Background:Loneliness is a common experience for pregnant women and correlates with perinatal depression and negative pregnancy outcomes.Women experiencing a high-risk pregnancy are at greater risk for loneliness beca...Background:Loneliness is a common experience for pregnant women and correlates with perinatal depression and negative pregnancy outcomes.Women experiencing a high-risk pregnancy are at greater risk for loneliness because of uncertainty with disease and the medicalization of pregnancy.International studies have identified an association between perceived stress and loneliness in pregnant women.The aim of this study is to explore factors related to loneliness among women of high-risk pregnancy,and to examine the associated relationship of loneliness and perceived stress.Methods:Using convenience sampling,109 women with high-risk pregnancies were enrolled.Data collection involved questionnaires on general demographic characteristics,the 6-item Loneliness Scale(ULS-6),and the Chinese version of the Perceived Stress Scale(CPSS-14).Data analysis was performed using SPSS 28.0 statistical software.Results:The mean loneliness score was 9.95±2.99,and the mean perceived stress score was 22.84±5.80.Women with high-risk pregnancies exhibited statistically significant differences in loneliness scores compared to the control group across among age,marital status,educational attainment,per capita monthly household income,spousal relationship,in-law relationship,and parental relationship(P<0.05).Correlation analysis revealed a positive correlation between loneliness and perceived stress(r=0.456,P<0.01).Multivariate regression analysis indicated that per capita monthly household income,marital relationship,in-law relationship,and perceived stress were the primary factors influencing loneliness among women with high-risk pregnancies(P<0.05).Conclusion:The results highlight the need for specific interventions addressing loneliness among women with high-risk pregnancies.Such interventions should focus on improving spousal and in-law relationships,reducing perceived stress,and implementing support measures,such as financial counseling or assistance programs,for those with lower per capita household income.This study establishes a foundation for the creation of integrated support systems that bring together families and healthcare providers to strengthen maternal mental health.展开更多
Objective:To explore the perspectives of high-risk pregnant women regarding the home care program for high-risk pregnancies.Methods:This qualitative study was conducted in a university hospital and 5 comprehensive hea...Objective:To explore the perspectives of high-risk pregnant women regarding the home care program for high-risk pregnancies.Methods:This qualitative study was conducted in a university hospital and 5 comprehensive health centers in Ahvaz,Iran,from February 2023 to July 2023.The sampling method used was purposive sampling considering the maximum possible diversity,which continued until data saturation.11 in-depth and semistructured interviews were conducted with high-risk pregnant women.Data were simultaneously analysed using Graneheim and Lundman content analysis by MAXQDA version 20 software.Results:Data analysis extracted 3 themes,12 categories,and 26 subcategories.The themes and categories were“high-risk pregnancy and related issues(pursuing treatment and paying attention to the high-risk situation by pregnant women,psychological aspect of high-risk pregnancy on pregnant women and caregivers,emotional and physical aspects of high-risk pregnancy,the consequences of high-risk pregnancy on the people around them and empowerment of high-risk pregnant women)”,“support dimension(family and community support for high-risk pregnant women)”,and“framework of program(acculturalization,means and equipment,security,manpower and the necessary arrangements for the home care)”.Conclusions:High-risk pregnancy affects various aspects of the lives of high-risk pregnant women and their families.Creating the necessary conditions for providing care at home plays a vital role in supporting high-risk pregnant women and removing related obstacles to receiving prenatal care in person.It will be especially beneficial for high-risk pregnant women in low-income areas.展开更多
Background: Gestational Diabetes Mellitus (GDM) poses significant risks to both mothers and fetuses, with an escalating global prevalence. This study addresses the critical need for timely GDM detection in high-risk p...Background: Gestational Diabetes Mellitus (GDM) poses significant risks to both mothers and fetuses, with an escalating global prevalence. This study addresses the critical need for timely GDM detection in high-risk pregnancies. By comparing the efficacy of the standard 28-week oral glucose tolerance test with an early 20-week screening, the research aims to enhance preventive interventions and minimise complications, contributing valuable insights for optimal GDM management in high-risk populations. Methodology: Conducted at Teaching Hospital Peradeniya, Sri Lanka, this prospective cohort study investigated early GDM diagnosis using a 20-week OGTT in high-risk pregnancies with negative booking screens. The research involved 385 singleton pregnancies, assessing risk factors like GDM history, family history of diabetes, macrosomia, BMI > 30 kg/m2, polycystic ovary syndrome, and advanced maternal age. The study included evaluating GDM incidence at 20 and 28 weeks, analysing risk factor associations, and determining the efficacy of early OGTT compared to routine testing. The data analysis aimed to establish the significance of a 20-week OGTT, identify the main contributory risk factors, and propose an optimal timing for GDM screening in high-risk pregnancies. Results: In the study involving 385 high-risk pregnant women, the incidence of gestational diabetes mellitus (GDM) was 7.27% at 20 weeks, 10.91% at 28 weeks, and 81.82% without GDM. Significant associations were found between GDM at 20 weeks, a history of GDM (78.57%), and a family history of diabetes (28.57%) (p = 0.011, 0.010 respectively). Notably, the McNemar test revealed no significant association between GDM cases at 20 and 28 weeks. Discussion and Conclusion: This study emphasises early diagnosis of GDM and evaluates outcomes of screening at 20 weeks in high-risk pregnancies. Effective GDM management mitigates short-term complications but raises concern about long-term impacts on offspring. Limited evidence prompts a call for further research to determine the optimal intervention window. Risk factors for early GDM include family history and prior GDM. Recommendations include refining screening protocols and conducting additional randomised trials. The study’s strengths lie in its comprehensive analysis, but limitations include its single-cohort nature. Future research should focus on personalised screening approaches and improve gestational age assessments. Overall, this study contributes to the ongoing discourse on early GDM management, highlighting the need for tailored prenatal care.展开更多
Objective:Given the unique cultural background,way of life,and physical environment of the Tibetan Plateau,this study aims to investigate the effects of health education using problem-based learning(PBL)approaches on ...Objective:Given the unique cultural background,way of life,and physical environment of the Tibetan Plateau,this study aims to investigate the effects of health education using problem-based learning(PBL)approaches on the knowledge,attitude,practice,and coping skills of women with high-risk pregnancies in this region.Methods:76 high-risk pregnancy cases were enrolled at Xizang’s Linzhi People’s Hospital between September 2023 and April 2024.30 patients admitted between September 2023 and December 2023 were selected as the control group and were performed with regular patient education.46 patients admitted between January 2024 and April 2024 were selected as the observation group and were performed regular patient education with problem-based learning approaches.Two groups’performance on their health knowledge,attitude,practice and coping skills before and after interventions were evaluated,and patient satisfaction were measured at the end of the study.Results:There was no statistical significance(P P P Conclusions:Health education with problem-based learning approaches is worth promoting as it can help high-risk pregnant women in plateau areas develop better health knowledge,attitude and practice and healthier coping skills.Also,it can improve patient sanctification.展开更多
In recent decades,maternal–fetal medicine has undergone substantial advancements in the management of high-risk pregnancies.These include enhanced prenatal screening and diagnosis facilitated by innovations in ultras...In recent decades,maternal–fetal medicine has undergone substantial advancements in the management of high-risk pregnancies.These include enhanced prenatal screening and diagnosis facilitated by innovations in ultrasound imaging,as well as the advances in fetal medical and interventional therapies informed by the deeper understanding of pathophysiological mechanisms underlying fetal and maternal disease processes.展开更多
