Construction of predictive model for pregnancy-related anxiety risk in pregnant women based on LASSO regression / 环境与职业医学

Background Pregnancy-related anxiety has a negative impact on the physical and mental health of pregnant women and the normal growth and development of the fetus. Establishing prediction models for pregnancy-related anxiety to screen associated predictive factors may provide important opportunities for prenatal intervention. Objective To establish a prediction model of pregnancy-related anxiety risk of pregnant women. Methods From January to July 2021, a questionnaire survey on pregnancy-related anxiety and predictors was conducted among pregnant women having routine prenatal check-ups provided by an obstetrics clinic of a tertiary grade A hospital in Ningxia. The socio-demographic characteristics of the subjects were collected, and the pregnant women were evaluated by the Life Event Scale (LES), Perceived Social Support Scale (PSSS), Family APGAR Index (APGAR), and Pregnancy-related Anxiety Questionnaire (PAQ). R 4.2.0 software was used to fit all selected variables by least absolute shrinkage and selection operator (LASSO) regression to identify predictors of pregnancy-related anxiety in the second and third trimesters. On the basis of logistic regression analysis, prediction models of pregnancy-related anxiety in the second and third trimesters were constructed, and the model nomogram and receiver operating characteristic curve (ROC) were drawn. The prediction effect of the model was evaluated by area under the curve (AUC). A calibration chart was drawn to evaluate the calibration of the model. Results A total of 1500 questionnaires were distributed, and 1448 valid questionnaires were recovered, with an effective rate of 96.53%. Among the 1448 pregnant women, the overall positive rate of pregnancy-related anxiety was 28.80% (417/1448), and the positive rates in the second and third trimesters were 29.21% (276/935) and 27.49% (141/513), respectively. The predictors entering the the second trimester model were age of marriage, family care, social support, family expectations for the fetus, physical condition during pregnancy, and whether experiencing life stressful events during pregnancy. The predictors entering the the third trimester model were pregnancy intention, physical discomfort, and whether experiencing life stress during pregnancy. A risk prediction model of pregnancy-related anxiety for the second trimester was established: risk of pregnancy-related anxiety=−0.07× marriage age +0.12× family care −0.03× social support −0.65× family expectation of fetal sex +0.42× physical condition during pregnancy +0.47× whether experiencing life stressful events during pregnancy. A risk prediction model of pregnancy-related anxiety for the third trimester was established: risk of pregnancy-related anxiety=−5.69+0.82× pregnancy intention +1.06× physical discomfort +0.94× whether experiencing life stressful events during pregnancy. The ROC curves of the two models were drawn. The AUC of the second trimester model was 0.71, and the AUC of related validation model was 0.68. The AUC of the third trimester model was 0.72, and the AUC of related validation model was 0.66. Conclusion The risk prediction models of pregnancy-related anxiety constructed based on LASSO regression and logistic regression have good prediction ability, and they suggest that pregnant women in the second trimester with short marriage age, high family care, low social support, family expectations for fetal sex, average physical condition, and experiencing life stress during pregnancy, and pregnant women in the third trimester with spontaneous pregnant intention, unintended pregnancy, physical discomfort, and experiencing life stress during pregnancy are high-risk groups for pregnancy-related anxiety.

Surveillance of maternal near miss in Hangzhou City from 2015 to 2020 / 预防医学

Objective@#To investigate the prevalence and types of maternal near miss in Hangzhou City from 2015 to 2020, so as to provide insights into early identification and interventions for maternal near miss.@*Methods@#The data of maternal near miss in 5 hospitals of Hangzhou City from 2015 to 2020 were collected from China's National Maternal Near Miss Obstetrics Surveillance System, and the incidence and mortality of maternal near miss, types of pregnancy-related complications/comorbidities and types of critical illness were descriptively analyzed.@*Results@#Totally 230 490 pregnant and lying-in women were recruited in 5 hospitals in Hangzhou City from 2015 to 2020, and there were 182 514 live births, 177 428 women with pregnancy-related complications/comorbidities, and 1 790 cases of maternal near miss with a 0.98% annual incidence rate. The incidence of maternal near miss was high in 2019 (1.18%). The hospital mortality and death index were respectively 3.29/105 and 0.33% among pregnant and lying-in women from 2015 to 2020, and there was no death found among pregnant and lying-in women from 2018 to 2020. The main pregnancy-related complications/comorbidities included anemia (79.33%), obstetric hemorrhagic disorders (69.83%), and gestational hypertension (16.65%). The main critical illness among maternal near miss included coagulation dysfunction (87.23/104), cardiovascular dysfunction (20.44/104), and respiratory dysfunction (9.70/104).@*Conclusions@#The incidence of maternal near miss was high and the hospital mortality appeared a reduction tendency among pregnant and lying-in women in Hangzhou City from 2015 to 2020. Coagulation dysfunction is the primary critical illness among maternal near miss, and the management of anemia and hemorrhagic diseases requires to be improved.

