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
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
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
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
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 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
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
Optimal health during pregnancy is crucial for ensuring the well-being of the mother and the developing fetus.This article is focused on the impact of oral health and the role of personalized oral hygiene management i...Optimal health during pregnancy is crucial for ensuring the well-being of the mother and the developing fetus.This article is focused on the impact of oral health and the role of personalized oral hygiene management in addressing prevalent dental issues among pregnant women,with particular emphasis on periodontal disease and dental caries.Despite the high prevalence of these dental problems and their association with obstetric complications such as pre-term birth and low birth weight,many pregnant women do not receive adequate dental care.This gap in care is often due to misconceptions about the safety of dental treat-ments during pregnancy and lack of awareness on the part of healthcare profes-sionals.Appreciations of the impacts of oral health and personalization of oral hygiene strategies such as tailored education and support,have proven effective in improving oral health in this population.Significant reductions in the incidence of caries and periodontal disease may be achieved by adapting care to the specific needs of each patient,thereby enhancing maternal and fetal health outcomes.Integration of personalized oral hygiene management into maternal health pro-grams and enhancement of ongoing education for pregnant women and healthcare professionals are essential steps in the reduction of pregnancy-related risks and improvement of maternal and neonatal well-being.Core Tip:In this article,we reviewed a recent study on the effects of personalized oral hygiene management on the oral health of pregnant women,as discussed in the article by Men et al.The study demonstrated that personalized oral hygiene interventions significantly improved oral health outcomes during pregnancy by reducing the prevalence of dental caries and periodontal disease.We emphasized the importance of individualized oral care programs that integrate education and tailored support,and we highlighted their significance in enhancing maternal and fetal health.This approach underscores the need for incorporating personalized oral hygiene management into routine prenatal care in order to optimize health outcomes.CONCLUSION This article emphasizes the critical role of personalized oral hygiene management in improving oral health during pregnancy.By tailoring oral care strategies to individual needs,significant improvements in dental health may be achieved,as evidenced by the reduced CAT scores observed in the experimental group in the study by Men et al[25].This personalized approach not only addresses common oral issues such as dental caries and periodontal disease but also underscores the broader implications for maternal and fetal health.Despite the positive results,there remains a gap in consistency in the application of oral health practices during pregnancy,partly due to misconceptions and lack of awareness among patients and healthcare providers.Future research should aim at validating these findings across diverse populations,investigating the impact of oral hygiene interventions at various stages of pregnancy,and evaluating their long-term effects on maternal and fetal health.Integrating personalized oral hygiene management into maternal health programs and promoting continuous education for pregnant women and healthcare professionals are essential steps toward enhancing overall health outcomes.By proactively managing oral health,the risks associated with pregnancy may be reduced while improving maternal and neonatal well-being.展开更多