Pregnant women with high-risk pregnancy face a higher risk of complications due to factors such as chronic diseases,multiple pregnancies,and a history of adverse pregnancy and childbirth,requiring more systematic and ...Pregnant women with high-risk pregnancy face a higher risk of complications due to factors such as chronic diseases,multiple pregnancies,and a history of adverse pregnancy and childbirth,requiring more systematic and dynamic health management support.In view of this,“Internet+continuous nursing”can break the limitations of time and space by integrating mobile communication,remote monitoring,data sharing,and intelligent analysis technologies,realizing closed-loop care with collaboration among hospitals,communities,and families.Research shows that continuous nursing based on the“Internet+”significantly improves the professional response ability of caregivers.Medical staff can grasp the patient’s status in real time,optimize diagnosis and treatment decisions,providing a feasible path for building an efficient,precise,and humanized high-risk pregnancy management system,which has broad clinical promotion value and public health significance.展开更多
Introduction: The association of sickle cell disease and pregnancy is a risky situation for the mother as well as the fetus and even the neonate. The objective of this work was to study the maternal and perinatal prog...Introduction: The association of sickle cell disease and pregnancy is a risky situation for the mother as well as the fetus and even the neonate. The objective of this work was to study the maternal and perinatal prognosis of pregnancies in women with sickle cell disease at CHUD-Borgou/Alibori from 2019 to 2023. Patients and Methods: This was a case-control study with a retrospective collection of data from January 1, 2019 to June 30, 2023. It covered sickle cell and non-sickle cell women and their neonates who having given birth at the maternity ward of CHUD-Borgou/Alibori. Results: The frequency of pregnant women with sickle cell disease was 1.36% (153/11212). The average age of the pregnant women with sickle cell disease was 26.77 years ± 5.03. Vaso-occlusive crisis (VOC) was the main complication observed in pregnant women with sickle cell disease during pregnancy (26%). Regarding the complications common to the 2 groups of pregnant women, urinary tract infections (18.1%), severe anemia (22.8%), and severe malaria (26.8%) were more reported in sickle cell patients with a statistically significant difference (p-value = 0.000). Delivery was premature in 61.9% of pregnant women with sickle cell disease compared to 18.5% in pregnant women without sickle cell disease, with a significant difference (p-value = 0.000). The main route of delivery among patients with sickle cell disease was cesarean section (94.4%), while it was vaginal delivery (50.4%) among non-sickle cell pregnant women. VOC (4.8%), severe anemia (39.7%), and acute pulmonary edema (2.4%) were the main complications reported among sickle cell pregnant women in the immediate postpartum period with a significant difference (p-value = 0.000). Three cases of maternal death (2.4%) were recorded in pregnant women with sickle cell disease. The neonatal pathologies identified in the neonates of pregnant women with and without sickle cell disease were mainly neonatal bacterial infection (20.0% vs. 17.2%), hypotrophy (17.0% vs. 5.7%), prematurity (14.8% vs. 7.3%) with a significant difference (p-value = 0.000). The perinatal mortality rate was 57.14‰ in sickle cell women compared to 30‰ with a significant difference (p-value = 0.000). Conclusion: Pregnancy in women with sickle cell disease carries a high risk of maternal and perinatal morbidity and mortality. Information, awareness raising among populations and the adaptation of prenatal care are essential.展开更多
BACKGROUND Complement-mediated thrombotic microangiopathy(TMA)is a rare endothelial injury syndrome caused by dysregulated activation of the alternative complement pathway,often linked to genetic abnormalities in comp...BACKGROUND Complement-mediated thrombotic microangiopathy(TMA)is a rare endothelial injury syndrome caused by dysregulated activation of the alternative complement pathway,often linked to genetic abnormalities in complement factor H(CFH),complement factor I,or complement factor H-related(CFHR)proteins.Both renal transplantation and pregnancy are independent triggers for recurrence.This case highlights a genetically high-risk patient who achieved a successful term pregnancy after renal transplantation without complement inhibition,emphasizing individualized risk stratification,close surveillance,and multidisciplinary management for favourable maternal and graft outcomes.CASE SUMMARY A 32-year-old woman with end-stage renal disease secondary to genetically confirmed complement-mediated TMA—homozygous CFH exon 17 deletion and CFHR3-CFHR1 duplication—was maintained on dialysis for 2.5 years before undergoing a successful live-donor kidney transplant from her mother.Post-transplant immunosuppression included tacrolimus,mycophenolate mofetil,and prednisolone,later modified to azathioprine during pregnancy planning.One-year post-transplant,she conceived spontaneously.Pregnancy was complicated by transient gestational hypertension,controlled with nifedipine,labetalol,and amlodipine.Proteinuria remained<150 mg/day;white blood cell counts 5.8-7.2×109/L without cytopenia.Serum creatinine ranged 0.9-1.1 mg/dL,and tacrolimus trough levels 5-7 ng/mL.At 36 weeks,she delivered a healthy 3 kg infant by elective caesarean section.Postpartum follow-up at three months confirmed stable maternal and graft function.CONCLUSION High-risk complement-mediated TMA patients can achieve successful pregnancy post-transplant through individualized care without mandatory complement blockade.展开更多
To inverstgate the safety, effectiveness and acceptability Of conbination Of mifepristone and misoproslol for termination of high-risk pregnancy (amenorrhea≤ 70 days ).Three hundred and eighty-eight high-risk pregnan...To inverstgate the safety, effectiveness and acceptability Of conbination Of mifepristone and misoproslol for termination of high-risk pregnancy (amenorrhea≤ 70 days ).Three hundred and eighty-eight high-risk pregnant women, complicated with scarreduterus, or reproductive tract malformation, or uterus fibromyoma, or histories of recentabortion or repeated abortions, or pregnancy during lactation, and having duration of gestation ranging from 34 to 69 days, were administered orally 150 mg mifepristone (50 mgat the first time, and then 25 mg q 12 h × 4), and 600 μg misoprostol on the third day.The complete abortion rate ωas 92. 3%, while the incomplete abortion rate was 6. 2%, ongoing and pregnancy rate was 1. 5%. It was shown that combination of mifepristone andmisoprostol was effective in inducing abortion Of those high-risk pregnancies. Theregimen's effectiveness for high-risk population was similar to that for general population. Its safety, effectiveness and acceptability were satifactory. In addition, the softenedand dilated cervix made it easier and less painful to make vacuum aspiration in case offailure of the abortion.展开更多
This study examined the misdiagnosis and delayed diagnosis factors for ectopic pregnancy（EP） and heterotopic pregnancy（HP） after in vitro fertilization and embryo transfer（IVF-ET） in an attempt to reduce the dia...This study examined the misdiagnosis and delayed diagnosis factors for ectopic pregnancy（EP） and heterotopic pregnancy（HP） after in vitro fertilization and embryo transfer（IVF-ET） in an attempt to reduce the diagnostic error. Clinical data of patients who underwent IVF-ET treatment and had clinical pregnancy from 12463 cycles were retrospectively analyzed. Their findings of serum β-hCG test and transvaginal ultrasonography were also obtained during follow-up. These patients were divided into two groups according to the diagnosis accuracy of EP/HP： early diagnosis and misdiagnosis/delayed diagnosis. The results showed that the incidence of EP and HP was 3.8%（125/3286） and 0.8%（27/3286） respectively for IVF/ICSI-ET cycle, and 3.8%（55/1431） and 0.7%（10/1431） respectively for frozen-thawed embryo transfer（FET） cycle. Ruptured EP occurred in 28 patients due to initial misdiagnosis or delayed diagnosis. Related factors fell in 3 categories：（1） clinician factors： misunderstanding of patients＇ medical history, insufficient training in ultrasonography and unawareness of EP and HP;（2） patient factors： noncompliance with medical orders and lack of communication with clinicians;（3） complicated conditions of EP： atypical symptoms, delayed elevation of serum β-hCG level, early rupture of cornual EP, asymptomatic in early gestation and pregnancy of unknown location. All the factors were interwoven, contributing to the occurrence of EP and HP. It was concluded that complicated conditions are more likely to affect the diagnosis accuracy of EP/HP after IVF-ET. Transvaginal ultrasonography should be performed at 5 weeks of gestation. Intensive follow-up including repeated ultrasonography and serial serum β-hCG tests should be performed in patients with a suspicious diagnosis at admission.展开更多
