Non-Invasive Prenatal Testing:Results in 3733 Cases of Twin Pregnancy and Association With Factors Such as Age / 中国医学科学院学报

Objective To explore the clinical significance of non-invasive prenatal testing(NIPT)for fetal chromosomal abnormalities in the cases of twin pregnancy and its relationship with age and other related factors.Methods A total of 3733 women with twin pregnancy of 12-26+6 weeks who voluntarily underwent NIPT in the Ningbo Women and Children's Hospital from January 2018 to December 2022 were selected.The results of NIPT and amniocentesis were compared and all the participants were followed up.The detection rate of chromosomal abnormalities by NIPT was calculated,and its correlations with age,gestational weeks,chorionicity,and pregnancy type were analyzed.Results Among the 3733 cases,71 cases of fetal chromosome abnormality were indicated by NIPT,including 13 cases of trisomy 21,19 cases of trisomy 18,5 cases of trisomy 13,18 cases of sex chromosome abnormality,and 16 cases of chromosome microdeletion/duplication(excluding 21,18,13,and sex chromosomes),among which 34 cases were true positive and 37 cases were false positive.The overall sensitivity,specificity,and positive predictive value(PPV)of NIPT for chromosomal abnormalities in the cases of twin pregnancy were 100%,98.99%,and 47.89%(34/71),respectively.NIPT showed the sensitivity,specificity,and PPV of 100%,99.78%,and 78.38%(29/37)for trisomy 21,18,and 13,100%,99.56%,and 16.67%(3/18)for sex chromosome abnormalities,and 100%,99.62%,and 12.5%(2/16)for chromosome microdeletion/duplication,respectively.In the age group of ≥40 years,the NIPT for chromosomal abnormalities showed the PPV of 66.67%,the sensitivity of 100%,and the misdiagnosis rate of 30%。However,the NIPT for trisomy 21,18,and 13 showed the PPV of 100%,the misdiagnosis rate of 0,and the sensitivity and specificity of 100%.In terms of grouping based on gestational weeks,the NIPT for chromosomal abnormalities showed the highest PPV(51.28%)in the women with twin pregnancy for 14-17+6 weeks,followed by that(50.00%)in the women with twin pregnancy for 22-26+6 weeks;the NIPT for trisomy 21,18,and 13 showed the highest PPV of 94.74% in the gestation group of 14-17+6 weeks,followed by that(83.33%)in the gestation group of 18-21+6 weeks.The rate of dichorionic diamniotic twins was higher in assisted pregnancies than in natural pregnancies,and NIPT showed the same detection efficiency for dichorionic diamniotic twins and monochorionic diamniotic twins and the same detection efficiency for different pregnancy types.Conclusions NIPT has high accuracy in the diagnosis of twin pregnancy and high sensitivity and high specificity for different ages and gestational weeks,especially for trisomy 21,18,and 13.NIPT is suitable for assisted pregnancy and natural pregnancy,and it is of high value in clinical application.However,extensive application needs a large population-based study.

Clinical Analysis of Pregnancy Outcome in 95 Cases with Preterm Premature Rupture of Membrane / 实用妇产科杂志

Objective:To investigate the risk factors of preterm premature ruPture of membrane(PPROM) and their pregnancy outcomes.Methods:The clinical data of 95 cases of patients with PPROM admitted and treated in our hospital from October 2013 to July 2016 were collected,which were divided into two groups,observation group(gestational week 28-33 +6 weeks) and control group(gestational week 34-36 +6 weeks).The risk factors of PPROM,delivery method and pregnancy outcomes were analyzed.Results:Genital tract infection was the main risk factor of PPROM(33.68％).of the incidences of cesarean delivery,neonatal asphyxia,neonatal infections and neonatal death in observation group were significantly higher than those of control group,the differences were statistically significant(P ＜ 0.05).The intrauterine infection and puerperal infection rates of observation group of were higher than those of control group,but differences were not statistically significant (P ＞ 0.05).Conclusions:Reproductive tract infections is the most important risk factor of PPROM.The purpose of active treatment including tocolytic therapy and prevention of infection for the patients with PPROM less than 34 weeks is to prolong the gestational weeks,to reduce the rate of neonatal complication,and to improve the pregnancy outcome.

