Impact of cervical intraepithelial neoplasia and treatment on IVF/ICSI outcomes.

STUDY QUESTION: Does treatment selection for cervical lesions affect the outcome of IVF/ICSI? SUMMARY ANSWER: There was no difference in pregnancy outcome between treated and untreated groups, or between different types of IVF/ICSI treatment. WHAT IS KNOWN ALREADY: Human papillomavirus (HPV) infection and HPV-induced cervical lesions are associated with decreased fertility, and cervical intraepithelial neoplasia (CIN) treatment may increase the risk of adverse pregnancy outcomes. STUDY DESIGN, SIZE, DURATION: Between 2018 and 2020, 190 women with infertility who had abnormal HPV screening or cytology results prior to IVF/ICSI, and were diagnosed with CIN2/CIN3 by colposcopy biopsy at a tertiary hospital, were enrolled in a retrospective cohort study with follow-up until 31 December 2021. PARTICIPANTS/MATERIALS, SETTING, METHODS: Patients with infertility who were diagnosed with CIN2/CIN3 by colposcopy biopsy were divided into the treatment and expectant management groups. The treatment group was divided into two intervention subgroups: the ablative therapy group and the surgical treatment group. The baseline data, number of oocytes retrieved, and rates of fertilization, high-quality embryos, positive serum HCG, clinical pregnancy, abortion, live birth, and cumulative pregnancy were compared among groups. MAIN RESULTS AND THE ROLE OF CHANCE: Among the 190 patients included in the study, 152 were diagnosed with CIN2, and 38 patients had CIN3. There was no significant difference in the baseline data between the treatment and expectant groups. The time from confirmed lesions to the onset of gonadotrophin administration in the surgical treatment group was significantly longer than in the ablative therapy group and the expectant group (P = 0.007 and P = 0.024, respectively). For the treatment and expectant groups, respectively, the average number of oocytes retrieved (12.95 ± 8.77; 13.32 ± 9.16), fertilization rate (71.01 ± 23.86; 64.84 ± 26.24), and high-quality embryo rate (48.93 ± 30.72; 55.17 ± 34.13) did not differ, and no differences were detected between the different treatment subgroups. There were no differences among groups in rates of HCG positivity, clinical pregnancy, miscarriage, live birth, or cumulative pregnancy. The live birth rate in the surgical treatment group was slightly higher than that in the expectant groups (77.78% versus 66.67%), but the difference was not statistically significant. The 3-year cumulative pregnancy rates in the surgical treatment and expectant groups were 58.19% and 64.00%, respectively. LIMITATIONS, REASONS FOR CAUTION: This is a retrospective study, which by nature can include selection bias, and the number of cases in the expectant group was <30, which may result in a false-negative result owing to the small sample size. WIDER IMPLICATIONS OF THE FINDINGS: For patients with CIN2/CIN3, the treatment of cervical lesions does not affect the outcome of IVF/ICSI. Patients with CIN2 can enroll for IVF/ICSI cycles, with close follow-up to prevent the progression of cervical lesions, in order to avoid further delay in starting ART. For patients with CIN3, ovulation induction and embryo cryopreservation can be initiated as soon as possible after cervical lesions are treated, and frozen-thawed embryo transfer can be carried out 9-12 months later. STUDY FUNDING/COMPETING INTEREST(S): This work was funded by the Key Clinical Projects of the Peking University Third Hospital (to Y.W., BYSYZD2021014). The authors declare no conflicts of interest. TRIAL REGISTRATION NUMBER: N/A.

Expectant treatment for angular pregnancy after assisted reproduction technology: a safe and patient-friendly treatment strategy.

Introduction: Currently, the treatment strategies for angular pregnancy in the first trimester after assisted reproduction technology (ART) are unclear. Improper treatment will cause unnecessary losses to patients, especially infertile patients, after ART. The purpose of this study was to clarify the pregnancy outcomes of expectant treatment for angular pregnancy post-ART and to provide a basis for the formulation of clinical treatment strategies. Method: This retrospective case series study was performed at the Reproductive Medicine Center of a university hospital. Maternal data and pregnancy outcomes were collected and analyzed for all patients diagnosed with angular pregnancies after ART between January 2016 and August 2021. The outcomes included live birth, term birth, premature birth, early pregnancy loss, fetal death, placental abruption, uterine rupture, maternal death, and hysterectomy. Results: A total of 78 patients were analyzed in this study, of whom 54 (69.2%) had live births, 44 (56.4%) had term births, 21 (26.9%) had an early pregnancy loss, 1 (1.3%) had mid-trimester missed abortion, 1 (1.3%) underwent mid-trimester labor induction due to fetal malformation, and 1 (1.3%) underwent uterine rupture. There were no cases of maternal death, placental abruption, or hysterectomies. Discussion: Angular pregnancy after ART is not as dangerous as that described in previous studies; most cases could be treated expectantly under close-interval follow-up and obtain live birth.