OBJECTIVE: To investigate whether female sub-health conditions and reproductive diseases areassociated with pregnancies and labors.METHODS: A cross-sectional survey was performed by using a structured questionnaire. A...OBJECTIVE: To investigate whether female sub-health conditions and reproductive diseases areassociated with pregnancies and labors.METHODS: A cross-sectional survey was performed by using a structured questionnaire. A total of 1343 women aged 35 years or younger in six urban areas of Chengdu were included in the study.According to the Screening Criteria of sub-health conditions, these women were categorized into three groups: postpartum healthy group,sub-healthy group, and reproductive disease group. Data were double-entered using EpiData and the nanalyzed by SPSS.RESULTS: Pregnancy and labor were correlated with postpartum sub-health conditions. The number of pregnancies was negatively correlated with women's postnatal health but was positively correlated with the incidence of postpartum reproductive diseases.CONCLUSION: The number of pregnancies and labors is probably an important factor leading to sub-health conditions and the occurrence of reproductive diseases in women. Avoiding or reducing unwanted pregnancies and labors, enhancing the awareness of health among child bearing-age women are effective measures for preventing sub-health conditions.展开更多
Objective: We aimed to evaluate the relationship between chorionicity, placental abnormalities and necrotizing enterocolitis in multiple pregnancies. We hypothesized that unbalanced interfetal transfusion through vasc...Objective: We aimed to evaluate the relationship between chorionicity, placental abnormalities and necrotizing enterocolitis in multiple pregnancies. We hypothesized that unbalanced interfetal transfusion through vascular anastomoses in monochorionic placentation causes hypoperfusion of the intestinal mucosa, increasing the risk of developing necrotizing enterocolitis. Material and methods: All women with multiple pregnancies who delivered at the University Medical Center Utrecht between January 1995 and December 2015 were retrospectively selected. We compared baseline characteristics and neonatal and maternal outcomes. Secondly, we analyzed ultrasound and placental pathology findings of monochorionic multiples with and without necrotizing enterocolitis. Finally, we compared illness characteristics of necrotizing enterocolitis in monochorionic multiples with necrotizing enterocolitis in dichorionic multiples. Results: We included 2859 dichorionic and 817 monochorionic neonates. Necrotizing enterocolitis occurred significantly more often in monochorionic as compared to dichorionic neonates (3.3% and 1.6% respectively), also after correction for birthweight, gestational age and nulliparity (OR 1.7, 95% CI 1.0 - 2.8). Ultrasound abnormalities were not associated with necrotizing enterocolitis. Histopathology showed that necrotizing enterocolitis was significantly associated with the presence of unbalanced interfetal transfusion (76.9% of monochorionic with necrotizing enterocolitis versus 31.4% of cases without necrotizing enterocolitis, P = 0.001). Conclusion: Necrotizing enterocolitis is more common in monochorionic multiples as compared to dichorionic multiples, at least in part due to the presence of and related to the presence of unbalanced interfetal transfusion through arterial-venous anastomoses in the placenta. Possibly, subtle ischemic damage caused by intra-uterine fetal hypotension or anemia plays a key role in the development of necrotizing enterocolitis in monochorionic twins.展开更多
Through systematic experimental and clinical studies,the physiological regulation of utero-placental circulation and the relation of the disturbance in this acirculation to pathogenic mechanisms of high risk pregnanci...Through systematic experimental and clinical studies,the physiological regulation of utero-placental circulation and the relation of the disturbance in this acirculation to pathogenic mechanisms of high risk pregnancies-Intrauterine Growth Retardation (IUfGR)and Pregnancy-induced hypertension(PIH) were explored.The pharmacological effects and mechanism of a Chinese herbal medicine-Qingxintong in improving the uteroplacental circulation and the therapeutic efficacy in treatment of IUGR and PIH,both accompanied by disturbance of utero-placental circulation.were investigated as well.展开更多
BACKGROUND Low-grade endometrial stromal sarcoma(LGESS)is a rare indolent tumor with a favorable prognosis.With the importance of improving quality of life recognized,fertility-sparing surgery may be an option for tho...BACKGROUND Low-grade endometrial stromal sarcoma(LGESS)is a rare indolent tumor with a favorable prognosis.With the importance of improving quality of life recognized,fertility-sparing surgery may be an option for those young women.However,most of the reports suggested that stage IA patients might be candidates for fertility-sparing surgery,and adjuvant hormonal treatment was considered a feasible adjuvant therapy for reducing the recurrence risk of patients with LGESS and hysterectomy was recommended after the completion of pregnancy and delivery.CASE SUMMARY A 28-year-old pregnant woman diagnosed with stage IB LGESS was treated by fertility-sparing surgery when term cesarean section delivery was performed.Without any adjuvant treatment,she had the other successful term pregnancy and cesarean section 45 mo after first fertility-sparing surgery.Moreover,only hysteroscopic resection was performed to retain fertility again even when the tumor recurred after 6 years.So far the patient’s fertility and disease-free status have remained for more than 8 years without any adjuvant therapy despite local resection of the sarcoma.And the two babies were in good health.CONCLUSION For young patients with stage I LGESS,it seems that repeated fertility-sparing surgeries could be performed even after two term deliveries and the tumor recurrence,and it might be attempted without adjuvant therapy but the counseling should be considered as mandatory.展开更多
Aims: Although the copper intrauterine device (Cu-IUD) is an effective contraceptive device, cases of pregnancy under the Cu-IUD have been reported. We here report 10 women who got pregnant under this condition, with ...Aims: Although the copper intrauterine device (Cu-IUD) is an effective contraceptive device, cases of pregnancy under the Cu-IUD have been reported. We here report 10 women who got pregnant under this condition, with special reference to etiologies and pregnancy outcomes. Methodology: We analyzed all women who got pregnant under Cu-IUD at ATBEF Main Clinic from July 1, 2015 to June 30, 2020. Results: We retrieved 10 patients. The durations of Cu-IUD use were 3 months to 6 years. The etiologies were poor insertion;migration and spontaneous expulsion. The occurrence of pregnancy was poorly accepted by the women: 20% of women considered it was due to the providers’ incompetence. Of the 10 pregnancies, 5 women had given vaginal birth spontaneously;2 induced abortions, 2 spontaneous abortions and 1 ectopic pregnancy. The contraceptive method adopted after pregnancy was jadelle implants in 8 cases and spousal vasectomy in 2 cases. Conclusion: The prevention of IUD pregnancies may require adequate insertion time, insertion technique and follow-up.展开更多
Intrapartum maternal normoglycemia seems to play an important role in the prevention of adverse perinatal, maternal and neonatal outcomes. Several glucose monitoring protocols have been developed, aiming to achieve a ...Intrapartum maternal normoglycemia seems to play an important role in the prevention of adverse perinatal, maternal and neonatal outcomes. Several glucose monitoring protocols have been developed, aiming to achieve a tight glucose monitoring and control. Depending on the type of diabetes and the optimal or suboptimal glycemic control, the treatment options include fasting status of the parturient, frequent monitoring of capillary blood glucose, intravenous dextrose infusion and subcutaneous or intravenous use of insulin. Continuous glucose monitoring system(CGMS) is a relatively new technology that measures interstitial glucose at very short time intervals over a specifi c period of time. The resulting profi le provides a more comprehensive measure of glycemic excursions than intermittent home blood glucose monitoring. Results of studies applying the CGMS technology in patients with or without diabetes mellitus(DM) have revealed new insights in glucose metabolism. Moreover, CGMS have a potential role in the improvement of glycemic control during pregnancy and labor, which may lead to a decrease in perinatal morbidity and mortality. In conclusion, the use of CGMS, with its important technical advantages compared to the conventional way of monitoring, may lead into a more etiological intrapartum management of both the mother and her fetus/infant in pregnancies complicated with DM.展开更多
