Duration of second stage of labor and its association with pregnancy outcome / 中华围产医学杂志

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.

Severe influenza A (H1N1) in late pregnancy: a case report / 中华危重病急救医学

Pregnancy has increased susceptibility to H1N1 influenza virus infection. Maternal influenza infection is associated with increased risk of morbidity and mortality. A case of influenza A (H1N1) during late pregnancy (pregnancy 1, birth 0, pregnancy 30+2 weeks) was admitted to the Second Affiliated Hospital of Kunming Medical University on December 16th, 2018. The patient was set on mechanical ventilation with a FiO2 of 1.0, a positive end-expiratory pressure (PEEP) of 15 cmH2O (1 cmH2O = 0.098 kPa), and a tidal volume of 4-6 mL/kg (ideal body weight). However the pulse oxygen saturation (SpO2) could only be maintained at about 0.85. The disease was controlled by the treatments of anti-infection, mechanical ventilation, immune therapy, nutritional support, preventive anticoagulant treatment by heparin sodium, adequate negative fluid balance, and other organ support therapy. This article introduced the treatment process of the patient in detail, and provided experience for clinical treatment.

Severe influenza A (H1N1) in late pregnancy: a case report / 中华危重病急救医学

Pregnancy has increased susceptibility to H1N1 influenza virus infection. Maternal influenza infection is associated with increased risk of morbidity and mortality. A case of influenza A (H1N1) during late pregnancy (pregnancy 1, birth 0, pregnancy 30+2 weeks) was admitted to the Second Affiliated Hospital of Kunming Medical University on December 16th, 2018. The patient was set on mechanical ventilation with a FiO2 of 1.0, a positive end-expiratory pressure (PEEP) of 15 cmH2O (1 cmH2O = 0.098 kPa), and a tidal volume of 4-6 mL/kg (ideal body weight). However the pulse oxygen saturation (SpO2) could only be maintained at about 0.85. The disease was controlled by the treatments of anti-infection, mechanical ventilation, immune therapy, nutritional support, preventive anticoagulant treatment by heparin sodium, adequate negative fluid balance, and other organ support therapy. This article introduced the treatment process of the patient in detail, and provided experience for clinical treatment.

Outcome of vaginal birth after cesarean section in women with advanced maternal age / 中华妇产科杂志

Objective To explore the perinatal outcome of vaginal birth after cesarean (VBAC) in women with advanced age.Methods Totally 2 587 women delivered after one or two prior cesarean sections (gestational age≥28 weeks) in the First Affiliated Hospital of Kunming Medical University from July 2013 to February 2017.909 trial of labor after cesarean(TOLAC) cases of singleton pregnancy with one prior cesarean section were studied retrospectively.According to the age,of the 909 TOLAC cases,237 were the advanced age group,and 672 cases were the low age group.The maternal and neonatal outcomes between the two groups were compared.Results The percentage of TOLAC in women with advanced age was 32.4％ (237/731),and VBAC rate was 88.2％ (209/237).The percentage of TOLAC in younger women was 36.2％ (672/1 856),and VBAC rate was 82.4％ (554/672).The difference of the TOLAC rate between the two groups was not significant (P＞0.05),and the VBAC rate of the advanced age group was higher than the low age group (P＜0.05).In the comparison of the two groups,the proportion of bachelor degree or above(55.7％,132/ 237),the prepregnancy BMI (22.4±3.0) kg/m2,pregnant interval time (68.5±38.3) months,the proportion of gestational hypertension (8.4％,20/237),the proportion of gestational diabetes(34.6％,82/237) and the rate of the neonatal ICU admission (18.1％,43/237) in the advanced age group were higher than those of the low age group (P＜0.05),respectively.And there were no significant differences in the rate of postpartum hemorrhage,the rate of postpartum hemorrhage≥1 500 ml,the rate of postpartum transfusion,puerperal morbidity,neonatal birth weight,neonatal 5 min Apgar score＜7 score,umbilical artery blood pH＜7.0,neonatal tracheal intubation and respiratory distress syndrome (all P＞0.05).In all TOLAC cases,the rate of uterine rupture was 0.11％(1/909) and there was no maternal and neonatal death.Conclusion VBAC is a safe and feasible way of delivery for singleton pregnancy after one prior cesarean section in women with advanced age.

