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Objective:To construct a system for evaluating the professional capability of provincial radiological health institutions.Methods:Based on the Donabedian model and the main professional responsibilities of provincial radiological health institutions, the logical framework and indicator database of the capability evaluation system were initially constructed, the Delphi expert consultation method and analytic hierarchy process were further used to determine each indicator and its weight. The self-assessment test was carried out throughout the provincial radiological health institutions by using the system established in this study.Results:The evaluation system included 3 primary-class indicators, 11 second-class indicators, 30 third-class indicators and 76 fourth-class indicators. Taking 100 points as the full score, the self-assessment scores of the 29 provincial institutions ranged from 28.7 to 97.7 with an average of 78.7, and the scores conform to the normal distribution.Conclusions:The system established in this study are scientific, comprehensive and operable, which can be used as an effective tool to evaluate the professional capability of provincial radiological health institutions.
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@#<b>Objective</b> To compare the precision and efficiency of computing the specific absorbed fraction (SAF) of a reference human with two grid methods in MCNP6.0. <b>Methods</b> Based on the adult female reference voxel phantom provided by the International Commission on Radiological Protection, assuming the liver as the source organ emitting single-energy photons (0.5 MeV), the SAF of each target organ/tissue was calculated by using the mesh method and repeated structure lattice method with the F4, F6, and *F8 tally cards in MCNP6.0. We compared the methods by assessing the relative deviation of SAF and computing time for 27 organs/tissues. <b>Results</b> Compared with reported data, the absolute values of relative deviations of SAF values for all the organs/tissues were less than 5%, except for the eye lens and skin. By using the repeated structure lattice-based *F8 tally, the relative deviations of SAF values of the organs/tissues were all smallest, but with the longest computing time. The computing time of the mesh-based F4 tally was slightly longer than that of the repeated structure lattice-based F6 tally, which was shortest. <b>Conclusion</b> The *F8 tally simultaneously simulating primary and secondary particle transport showed the highest precision. The mesh tally requireda longer computing time than the lattice tally when using the same tally card.
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Objective:To analyze the composition differences of intestinal microbiota in patients with colon cancer and rectal cancer.Methods:The fecal samples of 72 patients in the Second Affiliated Hospital of Harbin Medical University from July 2018 to January 2019 were collected, and they were divided into colon cancer group and rectal cancer group, 36 cases in each group. DNA from fecal samples was extracted, and then high-throughput sequencing was performed on DNA. Bioinformatics was used to analyze the diversity and composition differences of intestinal microbiota between the two groups, and the potential cancer-promoting mechanisms of the differential flora were also discussed.Results:From high-throughput sequencing, 2 356 560 original sequences and 32 730 high-quality sequences were obtained from 72 samples. The average length of the sample sequence was mainly in the interval of 401-460 bp. And 1 409 operational taxonomic units (OTU) were acquired after OTU species taxonomy annotation of all the sequences. Alpha diversity analysis showed that Shannon index of the rectal cancer group and the colon cancer group was 2.61±0.56 and 2.43±0.67, respectively, and the difference was statistically significant ( t = 1.229, P = 0.223); Simpson index of the rectal cancer group and the colon cancer group was 0.17±0.09 and 0.21±0.16, respectively, and the difference was statistically significant ( t = 1.449, P = 0.151). Differences analysis of both groups and linear discriminant analysis (LDA) showed at the phylum level, Firmicutes were more abundant in the intestine of patients with rectal cancer (LDA = 4.67, P = 0.014), while Proteobacteria were more abundant in the gut of colon cancer patients (LDA = 4.49, P = 0.042). From the perspective of class level, the abundance of Gammaproteobacteria was higher in the intestine of patients with colon cancer (LDA = 4.50, P = 0.033), while the abundance of Erysipelotrichia was higher in the intestine of patients with rectal cancer (LDA = 3.50, P = 0.035). At the order level, the abundance of Erysipelotrichales was higher in the intestine of patients with rectal cancer (LDA = 3.50, P = 0.035); at the family level, the abundance of Porphyromonadaceae was higher in the intestine of patients with rectal cancer (LDA = 3.97, P = 0.033). Conclusion:The compositions of intestinal microbiota in patients with colon cancer and rectal cancer are significantly different, indicating that the different floras may contribute to the progression of colon cancer and rectal cancer.
