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SUMMARY OBJECTIVE: The aim of this study was to determine the effect of anxiety and depression on pregnancy outcome in couples receiving in vitro fertilization treatment. METHODS: A total of 102 couples (102 females and 102 males) with unexplained infertility were included in the study. Personal Information Form was used to collect data, Case Follow-up Form to record the treatment process, and Spielberger's State-Trait Anxiety Inventory and Beck Depression Inventory to measure the anxiety and depression levels of couples. Couples were measured twice: before treatment and on oocyte pickup day. RESULTS: There was no statistically significant difference between the anxiety and depression levels and oocyte count of women (p>0.05). There were statistically significant differences between State-Trait Anxiety Inventory level and sperm count and between BID level and sperm motility (p<0.05). There was no statistically significant difference between the anxiety and depression levels and pregnancy outcomes of women (p>0.05). CONCLUSION: Anxiety and depression had no effect on pregnancy outcome. More studies are needed to investigate the effect of anxiety and depression on pregnancy outcome in unexplained infertility.
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Objetivo : Determinar los efectos de la infección Covid-19 asintomática, leve y moderada en el primer y segundo trimestres en los resultados del embarazo. Métodos : El estudio se realizó en las gestantes que acudieron al Departamento de Perinatología de la Universidad de Ciencias de la Salud de Izmir entre octubre de 2021 y julio de 2022. Se registraron las mujeres embarazadas que presentaban infección asintomática, leve y moderada por Covid-19 en el 1º y 2º trimestre y se siguió el desarrollo de la gestación. Resultados : Un total de 437 pacientes participaron en el estudio. El número de pacientes asintomáticos, leves y moderados de Covid-19 fue de 142, 157 y 138, respectivamente. Cada grupo se analizó como subgrupo del 1º y 2º trimestre según el momento de la infección por Covid-19. La edad media de las pacientes con Covid-19 moderado era superior a la de las pacientes con Covid-19 leve/asintomático (p=0,021). Se observó que el índice de masa corporal era mayor en las pacientes con Covid-19 moderado que en las pacientes con infección leve/asintomática (p=0,048). El parto pretérmino (entre las semanas 34 y 37) fue significativamente mayor en los casos con infección moderada por Covid-19 (p=0,041). Este aumento ocurrió principalmente en pacientes con infección por Covid-19 en el 2º trimestre. No hubo modificaciones significativas en las tasas de cesárea, trastornos hipertensivos del embarazo, pérdida fetal, retraso del crecimiento intrauterino, colestasis del embarazo y diabetes gestacional. Conclusiones : Los efectos de la infección por Covid-19 al inicio del embarazo (1º y 2º trimestres) siguen siendo objeto de investigación. La infección moderada por Covid-19, especialmente en el 2º trimestre, puede provocar un aumento de la tasa de partos prematuros.
Objectives: To evaluate the effects of asymptomatic, mild and moderate Covid-19 infection in the 1st and 2nd trimesters on pregnancy outcomes. Material and methods: The study was performed among patients who applied to the Perinatology Department of Izmir University of Health Sciences, between October 2021 and July 2022. Pregnant women who had asymptomatic, mild and moderate Covid-19 infection in the 1st and 2nd trimesters were registered and their pregnancy processes were followed. Results: A total of 437 patients participated in the study. The numbers of asymptomatic, mild and moderate Covid-19 patients were 142, 157 and 138, respectively. Each group was analyzed as 1st and 2nd trimester subgroups according to the time of Covid-19 infection. The mean age of patients with moderate Covid-19 was higher than with mild/asymptomatic Covid-19 (p=0.021). Body mass index was found to be higher in patients with moderate Covid-19 compared to patients with mild/asymptomatic infection (p=0.048). Preterm labor (between 34th and 37th weeks) was significantly higher with moderate Covid-19 infection (p=0.041). This significant increase was mainly due to the preterm birth rate in patients with previous Covid-19 infection in the 2nd trimester. There was no significant change in the rates of cesarean section, hypertensive disorders of pregnancy, fetal loss, intrauterine growth restriction, cholestasis of pregnancy and gestational diabetes. Conclusions: The effects of Covid-19 infection in early pregnancy (1st and 2nd trimester) are still the subject of research. Moderate Covid-19 infection, especially in the 2nd trimester, may lead to an increase in the rate of preterm birth.
