnancy（CSP）and placentaincreta，andtoinvestigatetheriskofexpectantmanagementofCSP.【Methods】Aretrospectivereviewof3women diagnosedwithCSP，whoweremanagedexpectantly，wasperformedintheThirdAffiliatedHospitalofSUNYat-sen UniversityfromJanuary2014toDecember2018.Theirclinicalcharacteristics，sonographicmanifestationandpoorout⁃ comeswereanalyzed.【Results】These3casesofCSPhad1~2previouslowersegmentcesareansectionsandtheirclinical symptomsincludedrecurrenthemorrhage，grosshematuriaandsevereabdominalpain.Amongthe3cases，thegestational ageatdiagnosisofCSPwas6+2weeks，7weeksand7+4weeks，respectively；thesonographicCSPtypewastypeⅠ，type ⅡandtypeⅢ，respectively；thegestationalageatthefirstdiagnosisofplacentaincretawas24+4weeks，12+2weeksand 13+1weeks，respectively；andall3caseswerediagnosedasplacentapercretabyultrasoundatthesecondtrimester.These 3casesofCSPwereterminatedatthesecondtrimesterwithoutlivebornneonatesbecauseofseverehemorrhage，colt tamponadeofbladderanduterinerupture；andallwereconfirmedasplacentapercretaduringsurgerywiththetotalblood lossofmorethan2500mLandwithoutmaternaldeath，andonegotapathologicaldiagnosisofplacentapercretaafter subtotal hysterectomy.【Conclusion】Placenta percreta should be noticed during the expectant management of CSP becauseof the close association between CSP and placenta increta. Natural history of CSP is usually associated with adverseoutcome，andthereforeexpectantmanagementofCSPshouldbecarefullychosen

Further Discussion on the Problems and Countermeasures of Single Disease Payment Reform / 中国卫生经济

Through the investigation of the single disease policy and the local actual situation in many regions of the country, it analyzed the practical problems faced by Chinese medical institutions in the implementation of single disease payment policy. The necessity and urgency of the national unified single disease payment policy were put forward, and the system of standard quota payment for single disease standard was preferred, supporting patients to pay extra fees for differential medical services, standardize the accounting policy of single disease payment.

Clinical Characteristics and Outcomes of 80 Pregnant Women after External Cephalic Version / 中山大学学报(医学科学版)

[Objective] To investigate the safety and associated factor of external cephalic version (ECV) in third trimester,and to enrich clinical experience to improve the successful rate and lower cesarean section (CS) rate.[Methods] 80 pregnant women conducting ECV in third trimester in the third affiliated hospital of Sun Yat-sen University from September 2015 to July 2017 were enrolled in our study.Divided to successful group and failing group,we compared the clinical characters and pregnancy outcomes.[Results] Of the 80 pregnancy,48 women (60.0％) succeed with cephalic presentation.Compared to the failing group,the successful group is statistically different in parity,BMI and amniotic fluid depth.In the failing group,all women underwent CS with 3/48 in successful group.No women conducted ECV complicated fetal distress and emergency CS,premature rupture of membranes complicated in 11 (13.8％) cases in all women.[Conclusions] ECV is safe for mother and fetus.Encouraging the suitable pregnancy women to conduct ECV and enhancing clinical skills can improve ECV success rate.

A Cross-sectional Survey About Awareness of Hepatitis B Virus Infection and Mother to Child Transmission among First Prenatal Visiting Pregnant Women / 中山大学学报(医学科学版)

[Objective]To investigate awareness of hepatitis B virus(HBV)infection and its mother to child transmis-sion(MTCT)among pregnant women attending their first prenatal visit.[Methods]Pregnant women who attended their first prenatal visit to obstetrics outpatient department of the third affiliated hospital of SUN Yat-sen University from May to Aug. 2014,were invited to participate this survey.The self-administered questionnaire about mother to child transmission of HBV was completed anonymously.Data were collected and using ANOVA and logistic analysis to assess the awareness of hepatitis B and its MTCT,and attitudes towards prevention of MTCT of HBV,and to analyze the effective factors of knowledge and at-titudes.[Results]①Of the 500 questionnaires,the effective response rate was 91.8%(459/500).② The total knowledge score of 11 knowledge questions was 11,and the mean score of participants was 6.09 ± 3.29(M±SD). Only about 50% of participants were aware of the complications of hepatitis B and increasing these complications if caused by MTCT. 65.3% of participants knew hepatitis B vaccine.The awareness about modes of HBV transmission including through blood,unprotected sexual intercourse,MTCT and unsafe needles or sharps were 72.0%,48.9%,75.9% and 66.3%,respectively.③The total attitudes score of 6 attitudes questions was 6,and the mean score of participants was 3.84±1.50(M±SD).More than 80% of pregnant women were willing to be screened for hepatitis B,and let neonate receive HBV vaccine.If diagnosed with hepatitis B,83.1% of pregnant women were willing to let neonate receive hepatitis B immunoglobulin,however,only 16.2% would take drugs to prevent MTCT of HBV.④Education with college or higher level was the independent effective factors associat-ed with better knowledge scores(OR=5.96,95%CI:2.95~12.06).Higher education level was the independent effective fac-tor associated with better attitude scores;when compared with junior high or below,the OR values of senior high and college or higher were 1.90(95%CI:1.01~3.55)and 2.50(95%CI:1.43~4.33),respectively.[Conclusion]Although education level is an independent effective factor associated with knowledge of hepatitis B and attitude towards prevention of MTCT of HBV,lack of knowledge about hepatitis B is common among first prenatal-visiting pregnant women,and more education about hepatitis B is necessary.