Effects of fetus gestational weeks on efficiency of Down's Screening dur-ing the second trimester / 中国现代医生

Objective To observe and analyze the effects of fetus gestational weeks on efficiency of Down's screening during the second trimester, and to provide certain reference data clinically. Methods A total of 36515 puerpera who received prenatal screening during the second trimester were selected. They were assigned to 5 groups according to their gestational weeks, which were group of 15 gestational weeks(15 to 16+6), group of 16 gestational weeks (16 to 16+6), group of 17 gestational weeks(17 to 17+6), group of 18 gestational weeks (18 to 18+6) and group of 19 ges-tational weeks (19 to 20 weeks). Detection rate and false screening positive rate of infants with Down's syndrome were compared between different gestation weeks. Results Two cases of missed diagnosis were seen in puerpera in the group of 15 gestation weeks. Detection rate of Down's screening in the group of 16 weeks to 18 weeks was 100%. No diagnosed infants with Down's syndrome were seen in the group of 19 gestational weeks. The false positive rate therefore was 7.85%. The screening results were different during different gestational weeks. Detection rate during 16 to 18 gestation weeks was 100%, and false positive rate of screening was 4.36%. In the negative groups of screened puerpera, AFP level increased with the increase of gestational weeks, and HCG level decreased with the increase of gestational weeks. In the positive groups of screened puerpera,their AFP levels were all lower than those in the nega-tive groups,and there HCG levels were higher than those in the negative groups. Conclusion Efficiency of screening is high when Down's screening during the second trimester of pregnancy is carried out during 16 to 18 gestational weeks.

Ultrasound Observe the Relationship between Fetus Cerebral Lateral Fissure Depth in Middle Pregnancy and Gestational Weeks / 浙江中医药大学学报

[Objective] To observe the relation between the fetus cerebral lateral fissure depth in middle pregnancy and gestational weeks and offer foundation for whether or not normal growth of fetus cerebral cortex in antenatal early evaluation. [Method] Observe the shape of fetus cerebral lateral fissure of 18~24w pregnant women 559 cases with ultrasound, and measure the depth at cerebel um cross section. [Result] The 559 cases of pregnant women ’s fetus cerebral lat-eral fissure depth increases with gestational weeks, the shape changes blunt from smooth. [Conclusion] The ultrasound observation of fetus cerebral lateral fis-sure depth which increases with gestational weeks can be taken to offer relative basis for early evaluation of whether or not normal cerebral cortex growth.

Evaluation of Preterm Delivery between 32(+0)-33(+6) Weeks of Gestation

Preterm labor after 34 weeks of gestation has shown no great difference from fullterm labor in terms of neonatal morbidity and mortality when proper antepartum management (antibiotics or steroids treatment) is done. However, various studies have discussed different views on the risks and safety of preterm delivery at 32(+0)- 33(+6) weeks of gestation. We evaluated the complications of different preterm groups that included the neonates born at 32(+0)-33(+6) weeks of gestation (142), stratified randomly selected neonates born at 34(+0)-36(+6) weeks of gestation (267) and neonates born after 37(+0) weeks of gestation (356) at our hospital between December 1999 and April 2006. As a result, it was found that neonates born at 3(+0)-36(+6) weeks of gestation showed no great difference from infants born at full term. However, neonates born at 32(+0)-33(+6) weeks were more likely to be admitted to neonatal intensive care unit or develop neonatal complications significantly than the neonates born at 34(+0)- 36(+6) weeks and at full term. Therefore, it is suggested that neonates born at 32(+0)-33(+6) weeks have higher risk of neonatal complications following their preterm labor than those born at later than 34(+0) weeks. Thus, it would be difficult to accept the idea that preterm labor at 32(+0)-33(+6) weeks is safe.