Influence of visfatin in expressions of insulin receptor substrate and PI3K in fat cells in vitro / 吉林大学学报(医学版)

Objective:To investigate the relationship between visfatin and insulin resistance (IR)of type 2 diabetes mellitus(T2DM) through the classic insulin signaling pathway phosphatidy inositol-3 kinase (PI3K).Methods:The human T2DM preadipocyte cells were recoveried, extended and differentiated.The visfatin overexpression vectors were built, transformated, cultivated and extracted.The fat cells were transfected with different overexpression levels (0.0, 1.0, 2.5 and 5.0 μg);0.0 μg group was used as control group,and the remaining three groups as observation groups.The mRNA expression levels of visfatin, insulin receptor substrate-1(IRS-1), insulin receptor substrate-2(IRS-2) and PI3K (P85α) were detected by Q-PCR.The protein expression levels of visfatin, IRS-1, IRS-2, PI3K (P85α), IRS-1 and IRS-2 phosphorylation levels were measured by Western blotting method.The glucose uptake rates of fat cells were determined by [3H]-2-deoxidation-D-glucose uptake assay.Results:The expression levels of visfatin mRNA and protein in various groups were increased with the increase of transfection concentration gradient (P0.05).The glucose uptake rates of fat cells were elevated with the increasing of visfatin expression (P<0.05).Conclusion:The visfatin overexpression of fat cells in vitro can increase the expression levels of IRS-1 and PI3K.

Effect of Vaspin in vitro expressed on insulin signal transduction pathway of GDM / 实用医学杂志

Objective To investigate the relationship between Vaspin and GDM insulin resistance. Methods The GDM preadipocyte cells were recoveried, extended and differentiated.Vaspin overexpression carriers were made to transformate, cultivate and extract the plasmid. The fat cells were transfected and extended using 4 overexpression levels (0.0 μg, 1.0 μg, 2.5 μg, 5.0 μg). Q-PCR was used to detect mRNA expression of Vaspin, insulin receptor substrate-1/2 (IRS-1/2), phosphatidy inositol 3 kinase (PI3K (P85a) Western Blot was used to detect protein expression of Vaspin, IRS-1/2, PI3K (P85a) and IRS-1/2 phosphorylation levels, and [3H]-2-deoxidation-D-glucose uptake assay was used to detecte glucose uptake rates. Results (1) According to the Q-PCR and WB results, the constructed Vaspin overexpression carrier was effective; (2) With the Vaspin expression increased, the mRNA and protein expression of IRS-1/2, PI3K (P85a) and IRS-1/2 tyrosine phosphorylation levels had no significant changes;(3) Glucose uptake rate of fat cells had no obvious correlation with Vaspin. Conclusion High expression of Vaspin in GDM serum and omental adipose tissue has no obvious link with the insulin resistance of GDM.

Establishment of Gestational Diabetes Rat Model Induced by High-fat Diet / 昆明医科大学学报

Objective To establish a gestational diabetes rat model by feeding the rats with high-fat diet.Methods A total of 55 female SD rats were divided into four groups:NV group,NP group,FV group and FP group.Three months after normal feeding,the female rats in NP and FP group were put into the same cage with the male rats at the ratio of 2∶1 and were given high-fat diet or normal diet as usual.Before pregnancy and day 1,7,14,20 in pregnancy,fasting plasma glucose and body weight of rats were detected.The fasting serum insulin and serum c-peptide levels were monitored by enzyme immunoassay and insulin resistance index was calculated.At late pregnancy,glucose tolerance and the indicator of fat were tested.Liver and pancreas were dyed to be observed under microscope.FResultS Body weights of the rats raised with high-fat diet were significantly higher than those of control group and body weight during pregnancy significantly increased (P＜0.05).Fasting glucose,fasting insulin and serum C-peptide in FP group were signifieantly higher than those in NP group and insulin resistance was evident (P＜0.05).The area under curve of GTT in FP group was significantly larger (P＜0.05).The levels of serum lipids in FP group were higher than those in normal group.CorncluSiornS The gestational diabetes rat model induced by high-fat diet can be successfully established.The model presents major pathophysiological manifestations of GDM and can be used as a good model of GDM in relevant research.