An Evaluation of Risk Factors Associated with Pregnancy Related Acute Kidney Injury in Women Admitted to the High Dependency Care Unit at Women and Newborn Hospital, Lusaka-Zambia

Objective:To evaluate factors associated with Pregnancy-related KidneyInjury(PRAKI) inwomen admitted to high dependency care unit at Women and Newborn Hospital in Lusaka, ZambiaMethodology:This was an unmatched case-control study conducted in the high-dependency care unit at Women and Newborn Hospital in Lusaka. Study participantswererecruitedconsecutivelybyconveniencesampling.Participants'medicalrecords were reviewed to capture serum creatinine levels;whileastructuredquestionnairewasadministeredto eligible andconsentedstudy participants to capture data on sociodemographic, obstetric, and medical factors. Serum creatinine levels above 84µmol/l were used as criteria for classifying PRAKI. Excel was used for data cleaningandStatav13usedforanalysis.Descriptive statistics were done for all variables followed by univariate and multivariable logistic regression to determine association. 95% CI was usedand p value of<0.05 was consideredsignificant.Results:Thestudy comprised of185 study participants, split into 85 women with PRAKI (cases) and 100 women without PRAKI (controls). The median age was 29 years with 11years interquartile range. 75.3%of the study participants wereinmarriagerelationships.Pre-existinghypertension was the most prevalent medical condition in both the cases (51.8%) and the controls (38%). Sickle celldisease was much less common at 1.2% in cases and 8% in controls. Among the obstetric conditions, preeclampsia was the most common condition at 77.6% and 60% in cases and controls respectively. Eclampsia was found in 38.8% of cases and 11% of controls. Sepsis was least common at 4.7% of cases. This study found that obstetricfactorssuch as eclampsia (AOR = 5.12, 95% CI [2.14 ­ 12.23]; p≤0.0001), preeclampsia (AOR = 2.46, 95% CI [1.12 ­ 5.39]; p = 0.025), and postpartum haemorrhage were associated with the development of PRAKI. Medical conditions were not associated with PRAKI.

Temporal Evolution of Maternal Mortality: 1980-2019 / Evolução temporal da mortalidade materna: 1980-2019

Abstract Objective To determine the profile of maternal deaths occurred in the period between 2000 and 2019 in the Hospital de Clínicas de Porto Alegre (HCPA, in the Portuguese acronym) and to compare it with maternal deaths between 1980 and 1999 in the same institution. Methods Retrospective study that analyzed 2,481 medical records of women between 10 and 49 years old who died between 2000 and 2018. The present study was approved by the Ethics Committee (CAAE 78021417600005327). Results After reviewing 2,481 medical records of women who died in reproductive age, 43 deaths had occurred during pregnancy or in the postpartum period. Of these, 28 were considered maternal deaths. The maternal mortality ratio was 37.6 per 100,000 live births. Regarding causes, 16 deaths (57.1%) were directly associated with pregnancy, 10 (35.1%) were indirectly associated, and 2 (7.1%) were unrelated. The main cause of death was hypertension during pregnancy (31.2%) followed by acute liver steatosis during pregnancy (25%). In the previous study, published in 2003 in the same institution4, the mortality rate was 129 per 100,000 live births, and most deaths were related to direct obstetric causes (62%). The main causes of death in this period were due to hypertensive complications (17.2%), followed by postcesarean infection (16%). Conclusion Compared with data before the decade of 2000, there was an important reduction in maternal deaths due to infectious causes.

Resumo Objetivo Determinar o perfil dos óbitos maternos ocorridos no período de 2000 a 2019 no Hospital de Clínicas de Porto Alegre (HCPA) e comparar com os óbitos maternos entre 1980 e 1999 na mesma instituição. Métodos Estudo retrospectivo que analisou 2.400 prontuários de mulheres entre 10 e 49 anos que morreram entre 2000 e 2019. O presente estudo foi aprovado pelo Comitê de Ética (CAAE 78021417600005327). Resultados Após revisão de 2.481 prontuários de mulheres que morreram em idade reprodutiva, 43 mortes ocorreram durante a gravidez ou no período pós-parto. Destas, 28 foram considerados óbitos maternos. A taxa de mortalidade materna foi de 37.6 por 100.000 nascidos vivos. Em relação às causas, 16 óbitos (57.1%) estiveram diretamente associados à gravidez, 10 (35.1%) estiveram indiretamente associados e 2 (7.1%) não estiveram relacionados. A principal causa de morte foi hipertensão na gravidez (31.2%) seguida de esteatose hepática aguda da gravidez (25%). No estudo anterior, publicado em 2003 na mesma instituição4, a taxa de mortalidade foi de 129 por 100.000 nascidos vivos, e a maioria dos óbitos estava relacionada a causas obstétricas diretas (62%). As principais causas de óbito neste período foram por complicações hipertensivas (17.2%), seguidas de infecção pós-cesárea (16%). Conclusão Em comparação com os dados anteriores à década de 2000, houve uma redução importante das mortes maternas por causas infecciosas.

