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.

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.

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 hiperparatiroidismo secundario a la deficiencia de vitamina D en el embarazo y la frecuencia de preeclampsia / Association between hyperparathyroidism secondary to vitamin D deficiency in pregnancy and the frequency of preeclampsia

Resumen OBJETIVO: Establecer si existe asociación entre el hiperparatiroidismo secundario a una deficiencia de vitamina D en el embarazo y la frecuencia de preeclampsia. MATERIALES Y MÉTODOS: Estudio de casos y controles, prospectivo y longitudinal efectuado en pacientes con y sin preeclampsia que entre el 1 de enero y el 30 de junio del 2021 acudieron al Hospital Universitario de la Universidad Autónoma de Nuevo León para la atención del parto. Criterios de inclusión: pacientes embarazadas con diagnóstico de preeclampsia en el último trimestre de la gestación con tensión arterial igual o mayor a 140-90 mmHg y proteinuria igual o mayor a 30 mg/dL. Para el grupo control: embarazadas sanas, sin diagnóstico de preeclampsia en el último trimestre de la gestación. Criterios de exclusión: tabaquismo, alcoholismo y drogadicción y quienes no aceptaron entrar al estudio o tuvieran diagnóstico de enfermedades médicas crónicas. RESULTADOS: Se estudiaron 90 pacientes divididas en dos grupos: con preeclampsia (n = 45) y sin ésta (control, n = 45). Se encontró una relación entre la deficiencia de vitamina D, la hipocalcemia y la preeclampsia; no así entre la paratohormona y la preeclampsia en los rangos internacionales de la primera. La preeclampsia se encontró con mayor frecuencia en pacientes de 12 a 15 años. CONCLUSIONES: El hiperparatiroidismo secundario a la deficiencia de vitamina D en el embarazo no se observó en pacientes con preeclampsia, quienes sí la padecieron tuvieron concentraciones de paratohormona en límites normales. Se encontró una relación entre la deficiencia de vitamina D, la hipocalcemia y la preeclampsia.

Abstract OBJECTIVE: To establish whether there is an association between hyperparathyroidism secondary to vitamin D deficiency in pregnancy and the frequency of preeclampsia. MATERIALSAND METHODS: Case-control, prospective, longitudinal study performed in patients with and without preeclampsia who between January 1 and June 30, 2021 attended the Hospital Universitario of the Universidad Autónoma de Nuevo Leon for delivery care. Inclusion criteria: pregnant patients with a diagnosis of preeclampsia in the last trimester of gestation with blood pressure equal to or greater than 140-90 mmHg and proteinuria equal to or greater than 30 mg/dL. For the control group: healthy pregnant women without a diagnosis of preeclampsia in the last trimester of gestation. Exclusion criteria: smoking, alcoholism and drug addiction and those who did not agree to enter the study or had a diagnosis of chronic medical diseases. RESULTS: We studied 90 patients divided into two groups: with preeclampsia (n = 45) and without preeclampsia (control, n = 45). A relationship was found between vitamin D deficiency, hypocalcemia, and preeclampsia; a relationship was not found between parathormone and preeclampsia in the international parathormone ranges. Preeclampsia was found more frequently in patients aged 12 to 15 years. CONCLUSIONS: Hyperparathyroidism secondary to vitamin D deficiency in pregnancy was not observed in patients with preeclampsia; those who had it had parathormone concentrations in normal limits. A relationship was found between vitamin D deficiency, hypocalcemia, and preeclampsia.

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.

