ABSTRACT
ABSTRACT A 7-week-old male delivered by cesarean section presented with a positive serology for dengue along with preretinal and retinal hemorrhages, vitreous opacities and cotton wool spots. The patient and his mother had positive serologies for Non Structural Protein 1 (NS1) by ELISA. Retinal and vitreous findings improved over a sixteen-week period. Spectral domain optical coherence tomography (OCT) showed preserved macular architecture. In this case report, we suggest that retinal and vitreous changes may be the ocular presenting features of vertically transmitted dengue in newborns, and that those findings may resolve with no major structural sequelae.
RESUMO Neonato de 7 semanas, do sexo masculino, nascido de parto cesárea, apresentou sorologia positiva para dengue com hemorragias retinianas e pré-retinianas, opacidades vítreas e manchas algodonosas. O paciente e sua mãe haviam apresentado sorologias positivas para Non Structural Protein 1 através de ELISA. Achados na retina e no vítreo melhoraram em um período de dezesseis semanas. O exame de tomografia de coerência óptica de domínio espectral demonstrou arquitetura macular preservada. Neste relato de caso, sugerimos que alterações na retina e no vítreo podem ser os achados oculares aparentes em neonatos com infecção vertical por dengue, e que estes podem se resolver sem maiores sequelas estruturais.
ABSTRACT
ABSTRACT Introduction: Pregnancy-related complications may impact women's reproductive cycle and health through their lives. The objective of this study was to evaluate the sociodemographic, clinical, and obstetric history of women undergoing hemodialysis. Methods: We performed a cross-sectional study in a specialized health facility with four hemodialysis units. Sociodemographic characteristics, clinical and personal history, obstetric and perinatal results of women with pregnancies before hemodialysis were evaluated. Prevalence, bivariate, and logistic regression analyses were performed. Results: We included 208 (87.76%) women. Hypertension was the main cause of chronic kidney disease (CKD) (128 women). Rates of adverse perinatal outcomes, including prematurity, low birth weight, miscarriage, fetal death, and neonatal death, were 19.3%, 14.5%, 25.5%, 12.1%, and 5.3%, respectively. Hypertensive syndromes during pregnancy occurred in 37.0% of women, with 12.5% reporting preeclampsia and 1.4% reporting eclampsia. Up to 1 year after birth, 45.2% of women reported hypertension. Hemodialysis due to hypertension was associated with a history of hypertension during pregnancy (OR 2.33, CI 1.27 - 4.24), gestational hypertension (2.41, CI 3.30 - 4.45), and hypertension up to one year after birth (OR 1.98, CI 1.11 - 3.51). Logistic regression showed that gestational hypertension was independently associated with CKD due to hypertension (aOR 2.76, CI 1.45 - 5.24). Conclusion: Women undergoing hemodialysis due to hypertension were more likely to have gestational hypertension or hypertension up to one year after birth. To delay end-stage renal disease, it is necessary to identify women at risk of kidney failure according to their reproductive history.
RESUMO Introdução: Complicações relacionadas à gestação podem afetar o ciclo reprodutivo e a saúde das mulheres ao longo de suas vidas. Este estudo visou avaliar histórico sociodemográfico, clínico e obstétrico de mulheres em hemodiálise. Métodos: Realizamos estudo transversal em unidade de saúde especializada com quatro unidades de hemodiálise. Avaliou-se características sociodemográficas, histórico clínico e pessoal, resultados obstétricos e perinatais de mulheres com gestações anteriores à hemodiálise. Foram realizadas análises de prevalência, bivariadas e regressão logística. Resultados: Incluímos 208 (87,76%) mulheres. Hipertensão foi a principal causa de doença renal crônica (DRC) (128 mulheres). Taxas de desfechos perinatais adversos, incluindo prematuridade, baixo peso ao nascer, aborto espontâneo, óbito fetal e neonatal, foram de 19,3%, 14,5%, 25,5%, 12,1% e 5,3%, respectivamente. Síndromes hipertensivas durante a gestação ocorreram em 37,0% das mulheres, com 12,5% relatando pré-eclâmpsia e 1,4% relatando eclampsia. Até 1 ano após o parto, 45,2% das mulheres relataram hipertensão. Hemodiálise devido à hipertensão foi associada ao histórico de hipertensão na gestação (OR 2,33; IC 1,27 - 4,24), hipertensão gestacional (2,41; IC 3,30 - 4,45), e hipertensão até um ano após o parto (OR 1,98; IC 1,11 - 3,51). A regressão logística mostrou que hipertensão gestacional foi independentemente associada à DRC devido à hipertensão (ORa 2,76; IC 1,45 - 5,24). Conclusão: Mulheres submetidas à hemodiálise por hipertensão foram mais propensas a apresentar hipertensão gestacional ou hipertensão até um ano após o parto. Para retardar a doença renal em estágio terminal, deve-se identificar mulheres em risco de insuficiência renal de acordo com sua história reprodutiva.