Risk factors and foetal growth restriction associated with expectant treatment of early-onset preeclampsia.

OBJECTIVE: To identify the factors affecting expectant management of early-onset preeclampsia, and evaluate the correlation between expectant treatment and foetal growth restriction. MATERIALS AND METHODS: The retrospective study included 72 women who were admitted for early-onset preeclampsia between February 2018 to April 2021. Data included maternal clinical parameters, demographic and maternal and neonatal outcomes, which were analysed for correlation. RESULTS: Multiple logistic regression analysis demonstrated that the time interval from the onset of 24-h proteinuria to termination of pregnancy showed a strong correlation with the expectant treatment; Univariate logistic analysis confirmed that there was no correlation between expectant treatment and foetal growth restriction. CONCLUSION: There was a negative correlation between the duration of 24-h proteinuria and the expectant treatment of patients with early-onset preeclampsia; Expectant treatment could not improve the development of foetal growth restriction in patients with early-onset preeclampsia.KEY MESSAGESThe duration of 24-h proteinuria affects the effectiveness of expectant management of early-onset preeclampsia.Expectant management can reduce adverse neonatal outcomes due to iatrogenic preterm delivery, but it cannot improve the occurrence of foetal growth restriction.

Term Neonatal Complications During the Second Localized COVID-19 Lockdown and Prolonged Premature Rupture of Membranes at Home Among Nulliparas With Reference Interval for Maternal C-Reactive Protein: A Retrospective Cohort Study.

Objective: The COVID-19 lockdown extended premature rupture of membranes (PROM) expectant time among nulliparas and increased the risk of term neonatal complications. This study investigated the impact of term nulliparas with PROM delays at home on neonatal outcomes during the COVID-19 lockdown period, considering the clinical diagnostic application of maternal C-reactive protein (CRP). Methods: This study collected 505 term nulliparous women who underwent PROM at home from five provinces in a non-designated hospital of China in 2020. We analyzed PROM maternal information at home and neonatal complications in the COVID-19 regional lockdown and compared related information in the national lockdown. Poisson regression models estimated the correlation of PROM management at home, maternal CRP, and neonatal morbidity. We constructed two diagnostic models: the CRP univariate model, and an assessed cut-off value of CRP in the combined model (CRP with PROM waiting time at home). Results: In the regional lockdown, PROM latency at home and the severity of neonatal complications were extended and increased lower than in the nationwide lockdown, but term neonatal morbidity was not reduced in the COVID-19 localized lockdown. Prolonged waiting time at home (≥8.17 h) was associated with increasing maternal CRP values and neonatal morbidity (adjusted risk ratio 2.53, 95% CI, 1.43 to 4.50, p for trend <0.001) in the regional lockdown period. In the combined model, CRP ≥7 mg/L with PROM latency ≥8.17 h at home showed higher diagnostic sensitivity and AUC than only CRP for initial assessing the risk of adverse neonatal complications in COVID-19 regional lockdowns (AUC, 0.714 vs. 0.534; sensitivity, 0.631 vs. 0.156). Conclusion: The impact of the acute COVID-19 national blockade on the PROM newborns' health could continue to the COVID-19 easing period. Maternal CRP reference interval (≥7 mg/L) would effectively assess the risk of term neonatal morbidity when nulliparas underwent prolonged PROM expectant at home (≥8.17 h) during the second COVID-19 lockdown.

Treatment of tubal heterotopic pregnancy with viable intrauterine pregnancy: Analysis of 81 cases from one tertiary care center.