Mortalidad materna: Hospital Profesor Alejandro Posadas, Buenos Aires. Evolución 2003-2015 / Maternal mortality. Hospital Profesor Alejandro Posadas, Buenos Aires. Evolution 2003-2015

Revisamos las historias clínicas de las mujeres cuyo fallecimiento fue notificado como muerte materna entre agosto de 2003 y diciembre de 2015 en nuestro hospital y calculamos índices, tendencias y años de vida potencialmente perdidos. La información aportada por los certificados de defunción fue exigua. Un total de 52 casos cumplía con los criterios de muerte materna. Dos fueron muertes "incidentales" y dejaron siete huérfanos: una fue causada por embolia grasa por inyección de siliconas en mamas post-cesárea y la otra fue consecuencia de un femicidio que incluyó al feto de 24 semanas. De las 50 muertes maternas restantes, 11 fueron tardías (> 42 días post-parto). Las otras 39 ocurrieron durante el embarazo, parto y puerperio (≤ 42 días): 20 tuvieron causas obstétricas directas, 18 causas indirectas, y la causa de la restante fue indeterminada. La causa más frecuente de muerte fue el aborto séptico. Las muertes maternas directas presentaron como antecedentes más del triple de cesáreas y el doble de gestas que las indirectas, y dejaron el doble de huérfanos. La muerte por placenta accreta tuvo relación directa significativa con el número de cesáreas. El índice de mortalidad materna total varió entre 25 y 150 (media: 72) por 100 000 recién nacidos vivos en el período, con tendencia ascendente. Los años de vida potencialmente perdidos fueron 1576. Se destaca la necesidad de mejorar el sistema de registro de defunción y reforzar las medidas de prevención y asistencia a fin de disminuir la mortalidad materna en el área de influencia del hospital.

We reviewed the medical records of women with maternal death reported from August 2003 to December 2015 in the Posadas Hospital (Buenos Aires Province, Argentina), and calculated indexes, trends and years of potential life lost. A total of 52 cases fulfilled the criteria of maternal death. The information provided by death certificates was meager. Two deaths were incidental: one occurred post-caesarean section and was caused by fat embolism following liquid silicone breast injection, and the other was the consequence of femicide which involved also the 24-week fetus. Of the remaining 50 cases, 11 were late deaths (> 42 days postpartum). In 39 women, death occurred during pregnancy, childbirth, or puerperium up to 42 days: 20 were due to direct obstetric causes, and 18 to indirect, non-obstetric causes, the cause of the remaining death was not determined. The most frequent cause was septic abortion. Direct maternal deaths had had more than twice pregnancies, thrice caesarean sections, and orphaned twice as children as indirect deaths. Death caused by placenta accreta was directly related to the number of previous caesarean sections. Throughout the period, maternal mortality index varied between 25 y 150 (mean: 72) per 100 000 live births with ascending trend and 1576 years of potential life were lost. The study exposes the need to improve the death registration system and, most importantly, strengthen prevention and assistance measures to reduce maternal mortality in the area of influence of our hospital.

Hyperreactio leuteinalis: benign tumour associated with pregnancy mimicking ovarian malignancy

Hyperreactio leuteinalis refers to pregnancy related enlargement of B/L ovaries rarely unilateral ovary, moderate to marked size due to multiple theca leutein cysts. It is a rare finding associated with pregnancy seen commonly in multiple gestation, GTDs and fetal abnormalities: viz hydrops. It is caused by elevated B-hcg level. We report a case of 28 years old female, primi with 13 spontaneously conceived weeks pregnancy who presented to ANC OPD for regular check-up and vague abdominal discomfort. USG revealed a large right sided ovarian mass, solid cystic in appearance pushing the uterus to left side and upwards. Staging laparotomy was done at 14 weeks viewing it to be a malignant mass. Unilateral right sided oophorectomy was done along with biopsy taken from left ovary. On microscopic histological examination diagnosis of hyperreactio leuteinalis unilateral ovary was made. Hyperreactio leuteinalis mimicking ovarian malignancy on USG results in unnecessary surgical intervention.