ABSTRACT
Objective:To investigate the clinicopathological features, diagnosis, treatment and outcomes of pregnancy with non-Hodgkin lymphoma (NHL).Methods:The clinicopathological data of 7 patients of pregnancy with NHL admitted to Nanjing Drum Tower Hospital from January 2010 to May 2022 were reviewed. General information, diagnosis, treatment and maternal and child outcomes were retrospectively analyzed.Results:(1) The median age of the 7 patients was 28 years old (range: 26-33 years); 3 cases complained of abdominal pain (2 cases of huge pelvic or abdominal mass with multiple metastases), 2 cases of cough (1 case with superior vena cava syndrome), 1 case of facial swelling and pain, and 1 case of poor appetite. The median time from the onset of symptoms to initial visit was 30 days (range: 15-188 days). (2) Only 3 cases were diagnosed during pregnancy through biopsy, and the biopsy sites including right nasal vestibular mass, left supraclavicular lymph node and lung respectively. One case was suspected to be splenic marginal zone lymphoma through bone marrow puncture during pregnancy, and confirmed by pathological results observed in splenectomy specimens after termination of pregnancy. Three cases were diagnosed as NHL by pathological results of focus biopsy or partial tumor resection during cesarean section. Pathological types: 5 cases of diffuse large B cell lymphoma, one splenic marginal zone lymphoma and one nasal cavity natural killer (NK)/T cell lymphoma. Stages: 1 case of stage Ⅱ, 6 cases of stage Ⅳ. Pathological examination of placentas was performed for 4 patients after delivery, included one case with tumor metastasis to the placenta. (3) Among the 7 patients, 1 case was induced in the second trimester; 5 cases were terminated by cesarean section in the third trimester, all of which were premature; one case of full-term was delivered with forceps. All 6 neonates survived healthy. Treatments: 5 cases received chemotherapy after termination of pregnancy (included 1 case received autologous hematopoietic stem cell retransfusion therapy after chemotherapy), and 1 case received chemotherapy combined nasopharyngeal radiotherapy, and six cases survived without recurrence (follow-up until October 2022). The other case was a patient with hepatitis B virus infection and congenital heart disease who died of multiple organ failure 18 days after cesarean section.Conclusions:It is difficult to diagnose, necessary to pay attention to the complaints of pregnant women, and to actively carry out related examinations during pregnancy. When the lesion involves multiple organs, the possibility of lymphoma should be considered. Pregnancy with NHL is sensitive to chemotherapy. Even for advanced patients, good outcome could still be obtained after standardized treatment.
ABSTRACT
Pulmonary arterial hypertension (PAH) is an abnormal remodeling of the pulmonary vascular wall due to various causes, resulting in severe cardiovascular disease characterized by increased pulmonary vascular resistance and pressure. The mortality and morbidity of pregnant women with PAH are extremely high. This article reports a woman with severe PAH associated with connective tissue disease who developed cardiac arrest, PAH crisis, and right heart failure during her two consecutive pregnancies without regular prenatal examination. After multidisciplinary consultation and extracorporeal membrane oxygenation, effective cardiopulmonary support was timely, and the patient was finally discharged from the hospital in stable condition. After ten months of follow-up, the mother and child both had good outcomes. Although the mother and her child were survived, severe PAH is a contraindication for pregnancy due to its severely harmful effect on endangering maternal and fetal health.
ABSTRACT
ObjectiveTo summarize and analyze the clinical characteristics， diagnosis process， treatment process， and obstetric outcomes of pregnant women with Cushing's syndrome， helping to optimize pregnancy management. MethodsA retrospective study was conducted on 8 pregnant women with Cushing’s syndrome who were hospitalized in the First Affiliated Hospital， Sun Yat-sen University between January 2006 and August 2022. The clinical characteristics， management and obstetric outcomes were recorded. ResultsPreeclampsia was detected in 4 cases，pre-gestational diabetes mellitus in 2 cases， gestational diabetes mellitus in 5 cases， and hypokalemia in all 8 cases. Elevated serum cortisol， disappearance of day-night rhythm of cortisol， increased 24-hour urine cortisol and decrease in serum ACTH were found in 8 cases by laboratory examination. Furthermore， adrenal adenoma was detected in all 8 cases by ultrasonography or Magnetic Resonance Imaging. Three cases underwent laparoscopic adrenalectomy in the second trimester and 4 cases received surgery after delivery. The diagnosis of adrenal cortical adenoma was confirmed by pathological report. Six cases had preterm birth， while one patient delivered after 37 weeks of gestation and one patient suffered from spontaneous abortion. Among 7 cases of live birth， 6 patients underwent cesarean section and 1 patient had vaginal delivery. Of all newborns， 3 had low birth weight. One case had a birth defect. Four infants were transferred to the neonatal intensive care unit， and two infants died. One child was diagnosed with nephrotic syndrome at 2 years of age. ConclusionsCushing's syndrome is rare and high risk during pregnancy. It requires multidisciplinary diagnosis， treatment， and long-term follow-up. Drug therapy carries a risk of progression and requires intensive care during pregnancy， postpartum follow-up， and specialist treatment.
