Objective:To analyze the impact of maternal-infant separation on the physical and mental state of high-risk pregnancy patients and explore the clinical efficacy of targeted nursing interventions.Methods:A total of 80 ...Objective:To analyze the impact of maternal-infant separation on the physical and mental state of high-risk pregnancy patients and explore the clinical efficacy of targeted nursing interventions.Methods:A total of 80 high-risk pregnancy patients treated in our hospital from January 2023 to January 2024 were selected as the study subjects.These patients were randomly divided into an observation group and a control group(40 cases each)using a random number table.The control group received routine high-risk pregnancy nursing care,while the observation group received specialized maternal-infant separation nursing interventions in addition to routine care.The psychological and physiological states and nursing satisfaction of the two groups were compared before and after the intervention.Results:The SAS scores,SDS scores,and sleep quality scores of the observation group were significantly lower than those of the control group,with statistically significant differences(p<0.05).The incidence of postpartum hemorrhage in the observation group was significantly lower than that in the control group,and the initiation time of lactation was significantly earlier than that in the control group,with both differences being statistically significant(p<0.05).The nursing satisfaction of the observation group was significantly higher than that of the control group(80%vs.32/40),with a statistically significant difference(p<0.05).Conclusion:Maternal-infant separation exacerbates anxiety and depression in high-risk pregnancy patients,reduces sleep quality,increases the risk of postpartum hemorrhage,and delays the initiation of lactation.Specialized nursing interventions for maternal-infant separation can improve the physical and mental state of high-risk pregnancy patients,reduce the incidence of postpartum complications,and enhance nursing satisfaction,making them worthy of clinical application and promotion.展开更多
Prenatal exposure to bisphenols and metals has raised significant concerns regarding their potential impact on fetal development,particularly the risk of fetal chromosome numerical abnormalities(CNA).In this case-cont...Prenatal exposure to bisphenols and metals has raised significant concerns regarding their potential impact on fetal development,particularly the risk of fetal chromosome numerical abnormalities(CNA).In this case-control study,we analyzed bisphenol and metal concentrations in amniotic fluid of high-risk pregnant women undergoing amniocentesis.Concentrations of bisphenols and metals were measured using ultra-performance liquid chromatography-tandem mass spectrometry and inductively coupled plasma-mass spectrometry,respectively.Logistic regression and quantile-based g-computation were applied to evaluate individual and combined effects,while dose-response relationships were assessed using restricted cubic splines.Our findings indicated that bisphenol S(BPS),bisphenol Z(BPZ),bisphenol AF(BPAF),antimony(Sb),and vanadium(V)were significantly associated with an increased risk of CNA when analyzed individually,whereas manganese,iron,copper(Cu),nickel(Ni),and zinc(Zn)were significantly and inversely associated with CNA risk.Combined exposure to bisphenol and metal mixtures was associated with an increased risk of CNA in multi-pollutant models.Cu and Ni exhibited a positive additive interaction.Furthermore,BPS,BPZ,and BPAF were individually associated with an increased risk of Down syndrome,while Zn was associated with a decreased risk of Down syndrome.BPS,Sb,V,and Zn were individually associated with an increased risk of Klinefelter syndrome.These findings underscore the potential role of prenatal bisphenol and metal exposure in the pathogenesis of fetal CNA,highlighting both additive and synergistic effects.展开更多
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
Autonomous vehicles operate without direct human intervention,which introduces safety risks that differ from those of conventional vehicles.Although many studies have examined safety issues related to autonomous drivi...Autonomous vehicles operate without direct human intervention,which introduces safety risks that differ from those of conventional vehicles.Although many studies have examined safety issues related to autonomous driving,high-risk situations have often been defined using single indicators,making it difficult to capture the complex and evolving nature of accident risk.To address this limitation,this study proposes a structured framework for defining and analyzing high-risk situations throughout the traffic accident process.High-risk situations are described