OBJECTIVES: The aim of our study was to analyze the treatment and pregnancy outcome of tubal heterotopic pregnancy (HP) patients with a viable intrauterine pregnancy (IUP) in our center. STUDY DESIGN: This was a retrospective analysis of 81 patients with tubal HP and a viable IUP. Patients were divided into either an expectant treatment group (29 patients) or a surgical treatment group (52 patients, 36 laparoscopy and 16 laparotomy). Data related to the basal clinical characteristic of all patients, rescue treatment and ectopic pregnancy (EP) rupture rate in the expectant treatment group, operation details in the surgical treatment group and pregnancy outcomes were collected and analyzed. Subgroup analyses were also performed. RESULTS: In the expectant treatment group, the abortion rate, EP rupture rate and rescue treatment rate were 10.34 % (3/29), 21.14 % (7/29) and 34.48 % (10/29), respectively; subgroup analysis revealed that the rescue treatment rate in patients with EP mass enlargement ≥50 % was 71.43 % (5/7), which was significantly higher than that in patients with EP mass enlargement <50 % (15.00 %, 3/20), with P = 0.011. In the surgical treatment group, the abortion rate of all patients was 15.38 % (8/52); the abortion rate was 22.22 % (8/36) in the laparoscopy subgroup, which was significantly higher than that in the laparotomy subgroup (0.00 %, 0/16), with P = 0.038. CONCLUSIONS: Surgical treatment is a safe treatment option for tubal HP with a viable IUP, and laparoscopic surgery may be a potential risk factor for abortion. A high risk of failure exists for expectant management of tubal HP with a viable IUP, and EP mass enlargement ≥50 % may be a potential predictor of rescue treatment.

Correlation of miRNA and VEGF expression with the outcome of early-onset severe preeclampsia in patients receiving expectant treatment.

The present study was planned to explore the relationship between miRNA and VEGF expression in serum as well as placenta tissue with the outcome of early-onset severe preeclampsia (EOSP) in patients receiving expectant treatment. Sixty EOSP patients who had expectant treatment indications were divided into the success group (n = 46) and the failure group (n = 14) according to the pregnancy outcomes. miR-210 and miR-155 expression levels were studied in serum, ante partum, and in placenta tissue. The vascular endothelial growth factor (VEGF) and soluble VEGF receptor 1 (sFlt-1) expression levels were also explored. miR-210 and miR-155 expression levels in serum and placenta tissue before treatment, ante partum, and after accouchement of the success group were significantly lower than those of the failure group. Further, VEGF expression levels in serum and placenta tissue before treatment, ante partum, and after accouchement of the success group were significantly higher than those of the failure group. However, sFlt-1 expression levels in the success group showed a decrease in comparison to the failure group. The increase of miR-210, miR-155 levels, sFlt-1 levels, and the decrease of VEGF levels in EOSP patients might be correlated with the failure of expectant treatment.

Feed-forward Control Nursing Model in Expectant Treatment of Placenta Previa.

BACKGROUND: We studied the possible advantages of feed-forward control nursing model in the treatment of placenta previa. METHODS: We enrolled 60 pregnant women who were receiving treatment for expectant placenta previa between January 2010 and January 2016 and randomly divided them into the control group and the observation group with 30 cases in each group. In the control group, we offered specialist nursing which included examination, body positioning, vaginal bleeding record, psychological consultation and medication observation. Feed-forward control nursing was applied in the observation group which included establishing feed-forward control nursing improvement team, conducting quality control of nursing defects and putting forward ideas for improvements and verifying improvement outcomes. RESULTS: The observation group got significantly higher success rate and lower complication rate compared with control group. Gestational age and fetal weights improved apparently in the observation group. When we compared the amount of postpartum bleeding and pregnancy bleeding in two groups we did not find any statistically significant difference (P>0.05). Patients' satisfaction rate toward our nursing services was much higher in the observation group and the rate of nursing errors was significantly lower in this group. All differences were statistically significant (P<0.05). CONCLUSION: Application of feed-forward control nursing model in the expectant treatment of placenta previa can improve treatment success rate, decrease complications and upgrade nursing quality.