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Background: Pregnancy is associated with various complications such as pre-eclampsia, SGA, preterm birth etc. Low dose aspirin is a possible medication to minimize these adverse outcomes. The aim of this study was to evaluate the use of low dose aspirin for primary prevention of adverse pregnancy outcome. Material & Methods: This cross-sectional study was conducted in department of Gynaecology, North Bengal Medical College Hospital, Mirjapur Bkash Hospital, Mirjapur, Tangail, Bangladesh, during the period from June 2021 to August 2022. Total 200 pregnant women were included in this study. Results: In this study, the mean (±SD) age of the study subjects were 25.12 ± 5.49 years and 25.00 ± 4.83 years in LDA group and control group, respectively. There was no statistically significant (p>0.05) difference in age between the groups. The rate of caesarean section was higher in control group (68%) compared to LDA group (59%) but there was no statistically significant (p>0.05) difference among the groups. In our study, 8% pregnant women in LDA group and 19% pregnant women in control group had gestational hypertension, pre-eclampsia was seen in 6% and 13% pregnant women in LDA group and control group, respectively, preterm birth was seen in 8% and 17% pregnant women in LDA group and control group, respectively, SGA was seen in 19% and 32% pregnant women in LDA group and control group, respectively, and fetal distress was seen in 2% pregnant women in both LDA group and control group. There were statistically significant (p<0.05) differences in complications except fetal distress. Mean (±SD) neonatal birth weight was 2.88±1.03 kg and 2.74±0.85 kg in LDA group and control group, respectively and there was no statistically significant (p>0.05) difference. Conclusion: We found that low dose aspirin could significantly reduce the risk of adverse outcomes, especially for pre-eclampsia, SGA and preterm birth.
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SUMMARY OBJECTIVE: There is an increase in the prevalence of pre-gestational diabetes in the past decades, mainly due to the increase in the prevalence of obesity in the general population and consequently type 2 diabetes among women of reproductive age. METHODS: This study purposed to describe the delivery characteristics, pregnancy complications, and outcomes among women in Serbia with the pre-gestational type 2 diabetes in the past decade, as well as their pregnancy complications, deliveries, and neonatal outcomes. The study included data from all the pregnant women with pre-gestational type 2 diabetes in Belgrade, Serbia during the period between 2010 and 2020. The final sample consisted of 138 patients. RESULTS: More than half, i.e., 70 (50.7%) had a vaginal delivery, while 48 (34.8%) had elective and 20 (14.5%) had emergency caesarean sections. Throughout the period, there was 1 patient with preeclampsia (0.7%), 5 with pregnancy-induced hypertension (3.6%), 7 had newborns with small for gestational age (5.1%), 28 with macrosomia (20.3%), 12 (8.7%) had preterm births, and one-fifth, i.e., 28 (20.3%) of the newborns had Apgar score under 8. CONCLUSION: The present study revealed that women with type 2 diabetes in pregnancy have a significant burden of pregnancy complications, related to pregnancy, delivery, and newborns.
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ABSTRACT Objective: To evaluate the effect of metabolic syndrome (MetS) diagnosis on oocyte quality and pregnancy outcomes in infertile women with polycystic ovary syndrome (PCOS) who undergoing antagonist-controlled ovarian stimulation (COS) and in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) cycles. Subject and methods: This prospective cohort study was conducted from November 2019 to November 2020 across two university-affiliated infertility centers in Iran. The PCOS diagnosis was defined according to the Rotterdam criteria. The patients prior to IVF/ICSI cycles were evaluated for MetS diagnosis. MetS was detected according to the National Cholesterol Education Program/Adult Treatment Panel III with the presence of at least three or more of the specific clinical criteria. The cycle outcomes were compared between MetS and non-MetS groups. Results: Overall, 68 eligible infertile PCOS patients with MetS diagnosis and 126 without MetS participated. The MetS diagnosis was associated with the increased requirement of gonadotropins and the COS duration significantly (P = 0.001). Although the total numbers of retrieved and MII oocytes, obtained and top-quality embryos as well as clinical pregnancy and live birth rates in the MetS group were lower than those of in the non-MetS group, the differences were not statistically significant (P > 0.05). In follow-up of the obstetrics complications, the rate of preeclampsia was significantly higher in patients with MetS (P = 0.02). Conclusion: MetS diagnosis in PCOS patients was associated with non-significant poor COS and pregnancy outcome. Further studies with larger sample sizes are recommended to clarify the risk of MetS in patients undergoing ART cycles.
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ABSTRACT Objective: This study aims to evaluate the impact of morning-evening preference in pregnancy outcomes in gestational diabetes mellitus (GDM). Materials and methods: This is a prospective cohort study of 2nd-3rd trimester GDM outpatient care in Fortaleza, Brazil (2018-2020). Eveningness was defined by the Horne-Östberg Morningness-Eveningness-Questionnaire (MEQ ≤ 41). Furthermore, we obtained a 7-day actigraphic register. Subjective sleep quality, daytime somnolence, insomnia, fatigue and depressive symptoms were also evaluated. Associations with pregnancy outcomes were investigated. Results: Among 305 patients with GDM, evening preference was found in 21 (6.9%). Patients with evening preference had worse sleep quality (p < 0.01), greater severity of insomnia (p < 0.005), fatigue (p < 0.005) and depressive symptoms (<0.009). Evening chronotype was associated with preeclampsia [p = 0.01; OR = 0.27; CI 0.09-0.79] and a greater need for admission to a neonatal intensive care unit (NICU) [p = 0.02; OR = 0.23; CI .0.06-0.80]. A lower MEQ score confirmed an association with preeclampsia [p = 0.002; OR = 0.94; CI 0.90-0.97] and this was maintained after controlling for age, arterial hypertension, sleep quality, fatigue and depressive symptoms [p < 005; OR = 0.91; CI 0.87-0.95]. Conclusion: In GDM, patients with evening preference had worse sleep quality, more insomnia, fatigue, and depressive symptoms. Furthermore, eveningness was independently associated with preeclampsia. These results indicate the important role of eveningness in adverse pregnancy outcomes.