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Objective:To estimate the organ doses and effective doses to different-age children during cardiovascular interventional radiological procedures under some specific exposure conditions, and explore the main influencing factors on the doses.Methods:Based on the paediatric reference computational phantoms recommended in the ICRP Publication 143, several specific exposure models of cardiovascular intervention were built, and the Monte Carlocook MCNPX 2.7.0, was used to calculate the organ doses and effective doses for 1-, 5-, 10- and 15-year-old children. To validate the simulation result , an experiment was implemented by putting the thermoluminescent dosimeters in a 5-y old phantom (ATOM 705-D) manufactured by the CIRS Inc. in the USA.Results:Both the height and weight of the reference children for 1-, 5- and 10-year-old provided for by Chinese national standards are nearly in consistency with those recommended by ICRP, and even for the 15-year-old, the maximum relative deviations of the height and weight are only -1.9% and -5.7%, respectively. Under the exposure condition where the focal spot to image receptor distance (SID) was 90 cm, the length of square field of view (FOV) was 30 cm with a dose area product (DAP) of 45 Gy·cm 2, the relative deviations between simulated and measured doses to main organs/tissues within the irradiation filed were within ±6.7%. Under the same exposure conditions, the younger the children, the larger the organ doses and effective doses, and the effective doses could vary by a factor of about 5 among the 4 age groups. The conversion coefficient between the organ dose and the value of DAP was not only closely related to the age of children, but also affected by the FOV. Conclusions:In combination with the paediatric reference computational phantoms and the exposure models of cardiovascular intervention, the Monte Carlo method can be used to calculate the doses to children undergoing cardiovascular interventional radiological procedures. The information on the values of DAP and FOV as well as the directions of projection are needed for more accurate estimation of the exposure doses.
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BACKGROUND@#Chromosomal abnormalities are important causes of ventriculomegaly (VM). In mild and isolated cases of fetal VM, obstetricians rarely give clear indications for pregnancy termination. We aimed to calculate the incidence of chromosomal abnormalities and incremental yield of chromosomal microarray analysis (CMA) in VM, providing more information on genetic counseling and prognostic evaluation for fetuses with VM.@*METHODS@#The Chinese language databases Wanfang Data, China National Knowledge Infrastructure, and China Biomedical Literature Database (from January 1, 1991 to April 29, 2020) and English language databases PubMed, Embase, and Cochrane Library (from January 1, 1945 to April 29, 2020) were systematically searched for articles on fetal VM. Diagnostic criteria were based on ultrasonographic or magnetic resonance imaging (MRI) assessment of lateral ventricular atrium width: ≥10 to <15 mm for mild VM, and ≥15 mm for severe VM. Isolated VM was defined by the absence of structural abnormalities other than VM detected by ultrasonography or MRI. R software was used for the meta-analysis to determine the incidence of chromosomal abnormalities and incremental yield of CMA in VM, and the combined rate and 95% confidence interval (CI) were calculated.@*RESULTS@#Twenty-three articles involving 1635 patients were included. The incidence of chromosomal abnormalities in VM was 9% (95% CI: 5%-12%) and incremental yield of CMA in VM was 11% (95% CI: 7%-16%). The incidences of chromosomal abnormalities in mild, severe, isolated, and non-isolated VM were 9% (95% CI: 4%-16%), 5% (95% CI: 1%-11%), 3% (95% CI: 1%-6%), and 13% (95% CI: 4%-25%), respectively.@*CONCLUSIONS@#Applying CMA in VM improved the detection rate of abnormalities. When VM is confirmed by ultrasound or MRI, obstetricians should recommend fetal karyotype analysis to exclude chromosomal abnormalities. Moreover, CMA should be recommended preferentially in pregnant women with fetal VM who are undergoing invasive prenatal diagnosis. CMA cannot completely replace chromosome karyotype analysis.
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Female , Humans , Pregnancy , Chromosome Aberrations , Chromosomes , Fetus , Hydrocephalus , Karyotyping , Microarray Analysis , Prenatal Diagnosis , Retrospective Studies , Ultrasonography, PrenatalABSTRACT
Objective:To explore the difference of high-risk factors between early-onset and late-onset pre-eclampsia, and to further understand high-risk factors of pre-eclampsia.Methods:Clinical data of pre-eclampsia pregnant women in 160 medical institutions in China in 2018 were retrospectively analyzed, including 8 031 cases of early-onset pre-eclampsia and 12 969 cases of late-onset pre-eclampsia. The proportion of high-risk factors, different body mass index (BMI) and age stratification between early-onset group and late-onset group were compared.Results:(1) Univariate analysis of high-risk factors: the proportions of high-risk factors in early-onset group and late-onset group were compared, and the differences were statistically significant (all P<0.05). Among them, the proportions of primipara and multiple pregnancy in early-onset group were lower than those in late-onset group, while the proportions of pregnant women with advanced age, irregular antenatal examination, obesity, family history of hypertension, pre-eclampsia, diabetes, kidney diseases, immune system diseases and assisted reproductive technology were higher than those in late-onset group. (2) Hierarchical analysis of BMI: the proportion of pregnant women with BMI≥24 kg/m 2 in early-onset group [48.2% (2 828/5 872) vs 45.5% (4 177/9 181), respectively; P=0.001] and the proportion of pregnant women with BMI ≥28 kg/m 2 in early-onset group [19.5% (1 143/5 872) vs 18.0% (1 656/9 181), respectively; P=0.028] were significantly higher than those in late-onset group. (3) Age stratification analysis: the proportion of pregnant women aged 35-39 years in the early-onset group [21.8% (1 748/8 023) vs 17.5% (2 110/12 068), respectively; P<0.01], the proportion of pregnant women 40-44 years old [6.8% (544/8 023) vs 5.4% (648/12 068), respectively; P<0.01], and the proportion of pregnant women ≥45 years old [0.7% (58/8 023) vs 0.5% (57/12 068), respectively; P=0.021] were significantly higher than those in the late-onset group. (4) Multivariate analysis: advanced age (≥35 years old), multiple pregnancy, irregular antenatal examination or transfer from other hospitals, family history of hypertension (including paternal, maternal and parental lines), previous history of pre-eclampsia, kidney diseases, immune system diseases (systemic lupus erythematosus, antiphospholipid antibody syndrome) and assisted reproductive technology pregnancy were the risk factors affecting the severity of pre-eclampsia (all P<0.05). Conclusion:Pregnant women with high risk factors such as age ≥35 years old, BMI ≥24 kg/m 2 before pregnancy, family history of hypertension, history of pre-eclampsia, chronic kidney diseases, immune diseases (mainly including systemic lupus erythematosus and antiphospholipid syndrome) and assisted reproductive technology are more likely to have early-onset pre-eclampsia.