Retrospective study of seven cases with acute Fatty liver of pregnancy.

Objectives. Our aim is to explore the clinical outcome of patients with acute fatty liver of pregnancy (AFLP), and evaluate the effect of early diagnosis and treatment. Methods. Seven patients who were diagnosed with AFLP were retrospectively analyzed from February 2005 to January 2013. The clinical records of the patients with AFLP were reviewed for clinical features, laboratory examinations, and maternal and perinatal prognosis. Routine laboratory evaluation revealed hyperbilirubinemia, moderately elevated liver transaminase, but negative serum hepatitis virus in each patient. For additional evidence, 126 cases of AFLP were reviewed retrospectively from original articles researched in A Medline-based English and Chinese Knowledge Infrastructure between the same periods. Results. The initial symptoms of all the 7 cases with AFLP were gastrointestinal symptoms; anorexia, nausea, vomiting, and progressive jaundice. Complications revealed with renal insufficiency in all 7 patients. Hepatic failure, MODS, hypoglycemia and DIC were seen in 4 patients (57.1%). Hemorrhagic shock, ARDS, and hepatic encephalopathy were seen in 3 patients (42.8%). There was only one case of maternal death (14.2%), three cases of perinatal death (30%) and one postnatal death (10%). Conclusion. AFLP occurs in late pregnancy is a rare clinical syndrome occurs at about 36 weeks of gestation. Early diagnosis and prompt termination of pregnancy is the key of management with multidisciplinary collaboration, comprehensive treatment and effective prevention are helpful to improve prognosis of the cases with AFLP and perinatal death.

Practice audits to reduce caesareans in a tertiary referral hospital in south-western China.

OBJECTIVE: To assess the effectiveness of a three-stage intervention to reduce caesarean deliveries in a Chinese tertiary hospital. METHODS: A retrospective study was conducted to assess whether educating staff, educating patients and auditing surgeon practices (introduced in 2005) had reduced caesarean delivery rates. Multiple logistic regression was used to check for a potential association between caesarean rates and rates of admission to the neonatal intensive care unit (NICU). FINDINGS: The caesarean delivery rate ranged from 53.5% to 56.1% in 2001-2004 and from 43.9% to 36.1% in 2005-2011. When 2001-2004 and 2005-2011 were treated as "before" and "after" periods to evaluate the intervention's impact on the mean caesarean section rate, a significant reduction was noted: from 54.8% to 40.3% (odds ratio, OR: 0.56; 95% confidence interval, CI: 0.52-0.59; χ(2) test: P < 0.001). The overall drop in the caesarean section rate was significant (χ(2) test: P < 0.001) and inversely correlated with the years (Spearman's ρ: -0.096; P < 0.001). Although complicated pregnancies increased after 2004, the primary caesarean section rate decreased annually by 20% on average in 2005-2011, after practice audits were implemented. Multiple logistic regression showed a positive association between the caesarean delivery rate and the rate of admission to the NICU (adjusted OR: 1.26; 95% CI: 1.14-1.40). CONCLUSION: Patient and staff education and practice audits reduced the Caesarean section rate in a tertiary referral hospital without an increase in admissions to the NICU.

Relationship between maternal red cell index in early pregnancy and gestational diabetes mellitus in Kunming / 中华围产医学杂志