An analysis on importance of drugs in traditional Chinese medicine for treatment of complications and symptoms of hypertension by QUEST algorithms / 中国中西医结合急救杂志

Objective To approach Professor Zhu Guangli's regular pattern of differentiation of symptoms and signs in patients with hypertension accompanied by complications and in accord with the individual manifestations to add or subtract the ingredients in the prescription.Methods The patients with essential hypertension selected were those who the first time came to the Affiliated Guangxing Hospital of Zhejiang Chinese Medical University or Hangzhou Hospital of Traditional Chinese Medicine (TCM) of Zhejiang Province from September 2012 to January 2015, and were continuously followed up in the hospitals having their clinical data comprehensive. The complications, combination diseases and symptoms of hypertension were conducted as dependent variables, while the applied Chinese medicines were acted as independent variables. QUEST algorithms were employed to analyze the different dependent variables to evaluate the importance contribution rate (ICR) of every kind of Chinese medicine.Results There were 9 types of complications or combination diseases [including hyperlipemia, coronary heart disease, cardiac arrhythmia, hyperglycemia, trace albuminuria, lacunar cerebral infarction, elevation of creatinine in blood (azotemia), liver dysfunction and cardiac dysfunction] and 39 types of symptoms obtained (including dizziness, palpitation, chest oppression, insomnia, lack of strength, soreness of the waist and knees, dry mouth, loose stool, fatigue, apontaneous sweating, headache, shortness of breath, coprostasis, fullness in the stomach, blurred vision, limb numbness, low spirit, chest pain, poor appetite, abdominal distension, excessive dreaming, tinnitus, flush of the face, neck rigidity, hectic fever, bitterness in the mouth, cough, ructus, nocturia, fremitus, stenagma, pharyngalgia, heaviness in head, nocturnal sweating, frequent urination, coughing of sputum, chillness and cold limbs, aphthous stomatitis and sialosis) being the QUEST decision models. All kinds of the TCM employed in all the patients paying visits for 755 times were summed up, and the individual drug frequency of presentation in the prescription was recorded. In the study, 171 sorts of TCM and 10 620 of cumulative frequency (freq.) were involved in 755 prescriptions. The average sorts of TCM was 14.07±1.53 per prescription. The top ten kinds of TCM the most commonly used (freq.) were as follows: tuckahoe (588), Chinese yam (551), wolfberry fruit (496), white peony root (442), abalone shell (405), gastrodia tuber (395), lilyturf root (325), Huai wheat (293), curcuma root (281), rush pith (277), accounting for 38.16% in the total frequency. There were 33 kinds of TCM with frequency > 100, accounting for 74.65% in the total frequency. By the analyses of QUEST algorithms directing to the complications and combination diseases to add or subtract the items of TCM, it was discovered that the drugs with ICR > 5% were as follows: in lacunar cerebral infarction, the drug application frequencies or ICRs of batryticated silkworm and bitter cardamom were 32.69% and 50.74% respectively; in coronary heart disease, the ICRs of pseudostellaria root, astragalus root, white sandal wood and lepidium seed were 23.05%, 17.70%, 15.31% and 5.06% respectively; in cardiac arrhythmia, the ICRs of astragalus root, flavescent sophora root, Huai wheat and dragon tooth and dragon bone were 46.65%, 11.56%, 7.56%, 7.13% and 6.28% respectively; in cardiac dysfunction, the ICRs of lepidium seed and white hyaciath bean were 92.97% and 7.03%; in hyperlipemia, the ICRs of cassia seed, white sandal wood, dried rehmannia root and sargentgloryvine stem were 24.26%, 12.47%, 10.51% and 5.81% respectively; in hyperglycemia, the ICRs of trichosanthes root and dried hawthorn fruit were 51.02% and 30.18%; in trace albuminuria, the ICR of snow in June herb was 83.33%; in elevation of creatinine in blood, the ICRs of Chinese actinidia root, herb of snow in June, glossy privet fruit and centella were 81.37%, 6.21%, 6.21% and 6.21% respectively; in liver dysfunction, the ICRs of coral ardisia root, purse grass and herb of stringy stonecrop were 86.37%, 6.82% and 6.82% respectively. When the symptoms were used as the dependent variables, for the top 3 commonly seen symptoms, in the prescription, the items of TCM used with ICR > 5% were as follows: in cases with elevation of blood pressure, parasitic loranthus (ICR 89.59%) was used; with dizziness, gastrodia tuber (ICR 46.96%) and/or abalone shell (ICR 33.61%) were added; headache, rhizome of Chinese ligusticum and/or rhizome of Sichuan lovage and/or large gentian with ICR at 85.77%, 7.11% and 7.11% respectively. Conclusion Professor Zhu's essential thought in differentiation of disease and expectant treatment of hypertension in accord with the individual manifestations to add and subtract drugs in TCM is under the guidance of TCM principle of differentiation of symptoms and signs for treatment, and based on the classical theories in TCM, the reliable drugs whose actions are demonstrated clinically and experimentally are preferentially selected.