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Objective@#To examine the association of pre-pregnancy obesity, excessive gestational weight gain (GWG) and gestational diabetes mellitus (GDM) with the risk of large for gestational age (LGA), and assess the dynamic changes in population attributable risk percent (PAR%) for having these exposures.@*Methods@#A retrospective cohort study was conducted to collect data on pregnant women who received regular health care and delivered in Beijing Obstetrics and Gynecology Hospital from January to December in 2011, 2014 and 2017, respectively. Information including baseline characteristics, metabolic indicators during pregnancy, pregnancy complications, and pregnancy outcomes were collected. Multivariate logistic regression model was constructed to assess their association with LGA delivery. Adjusted relative risk and prevalence of these factors were used to calculate PAR%and evaluate the comprehensive risk.@*Results@#(1)The number of participants were 11 132, 13 167 and 4 973 in 2011, 2014 and 2017, respectively. Corresponding prevalence of LGA were 15.19% (1 691/11 132), 14.98% (1 973/13 167) and 16.21% (806/4 973). No significant change in the prevalence of LGA was observed across all years investigated (all P>0.05). (2)According to results from multivariate logistic regression model, advanced maternal age, multiparity, pre-pregnancy overweight or obesity, GWG,GDM and serum triglyceride level≥1.7 mmol/L in the first trimester were associated with high risk of LGA (all P<0.05). Among these factors, pre-pregnancy overweight or obesity, excessive GWG and multiparity were common risk factors of LGA. GDM was not associated with risk of LGA in 2017 database. (3) Dynamic change of PAR% in these years were notable. PAR% of GWG for LGA decreased (32.6%, 27.2% and 22.2% in 2011, 2014 and 2017, respectively), while PAR% of pre-pregnancy overweight or obesity showed an upward trend (4.2%, 3.3% and 8.4%). In addition, PAR% of multiparity increased as well (3.5%, 6.3% and 15.9%). (4) Further analysis showed that excessive GWG in the first and second trimesters contributed the most (20.2% and 19.0% in 2014 and 2017).@*Conclusions@#Excessive GWG, pre-pregnancy overweight or obesity and multiparity are the important risk factors what contribute to LGA. PAR% of excessive GWG for LGA decrease in recent years. However, GWG in the first and second trimesters is a critical factor of LGA. Appropriate weight management in pre-pregnancy, the first or second trimester is the key point to reduce the risk of LGA.
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Objective@#To explore the effect of induced labor on delivery outcome of pregnant women undergoing vaginal trial of labor after cesarean section.@*Methods@#Totally, 173 pregnant women undergoing vaginal trial of labor after cesarean from April 1st, 2016 to October 31st, 2017 were involved. According to whether or not induced labor, pregnant women were divided into induced labor group (n=47) and natural labor group (n=126). The two groups of the general situation, the situation of delivery and delivery outcome were compared. Further more, the induced labor group were divided into cesarean section patients (n=20) and vaginal delivery patients (n=27) based on pregnancy outcomes, induction situation and delivery situation were analyzed.@*Results@#(1) The gestational weeks was 39.2±1.1 in induced labor group, 38.7±1.0 in natural labor group. The 1-minute Apgar score was 9.98±0.15 in induced labor group, and 9.87±0.60 in natural labor group. The neonatal weight was (3 497±426) g in induced labor group, and (3 288±350) g in natural labor group. The thickness of lower uterine segment at 36-39 weeks of pregnancy was (2.4±0.6) mm in induced labor group, (2.1±0.6) mm in natural labor group. There were obviously differences in the gestational week, the 1-minute Apgar score, the neonatal weight and the thickness of lower uterine segment at 36-39 weeks of pregnancy between the two groups (all P<0.05). There were no significant differences in 5-minute Apgar score, the interval between previous cesarean delivery, postpartum hemorrhage, fetal distress, and intrauterine infection, secondary uterine inertia, placental abruption and uterine ruption between the two groups (all P>0.05). (2) In induced labor group, the cervical score of cesarean section patients was 3.8±1.7, while the cervical score of vaginal delivery patients was 5.2±1.7. The induced labor days of cesarean section patients was (1.6±0.9) days, while the induced labor days of vaginal delivery patients was (1.2±0.4) days. There were obviously differences in the cervical score and the induced labor days among the two subgroup patients (all P<0.05). There were no significiant differences in Apgar score, neonatal weight, the thickness of lower uterine segment at 36-39 gestational weeks and the interval times of previous cesarean delivery between the two subgroup patients (P>0.05).@*Conclusion@#Induction of labor does not reduce neonatal Apgar score, and does not increase the incidence of postpartum complications, and eliminats the increase of cesarean section rate caused by increased gestational weeks and fetal enlargement, and increases the vaginal delivery rate of pregnant women undergoing vaginal trail of labor after cesarean section.