Objective To evaluate the impact of endometrial polyps(EP)on postoperative pregnancy outcomes in infertile women with endometriosis(EMs).Methods PubMed,Embase,The Cochrane Library,CNKI,VIP,SinoMed,and WanFang Data dat...Objective To evaluate the impact of endometrial polyps(EP)on postoperative pregnancy outcomes in infertile women with endometriosis(EMs).Methods PubMed,Embase,The Cochrane Library,CNKI,VIP,SinoMed,and WanFang Data databases were searched to include clinical studies on the effect of EP on pregnancy outcomes in patients with EMs,published before August 31,2020.A meta-analysis was performed using Rev Man 5.3 software after two investigators independently screened the literature,extracted information,and evaluated the risk of bias of the included studies.Results The meta-analysis included ten studies(651 and 1,040 in the combined EP and uncomplicated EP groups,respectively).The spontaneous pregnancy rate,clinical pregnancy rate,and live birth rate were significantly lower in the group with combined EPs than in the group without combined EPs[Odd’s ratio(OR)=0.63,95%confidence interval(CI):0.50–0.80,P=0.0001;OR=0.63,95%CI:0.48–0.84,P=0.001;OR=0.63,95%CI:0.42–0.96,P=0.03],and the rate of embryonic abortion was significantly higher than that in the uncomplicated EP group[OR=3.10,95%CI:1.52–6.32,P=0.002].Conclusion EP may adversely affect pregnancy outcomes in patients with infertility and EMs.Even after surgical treatment,EP can still reduce natural pregnancy,clinical pregnancy,and live birth rates in infertile women with EMs and increase the risk of embryo arrest in these women.展开更多
A 35-year-old woman with a history of regular menstruation presented with a positive urine pregnancy test and elevated blood human chorionic gonadotropin concentrations.Color Doppler ultrasound showed multiple slightl...A 35-year-old woman with a history of regular menstruation presented with a positive urine pregnancy test and elevated blood human chorionic gonadotropin concentrations.Color Doppler ultrasound showed multiple slightly hyperechoic areas within the uterine cavity.She was admitted to the hospital with a preliminary outpatient diagnosis of“suspected molar pregnancy,pending further evaluation.”展开更多
Objective:This study aimed to explore the clinical effect of acupuncture therapy for menstruation regu-lation and pregnancy promotion on thin endometrium in the real world.Design:This study is a single-center pragmati...Objective:This study aimed to explore the clinical effect of acupuncture therapy for menstruation regu-lation and pregnancy promotion on thin endometrium in the real world.Design:This study is a single-center pragmatic randomized controlled trial blinded to the statisticians.Using the“blockrand”software package,based on the age(≥35,<35),37 patients were randomized into an intervention group(19 cases)and a control group(18 cases).After reassignment regarding patient preference,21 patients were included in the intervention group and 16 in the control group.Setting:The trial was executed in the Specialty Outpatient Clinic,Acupuncture-Moxibustion Hospital of China Academy of Chinese Medical Sciences,from March 1,2019,to September 30,2020.Participants:The study included 37 patients with thin endometrium and without previous acupuncture treatment.Intervention:The intervention group was administered acupuncture for menstruation regulation and pregnancy promotion and a small-dose of progynova(2 mg daily),while the control group was adminis-tered a large-dose of progynova(4 mg daily).Interventions started from Day 5 of menstruation until the end of ovulation under B-ultrasound monitoring.The intervention lasted for three menstrual cycles.Measurements:Primary outcomes were changes in endometrial thickness between baseline and after intervention completion and the difference between the two groups after intervention.The secondary outcomes were endometrial and subendometrial blood flow,serum estradiol levels,menstrual conditions,and adverse reactions.Results:(1)Comparison of each indicator before and after intervention completion in the two groups:in the intervention group,the differences were significant in endometrial thickness,menstrual score,estra-diol(E2)level in ovulatory period,the pulsatility index(PI)and resistance index(RI)of uterine artery,the ratio of peak systolic velocity to end-diastolic velocity(S/D),the endometrial vascular index(VI),flow index(FI),and vascular flow index(VFI)and volume(P<0.01).In the control group,significant changes were observed in endometrial thickness,menstrual score,and E2 before and after the interven-tion(P<0.05),and no differences were observed in uterine artery PI,RI,S/D and endometrial VI,FI,VFI,and volume(P>0.05).Compared with the control group,the intervention group showed significant differences in endometrial thickness,menstrual score,E2,uterine artery PI,RI,S/D,and endometrial VI,FI,VFI,and volume after intervention(P<0.01).No adverse reactions were reported in the intervention group.In contrast,the control group had two cases of nausea and gastrointestinal discomfort after med-ication,eight cases of breast distention during medication,and one case of breast nodules enlarged by 1 cm after trial completion.展开更多