ABSTRACT
SUMMARY OBJECTIVE: The objective of this study was to compare the nutritional status and dietary intake of pregnant women with sickle cell disease (SS hemoglobinopathy and SC hemoglobinopathy) to healthy controls and report the maternal and perinatal outcomes. METHODS: This is a prospective, longitudinal cohort study. Pregnant women with a diagnosis of sickle cell disease and control group were recruited in an outpatient clinic of a tertiary care hospital in São Paulo, Brazil. Maternal anthropometric data and dietary intake data were collected at the second and third trimesters. RESULTS: A total of 49 pregnancies complicated by sickle cell disease were included. Prepregnancy body mass index was significantly lower in the SS hemoglobinopathy group (n=26, median 20.3 kg/m2) than the SC hemoglobinopathy group (n=23, 22.7 kg/m2) or control group (n=33, 23.2 kg/m2, p<0.05). The prepregnancy nutritional status revealed significantly more women classified as underweight in the SS hemoglobinopathy group (15.4%) than in the SC hemoglobinopathy group (4.4%) and control group (1.6%, p=0.009). In the second trimester, maternal protein intake was significantly lower in SS hemoglobinopathy (73.2 g/day) and SC hemoglobinopathy (68.8 g/day) than in the control group (95.7 g/day, p=0.004). In the third trimester, only SS hemoglobinopathy mothers showed dietary intake of protein significantly lower than that of the controls (67.5 g/day vs. 92.8 g/day, p=0.02). Vitamin A and E consumption was also reduced in the third trimester in the SS hemoglobinopathy group (p<0.05). CONCLUSION: The nutritional status of pregnant women with SS hemoglobinopathy is characterized by a state of undernutrition. The lower protein intake in the second and third trimesters of pregnant women with SS hemoglobinopathy may contribute to this condition. Undernourishment is a serious complication of sickle cell disease, primarily during pregnancy, and it should be addressed during the prenatal period.
ABSTRACT
@#Abstract: Objective To investigate the present reproductive health status of female employees and its influencing factors in Methods machinery manufacturing industries. A total of 762 female workers with pregnancy history from two machinery manufacturing enterprises in Chongqing City were selected by judgment sampling method. The reproductive health status of female workers was investigated by the Special Questionnaire on Reproductive Health of Female Workers in Typical Industries. Results （ ） The prevalence of pregnancy complications in the female workers was 27.6% 210/762 . The abnormal neonatal birth （ ） （ ）， ， outcomes rate was 15.1% 115/762 . The abortion rate was 64.4% 491/762 the spontaneous abortion rate was 14.3% and the induced abortion rate was 60.2%. The results of binary logistic regression analysis showed that female employees exposed to two ， or more occupational hazardous factors felt tired from work and suffered from gynecological diseases were risk factors for （ P ） ， ， pregnancy complications all <0.05 . Alcohol drinking abnormal menstruation and suffered from pregnancy complications （ P ） were risk factors for abnormal birth outcomes in newborns all <0.05 . The results of multiple logistic regression analysis ， （ P ） showed that the older the female workers the higher risk of spontaneous abortion or induced abortion or both all <0.05 . - Female workers suffered from gynecological diseases and engaged in front line production had higher risk of both spontaneous （ P ）Conclusion ， ， ， ， and induced abortion all <0.01 . Age position occupational hazardous factor exposure feeling tired at work ， ， alcohol drinking menstrual abnormalities a history of gynecological diseases and suffer from pregnancy complications can affect the reproductive health of female employees in machinery manufacturing industries.