using three complementary indicators:accident likelihood,accident severity,and accident duration.These indicators explain how risk emerges,increases,and persists over time.Based on this concept,a framework for traffic accident visualization analysis is developed to support phase-specific risk assessment and visualization.The framework combines accident-phase information with factor-level risk contributions,allowing systematic identification of key factors and their interactions across different accident stages.Using combinations of the three indicators,high-risk situations are classified into twenty-seven distinct types,providing a clear typology for complex accident scenarios involving autonomous vehicles.The applicability of the proposed framework is demonstrated through two representative accident scenarioswith different risk characteristics.The results showthat the framework effectively captures interactions among multiple risk factors,explains how risk levels change from pre-crash to post-crash phases,and identifies contributing factors that are difficult to detect using conventional traffic accident investigation methods.Overall,the proposed framework offers a practical basis for autonomous vehicle accident analysis,safety evaluation,and policy-related decision-making.展开更多
Objective The aim of this study was to analyze the correlation between the levels of 12 cytokines in the cervical microenvironment and cervical intraepithelial neoplasia in patients with high-risk human papillomavirus...Objective The aim of this study was to analyze the correlation between the levels of 12 cytokines in the cervical microenvironment and cervical intraepithelial neoplasia in patients with high-risk human papillomavirus(HR-HPV)infection.Methods Female patients(n=73)with HR-HPV infection were enrolled and divided into a high-grade squamous intraepithelial lesion(HSIL)group(n=33)and a non-HSIL(N-HSIL)group(n=40),which include low-grade squamous intraepithelial lesions and inflammation.Healthy screening subjects(n=31)with negative HR-HPV results were enrolled as a control group.We examined contemporaneous plasma and secretory cytokines from 25 study subjects to investigate the difference between systemic cytokine profiles and the local microenvironment immunity using the Wilcoxon matched-pairs signed rank test.The 12 cytokines from cervical secretions were compared between the three groups using the Mann-Whitney test,and logistic regression was used to analyze HSIL and N-HSIL.Results There were statistical differences in eight cytokines(IL-2,IL-6,TNF-α,IFN-γ,IL-1β,IL-12p70,IFN-α,and IL-8)between cervical secretion and plasma of the same patient,and seven cytokines were statistically different between the control and other two groups.We selected four independent variables(TNF-α,IFN-γ,IL-12p70,and IFN-α)commonly identified by univariate regression analysis and non-parametric tests for multivariate logistic regression analysis.Based on this model,HSIL could be predicted in patients with HR-HPV infection,with the area under the curve being 0.76.Conclusion The systemic cytokine profile cannot reflect the local microenvironment immunity,and the occurrence of HSIL is related to the cytokine levels in the cervical microenvironment.展开更多
Objective:To assess prenatal Bisphenol A(BPA)exposure levels and explore their preliminary associations with maternal and fetal characteristics in a population from Northeastern Yunnan.Methods:A cross-sectional analys...Objective:To assess prenatal Bisphenol A(BPA)exposure levels and explore their preliminary associations with maternal and fetal characteristics in a population from Northeastern Yunnan.Methods:A cross-sectional analysis was performed using data and urine samples from 70 pregnant women in their third trimester recruited at Qujing Central Hospital.Urinary BPA was measured by HPLC-MS/MS.Participants were stratified into high and low BPA exposure groups based on the median concentration.Results:BPA was detected in all samples(100%)with a median concentration of 2.41μg/L(IQR:0.68-4.96).The high BPA exposure group(≥2.41μg/L)had a significantly higher proportion of gestational diabetes mellitus(GDM)(42.9%vs.17.1%,p=0.021)and a lower median fetal birth weight(3250 g vs.3450 g,p=0.048)compared to the low exposure group.Conclusion:This pilot study reveals ubiquitous BPA exposure in pregnant women from Northeastern Yunnan.The observed preliminary associations with GDM and reduced fetal birth weight warrant further investigation in larger,longitudinal studies.展开更多