Prospective Study of Sonographical Scanning as Prenatal Screening for Abnormal Fetuses With Aneuploid Chromosome / 中国医师杂志

Objective To sonographically measure nuchal skin thickness(NT) and biparietal diameter/femur length (BPD/FL) for normal fetuses between 10 and 24 gestational weeks,screen abnormal cases then to culture fetal cells and chromosome analysis, diagnosis aneuploid chromosome deformed fetuses Methods Ultrosonic estimation of fetal gestation according to gestational sac or CRL or BPD/Fl and AC, measuring NT, BPD/Fl of 100 cases per gestational weeks, drawing normal curve of NT, making curve of 90 th and 10 th NT and BPD/Fl. Restropectively analysis 5 cases trisomy 21.Results The average of NT was 1 76mm between 10 and 13 gestational weeks. The average of NT was 3 52mm between14 and 24 gestational weeks. The value of 50th was 2 40～1 40 between14 and 24 gestational weeks.Conclusions If the value of NT is more than 90 percent of normal fetuses, and if BPD/FL ratio is morn than 90 percent of normal fetuses,the sensitivity of trisome 21 should increase.Combining factors as elderly and high risk parturition, the sensitivity of trisomy 21 is much more increasing.

Development of Algorithm for Estimation of Gestational Age using each Variable of Fetal Heart Rate / 대한산부인과학회잡지

OBJECTIVE: The objective of this study is to estimate gestational age by using FHR parameters after linear and nonlinear analysis of FHR data. Linear spectral decomposition has a limit to describe and analyze the nonlinear and complex physiological nature. Random processing and chaotic analysis assist to quantify some patterned energies, interaction of the physiological system in body system, which the constancy is preserved, and complexity of physical cardiovascular system. But there are no great development of new device which notify fetal age. METHODS: From March 1995 to December 2000, 2,548 cases who received NST during antenatal visit were included in this study. Among these cases, 1000 cases were sampled randomly. We divided this cases into a study and a control group, 500 cases for model building set and the other 500 cases for validation set. Each FHR parameters such as baseline FHR, variability (AMP, MMR), acceleration & deceleration (15 bpm-15 seconds), loss of signal, the number of fetal movement were analysed by using our own computerized HYFM-I, II software system. The linear and non-linear analysis of FHR were done after extracting approximate entropy (ApEn) value. Finally, we performed regression analysis and extract an equation for estimation of gestational weeks using bootstrap method. RESULTS: We extract a following equation using above study method: Log(GA)=5.870-0.051(Sloss*)-0.065(Mean FHR*)+0.049(Mean FHR*)2-0.058(FM*)+0.048(AMP*)2+0.121(A1515*)-0.031(A1515*)2+0.036(ApEn*)2. CONCLUSIONS: Accurate dating of pregnancy, namely gestational week is very important for antenatal diagnosis in the field of perinatal medicine. This study will propose scientific research results which are useful for studying normal and morbid generating physiological fetal condition. We extract an appropriate equation for estimation of gestational weeks only using FHR parameters. We hope to compare our result with other authors' results in the near future.

Development of Algorithm for Estimation of Gestational Age using each Variable of Fetal Heart Rate / 대한산부인과학회잡지

OBJECTIVE: The objective of this study is to estimate gestational age by using FHR parameters after linear and nonlinear analysis of FHR data. Linear spectral decomposition has a limit to describe and analyze the nonlinear and complex physiological nature. Random processing and chaotic analysis assist to quantify some patterned energies, interaction of the physiological system in body system, which the constancy is preserved, and complexity of physical cardiovascular system. But there are no great development of new device which notify fetal age. METHODS: From March 1995 to December 2000, 2,548 cases who received NST during antenatal visit were included in this study. Among these cases, 1000 cases were sampled randomly. We divided this cases into a study and a control group, 500 cases for model building set and the other 500 cases for validation set. Each FHR parameters such as baseline FHR, variability (AMP, MMR), acceleration & deceleration (15 bpm-15 seconds), loss of signal, the number of fetal movement were analysed by using our own computerized HYFM-I, II software system. The linear and non-linear analysis of FHR were done after extracting approximate entropy (ApEn) value. Finally, we performed regression analysis and extract an equation for estimation of gestational weeks using bootstrap method. RESULTS: We extract a following equation using above study method: Log(GA)=5.870-0.051(Sloss*)-0.065(Mean FHR*)+0.049(Mean FHR*)2-0.058(FM*)+0.048(AMP*)2+0.121(A1515*)-0.031(A1515*)2+0.036(ApEn*)2. CONCLUSIONS: Accurate dating of pregnancy, namely gestational week is very important for antenatal diagnosis in the field of perinatal medicine. This study will propose scientific research results which are useful for studying normal and morbid generating physiological fetal condition. We extract an appropriate equation for estimation of gestational weeks only using FHR parameters. We hope to compare our result with other authors' results in the near future.