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 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
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
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
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
Malfunction of the thyroid gland is the second most common endocrine disorder encountered during pregnancy. It is well known that overt disease of the thyroid gland, either hyper or hypo can adversely affect pregnancy...Malfunction of the thyroid gland is the second most common endocrine disorder encountered during pregnancy. It is well known that overt disease of the thyroid gland, either hyper or hypo can adversely affect pregnancy outcome. There is also an ongoing debate surrounding the issue of subclinical hypothyroidism and its effect on the cognitive development of the unborn child. The goal of this paper is to present a systematic review of the literature and the current recommendations for diagnosis and treatment of thyroid disease in pregnancy and postpartum.展开更多
Teenage pregnancy has been acknowledged as a global public health concern,especially in low-and middle-income nations[1].This is predominantly because teenagers are more likely to experience pregnancy complications(vi...Teenage pregnancy has been acknowledged as a global public health concern,especially in low-and middle-income nations[1].This is predominantly because teenagers are more likely to experience pregnancy complications(viz.anemia,obstructed labour,etc.),higher rates of maternal mortality,and neonatal complications,including mortality[1,2].It is not unusual that many teen mothers have to experience exclusion from their families and communities,which limits access to quality healthcare services and is a major reason for emotional stress and mental health problems[2].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
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
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
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
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
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
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
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
BACKGROUND Cecal and sigmoid volvulus during pregnancy are extremely rare.Symptoms of intestinal obstruction in pregnancy make accurate clinical diagnosis challenging.AIM To identify predictive factors for early diagn...BACKGROUND Cecal and sigmoid volvulus during pregnancy are extremely rare.Symptoms of intestinal obstruction in pregnancy make accurate clinical diagnosis challenging.AIM To identify predictive factors for early diagnosis and successful treatment and an association between the diagnosis and maternal/neonatal outcomes.METHODS A systematic review of human studies(PubMed,PubMedCentral,Google Scholar)up to October 2024 was conducted per PRISMA guidelines.Data on demographics,clinical features,diagnostics,treatment,and outcomes were analyzed.RESULTS Antepartum and postpartum volvulus occurred in 75.5%and 24.5%of cases,respectively,most commonly in the third trimester(70.3%).Nausea was less frequent and obstipation was more common in sigmoid volvulus(P=0.0004).Endoscopic detorsion was successful in 23.9%of sigmoid cases,with a mean gestational age of 33.5±3.5 weeks.Maternal mortality was 12.5%for cecal and 5.5%for sigmoid volvulus(P=0.103).While maternal mortality was unaffected by the timing of delivery relative to surgery,fetal mortality was significantly higher when the interval was<24 hours(52.9%vs 10.4%,P<0.001).Both maternal and fetal mortality declined over time.CONCLUSION Constipation was a risk factor for sigmoid volvulus and prior open appendectomy for cecal volvulus.Endoscopy was more often used in sigmoid cases.Gestational age and maternal age did not affect fetal outcomes.Earlier imaging and appropriate surgery were linked to lower mortality.Delay>24 hours between intervention and delivery increased fetal,but not maternal mortality.Successful endoscopic detorsion eliminated maternal mortality and significantly lowered fetal mortality.展开更多
