Evaluation of first- and third-trimester afamin levels in preeclampsia

SUMMARY OBJECTIVE: The aim of this study was to investigate serum afamin levels in the first and third trimesters in preeclampsia. METHODS: Serum samples from 118 patients in the first and third trimesters were analyzed. Serum samples were collected from pregnant women who had enrolled in the first trimester. Blood was then collected from pregnant women who had developed preeclampsia and from healthy controls in the third trimester. The collected blood samples were resolved for analysis, and serum afamin concentrations were measured in the first and third trimesters. Preeclampsia and healthy controls were compared. RESULTS: There was no significant difference between the control and preeclampsia groups in terms of age, body mass index, and smoking. Afamin levels in the first and third trimesters were higher in the preeclampsia group than in the control group (p<0.05). In the subgroup analysis of the preeclampsia group, afamin levels were higher in the early-onset preeclampsia group than in the late-onset preeclampsia group in the first and third trimesters (p<0.05). In the receiver operating characteristic analysis afamin levels were 96.23 ng/mL in the first trimester and 123.57 ng/mL in the third trimester as cut-off values for preeclampsia. CONCLUSION: Serum afamin levels are useful for predicting preeclampsia in the first trimester in pregnant women and can be used in clinical practice as a supportive biomarker for the diagnosis of preeclampsia in the third trimester. Meta-analyzes are needed to investigate the effect of afamin levels in the prediction and diagnosis of preeclampsia and to determine the cut-off value.

The correlation between serum vitamin D and the risk of pre-eclampsia in the early, middle and late stages of pregnancy / 中国医师进修杂志

Objective:To investigate the correlation between serum vitamin D and the risk of pre-eclampsia at the early, middle and late stages of pregnancy.Methods:Pregnant women who registered and delivered in Electric Power Teaching Hospital of Capital Medical University from August 2020 to July 2021 were included. Pregnant women with pre-eclampsia during pregnancy were selected as the case group (150 cases), while pregnant women without any complications after delivery were selected as the control group (600 cases) according to the 1∶4 matching principle (age, pre-pregnancy body mass index and last menstruation). The levels of serum vitamin D in differences stages of pregnancy between the two groups were compared. Logistic regression model was used to analyze the association between serum vitamin D levels and the risk of pre-eclampsia.Results:The levels of serum vitamin D at the early, middle and late stages of pregnancy in the case group were lower than those in the control group: (14.32 ± 3.61) μg/L vs. (18.78 ± 4.73) μg/L, (15.06 ± 3.12) μg/L vs. (19.88 ± 4.25) μg/L, (16.04 ± 3.51) μg/L vs. (22.04 ± 5.63) μg/L, there were statistical differences ( P<0.05). Taking pregnant women with adequate serum Vitamin D as a reference, and adjusting for confounding factors such as gain weight and primipara, the risk of pre-eclampsia in early stages pregnant women with serum Vitamin D serious deficiency, middle deficiency and deficiency was increased and the OR and 95% CI were 4.84(1.25 -31.42), 3.09(1.12 - 8.96), 1.48(1.12 - 13.05); the risk of pre-eclampsia in middle stages pregnant women with serum vitamin D serious deficiency, middle deficiency and deficiency was increased and the OR(95% CI) were 4.43(1.23 - 13.55), 2.22(1.05 - 6.78), 1.12(0.45 - 7.73); the risk of pre-eclampsia in late stages pregnant women with serum vitamin D serious deficiency, middle deficiency and deficiency was increased and the OR(95% CI) were 2.13(1.12 - 8.64), 1.76(1.02 - 4.98), 1.22(0.72 - 3.94). Conclusions:The level of serum vitamin D is associated with the risk of pre-eclampsia in pregnant women in the early, middle and late stages of pregnancy, and the risk of pre-eclampsia is significantly increase when the level of serum vitamin D is severely deficient or deficient during pregnancy.

Changing Paradigms in the Initial Treatment of Ectopic Pregnancy at a University Hospital in Brazil / Mudança de paradigmas do tratamento inicial de gravidez ectópica em um hospital universitário no Brasil

Abstract Objective To evaluate the use of different treatment options for ectopic pregnancy and the frequency of severe complications in a university hospital. Methods Observational study with women with ectopic pregnancy admitted at UNICAMP Womeńs Hospital, Brazil, between 01/01/2000 and 12/31/2017. The outcome variables were the type of treatment (first choice) and the presence of severe complications. Independent variables were clinical and sociodemographic data. Statistical analysis was carried out by the Cochran-Armitage test, chi-square test, Mann-Whitney test and multiple Cox regression. Results In total 673 women were included in the study. The mean age was 29.0 years (± 6.1) and the mean gestational age was 7.7 (± 2.5). The frequency of surgical treatment decreased significantly over time (z = -4.69; p < 0.001). Conversely, there was a significant increase in the frequency of methotrexate treatment (z = 4.73; p < 0.001). Seventy-one women (10.5%) developed some type of severe complication. In the final statistical model, the prevalence of severe complications was higher in women who were diagnosed with a ruptured ectopic pregnancy at admission (PR = 2.97; 95%CI: 1.61-5.46), did not present with vaginal bleeding (PR = 2.45; 95%CI: 1.41-4.25), had never undergone laparotomy/laparoscopy (PR = 6.69; 95%CI: 1.62-27.53), had a non-tubal ectopic pregnancy (PR = 4.61; 95%CI: 1.98-10.74), and do not smoke (PR = 2.41; 95%CI: 1.08-5.36). Conclusion there was a change in the first treatment option for cases of ectopic pregnancy in the hospital during the period of analysis. Factors inherent to a disease that is more difficult to treat are related to a higher frequency of severe complications.