OBJECTIVE:To develop an expert consensus on kidney deficiency syndrome(KDS)in pregnant women and construct a validated self-reported KDS Patient-Reported Measures Pregnancy Scale(KDS-PRMs-Pregnancy Scale)for early ide...OBJECTIVE:To develop an expert consensus on kidney deficiency syndrome(KDS)in pregnant women and construct a validated self-reported KDS Patient-Reported Measures Pregnancy Scale(KDS-PRMs-Pregnancy Scale)for early identification and management.METHODS:The study was conducted in three phases.First,a comprehensive review of Traditional Chinese Medicine(TCM)literature and diagnostic criteria was performed,generating initial KDS symptoms for pregnancy.Second,a two-round Delphi survey,involving 21 experts from TCM,obstetrics,and gynaecology,assessed importance,relevance,and appropriateness of the items.Third,a psychometric evaluation was conducted,including exploratory factor analysis and internal consistency assessment.RESULTS:In the first Delphi round,19 items were flagged for revision or removal due to expert variability,with 12 items deemed irrelevant.In the second round,consensus was reached,resulting in a 25-item scale.After psychometric evaluation,seven items were removed due to poor factor loadings,leaving an 18-item scale.Three factors—physiological discomfort,fatigue&weakness,and excretion abnormalities—accounted for 78.4%of the variance.The final scale demonstrated excellent internal consistency(Cronbach's alpha=0.959).CONCLUSION:The validated 18-item KDS-PRMsPregnancy Scale is a reliable tool for assessing KDS in pregnant women.Future research should focus on validation in diverse populations and exploring its predictive validity for pregnancy outcomes.展开更多
Recurrent pregnancy loss(RPL)affects 2%-5%of couples attempting to conceive.It is a highly heterogenous condition attributed to several factors including endocrine dysfunction,auto immune disorders,thrombophilia,genet...Recurrent pregnancy loss(RPL)affects 2%-5%of couples attempting to conceive.It is a highly heterogenous condition attributed to several factors including endocrine dysfunction,auto immune disorders,thrombophilia,genetic abnormalities,infectious diseases,uterine anomalies,sperm DNA fragmentation,and epigenetics.Among genetic causes,chromosomal abnormalities are the most frequent etiological factor of early miscarriage,accounting for 50%–60%of first trimester abortions.Numerical or structural chromosomal changes may result in spontaneous miscarriages.These anomalies arise as a result of chromosomal translocation,non-disjunction,or mutations[1].Transmission of parental chromosomal abnormalities may be one of the chances for a recurrence of miscarriage in the first trimester of pregnancy,albeit the cause is unknown[2,3].展开更多
Objective:To investigate the potential link between chromosomal polymorphisms in couples who had a medical history of idiopathic recurrent pregnancy loss.Methods:Cytogenetic investigation was conducted with mitogen(Ph...Objective:To investigate the potential link between chromosomal polymorphisms in couples who had a medical history of idiopathic recurrent pregnancy loss.Methods:Cytogenetic investigation was conducted with mitogen(Phytohemagglutinin-M,Gibco)stimulated blood T lymphocytes by Giemsa trypsin Giemsa banding and Ag-NOR banding on 580 couples with a history of idiopathic recurrent pregnancy loss and 240 couples from the general population.Thirty good chromosomal spreads were captured,karyotyped,and analyzed.The karyotypes were designated using the International System for Human Cytogenomic Nomenclature 2024.Pearson Chi-square test was used to compare the frequency of chromosomal polymorphism variations in the idiopathic recurrent pregnancy loss group with the general population group.Results:A conventional cytogenetic investigation revealed that 45.43%of couples experiencing idiopathic recurrent pregnancy loss presented with various types of chromosomal polymorphic variants,compared to 11.88%in the general population.The overall frequency of these chromosomal polymorphic variants was significantly higher in the idiopathic recurrent pregnancy loss group compared to the general population group(OR 9.97,95%CI 6.99-14.21;P<0.05).Additionally,the prevalence of polymorphic variants was higher among males(49.14%)than females(41.72%)(P=0.01).Conclusions:Chromosomal polymorphic analysis may play a crucial role in the assessment and careful clinical management of cases with idiopathic recurrent pregnancy loss,especially when no other conclusive reasons are identified during the initial evaluation.Therefore,heteromorphism should not be overlooked while investigating the causes of idiopathic recurrent pregnancy loss.展开更多