ABSTRACT
ObjectiveTo explore the impact of primiparas’ intention to have a second child on their delivery mode. MethodsDuring March 1st， 2019 and November 30th， 2020， the enrolled pregnant women were investigated by questionnaires at two points， first trimester pregnancy registration and post-natal visit at maternal and child healthcare community centers of Xuhui District. Logistic regression analysis was used to examine the association of willingness of a second birth and their mode of delivery. Results2 000 questionnaires were distributed and 1 664 valid questionnaires were analyzed. The overall cesarean delivery rate in nulliparous women was 40.08% （667/1 664）， with 8.95% （149/1 664） of non-medical indication cesarean delivery. Multiple Logistic regression analysis of overall delivery rate showed that age， willingness to have more children in the future， plan of vaginal delivery at first questionnaire， and complications during pregnancy were associated with overall cesarean delivery rate， and women without the willingness to have more children in the future were more likely to undergo cesarean delivery （OR=1.350， 95%CI： 1.052-1.732）. Age， whether to have a second child in the future， plan of vaginal delivery at first questionnaire， and complications during pregnancy were all factors associated with increased risks of non-medical indicated cesarean delivery， while women with no plan of a second child in the future had nearly 2 times of risk of non-medical indicated cesarean delivery （OR=1.909， 95%CI： 1.117-3.262）. ConclusionThe mode of delivery is affected by many factors， among which willingness to have more children in the future is an important factor associated with increased risks of overall cesarean delivery and non-medical indicated cesarean delivery.
ABSTRACT
Objective To determine the changing trend and causes of perinatal mortality in Changning District after the implementation of the universal two-child policy， and then explore effective interventions for preventing perinatal mortality. Methods Data of perinatal mortality in Changning District from 2011 to 2020 were retrospectively collected. Change of perinatal mortality， causes of death and related factors were compared in consecutive 5 years before and after the universal two-child policy. Results In total， there were 153 099 perinatal births from 2011 to 2020 in Changning District， in which 352 deaths were documented. The perinatal mortality was 2.30 per 1 000 births， showing an overall downward trend from 2011 to 2020 （ P <0.05）. Residents with local household registration had lower perinatal mortality， compared to those with non-local household registration， which was observed both before and after the universal two-child policy （ P <0.05）. Furthermore， the perinatal mortality showed an upward trend after the universal two-child policy （ χ 2trend=5.481， P <0.05）. The major causes of perinatal death were fetus and its accessories， fetal malformation， and maternal diseases during pregnancy before the universal two-child policy； in contrast， the causes changed to maternal diseases during pregnancy， fetus and its accessories， and neonatal diseases after the policy. The proportion of pregnant women of advanced maternal age， menstrual delivery， and pregnancy complications or comorbidities were significantly higher after the policy than that before the policy （ P <0.05）. The most common pregnancy complication was gestational diabetes mellitus， gestational hypertension， and hypothyroidism during pregnancy after the universal two-child policy. Of them， the proportion of gestational hypertension increased from 6.56% （4/61） to 25.88% （22/85）. Conclusion Before and after the universal two-child policy， the perinatal mortality in non-local residents remains high and further shows an upward trend. Moreover， pregnant women advanced maternal age and those with complications or comorbidities may increasingly contribute to perinatal deaths after the policy. Therefore， health education should be strengthened to improve the awareness of self-health care， especially for non-local women. Hierarchical perinatal health service， primary prevention and treatment of pregnancy complications or comorbidities should be improved to further reduce perinatal mortality.
ABSTRACT
Objective To determine the changing trend and causes of perinatal mortality in Changning District after the implementation of the universal two-child policy， and then explore effective interventions for preventing perinatal mortality. Methods Data of perinatal mortality in Changning District from 2011 to 2020 were retrospectively collected. Change of perinatal mortality， causes of death and related factors were compared in consecutive 5 years before and after the universal two-child policy. Results In total， there were 153 099 perinatal births from 2011 to 2020 in Changning District， in which 352 deaths were documented. The perinatal mortality was 2.30 per 1 000 births， showing an overall downward trend from 2011 to 2020 （ P <0.05）. Residents with local household registration had lower perinatal mortality， compared to those with non-local household registration， which was observed both before and after the universal two-child policy （ P <0.05）. Furthermore， the perinatal mortality showed an upward trend after the universal two-child policy （ χ 2trend=5.481， P <0.05）. The major causes of perinatal death were fetus and its accessories， fetal malformation， and maternal diseases during pregnancy before the universal two-child policy； in contrast， the causes changed to maternal diseases during pregnancy， fetus and its accessories， and neonatal diseases after the policy. The proportion of pregnant women of advanced maternal age， menstrual delivery， and pregnancy complications or comorbidities were significantly higher after the policy than that before the policy （ P <0.05）. The most common pregnancy complication was gestational diabetes mellitus， gestational hypertension， and hypothyroidism during pregnancy after the universal two-child policy. Of them， the proportion of gestational hypertension increased from 6.56% （4/61） to 25.88% （22/85）. Conclusion Before and after the universal two-child policy， the perinatal mortality in non-local residents remains high and further shows an upward trend. Moreover， pregnant women advanced maternal age and those with complications or comorbidities may increasingly contribute to perinatal deaths after the policy. Therefore， health education should be strengthened to improve the awareness of self-health care， especially for non-local women. Hierarchical perinatal health service， primary prevention and treatment of pregnancy complications or comorbidities should be improved to further reduce perinatal mortality.