Electrocardiogramas durante el tercer trimestre de embarazo: / Electrocardiography During the Third Trimester of Pregnancy:

RESUMEN Objetivo: Analizar las características electrocardiográficas en embarazadas sin patología cardiovascular. Material y métodos: Estudio de corte transversal, descriptivo, multicéntrico. Se incluyeron pacientes sin patología cardiovascular que cursaban el tercer trimestre de embarazo y que concurrieron a una evaluación cardiológica preparto entre abril y julio de 2020; todas ellas firmaron el consentimiento correspondiente. Resultados: Se analizaron 80 trazados. La mediana de la frecuencia cardíaca fue 82 lpm (RIC: 70-93 lpm). La mediana del eje QRS fue 54° (RIC: 39°-71°). Ondas q e infradesnivel del segmento ST en cara inferior y de V4 a V6 fueron hallazgos relativamente frecuentes. La mediana del QTc fue 422 mseg (RIC: 404 mseg-445 mseg). La mediana del tiempo del pico de la onda T a su fin fue 86 mseg (RIC: 74-95 mseg). Conclusión: Las alteraciones más frecuentes ocurrieron en DIII, DII, aVf y de V4 a V6. Las ondas q y el infraST fueron los cambios principales. Fueron infrecuentes las desviaciones del eje, la taquicardia sinusal o el QTc prolongado.

ABSTRACT Objective: The aim of this study was to analyze the electrocardiographic characteristics in pregnant women without cardiovascular disease. Methods: This was a descriptive, cross-sectional, multicenter study, including patients without cardiovascular disease in their third trimester of pregnancy, who underwent cardiac evaluation before delivery between April and July 2020. All patients signed the corresponding informed consent. Results: A total of 80 tracings were analyzed. Median heart rate was 82 bpm (IQR 70-93 bpm) and median QRS axis was 54° (IQR 39°-71°). Q waves and ST segment depression were relatively frequent in inferior leads and from V4 to V6. Median QTc was 422 msec (IQR 404-445 msec) and median time from T wave peak to T wave end was 86 msec (IQR 74-95 msec). Conclusion: The most common changes occurred in T wave peak to T wave end and from V4 to V6. Main changes included q waves and ST-segment depression. Axis deviations, sinus tachycardia or prolonged QTc were rare.

COVID-19 y embarazo: reporte de 15 casos / COVID-19 and pregnancy: report of 15 cases

Resumen OBJETIVO: Describir las características clínicas del embarazo, las alteraciones bioquímicas y desenlaces obstétricos de las pacientes con prueba positiva de COVID-19. MATERIALES Y MÉTODOS: Estudio observacional, de serie de casos, analítico, retrospectivo y transversal efectuado mediante la revisión de expedientes clínicos de pacientes embarazadas y cuadro clínico confirmado (mediante PCR para SARS-CoV-2) de COVID-19. RESULTADOS: Se estudiaron 15 casos de pacientes con prueba positiva para SARS-CoV-2. La media de edad fue de 28.67 años (DE ± 6.11); 14 de las 15 cursaban el tercer trimestre del embarazo, 11 de 15 tuvieran un cuadro leve de la enfermedad. La finalización del embarazo fue por cesárea en 12 de 15 pacientes y en las 3 restantes se requirió atención especializada por parte de Medicina crítica. CONCLUSIONES: Las características clínicas y la severidad de la enfermedad parecen ser similares en pacientes embarazadas y no embarazadas. El principal motivo de hospitalización y finalización del embarazo fue por causa obstétrica.

Abstract OBJECTIVE: To describe the clinical characteristics of pregnancy, biochemical alterations and obstetric outcomes of patients with positive COVID-19 test. MATERIALS AND METHODS: Observational, case series, analytical, retrospective, and cross-sectional study performed by reviewing clinical records of pregnant patients with confirmed clinical picture (by PCR for SARS-CoV-2) of COVID-19. RESULTS: Fifteen cases of patients with positive test for SARS-CoV-2 were studied. The mean age was 28.67 years (SD ± 6.11); 14 of the 15 were in the third trimester of pregnancy, 11 of 15 had mild disease. Pregnancy was terminated by cesarean section in 12 of 15 patients and 3 of 15 required specialized care by specialists in critical care medicine. CONCLUSIONS: The clinical features and severity of the disease appear to be similar in pregnant and non-pregnant patients. The main reason for hospitalization and termination of pregnancy was due to obstetric causes.