Resumo Objetivo Avaliar as diferentes opções de tratamento para gravidez ectópica e a frequencia de complicações graves em um hospital universitário. Métodos Estudo observacional com mulheres com gravidez ectópica admitidas no Hospital da Mulher da UNICAMP, no Brasill, entre 01/01/2000 e 31/12/2017. As variáveis de desfecho foram o tipo de tratamento (primeira escolha) e a presença de complicações graves. As variáveis independents foram dados clínicos e sociodemográficos. A análise estatística foi realizada pelo teste de Cochran-Armitage, teste de qui-quadrado, teste de Mann-Whitney e Regressão de Cox Múltipla. Resulados No total, 673 mulheres foram incluídas no estudo. A idade médica foi de 29.0 anos (± 6.1) e a idade gestacional media foi de 7.7 (± 2.5). A frequencia de tratamento cirúrgico diminuiu significativamente ao longo dos anos(z = -4.69; p < 0.001). Simultaneamente, houve um aumento da frequencia do tratamento clínico(z = 4.73; p < 0.001). Setenta e uma mulheres (10.5%) desenvolveram algum tipo de complicação grave. No modelo estatístico final, a prevalência de complicações graves foi maior nas mulheres que tiveram diagnóstico de gestação ectópica rota à admissão (PR = 2.97; 95%CI: 1.61-5.46), que não apresentaram sangramento vaginal (PR = 2.45; 95%CI: 1.41-4.25), sem antecedentes de laparotomia/laparoscopia (PR = 6.69; 95%CI: 1.62-27.53), com gravidez ectópica não-tubária (PR = 4.61; 95%CI: 1.98-10.74), e não tabagistas (PR = 2.41; 95%CI: 1.08-5.36). Conclusão Houve uma mudança na escolha do primeiro tratamento indicado nos casos de gravidez ectópica durante o período analisado. Os fatores inerentes a doença relacionados a maior dificuldade de tratamento foram associados a maior frequencia de complicações graves.

Lipid metabolism in late pregnancy and its correlation with adverse perinatal outcome among Tibetan pregnant women in high altitudes / 中华围产医学杂志

Objective:To analyze the lipid levels, adverse perinatal outcome and their correlation in Tibetan pregnant women in high altitudes in late pregnancy.Methods:Retrospective analysis was performed on clinical and laboratory data of 523 Tibetan singleton pregnant women who delivered after 28 weeks at the Department of Obstetrics and Gynecology, Chaya People's Hospital, Changdu City. The subjects were divided into three groups according to the altitude of their long-term residence, including altitude<3 500 m (Group A, n=161), altitude ≥3 500 m and <4 000 m (Group B, n=203) and altitude≥4 000 m (Group C, n=159). In addition, the subjects were also grouped into high TG group (TG≥3.23 mmol/L, n=80) and control group (TG<3.23 mmol/L, n=443). The baseline information, levels of lipid and perinatal outcome were compared among Group A,B and C, and also between the high TG and control group, respectively, using Mann-whitney U test, Kruskal-Wallis H test, LSD- t, Chi-square test, or Fisher exact test. Multivariate logistic regression analysis was also applied to analyze the correlation between hypertriglyceridemia and adverse perinatal outcome. Results:The maternal age, gravidity and parity, body mess index, blood pressure on admission and total cholesterol (TC), TG, high density lipoprotein-cholesterol (HDL-C), low density lipoprotein-cholesterol (LDL-C), TG/HDL-C ratio and LDL-C/HDL-C ratio in late pregnancy and the occurrence of adverse perinatal outcome did not show any significant differences among Group A, B and C (all P>0.05). However, the hemoglobin (Hb) level increased with the elevation of altitude as expected, and that in Group C was higher than that in Group A and B [121.0 g/L (108.0-132.0 g/L) vs 115.0 g/L (103.5-128.0 g/L) and 117.0 g/L (101.0-127.0 g/L), H=2.37 and 1.97, both P<0.05]. The proportion of women with hypertriglyceridemia, the high TG group, in late pregnancy was 15.3% (80/523), and no significant difference was found in HDL-C or Hb levels between the high TG and control group [1.7 mmol/L (1.5-2.0 mmol/L) vs 1.8 mmol/L (1.5-2.1 mmol/L), Z=－1.51;123.5 g/L (110.0-131.8 g/L) vs 117.0 g/L (104.0-128.0 g/L), Z=1.69; both P>0.05]. Higher rates of cesarean section [13.8% (11/80) vs 6.6% (29/443), χ2＝4.98], hypertensive disorders of pregnancy (HDP) [16.3% (13/80) vs 7.5% (33/443), χ2＝6.54], preeclampsia (PE) [8.8% (7/80) vs 1.6% (7/443), χ2＝13.37], hyperglycemia during pregnancy [11.3%( 9/80) vs 3.6% (16/443), χ2＝8.69], preterm birth (PB) [7.5% (6/80) vs 2.0% (9/443), χ2＝7.27], microsomia [5.0% (4/80) vs 0.9% (4/443), Fisher exact test] and neonatal asphyxia [8.8%(7/80) vs 2.5% (11/443), χ2＝8.01] were observed in the high TG group than in the control group (all P<0.05). Regarding the pregnant women at different altitude, TG was negatively correlated with Hb ( r=－0.17, P=0.037) only in Group C .Multivariate logistic regression analysis revealed higher risk of HDP ( OR=2.42,95% CI:1.17-5.00), PE ( OR=5.25, 95% CI:1.73-16.00), hyperglycemia during pregnancy ( OR=3.77, 95% CI:1.56-9.09), PB ( OR=4.33, 95% CI:1.42-13.22), microsomia ( OR=4.33, 95% CI:1.42-13.22), neonatal asphyxia ( OR=3.45, 95% CI:1.27-9.35) and fetal demise ( OR=4.94, 95% CI:1.01-24.21) in women with high TG level in late pregnancy (all P<0.05). Conclusions:There were no differences in adverse perinatal outcomes or serum lipid levels in late pregnancy among women living at different high altitudes. However, hypertriglyceridemia at the third trimester is closely associated with the incidence of HDP, PE, hyperglycemia during pregnancy, PB, microsomia, neonatal asphyxia and fetal demise in this group of women.

Effectiveness and safety of intra-amniotic ethacridine injection for third trimester induction due to fetal demise / 中华围产医学杂志

Objective:To study the effectiveness and safety of intra-amniotic ethacridine injection in pregnancy induction at ≥28 gestational weeks due to fetal demise.Methods:This retrospective study recruited 77 singleton pregnant women who were admitted to Peking University First Hospital at ≥28 gestational weeks, from January 1, 2011 to December 31, 2021, because of fetal demise diagnosed by ultrasound. Four groups were classified according to different methods of induction, including ethacridine success group ( n=63), ethacridine failure group ( n=4), mifepristone plus misoprostol group ( n=5), and spontaneous delivery group ( n=5). Those in the ethacridine success group were further divided into scarred and non-scarred uterus group. The differences in general conditions and delivery outcomes among these women were analyzed using t-test, one-way analysis of variance, Chi-square test, and Mann-Whitney U test or Kruskal-Wallis H test. Results:(1) Among the 67 patients induced by ethacridine, the success rate was 94.0% (63/67). (2) Compared the ethacridine success group with the mifepristone plus misoprostol group or spontaneous delivery group, respectively, there was no significant difference in total labor duration, intrapartum hemorrhage volume, weight of the dead fetus, and the incidence of postpartum hemorrhage, perineal laceration, and intrauterine residue (all P>0.05). No serious complications such as placental abruption, disseminated intravascular coagulation, intrauterine infection, uterine rupture, conversion to cesarean section, or puerperal infection occurred in the three groups. (3) The duration between ethacridine injection and labor onset was shorter in the ethacridine success group than in the mifepristone plus misoprostol group [(28.5±12.0) h vs (54.2±17.6) h, t=－4.45, P<0.001]. (4) Among the 63 cases of ethacridine success group, the outcomes after induction were similar between scarred and non-scarred uterus group (all P>0.05). (5) The median duration between ethacridine injection and labor onset in the ethacridine success group was 26.8 h (2.3-66.0 h), which meant 95% of the patients went into labor within 51.7 h and 100% within 66 h after the injection. Conclusion:Intra-amniotic injection of ethacridine is safe and effective in termination for singleton pregnancy due to fetal demise at the third trimester and the duration from drug administration to labor onset was significantly shorter than that of mifepristone plus misoprostol, without increasing the risk of any complications.