ABSTRACT
Objective@#To learn the characteristics of adolescent pregnancy in Wenzhou from 2015 to 2019, so as to provide basis for protecting adolescent physical and mental health. @*Methods@#Data of demographic characteristics, pregnancy and delivery outcomes of the women aged under 19 years ( adolescent pregnant ) and 20 to 34 years ( right-age pregnant ) who delivered in Wenzhou from 2015 to 2019 were collected from Wenzhou Maternal and Child Health Information Management System. The incidence of pregnancy complication, comorbidity and adverse delivery outcomes of adolescent pregnant women was compared with that of right-age pregnant women.@*Results@#Among 536 753 parturients reported in Wenzhou from 2015 to 2019, there were 22 419 ( 4.18% ) of adolescent pregnancy and 430 163 ( 80.14% ) of right-age pregnancy. The average age of adolescent pregnant women was (18.11±0.82) years ( range, 10-19 years ). The majority of adolescent pregnant women were migrant population (19 437 cases, 86.70%), had an education level of junior high school and below ( 18 594 cases, 82.94% ), and had no occupation (19 192 cases, 85.61%). The incidence rates of anemia, gestational diabetes, postpartum hemorrhage, perineal laceration and premature delivery in adolescent pregnant women increased from 2015 to 2019 ( all P<0.05 ). The incidence rates of gestational diabetes, anemia, gestational hypertension, placental abruption, postpartum hemorrhage, perineal laceration, premature delivery, low birth weight, fetal death and stillbirth were 1.65%, 11.76%, 0.19%, 0.26%, 3.19%, 24.52%, 6.03%, 5.53%, 0.50% and 0.04% in adolescent pregnant women, which were significant different from 5.49%, 8.94%, 0.13%, 0.01%, 0.17%, 23.46%, 4.66%, 3.08%, 0.26% and 0.01% in the right-age pregnant women, respectively ( all P<0.05 ). @*Conclusions@#The adolescent pregnant population in Wenzhou are mainly migrant population with lower education level and no occupation. The incidence rates of pregnancy complication, comorbidity and adverse birth outcomes in adolescent pregnant population are higher than those in right-age pregnant population, and are increasing year by year.
ABSTRACT
Background: Hypertensive in pregnancy is the second most common cause of maternal mortality in India. Among the hypertensive disorders that complicate pregnancy, pre-eclampsia and eclampsia stand out as major causes of maternal and perinatal mortality and morbidity. The majority of deaths due to pre-eclampsia and eclampsia are avoidable through the provision of timely and effective care to the women presenting with these complications. Objectives of this study were to find out the effectiveness of intravascular and intramuscular magnesium sulfate in management of eclampsia. To compare the side effects and complications of intravascular and intramuscular magnesium sulfate in management of eclampsia.Methods: A total 100 patients presenting with eclamptic fits reporting to the center that has been included in the study. The study has been conducted in the labor room of Nehru Chikitsalaya of B. R. D. Medical College, Gorakhpur, Uttar Pradesh for 12 months duration period. Statistical analysis of observations has been done by Chi-square test with p-value <0.05 has been considered in the study.Results: Majority of eclampsia patients belonged to 20-25 years age group (63%) followed by above 30 years of age (22%). Nearly 16% patients in IM MgSO4 group and 12% patients in IV MgSO4 received recurrence of seizure after starting of treatment (p value >0.5). About 26% patients in IM MgSO4 group and 18% patients in IV MgSO4 group had mild side effects of MgSO4 but no patients in both the group had major side effects of MgSO4.Conclusions: The study concludes that intramuscular injection of MgSO4 is painful and the chances of abscess formation that's why compliance of intramuscular MgSO4 is not very good in compared to intravascular infusion of MgSO4. The chances of Mg toxicity are more MgSO4 regimen because of the dose required in IM MgSO4 regimen is more (44gm) that of IV MgSO4 (28 gm).