Successful cesarean sections under rigid bronchoscopy combined with general anesthesia in two cases of massive hemoptysis during late pregnancy / 中华围产医学杂志

We report two women with massive hemoptysis during late pregnancy, who gave birth to two live neonates by cesarean section under a rigid bronchoscopy-guided high-frequency jet ventilation combined with general anesthesia at 33 and 28 gestational weeks, respectively. Bronchoscopy- guided hemostasis was achieved during the operation. Postoperative bronchial arteriography and bronchial artery embolization confirmed the diagnosis of pulmonary vascular malformations. During the 12-month follow-up, no relapse of hemoptysis was observed and the two babies were healthy.

The correlation of glycosylated hemoglobin level in the late pregnancy gestational diabetes mellitus patients and fetal weights, neonatal Apgar scores, maternal and infant adverse outcomes / 中国医师进修杂志

Objective:To analyze the correlation of glycosylated hemoglobin (HbA 1c) level in the late pregnancy gestational diabetes mellitus (GDM) patients and fetal weights, neonatal Apgar scores, maternal and infant adverse outcomes. Methods:One hundred and eighty-seven pregnant women who were diagnosed with GDM from January 2015 to July 2019 and delivered in Yixing People′s Hospital after standard diagnosis and treatment were divided into four groups (A group: HbA 1c<6.0%, 65 cases; B group: HbA 1c: 6.0% - 6.5%, 49 cases; C group: HbA 1c 6.6%-7.0%, 39 cases; D group: HbA 1c>7.0%, 34 cases) according to the HbA 1c examination results at 28 to 32 weeks of gestation. General data, fetal weights, neonatal Apgar scores and maternal and infant adverse outcomes were compared among the four groups. The correlation between GDM HbA 1c and fetal weights, neonatal Apgar scores and maternal and infant adverse outcomes were analyzed by unconditional Logistic regression. Results:In general data of GDM pregnant women with different HbA 1c levels, only oral glucose tolerance test (OGTT) fasting blood glucose: (4.68 ± 0.60), (4.89 ± 0.69), (5.23 ± 0.90), (6.48 ± 2.17) mmol/L; postprandial 1 h blood glucose: (9.84 ± 1.56), (10.09 ± 1.84), (10.6 ± 2.01), (12.74 ± 4.12) mmol/L; postprandial 2 h blood glucose: (8.65 ± 1.49), (8.86 ± 1.76), (9.28 ± 2.15), (11.56 ± 4.93) mmol/L, showed statistically significant differences ( P<0.05). Among the newborns of GDM pregnant women with different HbA 1c levels, there were statistically significant differences in the macrosomic infant rates: 1.54%(1/65), 10.20%(5/49), 12.82%(5/39), 17.65%(6/34); rates of neonatal Apgar scores<7 points:13.85%(9/65), 16.33%(8/49), 25.64%(10/39), 44.12%(15/34); the proportion of maternal and infant adverse outcomes: 24.62%(16/65), 24.49%(12/49), 28.21%(11/39), 50.00%(17/34), showed statistically significant differences ( P<0.05). After adjusting OGTT by unconditional Logistic regression analysis, HbA 1c (6.6%-7.0% and>7.0%) was independent risk factor for macrosomic infants: OR = 1.430, 95% CI = 1.035-1.977, P = 0.030; OR = 2.042, 95% CI = 1.311-3.180, P = 0.001; maternal and infant adverse outcomes: OR = 1.774, 95% CI = 1.130-2.874, P = 0.010; OR = 3.387, 95% CI = 1.608-7.133, P = 0.001. HbA 1c>7.0% was independent risk factors for neonatal Apgar scores<7 points: OR = 1.848 95% CI = 1.086-3.143, P = 0.023. Conclusions:There was a significant correlation between HbA 1c in GDM pregnant women in the late pregnancy and macrosomic infants, neonatal Apgar scores, and maternal and infant adverse outcomes. In particular, GDM pregnant women with HbA 1c>7.0% should be alert to the risk of macrosomic infants, neonatal Apgar score<7 points, and maternal and infant adverse outcomes.