Correlation of serum homocysteine levels in pregnancy related hypertensive disorders versus normotensive pregnancies

Background: Homocysteine concentrations decrease during normal pregnancy, but this does not occur in pre-eclampsia. In pre-eclampsia, homocysteine levels further increase with severity of pre-eclampsia. Elevated homocysteine levels can be due to genetic or multifactorial deficit or a combination of both.Methods: The present study is conducted at department of obstetrics and gynaecology, Narayana Medical College and Hospital, Nellore. 200 pregnant (100 women with pregnancy related hypertensive disorders and 100 normotensive pregnants) recruited. Maternal serum Homocysteine levels were analyzed among women with pregnancy related hypertensive disorders and compared with normotensive pregnant. Chemiluminescence immunoassay was used for determining the Homocysteine levels.Results: The study revealed significant elevation in the levels of homocysteine in pre-eclamptic women (17.54±5.34) compared to normotensive women (7.59±1.91). The study showed a strong association between serum homocysteine levels and severity of pre-eclampsia. The mean homocysteine levels in women with severe Pre-eclampsia (20.59±4.3) were significantly higher than those with mild pre-eclampsia (15.17±1.9). A positive correlation is found between homocysteine levels with serum uric acid and LDH demonstrating the harmful action of hyperhomocysteinemia upon the endothelium. A negative correlation is found between homocysteine levels with hemoglobin and hematocrit even though in anemic patients the hematological levels are found to be little high due to hemoconcentration. The perinatal outcome in women with raised levels of homocysteine was poor with an increased incidence of IUGR (41%), SGA (9%), still births (3%) and IUD (4%) among women with pregnancy related hypertensive disorders when compared to normotensive pregnant women.Conclusions: Elevated levels of homocysteine can be reduced by administering vitamins which help by increasing the metabolism of homocysteine. The internationally accepted treatment for hyperhomocystenemia is using a combination of folic acid 400 µg, vitamin B12 500 µg and pyridoxine 10mg initiating from pre-conceptional period can be used.

Acute kidney injury in obstetrics: a five-year study in a tertiary centre

Background: Pregnancy Related Acute Kidney Injury (PRAKI) is a major cause of maternal and foetal morbidity and mortality in developing countries. The incidence has declined due to improvements in reproductive health but it is still associated with significant perinatal mortality and maternal morbidity. It may be due to decrease in renal perfusion or ischemic tubular necrosis from a variety of conditions encountered during pregnancy. Our study aims at determining the predisposing factors and causes of AKI during pregnancy and its impact on maternal and foetal outcome.Methods: A retrospective cohort study over a period of 5 years was conducted on pregnant women with AKI as per inclusion and exclusion criteria. The detailed history, events, mode of delivery, cause leading to AKI, management, hospital stay, maternal and foetal outcome were studied in detail and evaluated. These patients were classified according to RIFLE criteria and were followed up for hospital stay and residual morbidities.Results: The incidence of PRAKI in the study was 0.07% (36 out of 50,735 deliveries) and among obstetric ICU patients, it was 6.8%. Most of the majority of the cases were unbooked (66.7%) and multipara (61.1%). Maternal morbidity was seen in 66.7% and mortality was 27.8%. Poor foetal outcome was seen in 44.4%.Conclusions: Haemorrhage is the most common cause of PRAKI, followed by toxaemia of pregnancy and sepsis. Early detection and meticulous management of haemorrhage, hypertension and sepsis reduce the incidence of PRAKI and associated maternal mortality.

Effect of hypertension on prognosis in patients with pregnancyrelated acute kidney injury: A retrospective, propensity scorematched cohort study / 中南大学学报(医学版)

OBJECTIVES@#Hypertension is a serious complication of pregnancy-related acute kidney injury (PR-AKI). This study aimed to determine the effect of hypertension on the prognosis of PR-AKI, maternal outcomes, and fetal outcome.@*METHODS@#Patients with PR-AKI in a hospital from January 2008 to June 2018 were enrolled for this study. Patients with or without hypertension were grouped by 1꞉1 propensity matching score. The effect of hypertension on the prognosis of PR-AKI was evaluated by multivariate Cox regression before and after matching.@*RESULTS@#Of the 30 680 women who attended the Department of Obstetrics, 126 patients were diagnosed as PR-AKI, the incidence was 0.41%. The age was (29.04±2.32) years. There were 50 cases in the hypertension group, accounting for 39.68%. Using the propensity score method, 48 pairs of patients were successfully matched, and the covariates between the two groups were balanced. After matching and adjusting for relevant clinical factors, Cox regression analysis showed that risk of end-stage renal disease (ESRD) was increased in the hypertension group compared with the normal blood pressure group (HR=2.951, 95％ CI 1.067 to 8.275, =0.034). The risk of risk of adverse maternal outcome was increased (HR=2.815, 95% CI 1.271 to 6.233, =0.009), and the risk of fetal adverse outcome was increased (HR=1.437, 95% CI 1.028 to 4.623, =0.021).@*CONCLUSIONS@#Hypertension is an independent risk factor for ESRD, adverse maternal outcomes, and adverse fetal outcomes in the PR-AKI patients.