Objective:To explore the clinical effect of personalized nutritional support in elderly women with gestational diabetes(GDM),and explore its impact on the incidence of maternal complications and pregnancy outcomes.Met...Objective:To explore the clinical effect of personalized nutritional support in elderly women with gestational diabetes(GDM),and explore its impact on the incidence of maternal complications and pregnancy outcomes.Methods:A total of 90 elderly pregnant women with gestational diabetes who were delivered in our hospital from January 2023 to January 2024 were selected as the research objects.They were randomly divided into an observation group and a control group,with 45 cases in each group.The control group only received routine pregnancy care and basic nutrition guidance,while the observation group received personalized nutrition support on this basis.Compare the blood glucose control,incidence of pregnancy complications,pregnancy outcomes,and neonatal outcomes between two groups of parturient.Result:After intervention,the fasting blood glucose(FPG),2-hour postprandial blood glucose(2hPG),and glycated hemoglobin(HbA1c)of the observation group were significantly lower than those of the control group,and the differences were statistically significant(p<0.05);The incidence of complications such as gestational hypertension syndrome,polyhydramnios,premature rupture of membranes,and postpartum hemorrhage in the observation group was significantly lower than that in the control group,and the difference was statistically significant(p<0.05);The cesarean section rate in the observation group was significantly lower than that in the control group,and the incidence of adverse neonatal outcomes such as fetal distress,macrosomia,neonatal asphyxia,and neonatal hypoglycemia in the observation group was significantly lower than that in the control group,with statistical significance(p<0.05).Conclusion:Individualized nutritional support for elderly women with gestational diabetes can effectively improve the level of maternal blood sugar control,reduce the incidence of complications during pregnancy,and improve the outcome of pregnancy and neonatal outcomes,which is of high clinical value.展开更多
Objective:To characterize placental morphologic features in Moroccan women with adverse outcomes,across different clinical contexts,based on the Amsterdam consensus classification.Methods:A prospective analysis was co...Objective:To characterize placental morphologic features in Moroccan women with adverse outcomes,across different clinical contexts,based on the Amsterdam consensus classification.Methods:A prospective analysis was conducted on placentas with umbilical cords collected fresh between March 1,2024 and July 15,2024 from women with adverse pregnancy outcomes.Clinical data(age,parity,gravidity,complications)were retrieved.Macroscopic parameters(weight,dimensions,cord insertion,membranes,lesions)were assessed,followed by systematic sampling.Tissue was processed by standard histology(formalin fixation,paraffin embedding,hematoxylin and eosin staining),and lesions were classified per Amsterdam criteria.Results:16 placentas from patients with adverse pregnancy outcomes were included.The median maternal age was 30 years.Adverse conditions included placental abruption(50%),intrauterine growth restriction(IUGR,38%),intrauterine fetal death(IUFD,31%),pre-eclampsia/eclampsia(19%),premature rupture of membranes(13%),and oligohydramnios(13%).Several placentas were associated with more than one adverse condition.Histopathology revealed maternal vascular malperfusion lesions in 94%,particularly in pre-eclampsia,IUGR,and IUFD.Fetal vascular malperfusion was found in 88%,mainly in IUGR and IUFD.Inflammatory lesions,dominated by acute maternal and fetal responses stage 3(necrotizing chorioamnionitis and funisitis),were primarily linked to IUFD.Conclusions:Placental examination enhances understanding of the pathophysiology underlying adverse pregnancy outcomes,supports diagnostic confirmation,and guides preventive strategies for recurrence.This study highlights the prevalence of maternal vascular malperfusion in Moroccan women and emphasizes the importance of systematic placental histopathology in obstetric care.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
文摘Objective:To analyze the impact of maternal-infant separation on the physical and mental state of high-risk pregnancy patients and explore the clinical efficacy of targeted nursing interventions.Methods:A total of 80 high-risk pregnancy patients treated in our hospital from January 2023 to January 2024 were selected as the study subjects.These patients were randomly divided into an observation group and a control group(40 cases each)using a random number table.The control group received routine high-risk pregnancy nursing care,while the observation group received specialized maternal-infant separation nursing interventions in addition to routine care.The psychological and physiological states and nursing satisfaction of the two groups were compared before and after the intervention.Results:The SAS scores,SDS scores,and sleep quality scores of the observation group were