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Objective@#To analyze the pregnancy outcomes of fetal tetralogy of Fallot and to explore its prenatal diagnosis and treatment procedures.@*Methods@#The clinical data of 63 cases of fetal tetralogy of Fallot (62 cases were singleton and 1 case was one of twin) were collected retrospectively from November, 2013 to November, 2017 in Beijing Obstetrics and Gynecology Hospital.@*Results@#(1) Totally, 63 cases out of 46 352 pregnancies were diagnosed fetal tetralogy of Fallot by fetal ultrasonic cardiogram with about 0.136%(63/46 352) occurrence rate, and the mean gestational age was (23±3) weeks. And 50 cases (79%, 50/63) terminated pregnancy by induced labour. (2) Totally, 57 cases (90%,57/63) accepted genetic diagnosis.Eight cases (13%, 8/63) existed chromosome abnormality including 21-trimosy in 6 cases, 18-trisomy in 1 case and 22q11.2 microdeletion syndrome in 1 case; and these 8 cases were determined before 28 gestational weeks. (3) And 13 cases (21%, 13/63) of no fetal genetic abnormality selected to continue pregnancy. Twelve cases underwent full term delivery (5 cases were cesarean section delivery and 7 cases were vaginal delivery). Twelve newborns underwent surgical radical operation on heart malformation and got recovery. One case underwent preterm cesarean section at 35 gestational weeks for one of twin, and the newborn with tetralogy of Fallot was dead. The other the newborns survived and were followed up for tetralogy of Fallot surgery from 1 month to 3 years old after birth and recovered.@*Conclusions@#Fetal tetralogy of Fallot mainly is diagnosed by ultrasonic cardiogram in the second trimester. The gestational age of diagnosis may be as early as 15 gestational weeks. Fetal tetralogy of Fallot with no genetic abnormality could underwent radical heart malformation operation after birth. It is necessary to undergo genetic testing on fetal tetralogy of Fallot and prenatal multidisciplinary counseling as well.
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Objective To analyze the pregnancy outcomes of fetal tetralogy of Fallot and to explore its prenatal diagnosis and treatment procedures. Methods The clinical data of 63 cases of fetal tetralogy of Fallot (62 cases were singleton and 1 case was one of twin) were collected retrospectively from November, 2013 to November, 2017 in Beijing Obstetrics and Gynecology Hospital. Results (1) Totally, 63 cases out of 46 352 pregnancies were diagnosed fetal tetralogy of Fallot by fetal ultrasonic cardiogram with about 0.136%(63/46 352) occurrence rate, and the mean gestational age was (23±3) weeks. And 50 cases (79%, 50/63) terminated pregnancy by induced labour. (2) Totally, 57 cases (90%,57/63) accepted genetic diagnosis.Eight cases (13%, 8/63) existed chromosome abnormality including 21-trimosy in 6 cases, 18-trisomy in 1 case and 22q11.2 microdeletion syndrome in 1 case; and these 8 cases were determined before 28 gestational weeks. (3) And 13 cases (21%, 13/63) of no fetal genetic abnormality selected to continue pregnancy. Twelve cases underwent full term delivery (5 cases were cesarean section delivery and 7 cases were vaginal delivery). Twelve newborns underwent surgical radical operation on heart malformation and got recovery. One case underwent preterm cesarean section at 35 gestational weeks for one of twin, and the newborn with tetralogy of Fallot was dead. The other the newborns survived and were followed up for tetralogy of Fallot surgery from 1 month to 3 years old after birth and recovered.Conclusions Fetal tetralogy of Fallot mainly is diagnosed by ultrasonic cardiogram in the second trimester. The gestational age of diagnosis may be as early as 15 gestational weeks. Fetal tetralogy of Fallot with no genetic abnormality could underwent radical heart malformation operation after birth. It is necessary to undergo genetic testing on fetal tetralogy of Fallot and prenatal multidisciplinary counseling as well.