Pregnancy anxiety scale:development,reliability and validity / 中华行为医学与脑科学杂志

Objective To develop anxiety scale suitable for Chinese pregnant women and evaluate its reliability and validity. Methods Based on existing research results and clinical experience,this study compiled pregnancy anxiety scale(PAS). A sample of 509 pregnant women were selected for investigation and 65 of them were randomly retested for test-retest reliability with 2 week interval. Item analysis was con-ducted to screen valid items. Then the construct validity of the scale was tested by exploratory factor analysis ( EFA) and confirmatory factor analysis(CFA). Finally the reliability and criterion validity of the scale were evaluated using Cronbach's α coefficient,retest reliability coefficient and Pearson correlation coefficient. Re-sults The PAS was composed of 27 items in four factors,including worry about delivery,worry about them-selves,worry about fetal health and general anxiety. The four factors were extracted by EFA which could ex-plain 62. 48% of the total variance. Besides,the result of CFA demonstrated that the model fitted the data with well construct validity (χ2/df=1. 89,RMR=0. 04,RMSEA=0. 06,IFI=0. 92,TLI=0. 91,CFI=0. 92, PGFI=0. 70,PNFI=0. 74,PCFI=0. 81). The score of the pregnancy-related anxiety scale and its factors scores were positively correlated with the scores of pregnancy-related anxiety questionnaire(PAQ) and child-birth attitudes questionnaire(CAQ). The correlation coefficients were 0. 60-0. 80 and 0. 50-0. 78 respectively (all P<0. 01). The Cronbach's α coefficient was 0. 93 for the total scale and that of the four factors ranged from 0. 82 to 0. 90. The test-retest reliability was 0. 68 for the total scale and ranged from 0. 54 to 0. 75 for the four factors. Conclusion The PAS has a good reliability and validity,and it can be used as a valid tool to measure the anxiety level of pregnant women.

Incidence and mortality risk factors of acute kidney injury in critical ill pregnancies: a single center retrospective analysis / 中华危重病急救医学

Objective@#To evaluate the incidence and mortality risk factors of pregnancy-related acute kidney injury (PR-AKI) in intensive care unit (ICU).@*Methods@#A retrospective analysis was conducted. Critically ill pregnancies admitted to ICU of Shandong University Affiliated Provincial Hospital from January 1st, 2012 to December 31st, 2016 were enrolled. Based on the Kidney Disease: Improving Global Outcomes (KDIGO)-acute kidney injury (AKI) criteria, patients were divided into two groups: PR-AKI group and non-PR-AKI group. Clinical characteristics and laboratory data of two groups were compared. Risk factors of incidence and mortality of PR-AKI patients were analyzed, and the receiver operating characteristic (ROC) curve was drawn to evaluate the value of these risk factors in predicting mortality of PR-AKI patients in ICU.@*Results@#①A total of 219 pregnancies in ICU were included in the analysis, 85 cases (38.8%) were diagnosed with PR-AKI, with 29.4% in AKI stage 1, 27.1% in AKI stage 2 and 43.5% in AKI stage 3. ②Nineteen of 219 critically ill pregnancies died in ICU, the total ICU mortality was 8.7%. The mortality of PR-AKI group was higher than non-PR-AKI group (16.5% vs. 3.7%, P = 0.003). The mortality was worsened with increasing severity of AKI (4.0% for AKI stage 1, 4.3% for AKI stage 2, 32.4% for AKI stage 3). ③Acute fatty liver of pregnancy (AFLP) and lactate (Lac) were the independent risk factors for PR-AKI [AFLP: odds ratio (OR) = 6.081, 95% confidence interval (95%CI) was 1.587-23.308, P = 0.008; Lac: OR = 1.460, 95%CI was 1.078-1.977, P = 0.014]. ④ Age, Lac, acute physiology and chronic health evaluation Ⅱ(APACHEⅡ) and sequential organ failure assessment (SOFA) were the independent risk factors associated with the mortality of PR-AKI patients in ICU (age: OR = 1.130, 95%CI was 1.022-1.249, P = 0.017; Lac: OR = 1.198, 95%CI was 1.009-2.421, P = 0.039; APACHEⅡ: OR = 1.211, 95%CI was 1.102-1.330, P < 0.001; SOFA: OR = 1.411, 95%CI was 1.193-1.669, P < 0.001). ⑤ ROC curve analysis showed that age, Lac, APACHEⅡscore and SOFA score all had good predictive values for in-hospital mortality among PR-AKI patients in ICU, the cut-off value was 29 years old, 3.8 mmol/L, 16 and 8, respectively, and the AUC was 0.751, 0.757, 0.892 and 0.919, respectively (all P < 0.01).@*Conclusions@#The incidence and mortality of PR-AKI of critically ill pregnancies in ICU are high. Increased age, Lac, APACHEⅡ score and SOFA score are independent risk factors associated with the mortality of PR-AKI patients in ICU, and have good predictive values for prognosis.