BACKGROUND A twin pregnancy can carry greater risks than singleton pregnancies.About 60 in 100 twin pregnancies result in spontaneous birth before 37 wk,which is associated with several complications in the premature ...BACKGROUND A twin pregnancy can carry greater risks than singleton pregnancies.About 60 in 100 twin pregnancies result in spontaneous birth before 37 wk,which is associated with several complications in the premature babies.Clinical detection of biomarkers may help to predict the possibility of premature birth so that corresponding interventions can be given to the pregnant women in a timely manner,in order to reduce the risk of preterm birth and improve the outcomes of the newborn infants.AIM To explore the clinical value of transvaginal ultrasound measurement of cervical length combined with insulin-like growth factor binding protein-1(IGFBP-1)hyperphosphorylation in cervical secretions as predictors of preterm delivery in twin pregnancies.METHODS A total of 254 pregnant women with twin pregnancies,who were admitted to Hainan General Hospital and underwent maternity examination,were selected as the study subjects from January 2015 to December 2018.All participants received transvaginal ultrasound measurement of cervical length and phosphorylated IGFBP-1(phIGFBP-1)test between 24 and 34 wk gestation.The pregnancy outcomes were analyzed.RESULTS Of the women with a positive phIGFBP-1 test result,preterm birth rate was higher in those with a cervical length≤25 mm than those with a cervical length>25 mm(all P<0.05).Similarly,in women with a negative phIGFBP-1 test result,preterm birth rate was higher in those with a cervical length≤25 mm than those with a cervical length>25 mm(all P<0.05).The sensitivity,specificity,and positive and negative predictive values of the phIGFBP-1 test combined with the cervical length test were 95.71%,91.21%,95.12%and 92.22%,respectively,for the prediction of preterm birth.CONCLUSION Cervical length combined with phIGFBP-1 tests is of value for the prediction of outcomes of preterm delivery in twin pregnancies.展开更多
AIM:To describe maternity and newborn charges for an economic analysis of surrogate pregnancies on the health care resource utilization.METHODS:A retrospective chart review of all women identified as being surrogates ...AIM:To describe maternity and newborn charges for an economic analysis of surrogate pregnancies on the health care resource utilization.METHODS:A retrospective chart review of all women identified as being surrogates and the infants born from these pregnancies was performed between January 1,2012 and December 31,2013.Selected maternity diagnoses,mode of delivery,duration of hospitalization,and hospital charges were collected together with infants' birth weights,gestational age,length of hospital stay,and hospital charges.Charges associated with the in vitro fertilization cycles,artificial insemination,or embryo(s)transfer into the surrogate were not considered in the maternity charges.A ratio contrasting the maternity hospital charges for the surrogate carrier was compared as a ratio to the mean charges for 2540 infants delivered in 2013 after naturalconception and adjusted to the baseline hospital charges for both maternity and newborn care.RESULTS:Analysis of sixty-nine infants delivered from both gestational and traditional surrogate women found an increased in multiple births,NICU admission,and length of stay with hospital charges several multiples beyond that of a term infant conceived naturally and provided care in our nursery.Among singletons and twins(per infant)hospital charges were increased 26 times(P < 0.001)and in triplets charges were increased 173 times(P < 0.0001)when compared to a term infant provided care in a normal nursery at our center.CONCLUSION:Maternity costs for surrogates exceed those of women who conceive naturally,and these costs are especially magnified in women with triplets and multiple births.展开更多
BACKGROUND There are many drawbacks to the traditional midwifery service management model,which can no longer meet the needs of the new era.The Internet+continuous midwifery service management model extends maternal m...BACKGROUND There are many drawbacks to the traditional midwifery service management model,which can no longer meet the needs of the new era.The Internet+continuous midwifery service management model extends maternal management from prenatal to postpartum,in-hospital to out-of-hospital,and offline to online,thereby improving maternal and infant outcomes.Applying the Internet+continuous midwifery service management model to manage women with highrisk pregnancies(HRP)can improve their psycho-emotional opinion and,in turn,minimize the risk of adverse maternal and/or fetal outcomes.AIM To explore the effectiveness of a midwife-led Internet+continuous midwifery service model for women with HRP.METHODS We retrospectively analyzed the clinical data of 439 women with HRP who underwent prenatal examination and delivered at Shanghai Sixth People's Hospital(affiliated to the Shanghai Jiao Tong University School of Medicine)from April to December 2022.Among them,239 pregnant women underwent routine obstetric management,and 200 pregnant women underwent Internet+continuous midwifery service mode management.We used the State-Trait Anxiety Inventory,Edinburgh Postnatal Depression Scale,and analysis of delivery outcomes to compare psychological mood and the incidence of adverse delivery outcomes between the two groups.RESULTS The data showed that in early pregnancy,the anxiety and depression levels of the two groups were similar;the levels gradually decreased as pregnancy progressed,and the decrease in the continuous group was more significant[31.00(29.00,34.00)vs 34.00(32.00,37.00),8.00(6.00,9.00)vs 12.00(10.00,13.00),P<0.05].The maternal self-efficacy level and strategy for weight gain management were better in the continuous group than in the traditional group,and the effective rate of midwifery service intervention in the continuous group was significantly higher than in the control group[267.50(242.25,284.75)vs 256.00(233.00,278.00),74.00(69.00,78.00)vs 71.00(63.00,78.00),P<0.05].The incidence of adverse delivery outcomes in pregnant women and newborns and fear of maternal childbirth were lower in the continuous group than in the traditional group,and nursing satisfaction was higher[10.50%vs 18.83%,8.50%vs 15.90%,24.00%vs 42.68%,89.50%vs 76.15%,P<0.05].CONCLUSION The Internet+continuous midwifery service model promotes innovation through integration and is of great significance for improving and promoting maternal and child health in HRP.展开更多
Background: Pregnancies progressing postterm are associated with a higher perinatal morbidity and mortality rates than those delivered at term. In a United Kingdom study, the rate of stillbirth increased from 0.35 in ...Background: Pregnancies progressing postterm are associated with a higher perinatal morbidity and mortality rates than those delivered at term. In a United Kingdom study, the rate of stillbirth increased from 0.35 in 1000 live births in pregnancies of 37 weeks to 2.12 in 1000 live births in pregnancies of 43 weeks gestation. Morbidities associated with postterm births include an increased risk of fetal distress, intrauterine growth restriction, dysfunctional labor, shoulder dystocia, obstetric trauma (relative risk 1.09 - 1.68) and an increase in perinatal complications, such as aspiration of meconium and asphyxia, peripheral nerve injury, greenstick bone fractures, pneumonia and septicemia (adjusted odds ratio 1.4 - 2.0). Antenatal surveillance and induction of labor may decrease the risks of an adverse outcome. In a recent review of term and postterm pregnancies in Norway, we found that there were adverse outcomes associated with both postterm pregnancy and induction of labor independently. On comparison of the two, a randomized controlled trial showed no difference in their neonatal outcome, but demonstrated a reduction in the cesarean delivery rate when labor was induced at 41 weeks. Aim of the Work: The aim of this study was to determine the effect of labor induction on maternal and fetal outcome in postterm pregnancies. Subjects and Methods: This study was carried out on 150 pregnant women who had completed 41 weeks of gestation between Jun. 1, 2012 up to Dec. 31, 2012 at Department of Obstetrics & Gynecology, Faculty of Medicine, Benghazi University, and were scheduled for induction of labor after cardiotocography (CTG) and ultrasonography (USS) have been done and Bishop’s score assessed, to determine the effects of labor induction on maternal and fetal outcome in postterm pregnancies (41 weeks plus). Results: Regarding the relationship between a history of (H/O) postdatism and fetal distress, it was found that there was no significant relationship between them. There was a significant relationship between a history of macrosomia and fetal distress. There was a significant relationship between instrumental delivery and fetal distress. The majority of the fetal distress had an indication for Caesarean section (CS) (fetal distress (FD) and fetal distress meconium (FDM) more than those without fetal distress. All fetuses that had APGAR scores of 8 were distressed. There was a significant relationship between the APGAR score at 10 minutes with fetal distress. All fetuses that had meconium aspiration had fetal distress. There was a significant increase in the amount of oxytocin in unit in distressed cases than the non-distressed ones. The total duration of induction was also significantly increased in stressed fetuses than the non-stressed ones. There was a significant increase in the weight of distressed fetuses than the non-distressed. Conclusions: In conclusion, there was no difference in the neonatal outcome or mode of delivery for postterm pregnancies managed either by immediate induction of labor or expectantly with serial antenatal surveillance. The outcomes were generally good, and neonatal morbidity, cesarean section, and operative vaginal delivery rates were low. If pregnancy is uncomplicated and continued surveillance is possible, women’s own wishes may guide the decision to induce or monitor a pregnancy beyond 41 weeks.展开更多