Acute adverse events and pregnancy outcome after inactivated COVID-19 vaccination in first trimester / 中华围产医学杂志

Objective:To investigate acute adverse events and pregnancy outcome after vaccination of inactivated COVID-19 vaccine in the first trimester of pregnancy.Methods:The retrospective-prospective cohort study was conducted among pregnant women of 11-13 +6 weeks of gestation who visited the obstetric clinics for prenatal check in Lianyungang Maternal and Child Health Hospital from May to November in 2021, after registration for perinatal health cards in the community. Those who met the inclusion criteria were recruited and were divided into vaccination group and non-vaccination group according to whether they received inactivated COVID-19 vaccine in the first trimester. Women in the vaccination group were further divided into 1-dose group and 2-dose group. Information, including pregnancy-related screening, pregnancy complications, pregnancy outcome and acute adverse events, were collected and compared with independent samples t-test or ANOVA, Kruskal- Wallis H test or Mann-Whitney U test, χ2 test or Fisher's exact probability method. Results:Totally, 105 pregnant women were analyzed in 1-dose group, 90 in 2-dose group, and 194 in non-vaccination group. (1) There were no statistically significant differences in the occurrence of acute adverse events [1-dose group: 2.86% (3/105); 2-dose group: 6.67% (6/90); non-vaccination group: 4.63% (9/194); χ2=1.59; vaccination group was 4.61% (9/195), when compared with non-vaccination group, χ2=0.00], abnormal pregnancy-related screening indicators and abnormal pregnancy outcome among the three groups (all P>0.05), neither between the vaccination and non-vaccination group (all P>0.05). The acute adverse events in these women included fever, pain at the inoculation site, fatigue, local induration and rash.(2) The differences in hypertensive disorders in pregnancy among the three groups were statistically significant [1-dose group: 10.5%(11/105); 2-dose group: 17.8%(16/90); non-vaccination group: 7.7%(15/194); χ2=6.46, P=0.040], and the incidence was higher in the 2-dose group than that in the non-vaccination group (adjusted by Bonferroni, P<0.017). (3) Regarding other pregnancy complications, no difference was found among the three groups (all P>0.05), neither between the vaccination and non-vaccination group (all P>0.05). Conclusion:The risk of acute adverse events and adverse pregnancy outcome is similar in pregnant women who received inactivated COVID-19 vaccine versus those who did not in the first trimester, and regular blood pressure monitoring is recommended for those who received two doses of inactivated COVID-19 vaccine.

Cambios de adiposidad corporal entre la captación del embarazo y el posparto a corto plazo

Introducción: Las acumulaciones excesivas de tejido adiposo, general o regional, constituyen hallazgos de valor clínico en el seguimiento nutricional y cardiometabólico durante la gestación y en el período posparto. Objetivo: Describir los cambios en la adiposidad corporal trascurridos 18 meses después del parto. Método: Se realizó un estudio observacional descriptivo de la adiposidad corporal, entre enero 2017 y agosto 2018, en 119 mujeres en el posparto a corto plazo, cuya adiposidad corporal se había estudiado al momento de la captación en el policlínico "Chiqui Gómez Lubián". Resultados: En el posparto con respecto al momento de la captación, se observó una disminución de las mujeres sin adiposidad general de 28,6 % a 21,8 % y de las mujeres con adiposidad general intermedia de 62,2 % a 53,8 %; con un aumento marcado de aquellas con adiposidad general alta de 9,2 % a 24,4 %. Aumentó la cantidad de mujeres con adiposidad central alta de 35,3 % a 43,7 % y disminuyeron las mujeres sin adiposidad central de 64,7 % a 56,3 %. Conclusiones: Evaluar los cambios de la adiposidad corporal por técnicas antropométricas sencillas y de fácil acceso, durante el embarazo y en el posparto a corto plazo, puede ofrecer información de utilidad para una mejor orientación del seguimiento de la salud cardiometabólica de la mujer.

Introduction: Excessive accumulations of adipose tissue, whether general or regional, are findings of clinical value in nutritional and cardiometabolic follow-up during pregnancy and in the postpartum period. Objective: To describe the changes in body adiposity at eighteenth months after delivery. Methods: A descriptive and observational study of body adiposity was carried from January 2017 to August 2018 in 119 women in the short-term postpartum period, whose body adiposity had been studied during the first antenatal visit at "Chiqui Gómez Lubián" Polyclinic. Results: In the postpartum period, with respect to the first antenatal visit, a decrease was observed in the number of women without general adiposity (from 28.6 % to 21.8 %) and of women with intermediate general adiposity (from 62.2 % to 53.8 %), with a marked increase in the number of women with high general adiposity (from 9.2 % to 24.4 %). The number of women with high central adiposity increased (from 35.3 % to 43.7 %), while the number of women without central adiposity decreased (from 64.7 % to 56.3 %). Conclusions: To evaluate the changes in body adiposity by simple and easily accessible anthropometric techniques, during pregnancy and in the short-term postpartum period, may provide useful information for designing better the follow-up of cardiometabolic health of women.