Incidence and mortality risk factors of acute kidney injury in critical ill pregnancies: a single center retrospective analysis / 中华危重病急救医学

Objective To evaluate the incidence and mortality risk factors of pregnancy-related acute kidney injury (PR-AKI) in intensive care unit (ICU). Methods A retrospective analysis was conducted. Critically ill pregnancies admitted to ICU of Shandong University Affiliated Provincial Hospital from January 1st, 2012 to December 31st, 2016 were enrolled. Based on the Kidney Disease: Improving Global Outcomes (KDIGO)-acute kidney injury (AKI) criteria, patients were divided into two groups: PR-AKI group and non-PR-AKI group. Clinical characteristics and laboratory data of two groups were compared. Risk factors of incidence and mortality of PR-AKI patients were analyzed, and the receiver operating characteristic (ROC) curve was drawn to evaluate the value of these risk factors in predicting mortality of PR-AKI patients in ICU. Results ①A total of 219 pregnancies in ICU were included in the analysis, 85 cases (38.8％) were diagnosed with PR-AKI, with 29.4％ in AKI stage 1, 27.1％ in AKI stage 2 and 43.5％ in AKI stage 3. ②Nineteen of 219 critically ill pregnancies died in ICU, the total ICU mortality was 8.7％. The mortality of PR-AKI group was higher than non-PR-AKI group (16.5％ vs. 3.7％, P = 0.003). The mortality was worsened with increasing severity of AKI (4.0％ for AKI stage 1, 4.3％ for AKI stage 2, 32.4％ for AKI stage 3). ③Acute fatty liver of pregnancy (AFLP) and lactate (Lac) were the independent risk factors for PR-AKI [AFLP: odds ratio (OR) = 6.081, 95％ confidence interval (95％CI) was 1.587-23.308, P = 0.008; Lac: OR = 1.460, 95％CI was 1.078-1.977, P = 0.014]. ④ Age, Lac, acute physiology and chronic health evaluation Ⅱ(APACHEⅡ) and sequential organ failure assessment (SOFA) were the independent risk factors associated with the mortality of PR-AKI patients in ICU (age: OR = 1.130, 95％CI was 1.022-1.249, P = 0.017; Lac: OR = 1.198, 95％CI was 1.009-2.421, P = 0.039; APACHEⅡ: OR = 1.211, 95％CI was 1.102-1.330, P < 0.001; SOFA: OR = 1.411, 95％CI was 1.193-1.669, P < 0.001). ⑤ ROC curve analysis showed that age, Lac, APACHEⅡscore and SOFA score all had good predictive values for in-hospital mortality among PR-AKI patients in ICU, the cut-off value was 29 years old, 3.8 mmol/L, 16 and 8, respectively, and the AUC was 0.751, 0.757, 0.892 and 0.919, respectively (all P < 0.01). Conclusions The incidence and mortality of PR-AKI of critically ill pregnancies in ICU are high. Increased age, Lac, APACHEⅡ score and SOFA score are independent risk factors associated with the mortality of PR-AKI patients in ICU, and have good predictive values for prognosis.

Study of Acute Kidney Injury Associated with Pregnancy

Background: Pregnancy related acute kidney injury(PRAKI) is common in developing countries like India. The aim of the study was to identify the etiology, prognosis, management and to have preventable measures, to improve the maternal and fetal outcome. Methods: The study was conducted in S.P. Medical College& Hospital – Obstetrics and Gynecology Department from July 2017 to December 2017.A total of 22 cases has been studied. Results: The incidence of PRAKI was 1.3% in our hospital. Pregnancy induced hypertension, pre-eclampsia, eclampsia was found to be commonest cause. Incidence of PRAKI was high in third trimester. The outcome was favorable with complete recovery in 45.47% patients. Conclusion: The low incidence of PRAKI was probably due to improved obstetric practices. Future research is further needed, to decrease the incidence.

