Résumé
Objective:To analyze the predictive value of six hormonal changes in pregnant women with scarred uterus for the occurrence of oligohydramnios in their second pregnancy.Methods:A retrospective study was conducted to select the clinical data of 54 pregnant women with hypohydramnios in scarred uterus who were admitted to the First People’s Hospital of Suzhou from May. 2021 to Mar. 2023. They were included in the oligohydramnios group, and another 54 patients with normal amniotic fluid in scar uterus re-pregnancy during the same period were selected and included in the normal amniotic fluid group. Both groups of postpartum women underwent six hormone tests, including follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E 2), progesterone (P), testosterone (T), and prolactin (PRL). Two sets of baseline data were collected and binary logistic analysis was used to investigate the relationship between six hormones and oligohydramnios in women with scarred uterus during re-pregnancy. Receiver operating characteristic curve (ROC) was adopted to evaluate the six hormonal factors in predicting oligohydramnios in pregnant women with scar uterus during re pregnancy. The restricted cubic spline method combining spline function and logistic regression were used to analyze the dose-response relationship between six hormones and oligohydramnios in scar pregnant women during re-pregnancy. Results:The proportion of multiple pregnant women in the oligoamnios group [20.37% (11/54) ] was higher than that in the normal amniotic fluid group [5.56% (3/54) ] ( P < 0.05). The levels of FSH, E 2, P and PRL in oligohydramnios group were lower than those in normal amniotic fluid group [ (8.11±1.83) IU/L, (125.61±61.43) p /L, (16.33±3.15) mmol /L, (315.15±87.63) mIU/L],[ (9.87±2.05) IU/L, (148.52±50.57) pg/L, (20.14±4.07) mmol/L, (366.18±99.36) mIU/L] ( P<0.05) ; The levels of LH and T in oligohydramnios group [ (18.65±7.16) IU/L, (1.75±0.19) mmol/L] were compared with those in normal amniotic fluid group [ (20.67±8.53) IU/L, (1.73±0.11) mmol/L] and there was no significant difference between the two groups ( P<0.05). The results of binary logistic regression analysis showed that multiple pregnancy ( OR=11.507, 95% CI: 2.174-60.902, P=0.004) was a risk factor for recurrent oligohydramnios in women with scarred uterus. The high expression of FSH ( OR=0. 620, 95% CI: 0.224-0.845, P=0.001), E 2 ( OR=0.988, 95% CI: 0.978-0.998, P=0.021), and P ( OR=0.750, 95% CI: 0.645-0.873, P<0.001) was a protective factor for oligohydramnios in pregnant women with scar uterus during re-pregnancy. The ROC curve was plotted, and the results showed that AUC of FSH, P, and combined detection for predicting oligohydramnios in pregnant women with scarred uterus during re-pregnancy were 0.754, 0.768, and 0.870, respectively. The correlation between serum levels of FSH, E 2, and P and the occurrence of oligohydramnios in pregnant women with scarred uterus during re-pregnancy showed a linear dose-response relationship ( P<0.05). The levels of serum FSH, E 2, and P were negatively correlated with the occurrence of oligohydramnios in pregnant women with scar uterus. Especially when FSH<9.255 IU/L, E 2<158.465 pg/L, P<19.000 mmol/L, the occurrence of oligohydramnios in pregnant women with scar uterus increased with the decrease of FSH, E 2, and P levels. Conclusion:The six hormonal changes in pregnant women with scar uterus are closely related to the occurrence of oligohydramnios during re-pregnancy, and can effectively predict the risk of oligohydramnios during re-pregnancy.
Résumé
Objective:To summarize the scope of relevant research on the psychological state of parents during perinatal loss of re-pregnancy, and summarize the research status, so as to provide reference for future research and intervention.Methods:From the establishment of the database to December 2020, the literatures of China biomedical literature database, China Knowledge Network, VIP, Wanfang database, Medline, CINAHL, Web of Science, psychINFO and Cochrane Library were searched, the studies related to the psychological state, feelings and experience of the population were screened, and the JBI scope Review Guide was used as the methodological framework for analysis.Select the research related to the psychological state, feelings and experience of the population, and use the JBI scope review guide as the methodological framework for analysis.Results:Finally, 25 literatures were included, including 11 qualitative studies and 14 quantitative studies. Perinatal loss leads to an increased risk of psychological diseases when parents were re-pregnants, facing a complex mixture of new hope and uncertainty, and fathers were even more troubled by dual identity, but some parents could still benefit from perinatal loss.Conclusions:At present, China is lack of attention to the parents of perinatal loss of re-pregnancy. Medical staff should respect the differences of parents′ emotional expression, formulate targeted intervention measures, reduce the negative impact of perinatal loss, and guide the generation of positive psychology of the parents of re pregnancy.
Résumé
Objective To discuss the main reason of re -pregnant patients'delivery mode selection after cesarean delivery and to guide the future clinical work.Methods Retrospectively analyzed the 181 cases of re -pregnancy after cesarean delivery and compare the clinical data of 140 cases of reselecting cesarean delivery with 41 cases of selecting vaginal trial production.Results Calculated the risks of vaginal trial production and cesarean delivery of scarred uterus by Smith formula.There was no statistically significant difference in two groups (P >0.05). Reselection of cesarean delivery accounted for 77.0% among the cases of re -pregnancy after cesarean delivery.In the investigation on the reason for re -pregnant patients reselecting cesarean delivery,38 patients chose cesarean delivery for the first time owing to social factors,accounted for 27.1%,taking the first place.While in the investiga-tion on the reason for re -pregnant patients selecting vaginal trial production,10 patients were operated on cesarean section for the first time due to fetal distress,accounted for 24.4%,coming first.Conclusion In the investigation on the reason for re -pregnant patients reselecting cesarean delivery,the result shows that the high possibility of reselect-ing cesarean delivery lies on those who chose cesarean delivery for the first time owing to social factors.While those who were transferred to cesarean section due to abnormal fetal heart rate during the first vaginal trial production,may have high possibility to select vaginal trial production when re -pregnancy.As a result,the key is to decrease the rate of cesarean delivery for the first time.