Supresión de la visita de tercer trimestre en embarazo de bajo riesgo en la pandemia de SARS-CoV-2 / Third trimester suppression in low-risk pregnancy in the SARS-CoV-2 pandemic

Resumen Objetivo: La pandemia de SARS-CoV-2 ha obligado a una reorganización de las visitas presenciales, y por ese motivo se han minimizado hasta el punto de reconsiderar la realización de la visita del tercer trimestre. Nuestro centro suprimió dicha visita obstétrica y obtuvo datos propios para comparar los resultados perinatales logrados con dicho manejo. Método: Se realizó un estudio de cohortes retrospectivo, en marzo de 2020, con una cohorte con visita presencial única en la semana 40 de gestación (122 gestantes) frente a una cohorte con seguimiento convencional con visita presencial en la semana 36 de gestación (162 gestantes). Se evaluaron la restricción del crecimiento fetal, la edad gestacional al nacimiento, el peso neonatal y las tasas de inducciones, partos eutócicos y cesáreas urgentes en trabajo de parto. Resultados: Se encontraron diferencias leves en la tasa de nuliparidad (p < 0,04), sin hallarlas en el resto de las variables maternas. No hubo diferencias entre las dos cohortes en los resultados neonatales. Conclusiones: No hay diferencias entre los resultados materno-fetales obtenidos en gestantes con seguimiento gestacional con restricción de la visita del tercer trimestre respecto del seguimiento tradicional, excepto en el diagnóstico de las alteraciones de la estática fetal al término de la gestación.

Abstract Objective: The SARS-CoV-2 pandemic has forced a reorganization of face-to-face visits, for this reason they have been minimized to the point of reconsidering the completion of the third trimester visit. Our center eliminated the performance of this obstetric visit and obtained its own data to compare the perinatal results obtained with such management. Method: A retrospective cohort study was carried out in March 2020, with a cohort with a single face-to-face visit at 40th week of gestation (122 pregnant women), versus a cohort with conventional follow-up with face-to-face visit at 36th week of gestation (162 pregnant women). The following were evaluated fetal growth restriction, gestational age at birth, neonatal weight, rate of inductions, of eutocic deliveries, and of urgent cesarean sections in labor. Results: Slight differences were found in the nulliparity rate (p < 0.04), without finding them in the rest of the maternal variables. There were no differences between the two cohorts in neonatal outcomes. Conclusions: There were no differences between the maternal-fetal results obtained in pregnant women with gestational follow-up with restriction of the third trimester visit compared to traditional follow-up, except in the diagnosis of alterations in fetal statics at the end of pregnancy.

Asociación entre el hipotiroidismo subclínico de anticuerpos antiperoxidasa tiroidea negativos y los resultados perinatales adversos diagnosticados con diferentes criterios en el tercer trimestre del embarazo

Antecedentes. El efecto del hipotiroidismo subclínico (HSC) en los resultados perinatales adversos no está claro, y los valores de referencia de la hormona tiroestimulante (TSH) en el embarazo son controvertidos. Objetivo. Evaluar los efectos del HSC negativo para los anticuerpos de la peroxidasa tiroidea (TPOAbs) sobre los resultados perinatales según los diferentes valores de referencia de la TSH. Métodos. Un total de 554 mujeres embarazadas, incluyendo 509 eutiroideas y 45 gestantes hipotiroideas subclínicas (TSH > 3 mIU/L), fueron incluidas en este estudio prospectivo de casos y controles. Todas las gestantes estaban en el tercer trimestre y eran negativas a los TPOAbs. Las funciones tiroideas fueron evaluadas utilizando los valores de referencia específicos para el trimestre recomendados por el Colegio Americano de Obstetricia y Ginecología (ACOG) (TSH > 3 mIU/L) y la Asociación Americana de Tiroides (ATA) (TSH > 4 mIU/L). Resultados. La mortalidad neonatal en el hipotiroidismo subclínico con un límite superior de TSH de 4 mIU/L fue significativamente menor que en el grupo eutiroideo (2 (0,4%) frente a 1 (4,5%); p=0,009). No hubo diferencias significativas en resultados maternos y perinatales adversos en las gestantes con HSC y eutiroideas en ambos valores de referencia de la TSH. No hubo correlación significativa entre los valores de TSH y las semanas de parto de las gestantes con parto prematuro (r=0,169, p=0,146). Conclusiones. En este estudio, utilizando los diferentes valores basales de TSH recomendados por las directrices del ACOG de 2020 y de la ATA de 2017 en el tercer trimestre del embarazo para el diagnóstico de hipotiroidismo subclínico, no hubo una relación significativa entre los casos de hipotiroidismo subclínico con TPOAbs negativos y los resultados perinatales adversos.

Background: The effect of subclinical hypothyroidism (SCH) on adverse perinatal outcomes is unclear, and thyroid-stimulating hormone (TSH) reference values in pregnancy are controversial. Objective: To evaluate the effects of thyroid peroxidase antibody (TPOAbs) negative SCH on perinatal outcomes according to the different TSH reference values. Methods: A total of 554 pregnant women, including 509 euthyroid and 45 subclinical hypothyroid (TSH > 3 mIU/L) pregnant women, were included in this prospective case-controlled study. All pregnant women were in the third trimester and were TPOAbs negative. Thyroid functions were evaluated using trimester-specific reference values recommended by the American College of Obstetrics and Gynecology (ACOG) (TSH > 3 mIU/L) and the American Thyroid Association (ATA) (TSH > 4 mIU/L) guidelines. Results: Neonatal mortality in subclinical hypothyroidism with a TSH upper limit of 4 mIU/L was significantly lower than in the euthyroid group (2 (0.4%) vs 1 (4.5%); p=0.009). There was no significant difference in terms of adverse maternal and perinatal outcomes in SCH and euthyroid pregnant women in both TSH reference values. There was no significant correlation between TSH values and delivery weeks of pregnant women with preterm delivery (r=0.169, p=0.146). Conclusions: In this study, using different baseline TSH values recommended by the 2020 ACOG and 2017 ATA guidelines in the third trimester of pregnancy for the diagnosis of subclinical hypothyroidism, it was shown that there was no significant relationship between cases of subclinical hypothyroidism with negative TPOAbs and adverse perinatal outcomes.

The Effect of an educational Intervention on Anxiety of Pregnant Women: A Quasi-Experimental Study / El efecto de una intervención educativa sobre la ansiedad de las mujeres embarazadas: Un estudio cuasi experimental / O efeito de uma intervenção educativa na ansiedade de gestantes: um estudo quase experimental

Objective. The aim of study is the effect of educational intervention on anxiety of pregnant women. Methods. This quasi-experimental study is done on the pregnant women referring to family physician's offices in Gerash City, Iran. 62 women were selected and divided into 2 groups (control and intervention). In intervention group the anxiety reduction training classes were held as a group discussion in 4 weekly 90-minute sessions. Control group received routine care. The anxiety assessment completed by two groups before and after the educational intervention. The measurement instruments included a demographic information questionnaire and the short form of the Pregnancy Related Anxiety Questionnaire (PRAQ-17). Results. Comparison of the mean scores of different dimensions of pregnancy anxiety in the pre-intervention and post-intervention stages in the intervention group using paired t-test indicated a statistically significant difference in the dimensions Fear of childbirth, Fear of giving birth to a physically or mentally disabled child, Fear of mood swings and Fear of changes in marital relations (p < 0.05) in comparison with control group. Conclusion. Holding pregnancy-training classes using group discussion method is a good strategy to reduce anxiety in pregnant women. Therefore, it is recommended that this educational strategy classes be used with mothers from the second trimester of pregnancy in urban family physician centers or those referred to a nearby clinic.