Trasmisión vertical de la enfermedad de Chagas: reporte de caso / Chagas disease vertical transmission: Case report

Resumen ANTECEDENTES: La enfermedad de Chagas es una zoonosis causada por Trypanosoma cruzi, un parásito endémico de América Latina. Los niños se infectan por el contacto con vectores o por trasmisión congénita. CASO CLINICO: Paciente indígena, de 32 años, procedente del área rural del occidente colombiano, analfabeta, con antecedente de 7 embarazos y 6 partos, el embarazo actual con 29.5 semanas determinadas por la ecografía del tercer trimestre, sin controles prenatales, con trabajo de parto pretérmino y oligohidramnios severo. El embarazo finalizó por cesárea, sin complicaciones y el nacimiento de una niña que pesó 1290 gramos. A los 50 días de vida cursó con inestabilidad hemodinámica, dificultad respiratoria, palidez mucocutánea y fiebre con diagnóstico de sepsis de origen indeterminado. Los estudios de extensión reportaron: parasitemia positiva por microhematocrito para Trypanosoma cruzi, con amastigotes en el líquido cefalorraquídeo. Diagnóstico: meningoencefalitis chagásica. CONCLUSIONES: La trasmisión vertical de la enfermedad de Chagas es baja; la trasmisión congénita es la responsable de la progresiva aparición de la enfermedad en zonas endémicas y no endémicas. En las embarazadas es importante la inclusión del tamizaje para infección por Trypanosoma cruzi, como parte del conjunto de pruebas de control prenatal.

Abstract BACKGROUND: Chagas disease is a zoonosis caused by Trypanosoma cruzi, a parasite endemic to Latin America. Children become infected by contact with vectors or by congenital transmission. CLINICAL CASE: Illiterate indigenous patient, 32 years old, from the rural area of western Colombia, with a history of 7 pregnancies and 6 deliveries, the current pregnancy with 29.5 weeks determined by the third trimester ultrasound, without prenatal controls, with preterm labor and severe oligohydramnios. The pregnancy ended by cesarean section, without complications and the birth of a girl who weighed 1290 g. At 50 days of life, he developed hemodynamic instability, respiratory distress, mucocutaneous pallor and fever with a diagnosis of sepsis of undetermined origin. Extension studies reported: positive microhematocrit parasitaemia for Trypanosoma cruzi, with amastigotes in the cerebrospinal fluid. Diagnosis: Chagasic meningoencephalitis. CONCLUSIONS: The vertical transmission of Chagas disease is low; congenital transmission is responsible for the progressive appearance of the disease in endemic and non-endemic areas. In pregnant women, it is important to include screening for Trypanosoma cruzi infection, as part of the prenatal control test suite.