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Objective To examine the association of pre-pregnancy obesity, excessive gestational weight gain (GWG) and gestational diabetes mellitus (GDM) with the risk of large for gestational age (LGA), and assess the dynamic changes in population attributable risk percent (PAR%) for having these exposures. Methods A retrospective cohort study was conducted to collect data on pregnant women who received regular health care and delivered in Beijing Obstetrics and Gynecology Hospital from January to December in 2011, 2014 and 2017, respectively. Information including baseline characteristics, metabolic indicators during pregnancy, pregnancy complications, and pregnancy outcomes were collected. Multivariate logistic regression model was constructed to assess their association with LGA delivery. Adjusted relative risk and prevalence of these factors were used to calculate PAR%and evaluate the comprehensive risk. Results (1) The number of participants were 11 132, 13 167 and 4 973 in 2011, 2014 and 2017, respectively. Corresponding prevalence of LGA were 15.19% (1 691/11 132), 14.98% (1 973/13 167) and 16.21% (806/4 973). No significant change in the prevalence of LGA was observed across all years investigated (all P>0.05). (2) According to results from multivariate logistic regression model, advanced maternal age, multiparity, pre-pregnancy overweight or obesity, GWG, GDM and serum triglyceride level≥1.7 mmol/L in the first trimester were associated with high risk of LGA (all P<0.05). Among these factors, pre-pregnancy overweight or obesity, excessive GWG and multiparity were common risk factors of LGA. GDM was not associated with risk of LGA in 2017 database. (3) Dynamic change of PAR% in these years were notable. PAR% of GWG for LGA decreased (32.6%, 27.2% and 22.2% in 2011, 2014 and 2017, respectively), while PAR% of pre-pregnancy overweight or obesity showed an upward trend (4.2%, 3.3% and 8.4%). In addition, PAR% of multiparity increased as well (3.5%, 6.3% and 15.9%). (4) Further analysis showed that excessive GWG in the first and second trimesters contributed the most (20.2% and 19.0% in 2014 and 2017). Conclusions Excessive GWG, pre-pregnancy overweight or obesity and multiparity are the important risk factors what contribute to LGA. PAR% of excessive GWG for LGA decrease in recent years. However, GWG in the first and second trimesters is a critical factor of LGA. Appropriate weight management in pre-pregnancy, the first or second trimester is the key point to reduce the risk of LGA.
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Objective To explore the effect of induced labor on delivery outcome of pregnant women undergoing vaginal trial of labor after cesarean section. Methods Totally, 173 pregnant women undergoing vaginal trial of labor after cesarean from April 1st, 2016 to October 31st, 2017 were involved. According to whether or not induced labor, pregnant women were divided into induced labor group (n=47) and natural labor group (n=126). The two groups of the general situation, the situation of delivery and delivery outcome were compared. Further more, the induced labor group were divided into cesarean section patients (n=20) and vaginal delivery patients (n=27) based on pregnancy outcomes, induction situation and delivery situation were analyzed.Results (1) The gestational weeks was 39.2±1.1 in induced labor group, 38.7±1.0 in natural labor group. The 1?minute Apgar score was 9.98±0.15 in induced labor group, and 9.87± 0.60 in natural labor group. The neonatal weight was (3 497±426) g in induced labor group, and (3 288±350) g in natural labor group. The thickness of lower uterine segment at 36-39 weeks of pregnancy was (2.4±0.6) mm in induced labor group, (2.1 ± 0.6) mm in natural labor group. There were obviously differences in the gestational week, the 1?minute Apgar score, the neonatal weight and the thickness of lower uterine segment at 36-39 weeks of pregnancy between the two groups (all P<0.05). There were no significant differences in 5?minute Apgar score, the interval between previous cesarean delivery, postpartum hemorrhage, fetal distress, and intrauterine infection, secondary uterine inertia, placental abruption and uterine ruption between the two groups (all P>0.05). (2) In induced labor group, the cervical score of cesarean section patients was 3.8±1.7, while the cervical score of vaginal delivery patients was 5.2±1.7. The induced labor days of cesarean section patients was (1.6 ± 0.9) days, while the induced labor days of vaginal delivery patients was (1.2 ± 0.4) days. There were obviously differences in the cervical score and the induced labor days among the two subgroup patients (all P<0.05). There were no significiant differences in Apgar score, neonatal weight, the thickness of lower uterine segment at 36-39 gestational weeks and the interval times of previous cesarean delivery between the two subgroup patients (P>0.05). Conclusion Induction of labor does not reduce neonatal Apgar score, and does not increase the incidence of postpartum complications, and eliminats the increase of cesarean section rate caused by increased gestational weeks and fetal enlargement, and increases the vaginal delivery rate of pregnant women undergoing vaginal trail of labor after cesarean section. [Key words] Labor, induced; Vaginal birth after cesarean; Trial of labor; Prognosis