significantly lower than those of the control group,with statistically significant differences(p<0.05).The incidence of postpartum hemorrhage in the observation group was significantly lower than that in the control group,and the initiation time of lactation was significantly earlier than that in the control group,with both differences being statistically significant(p<0.05).The nursing satisfaction of the observation group was significantly higher than that of the control group(80%vs.32/40),with a statistically significant difference(p<0.05).Conclusion:Maternal-infant separation exacerbates anxiety and depression in high-risk pregnancy patients,reduces sleep quality,increases the risk of postpartum hemorrhage,and delays the initiation of lactation.Specialized nursing interventions for maternal-infant separation can improve the physical and mental state of high-risk pregnancy patients,reduce the incidence of postpartum complications,and enhance nursing satisfaction,making them worthy of clinical application and promotion.
基金supported by the Key Project of Natural Science Foundation of Tianjin(No.23JCZDJC00330)Tianjin Municipal Education Commission Scientific Research Program(No.2022ZD056).
文摘Prenatal exposure to bisphenols and metals has raised significant concerns regarding their potential impact on fetal development,particularly the risk of fetal chromosome numerical abnormalities(CNA).In this case-control study,we analyzed bisphenol and metal concentrations in amniotic fluid of high-risk pregnant women undergoing amniocentesis.Concentrations of bisphenols and metals were measured using ultra-performance liquid chromatography-tandem mass spectrometry and inductively coupled plasma-mass spectrometry,respectively.Logistic regression and quantile-based g-computation were applied to evaluate individual and combined effects,while dose-response relationships were assessed using restricted cubic splines.Our findings indicated that bisphenol S(BPS),bisphenol Z(BPZ),bisphenol AF(BPAF),antimony(Sb),and vanadium(V)were significantly associated with an increased risk of CNA when analyzed individually,whereas manganese,iron,copper(Cu),nickel(Ni),and zinc(Zn)were significantly and inversely associated with CNA risk.Combined exposure to bisphenol and metal mixtures was associated with an increased risk of CNA in multi-pollutant models.Cu and Ni exhibited a positive additive interaction.Furthermore,BPS,BPZ,and BPAF were individually associated with an increased risk of Down syndrome,while Zn was associated with a decreased risk of Down syndrome.BPS,Sb,V,and Zn were individually associated with an increased risk of Klinefelter syndrome.These findings underscore the potential role of prenatal bisphenol and metal exposure in the pathogenesis of fetal CNA,highlighting both additive and synergistic effects.
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.
基金supported by the Korea Institute of Police Technology(No.:RS-2024-00405603).
文摘Autonomous vehicles operate without direct human intervention,which introduces safety risks that differ from those of conventional vehicles.Although many studies have examined safety issues related to autonomous driving,high-risk situations have often been defined using single indicators,making it difficult to capture the complex and evolving nature of accident risk.To address this limitation,this study proposes a structured framework for defining and analyzing high-risk situations throughout the traffic accident process.High-risk situations are described using three complementary indicators:accident likelihood,accident severity,and accident duration.These indicators explain how risk emerges,increases,and persists over time.Based on this concept,a framework for traffic accident visualization analysis is developed to support phase-specific risk assessment and visualization.The framework combines accident-phase information with factor-level risk contributions,allowing systematic identification of key factors and their interactions across different accident stages.Using combinations of the three indicators,high-risk situations are classified into twenty-seven distinct types,providing a clear typology for complex accident scenarios involving autonomous vehicles.The applicability of the proposed framework is demonstrated through two representative accident scenarioswith different risk characteristics.The results showthat the framework effectively captures interactions among multiple risk factors,explains how risk levels change from pre-crash to post-crash phases,and identifies contributing factors that are difficult to detect using conventional traffic accident investigation methods.Overall,the proposed framework offers a practical basis for autonomous vehicle accident analysis,safety evaluation,and policy-related decision-making.