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Objective: To compare the neonatal outcomes in pregnant women with repaired vs unrepaired congenital heart disease (CHD). Methods: Data on pregnant women with CHD was retrieved from our hospital records for the duration April, 2014 to December, 2021. Pregnant women with CHD were divided into two groups: simple CHD and moderate-tocomplex CHD. Results: In simple CHD group, neonatal outcomes were similar in pregnant women with repaired and unrepaired CHD. By contrast, in moderate-to-complex CHD group, the offspring of women with unrepaired CHD had lower gestational age [mean (SD) 34.3 (2.7) vs 36.8 (2.1) week; P=0.016] and lower birth weight [mean (SD) 2126.8 (711.9) vs 2720 (645.7); P=0.037] than those with repaired CHD. Infants of women with unrepaired moderate-to-complex CHD had a higher risk of premature delivery (87.5% vs 45.5%, P=0.013), low birth weight (81.3% vs 36.4%, P=0.04) and neonatal intensive care unit (NICU) admission (68.8% vs 27.3%, P=0.034). Conclusions: Surgical repair before pregnancy in women with moderate-to-complex CHD significantly minimized the risks of neonatal complications.
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SUMMARY OBJECTIVE: This study sought to evaluate the influence of time (early <90 days and late >90 days) and endometrial injury on pregnancy success. METHODS: This is a retrospective study in which all infertile women who underwent at least one in vitro fertilization cycle at Clinica Gera between 2010 and 2015 were considered for inclusion. We included patients with a normal ovarian reserve and regular menses at intervals of up to 30 days. A total of 315 patient files were reviewed, and the study group was composed of patients who faced fertility issues and had male-caused infertility or idiopathic infertility. Also, women with male or unknown cause of infertility who have performed endometrial biopsy and have undergone embryo transfer up to 180 days after this procedure between 2010 and 2015 were included. The patients were divided into two groups according to the interval between biopsy and embryo transfer: group 1 (early—an interval of <90 days) and group 2 (late—an interval of >90 days and up to 180 days). RESULTS: The results were superior for the group with an interval of less than 90 days relative to the group with an interval of more than 90 days (p<0.04). The pregnancy rates for group 1 and group 2 were 58.5% and 43.4%, respectively. The odds ratio for pregnancy success was 1.63 (95% confidence interval: 1.04 to 2.55). CONCLUSION: The early transfer of embryos (<90 days) may produce better results with a high rate of pregnancy. Further studies are necessary to identify the mechanism involved in this phenomenon.
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Objective: This study aims at comparative analysis of outcome of pregnancy in patients with 1st trimester bleeding ,with & without sub-chorionic haemorrhage (SCH). Pregnant Material and Methods: women with vaginal bleeding upto14 wks. Study period was Jan 2020 - Dec 2021. Presence& absence of SCH formed the study & the control group respectively. Both groups had similar demographic patterns & parameters (parity, previous Results: miscarriages & gestational age at ?rst miscarriage). 15 out of 50 pregnancies (30%) with subchorionic Hematoma resulted in miscarriage, whereas it was 28 out of 210 pregnancies (13%) withoutsubchorionic hematoma. No signi?cant difference was found on the gestational age at miscarriage & duration between 1st vaginal bleeding & miscarriage.The outcome measures were also similar in both groups. Presence of subchorionic hematoma up to 14 wks. Of gestation increases risk of Conclusion: miscarriage, but pregnancy outcome in ongoing pregnancy is not altered
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Objective:To investigate the incidence and risk factors of hypertensive disorders in pregnancy (HDP) in high altitude areas and their influence on maternal and infant outcomes.Methods:This was a retrospective case-control study. A total of 220 newborns were selected as the high altitude group, who were born to 216 mothers with HDP and admitted to the Neonatal Intensive Care Unit of the Lhasa People's Hospital from June 1, 2018, to June 1, 2020. The low altitude group consisted of 235 newborns born to 231 mothers with HDP and admitted to the Department of Neonatology of the Children's Hospital Affiliated to Beijing Capital Institute of Pediatrics from January 1, 2018, to December 31, 2021. Differences in the types of HDP between the two groups and the risk factors for the high incidence of preeclampsia-eclampsia and early-onset preeclampsia in high altitude area were analyzed. The influences of HDP in high and low altitude areas on maternal and infant outcomes were compared. Statistical analysis was performed using t-test, Mann-Whitney U test, Pearson Chi-square test, or continuous correction Chi-square test, and univariate and multivariate logistic regression analysis. Results:Maternal age and the proportions of primiparae and women of advanced age or having irregular prenatal examination were greater in the high altitude group than those in the low