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<p><b>OBJECTIVE</b>To explore the genetic basis for fetuses with cleft lip and palate.</p><p><b>METHODS</b>For 100 fetuses diagnosed with cleft lip with or without palate, G-banding chromosomal karyotyping and copy number variation sequencing (CNV-seq) were carried out on chorionic villi, amniotic fluid or cordocentesis samples.</p><p><b>RESULTS</b>No genomic abnormality was found among 49 fetuses with isolated cleft lip and palate, while 12 genomic aberrations were found among 51 fetuses with syndromic cleft lip and palate, which included 4 cases with trisomy 13, 2 cases with trisomy 18, 1 with X chromosome aneuploidy, 2 with other chromosomal aneuploidies and 3 with pathogenic CNVs.</p><p><b>CONCLUSION</b>The incidence of genomic abnormalities in fetuses with cleft lip and palate was high. In addition to chromosomal abnormalities, attention should also be paid to pathogenic CNVs.</p>
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Objective To explore the neurological development of fetal with ventriculomegaly at 1 year after birth by systematically reviewing the domestic and international literature about prognosis of fetal ventriculomegaly. Methods Wanfang database, CNKI, CBM, PubMed, EMBASE and the Cochrane Library were online searched to collect relevant literature published from January 1st, 1980 to November 22th, 2017. Literature were extracted based on the Newcastle-Ottawa Scale(NOS), and analyzed by R software for meta-analysis. The corresponding model was selected according to the results of heterogeneity test to comprehensively analyze the prognosis of the fetus with ventriculomegaly. Results Five studies were included in the meta analysis, all of them were of high quality(scores>5).(1)The good prognosis rate of nervous system was 88％(95％CI:0.77-0.95)in fetus with mild ventriculomegaly,was 57％(95％CI:0.18-0.91)in those with moderate ventriculomegaly, and was 36％(95％CI: 0.16-0.59)in those with severe ventriculomegaly.(2)The good prognosis rate of the nervous system was 86％(95％CI:0.75-0.94)in fetus with the isolated ventriculomegaly, while was 58％ (95％CI: 0.20-0.91) in those with non-isolated ventriculomegaly.Theincidenceofchromosomalabnormalitieswas 7％(95％CI:0.05-0.09)inventriculomegaly. The improvement rate of lateral ventricle width in pregnancy was 41％(95％CI:0.27-0.57). Conclusions The prognosis of nervous system with mild ventriculomegaly is better than that of moderate and severe ventriculomegaly. The prognosis of nervous system with isolated ventriculomegaly is better than that of non-isolated ventriculomegaly. Fetal ventriculomegaly may be associated with fetal chromosomal abnormalities and intrauterine infection. The variation of fetal lateral ventricular width should be monitored regularly during pregnancy, the risk of poor prognosis should be informed, and pediatrician should be asked for evaluation.
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Objective To investigate the relationship between 24-hour urinary protein quantification and maternal and neonatal complications in severe preeclampsia. Methods Totally 2305 cases of pregnant women which were diagnosed as severe preeclampsia more than 28 weeks of single pregnancy in 37 hospitals in mainland China were selected from January 1 to December 31, 2011. According to the results of the highest 24 hours urine protein quantitative after admission, the subjects were divided into 3 groups. The group Ⅰ included 590 cases whose 24h urinary protein were 0-2g. There were 843 cases in group Ⅱ whose 24h urinary protein were 2-5g, 872 cases were in group Ⅲ whose 24h urinary protein were more than 5g. The complications of the maternal and neonatal outcome were analyzed among the three groups. Results The incidence of hypoalbuminemia was 14. 8％, the rate of chest /ascites /pulmonary edema / heart failure was 1. 6％, the incidence of renal dysfuction was 0. 6％ and the incidence of placental abruption and HELLP syndrome was 2. 7％ and 3. 0％. There was significant difference in the incidence of hypoalbuminemia among the three groups of which the incidence of groupⅠwas significantly lower than that of group Ⅱ and group Ⅲ (P ＜ 0. 017). The rate of fetal growth restriction, fetal distress and neonatal asphyxia was 3. 3％, 9. 5％, and 1. 1％. The incidence of neonatal body weight, fetal growth restriction and neonatal asphyxia among the three groups were significantly different (P ＜ 0. 05). The body weight of neonatal group was significantly higher than that of group Ⅱ and group Ⅲ (P ＜ 0. 017). The incidence of FGR in group Ⅱ was significantly higher than that in group Ⅲ (P ＜ 0. 017). The rate of neonatal asphyxia in group Ⅰ was significantly lower than that in group Ⅲ (P ＜ 0. 017). There are no significant difference in the incidence of heart failure /pulmonary edema, placental abruption, HELLP syndrome and cesarean section among the three groups. Conclusion 24-hour urinary protein may increase the risk of hypoalbuminemia in pregnant women with severe preeclampsia, but do not increase the risk of heart failure /pulmonary edema, placental abruption and HELLP syndrome. 24-hour urinary protein was associated with severe preeclampsia neonatal body weight, fetal growth restriction, and neonatal asphyxia.