This article comprehensively explores the relationship between anxiety and hypertensive disorders of pregnancy(HDP),covering epidemiology,potential mechanisms,and management strategies.HDP is the second leading cause ...This article comprehensively explores the relationship between anxiety and hypertensive disorders of pregnancy(HDP),covering epidemiology,potential mechanisms,and management strategies.HDP is the second leading cause of maternal and perinatal morbidity and mortality,encompassing subtypes such as gestational hypertension,preeclampsia,and eclampsia.Research indicates that anxiety is closely associated with the occurrence of HDP,potentially influencing blood pressure regulation and vascular function through neuroendocrine,inflammatory,genetic,and gut microbiota effects.Epidemiological data show that anxiety is prevalent during pregnancy and is linked to an increased risk of HDP.Biological mechanism studies reveal that anxiety can increase the risk of HDP by activating the hypothalamic-pituitary-adrenal axis,promoting inflammation,and affecting gut microbiota.In terms of treatment and management,psychological interventions(such as relaxation training,yoga,and mindfulness meditation)and pharmacological treatments(such as labetalol and nifedipine)play important roles in alleviating anxiety and improving the prognosis of HDP.Additionally,multidisciplinary collaboration and long-term postpartum follow-up are crucial for reducing the long-term risk of cardiovascular diseases.Despite significant progress in research on anxiety and HDP,many issues still require further exploration,including in-depth mechanism studies,optimization of clinical interventions,improvement of multidisciplinary collaboration models,long-term follow-up studies,and the impact of cultural and social factors.展开更多
BACKGROUND Acute pancreatitis in pregnancy is a rare but serious condition that can lead to high maternal mortality and fetal loss.Instances of pregnancy complicated by severe acute pancreatitis,particularly with subs...BACKGROUND Acute pancreatitis in pregnancy is a rare but serious condition that can lead to high maternal mortality and fetal loss.Instances of pregnancy complicated by severe acute pancreatitis,particularly with subsequent respiratory and cardiac arrest,are rarely reported.CASE SUMMARY We present the case of a 35-year-old woman,at 36+5 weeks of gestation,who presented with paroxysmal epigastric pain accompanied by low back pain,nausea,and vomiting.According to the clinical symptoms,B-ultrasound imaging and biochemical indicators,the patient was diagnosed with acute pancreatitis and initially managed conservatively.However,3 hours after admission,the patient experienced respiratory and cardiac arrest,and the fetus died.In this case,the adverse outcomes occurred due to the lack of aggressive fluid resuscitation and an active surgical intervention.CONCLUSION Implementing aggressive fluid resuscitation to sustain tissue perfusion,alongside the proactive evaluation of pharmacological agents that suppress gastric acid secretion and inhibit pancreatic enzyme activity,may be beneficial in mitigating the risk of a severely adverse prognosis.Effective management of acute pancreatitis during pregnancy requires careful timing of surgical intervention,a thorough evaluation of the risks and benefits regarding the continuation or termination of pregnancy,and a focus on safeguarding both maternal and fetal health.展开更多