文摘Background:Loneliness is a common experience for pregnant women and correlates with perinatal depression and negative pregnancy outcomes.Women experiencing a high-risk pregnancy are at greater risk for loneliness because of uncertainty with disease and the medicalization of pregnancy.International studies have identified an association between perceived stress and loneliness in pregnant women.The aim of this study is to explore factors related to loneliness among women of high-risk pregnancy,and to examine the associated relationship of loneliness and perceived stress.Methods:Using convenience sampling,109 women with high-risk pregnancies were enrolled.Data collection involved questionnaires on general demographic characteristics,the 6-item Loneliness Scale(ULS-6),and the Chinese version of the Perceived Stress Scale(CPSS-14).Data analysis was performed using SPSS 28.0 statistical software.Results:The mean loneliness score was 9.95±2.99,and the mean perceived stress score was 22.84±5.80.Women with high-risk pregnancies exhibited statistically significant differences in loneliness scores compared to the control group across among age,marital status,educational attainment,per capita monthly household income,spousal relationship,in-law relationship,and parental relationship(P<0.05).Correlation analysis revealed a positive correlation between loneliness and perceived stress(r=0.456,P<0.01).Multivariate regression analysis indicated that per capita monthly household income,marital relationship,in-law relationship,and perceived stress were the primary factors influencing loneliness among women with high-risk pregnancies(P<0.05).Conclusion:The results highlight the need for specific interventions addressing loneliness among women with high-risk pregnancies.Such interventions should focus on improving spousal and in-law relationships,reducing perceived stress,and implementing support measures,such as financial counseling or assistance programs,for those with lower per capita household income.This study establishes a foundation for the creation of integrated support systems that bring together families and healthcare providers to strengthen maternal mental health.
文摘Objective:To explore the perspectives of high-risk pregnant women regarding the home care program for high-risk pregnancies.Methods:This qualitative study was conducted in a university hospital and 5 comprehensive health centers in Ahvaz,Iran,from February 2023 to July 2023.The sampling method used was purposive sampling considering the maximum possible diversity,which continued until data saturation.11 in-depth and semistructured interviews were conducted with high-risk pregnant women.Data were simultaneously analysed using Graneheim and Lundman content analysis by MAXQDA version 20 software.Results:Data analysis extracted 3 themes,12 categories,and 26 subcategories.The themes and categories were“high-risk pregnancy and related issues(pursuing treatment and paying attention to the high-risk situation by pregnant women,psychological aspect of high-risk pregnancy on pregnant women and caregivers,emotional and physical aspects of high-risk pregnancy,the consequences of high-risk pregnancy on the people around them and empowerment of high-risk pregnant women)”,“support dimension(family and community support for high-risk pregnant women)”,and“framework of program(acculturalization,means and equipment,security,manpower and the necessary arrangements for the home care)”.Conclusions:High-risk pregnancy affects various aspects of the lives of high-risk pregnant women and their families.Creating the necessary conditions for providing care at home plays a vital role in supporting high-risk pregnant women and removing related obstacles to receiving prenatal care in person.It will be especially beneficial for high-risk pregnant women in low-income areas.
文摘Background: Gestational Diabetes Mellitus (GDM) poses significant risks to both mothers and fetuses, with an escalating global prevalence. This study addresses the critical need for timely GDM detection in high-risk pregnancies. By comparing the efficacy of the standard 28-week oral glucose tolerance test with an early 20-week screening, the research aims to enhance preventive interventions and minimise complications, contributing valuable insights for optimal GDM management in high-risk populations. Methodology: Conducted at Teaching Hospital Peradeniya, Sri Lanka, this prospective cohort study investigated early GDM diagnosis using a 20-week OGTT in high-risk pregnancies with negative booking screens. The research involved 385 singleton pregnancies, assessing risk factors like GDM history, family history of diabetes, macrosomia, BMI > 30 kg/m2, polycystic ovary syndrome, and advanced maternal age. The study included evaluating GDM incidence at 20 and 28 weeks, analysing risk factor associations, and determining the efficacy of early OGTT compared to routine testing. The data analysis aimed to establish the significance of a 20-week OGTT, identify the main contributory risk factors, and propose an optimal timing for GDM screening in high-risk pregnancies. Results: In the study involving 385 high-risk pregnant women, the incidence of gestational diabetes mellitus (GDM) was 7.27% at 20 weeks, 10.91% at 28 weeks, and 81.82% without GDM. Significant associations were found between GDM at 20 weeks, a history of GDM (78.57%), and a family history of diabetes (28.57%) (p = 0.011, 0.010 respectively). Notably, the McNemar test revealed no significant association between GDM cases at 20 and 28 weeks. Discussion and Conclusion: This study emphasises early diagnosis of GDM and evaluates outcomes of screening at 20 weeks in high-risk pregnancies. Effective GDM management mitigates short-term complications but raises concern about long-term impacts on offspring. Limited evidence prompts a call for further research to determine the optimal intervention window. Risk factors for early GDM include family history and prior GDM. Recommendations include refining screening protocols and conducting additional randomised trials. The study’s strengths lie in its comprehensive analysis, but limitations include its single-cohort nature. Future research should focus on personalised screening approaches and improve gestational age assessments. Overall, this study contributes to the ongoing discourse on early GDM management, highlighting the need for tailored prenatal care.
基金Leading Specialist Construction Project-Department of the First Affiliated Hospital,Jinan University(2022225).
文摘Objective:Given the unique cultural background,way of life,and physical environment of the Tibetan Plateau,this study aims to investigate the effects of health education using problem-based learning(PBL)approaches on the knowledge,attitude,practice,and coping skills of women with high-risk pregnancies in this region.Methods:76 high-risk pregnancy cases were enrolled at Xizang’s Linzhi People’s Hospital between September 2023 and April 2024.30 patients admitted between September 2023 and December 2023 were selected as the control group and were performed with regular patient education.46 patients admitted between January 2024 and April 2024 were selected as the observation group and were performed regular patient education with problem-based learning approaches.Two groups’performance on their health knowledge,attitude,practice and coping skills before and after interventions were evaluated,and patient satisfaction were measured at the end of the study.Results:There was no statistical significance(P P P Conclusions:Health education with problem-based learning approaches is worth promoting as it can help high-risk pregnant women in plateau areas develop better health knowledge,attitude and practice and healthier coping skills.Also,it can improve patient sanctification.