altitude group (all P<0.05). Besides, the incidence of early-onset preeclampsia, eclampsia, preeclampsia-eclampsia, and chronic hypertension complicated by preeclampsia were also higher in the high altitude group (all P<0.05). Multivariate logistic regression analysis showed that high altitude was a risk factor for the development of preeclampsia-eclampsia ( OR=4.437, 95% CI:2.582-7.626). Adverse pregnancy history ( OR=2.576, 95% CI:1.217-5.452) and irregular prenatal examination ( OR=2.862, 95% CI:1.412-5.800) were independent risk factors for early-onset preeclampsia in pregnant women in high altitude areas. Twin-pregnancy was a protective factor for early-onset preeclampsia in pregnant women in high altitude areas ( OR=0.183, 95% CI: 0.054-0.623). The incidence of maternal heart failure [7.9% (17/216) vs 0.4% (1/231), χ2=15.98], placental abruption [7.9% (17/216) vs 3.5% (8/231), χ2=4.11], hemolysis, elevated liver function and low platelet count syndrome [14.4% (31/216) vs 1.7% (4/231), χ2=24.64], premature delivery [86.1% (118/216) vs 73.6% (170/231), χ2=10.79], fetal growth restriction [52.3% (115/220) vs 18.7% (44/235), χ2=56.26], fetal distress [18.2% (40/220) vs 8.1% (19/235), χ2=10.26], neonatal asphyxia [29.5% (65/220) vs 11.1% (26/235), χ2=24.26], severe asphyxia [8.6% (19/220) vs 2.6% (6/235), χ2=8.10] and the proportion of neonates requiring mechanical ventilation within 24 h after birth [69.5% (153/220) vs 42.6% (100/235), χ2=33.54] as well as neonatal death within 7 d after birth [5.5% (12/220) vs 1.3% (3/235), χ2=6.22] in the high altitude group were significantly higher than those in the low altitude group (all P<0.05). Conclusion:High altitude is a risk factor for preeclampsia-eclampsia, and the adverse effects of HDP on mothers and infants are more severe in high altitude areas.
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Objective:To explore the value of jellyfish sign, an abnormal ultrasonographic sign, in predicting adverse perinatal outcomes of women with complete placenta previa combined with placenta accreta spectrum disorders (PAS).Methods:This retrospective study analyzed the ultrasound images of 72 singleton gravidas, diagnosed with complete placenta previa combined with PAS, who underwent cesarean section at the First Affiliated Hospital of Nanjing Medical University between January 2020 and February 2023. Based on the presence and absence of the jellyfish sign in ultrasound images, these gravidas were divided into the jellyfish-sign group (15 cases, 20.8%) and the non-jellyfish-sign group (57 cases, 79.2%). The clinical data and perinatal outcomes of the two groups were analyzed. The adverse perinatal outcomes encompassed conditions such as abdominal aorta balloon block, uterine artery embolism, hysterectomy, postpartum hemorrhage, and neonatal intensive care unit (NICU) admission of their neonates. Statistical analysis was performed using two independent samples t-test, the Mann-Whitney U test and the Chi-square (or Fisher's exact) test. Results:(1) The jellyfish-sign group exhibited a higher parity [(1.6±0.7) times vs (1.2±0.6) times, t=2.01] and higher prenatal scores of placenta accreta [(12.3±1.5) scores vs (8.6±2.9) scores, t=6.59] than those in the non-jellyfish-sign group (both P<0.05). Among the 57 cases in the non-jellyfish-sign group, there were 14 cases of placenta creta (24.6%), 40 cases of placenta increta (70.2%), and three cases of placenta percreta (5.3%). Among the 15 cases in the jellyfish-sign group, nine cases were diagnosed with placenta increta, six with placenta percreta, and none with placenta creta. The difference in distribution between the two groups was statistically significant (Fisher's exact test, P<0.001). (2) Intraoperative blood loss [(for those who accepted abdominal aorta balloon block, 1 973±1 057) ml vs (1 211±576) ml, t=2.55], red blood cells transfused [4.0 U (2.0-23.0 U) vs 2.5 U (0.0-11.0 U), Z=－2.53], postoperative hospitalization time [(9.7±2.4) vs (7.5±2.2) d, t=3.36], the incidence of abdominal aorta balloon block [15/15 vs 38.6% (22/57), χ2=17.92], uterine artery embolism [for those who accepted abdominal aorta balloon block, 3/15 vs 1.8% (1/57), Fisher's exact test], and requiring blood transfusion [15/15 vs 63.2% (36/57), Fisher's exact test] were higher in the jellyfish-sign group than those in the non-jellyfish-sign group. However, the non-jellyfish-sign group had lower gestational age at delivery [(33.6±1.5) weeks vs (35.2±1.8) weeks, t=－3.24], and lower neonatal Apgar score at 1 min and 5 min [1 min: 8 scores (3-10 scores) vs 9 scores (4-10 scores), Z=－2.46; 5 min: 9 scores (7-10 scores) vs 10 scores (6-10 scores), Z=－2.02] (all P<0.05). There were no significant differences in emergency surgery rate, 24 h postoperative blood loss, neonatal birth weight, and proportion of NICU admission between the two groups. Additionally, no cases of hysterectomy or death were observed in the two groups. Conclusions:Ultrasound examination revealing jellyfish signs in patients with complete placenta previa and PAS is associated with an increased likelihood of adverse perinatal outcomes. Consequently, the management of these patients should be given greater attention.