Comparison of four screening methods for group B streptococcus / 中华检验医学杂志

Objective@#To evaluate diagnostic performance of Todd-Hewitt (T-H) broth culture method, direct culture method, liquid chromogenic culture method, and loop-mediated isothermal amplification (LAMP) method for screening group B streptococcus (GBS) during late pregnancy.@*Methods@#In the retrospective study, the rectal vaginal secretions samples were collected from pregnant women at 35 to 37 weeks at the obstetrics clinic of Guangzhou Women and Children′s Medical Center affiliated to Guangzhou Medical University during October 2016 to April 2018. For the purposes of clinical evaluation, T-H broth culture was used as the standard reference method, and double-blind trials were used to evaluate diagnostic performance of direct culture method, liquid chromogenic culture method, and LAMP method for screening group B streptococcus during late pregnancy in three research stages. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), coincidence rate and Yoden index for each method were calculated. Also, the level of agreement between each method and T-H broth was assessed using the kappa (k) coefficient.@*Results@#A total of 969 specimens were detected by the T-H enrichment culture method, and 90 were positive (9.3%). The sensitivities from high to low were LAMP method [100% (25/25)], direct culture method [81.5% (22/27), 95%CI:65.8%-97.1%], and liquid color culture method [71.1% (27/38), 95%CI:55.9%-86.2%]. Specificities were direct culture method [100% (282/282)], liquid color culture method [98.1% (455/464), 95%CI:96.8%-99.3%], and LAMP method [94.0% (125/133), 95%CI: 89.9%-98.1%]. The coincidence rates were direct culture method [98.4% (22+282)/309], liquid color culture method [96.0% (27+455)/502], and LAMP method [94.9% (25+125)/158]. The Kappa values of the direct culture method (0.889), LAMP method (0.832) and the enrichment culture method were all ≥0.75, and that of the liquid color culture method was 0.708. The false negative rate of direct culture method was 18.5% (5/27), and no false negative case by LAMP method, but its false positive rate was 6.0% (8/133). The false negative rate and false positive rate of liquid color culture method were 28.9% (11/38) and 1.9% (9/464), respectively.@*Conclusions@#Of the three screening methods compared in this study, only the LAMP method has the advantages in sensitivity, specificity, and coincidence rate compared with T-H enriched culture method, while the others have a certain degree of false negatives rate. The clinical laboratory can introduce these methods based on laboratory facilities and staffing, or refer to the European and American guidelines and combine the recommended antenatal GBS screening method with intrapartum nucleic acid amplification tests to best meet the clinical demands.

Death of a neonate born to a critically ill mother with COVID-19: a case report / 中华围产医学杂志

We report a critically ill pregnant woman in the third trimester with severe pneumonia due to COVID-19 who presented to Xiaolan People's Hospital of Zhongshan in February 2020. The 32-year-old patient was admitted at 35 +2 gestational weeks with a 4-day history of a sore throat and a fever for three hours. The patient had been to Xiaogan City, Hubei Province, and the symptoms occurred during a period of self-isolation after back home. The condition of the patient deteriorated rapidly, with left-sided chest and back pain, shortness of breath, dizziness, progressing to respiratory failure and septic shock 7 hours after her admission. In view of her critical condition and a history of two previous cesarean sections, an emergency cesarean section was performed. Blood gas analysis of the mother before the operation suggested respiratory failure, respiratory acidosis, and metabolic acidosis. During the operation, a baby boy was born. The Apgar score of the boy, birth weight of 2 700 g, was one at 1, 5 and 10 minutes despite the resuscitation efforts. The neonate died after withdrawing treatment. The patient was treated with tracheal intubation ventilator and other supportive treatments after the operation. The result of the new coronavirus nucleic acid test, taken on admission, but which was reported after delivery, was positive. The patient was transferred to the designated hospital for further treatment and was recovering with the withdrawal of extracorporeal membrane oxygenation and ventilation support at 26 and 36 days after surgery, respectively.

Effect of single-chamber balloon combined with dinoprostone suppository on cervical ripening induced by full-term maternal delivery / 中国基层医药