Objetivo. Evaluar el efecto de una intervención educativa sobre la ansiedad de las mujeres embarazadas. Métodos. Estudio cuasi-experimental realizado con la participación de mujeres embarazadas que acuden a las consultas de los médicos de familia en la ciudad de Gerash, Irán. Se seleccionaron 62 mujeres y se dividieron en 2 grupos (control e intervención). En el grupo de intervención, las clases de entrenamiento para la reducción de la ansiedad se impartieron en forma de debate grupal en 4 sesiones semanales de 90 minutos. El grupo de control recibió atención rutinaria. Los dos grupos completaron la evaluación de la ansiedad antes y después de la intervención educativa. Los instrumentos de medición incluían un cuestionario de información sociodemográfica y la forma corta del Cuestionario de Ansiedad Relacionada con el Embarazo (PRAQ-17). Resultados. La comparación de las puntuaciones medias de las distintas dimensiones de la ansiedad durante el embarazo en las etapas previa y posterior a la intervención en el grupo de estudio indicó una diferencia estadísticamente significativa en las dimensiones Miedo al parto, Miedo a dar a luz a un niño discapacitado física o mentalmente, Miedo a los cambios de humor, y Miedo a los cambios en las relaciones conyugales (p < 0.05), en comparación con el grupo de control. Conclusión. La realización de clases de formación durante el embarazo utilizando el método de discusión en grupo es una buena estrategia para reducir la ansiedad en las mujeres embarazadas. Por lo tanto, se recomienda que esta estrategia educativa se emplee con las madres desde el segundo trimestre del embarazo en los centros de medicina de familia o a aquellas que sean derivadas a la consulta externa.

Objetivo. Avaliar o efeito de uma intervenção educativa sobre a ansiedade em gestantes. Métodos. Estudo quase experimental realizado com a participação de gestantes atendidas em consultórios médicos de família na cidade de Gerash, Irã. 62 mulheres foram selecionadas e divididas em 2 grupos (controle e intervenção). No grupo de intervenção, as aulas de treinamento de redução de ansiedade foram ministradas como uma discussão em grupo e em 4 sessões semanais de 90 minutos. O grupo de controle recebeu cuidados de rotina. Ambos os grupos completaram a avaliação da ansiedade antes e após a intervenção educativa. Os instrumentos de medida incluíram um questionário de informações sociodemográficas e a versão curta do Questionário de Ansiedade Relacionada à Gravidez (PRAQ-17). Resultados. A comparação das pontuações médias das diferentes dimensões da ansiedade durante a gravidez nas etapas antes e após a intervenção no grupo de estudo indicou diferença estatisticamente significativa nas dimensões; medo do parto, medo de dar à luz um filho com deficiência física ou mental, medo de mudanças de humor e medo de mudanças nas relações conjugais (p < 0,05), em comparação com o grupo de controle. Conclusão. A realização de aulas de capacitação durante a gravidez utilizando o método de discussão em grupo é uma boa estratégia para reduzir a ansiedade em gestantes. Portanto, recomenda-se que essa estratégia educativa seja utilizada com mães a partir do segundo trimestre de gestação em centros de medicina de família ou com aquelas que são encaminhadas ao ambulatório.

Placenta accreta in early pregnancy: case report / Placenta acreta en un embarazo temprano: reporte de caso

ABSTRACT First trimester placenta accreta is an uncommon event. There are few cases reported in the literature, several associated with uterine rupture and all of them with risk factors. This pathology can be life-threatening for the mother. At such an early stage of pregnancy, abnormal placentation is diagnosed mainly due to massive hemorrhage during uterine curettage. It is of extreme importance to diagnose it before delivery or uterine evacuation, to prevent associated morbidity and mortality. We present the case of a patient with placenta accreta in early pregnancy who consulted for abnormal uterine bleeding. We describe the clinical history, imaging and management of the patient.

RESUMEN La placenta acreta del primer trimestre es un evento poco común. Hay pocos casos publicados en la literatura, varios asociados a rotura uterina y en todos ellos con factores de riesgo. Esta patología puede poner en peligro la vida de la madre. En una etapa tan temprana del embarazo, la placentación anormal se diagnostica principalmente debido a una hemorragia masiva durante el legrado uterino. Es de extrema importancia diagnosticarla antes del parto o de la evacuación uterina, para prevenir la morbimortalidad asociada. Presentamos el caso de una paciente con placenta acreta en embarazo temprano quien consultó por hemorragia uterina anormal. Describimos la historia clínica, las imágenes y el manejo realizado a la paciente.

Two-dimensional ultrasound combined with HD-live silhouette technology in embryos/fetuses with normal or abnormal central nervous system during early pregnancy / 中华围产医学杂志

Objective:To study the ultrasonographic characteristics of embryos/fetuses with normal or abnormal central nervous system (CNS) from 7 to 13 +6 weeks of gestation using high resolution two-dimensional ultrasound combined with HD-live silhouette technology and provide a reference for early diagnosis of CNS abnormalities. Methods:Eighty normal embryos/fetuses during 7-13 +6 weeks and 41 fetuses with CNS malformations in early pregnancy during 11-13 +6 weeks were selected to observe the ultrasonographic features of embryos/fetuses with normal or abnormal CNS using transvaginal high resolution two-dimensional ultrasound and HD-live silhouette technology. Descriptive analysis was performed on the results. Results:From seven weeks of gestational age, high resolution two-dimensional ultrasound combined with HD-live silhouette technology can clearly and stereoscopically show the prosencephalon, mesencephalon and rhombencephalon. The rhombencephalon changed the most in the brain development of embryos. At nine weeks of gestation, cleared structures of pons curvature, the fourth ventricle and cisterna magna were observed. The developing cerebellum and the original Blake pouch cyst were seen at 10 weeks of gestation. From 11 to 13 +6 weeks, the most remarkable change was the choroid plexus of the fourth ventricle changed from perpendicular to parallel to the long axis of the neural tube. Of the 41 fetuses with CNS malformation, 16 (39.0%) were exencephaly, 11 (26.8%) were holoprosencephaly, five (12.2%) were encephalocele, four (9.7%) were anencephaly, three (7.3%) were fourth ventricle dilatation, and two (4.9%) were open spina bifida. Conclusions:High resolution two-dimensional ultrasound combined with HD-live silhouette technology can clearly and stereoscopically display the morphological changes in embryonic embryos/fetuses with development of normal CNS at 7-13 +6 weeks, which is helpful to better understand the origin of CNS embryonic abnormalities and provide diagnostic clues for the early detection of CNS abnormalities.