基金supported by the National Key Research and Development Program of China(2023YFC2308800)the Natural Science Foundation of Shanghai(25ZR1402053)the Key Discipline of Public Health of the Shanghai Municipal Health Commission(Grant No.GWVI-11.1-07).
文摘Objective The aim of this study was to analyze the correlation between the levels of 12 cytokines in the cervical microenvironment and cervical intraepithelial neoplasia in patients with high-risk human papillomavirus(HR-HPV)infection.Methods Female patients(n=73)with HR-HPV infection were enrolled and divided into a high-grade squamous intraepithelial lesion(HSIL)group(n=33)and a non-HSIL(N-HSIL)group(n=40),which include low-grade squamous intraepithelial lesions and inflammation.Healthy screening subjects(n=31)with negative HR-HPV results were enrolled as a control group.We examined contemporaneous plasma and secretory cytokines from 25 study subjects to investigate the difference between systemic cytokine profiles and the local microenvironment immunity using the Wilcoxon matched-pairs signed rank test.The 12 cytokines from cervical secretions were compared between the three groups using the Mann-Whitney test,and logistic regression was used to analyze HSIL and N-HSIL.Results There were statistical differences in eight cytokines(IL-2,IL-6,TNF-α,IFN-γ,IL-1β,IL-12p70,IFN-α,and IL-8)between cervical secretion and plasma of the same patient,and seven cytokines were statistically different between the control and other two groups.We selected four independent variables(TNF-α,IFN-γ,IL-12p70,and IFN-α)commonly identified by univariate regression analysis and non-parametric tests for multivariate logistic regression analysis.Based on this model,HSIL could be predicted in patients with HR-HPV infection,with the area under the curve being 0.76.Conclusion The systemic cytokine profile cannot reflect the local microenvironment immunity,and the occurrence of HSIL is related to the cytokine levels in the cervical microenvironment.
文摘Objective:To assess prenatal Bisphenol A(BPA)exposure levels and explore their preliminary associations with maternal and fetal characteristics in a population from Northeastern Yunnan.Methods:A cross-sectional analysis was performed using data and urine samples from 70 pregnant women in their third trimester recruited at Qujing Central Hospital.Urinary BPA was measured by HPLC-MS/MS.Participants were stratified into high and low BPA exposure groups based on the median concentration.Results:BPA was detected in all samples(100%)with a median concentration of 2.41μg/L(IQR:0.68-4.96).The high BPA exposure group(≥2.41μg/L)had a significantly higher proportion of gestational diabetes mellitus(GDM)(42.9%vs.17.1%,p=0.021)and a lower median fetal birth weight(3250 g vs.3450 g,p=0.048)compared to the low exposure group.Conclusion:This pilot study reveals ubiquitous BPA exposure in pregnant women from Northeastern Yunnan.The observed preliminary associations with GDM and reduced fetal birth weight warrant further investigation in larger,longitudinal studies.