ABSTRACT
Pregnancy has been removed from the list of contraindications for hot spring bathing. Therefore, The Japanese Society of Balneology, Climatology and Physical Medicine has considered that it is necessary to conduct a joint research on the safety of hot spring bathing for pregnant women, publish the results extensively, and enlighten the public about this matter. Considering that only a small number of reports have been published in Japan about the safety of hot spring bathing for pregnant women, the Society has decided to study this subject. Expectant and nursing mothers living in hot spring towns, such as Beppu and Ibusuki City, have responded to questions about the period between the early stages of pregnancy and delivery via a self-administered questionnaire; The questions included: 1) age when the pregnancy ended, 2) number of previous deliveries, 3) details of hot spring bathing habits (whether they bathed in hot springs on a daily basis, how often they bathed during the different [early, middle, and late] stages of pregnancy, and whether they used hot spring baths attached to their homes or hot spring facilities away from their homes), and 4) whether they had pregnancy complications such as miscarriages (excluding those occurring in the early stages of pregnancy), premature delivery, threatened premature delivery, or toxemia of pregnancy/pregnancy-induced hypertension (edema, hypertension). Total 1,721 responses were collected (86% reply rate). The mean participant age was 30.8 years. Importantly, there were 643 (37.6%) primigravid and 1,078 (62.4%) parous women. Age and gravidity were not associated with pregnancy complications. In the early and middle stages of pregnancy, there were no significant differences in the incidence of pregnancy complications between individuals who bathed ≥ once per week [hot spring bath (+)] group and those who bathed < once per week [hot spring bath (−)] group. In the late stages of pregnancy, the number of pregnancy complications were fewer in the hot spring bath (+) group (20.3%) than that in the hot spring bath (−) group (25.9%) (p = 0.028). In addition, there were no significant differences in the pregnancy complications between hot spring bathing (+) and hot spring bath (−) groups in the early and middle stages of pregnancy even if we focused on the homecoming pregnant women. Whereas, in the late stages of pregnancy, the number of pregnancy complications were fewer in the hot spring bath (+) group (13.0%) compared with the hot spring bath (−) group (24.5%) (p = 0.028) in the homecoming pregnant women. This study has confirmed that daily hot spring bathing during pregnancy does not increase the incidence of pregnancy complications. Furthermore, it can be stated that the removal of “pregnancy” from the contraindications of hot spring bathing was appropriate.
ABSTRACT
Cadmium is a toxic metal, an environmental contaminant and a multi-organ poison which has been implicated in the derangement of a number of biological and molecular systems. Exposure to cadmium is a serious global health threat particularly in developing countries and pregnant women are at great risk, This is because they have increased gastrointestinal absorption and retention of cadmium and the tendency for increased risk of complications owing to its toxic effects. Preeclampsia is a pregnancy complication characterized by the development of onset of hypertension and significant proteinuria after 20 weeks of gestation or during labour and/or within 48 hours of delivery. This pregnancy-specific syndrome is a leading cause of maternal death particularly in developing countries. Several reports have provided evidence of remote association between preeclampsia and cadmium but the mechanism of the involment of this toxic metal in this disease is still surrounded with uncertainty. Some possible mechanistic pathways such as induction of oxidative stress, acting as an antimetabolite to zinc and deregulation of epigenetic mechanisms have been elucidated in this article may be interconnected, work synergistically or act independently. However, pertinent to understand them in a bid to possibly prevent the disease or forestall its devastating consequences. Environmental cadmium exposure may be considered a factor that merits further serious attention in the continuous search for the precise an etiology of preeclampsia particularly in developing countries that experience uncontrolled cadmium release into the environment.
ABSTRACT
Introduction: Spontaneous hepatic rupture is one of the most feared complications of pregnancy that leads to maternal near miss and death and is mainly associated with severe preeclampsia. Objective: To determine risk factors for spontaneous hepatic rupture in pregnant women with severe preeclampsia. Methods: We performed a cross-sectional, retrospective case-control study during the period January 1, 2006 through December 31, 2018. Thirty-one women with severe preeclampsia who presented hepatic rupture (cases) were compared to sixty-two controls (women with severe preeclampsia without hepatic rupture), in a ratio of two controls per case. Results: Factors significantly associated with hepatic rupture in women with severe preeclampsia were HELLP syndrome (OR = 3.42, 95% CI: 1.51 to 6.17), advanced maternal age (OR = 2.18; 95% CI: 1.13 to 5.02) and eclampsia (OR = 1.94, 95% CI: 1.09 to 4.38). Conclusions: In this study of pregnant women with severe preeclampsia, advanced maternal age was a risk factor for spontaneous hepatic rupture, and HELLP syndrome and eclampsia were associated factors.
Introducción. La rotura hepática espontánea es una de las complicaciones más temidas del embarazo, que causa morbilidad materna extrema y muerte y se asocia principalmente con la preeclampsia severa. Objetivo. Determinar los factores de riesgo para rotura hepática espontánea en gestantes con preeclampsia severa. Método. Se realizó un estudio retrospectivo transversal, observacional analítico, de tipo casos y controles, durante el período comprendido entre el 1º de enero de 2006 y el 31 de diciembre de 2018. Treinta y una mujeres con preeclampsia severa que presentaron rotura hepática (casos) fueron comparadas con un grupo de sesenta y dos controles (mujeres con preeclampsia severa que no presentaron rotura hepática), correspondiendo dos controles por caso. Resultados. Los factores estadísticamente significativos para rotura hepática en mujeres con preeclampsia severa fueron el síndrome HELLP (OR = 3,52; IC 95%: 1,58 a 6,39), la eclampsia (OR = 2,23; IC 95%: 1,16 a 5,11) y la edad materna avanzada (OR = 1,96; IC 95%: 1,09 a 4,38) tuvieron asociación estadísticamente significativa para rotura hepática espontánea. Conclusiones. En el presente estudio de gestantes con preeclampsia severa, la edad materna avanzada constituyó factor de riesgo para la rotura hepática espontánea, y el síndrome HELLP y la eclampsia fueron factores asociados.