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Objective:To investigate the effects of placenta previa on the surgical and pregnancy outcomes in patients with total/subtotal or segmental hysterectomy attributed to placenta accreta spectrum disorders (PAS).Methods:This study retrospectively enrolled 510 patients who gave birth and underwent total/subtotal hysterectomy or segmental hysterectomy (local implantation site) due to PAS at the third Affiliated Hospital of Guangzhou Medical University from January 1, 2017, to December 31, 2022. These subjects were divided into the placenta previa group (427 cases) and non-placenta previa group (83 cases). According to the type of hysterectomy, they were further divided into the total/subtotal hysterectomy and placenta previa subgroup (221 cases), total/subtotal hysterectomy and non-placenta previa subgroup (23 cases), segmental hysterectomy and placenta previa subgroup (206 cases), and segmental hysterectomy and non-placenta previa subgroup (60 cases). Nonparametric test or Chi-square test were used to compare the differences in the clinical features, surgical and pregnancy outcomes between different groups. Binary logistic regression was used to analyze the effects of placenta previa on the risk of additional surgical procedures and adverse maternal outcomes. Results:(1) Compared with the non-placenta previa group, the hemorrhage volume within 24 h postpartum [1 541 ml (1 036-2 368 ml) vs 1 111 ml (695-2 000 ml), Z=－3.91] and the proportion of women requiring additional surgical procedures [84.8% (362/427) vs 69.9% (58/83), χ2=10.61], with total/subtotal hysterectomy [51.8% (221/427) vs 27.7% (23/83), χ2=16.10], cystoscopy and/or ureteral stenting [60.7% (259/427) vs 31.3% (26/83), χ2=24.25], total adverse pregnancy outcomes [86.9% (371/427) vs 65.1% (54/83), χ2=17.75], hemorrhage volume>1 500 ml within 24 h postpartum [54.1% (231/427) vs 33.7% (28/83), χ2=29.94], transfusion of blood products [75.9% (324/427) vs 47.0% (39/83), χ2=28.27] were all higher in the placenta previa group (all P<0.05). Binary logistic regression analysis found that for PAS patients with hysterectomy, regardless of the hysterectomy type (total/subtotal/segmental), placenta previa was risk factor for requiring additional surgical procedures ( aOR=3.26, 95% CI: 1.85-5.72) and adverse pregnancy outcomes ( aOR=5.59, 95% CI: 2.01-6.42), even if adjusting for the confounding factors such as maternal age, number of previous cesarean sections, parity, gestational weight gain, twin pregnancy, and the use of assisted reproductive technology. (2) In patients with total/subtotal hysterectomy, the proportion of women requiring additional surgical procedures was higher in those with placenta previa [82.8% (183/221) vs 56.5% (13/23), χ2=9.11] than those without placenta previa, especially the proportion of cystoscopy and/or ureteral stenting [67.9% (150/221) vs 34.8% (8/23), χ2=9.99] (both P<0.05). However, no significant difference was found in adverse pregnancy outcomes [89.6% (198/221) vs 87.0% (20/23), χ2<0.01, P=0.972] between the two groups. In patients with segmental hysterectomy, higher proportions of women requiring additional surgery [86.9% (179/206) vs 75.0% (45/60), χ2=4.94], with adverse pregnancy outcomes [84.0% (173/206) vs 56.7% (34/60), χ2=25.31], cystoscopy and/or ureteral stenting [52.9% (109/206) vs 30.0% (18/60), χ2=9.78], vascular occlusion [94.2% (194/206) vs 71.7% (43/60), χ2=24.23], hemorrhage volume>1 500 ml within 24 h postpartum [46.6% (96/206) vs 23.3% (14/60), χ2=10.37], and transfusion of blood products [68.9% (142/206) vs 33.3% (20/60), χ2=24.73] were found in the placenta previa group (all P<0.05). Furthermore, patients with placenta previa had more hemorrhage volume within 24 h postpartum [1 368 ml (970-2 026 ml) vs 995 ml (654-1 352 ml), Z=－3.66, P<0.001] in the segmental hysterectomy subgroup. After adjusting for the confounding factors such as age, number of previous cesarean sections, parity, gestational weight gain, twin pregnancy, and the use of assisted reproductive technology, binary logistic regression analysis found that placenta previa did not increase the risk of additional surgical operations ( aOR=2.71, 95% CI: 0.99-7.42) and adverse pregnancy outcomes ( aOR=2.14, 95% CI: 0.54-8.42) in patients with total/subtotal hysterectomy but were risk factors of the two outcomes for those with segmental hysterectomy ( aOR=4.67, 95% CI: 2.15-10.10; aOR=3.80, 95% CI: 1.86-7.77). Conclusions:Placenta previa increases the risk of additional surgical procedures and adverse pregnancy outcomes in patients with total/subtotal or segmental hysterectomy caused by PAS. Appropriate preparation is required after the clinical diagnosis of PAS with placenta previa.