Pregnancy in cirrhotic-woman is a rare event [1] [2]. It causes particular risks related to liver disease and its treatments, with maternal and fetal consequences. The largest reported series to date is by Welton’s w...Pregnancy in cirrhotic-woman is a rare event [1] [2]. It causes particular risks related to liver disease and its treatments, with maternal and fetal consequences. The largest reported series to date is by Welton’s with 13 cases [3]. In Africa, few cases were reported. The purpose of this work was to report the hepatic and obstetric complications in pregnant women in Burkina Faso, a low-income country. It was a descriptive cross-sectional study with retrospective data collection covering the period from January 1, 2013 to December 31, 2023. All the women diagnosed with cirrhosis through clinical basis, biological and imaging arguments associated with a pregnancy confirmed by ultrasound were included. A total of ten women were included in the study. Among them, two were known cirrhotics and were being followed. In the other eight cases, cirrhosis was discovered during pregnancy. Eight women were HBsAg positive and two of them had only the contact marker of hepatitis B virus (anti- HBc antibody). The evolution was, ascitic decompensation in nine cases, digestive hemorrhage due to rupture of esophageal varices in two cases, nine cases of anemia, two cases of ascitic fluid infection and one case of conjunctival jaundice. Two cases of probable hepatocellular carcinoma were noted with one case of extensive portal thrombosis. The evolution was without maternal complications in one case. Regarding fetal and neonatal complications, there were three cases of hypotrophy, one case of prematurity, one case of acute neonatal distress, two cases of fetal death in utero and one case of fetal tachycardia. Four pregnancies had a favorable evolution without any complications. The association of cirrhosis and pregnancy is an uncommon event, and maternal and fetal complications can occur, making this pregnancy a high-risk pregnancy.展开更多
Dear Editor,Early pregnancy loss is a condition whose relevance is determined not only by high incidence but also by the frequency of this pathology progressing into habitual miscarriage.According to the American Preg...Dear Editor,Early pregnancy loss is a condition whose relevance is determined not only by high incidence but also by the frequency of this pathology progressing into habitual miscarriage.According to the American Pregnancy Association,non-developing pregnancy(NDP),one of the forms of pregnancy loss,accounts for half of all miscarriages in the early stages[1].展开更多
To editor:In recent years,obstetricians have needed to managemore complex pregnancies involving acute and chronicmedical disorders,and a greater number of pregnancieseach year are now delivered by critical care servic...To editor:In recent years,obstetricians have needed to managemore complex pregnancies involving acute and chronicmedical disorders,and a greater number of pregnancieseach year are now delivered by critical care services.1Datafrom the United States show that poorly controlled maternal medical conditions can have an adverse impact on preg-nancy outcomes.展开更多
Acute fatty liver of pregnancy(AFLP)is a rare but potentially life-threatening liver disease associated with mitochondrial dysfunction.It is characterized by microvesicular hepatic steatosis and typically occurs in th...Acute fatty liver of pregnancy(AFLP)is a rare but potentially life-threatening liver disease associated with mitochondrial dysfunction.It is characterized by microvesicular hepatic steatosis and typically occurs in the third trimester,though it may rarely present postpartum.AFLP is considered a non-thrombotic microangiopathy(TMA)but may present with overlapping TMA features.Its incidence ranges from 1 in 7000 to 1 in 20000 pregnancies,although milder cases may go unrecognized.AFLP can rapidly progress to acute liver failure and 20%to 40%of affected women exhibit clinical features of preeclampsia.Acute kidney injury(AKI)is a frequent complication,observed in 55%to 75%of AFLP cases,which is significantly higher than the 7%to 20%occurrence seen in preeclampsia or hemolysis,elevated liver enzymes,and low platelets syndrome.The exact mechanism behind AKI in AFLP remains unclear,but renal histology has shown tubular deposits of free fatty acids,which correlate with current theories regarding liver pathology.While AFLP-associated AKI is often reversible after delivery,some patients may develop persistent AKI that requires dialysis.Therapeutic plasma exchange(TPE)has been explored in these cases,but available evidence is limited.This review summarizes the current understanding of the epidemiology,pathophysiology,clinical features,and management of AKI in the context of AFLP,and discusses the potential role of adjunctive therapies such as TPE.展开更多
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.