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Objective To investigate the risk of emergency cesarean section during labor with the pre-pregnancy body mass index or gestational weight gain.Methods A total of 6 908 healthy nullipara with singleton pregnancy and cephalic presentation who was in term labor in Beijing Obstetrics and Gynecology Hospital from August 1st,2014 to September 30th,2015 were recruited.They were divided into two groups,the vaginal delivery group (92.88％,6 416/6 908) and the emergency cesarean section group (7.12％,492/6 908).According to WHO body mass index (BMI) classification criteria and the pre-pregnancy BMI,the 6 908 women were divided into three groups,the underweight group(BMI＜18.5 kg/m2;17.39％,1 201/6 908),the normal weight group(18.5-24.9 kg/m2;73.00％,5 043/6 908),the overweight and obese group (≥ 25.0 kg/m2;9.61％,664/6 908).According to the guidelines of Institute of Medicine (IOM),they were divided into three groups,the inadequate gestational weight gain (GWG) group (16.72％,1 155/6 908),the appropriate GWG group (43.11％,2 978/6 908),the excessive GWG group (40.17％,2 775/6 908).Unadjusted and adjusted odds ratio (OR) and confidence interval (CI) of the risk of emergency cesarean section were calculated by bivariate logistic regression.Results (1) Comparing to the vaginal delivery group,women in the emergency cesarean section group were older,with a lower education level.Their prepregnancy BMI was higer and had more gestational weight gain.They had higher morbidity of pregnancy induced hypertension and gestational diabetes mellitus.Comparing to the vaginal delivery group,the neonates in the emergency cesarean section group were elder in gestational week,with higher birth weight.More male infants and large for gestation age infants were seen in the emergency cesarean section group (all P ＜ 0.05).(2) Overweight and obesity were associated with the increased risk of emergency cesarean section for nullipara,with the unadjusted OR of 1.98 (95％CI:1.54-2.54),adjusted OR(aOR) of 1.66 (95％CI:1.27-2.16).In the inadequate GWG group and the excessive GWG group,overweight and obese women had increased risk of emergency cesarean section,with adjusted OR of 2.33 (95％CI:1.06-5.14) and 1.62 (95％CI:1.44-2.28),respectively.In the appropriate GWG group,there was no significant difference in the risk of emergency cesarean section between the overweight and obese women and the normal weight women,with aOR of 1.54 (95％CI:0.94-2.54).The underweight group was associated with decreased risk of emergency cesarean section (OR=0.55,95％CI:0.40-0.74;aOR=0.66,95％ CI:0.48-0.90).While no significant difference in the risk of emergency cesarean section was found between the underweight women,the overweight and obese women,with the aOR of 0.31 (95％CI:0.07-1.32),0.73 (95％CI:0.48-1.10),0.66 (95％CI:0.38-1.12),respectively.(3) Absolute value of gestational weight gain was associated with the increased risk of emergency cesarean section,(aOR=1.03,95％CI:1.01-1.05).GWG above IOM giudelines did not independently affect the risk of emergency cesarean section (OR=1.30,95％CI:1.07-1.58;aOR=1.01,95％CI:0.82-1.24).In the underweight group,the normal weight group and the overweight or obese group,the excessive GWG women and the appropriate GWG women had no significant difference in the risk of emergency cesarean section (aOR=1.03,95％CI:0.55-1.12;aOR=1.02,95％CI:0.80-1.30;aOR=1.03,95％ CI:0.59-1.78),respectively.GWG below IOM giudelines was associated with decreased risk of emergency cesarean section (OR=0.62,95％ CI:0.45-0.85;aOR=0.64,95％ CI:0.46-0.88).In the underweight group and the overweight or obese group,there was no significant difference in the emergency cesarean section risk between the inadequate GWG women and the appropriate GWG within women (aOR=0.24,95％CI:0.06-1.01;aOR=0.90,95％CI:0.40-2.04).In the normal weight group,the inadequate GWG women had lower risk of emergency cesarean section (aOR=0.65,95％ CI:0.45-0.95).Conclusions Overweight and obese women have increased risk of emergency cesarean section.The prepregnancy BMI is supposed to be an appropriate level.Absolute value of gestational weight gain is associated with increased risk of emergency cesarean section.There is no correlation between the excessive GWG and the risk of emergency cesarean section.
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Objective To explore the association between maternal age and perinatal outcomes.Methods Totally,3 151 women with advanced maternal age and 6 098 women younger than 35 years old who delivered in Beijing Obstetrics and Gynecology Hospital in 2016 were recruited.Their clinic characteristics and perinatal outcomes were collected to divide into 3 groups based on delivery age,Group 1 (aged 35-39 years,2 683 cases),Group 2 (aged ≥40 years,366 cases) and the control group (aged＜35 years,6 098 cases).The association between maternal age and adverse perinatal outcomes were analyzed,including hypertensive disorder complicating pregnancy,gestational diabetes mellitus (GDM),preterm birth and postpartum hemorrhage.Results The rate of cesarean section history (27.39％,33.61％,5.53％) or previous myomectomy history (2.80％,5.46％,0.72％) were compared between the advanced maternal age groups and the control group,and the differences were statistically significant (P＜0.05).The percentage of prepregnancy overweight and obesity (29.67％,27.05％,18.47％),complicated with myoma (14.83％,19.95％,5.64％) were compared among the three groups,and the differences were statistically significant (P＜ 0.05).The percentage of pregnancy through assisted reproductive technology (9.84％,15.03％,3.12％) also had statistically significant differences (P＜0.05).The incidence of fetal chromosomal abnormalities (1.23％,3.01％,0.36％) and fetal malformations (1.94％,4.37％,0.48％) increased with the maternal age,with statistically significant differences (P＜0.01).The mobidity of hypertensive disorders (9.84％,13.11％,9.23％),pregestational diabetes mellitus (1.83％,2.19％,0.72％),gestational diabetes mellitus (22.70％,28.42％,14.87％),premature rupture of membranes (25.57％,19.40％,31.42％),placenta previa (2.05％,2.46％,0.92％),preterm birth(8.35％,11.20％,5.51％),postpartum hemorrhage (25.11％,18.31％,20.27％)and forceps delivery (5.42％,2.33％,5.71％) were compared,and the differences were statistically significant (P＜0.05).The cesarean section rate in primipara (45.42％,75.74％,21.33％) and multipara (51.46％,61.54％,30.95％) had statistically significant difference (P＜0.05).The proportion of macrosomia (10.80％,8.85％,7.96％) and neonates transferred into neonatal ICU (9.63％,11.48％,5.21％) in term neonates had statistically significant difference (P＜0.05).Conclusions Women with advanced maternal age increase after new family planning policy put into effect,so do the risk of adverse perinatal outcomes.Attention and interventions should be made to cope with the occurrence of adverse perinatal outcomes.