文摘In recent decades,maternal–fetal medicine has undergone substantial advancements in the management of high-risk pregnancies.These include enhanced prenatal screening and diagnosis facilitated by innovations in ultrasound imaging,as well as the advances in fetal medical and interventional therapies informed by the deeper understanding of pathophysiological mechanisms underlying fetal and maternal disease processes.
文摘Pregnant women with high-risk pregnancy face a higher risk of complications due to factors such as chronic diseases,multiple pregnancies,and a history of adverse pregnancy and childbirth,requiring more systematic and dynamic health management support.In view of this,“Internet+continuous nursing”can break the limitations of time and space by integrating mobile communication,remote monitoring,data sharing,and intelligent analysis technologies,realizing closed-loop care with collaboration among hospitals,communities,and families.Research shows that continuous nursing based on the“Internet+”significantly improves the professional response ability of caregivers.Medical staff can grasp the patient’s status in real time,optimize diagnosis and treatment decisions,providing a feasible path for building an efficient,precise,and humanized high-risk pregnancy management system,which has broad clinical promotion value and public health significance.
文摘Introduction: The association of sickle cell disease and pregnancy is a risky situation for the mother as well as the fetus and even the neonate. The objective of this work was to study the maternal and perinatal prognosis of pregnancies in women with sickle cell disease at CHUD-Borgou/Alibori from 2019 to 2023. Patients and Methods: This was a case-control study with a retrospective collection of data from January 1, 2019 to June 30, 2023. It covered sickle cell and non-sickle cell women and their neonates who having given birth at the maternity ward of CHUD-Borgou/Alibori. Results: The frequency of pregnant women with sickle cell disease was 1.36% (153/11212). The average age of the pregnant women with sickle cell disease was 26.77 years ± 5.03. Vaso-occlusive crisis (VOC) was the main complication observed in pregnant women with sickle cell disease during pregnancy (26%). Regarding the complications common to the 2 groups of pregnant women, urinary tract infections (18.1%), severe anemia (22.8%), and severe malaria (26.8%) were more reported in sickle cell patients with a statistically significant difference (p-value = 0.000). Delivery was premature in 61.9% of pregnant women with sickle cell disease compared to 18.5% in pregnant women without sickle cell disease, with a significant difference (p-value = 0.000). The main route of delivery among patients with sickle cell disease was cesarean section (94.4%), while it was vaginal delivery (50.4%) among non-sickle cell pregnant women. VOC (4.8%), severe anemia (39.7%), and acute pulmonary edema (2.4%) were the main complications reported among sickle cell pregnant women in the immediate postpartum period with a significant difference (p-value = 0.000). Three cases of maternal death (2.4%) were recorded in pregnant women with sickle cell disease. The neonatal pathologies identified in the neonates of pregnant women with and without sickle cell disease were mainly neonatal bacterial infection (20.0% vs. 17.2%), hypotrophy (17.0% vs. 5.7%), prematurity (14.8% vs. 7.3%) with a significant difference (p-value = 0.000). The perinatal mortality rate was 57.14‰ in sickle cell women compared to 30‰ with a significant difference (p-value = 0.000). Conclusion: Pregnancy in women with sickle cell disease carries a high risk of maternal and perinatal morbidity and mortality. Information, awareness raising among populations and the adaptation of prenatal care are essential.
文摘BACKGROUND Complement-mediated thrombotic microangiopathy(TMA)is a rare endothelial injury syndrome caused by dysregulated activation of the alternative complement pathway,often linked to genetic abnormalities in complement factor H(CFH),complement factor I,or complement factor H-related(CFHR)proteins.Both renal transplantation and pregnancy are independent triggers for recurrence.This case highlights a genetically high-risk patient who achieved a successful term pregnancy after renal transplantation without complement inhibition,emphasizing individualized risk stratification,close surveillance,and multidisciplinary management for favourable maternal and graft outcomes.CASE SUMMARY A 32-year-old woman with end-stage renal disease secondary to genetically confirmed complement-mediated TMA—homozygous CFH exon 17 deletion and CFHR3-CFHR1 duplication—was maintained on dialysis for 2.5 years before undergoing a successful live-donor kidney transplant from her mother.Post-transplant immunosuppression included tacrolimus,mycophenolate mofetil,and prednisolone,later modified to azathioprine during pregnancy planning.One-year post-transplant,she conceived spontaneously.Pregnancy was complicated by transient gestational hypertension,controlled with nifedipine,labetalol,and amlodipine.Proteinuria remained<150 mg/day;white blood cell counts 5.8-7.2×109/L without cytopenia.Serum creatinine ranged 0.9-1.1 mg/dL,and tacrolimus trough levels 5-7 ng/mL.At 36 weeks,she delivered a healthy 3 kg infant by elective caesarean section.Postpartum follow-up at three months confirmed stable maternal and graft function.CONCLUSION High-risk complement-mediated TMA patients can achieve successful pregnancy post-transplant through individualized care without mandatory complement blockade.
文摘To inverstgate the safety, effectiveness and acceptability Of conbination Of mifepristone and misoproslol for termination of high-risk pregnancy (amenorrhea≤ 70 days ).Three hundred and eighty-eight high-risk pregnant women, complicated with scarreduterus, or reproductive tract malformation, or uterus fibromyoma, or histories of recentabortion or repeated abortions, or pregnancy during lactation, and having duration of gestation ranging from 34 to 69 days, were administered orally 150 mg mifepristone (50 mgat the first time, and then 25 mg q 12 h × 4), and 600 μg misoprostol on the third day.The complete abortion rate ωas 92. 3%, while the incomplete abortion rate was 6. 2%, ongoing and pregnancy rate was 1. 5%. It was shown that combination of mifepristone andmisoprostol was effective in inducing abortion Of those high-risk pregnancies. Theregimen's effectiveness for high-risk population was similar to that for general population. Its safety, effectiveness and acceptability were satifactory. In addition, the softenedand dilated cervix made it easier and less painful to make vacuum aspiration in case offailure of the abortion.
基金supported by the National Natural Science Foundation of China(No.81170574)the National Key Basic Research Development Plan of China(973 Program)(No.2007CB948104)+1 种基金Key Science and Technology Projects of Guangzhou(No.11C22120737)Comprehensive Strategic Sciences Cooperation Projects of Guangdong Province and Chinese Academy(No.04020416)
文摘This study examined the misdiagnosis and delayed diagnosis factors for ectopic pregnancy（EP） and heterotopic pregnancy（HP） after in vitro fertilization and embryo transfer（IVF-ET） in an attempt to reduce the diagnostic error. Clinical data of patients who underwent IVF-ET treatment and had clinical pregnancy from 12463 cycles were retrospectively analyzed. Their findings of serum β-hCG test and transvaginal ultrasonography were also obtained during follow-up. These patients were divided into two groups according to the diagnosis accuracy of EP/HP： early diagnosis and misdiagnosis/delayed diagnosis. The results showed that the incidence of EP and HP was 3.8%（125/3286） and 0.8%（27/3286） respectively for IVF/ICSI-ET cycle, and 3.8%（55/1431） and 0.7%（10/1431） respectively for frozen-thawed embryo transfer（FET） cycle. Ruptured EP occurred in 28 patients due to initial misdiagnosis or delayed diagnosis. Related factors fell in 3 categories：（1） clinician factors： misunderstanding of patients＇ medical history, insufficient training in ultrasonography and unawareness of EP and HP;（2） patient factors： noncompliance with medical orders and lack of communication with clinicians;（3） complicated conditions of EP： atypical symptoms, delayed elevation of serum β-hCG level, early rupture of cornual EP, asymptomatic in early gestation and pregnancy of unknown location. All the factors were interwoven, contributing to the occurrence of EP and HP. It was concluded that complicated conditions are more likely to affect the diagnosis accuracy of EP/HP after IVF-ET. Transvaginal ultrasonography should be performed at 5 weeks of gestation. Intensive follow-up including repeated ultrasonography and serial serum β-hCG tests should be performed in patients with a suspicious diagnosis at admission.