BACKGROUND The special physiological changes during pregnancy pose a huge challenge to the diagnosis of cervical cancer in pregnancy(CCIP).However,due to the poor prognosis of advanced-stage CCIP,there is currently no...BACKGROUND The special physiological changes during pregnancy pose a huge challenge to the diagnosis of cervical cancer in pregnancy(CCIP).However,due to the poor prognosis of advanced-stage CCIP,there is currently no consensus or guideline for diagnosis and treatment.CASE SUMMARY In this case report,we presented the case of a 30-year-old woman at 30 weeks of gestation who presented with irregular vaginal bleeding and was admitted to a local hospital at 35 weeks of gestation with a sudden gush of fluid and underwent a C-section.During the surgery,a rotten fish-like solid mass in the lower segment of the posterior wall of the uterus was excised for biopsy.The patient was referred to our hospital because she experienced heavy vaginal bleeding 13 days after one chemotherapy session.The solid mass was initially misdiagnosed as uterine clearcell carcinoma at local hospital but later confirmed as cervical adenosquamous carcinoma by a multidisciplinary team.Three months posttreatment,she succumbed to multiple tumor metastases.The infant was healthy at the latest 2-year follow-up.CONCLUSION Obstetricians should expand differential diagnoses when obstetric factors cannot explain symptoms of persistent vaginal bleeding during pregnancy.Atypical and insidious clinical presentations are often concealed by physiological changes during pregnancy,which may increase the difficulty of diagnosis and result in misdiagnosis.展开更多
BACKGROUND Unintended pregnancy occurs when an individual or couple conceives without planning or desire,which can potentially affect a child’s physical,mental,and social well-being.This can then lead to long-term so...BACKGROUND Unintended pregnancy occurs when an individual or couple conceives without planning or desire,which can potentially affect a child’s physical,mental,and social well-being.This can then lead to long-term socioeconomic challenges for families and communities.Although its impact on child growth and development is a pressing concern,research remains limited particularly in multicenter settings.AIM To examine the long-term consequences of unintended pregnancy on the critical years of early childhood growth and development.METHODS This analytical observational study employed a case-control design and was conducted in research centers across Indonesia,encompassing those located in Central Java,Lampung,Bali,and West Nusa Tenggara.A total of 700 children aged≤5 years with histories of intended or unintended pregnancies participated.Data collection involved structured interviews and direct anthropometric and developmental assessments.Data analyses were conducted using multivariate statistics and partial least squares structural equation modeling.RESULTS Unintended pregnancy was found to have a statistically significant effect on both child growth(t=8.178;P<0.001)and child development(t=25.688;P<0.001).Key growth problems identified included underweight,undernutrition,abnormal head circumference,and stunting.Developmental challenges prominently associated with unintended pregnancy included behavioral and emotional disorders,autism spectrum disorder,attentiondeficit/hyperactivity disorder,social and motor skill deficits,as well as visual and hearing impairments.CONCLUSION Unintended pregnancy significantly affects child growth and development,underscoring the need for early intervention,quality prenatal care,and strengthened family planning policies.展开更多
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.
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.
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].
文摘Malfunction of the thyroid gland is the second most common endocrine disorder encountered during pregnancy. It is well known that overt disease of the thyroid gland, either hyper or hypo can adversely affect pregnancy outcome. There is also an ongoing debate surrounding the issue of subclinical hypothyroidism and its effect on the cognitive development of the unborn child. The goal of this paper is to present a systematic review of the literature and the current recommendations for diagnosis and treatment of thyroid disease in pregnancy and postpartum.
文摘Teenage pregnancy has been acknowledged as a global public health concern,especially in low-and middle-income nations[1].This is predominantly because teenagers are more likely to experience pregnancy complications(viz.anemia,obstructed labour,etc.),higher rates of maternal mortality,and neonatal complications,including mortality[1,2].It is not unusual that many teen mothers have to experience exclusion from their families and communities,which limits access to quality healthcare services and is a major reason for emotional stress and mental health problems[2].
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.
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.
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.”