ABSTRACT
Background: Amniotic fluid is an indicator of placental function on the fetal development. It is regulated by several systems, including transmembraneous pathway, fetal production (fetal urine and lung fluid) and uptake (fetal swallowing), and the balance of fluid movement via osmotic gradients. The amniotic fluid index is the most commonly used method of measuring amniotic fluid. An AFI between 5 to 8 cms is borderline oligohydraminos. To compare the fetal and maternal outcome in pregnancies with borderline amniotic fluid index (5 to 8 cms) and normal AFI.Methods: This prospective cohort study was carried out on 94 pregnant patients attending the antenatal clinic of MES Medical College, Perinthalmanna between January 1st and December 31st 2016. Women with a singleton pregnancy in the third trimester were enrolled into the study. Of these 47 cases were in the normal AFI group and 47 cases in the borderline group. Adequate information was obtained from the patient’s medical record and the groups were compared on maternal and fetal complications.Results: The study results showed that more cases with borderline AFI had their non stress test to be nonreactive (59.6% versus 23.4%) and was associated with more fetal heart rate abnormalities (51% versus 17%). The number of meconium stained amniotic fluid (48.9% versus 19.1%) and caesarean deliveries (51.1% versus 21.2%) were also more among the borderline group.Conclusions: Findings indicated that there are more adverse fetal and maternal outcome among the borderline AFI group.
ABSTRACT
@#【Objective】To explore the application prospect of single embryo transfer（SET）in assisted reproduction. 【Methods】A total of 5 130 cases of fresh and frozen embryo transfer in the Reproductive Center of the First Affiliated Hospital，Sun Yat-sen University in the recent two years were analyzed retrospectively. To analyze the main outcome of clinical pregnancy in different age groups，we classified the SET cycles into 4 groups of fresh or frozen，elective or obliged.【Results】In non-preimplantation genetic testing（PGT）elective SET cycles，the clinical pregnancy rate of the day 3 embryos（D3）and day 6 embryos（D6）in patients under 35 were as high as 35%. The clinical pregnancy rate of day 5 embryos（D5）was 50% approximately. While in PGT cycles，the clinical pregnancy rate of patients less than 42 years old was 45%，especially implantation rate of D5 embryos was close to 60% in all patients under 40. With the increase of age，the pregnancy rate of SET decreased. In non-PGT group，D3 embryos showed significant difference in either elective/obliged or fresh/frozen cycles（P < 0.001 for all）. In general，elective SET showed a higher pregnancy rate than obliged cycles. There was no significant difference between the elective and obliged frozen cycles of D5 or D6 embryos regarding clinical pregnancy rate（P = 0.074 and P = 0.596，respectively）. Elective D5 embryo transfer group had a higher pregnancy rate than that of the obliged group（P = 0.011）. However，there was no significant difference of clinical pregnancy rate between elective and obliged groups of D6 embryos（P = 0.979）. In non-PGT cycles，clinical pregnancy rate was significantly different among different age groups of either elective/obliged or fresh/ frozen cycles（P < 0.001）. Obliged D3 and D6 embryo transfer groups showed the lowest pregnancy rate，and in PGT cycles of patients under 40，D5 embryo showed a higher pregnancy rate than that of D6 group as a whole（P < 0.001）.【Conclusion】The outcome of SET strategy seemed good in the last 2 years. In order to avoid perinatal complications caused by multiple fetuses，clinicians and patients should actively promote and choose SET.
ABSTRACT
The maternal components are constantly changing with gestational weight gains during pregnancy. Body composition analysis is a method for evaluating the maternal body composition accurately during pregnancy, models of which consist of fat mass, extracellular water, intracellular water, inorganic salts and protein basically. Among various methods to execute body composition analysis, bioelectrical impedance analysis is an important method for pregnant women. Many studies have reported about clinical applications based on correlations between maternal individual components and gestational diseases. This article reviews the researches on clinical applications of body composition analysis to pregnant women.