Objective@#To investigate the effects of single-chamber balloon combined with dinoprostone suppository on the progestation of the cervix in full-term maternal delivery.@*Methods@#From January 2017 to December 2018, 120 cases of full-term maternal women admitted to the Central Hospital of Yiwu were selected.According to the random number table method, all women were divided into control group (60 cases) and observation group (60 cases). The control group was given a single-cavity balloon to promote cervical ripening.The observation group received single-chamber balloon combined with dinoprostone to promote cervical ripening.The effects of maternal cervical ripening were observed.@*Results@#The total effective rate of maternal cervical ripening in the observation group (95.00%) was significantly higher than that in the control group (81.67%), and the difference was statistically significant (χ2=6.135, P<0.05). The differences of maternal postpartum hemorrhage and neonatal asphyxia rate were not statistically significant (t=1.684 , χ2=2.563, all P>0.05). The total maternal labor [(5.8±2.1)h] in the observation group was significantly shorter than that in the control group [(7.6±2.5)h], the difference was statistically significant (t=3.126, P<0.05). The vaginal delivery rate (95.00%) of the observation group was higher than that of the control group (73.33%), the difference was statistically significant (χ2=5.342, P<0.05). Before implanting the balloon and balloon combination, the Bishop score between the two groups had no statistically significant difference (t=3.623, P>0.05). After the balloon and balloon combination were taken out, the Bishop score of the maternal cervix[(8.6±1.5)points] in the observation group was higher than that in the control group [(7.2±1.3)points], and the difference was statistically significant (t=4.354, P<0.05). The incidence of adverse reaction of the observation group (6.67%) was lower than that of the control group (13.33%), the difference was statistically significant between the groups(χ2=3.821, P<0.05).@*Conclusion@#Compared with simple single-chamber balloon, single-chamber balloon combined with dinoprostone suppository has more significant effect on the maternal ripening of the cervix, it can improve the vaginal delivery rate and maternal cervical Bishop scores, effectively reduce the maternal total labor, and reduce the incidence of maternal adverse reactions.

Analysis of psychological stress and its influencing factors in pregnant women in late pregnancy / 中国基层医药

Objective@#To explore the status quo and influencing factors of psychological stress in pregnant women in the third trimester, and to propose reasonable intervention measures to improve their current situation, and to provide reference and guarantee for their smooth transition through pregnancy.@*Methods@#A questionnaire survey was conducted to investigate 92 pregnant women in the second trimester of pregnancy from the Second Affiliated Hospital of Wenzhou Medical University from June 2017 to June 2018 by using questionnaires, quality of life and stress scales.The results of the survey were investigated and analyzed.@*Results@#The survey showed that the average psychological stress score of pregnant women in the third trimester was (1.79±0.46)points.The main stressors were psychological pressures to protect the health of pregnant women and the safety of the fetus.The planned pregnancy was the influencing factor of psychological stress (F=2.456, P=0.015). The negative life events and subjective support and stressors 1, 2, 3, etc.as independent variables, the results showed that stress source 2, positive life events and anxiety were the main influencing factors of patients' psychological stress (t=6.874, 3.692, 2.754, all P<0.05).@*Conclusion@#The psychological stress status of pregnant women in the third trimester is moderate, and the planned pregnancy is the influencing factor.The main psychological stress is to protect the health of the pregnant woman and the safety of the fetus.Therefore, the clinical counseling can be actively carried out in the clinic and the intervention of pregnant women's psychology should be strengthened to alleviate the bad mood and relieve psychological stress.

Streptococcal toxic shock syndrome in third trimester: a report of two cases and literature review / 中华围产医学杂志