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BACKGROUND Cecal and sigmoid volvulus during pregnancy are extremely rare.Symptoms of intestinal obstruction in pregnancy make accurate clinical diagnosis challenging.AIM To identify predictive factors for early diagnosis and successful treatment and an association between the diagnosis and maternal/neonatal outcomes.METHODS A systematic review of human studies(PubMed,PubMedCentral,Google Scholar)up to October 2024 was conducted per PRISMA guidelines.Data on demographics,clinical features,diagnostics,treatment,and outcomes were analyzed.RESULTS Antepartum and postpartum volvulus occurred in 75.5%and 24.5%of cases,respectively,most commonly in the third trimester(70.3%).Nausea was less frequent and obstipation was more common in sigmoid volvulus(P=0.0004).Endoscopic detorsion was successful in 23.9%of sigmoid cases,with a mean gestational age of 33.5±3.5 weeks.Maternal mortality was 12.5%for cecal and 5.5%for sigmoid volvulus(P=0.103).While maternal mortality was unaffected by the timing of delivery relative to surgery,fetal mortality was significantly higher when the interval was<24 hours(52.9%vs 10.4%,P<0.001).Both maternal and fetal mortality declined over time.CONCLUSION Constipation was a risk factor for sigmoid volvulus and prior open appendectomy for cecal volvulus.Endoscopy was more often used in sigmoid cases.Gestational age and maternal age did not affect fetal outcomes.Earlier imaging and appropriate surgery were linked to lower mortality.Delay>24 hours between intervention and delivery increased fetal,but not maternal mortality.Successful endoscopic detorsion eliminated maternal mortality and significantly lowered fetal mortality.
基金Supported by National Key Research and Development Program of China,No.2021YFC2701603.
文摘BACKGROUND The special physiological changes during pregnancy pose a huge challenge to the diagnosis of cervical cancer in pregnancy(CCIP).However,due to the poor prognosis of advanced-stage CCIP,there is currently no consensus or guideline for diagnosis and treatment.CASE SUMMARY In this case report,we presented the case of a 30-year-old woman at 30 weeks of gestation who presented with irregular vaginal bleeding and was admitted to a local hospital at 35 weeks of gestation with a sudden gush of fluid and underwent a C-section.During the surgery,a rotten fish-like solid mass in the lower segment of the posterior wall of the uterus was excised for biopsy.The patient was referred to our hospital because she experienced heavy vaginal bleeding 13 days after one chemotherapy session.The solid mass was initially misdiagnosed as uterine clearcell carcinoma at local hospital but later confirmed as cervical adenosquamous carcinoma by a multidisciplinary team.Three months posttreatment,she succumbed to multiple tumor metastases.The infant was healthy at the latest 2-year follow-up.CONCLUSION Obstetricians should expand differential diagnoses when obstetric factors cannot explain symptoms of persistent vaginal bleeding during pregnancy.Atypical and insidious clinical presentations are often concealed by physiological changes during pregnancy,which may increase the difficulty of diagnosis and result in misdiagnosis.
文摘BACKGROUND Unintended pregnancy occurs when an individual or couple conceives without planning or desire,which can potentially affect a child’s physical,mental,and social well-being.This can then lead to long-term socioeconomic challenges for families and communities.Although its impact on child growth and development is a pressing concern,research remains limited particularly in multicenter settings.AIM To examine the long-term consequences of unintended pregnancy on the critical years of early childhood growth and development.METHODS This analytical observational study employed a case-control design and was conducted in research centers across Indonesia,encompassing those located in Central Java,Lampung,Bali,and West Nusa Tenggara.A total of 700 children aged≤5 years with histories of intended or unintended pregnancies participated.Data collection involved structured interviews and direct anthropometric and developmental assessments.Data analyses were conducted using multivariate statistics and partial least squares structural equation modeling.RESULTS Unintended pregnancy was found to have a statistically significant effect on both child growth(t=8.178;P<0.001)and child development(t=25.688;P<0.001).Key growth problems identified included underweight,undernutrition,abnormal head circumference,and stunting.Developmental challenges prominently associated with unintended pregnancy included behavioral and emotional disorders,autism spectrum disorder,attentiondeficit/hyperactivity disorder,social and motor skill deficits,as well as visual and hearing impairments.CONCLUSION Unintended pregnancy significantly affects child growth and development,underscoring the need for early intervention,quality prenatal care,and strengthened family planning policies.