基金Supported by The correlation research between maternal reproductive health and kidney,Sichuan Provincial Science and Technology Department of China(No.2006j13-003)
文摘OBJECTIVE: To investigate whether female sub-health conditions and reproductive diseases areassociated with pregnancies and labors.METHODS: A cross-sectional survey was performed by using a structured questionnaire. A total of 1343 women aged 35 years or younger in six urban areas of Chengdu were included in the study.According to the Screening Criteria of sub-health conditions, these women were categorized into three groups: postpartum healthy group,sub-healthy group, and reproductive disease group. Data were double-entered using EpiData and the nanalyzed by SPSS.RESULTS: Pregnancy and labor were correlated with postpartum sub-health conditions. The number of pregnancies was negatively correlated with women's postnatal health but was positively correlated with the incidence of postpartum reproductive diseases.CONCLUSION: The number of pregnancies and labors is probably an important factor leading to sub-health conditions and the occurrence of reproductive diseases in women. Avoiding or reducing unwanted pregnancies and labors, enhancing the awareness of health among child bearing-age women are effective measures for preventing sub-health conditions.
文摘Objective: We aimed to evaluate the relationship between chorionicity, placental abnormalities and necrotizing enterocolitis in multiple pregnancies. We hypothesized that unbalanced interfetal transfusion through vascular anastomoses in monochorionic placentation causes hypoperfusion of the intestinal mucosa, increasing the risk of developing necrotizing enterocolitis. Material and methods: All women with multiple pregnancies who delivered at the University Medical Center Utrecht between January 1995 and December 2015 were retrospectively selected. We compared baseline characteristics and neonatal and maternal outcomes. Secondly, we analyzed ultrasound and placental pathology findings of monochorionic multiples with and without necrotizing enterocolitis. Finally, we compared illness characteristics of necrotizing enterocolitis in monochorionic multiples with necrotizing enterocolitis in dichorionic multiples. Results: We included 2859 dichorionic and 817 monochorionic neonates. Necrotizing enterocolitis occurred significantly more often in monochorionic as compared to dichorionic neonates (3.3% and 1.6% respectively), also after correction for birthweight, gestational age and nulliparity (OR 1.7, 95% CI 1.0 - 2.8). Ultrasound abnormalities were not associated with necrotizing enterocolitis. Histopathology showed that necrotizing enterocolitis was significantly associated with the presence of unbalanced interfetal transfusion (76.9% of monochorionic with necrotizing enterocolitis versus 31.4% of cases without necrotizing enterocolitis, P = 0.001). Conclusion: Necrotizing enterocolitis is more common in monochorionic multiples as compared to dichorionic multiples, at least in part due to the presence of and related to the presence of unbalanced interfetal transfusion through arterial-venous anastomoses in the placenta. Possibly, subtle ischemic damage caused by intra-uterine fetal hypotension or anemia plays a key role in the development of necrotizing enterocolitis in monochorionic twins.
文摘Through systematic experimental and clinical studies,the physiological regulation of utero-placental circulation and the relation of the disturbance in this acirculation to pathogenic mechanisms of high risk pregnancies-Intrauterine Growth Retardation (IUfGR)and Pregnancy-induced hypertension(PIH) were explored.The pharmacological effects and mechanism of a Chinese herbal medicine-Qingxintong in improving the uteroplacental circulation and the therapeutic efficacy in treatment of IUGR and PIH,both accompanied by disturbance of utero-placental circulation.were investigated as well.
基金Supported by Open Foundation of Key Laboratory of Birth Regulation and Control Technology of National Health Commission of China,No.2018KF003.
文摘BACKGROUND Low-grade endometrial stromal sarcoma(LGESS)is a rare indolent tumor with a favorable prognosis.With the importance of improving quality of life recognized,fertility-sparing surgery may be an option for those young women.However,most of the reports suggested that stage IA patients might be candidates for fertility-sparing surgery,and adjuvant hormonal treatment was considered a feasible adjuvant therapy for reducing the recurrence risk of patients with LGESS and hysterectomy was recommended after the completion of pregnancy and delivery.CASE SUMMARY A 28-year-old pregnant woman diagnosed with stage IB LGESS was treated by fertility-sparing surgery when term cesarean section delivery was performed.Without any adjuvant treatment,she had the other successful term pregnancy and cesarean section 45 mo after first fertility-sparing surgery.Moreover,only hysteroscopic resection was performed to retain fertility again even when the tumor recurred after 6 years.So far the patient’s fertility and disease-free status have remained for more than 8 years without any adjuvant therapy despite local resection of the sarcoma.And the two babies were in good health.CONCLUSION For young patients with stage I LGESS,it seems that repeated fertility-sparing surgeries could be performed even after two term deliveries and the tumor recurrence,and it might be attempted without adjuvant therapy but the counseling should be considered as mandatory.
文摘Aims: Although the copper intrauterine device (Cu-IUD) is an effective contraceptive device, cases of pregnancy under the Cu-IUD have been reported. We here report 10 women who got pregnant under this condition, with special reference to etiologies and pregnancy outcomes. Methodology: We analyzed all women who got pregnant under Cu-IUD at ATBEF Main Clinic from July 1, 2015 to June 30, 2020. Results: We retrieved 10 patients. The durations of Cu-IUD use were 3 months to 6 years. The etiologies were poor insertion;migration and spontaneous expulsion. The occurrence of pregnancy was poorly accepted by the women: 20% of women considered it was due to the providers’ incompetence. Of the 10 pregnancies, 5 women had given vaginal birth spontaneously;2 induced abortions, 2 spontaneous abortions and 1 ectopic pregnancy. The contraceptive method adopted after pregnancy was jadelle implants in 8 cases and spousal vasectomy in 2 cases. Conclusion: The prevention of IUD pregnancies may require adequate insertion time, insertion technique and follow-up.
文摘Intrapartum maternal normoglycemia seems to play an important role in the prevention of adverse perinatal, maternal and neonatal outcomes. Several glucose monitoring protocols have been developed, aiming to achieve a tight glucose monitoring and control. Depending on the type of diabetes and the optimal or suboptimal glycemic control, the treatment options include fasting status of the parturient, frequent monitoring of capillary blood glucose, intravenous dextrose infusion and subcutaneous or intravenous use of insulin. Continuous glucose monitoring system(CGMS) is a relatively new technology that measures interstitial glucose at very short time intervals over a specifi c period of time. The resulting profi le provides a more comprehensive measure of glycemic excursions than intermittent home blood glucose monitoring. Results of studies applying the CGMS technology in patients with or without diabetes mellitus(DM) have revealed new insights in glucose metabolism. Moreover, CGMS have a potential role in the improvement of glycemic control during pregnancy and labor, which may lead to a decrease in perinatal morbidity and mortality. In conclusion, the use of CGMS, with its important technical advantages compared to the conventional way of monitoring, may lead into a more etiological intrapartum management of both the mother and her fetus/infant in pregnancies complicated with DM.