Predictive value of transvaginal ultrasound measurement of cervical length in first and second trimester on spontaneous preterm birth in singleton pregnancies / 中华围产医学杂志

Objective:To explore the predictive value of transvaginal ultrasound measurement of cervical length (CL) in the first and second trimester on spontaneous preterm birth in singleton pregnant women.Methods:This study retrospectively recruited 2 254 singleton pregnancies without severe comorbidities at Peking University First Hospital from January 2019 to June 2019. CL was measured for all subjects using transvaginal ultrasound in the first (11-13 +6 weeks) and second trimester (21-23 +6 weeks). Differences in CL between women with preterm (preterm group) and full-term delivery (full-term group) as well as the CL during the first and second trimester were compared. The independent risk factors for preterm birth and the predictive value of CL in the first and second trimester for spontaneous preterm birth were also explored. Fisher's exact test, t-test, χ2 test, and logistic regression analysis, etc, were adopted for statistical analysis. Results:(1) For the 2 254 subjects, CL measured in the first trimester and second trimester were (36.1±4.2) mm (22.4-52.6 mm) and (36.9±5.3) mm (2.9-59.7 mm), respectively. The incidence of short cervix in the first trimester and second trimester were 0.31% (7/2 254) and 1.46% (33/2 254), respectively. When CL was ≤25.0 mm ( OR=43.92, 95% CI:6.83-282.49) or >25.0-≤30.3 mm ( OR=6.59, 95% CI:1.97-22.0) in the first trimester, the risk of short cervix increased in the second trimester (both P<0.05). (2) The total incidence of preterm delivery was 3.06% (69/2 254). CL and the incidence of short cervix did not differ significantly in the first trimester between the preterm and full-term group [(35.2±4.5) and (36.1±4.1) mm, t=－1.78, P=0.076; 1.5% (1/69) and 0.3% (6/2 185), χ 2=2.98, P=0.084]. Compared with the full-term group, CL was shorter and the incidence of short cervix was higher in the second trimester in the preterm group [(33.6±6.7) vs (37.0±5.2) mm, t=－5.12;8.7% (6/69) vs 1.2% (27/2 185), χ 2=25.80, P<0.001]. (3) Multivariate regression analysis showed that age ≥35 years ( OR=2.05, 95% CI:1.22-3.46), history of spontaneous preterm birth ( OR=25.25, 95% CI:5.01-127.28), conception assisted by reproductive technology ( OR=10.39, 95% CI:2.39-50.33), and short cervix during the second trimester were independent risk factors for premature delivery. (4) There was no significant difference in the risk of preterm delivery when comparing to those with CL≤25.0 mm, >25.0-≤30.3 mm, >30.3-≤33.0 mm, >33.0-≤35.7 mm, >35.7-≤38.7 mm women with CL>38.7 mm during the first trimester (all P>0.05). The risk of premature delivery was relatively increased for those with CL≤25.0 mm,>25.0-≤29.5 mm, >29.5-≤33.6 mm, >33.6~≤36.8 mm, >36.8~≤40.1 mm during the second trimester compared to those with CL>40.1 mm [ OR (95% CI):17.64 (4.99-62.32), 6.89 (2.11-22.55), 3.58 (1.34-9.59), 4.04 (1.58-10.32), 3.34 (1.28-8.67), respectively , all P<0.05]. (5) When CL≤25.0 mm and ≤29.5 mm in the second trimester were used as the cut-off value, the prediction of preterm delivery was with a sensitivity of 8.70% and 17.39%, specificity of 98.80% and 95.29%, positive predictive value of 18.20% and 10.43%, negative predictive value of 97.16% and 97.34%, and the accuracy rate of 96.01% and 92.90%, respectively. Conclusions:There were no significant differences in CL and the incidence of short cervix during the first trimester among women with preterm or full-term delivery. CL in the first trimester is not an independent risk factor for preterm birth, but the risk of short cervix in the second trimester is increased when CL≤30.3 mm in the first trimester. The shorter the cervix during the second trimester, the greater the risk of preterm birth.

Maternal hemoglobin levels in the third trimester and its correlation with pregnancy outcomes among rural residents in Tibetan Plateau / 中华围产医学杂志

Objective:To study the relationship between maternal hemoglobin concentration, anemia rate in the third trimester and the altitudes, pregnancy outcomes among pregnant women in Tibet rural areas.Methods:This prospective study collected clinical and laboratory data of 390 Tibetan pregnant women who delivered after 28 gestational weeks at Chaya People's Hospital, Changdu city, Tibet autonomous region, from May 2020 to March 2021. Blood routine examination was performed at admission and 24-72 h postpartum using an automatic hematologic analyzer. According to the hemoglobin standard adjusted for altitude by World Health Organization (WHO), the association between pregnancy outcomes and maternal hemoglobin levels and anemia rate before and after adjustment were analyzed using Mann-Whitney U one-way analysis of variance, Chi-square, Pearson correlation, and Spearman correlation tests. Results:(1) In these women, the mean actual hemoglobin concentration in the third trimester was (121±16) g/L, and the prevalence of anemia and microcytic hypochromic anemia was 23.8% (93/390) and 20.3% (79/390), respectively. (2) After adjustment, the mean hemoglobin concentration was (93±17) g/L, and the prevalence of anemia and microcytic hypochromic anemia was 84.4% (329/390) and 30.5% (119/390), respectively. (3) Actual hemoglobin levels showed an increasing tendency as the altitude rose. At the altitude of 3 000-3 500 m, >3 500-4 000 m, and >4 000 m, the mean hemoglobin levels were (118±15) g/L, (119±17) g/L, and (124±16) g/L, respectively ( Ftrend=7.38, P=0.007). However, the prevalence of anemia and microcytic hypochromic anemia did not differ significantly between different altitude ( P>0.05). (4) Corrected hemoglobin levels were negatively associated with the altitude ( r=－0.31, P<0.001). At the altitude of 3 000~3 500 m, 3 500~4 000 m and >4 000 m, the mean corrected hemoglobin levels were (100±15) g/L, (92±17) g/L, and (87±18) g/L, respectively ( Ftrend=30.36, P<0.001). The prevalence of anemia increased with altitude ( χ2trend=15.44, P<0.001), but no association was observed between microcytic hypochromic anemia and altitudes ( P>0.05). (5) No association was found between actual or corrected anemia in the third trimester and adverse pregnancy outcomes, nor the hemoglobin level before or after adjustment and neonatal birth weight. Conclusions:In Tibet rural areas, the mean actual hemoglobin level in pregnant women tends to increase with the altitude. However, the prevalence of anemia and microcytic hypochromic anemia remains high and more attention should be paid to iron supplementary during pregnancy. After adjusting hemoglobin concentration based on WHO standard, more women were diagnosed as having anemia during pregnancy in this area, and the applicability of the diagnostic criteria for Tibetan residents requires further investigations.

