Clinical analysis of 102 cases of labor induction in the third trimester on twin pregnancy / 中华妇产科杂志

Objective: To investigate the clinical characteristics of induced labor in twin pregnancy and the related factors of induced labor failure. Methods: The clinical data of twin pregnant women who underwent induced labor in Peking University Third Hospital from January 2016 to December 2022 were retrospectively analyzed. According to whether they had labor or not after induction, pregnant women were divided into the success group (pregnant women who had labor after induction, 72 cases) and the failure group (pregnant women who did not have labor after induction, 30 cases). Logistic regression was used to analyze the related factors of induction failure in twin pregnant women. Results: The parity and cervical Bishop score in the failure group were significantly lower than those in the success group, while the proportion of dichorionic diamniotic twins, assisted reproductive technology pregnancy and cervical Bishop score <6, postpartum hospital stay and total hospital stay in the failure group were significantly higher than those in the success group (all P<0.05). The proportion of induced labor by artificial rupture of membranes ± oxytocin intravenous infusion in the success group was 72.2% (52/72), which was significantly higher than that in the failure group (46.7%, 14/30; P=0.030). There were no significant differences between the two groups in the gestational age at delivery, the incidence of severe postpartum hemorrhage and blood transfusion, the amount of postpartum hemorrhage, the neonatal weight of two fetuses, the incidence of neonatal asphyxia, and the proportion of neonates admitted to the neonatal intensive care unit (all P>0.05). There were no severe perineal laceration and hysterectomy in all pregnant women. Multivariate logistic regression analysis showed that primipara (OR=3.064, 95%CI: 1.112-8.443; P=0.030) and cervical Bishop score <6 (OR=5.208, 95%CI: 2.008-13.508; P=0.001) were the independent risk factors for induction failure in twin pregnancy. Conclusions: Elective induction of labor in twin pregnancy is safe and feasible. It is helpful to improve the success rate of induction of labor by strictly grasping the timing and indications of termination of pregnancy, choosing the appropriate method of induction according to the condition of the cervix, and actively promoting cervical ripening .

A case of systemic lupus erythematosus in pregnancy complicated by pulmonary hypertension / 北京大学学报(医学版)

To investigate the pathophysiology, screening, diagnosis and treatment of the systemic lupus erythematosus (SLE) in pregnancy complicated with pulmonary hypertension. Retrospective analysis was made of one case of SLE in pregnancy complicated with pulmonary hypertension in Peking University Third Hospital. Literature was reviewed to investigate the pathophysiology, screening, diagnosis and treatment of the SLE in pregnancy complicated with pulmonary hypertension. SLE is an autoimmune mediated diffuse connective tissue disease characterized by immunological inflammation. The incidence of SLE combined with pulmonary hypertension was low, but the risk was high with pregnancy, with a high perinatal mortality rate. Pulmonary hypertension is the leading cause of the death in patients with pregnancy complicated with SLE. This patient was diagnosed with SLE six years before and was hospitalized for 29 weeks of menopause, with fatigue five months and chest congestion one month. Ultrasonic cardiogram showed severe pulmonary hypertension, with pulmonary arterial systolic pressure being 96 mmHg. After admission, multidisciplinary consultation was organized to draw up a diagnosis and treatment plan. The patient received the treatment of rest,oxygen,blood gas and pulmonary artery pressure monitoring. Considering perioperative pulmonary hypertension crisis likely to occur, pulmonary artery catheter was placed preoperatively. In general anesthesia, the cesarean was performedfter operation,the patient was transferred to the intensive care unit, with the treatment of expanding blood vessels, reducing pulmonary artery pressure,administering anticoagulation and preventing infection. Ten days after operation, the patient was discharged from hospital with smooth condition. Strengthening the management of SLE patients in pregnancy, early detection, and cooperation of multidisciplinary teams can help improve maternal and fetal outcomes. Termination of pregnancy should be offered to the patients with severe pulmonary hypertension. Right cardiac catheterization is the gold standard for diagnosing pulmonary hypertension. Some patients are diagnosed in later stage of pregnancy, regular antenatal examination, interdisciplinary co-operation, assessment of cardiac function, monitoring the condition of the pregnant woman and fetus and timely termination of pregnancy are needed. Epidural anesthesia is the appropriate choice for cesarean delivery.