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Objective To investigate the influence of gestational weight gain (GWG) on the incidence of macrosomia, and to establish the reference ranges of GWG based on the incidence of macrosomia. Methods A multicenter, cross-sectional study was conducted. Totally, 112485 women were recruited from 39 hospitals in 14 provinces in China. Totally, 61149 cases were eligible with singleton pregnancies and non-premature deliveries. The associations of pre-pregnancy body mass index (BMI), GWG, newborn gender and gestational diabetes with macrosomia were analyzed with logistic regression. The normal GWG ranges were calculated in all maternal BMI subgroups, based on the normal incidence of macrosomia was set as the range of 5.0% to 10.0%. Results In this study, the incidence of macrosomia was 7.46%(4563/611149). The macrosociam was positive related with maternal height, delivery week,pre-pregnancy BMI, GWG, gestational diabetes, primipara, and male babies significantly (P<0.05), based on unadjusted and adjusted logestic regression. The normal range of GWG 20.0-25.0, 10.0-20.0, 0-10.0 and 0-5.0 kg in subgroups of underweight (pre-pregnancy BMI<18.5 kg/m2), normal (18.5-24.9 kg/m2), overweight (25.0-29.9 kg/m2) and obese (≥30.0 kg/m2), respectively. Conclusion The reference range of GWG in China based on the incidence of macrosomia is established.
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Objective To explore the associations of the genetic polymorphisms of cytochrome P450, family 2, subfamily D, polypeptide 6 (CYP2D6) and cytochrome P450, family 2, subfamily C, polypeptide 9 (CYP2C9) with early-onset severe pre-eclampsia and the efficacy of labetalol therapy. Methods Totally 105 gravidas diagnosed with early-onset severe pre-eclampsia (experimental group) and 103 healthy gravidas (control group) were recruited from Beijing Obstetrics and Gynecology Hospital between August 2013 and July 2016. Labetalol was given to control blood pressures in gravidas with early-onset severe pre-eclampsia. If labetalol administration alone did not exceed the mean dose (100 mg, one dose per eight hours) and effectively controlled the blood pressures, it would be considered to be valid (n=75), otherwise it would be viewed as an invalid treatment. Genotype and allele frequencies of CYP2C9 gene (rs1057910 and rs4918758) and CYP2D6 gene (rs1065852, rs28371725, rs35742686 and rs3892097) in the gravidas were analyzed by TaqMan probe polymerase chain reaction. Differences in the genotype and allele frequencies were compared between the experimental and control groups, and the valid and invalid labetalol treatment groups. Chi-square test, analysis of variance and LSD test were used as statistical methods. Results The gravidas in both experimental and control groups were AA genotype in CYP2C9 gene rs1057910, TT genotype in CYP2D6 gene rs35742686 and CC genotype in CYP2D6 gene rs3892097. Frequencies of CC and CT genotypes in CYP2D6 gene rs28371725 in the experimental group were higher than those in the control group [18.1% (19/105) vs 14.6% (15/103);56.2% (59/105) vs 42.7% (44/103); χ2=6.707], and higher C allele frequency in CYP2D6 gene rs28371725 was also observed in the experimental group [46.2% (97/210) vs 35.9% (74/206), χ2=4.529] (all P0.05). Compared with the gravidas with CT or TT genotype of CYP2D6 gene rs28371725, those with CC genotype had longer gestational age [(32.5±2.1) vs (29.5±1.8) and (29.8±2.2) weeks] and higher plasma albumin [(27.2±9.3) vs (20.3±10.4) and (22.5±7.4) g/L], but lower systolic pressure and 24 hours urine protein (LSD test, all P<0.05). The G allele frequency in CYP2D6 gene rs1065852 in invalid labetalol treatment group was higher than that in valid labetalol treatment group [93.3% (56/60) vs 76.0% (114/150), χ2=8.351, P=0.004]. Conclusions The polymorphism of CYP2D6 gene rs28371725 may be associated with early-onset severe pre-eclampsia, and the allele of G in CYP2D6 gene rs1065852 may be associated with the efficacy of labetalol in treatment of early-onset severe pre-eclampsia.