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Optimal health during pregnancy is crucial for ensuring the well-being of the mother and the developing fetus.This article is focused on the impact of oral health and the role of personalized oral hygiene management in addressing prevalent dental issues among pregnant women,with particular emphasis on periodontal disease and dental caries.Despite the high prevalence of these dental problems and their association with obstetric complications such as pre-term birth and low birth weight,many pregnant women do not receive adequate dental care.This gap in care is often due to misconceptions about the safety of dental treat-ments during pregnancy and lack of awareness on the part of healthcare profes-sionals.Appreciations of the impacts of oral health and personalization of oral hygiene strategies such as tailored education and support,have proven effective in improving oral health in this population.Significant reductions in the incidence of caries and periodontal disease may be achieved by adapting care to the specific needs of each patient,thereby enhancing maternal and fetal health outcomes.Integration of personalized oral hygiene management into maternal health pro-grams and enhancement of ongoing education for pregnant women and healthcare professionals are essential steps in the reduction of pregnancy-related risks and improvement of maternal and neonatal well-being.Core Tip:In this article,we reviewed a recent study on the effects of personalized oral hygiene management on the oral health of pregnant women,as discussed in the article by Men et al.The study demonstrated that personalized oral hygiene interventions significantly improved oral health outcomes during pregnancy by reducing the prevalence of dental caries and periodontal disease.We emphasized the importance of individualized oral care programs that integrate education and tailored support,and we highlighted their significance in enhancing maternal and fetal health.This approach underscores the need for incorporating personalized oral hygiene management into routine prenatal care in order to optimize health outcomes.CONCLUSION This article emphasizes the critical role of personalized oral hygiene management in improving oral health during pregnancy.By tailoring oral care strategies to individual needs,significant improvements in dental health may be achieved,as evidenced by the reduced CAT scores observed in the experimental group in the study by Men et al[25].This personalized approach not only addresses common oral issues such as dental caries and periodontal disease but also underscores the broader implications for maternal and fetal health.Despite the positive results,there remains a gap in consistency in the application of oral health practices during pregnancy,partly due to misconceptions and lack of awareness among patients and healthcare providers.Future research should aim at validating these findings across diverse populations,investigating the impact of oral hygiene interventions at various stages of pregnancy,and evaluating their long-term effects on maternal and fetal health.Integrating personalized oral hygiene management into maternal health programs and promoting continuous education for pregnant women and healthcare professionals are essential steps toward enhancing overall health outcomes.By proactively managing oral health,the risks associated with pregnancy may be reduced while improving maternal and neonatal well-being.
文摘Objective To evaluate the impact of endometrial polyps(EP)on postoperative pregnancy outcomes in infertile women with endometriosis(EMs).Methods PubMed,Embase,The Cochrane Library,CNKI,VIP,SinoMed,and WanFang Data databases were searched to include clinical studies on the effect of EP on pregnancy outcomes in patients with EMs,published before August 31,2020.A meta-analysis was performed using Rev Man 5.3 software after two investigators independently screened the literature,extracted information,and evaluated the risk of bias of the included studies.Results The meta-analysis included ten studies(651 and 1,040 in the combined EP and uncomplicated EP groups,respectively).The spontaneous pregnancy rate,clinical pregnancy rate,and live birth rate were significantly lower in the group with combined EPs than in the group without combined EPs[Odd’s ratio(OR)=0.63,95%confidence interval(CI):0.50–0.80,P=0.0001;OR=0.63,95%CI:0.48–0.84,P=0.001;OR=0.63,95%CI:0.42–0.96,P=0.03],and the rate of embryonic abortion was significantly higher than that in the uncomplicated EP group[OR=3.10,95%CI:1.52–6.32,P=0.002].Conclusion EP may adversely affect pregnancy outcomes in patients with infertility and EMs.Even after surgical treatment,EP can still reduce natural pregnancy,clinical pregnancy,and live birth rates in infertile women with EMs and increase the risk of embryo arrest in these women.
文摘A 35-year-old woman with a history of regular menstruation presented with a positive urine pregnancy test and elevated blood human chorionic gonadotropin concentrations.Color Doppler ultrasound showed multiple slightly hyperechoic areas within the uterine cavity.She was admitted to the hospital with a preliminary outpatient diagnosis of“suspected molar pregnancy,pending further evaluation.”