Indications of invasive prenatal diagnosis in third trimester and pregnancy outcome / 中华围产医学杂志

Objective:To analyze the indications for invasive prenatal diagnosis in the third trimester and summarize the pregnant outcome.Methods:Clinical data of 121 women who underwent invasive prenatal diagnosis in the third trimester in the prenatal diagnostic center of the First Medical Center of Chinese PLA General Hospital from January 2016 to December 2020 was retrospectively analyzed. Different genetic diagnostic methods were used according to different indications. Indications and results of prenatal diagnosis, as well as the complications within two weeks after the invasive procedure, pregnancy outcome, and neonatal follow-up of all the participants were described.Results:Among the 121 cases, 107 cases underwent amniocentesis, seven underwent percutaneous umbilical blood sampling, and seven had both procedures performed at the same time (one underwent thoracocentesis at the same time). Newly identified ultrasound abnormalities in the second and third trimesters were the main indications for prenatal diagnosis, accounting for 99.2%(120/121), of which short limbs and fetal growth restriction accounted for 25.0% (30/120) and 20.0% (24/120), respectively. Genetic abnormalities and congenital diseases were detected in 20 cases with a detection rate of 16.5%(20/121). Among them, there were nine cases of achondroplasia, five cases of pathogenic copy number variations, one case of achondroplasia with pathogenic copy number variation, one trisomy 18, one 47,XXX, one tetrasome mosaicism of 12p, one de novo WTX c. 1072(Exon2) C>Tp.R358X heterozygous mutation, and one fetal hypoproteinemia. In addition, six cases with copy number variation of unknown significance (VUS) were detected, noting for a detection rate of 5.0%(6/121). Among the 20 cases with abnormal detection, 15 were terminated, two delivered prematurely before obtaining the prenatal diagnosis results, one underwent cesarean section before obtaining prenatal diagnostic results and two continued the pregnancies. In the six cases with VUS, one was terminated and the other five continued the pregnancy. Only one case had preterm premature rupture of membranes 2 d after amniocentesis and the incidence rate of complications after all kinds of invasive procedures was 0.8% (1/121). During the neonatal follow-up, postnatal whole exome sequencing revealed monogenetic disorder in two cases with normal prenatal diagnostic results; the patient with 12p chimerism had developmental delay; the one with WTX mutation deceased on the day of born; the rest newborns developed normally. Conclusions:As a relatively safe method, invasive prenatal diagnosis in the third trimester is of great importance and value in reducing the miss diagnostic rate of fetuses with severe genetic diseases and birth defects. The appropriate application of prenatal whole exome sequencing could further help to decrease the miss diagnostic rate of monogenetic disorder.

Prenatal diagnosis and pregnancy outcome of increased nuchal translucency with or without nuchal cystic hygroma in fetuses during first trimester / 中华围产医学杂志

Objective:To compare the prenatal diagnosis and pregnancy outcome of increased nuchal translucency (NT) with or without nuchal cystic hygroma (CH) in fetuses with first-trimester NT ≥5 mm.Methods:Data from 131 fetuses with NT ≥5 mm who received invasive prenatal diagnosis at Guangzhou Women and Children's Medical Center from July 2017 to December 2020 were retrospectively collected and analyzed. Those with a septum in the cyst were grouped as NT with CH group ( n=57), and those without as increased NT without CH group ( n=74). Genetic test results, incidence of structural malformations, survival rate after birth were compared using Chi-square test or Fisher's exact test and non-parametric test. Results:There was no significant difference in the incidence of fetal genetic abnormalities[67.6%(50/74) vs 61.4%(35/57), χ 2=0.54, P=0.464], ultrasonic structural malformations [21.6%(16/74) vs 33.3%(19/57), χ 2=2.26, P=0.133], or in the survival rate (12/14 vs 3/8, P=0.053) between increased NT without CH group and NT with CH group. Conclusions:For increased NT with or without CH, although the two groups had different spectrum of disease, they had a high incidence of chromosomal abnormalities and structural malformations, and both groups had a certain healthy survival rate after birth.

The predictive value of the distance between the placenta and the internal os of the cervix in second trimester to placenta previa / 中国医师杂志

Objective:To explore the predictive value of the distance between the placenta and the internal os of the cervix (IOD) in second trimester to placenta previa.Methods:476 pregnant women with placenta previa diagnosed by systematic ultrasound in the Affiliated Hospital of North Sichuan Medical College from May 2016 to June 2020 were analyzed retrospectively. The ultrasonic parameters such as IOD, cervical length and placental main attachment position were measured, and the clinical characteristics and pregnancy outcome were recorded. Logistic regression analysis was used to analyze the influencing factors of placenta previa from mild pregnancy to late pregnancy. The receiver operating characteristic (ROC) curve was used to analyze the predictive value of IOD value for placenta previa.Results:197 cases of placenta previa were diagnosed in this study. Multivariate regression analysis showed that the number of previous pregnancies, IOD and history of cesarean section were the related factors of placenta previa from mid pregnancy to late pregnancy ( P<0.05). The risk of placenta previa in pregnant women ≥3 pregnancies was 1.826 times that in pregnant women with less than 3 pregnancies. The risk of placenta previa when the lower edge of placenta covers and crosses the internal orifice of cervix (IOD<0 mm) was 11.494 times that of IOD=0 mm and 22.222 times that of IOD>0 mm<20 mm (low placenta). The risk of placenta previa in pregnant women with a history of cesarean section was 1.908 times that of pregnant women without a history of cesarean section. When the cutoff value of IDO was 20 mm, all pregnant women with placenta previa could be screened out in the group with cesarean section history and the area under the curve (AUC) was 0.840 (95% CI: 0.783-0.896, P<0.05); When the cutoff value of IOD was 13.5 mm, all pregnant women with placenta previa could be screened in the group without cesarean section history, and the AUC was 0.814 (95% CI: 0.759-0.869, P<0.05). Conclusions:The second trimester IOD has a good predictive value for placenta previa.