Pregnancy-related anxiety associated with small-for-gestational-age infants / 中华流行病学杂志

Objective To investigate the second or third trimester pregnancy-related anxiety on small-for-gestational-age infants.Methods This study was based on Ma'anshan Birth Cohort Study (MABC),with 3 040 maternal-singleton pairs finally selected for data analysis,from May 2013to September 2014.The psychological state of pregnancy was evaluated according to a self-developed ‘ anxiety scale for gestation'.Small-for-gestational-age was defined as ‘ having birth weight below the 10th percentile at a particular gestational week',while large-for-gestational-age infants was defined as ‘having birth weight above the 90th percentile'.Birth weight between the 10th and 90th percentile was classified as appropriate-for-gestational age infants.x2 test was used to compare the distribution of characteristics in pregnancy among three groups with different birth weights.Multivariate logistic regression models were conducted to evaluate the associations between third trimester pregnancy-related anxiety and birth weight.Results The incidence rates of small-and large-gestational-age infants were 9.6％ and 16.6％,respectively.Difference between women with only one of the second or third trimester pregnancy-related anxiety syndromes and small-for-gestational-age infants showed no statistical significance.Women with both second and third trimester pregnancy-related anxieties might increase the risk of small-for-gestational-age infants (OR=1.39,95％CI:1.04-1.87).However,there was no significant difference between pregnancy-related anxiety and large-for-gestational-age infants (OR=1.05,95％ CI:0.81-1.35) noticed.Conclusion Women with second and third trimesterpregnancy-related anxiety appeared a risk factor for small-for-gestational-age infants.

Association between pregnancy-related anxiety of pregnant women and autism-like behavior in their offspring at 18 months of age / 中华流行病学杂志

Objective To investigate the relationship of pregnancy-related anxiety of pregnant women in second/third trimesters and autism-like behaviors in their offspring at 18 months of age.Methods Based on a prospective cohort study design,we evaluated the situation of pregnancy-related anxiety of women during second and third trimesters through a Pregnancy-Related Anxiety Questionnaire.Subjects under study were classified into three groups,1) those with pregnancy-related anxiety during both trimesters,2) those with pregnancy-related anxiety at one trimester and 3) those without pregnancy-related anxiety in either trimester.When their children were 18 months,autism-like behaviors (ALB) were evaluated,using the part A of Checklist for Autism in Toddlers-23,and then classified into three groups as non-ALB group,minor ALB group and major ALB group.Multi-nominal logistic Regression was used to analyze the relationship of pregnancy-related anxiety with autism-like behaviors.Results Compared with non-ALB group,children whose mother with pregnancy-related anxiety during both trimesters presented significant higher risk on ALB than children whose mother without pregnancy-related anxiety in these two periods (relative risk,RR=2.43,95％ CI:1.21-4.86,P=0.012),major factors as pregnant women's IQ and gestational diabetes mellitus,premature delivery and education levels of fosterers on these pregnant women were under control.Our results from the stratified analysis showed:when in the subgroup that mother was the main fosterer of the child,there was an significant increase of risk in children whose mothers with pregnancy-related anxiety during both trimesters (RR=4.22,95％ CI:1.73-10.32,P=0.002).Conclusion The association between pregnancy-related anxiety and autism-like behavior was not strong but influenced by the fosterer of the child.

Pregnancy-related anxiety associated with small-for-gestational-age infants / 中华流行病学杂志

Objective To investigate the second or third trimester pregnancy-related anxiety on small-for-gestational-age infants.Methods This study was based on Ma'anshan Birth Cohort Study (MABC),with 3 040 maternal-singleton pairs finally selected for data analysis,from May 2013to September 2014.The psychological state of pregnancy was evaluated according to a self-developed ‘ anxiety scale for gestation'.Small-for-gestational-age was defined as ‘ having birth weight below the 10th percentile at a particular gestational week',while large-for-gestational-age infants was defined as ‘having birth weight above the 90th percentile'.Birth weight between the 10th and 90th percentile was classified as appropriate-for-gestational age infants.x2 test was used to compare the distribution of characteristics in pregnancy among three groups with different birth weights.Multivariate logistic regression models were conducted to evaluate the associations between third trimester pregnancy-related anxiety and birth weight.Results The incidence rates of small-and large-gestational-age infants were 9.6％ and 16.6％,respectively.Difference between women with only one of the second or third trimester pregnancy-related anxiety syndromes and small-for-gestational-age infants showed no statistical significance.Women with both second and third trimester pregnancy-related anxieties might increase the risk of small-for-gestational-age infants (OR=1.39,95％CI:1.04-1.87).However,there was no significant difference between pregnancy-related anxiety and large-for-gestational-age infants (OR=1.05,95％ CI:0.81-1.35) noticed.Conclusion Women with second and third trimesterpregnancy-related anxiety appeared a risk factor for small-for-gestational-age infants.