基金Supported by Special Funds for Basic Scientific Research of Central Public Welfare Research Institutes:201814006。
文摘Objective:This study aimed to explore the clinical effect of acupuncture therapy for menstruation regu-lation and pregnancy promotion on thin endometrium in the real world.Design:This study is a single-center pragmatic randomized controlled trial blinded to the statisticians.Using the“blockrand”software package,based on the age(≥35,<35),37 patients were randomized into an intervention group(19 cases)and a control group(18 cases).After reassignment regarding patient preference,21 patients were included in the intervention group and 16 in the control group.Setting:The trial was executed in the Specialty Outpatient Clinic,Acupuncture-Moxibustion Hospital of China Academy of Chinese Medical Sciences,from March 1,2019,to September 30,2020.Participants:The study included 37 patients with thin endometrium and without previous acupuncture treatment.Intervention:The intervention group was administered acupuncture for menstruation regulation and pregnancy promotion and a small-dose of progynova(2 mg daily),while the control group was adminis-tered a large-dose of progynova(4 mg daily).Interventions started from Day 5 of menstruation until the end of ovulation under B-ultrasound monitoring.The intervention lasted for three menstrual cycles.Measurements:Primary outcomes were changes in endometrial thickness between baseline and after intervention completion and the difference between the two groups after intervention.The secondary outcomes were endometrial and subendometrial blood flow,serum estradiol levels,menstrual conditions,and adverse reactions.Results:(1)Comparison of each indicator before and after intervention completion in the two groups:in the intervention group,the differences were significant in endometrial thickness,menstrual score,estra-diol(E2)level in ovulatory period,the pulsatility index(PI)and resistance index(RI)of uterine artery,the ratio of peak systolic velocity to end-diastolic velocity(S/D),the endometrial vascular index(VI),flow index(FI),and vascular flow index(VFI)and volume(P<0.01).In the control group,significant changes were observed in endometrial thickness,menstrual score,and E2 before and after the interven-tion(P<0.05),and no differences were observed in uterine artery PI,RI,S/D and endometrial VI,FI,VFI,and volume(P>0.05).Compared with the control group,the intervention group showed significant differences in endometrial thickness,menstrual score,E2,uterine artery PI,RI,S/D,and endometrial VI,FI,VFI,and volume after intervention(P<0.01).No adverse reactions were reported in the intervention group.In contrast,the control group had two cases of nausea and gastrointestinal discomfort after med-ication,eight cases of breast distention during medication,and one case of breast nodules enlarged by 1 cm after trial completion.
文摘This article comprehensively explores the relationship between anxiety and hypertensive disorders of pregnancy(HDP),covering epidemiology,potential mechanisms,and management strategies.HDP is the second leading cause of maternal and perinatal morbidity and mortality,encompassing subtypes such as gestational hypertension,preeclampsia,and eclampsia.Research indicates that anxiety is closely associated with the occurrence of HDP,potentially influencing blood pressure regulation and vascular function through neuroendocrine,inflammatory,genetic,and gut microbiota effects.Epidemiological data show that anxiety is prevalent during pregnancy and is linked to an increased risk of HDP.Biological mechanism studies reveal that anxiety can increase the risk of HDP by activating the hypothalamic-pituitary-adrenal axis,promoting inflammation,and affecting gut microbiota.In terms of treatment and management,psychological interventions(such as relaxation training,yoga,and mindfulness meditation)and pharmacological treatments(such as labetalol and nifedipine)play important roles in alleviating anxiety and improving the prognosis of HDP.Additionally,multidisciplinary collaboration and long-term postpartum follow-up are crucial for reducing the long-term risk of cardiovascular diseases.Despite significant progress in research on anxiety and HDP,many issues still require further exploration,including in-depth mechanism studies,optimization of clinical interventions,improvement of multidisciplinary collaboration models,long-term follow-up studies,and the impact of cultural and social factors.
文摘BACKGROUND Acute pancreatitis in pregnancy is a rare but serious condition that can lead to high maternal mortality and fetal loss.Instances of pregnancy complicated by severe acute pancreatitis,particularly with subsequent respiratory and cardiac arrest,are rarely reported.CASE SUMMARY We present the case of a 35-year-old woman,at 36+5 weeks of gestation,who presented with paroxysmal epigastric pain accompanied by low back pain,nausea,and vomiting.According to the clinical symptoms,B-ultrasound imaging and biochemical indicators,the patient was diagnosed with acute pancreatitis and initially managed conservatively.However,3 hours after admission,the patient experienced respiratory and cardiac arrest,and the fetus died.In this case,the adverse outcomes occurred due to the lack of aggressive fluid resuscitation and an active surgical intervention.CONCLUSION Implementing aggressive fluid resuscitation to sustain tissue perfusion,alongside the proactive evaluation of pharmacological agents that suppress gastric acid secretion and inhibit pancreatic enzyme activity,may be beneficial in mitigating the risk of a severely adverse prognosis.Effective management of acute pancreatitis during pregnancy requires careful timing of surgical intervention,a thorough evaluation of the risks and benefits regarding the continuation or termination of pregnancy,and a focus on safeguarding both maternal and fetal health.