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Objective:To evaluate the role of improved management procedures in placenta accreta spectrum disorders (PAS) and its impact on maternal and infant outcomes.Methods:This retrospective study involved 164 pregnant women who were diagnosed with PAS complicated with placenta previa and delivered at Nanjing Drum Tower Hospital, Nanjing University Medical School from January 2019 to December 2022. All subjects were allocated to pre-improvement group (January 2019 to December 2020, n=96) and post-improvement group (January 2021 to December 2022, n=68). The management was improved in the following five aspects: (1) The time for scheduled delivery was postponed to 37 weeks from 34-36 weeks;(2) Intraoperative cell salvage was encouraged despite autologous blood donation during pregnancy;(3) Original surgical incision was utilized instead of mid-longitudinal incision in the lower abdomen to reduce operative trauma; (4) A lower segment incision of the uterus was not prohibited based on pre-operative PAS classification and intra-operative situation to enter the uterine cavity, even through the placenta instead of pass-by;(5) The interface between lower uterine segment and bladder was dissected before instead of after the baby was born and uterine blood supply was stopped by tourniquet or Scharr forceps. Statistical methods such as t-test, Chi-square test or Fisher exact probability method were used to compare the difference in maternal and infant outcomes between the two groups. Results:After the improvement, the delivery rate beyond 37 weeks decreased significantly [83.3% (80/96) vs 69.1% (47/68), χ 2=4.60, P=0.038]. There was no significant difference in the distribution of elective, subemergency and emergency surgeries before and after the improvement ( χ 2=0.36, P=0.834). Compared to the pre-improvement group, the proportion of women who underwent cesarean section through previous abdominal incisions increased significantly [74.0% (71/96) vs 91.1% (64/68), χ 2=11.11, P=0.001] in the post-improvement group, while the proportion of application of abdominal longitudinal incision and classical cesarean section decreased significantly [84.3% (81/96) vs 57.3% (39/68), χ 2=14.81, P<0.001; 83.3% (80/96) vs 61.8% (42/68), χ 2=9.72, P=0.003]. No significant difference was found between the two groups in terms of the transfusion rate of allogeneic red blood cell, platelet and other blood components, pre-discharge hemoglobin level, subtotal hysterectomy rate, bladder injury, thrombus event, the admission rate of intensive care unit and unplanned reoperation rate (all P>0.05). The incidence of admission in neonatal intensive care unit (NICU) and necrotizing enterocolitis decreased significantly after improvement [24.7% (24/97) vs 11.8% (8/68), χ 2=4.31, P=0.038; 4.1% (4/97) vs 0.0% (0/68), χ 2=58.06, P<0.001]. The incidence of respiratory distress syndrome, mechanical ventilation, and neonatal septicemia also decreased, but without statistical difference. Conclusions:After adopting a series of improvement measures, such as delaying planned delivery to 37 weeks of gestation, individualized cesarean section plan, and changing the method of obtaining autoblood, the number of premature infants and the NICU admission rate decreased significantly without increasing the risk of maternal complications and emergency operation. Furthermore, the incidence of adverse events such as maternal organ injury, unplanned reoperation, and re-admission remains at a low level. Therefore, this improved management is feasible.
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Escherichia coli is an important pathogen causing neonatal infectious diseases, such as neonatal meningitis and sepsis, and poses a great threat to the health of neonates. Currently, no effective screening and prevention measures are available. This article briefly reviews the rates of Escherichia coli colonization in pregnant women and newborns, the risk factors of colonization and transmission from mother to infant and the influences of Escherichia coli on pregnancy outcome, especially the harm to newborns. In clinical practice, more attention should be paid to high-risk pregnant women and the possible adverse pregnancy outcomes. For newborns born to mothers with Escherichia coli colonization, the possibility of Escherichia coli infection should be considered first if early meningitis and septicemia occur, which would be of great significance for the selection of antibiotics.