Objective To investigate the role of hemoglobin (Hb),red blood cell count (RBC) and hematocrit (HCT) during the first trimester in predicting the occurrence of gestational diabetes mellitus (GDM) in the third trimester in nonanemic women in Kunming.Methods A prospective study was carried out.Routine blood tests were performed in 1189 nondiabetic singleton pregnant Chinese women at their initial prenatal healthcare before 14 gestational weeks in the First Affiliated Hospital of Kunming Medical University from January 1,2008 to December 31,2009.They were divided into four groups by quartiles of Hb,RBC and HCT levels respectively.Differences of GDM incidence at the third trimester were compared among groups.Kollmogorov Smirnov test was used to detect normal distribution of Hb,RBC and HCT results.Differences between rates of groups were detected by Chi-square test.Independent risk factors of GDM were screened by Logistic regression analysis.Results The incidence of GDM at the third trimester increased as quartile categories of Hb,RBC and HCT ascended.The GDM incidence (13.1 ％,34/259) of ≥75th Hb group was higher than that of ＜ 25th group (5.9 ％,18/304,x2 =8.53,P＜ 0.0 1),25th ～ group (9.2 ％,30/326,x2=4.18,P＜0.05) and 50th～ group (9.3％,28/300,x2=3.96,P＜0.05).The GDM incidence (11.7 ％,34/290) of 50th～ RBC group (RBC≥4.44 × 1012/L) was higher than that of ＜25th group (6.3％,19/304,x2=5.30,P＜0.05),25th～ group (7.0％,21/298,x2 =3.93,P＜0.05); and the GDM incidence (12.1％,36/297) of ≥75th group was also higher than that of ＜25th group (6.3％,19/304,x2 =6.49,P＜0.05),25th～ group (7.0％,21/298,x2=3.85,P＜0.05).The GDM incidence of ＜25th HCT group (5.3％,16/303) was lower than that of 25th～ group (9.3％,29/311,x2=7.04,P＜0.01),50th～ group (10.8％,31/287,x2=3.93,P＜0.05) and ≥75th group (11.8％,34/288,x2=6.49,P＜0.05).Logistic regression analysis showed that Hb (OR=1.031,95％ CI:1.010-1.052),RBC (OR=2.286,95％CI:1.318-3.963) and HCT (OR=1.106,95％ CI:1.037-1.179) were independent risk factors of GDM (all P＜0.05).Conclusions High maternal Hb,RBC and HCT levels in the first trimester could be used in predicting GDM in pregnant women in Kunming area.

Clinical study on dinoprostone suppositories 0.8 mm used in cervical ripening and labor induction of women with term pregnancy of premature rupture of the membranes:a multicenter study / 中华妇产科杂志

Objective To investigate safety and efficacy of dinoprostone suppositories(0.8 mm) used in cervical ripening and labor induction in women with term premature rupture of the membranes.Methods One hundred women of term monocyesis with premature rupture of the membranes,head presentation,bishop score less than 6(test group)and 180 women with intact fetal membranes(control group)were enrolled into this multicenter,prospective clinical study.The vaginal delivery system was inserted into the posterior foruix,and the patients were recumbent for 2 hours after insertion.The interval time from using dinoprostone suppositories to uterine contraction,to labor and delivery were recorded.The following index were also recorded and compared,including the mean inserted time of dinoprostone suppositories,fetal heart beat,meconium stained amniotic fluid,hyperstimulation of uterus and the other complications,mode of delivery,stage of labor,postpartum hemorrhage,status of neonates.Results Three cases intest group and 23 casesin control group weren't in labor within 24 hours.The rate of labor within 24 hours in test group was significant higher than that in control group(97.0% vs.87.2%,P<0.01).It was observed that 73 cases undergoing vaginal deliveries(75.3%,73/97)and 24 cases undergoing cesarean section dehveries(24.7%,24/97)in test group and 107 cases undergoing vaginal delivery(68.2%,107/157)and 50 cases undergoing cesarean section delivery(31.8%,50/157)in control group,when compared the rate of vaginal or cesarean section deliveries between two group,it didn't reach statistical difference (P >0. 05). It had no significant difference in the interval time from using dinoprostone suppositories to labor starting and the mean inserted time and the total labor time between two groups ( P > 0.05 ). The incidence of uterine tachysystole was 11.3% (11/97) in test group and 19. 1% (30/157) in control group (P>0. 05), which did not reach statistical difference (P>0. 05). There wasn't neonatal asphyxia in both groups. Conclusion It was safe and efficient to use dinoprostone suppositories for cervical ripening and induction of term pregnancy with premature rupture of the membranes, however, monitoring should be intensified.