Objective@#To analyze the clinical characteristics of streptococcal toxic shock syndrome (STSS) caused by Streptococcus pyogenes (S. pyogenes) in the third trimester to improve clinical awareness of this disease.@*Methods@#A retrospective study was conducted to analyze the clinical data of two patients with STSS caused by S. pyogenes in Jinan Maternal and Child Health Care Hospital and nine reported cases of healthy pregnant women infected with S. pyogenes at 28-42 gestational weeks with detailed data retrieved from Chinese National Knowledge Infrastructure and PubMed database from January 1997 to December 2018.@*Results@#The two cases admitted to our hospital were both multiparas, with onset in winter and no specific symptoms in early stage. Disseminated intravascular coagulation (DIC) was developed in both cases on admission. In one case, the fetal heart rate was reduced and disappeared soon after admission. The other patient was diagnosed as stillbirth on admission. Both patients died and blood culture revealed infection of group A streptococcus. Nine previous cases were reported in one Chinese and five English articles. No high-risk pregnancy or premature rupture of membranes was reported in these 11 cases. Among the 11 cases, ten were positive for S. pyogenes indicated by blood or tissue culture and one was positive for streptococcal toxin. Ten cases had high fever and three presented with respiratory symptoms in early stage. Abdominal pain and watery diarrhea were common symptoms and all patients developed multiple organ dysfunction and DIC. Cases occurred in winter or spring were more common. Nine women died within 36 h after the onset of fulminant symptoms. Only two survived and hospitalized for 90 d and 25 d, respectively, after emergent cesarean section indicated by reduced fetal heart rate. Unfortunately, both neonates died after birth. For the babies, there were seven intrauterine fetal deaths, one stillbirth and three live births, but only one survived (whose mother developed respiratory cardiac arrest 90 min after delivery).@*Conclusions@#STSS caused by S. pyogenes in pregnant women exacerbates rapidly with a high mortality. Early identification of clinical manifestations and rapid progress of the disease are crucial for early diagnosis and treatment, which may help improve maternal and fetal outcomes.

Variations of coagulation biochemical markers in normal pregnant women in early and late pregnancy / 中华围产医学杂志

Objective@#To investigate the changes of coagulation indexes in normal pregnant women in early and late pregnancy.@*Methods@#The coagulation indexes in early and late pregnancy including activated partial thromboplastin time (APTT), APTT ratio, prothrombin time (PT), PT ratio, prothrombin activity, international normalized ratio, fibrinogen (Fib) and thrombin time (TT) were retrospectively collected from 196 normal pregnant women delivered in Peking University First Hospital from August 2013 to September 2014. Differences in these indexes before and after the seventh gestational week of early pregnancy and in early and late pregnancy were compared. In addition, the normal reference values were calculated. Paired t test and sum-rank test were used for statistical analysis. The reference values were presented with P2.5-P97.5.@*Results@#In early pregnancy, some coagulation indexes after the seventh weeks were shorter than those before, such as APTT [30.3 (26.1-35.5) vs 32.1 (27.9-36.8) s, Z=25.850, P<0.001] and TT [13.8 (12.2-16.0) vs 14.5 (12.3-16.4) s, Z=16.720, P<0.001], but Fib [3.3 (2.5-4.3) vs 2.9 (2.2-3.8) g/L, Z=43.180, P<0.001] became higher. APTT [(27.5±1.6) vs (31.4±2.4) s, t=24.736, P<0.001], PT [(9.7±0.5) vs (11.0±0.8) s, t=18.647, P<0.001] and TT [(13.3±0.8) vs (14.2±1.0) s, t=9.255, P<0.001] were significantly shorter, while Fib [(4.4±0.5) vs (3.1±0.4) g/L, t=-29.152, P<0.001] was higher in late pregnancy than in early pregnancy. The reference values of APTT, PT, Fib and TT in early pregnancy were 26.5-36.0 s, 9.4-12.4 s, 2.4-4.0 g/L and 12.3-16.4 s, and those in late pregnancy were 25.0-31.2 s, 8.8-10.6 s, 3.4-5.4 g/L and 12.0-14.9 s, respectively.@*Conclusions@#The coagulation indexes of pregnant women change significantly since the beginning of early pregnancy. APTT, PT and TT are shorter, while Fib is higher in late pregnancy than in early pregnancy.