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Objective:To investigate the clinical value of isolated fetal echogenic bowel (FEB) as an indicator for invasive prenatal diagnosis.Methods:This retrospective study enrolled 183 pregnant women who were diagnosed with isolated FEB and underwent invasive prenatal diagnosis in Fujian Maternity and Child Health Hospital from August 2013 to January 2021. Clinical data including the results of conventional karyotyping and chromosomal microarray analysis (CMA), cytomegalovirus (CMV) DNA loads in amniotic fluid and pregnancy outcomes were reviewed analyzed. Chi-square test was used for statistical analysis Results:Karyotyping was performed on all of the 183 fetuses and three (1.64%) aneuploidies (one case of trisomy 21, one trisomy 18 and one 47,XYY syndrome) were detected. One trisomy 21 and four pathogenic (P)/likely pathogenic (LP) copy number variation (CNV) were detected among 108 fetuses who received CMA. The detection rate of P/LP chromosomal abnormalities by CMA was higher than that by karyotyping, but there was no significant difference between them [4.63% (5/108) vs 0.93% (1/108), χ 2=1.54, P>0.05]. In addition, three cases of variants of uncertain significance (VOUS) were detected by CMA. CMV DNA loads of fetal cells in the amniotic fluid samples of the 166 cases were determined, and only one (0.6%) was positive (CMV DNA up to 7.01×10 6 copies/ml), and no abnormalities were found in karyotype analysis and CMA detection. A total of 176 cases were followed up, and among them only one case of intrauterine infection and seven cases (three aneuploidies and four P/LP CNV) of chromosomal abnormalities were terminated after genetic counseling. Three fetuses with VOUS and other 165 fetuses without chromosomal abnormalities had a good prognosis after birth. Conclusions:Isolated FEB may be the abnormal ultrasound finding in fetuses with chromosomal abnormalities or CMV infection. Prenatal genetic testing and the exclusion of intrauterine infection are important for management during pregnancy and prognosis assessment of FEB.
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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.
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Objective:To analyze the maternal and neonatal outcomes of pregnant women with leukemia.Methods:This retrospective study analyzed the clinical data of singleton pregnant women with leukemia and their neonates at the Obstetrics Department of Peking University People's Hospital from June 2009 to May 2021. Statistical analysis was performed using a two-sample t-test, the Wilcoxon Mann-Whitney rank sum test, and the Chi-square test (or Fisher's exact test). Results:(1) Ninety-one pregnant women were enrolled in this study, accounting for 2.8‰ of all deliveries during the same period. Among them, there were 15 (16.5%) with acute lymphoblastic leukemia, 38 (41.8%) with acute myeloid leukemia, and 38 (41.8%) with chronic myelogenous leukemia. Twenty-nine of the 91 pregnancies (31.9%) were terminated in the second or third trimester, and 62 babies (68.1%) were born through spontaneous delivery or cesarean section. The 62 parturients were (30.1±5.0) years old, of whom two died of complications of leukemia within 7 d after delivery, and five were transferred to the intensive care unit after delivery. Of the 62 cases, 18 (29.0%) received a blood transfusion and 12 (19.3%) received chemotherapy during pregnancy. (2) The proportion of patients with unremitted leukemia during pregnancy or newly developed leukemia was higher in women with terminated pregnancy than in those who continued the pregnancy [96.6% (28/29) vs 54.8% (34/62), χ2=15.83, P<0.001]. (3) The gestational age of the 62 newborns was (37.7±2.7) weeks. Premature, low birth weight and small-for-gestational-age infants accounted for 29.0% (18/62), 25.8% (16/62), and 12.9% (8/62), respectively. Hyperbilirubinemia occurred in 10 neonates (16.1%) and hypoglycemia in two (3.2%). Perinatal anoxia and asphyxia were reported in 13 cases (21.0%). Appearance, organ malformations, or chromosomal abnormalities were found in four neonates (6.4%) whose mothers did not receive chemotherapy during pregnancy. Fifty-nine infants underwent routine blood tests within 3 d after birth. The results showed that the mean white blood cell count, hemoglobin concentration, and platelet count were (16.1±7.0)×10 9/L, (181.5±20.0) g/L and (266.2±63.7)×10 9/L, respectively, and no juvenile cells were detected in their peripheral blood samples. Twenty children were followed up to 4 years and 4 months (9 months to 10 years and 3 months). No abnormalities in physical or mental development, motor function, or hematological system were reported. Conclusions:Pregnancy complicated by leukemia is rare and dangerous, which requires an individualized management strategy besides therapy for leukemia. A good prognosis is still expected with appropriate treatment.
