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Objective:To investigate the prevention and treatment status of venous thromboembolism (VTE) of pregnant women in general hospitals and specialized hospitals in China.Methods:This study was a cross-sectional survey about VTE prevention and treatment in 112 hospitals across China from January 1st to December 31st, 2019, including general information, resource accessibility, hospital system and strategy. According to the characteristics, the hospitals were divided into general hospital group (70 hospitals) and specialized hospital group (42 hospitals). The basic information, VTE diagnosis and treatment resources, prevention systems and the preference of the VTE risk assessment form of the two groups were compared. Logistic regression was used to analyze the proportion of VTE incidence and related factors in the two groups of hospitals.Results:(1) The median annual delivery volume of the general hospital group was significantly lower than that of the specialized hospital group (3 428 vs 9 969 cases, P<0.01), the diagnostic accessibility of CT pulmonary angiography (CTPA) was significantly higher than that of the specialized hospital [92.9% (65/70) vs 59.5% (25/42), P<0.01], and the proportion of obstetric VTE risk assessment was significantly higher than that of the specialized hospital group [85.7% (60/70) vs 66.7% (28/42), P=0.017]. (2) Among the 88 hospitals using the VTE risk assessment sheet, the utilization rate of the evaluation sheet recommended by the obstetric VTE guideline in specialized hospitals (78.6%, 22/28) was higher than that of general hospitals (48.3%, 29/60), and the difference was statistically significant ( P=0.007). (3) The proportion of VTE incidence in general hospital group was 0.126% (360/286 517), and the proportion of VTE incidence in specialized hospital group was 0.032% (154/484 111). Logistic regression analysis showed that the OR value of the specialized hospital group was 0.253 (95% CI: 0.209-0.305) and the difference was statistically significant ( P<0.01) compared with the general hospital group. After adjusting the hospital level, B-ultrasonography and CTPA accessibility, whether to establish a risk assessment and obstetric VTE system, the proportion of VTE incidence in specialized hospitals was still lower than that in general hospitals ( OR=0.307, 95% CI: 0.251-0.376, P<0.01). Conclusions:General hospitals have higher access to resources for diagnosing VTE than specialized hospitals, and the VTE evaluation system is better implemented. The utilization rate of the obstetric VTE guidelines in specialized hospitals is higher than that of general hospitals.
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Objective To explore the predictive accuracy of two estimated fetal weight ( EFW ) standards ( INTERGROWT H and Hadlock) and Doppler parameters for late-onset fetal growth restriction ( FGR) . Methods A prospective cohort of women with singleton pregnancies who attended research scans and had a livebirth at the obstetrics and gynecology hospital of Fudan University during 32 - 41 weeks of gestation was involved . The markers of ultrasound examinations (including growth measurements ,umbilical artery and middle cerebral artery parameters) were obtained every two weeks . The INTERGROWT H -EFWc and Hadlock-EFWc data were obtained from the last ultrasonography ( within 7 days before delivery) and were used to predict later-onset FGR in a single model or in combined models with other Doppler parameters by logistic regression analyses ,respectively . According to delivery gestation of age and Chinese birth weight (BW) standards ,all cases were divided into a control group ( non-FGR ,BW ≥ 10th ％ ) and a FGR group ( Late-onset FGR ,BW < 10th ％ ) . ROC curve analyses were performed to compare the predictive accuracy for the late-onset FGR between the Hadlock-EFWc and INTERGROWT H-EFWc . Results A total of 820 eligible women were identified and 676 had finished the follow-up and were enrolled in this prospective cohort study . Among them ,116 neonates were assigned to the late-onset FGR group ,and 560 as control group ( non-FGR) . The cut-off value of the INTERGROWT H-EFWc was percentile 27 .5 ,at which had a sensitivity and specificity of 71 .4％ and 83 .7％ . The corresponding sensitivity and specificity were 87 .3％ and 82 .8％ at a cut-off value of percentile 22 .6 of the Hadlock-EFWc . The Hadlock-EFWc had a higher predictive accuracy for the late-onset FGR than the INTERGROWT H-EFWc ,their AUC were 0 .930 ( 0 .908 - 0 .953 ) and 0 .847 ( 0 .807 - 0 .888 ) ,respectively . The accuracy of Doppler single-parameter ( umbilical artery and middle cerebral artery) for late-onset FGR were low ( AUC < 0 .7) ,but the accuracy of combined model- Ⅰ and Ⅱ were high ( AUC 0 .865 and 0 .936 ,respectively) ,similar to their corresponding EFWc models ,respectively . Conclusions The INTERGROWT H-EFWc could predict effectively for late-onset FGR ,however ,its predictive accuracy is lower than that of the Hadlock-EFWc . The predictive accuracy of Doppler parameters for late-onset FGR are poor ,routine monitoring of non-selected populations is not recommended .
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OBJECTIVE: To compare the efficacy of metformin plus megestrol acetate (MA) with that of MA alone for treating endometrial atypical hyperplasia (EAH). METHODS: This pilot study included 16 EAH patients who met at least one metabolic syndrome (MS) criterion and received either adjunctive metformin plus MA (MET group) or MA monotherapy (MA group). Each patient in the MA group received 160 mg of MA daily, whereas patients in the MET group received the same dose of MA plus 0.5 g of metformin thrice daily. Treatment response was assessed by histological examination of dilation and curettage specimens obtained after 12 weeks of therapy. RESULTS: Each group had eight patients, and half of the patients in each group were diagnosed with MS. The complete response (CR) rate was 75% (6/8) in the MET group and 25% (2/8) in the MA group (p=0.105). Complications of MS did not affect the response rates in either group. In the MET group, 75% (3/4) of the patients had CR in the presence or absence of MS. In the MA group, 50% (2/4) of the patients with MS had CR, whereas no patient without MS had CR. No irreversible toxicities were observed. CONCLUSION: Metformin plus MA may be a potential alternative therapy for treating EAH, and the MS status of patients may have no effect on the efficacy of metformin plus MA therapy.