Clinical value of echocardiography in the diagnosis of fetal arrhythmia / 中国基层医药

Objective:To investigate the clinical value of echocardiography in the diagnosis of fetal arrhythmia.Methods:1 500 pregnant women who underwent a regular prenatal examination in Cangnan Hospital Affiliated to Wenzhou Medical University from March 2018 to March 2020 were included in this study. These pregnant women underwent fetal echocardiography in the second trimester of pregnancy (24-26 weeks). We evaluated the condition of, and calculated the incidence of, fetal arrhythmia complicated by fetal cardiac structure abnormality . The diameters of the descending aorta, umbilical artery, and middle cerebral artery were compared between normal fetuses and arrhythmia fetuses.Results:Fetal arrhythmia was found in 131 pregnant women who were in the second trimester of pregnancy, with an incidence of fetal arrhythmia of 8.73%. Fetal arrhythmia and cardiac structure abnormality were detected in 19 pregnant women, with an incidence of fetal arrhythmia and cardiac structure abnormality of 1.27%. Fetal arrhythmia was detected in 131 (8.73%) pregnant women who were in the second trimester of pregnancy and it was detected in 32 (2.13%) pregnant women who were in the third trimester of pregnancy. Arrhythmia was detected in 18 (1.2%) newborns. Only 5 (0.33%) fetuses died during the perinatal period. Four (0.27%) fetuses had arrhythmia complicated by cardiac structure abnormality. One (0.07%) fetus was normal. The diameters of the descending aorta and middle cerebral artery were greater in normal fetuses than in arrhythmia fetuses in pregnant women who were in the second trimester of pregnancy, and the diameter of the umbilical artery was significantly smaller in normal fetuses than in arrhythmia fetuses ( t = -8.27-19.62, all P < 0.001). Conclusion:Echocardiography can effectively help diagnose fetal arrhythmia and observe abnormal cardiac structure. The imaging technique is of great clinical value in improving the diagnosis and treatment of fetal arrhythmia.

Association between thyroid function in the first trimester in twin pregnancies and gestational diabetes mellitus / 中华围产医学杂志

Objective:To explore the associations between thyroid function in the first trimester in twin pregnancies and gestational diabetes mellitus (GDM) and the risk factors of twin pregnancies complicated by GDM.Methods:Retrospective analysis was performed on 745 twin pregnancies delivered after 28 weeks at the Third Affiliated Hospital of Sun Yat-sen University from January 2015 to December 2021, and they were divided into GDM group ( n=186) and the control (non-GDM) group ( n=559). Thyroid dysfunction was diagnosed based on the reference range of singleton and twin pregnancies recommended by the Guideline on diagnosis and management of thyroid diseases (2nd edition) in China and the literature, respectively. Independent sample t-test, Chi-square test, or Fisher exact test, and Mann-Whitney U test were used to compare the general clinical characteristics and thyroid function between the two groups. Spearman rank correlation analysis was performed to analyze the correlation between free thyroxine (FT 4), thyroid stimulating hormone (TSH), thyroid peroxidase antibody (TPOAb), and fasting plasma glucose (FPG) in the first trimester as well as glucose levels in 75 g oral glucose tolerance test (OGTT). The associations between FT 4, TSH at different levels, and the detection rate of GDM, and the risk factors of GDM in twin pregnancies were analyzed using logistic regression. Results:(1) The prevalence of GDM in twin pregnancies was 25.0% (186/745). The positive rate of TPOAb was 13.6% (101/745). FPG in the first trimester was higher in the GDM group than that in the control [(4.7±0.5) vs (4.5±0.4) mmol/L, t=－5.08, P<0.001]. (2) No correlation between FT 4, TSH levels, the positive rate of TPOAb in the first trimester and FPG in the first trimester as well as OGTT results was found (all P>0.05). (3) There was no significant difference when using the thyroid function reference range for twin or singleton pregnancy in detecting hypothyroidism [0.5% (4/745) vs 0.4% (3/745)] and subclinical hypothyroidism [1.2% (9/745) vs 1.3% (10/745)] among the included subjects (both P>0.05), however, there were significant differences in the detection rates of hypothyroxinemia alone [25.0% (186/745) vs 12.9% (96/745)], hyperthyroidism [2.4% (18/745) vs 12.9% (96/745)] and subclinical hyperthyroidism [5.8% (43/745) vs 12.1% (90/745)]( χ2 were 35.43, 33.43 and 18.24, all P<0.001). There was no significant difference in the detection rate of thyroid disease between the GDM and control groups (all P>0.05). (4) FT 4 and TSH levels were grouped into quartiles ( Q1, Q2, Q3, and Q4), which showed that the detection rate of GDM was the highest [27.8% (52/187)] in women with FT 4 in Q1 and was the lowest [23.0% (43/187)] in those with FT 4 in Q2. However, the detection rate was the lowest in women with TSH in Q1 [24.1% (45/187)] and was the highest [27.4%(51/186)] in those with TSH in Q4. Taking Q1 of FT 4 and TSH as a reference, the logistic regression model showed that there were no statistically significant differences between FT 4, TSH at different levels, and GDM, even after adjusting for age, preconception-body mass index (pre-BMI), family history of diabetes, mode of conception, and chorionicity (all P>0.05). (5) Multivariate logistic regression analysis showed that maternal age ( OR=1.10, 95% CI: 1.05-1.15), pre-BMI ( OR=1.13, 95% CI: 1.07-1.21), family history of diabetes ( OR=2.73, 95% CI: 1.53-4.85), and FPG in the first trimester ( OR=2.14, 95% CI: 1.38-3.32) were independent risk factors for twin pregnancies complicated by GDM. Conclusions:Twin pregnant women with higher maternal age, pre-BMI, FPG in the first trimester and family history of diabetes were at higher risk of GDM. No significant correlation is found between maternal thyroid function in the first trimester and GDM in twin pregnancies.

Fetal cervical aortic arch with closure of ductus arteriosus: a case report / 中华围产医学杂志

This paper reported the ultrasonographic findings and pregnancy outcome in a case of fetal cervical aortic arch complicated by premature closure of ductus arteriosus. Ultrasound at 22+6weeks of gestation showed that the apex of fetal aortic arch reached the level of left clavicle, but no obvious abnormality in fetal intracardiac structure was found. Ultrasound examinations showed premature contraction of the fetal ductus arteriosus at 25+ 4 weeks of gestation and premature closure at 27+6 weeks. The pregnant woman was hospitalized due to the aggravation of fetal right heart failure at 34+1 gestational weeks and delivered by cesarean section at 34+3weeks. After 17 d of intensive care, the newborn was discharged in good condition. Ultrasound examination performed three months after birth showed that the aortic arch was at the level of left clavicle and the right cardiac system recovered well.