Clinical study on the time and ways for pregnancy termination of patients with early onset severe preeclampsia / 中国综合临床

Objective To discuss the safety and operation effect of cesarean sectionof patients with early onset severe preeclampsia.Methods Clinical data were retrospectively analyzed,the treatment group made up of 236 patients with severe preeclampsia whose gestational age from 28 to 33 +6 weeks and the control group with 399 pregnancy women above 34 weeks.Main analytical items included:onset of gestational age,gestational age of termination of pregnancy,protensive of gestation,methods of termination of pregnancy,status of the occurrence of serious complications,fetal and neonatal mortality and the rate of neonatal asphyxia.Results The average conservative treatment time of treatment group was was significantly longer than that of control group [ ( 13.5 ± 1.2) d vs (9.6 ± 1.0 ) d,t =3.760,P ＜ 0.001].There was no significant difference on the cesarean section rate[70.8％ (167/236) vs 71.2％ (284/399),x2 =0.012,P =0.911 ] and neonatal mortality(2.5％vs 2.8 ％,x2 =0.026,P =0.871 ) between these two gourps.However there was significant difference on the rate of neonatal asphyxia(25.8％ vs 10.8％,x2 =20.792,P ＜ 0.001 ) and perinatal mortalit (22.0％ vs 6.9％,x2=27.782,P ＜ 0.001 ) between these two groups.Conclusion For the patients with severe early onset preeclampsia,to take conservative expectant treatment appropriately based on the safety of motherhood could avoid or reduce the possibility of the occurrence of serious complications,could extend the gestational age appropriately as well as reduce fetal and neonatal prevalence and mortality.Cesarean section is proper for the termination of pregnancy.

Clinical observation of expectant treatment for placenta previa / 中国基层医药

Objective To explore the feasibility of expectant treatment for placenta previa. Methods 90 patients with placenta previa were selected. 30 cases of 90 patients with vaginal bleeding,strongly spontaneous contractions .full-term pregnancy .which pregnant women and their families required termination of pregnancy were selected as the control group;The remaining 60 cases were expected as the observation group,and were given expectant treatment. Then termination of pregnancy was carried out choosing the right time. The differences in gestational age at delivery, prenatal postpartum hemorrhage, puerperal infection, perinatal child weight, Apgar score, mortality .respiratory distress syndrome and other aspects were compared. Results There was no significant difference in pre-natal bleeding between two group(P > 0. 05); But compared with control group, in observation group postpartum hemorrhage and puerperal infection was less, neonatal weight increased, Apgar score was improved, RDS decreased ( P < 0.05 ). Conclusion Under close observation,expectant treatment of placenta previa by looking in the premise of ensuring the safety of extended maternal gestational age, could increase the weight of newboms and reduce the mortality of perinatal children.

Study on tubal patency after treatment of unruptured tubal pregnancy / 中国基层医药

Objective To evaluate tubal pateney by hysterosalpingography after treatment of tubal pregnancy.Methods 80 patients with tubal pregnancy underwent hysteresalpingography after clinical treatment.Of them,30 were treated with methotrexate of 50mg/m2 intramuscularly( study group,n=30) and 50 were followed up expeetandy (control group,n=50).Results Ipsilateral and contralateral tubal pateneies in the study group were 84% and 97% ,respectively,whereas in the control group were 78% and 92% ,respeetively.There were no statistically significant differences between the two groups.Conclusion Appropriate options for unruptured tubal pregnancy includes either expectant management or methotrexate treatment,both of which result in similar tubal patency rate.

A Follow-up Study of 221 Women With Cervical Intraepithelial Neoplasia / 中国医师杂志

0 05). In high grade squamous intraepithelial lesion (HGSIL), the differences between the laser treated group and either LLETZ or total hysterectomy groups turned into normal rate was significantly (P0 05).Conclusions Expectant treatment for CIN I is safe in a reliable patient population. LLETZ is a safe and effective treatment for HGSIL. The long-term efficacy of LLETZ should be investigated and assessed by extending the period of follow-up.