文摘BACKGROUND A twin pregnancy can carry greater risks than singleton pregnancies.About 60 in 100 twin pregnancies result in spontaneous birth before 37 wk,which is associated with several complications in the premature babies.Clinical detection of biomarkers may help to predict the possibility of premature birth so that corresponding interventions can be given to the pregnant women in a timely manner,in order to reduce the risk of preterm birth and improve the outcomes of the newborn infants.AIM To explore the clinical value of transvaginal ultrasound measurement of cervical length combined with insulin-like growth factor binding protein-1(IGFBP-1)hyperphosphorylation in cervical secretions as predictors of preterm delivery in twin pregnancies.METHODS A total of 254 pregnant women with twin pregnancies,who were admitted to Hainan General Hospital and underwent maternity examination,were selected as the study subjects from January 2015 to December 2018.All participants received transvaginal ultrasound measurement of cervical length and phosphorylated IGFBP-1(phIGFBP-1)test between 24 and 34 wk gestation.The pregnancy outcomes were analyzed.RESULTS Of the women with a positive phIGFBP-1 test result,preterm birth rate was higher in those with a cervical length≤25 mm than those with a cervical length>25 mm(all P<0.05).Similarly,in women with a negative phIGFBP-1 test result,preterm birth rate was higher in those with a cervical length≤25 mm than those with a cervical length>25 mm(all P<0.05).The sensitivity,specificity,and positive and negative predictive values of the phIGFBP-1 test combined with the cervical length test were 95.71%,91.21%,95.12%and 92.22%,respectively,for the prediction of preterm birth.CONCLUSION Cervical length combined with phIGFBP-1 tests is of value for the prediction of outcomes of preterm delivery in twin pregnancies.
文摘AIM:To describe maternity and newborn charges for an economic analysis of surrogate pregnancies on the health care resource utilization.METHODS:A retrospective chart review of all women identified as being surrogates and the infants born from these pregnancies was performed between January 1,2012 and December 31,2013.Selected maternity diagnoses,mode of delivery,duration of hospitalization,and hospital charges were collected together with infants' birth weights,gestational age,length of hospital stay,and hospital charges.Charges associated with the in vitro fertilization cycles,artificial insemination,or embryo(s)transfer into the surrogate were not considered in the maternity charges.A ratio contrasting the maternity hospital charges for the surrogate carrier was compared as a ratio to the mean charges for 2540 infants delivered in 2013 after naturalconception and adjusted to the baseline hospital charges for both maternity and newborn care.RESULTS:Analysis of sixty-nine infants delivered from both gestational and traditional surrogate women found an increased in multiple births,NICU admission,and length of stay with hospital charges several multiples beyond that of a term infant conceived naturally and provided care in our nursery.Among singletons and twins(per infant)hospital charges were increased 26 times(P < 0.001)and in triplets charges were increased 173 times(P < 0.0001)when compared to a term infant provided care in a normal nursery at our center.CONCLUSION:Maternity costs for surrogates exceed those of women who conceive naturally,and these costs are especially magnified in women with triplets and multiple births.
文摘BACKGROUND There are many drawbacks to the traditional midwifery service management model,which can no longer meet the needs of the new era.The Internet+continuous midwifery service management model extends maternal management from prenatal to postpartum,in-hospital to out-of-hospital,and offline to online,thereby improving maternal and infant outcomes.Applying the Internet+continuous midwifery service management model to manage women with highrisk pregnancies(HRP)can improve their psycho-emotional opinion and,in turn,minimize the risk of adverse maternal and/or fetal outcomes.AIM To explore the effectiveness of a midwife-led Internet+continuous midwifery service model for women with HRP.METHODS We retrospectively analyzed the clinical data of 439 women with HRP who underwent prenatal examination and delivered at Shanghai Sixth People's Hospital(affiliated to the Shanghai Jiao Tong University School of Medicine)from April to December 2022.Among them,239 pregnant women underwent routine obstetric management,and 200 pregnant women underwent Internet+continuous midwifery service mode management.We used the State-Trait Anxiety Inventory,Edinburgh Postnatal Depression Scale,and analysis of delivery outcomes to compare psychological mood and the incidence of adverse delivery outcomes between the two groups.RESULTS The data showed that in early pregnancy,the anxiety and depression levels of the two groups were similar;the levels gradually decreased as pregnancy progressed,and the decrease in the continuous group was more significant[31.00(29.00,34.00)vs 34.00(32.00,37.00),8.00(6.00,9.00)vs 12.00(10.00,13.00),P<0.05].The maternal self-efficacy level and strategy for weight gain management were better in the continuous group than in the traditional group,and the effective rate of midwifery service intervention in the continuous group was significantly higher than in the control group[267.50(242.25,284.75)vs 256.00(233.00,278.00),74.00(69.00,78.00)vs 71.00(63.00,78.00),P<0.05].The incidence of adverse delivery outcomes in pregnant women and newborns and fear of maternal childbirth were lower in the continuous group than in the traditional group,and nursing satisfaction was higher[10.50%vs 18.83%,8.50%vs 15.90%,24.00%vs 42.68%,89.50%vs 76.15%,P<0.05].CONCLUSION The Internet+continuous midwifery service model promotes innovation through integration and is of great significance for improving and promoting maternal and child health in HRP.
文摘Background: Pregnancies progressing postterm are associated with a higher perinatal morbidity and mortality rates than those delivered at term. In a United Kingdom study, the rate of stillbirth increased from 0.35 in 1000 live births in pregnancies of 37 weeks to 2.12 in 1000 live births in pregnancies of 43 weeks gestation. Morbidities associated with postterm births include an increased risk of fetal distress, intrauterine growth restriction, dysfunctional labor, shoulder dystocia, obstetric trauma (relative risk 1.09 - 1.68) and an increase in perinatal complications, such as aspiration of meconium and asphyxia, peripheral nerve injury, greenstick bone fractures, pneumonia and septicemia (adjusted odds ratio 1.4 - 2.0). Antenatal surveillance and induction of labor may decrease the risks of an adverse outcome. In a recent review of term and postterm pregnancies in Norway, we found that there were adverse outcomes associated with both postterm pregnancy and induction of labor independently. On comparison of the two, a randomized controlled trial showed no difference in their neonatal outcome, but demonstrated a reduction in the cesarean delivery rate when labor was induced at 41 weeks. Aim of the Work: The aim of this study was to determine the effect of labor induction on maternal and fetal outcome in postterm pregnancies. Subjects and Methods: This study was carried out on 150 pregnant women who had completed 41 weeks of gestation between Jun. 1, 2012 up to Dec. 31, 2012 at Department of Obstetrics & Gynecology, Faculty of Medicine, Benghazi University, and were scheduled for induction of labor after cardiotocography (CTG) and ultrasonography (USS) have been done and Bishop’s score assessed, to determine the effects of labor induction on maternal and fetal outcome in postterm pregnancies (41 weeks plus). Results: Regarding the relationship between a history of (H/O) postdatism and fetal distress, it was found that there was no significant relationship between them. There was a significant relationship between a history of macrosomia and fetal distress. There was a significant relationship between instrumental delivery and fetal distress. The majority of the fetal distress had an indication for Caesarean section (CS) (fetal distress (FD) and fetal distress meconium (FDM) more than those without fetal distress. All fetuses that had APGAR scores of 8 were distressed. There was a significant relationship between the APGAR score at 10 minutes with fetal distress. All fetuses that had meconium aspiration had fetal distress. There was a significant increase in the amount of oxytocin in unit in distressed cases than the non-distressed ones. The total duration of induction was also significantly increased in stressed fetuses than the non-stressed ones. There was a significant increase in the weight of distressed fetuses than the non-distressed. Conclusions: In conclusion, there was no difference in the neonatal outcome or mode of delivery for postterm pregnancies managed either by immediate induction of labor or expectantly with serial antenatal surveillance. The outcomes were generally good, and neonatal morbidity, cesarean section, and operative vaginal delivery rates were low. If pregnancy is uncomplicated and continued surveillance is possible, women’s own wishes may guide the decision to induce or monitor a pregnancy beyond 41 weeks.
