Analysis of the clinical diagnosis and treatment of fetal meconium peritonitis.

BACKGROUND: The purpose of this study was to improve diagnostic and therapeutic standards by examining the clinical features, treatment, and prognosis of fetal meconium peritonitis (FMP), as well as the diagnostic efficacy of ultrasound for FMP. METHODS: The clinical data of 41 infants and pregnant women diagnosed with meconium peritonitis (MP) and treated at the Fujian Maternal and Child Health Hospital from January 2013 to January 2020 were analyzed retrospectively. Clinical data, imaging data, complications, treatment strategies, pregnancy outcomes, neonatal prognoses, and follow-up outcomes were all analyzed. RESULTS: The MP prenatal diagnosis rate was 56.1% (23/41), the neonatal surgery rate was 53.7% (22/41), and the survival rate was 85.4% (35/41). Intraperitoneal calcification (23 pregnant women, 56.1%), intestinal dilatation (13 pregnant women, 31.7%), peritoneal effusion (22 pregnant women, 53.7%), intraperitoneal pseudocyst (7 pregnant women, 17.1%), and polyhydramnios were diagnosed via prenatal ultrasound (18 pregnant women, 43.9%). Twenty-two pregnant women were assigned to the surgical treatment (operation) group, while 18 were assigned to the conservative treatment group. In the operation group, there were 9 cases of ileal atresia (40.9%), 7 cases of jejunal atresia (31.8%), 2 cases of atresia at the jejunum-ileum junction (9.1%), 2 cases of ileal perforation (9.1%), 1 case of ileal necrosis (4.5%), and 1 case of adhesive obstruction (4.5%). There was no statistically significant difference (p > .05) in the occurrence of various prenatal ultrasound findings by etiology. CONCLUSION: Multiple prenatal ultrasound markers have been identified for MP. To improve the efficacy of newborn treatment for FMP and reduce neonatal mortality, dynamic monitoring of ultrasound image alterations and strengthened integrated perinatal management are necessary.

[Study on the risk factors related vertical transmission of HBV positive couples to their infant].

OBJECTIVE: To explore the risk factors and the rate of HBV vertical transmission from HBsAg-positive couple to their infant. METHODS: 46 families who had antenatal examination at Fujian Provincial Maternal and Child Health Hospital during August 2010 and November 2011 were chosen as research object. Cord blood was sampled after delivery for HBVM and HBV-DNA quantification. Those with HBV-DNA load ≥ 5 × 10(2) copies/ml were involved in the case group while those having < 5 × 10(2) copies/ml were chosen as controls. RESULTS: The average positive rate of neonatal cord blood HBV-DNA was 45.7% (21/46), while the positive rates of cord blood HBsAg and HBeAg were 34.8% (16/46) and 23.9% (11/46) respectively. The positive rates of maternal serum HBV-DNA and paternal serum HBV-DNA were 52.2% (24/46) and 69.6% (32/46) respectively, with the positive rate of couple serum HBeAg as 39.1% (18/46) and 32.6% (15/46) respectively. Results from univariate analysis showed that hepatitis B surface markers, serum HBeAg-positive, serum HBV-DNA positive, and serum HBV-DNA load of the couples were risk factors to the HBV vertical transmission (χ(2) = 8.731, 8.414, 8.932, 9.663, 10.823, 3.962, 13.638, 36.501; P < 0.05). Data from the multivariate analysis showed that maternal serum HBV-DNA positive and paternal serum HBV-DNA load were risk factors to the HBV vertical transmission[OR = 17.6 (1.3 - 238.4) ; OR = 3.5 (1.6-7.6)]. Serum HBV-DNA loads of the couples were positively correlated with the cord blood HBV-DNA load, while the load levels of the couple's serum HBV-DNA were higher than cord blood HBV-DNA. There appeared dose-response relationship between couple's serum HBV-DNA load level and the cord blood HBV-DNA load level. RESULTS: from the analysis of ROC curve showed that both maternal serum HBV-DNA load level (10(3) copies/ml) and paternal serum HBV-DNA load level (10(4) copies/ml) were demarcation points to better forecast the occurrence of vertical transmission of HBV, because there showed higher sensitivity and specificity for the forecasting process. Neonatal outcomes showed no significant difference between the case group and the control group. The negative conversion rate became 15.0% (3/20) when the HBV-DNA positive infants were followed up for 7 months. CONCLUSION: Both maternal serum HBV-DNA positive and paternal serum HBV-DNA load were risk factors of HBV vertical transmission. When the maternal serum HBV-DNA load appeared > 10(3) copies/ml and paternal serum HBV-DNA load > 10(4) copies/ml, the rate of HBV vertical transmission would increase.