Association between pregnancy-related anxiety of pregnant women and autism-like behavior in their offspring at 18 months of age / 中华流行病学杂志

Objective To investigate the relationship of pregnancy-related anxiety of pregnant women in second/third trimesters and autism-like behaviors in their offspring at 18 months of age.Methods Based on a prospective cohort study design,we evaluated the situation of pregnancy-related anxiety of women during second and third trimesters through a Pregnancy-Related Anxiety Questionnaire.Subjects under study were classified into three groups,1) those with pregnancy-related anxiety during both trimesters,2) those with pregnancy-related anxiety at one trimester and 3) those without pregnancy-related anxiety in either trimester.When their children were 18 months,autism-like behaviors (ALB) were evaluated,using the part A of Checklist for Autism in Toddlers-23,and then classified into three groups as non-ALB group,minor ALB group and major ALB group.Multi-nominal logistic Regression was used to analyze the relationship of pregnancy-related anxiety with autism-like behaviors.Results Compared with non-ALB group,children whose mother with pregnancy-related anxiety during both trimesters presented significant higher risk on ALB than children whose mother without pregnancy-related anxiety in these two periods (relative risk,RR=2.43,95％ CI:1.21-4.86,P=0.012),major factors as pregnant women's IQ and gestational diabetes mellitus,premature delivery and education levels of fosterers on these pregnant women were under control.Our results from the stratified analysis showed:when in the subgroup that mother was the main fosterer of the child,there was an significant increase of risk in children whose mothers with pregnancy-related anxiety during both trimesters (RR=4.22,95％ CI:1.73-10.32,P=0.002).Conclusion The association between pregnancy-related anxiety and autism-like behavior was not strong but influenced by the fosterer of the child.

Pregnancy intention and pregnancy-related anxiety in the second and third trimester: a birth cohort study / 中华流行病学杂志

Objective To understand the association between pregnancy intention and pregnancy-related anxiety in the second and third trimester and its strength.Methods A prospective cohort study was conducted in Ma' anshan,Anhui province.A total of 3 474 eligible pregnant women within 14 weeks of gestation were recruited.The information about their demographic characteristics were collected in early pregnancy.The completed questionnaire of pregnancy-related anxiety were asked to return in the second and third trimester.Logistic regression analysis was conducted to evaluate the association between pregnancy intention and pregnancy-related anxiety in the second and third trimester.Results A total of 3 083 pregnant women were included in final analysis,The rate of unintentional pregnancy was 15.00％ (n=461).The detection rates of pregnancy-related anxiety in the second and third trimester were 29.13％ (n=898) and 30.36％ (n=936).After controlling potential confounding factors,unintentional pregnancy increased the risk of pregnancy-related anxiety in the second trimester compared with intentional pregnancy (OR=1.85,95％ CI:1.44-2.38);The risk of pregnancy-related anxiety also increased in the third trimester (OR=1.84,95％ CI:1.44-2.35).Intentional pregnancy did not increase the risk of pregnancy-related anxiety in the second and third trimester.Conclusion The study results suggests that unintentional pregnancy could increase the risk of pregnancy-related anxiety in the second and third trimester.

Pregnancy intention and pregnancy-related anxiety in the second and third trimester: a birth cohort study / 中华流行病学杂志

Objective To understand the association between pregnancy intention and pregnancy-related anxiety in the second and third trimester and its strength.Methods A prospective cohort study was conducted in Ma' anshan,Anhui province.A total of 3 474 eligible pregnant women within 14 weeks of gestation were recruited.The information about their demographic characteristics were collected in early pregnancy.The completed questionnaire of pregnancy-related anxiety were asked to return in the second and third trimester.Logistic regression analysis was conducted to evaluate the association between pregnancy intention and pregnancy-related anxiety in the second and third trimester.Results A total of 3 083 pregnant women were included in final analysis,The rate of unintentional pregnancy was 15.00％ (n=461).The detection rates of pregnancy-related anxiety in the second and third trimester were 29.13％ (n=898) and 30.36％ (n=936).After controlling potential confounding factors,unintentional pregnancy increased the risk of pregnancy-related anxiety in the second trimester compared with intentional pregnancy (OR=1.85,95％ CI:1.44-2.38);The risk of pregnancy-related anxiety also increased in the third trimester (OR=1.84,95％ CI:1.44-2.35).Intentional pregnancy did not increase the risk of pregnancy-related anxiety in the second and third trimester.Conclusion The study results suggests that unintentional pregnancy could increase the risk of pregnancy-related anxiety in the second and third trimester.

Non-neoplastic lesions of the ovary - A review.

Ovary is an important organ as it is concerned with the production of progeny. Ovary is the commonest site of neoplastic and non-neoplastic lesion, can present in childhood to postmenopausal age group and accounts for the most prevalent cause of hospital admissions. non-neoplastic ovarian lesions are classified as inflammatory (infectious and non infection ), non-inflammatory (cystic and non-cystic) and pregnancy related disorders.