基金Supported by the National Natural Science Foundation of China:to Explore the Intergenerational Effects of Bu-Shen-Tian-Jing Therapeutic Principle on the Offspring of Hyper-Androgenic Polycystic Ovary Syndrome Based on Regulating Rhythmic Iron Death in the Ovarian Granulosa Cells Mediated by Fos Proto-OncogeneRetinoic Acid Receptor-Related Orphan Receptor A-Solute Carrier Family 7 Member 11(No.82274564)the National Natural Science Foundation of China:the Underlying Mechanism of Bu-Shen-Jian-Pi Therapeutic Principle in Regulating Ovarian Granulosa Cells Autophagy Mediated by Short-chain Fatty Acids-forkhead Box O1 Pathway and its Effects on the Development of Offspring of Polycystic Ovary Syndrome(No.82074476)the Open Fund Project of Zhejiang Key Laboratory of Maternal and Infant Health,Women’s Hospital,School of Medicine,Zhejiang University:Mediating Role of Kidney Deficiency in the Relationship between Fear of Childbirth and Delivery Modes:an Exploratory Investigation Grounded in the Classic Traditional Chinese Medicine Theories of“Fear Injuring Kidney”and“Kidney Storing Essence”(No.ZDFY2024-MI-2)。
文摘OBJECTIVE:To develop an expert consensus on kidney deficiency syndrome(KDS)in pregnant women and construct a validated self-reported KDS Patient-Reported Measures Pregnancy Scale(KDS-PRMs-Pregnancy Scale)for early identification and management.METHODS:The study was conducted in three phases.First,a comprehensive review of Traditional Chinese Medicine(TCM)literature and diagnostic criteria was performed,generating initial KDS symptoms for pregnancy.Second,a two-round Delphi survey,involving 21 experts from TCM,obstetrics,and gynaecology,assessed importance,relevance,and appropriateness of the items.Third,a psychometric evaluation was conducted,including exploratory factor analysis and internal consistency assessment.RESULTS:In the first Delphi round,19 items were flagged for revision or removal due to expert variability,with 12 items deemed irrelevant.In the second round,consensus was reached,resulting in a 25-item scale.After psychometric evaluation,seven items were removed due to poor factor loadings,leaving an 18-item scale.Three factors—physiological discomfort,fatigue&weakness,and excretion abnormalities—accounted for 78.4%of the variance.The final scale demonstrated excellent internal consistency(Cronbach's alpha=0.959).CONCLUSION:The validated 18-item KDS-PRMsPregnancy Scale is a reliable tool for assessing KDS in pregnant women.Future research should focus on validation in diverse populations and exploring its predictive validity for pregnancy outcomes.
文摘Recurrent pregnancy loss(RPL)affects 2%-5%of couples attempting to conceive.It is a highly heterogenous condition attributed to several factors including endocrine dysfunction,auto immune disorders,thrombophilia,genetic abnormalities,infectious diseases,uterine anomalies,sperm DNA fragmentation,and epigenetics.Among genetic causes,chromosomal abnormalities are the most frequent etiological factor of early miscarriage,accounting for 50%–60%of first trimester abortions.Numerical or structural chromosomal changes may result in spontaneous miscarriages.These anomalies arise as a result of chromosomal translocation,non-disjunction,or mutations[1].Transmission of parental chromosomal abnormalities may be one of the chances for a recurrence of miscarriage in the first trimester of pregnancy,albeit the cause is unknown[2,3].
基金funded by the Technology Development Board(TDB)of India's Ministry of Science and Technology(TDB/M-25/2018-19).
文摘Objective:To investigate the potential link between chromosomal polymorphisms in couples who had a medical history of idiopathic recurrent pregnancy loss.Methods:Cytogenetic investigation was conducted with mitogen(Phytohemagglutinin-M,Gibco)stimulated blood T lymphocytes by Giemsa trypsin Giemsa banding and Ag-NOR banding on 580 couples with a history of idiopathic recurrent pregnancy loss and 240 couples from the general population.Thirty good chromosomal spreads were captured,karyotyped,and analyzed.The karyotypes were designated using the International System for Human Cytogenomic Nomenclature 2024.Pearson Chi-square test was used to compare the frequency of chromosomal polymorphism variations in the idiopathic recurrent pregnancy loss group with the general population group.Results:A conventional cytogenetic investigation revealed that 45.43%of couples experiencing idiopathic recurrent pregnancy loss presented with various types of chromosomal polymorphic variants,compared to 11.88%in the general population.The overall frequency of these chromosomal polymorphic variants was significantly higher in the idiopathic recurrent pregnancy loss group compared to the general population group(OR 9.97,95%CI 6.99-14.21;P<0.05).Additionally,the prevalence of polymorphic variants was higher among males(49.14%)than females(41.72%)(P=0.01).Conclusions:Chromosomal polymorphic analysis may play a crucial role in the assessment and careful clinical management of cases with idiopathic recurrent pregnancy loss,especially when no other conclusive reasons are identified during the initial evaluation.Therefore,heteromorphism should not be overlooked while investigating the causes of idiopathic recurrent pregnancy loss.