Identification of risk factors related to the failure of immunization to interrupt hepatitis B virus perinatal transmission / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To explore the factors influencing failure of an immunization to interrupt perinatal (mother-to-child) transmission of hepatitis B virus (HBV).</p><p><b>METHODS</b>Between June 2006 and March 2010, a total of 1355 pregnant women testing positive for the hepatitis B surface antigen (HBsAg), at gestational weeks 20 to 42, and without use of antiviral or immunomodulatory drugs during the pregnancy were prospectively recruited to the study. The mothers were given a choice of receiving hepatitis B immunoglobulin (HBIG; three 200 IU intramuscular injections give at four-week intervals starting from gestation week 28) or not. All neonates (1360, including five sets of twins) received hepatitis B vaccine (10 mug) plus HBIG (200 IU) combined immunization within 24 h of birth, as early as possible. Peripheral venous blood samples were collected from the neonates within 24 h of birth and at 7 and 12 months of age for detection of HBV markers, including hepatitis B e antigen (HBeAg) and HBV DNA. The infants were classified according to HBV perinatal transmission status (infection group and non-infection group) and various factors (maternal-related: age, gravidity, parity; pregnancy/birth-related: threatened premature labor, complications; neonate-related: sex, birth weight, apgar score) were compared between the two groups by using non-conditional logistic regression analysis to determine their potential influence on failure of immunization to inhibit transmission.</p><p><b>RESULTS</b>After 12 months of follow-up, 1.54% (21/1360) of the neonates had presented with HBV infection. Analysis of the HBV-infected neonates revealed differences in infection rates between neonates born to mothers with HBIG injection (2.22% vs. without HBIG injection: 1.11%, P less than 0.05) and caesarean section (1.35% vs. vaginal delivery: 1.73%) but neither reached statistical significance (P less than 0.05); only the practice of breastfeeding showed a significant difference for infection rate, with neonates fed artificial formula having higher infection rate (3.13%) than the breastfed neonates (0.27%, P less than 0.05). The neonate HBV infection rate was also significantly higher for neonates born to HBeAg-positive mothers (4.44% vs. HBeAg-negative mothers: 0%, P less than 0.05) and HBV DNA-positive mothers (3.13% vs. HBV DNA-negative mothers: 0%, P less than 0.05). When the mothers were stratified by serum level of HBV DNA, there was a significant difference in HBV-infected neonates born to mothers with more than or equal to 1*10(7) IU/ml(6.01% vs. 10(3)-10(6) IU/ml: 0.56% and less than 1*10(3) IU/ml: 0%, both P less than 0.05). Logistic regression analysis indicated that the independent risk factors for HBV perinatal transmission despite immunization were maternal serum HBeAg-positive status (relative risk (RR)=31.74, 95% confidence interval (CI): 3.88-259.38) and maternal HBV DNA of ≥ 10⁷ copies/mL (RR=22.58, 95% CI: 4.75-107.40).</p><p><b>CONCLUSION</b>Failure of vaccine plus HBIG to interrupt mother-to-child transmission of HBV is influenced by maternal serum HBeAg-positive status and maternal HBV DNA of ≥10⁷ copies/mL.</p>

Intrauterine HBV infection: risk factors and impact of HBV DNA / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the risk factors of intrauterine hepatitis B virus (HBV) infection and the impact of HBV DNA on the infection.</p><p><b>METHODS</b>The serum levels of HBsAg, HbsAb, HBeAg, HBeAb, HBcAb and HBV DNA were determined in blood samples from 230 HBsAg-positive pregnant women and their newborns by enzyme-linked immunosorbent assay (ELISA) and fluorescence quantitative PCR (FQ-PCR), respectively. The newborns acquiring HBV infection via intrauterine transmission were selected as the case group and others as the control group. The risk factors for intrauterine HBV infection were analyzed by non-conditional logistic regression model.</p><p><b>RESULTS</b>Six infants were found to be HBsAg-positive, and 18 HBV DNA-positive, and 3 of them were positive for both HBsAg and HBV DNA. The rate of intrauterine HBV infection was 9.6% (22/230). The grade of HBV DNA level was identified as the only risk factor of intrauterine HBV infection by non-conditional logistic regression model, with odds ratio (OR) of 1.57 (95% confidence interval 1.12-2.21). Of the 119 pregnant women positive for HBV DNA, 18 were diagnosed as having intrauterine HBV infection, and the likeliness of the infection significantly increased for a maternal serum HBV DNA level > or =10(7) copies/ml (chi(2)=7.92, P<0.05).</p><p><b>CONCLUSION</b>The grade of serum HBV DNA level is the predominant risk factor for intrauterine HBV infection in pregnant women, and for those with serum HBV DNA lever > or =10(7) copies/ml, the chance for intrauterine HBV infection can be significantly increased.</p>