ABSTRACT
AIMS: To review the historical reports on antiphospholipid antibodies (aPL) from the early years of the 20th century; to outline the cardinal features of the antiphospholipid syndrome (APS) from 1983 on, including clinical criteria, etiopathogenesis and current therapy. METHODS: Literature review using PubMed. Articles on the history of aPL and APS were selected. RESULTS: The original aPL were described in patients with syphilis yet in 1906 by Wassermann. A first definition of lupus anticoagulant was proposed in 1963,while the anticardiolipin antibody (aCL) test was depicted twenty years later. The APS, initially reported by Hughes in 1985as the "aCL syndrome", is one of the most prevalent acquired thrombophilia. Venous and arterial thrombosis, associated or not to pregnancy morbidity, comprise the main features. It is a novel disorder firstly associated to systemic lupus erythematosus. A primary form of APS was put forward in 1989, and many APS variants are currently known. Lifelong, full-dose anticoagulation is the mainstream for treatment of thrombotic APS. In obstetric APS, the combination of acetil-salicilic acid and enoxoparin has been a mostly effective therapy. CONCLUSIONS: The sequential characterization of aPL since Wassermann in 1906, and later of the APS in the 1980-thies, is a rather interesting example of how a new entity is sketched step by step. APS is an intriguing novel cause of autoimmune thrombophilia, with a complex pathogenesis and a plethora of clinical and laboratory abnormalities. Treatment is based on life-long anticoagulation.
OBJETIVOS: Revisar os relatos históricos sobre anticorpos antifosfolípides (aAF) dos primeiros anos do século XX; delinear as características cardinais da síndrome antifosfolípide (SAF) a partir de 1983, incluindo critérios clínicos, etiopatogênese e terapia atual. MÉTODOS: Revisão de literatura utilizando o PubMed. Foram selecionados artigos com foco na história dos aAF e da SAF. RESULTADOS: Os aAF foram originalmente descritos em pacientes com sífilis ainda em 1906 por Wassermann. Uma primeira definição do anticoagulante lúpico foi proposta em 1963, enquanto o anticorpo anticardiolipina (aCL) foi descrito 20 anos mais tarde. A SAF, inicialmente reportada por Hughes em 1985 como "síndrome do aCL" é uma das mais prevalentes trombofilias adquiridas. Tromboses arteriais e venosas, associadas ou não à morbidade gestacional, compreendem os achados principais. É uma nova entidade, tendo sido primeiramente associada ao lupus eritematoso sistêmico. Uma forma primária de SAF foi reconhecida em1989, e muitas variantes de SAF são modernamente conhecidas. A terapia-padrão para a SAF trombótica é a anticoagulação plena e ininterrupta. Na SAF obstétrica, a combinação de ácido acetil-salicílico com enoxaparina tem-se mostrado altamente efetiva. CONCLUSÕES: A caracterização sequencial dos aAF desde Wasserman em 1906, e mais tarde da SAF nos anos 1980, é um interessante exemplo de como uma nova entidade é concebida passo a passo. A SAF é uma nova e intrigante causa de trombofilia autoimune, com uma complexa patogênese e uma pletora de manifestações clínicas e laboratoriais. O tratamento é baseado em anticoagulação contínua.
Subject(s)
Pregnancy Complications , Thrombosis , Antiphospholipid SyndromeABSTRACT
Objective To study the pregnancy complication incidences, delivery manners and pregnancy outcomes of senile pregnant women. Methods The medical records of 10 508 cases of pregnant and delivery women, who were hospitalized for delivery in Obstetrical Department of Changhai Hospital of Second Military Medical University from Jan. 2010 to Dec. 2016, were collected and analyzed. According to delivery age, they were divided into the senile group (≥35 years old, n＝1 130) and the non-senile group (35 years old, n＝9 378). Chi-square test was used to compare the incidences of pregnancy complications, cesarean section rate, ratio of cesarean section indications and outcomes of maternal and perinatal infants between the two groups. Results The proportion of senile pregnant women increased from 6.75% (89/1 319) in 2010 to 15.82% (267/1 688) in 2016. The cesarean section rate and the ratio of social factors in the senile group were higher than those in the non-senile group (67.08% [758/1 130] vs 48.51% [4 549/9 378], 42.88% [325/758] vs 10.07% [458/4 549], both P0.01). The incidences of gestational diabetes mellitus, premature rupture of membrane, placenta praevia, placental implantation abnormality and postpartum hemorrhage of the senile group were significantly higher than those of the non-senile group (all P0.05). The incidences of pregnancy-induced hypertension syndrome, pre-eclampsia, chronic hypertension complicating pregnancy of the senile group were significantly higher than those of the non-senile group (all P0.05). The incidences of liver diseases, diseases of urinary system, abnormal thyroid function, thrombotic diseases and malignant tumor complicated with pregnancy were significantly higher in the senile group than those in the non-senile group (all P0.05). For outcome of perinatal infants, the onset rates of asphyxia neonatorum, death of perinatal infants and premature infants were significantly higher in the senile group than those in the non-senile group (all P0.05). Conclusion The risks of pregnancy complications and adverse pregnancy outcomes are increased in senile pregnant women. Appropriate-age pregnancy and perinatal care of senile pregnancy should be advocated in clinic.