文摘Objective:To explore the clinical effect of personalized nutritional support in elderly women with gestational diabetes(GDM),and explore its impact on the incidence of maternal complications and pregnancy outcomes.Methods:A total of 90 elderly pregnant women with gestational diabetes who were delivered in our hospital from January 2023 to January 2024 were selected as the research objects.They were randomly divided into an observation group and a control group,with 45 cases in each group.The control group only received routine pregnancy care and basic nutrition guidance,while the observation group received personalized nutrition support on this basis.Compare the blood glucose control,incidence of pregnancy complications,pregnancy outcomes,and neonatal outcomes between two groups of parturient.Result:After intervention,the fasting blood glucose(FPG),2-hour postprandial blood glucose(2hPG),and glycated hemoglobin(HbA1c)of the observation group were significantly lower than those of the control group,and the differences were statistically significant(p<0.05);The incidence of complications such as gestational hypertension syndrome,polyhydramnios,premature rupture of membranes,and postpartum hemorrhage in the observation group was significantly lower than that in the control group,and the difference was statistically significant(p<0.05);The cesarean section rate in the observation group was significantly lower than that in the control group,and the incidence of adverse neonatal outcomes such as fetal distress,macrosomia,neonatal asphyxia,and neonatal hypoglycemia in the observation group was significantly lower than that in the control group,with statistical significance(p<0.05).Conclusion:Individualized nutritional support for elderly women with gestational diabetes can effectively improve the level of maternal blood sugar control,reduce the incidence of complications during pregnancy,and improve the outcome of pregnancy and neonatal outcomes,which is of high clinical value.
文摘Objective:To characterize placental morphologic features in Moroccan women with adverse outcomes,across different clinical contexts,based on the Amsterdam consensus classification.Methods:A prospective analysis was conducted on placentas with umbilical cords collected fresh between March 1,2024 and July 15,2024 from women with adverse pregnancy outcomes.Clinical data(age,parity,gravidity,complications)were retrieved.Macroscopic parameters(weight,dimensions,cord insertion,membranes,lesions)were assessed,followed by systematic sampling.Tissue was processed by standard histology(formalin fixation,paraffin embedding,hematoxylin and eosin staining),and lesions were classified per Amsterdam criteria.Results:16 placentas from patients with adverse pregnancy outcomes were included.The median maternal age was 30 years.Adverse conditions included placental abruption(50%),intrauterine growth restriction(IUGR,38%),intrauterine fetal death(IUFD,31%),pre-eclampsia/eclampsia(19%),premature rupture of membranes(13%),and oligohydramnios(13%).Several placentas were associated with more than one adverse condition.Histopathology revealed maternal vascular malperfusion lesions in 94%,particularly in pre-eclampsia,IUGR,and IUFD.Fetal vascular malperfusion was found in 88%,mainly in IUGR and IUFD.Inflammatory lesions,dominated by acute maternal and fetal responses stage 3(necrotizing chorioamnionitis and funisitis),were primarily linked to IUFD.Conclusions:Placental examination enhances understanding of the pathophysiology underlying adverse pregnancy outcomes,supports diagnostic confirmation,and guides preventive strategies for recurrence.This study highlights the prevalence of maternal vascular malperfusion in Moroccan women and emphasizes the importance of systematic placental histopathology in obstetric care.
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.