文摘Pregnancy in cirrhotic-woman is a rare event [1] [2]. It causes particular risks related to liver disease and its treatments, with maternal and fetal consequences. The largest reported series to date is by Welton’s with 13 cases [3]. In Africa, few cases were reported. The purpose of this work was to report the hepatic and obstetric complications in pregnant women in Burkina Faso, a low-income country. It was a descriptive cross-sectional study with retrospective data collection covering the period from January 1, 2013 to December 31, 2023. All the women diagnosed with cirrhosis through clinical basis, biological and imaging arguments associated with a pregnancy confirmed by ultrasound were included. A total of ten women were included in the study. Among them, two were known cirrhotics and were being followed. In the other eight cases, cirrhosis was discovered during pregnancy. Eight women were HBsAg positive and two of them had only the contact marker of hepatitis B virus (anti- HBc antibody). The evolution was, ascitic decompensation in nine cases, digestive hemorrhage due to rupture of esophageal varices in two cases, nine cases of anemia, two cases of ascitic fluid infection and one case of conjunctival jaundice. Two cases of probable hepatocellular carcinoma were noted with one case of extensive portal thrombosis. The evolution was without maternal complications in one case. Regarding fetal and neonatal complications, there were three cases of hypotrophy, one case of prematurity, one case of acute neonatal distress, two cases of fetal death in utero and one case of fetal tachycardia. Four pregnancies had a favorable evolution without any complications. The association of cirrhosis and pregnancy is an uncommon event, and maternal and fetal complications can occur, making this pregnancy a high-risk pregnancy.
基金financial support of the Russian Science Foundation(Grant No.23-13-00201)。
文摘Dear Editor,Early pregnancy loss is a condition whose relevance is determined not only by high incidence but also by the frequency of this pathology progressing into habitual miscarriage.According to the American Pregnancy Association,non-developing pregnancy(NDP),one of the forms of pregnancy loss,accounts for half of all miscarriages in the early stages[1].
基金funded by Natural Science Foundation of Guangdong Province(2020A1515010273 and 2022A1515012405)。
文摘To editor:In recent years,obstetricians have needed to managemore complex pregnancies involving acute and chronicmedical disorders,and a greater number of pregnancieseach year are now delivered by critical care services.1Datafrom the United States show that poorly controlled maternal medical conditions can have an adverse impact on preg-nancy outcomes.
文摘Acute fatty liver of pregnancy(AFLP)is a rare but potentially life-threatening liver disease associated with mitochondrial dysfunction.It is characterized by microvesicular hepatic steatosis and typically occurs in the third trimester,though it may rarely present postpartum.AFLP is considered a non-thrombotic microangiopathy(TMA)but may present with overlapping TMA features.Its incidence ranges from 1 in 7000 to 1 in 20000 pregnancies,although milder cases may go unrecognized.AFLP can rapidly progress to acute liver failure and 20%to 40%of affected women exhibit clinical features of preeclampsia.Acute kidney injury(AKI)is a frequent complication,observed in 55%to 75%of AFLP cases,which is significantly higher than the 7%to 20%occurrence seen in preeclampsia or hemolysis,elevated liver enzymes,and low platelets syndrome.The exact mechanism behind AKI in AFLP remains unclear,but renal histology has shown tubular deposits of free fatty acids,which correlate with current theories regarding liver pathology.While AFLP-associated AKI is often reversible after delivery,some patients may develop persistent AKI that requires dialysis.Therapeutic plasma exchange(TPE)has been explored in these cases,but available evidence is limited.This review summarizes the current understanding of the epidemiology,pathophysiology,clinical features,and management of AKI in the context of AFLP,and discusses the potential role of adjunctive therapies such as TPE.