Streptococcal toxic shock syndrome in third trimester: a report of two cases and literature review / 中华围产医学杂志

Objective To analyze the clinical characteristics of streptococcal toxic shock syndrome (STSS) caused by Streptococcus pyogenes (S.pyogenes) in the third trimester to improve clinical awareness of this disease.Methods A retrospective study was conducted to analyze the clinical data of two patients with STSS caused by S.pyogenes in Jinan Maternal and Child Health Care Hospital and nine reported cases of healthy pregnant women infected with S.pyogenes at 28-42 gestational weeks with detailed data retrieved from Chinese National Knowledge Infrastructure and PubMed database from January 1997 to December 2018.Results The two cases admitted to our hospital were both multiparas,with onset in winter and no specific symptoms in early stage.Disseminated intravascular coagulation (DIC) was developed in both cases on admission.In one case,the fetal heart rate was reduced and disappeared soon after admission.The other patient was diagnosed as stillbirth on admission.Both patients died and blood culture revealed infection of group A streptococcus.Nine previous cases were reported in one Chinese and five English articles.No high-risk pregnancy or premature rupture of membranes was reported in these 11 cases.Among the 11 cases,ten were positive for S.pyogenes indicated by blood or tissue culture and one was positive for streptococcal toxin.Ten cases had high fever and three presented with respiratory symptoms in early stage.Abdominal pain and watery diarrhea were common symptoms and all patients developed multiple organ dysfunction and DIC.Cases occurred in winter or spring were more common.Nine women died within 36 h after the onset of fulminant symptoms.Only two survived and hospitalized for 90 d and 25 d,respectively,after emergent cesarean section indicated by reduced fetal heart rate.Unfortunately,both neonates died after birth.For the babies,there were seven intrauterine fetal deaths,one stillbirth and three live births,but only one survived (whose mother developed respiratory cardiac arrest 90 min after delivery).Conclusions STSS caused by S.pyogenes in pregnant women exacerbates rapidly with a high mortality.Early identification of clinical manifestations and rapid progress of the disease are crucial for early diagnosis and treatment,which may help improve maternal and fetal outcomes.

Variations of coagulation biochemical markers in normal pregnant women in early and late pregnancy / 中华围产医学杂志

Objective To investigate the changes of coagulation indexes in normal pregnant women in early and late pregnancy.Methods The coagulation indexes in early and late pregnancy including activated partial thromboplastin time (APTT),APTT ratio,prothrombin time (PT),PT ratio,prothrombin activity,international normalized ratio,fibrinogen (Fib) and thrombin time (TT) were retrospectively collected from 196 normal pregnant women delivered in Peking University First Hospital from August 2013 to September 2014.Differences in these indexes before and after the seventh gestational week of early pregnancy and in early and late pregnancy were compared.In addition,the normal reference values were calculated.Paired t test and sum-rank test were used for statistical analysis.The reference values were presented with P2.5-P97.5.Results In early pregnancy,some coagulation indexes after the seventh weeks were shorter than those before,such as APTT [30.3 (26.1-35.5) vs 32.1 (27.9-36.8) s,Z=25.850,P＜0.001] and TT [13.8 (12.2-16.0) vs 14.5 (12.3-16.4) s,Z=16.720,P＜0.001],but Fib [3.3 (2.5-4.3) vs 2.9 (2.2-3.8) g/L,Z=43.180,P＜0.001] became higher.APTT [(27.5± 1.6) vs (31.4±2.4) s,t=24.736,P＜0.001],PT [(9.7±0.5) vs (11.0±0.8) s,t=1 8.647,P＜0.001] and TT [(13.3 ±0.8) vs (14.2±1.0) s,t=9.255,P＜0.001] were significantly shorter,while Fib [(4.4±0.5) vs (3.1 ±0.4) g/L,t=-29.152,P＜0.001] was higher in late pregnancy than in early pregnancy.The reference values ofAPTT,PT,Fib and TT in early pregnancy were 26.5-36.0 s,9.4-12.4 s,2.4-4.0 g/L and 12.3-16.4 s,and those in late pregnancy were 25.0-31.2 s,8.8-10.6 s,3.4-5.4 g/L and 12.0-14.9 s,respectively.Conclusions The coagulation indexes of pregnant women change significantly since the beginning of early pregnancy.APTT,PT and TT are shorter,while Fib is higher in late pregnancy than in early pregnancy.