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Asymptomatic bacteriuria (ASB) refers to the presence of one or more species of bacteria in an individual's urine without the symptoms of a urinary tract infection. Previous studies have shown that untreated ASB during pregnancy is associated with adverse pregnancy outcomes. Many international guidelines recommend a single screen-and-treat approach to ASB during pregnancy. Still, this approach has not been proven favorable to pregnancy outcomes in low-risk populations by recent studies. ASB screening is not a routine obstetric examination in clinical practice in China. Given this, this article will review the evidence of ASB screening during pregnancy and analyze the recommendations and existing problems in the guidelines from various academic organizations. Clinical studies should be carried out according to the situation in the region, and the basic risks and treatment benefits of ASB in pregnancy should be analyzed in combination with specific data to establish a proper screening and treatment plan for ASB during pregnancy. Screening for ASB is recommended for pregnant women with high-risk factors at this stage.
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Objective:To analyze the duration of the second stage of labor without epidural anesthesia and its association with pregnancy outcome.Methods:This retrospective study involved 12 789 women who delivered without epidural anesthesia in the First Affiliated Hospital of Kunming Medical University from January 1, 2014 to December 31, 2017. These subjects were divided into primipara group (9 517 cases) and multipara group (3 272 cases). Demographic characteristics, maternal and neonatal outcomes and the duration of the second stage of labor were compared between the two groups using two independent samples t-test, Mann-Whitney U test and Chi-square test (Fisher's exact test). Differences in the maternal and neonatal outcomes were also analyzed among different subgroups in primiparae [length of second stage: <1 h group ( n=6 265), ≥1-2 h group ( n=2 305), ≥2-3 h group ( n=831) and ≥3 h group ( n=116)] and multiparae [length of second stage <1 h group ( n=3 144), ≥1-2 h group ( n=102) and ≥2 h group ( n=26)]. The association between second stage length and pregnancy outcomes was analyzed with Cramer's V. After adjusted for maternal age, gestational weeks at delivery, body mass index before pregnancy, complications during pregnancy and neonatal birth weight, the relationship between the duration of the second stage and adverse outcomes was analyzed by binary logistic regression analysis. Results:The 95 th percentile of the second-stage labor duration was 143 min for primiparae and 52 min for multiparae. The rates of vaginal delivery, forceps delivery, cesarean section in the second stage, episiotomy, third- or fourth-degree perineal laceration, postpartum hemorrhage, grade Ⅱ postpartum hemorrhage, transfusion, umbilical arterial blood gas pH<7.15 and transferring to neonatal intensive care unit (NICU) were all correlated with the duration of second stage in primiparae (Cramer's V values: 0.22, 0.23, 0.03, 0.22, 0.05, 0.10, 0.03, 0.03, 0.03 and 0.07, respectively, all P<0.05), and so did those of vaginal delivery, forceps delivery, episiotomy, postpartum hemorrhage, grade Ⅱ postpartum hemorrhage, transfusion and transferring to NICU in multiparae (Cramer's V values: 0.18, 0.19, 0.28, 0.14, 0.09, 0.13 and 0.06, respectively, all P<0.05). Logistic analysis showed that in primiparae, the duration of second stage >1 h was an independent risk factor for episiotomy, third- or fourth-degree perineum laceration, forceps delivery, postpartum hemorrhage, admission to NICU and umbilical arterial blood gas pH<7.15 [adjusted OR (95% CI): 2.080 (1.907-2.268), 1.773 (1.080-2.911), 1.625 (1.420-1.859), 1.365 (1.231- 1.514), 1.305 (1.165-1.462) and 1.246 (1.081-1.436), respectively], while second stage length >2 h was the independent risk factor for episiotomy, forceps delivery, third- or fourth-degree perineum laceration, postpartum hemorrhage, grade Ⅱ postpartum hemorrhage, blood transfusion, admission to NICU and umbilical arterial blood gas pH<7.15 [adjusted OR (95% CI): 4.844 (4.132-5.678), 4.223 (3.571-4.993), 3.289 (1.806-5.989), 1.952 (1.675-2.274), 1.781 (1.057-3.001), 1.654 (1.025-2.668), 1.682 (1.421-1.991) and 1.298 (1.039-1.620), respectively]. In multiparae, the length of second stage >1 h was an independent risk factor for episiotomy, blood transfusion, forceps delivery, postpartum hemorrhage and admission to NICU [adjusted OR (95% CI): 8.796 (5.717-13.534), 7.469 (2.874-19.411), 6.135 (3.217-11.699), 2.697 (1.624-4.477) and 1.814 (1.063-3.097), respectively], while the duration of second stage >2 h was the independent risk factor for episiotomy, third- or fourth-degree perineum laceration, blood transfusion, grade Ⅱ postpartum hemorrhage, forceps delivery and postpartum hemorrhage [adjusted OR (95% CI): 38.868 (14.948-101.063), 28.046 (2.780-282.490), 20.076 (5.384-74.866), 16.327 (3.406-78.274), 14.337 (5.351-38.411) and 9.036 (3.880-21.011), respectively]. Conclusions:The duration of the second stage of labor without epidural anesthesia is between that reported by Friedman and by Zhang. A prolonged second stage of labor may increase the risk of adverse pregnancy outcomes.
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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.