BACKGROUND The common cause of sodium nitrite poisoning has shifted from previous accidental intoxication by exposure or ingestion of contaminated water and food to recent alarming intentional intoxication as an emplo...BACKGROUND The common cause of sodium nitrite poisoning has shifted from previous accidental intoxication by exposure or ingestion of contaminated water and food to recent alarming intentional intoxication as an employed method of suicide/exit.The subsequent formation of methemoglobin(MetHb)restricts oxygen transport and utilization in the body,resulting in functional hypoxia at the tissue level.In clinical practice,a mismatch of cyanotic appearance and oxygen partial pressure usually contributes to the identification of methemoglobinemia.Prompt recognition of characteristic mismatch and accurate diagnosis of sodium nitrite poisoning are prerequisites for the implementation of standardized systemic interventions.CASE SUMMARY A pregnant woman was admitted to the Department of Critical Care Medicine at the First Affiliated Hospital of Harbin Medical University due to consciousness disorders and drowsiness 2 h before admission.Subsequently,she developed vomiting and cyanotic skin.The woman underwent orotracheal intubation,invasive mechanical ventilation(IMV),and correction of internal environment disturbance in the ICU.Her premature infant was born with a higher-than-normal MetHb level of 3.3%,and received detoxification with methylene blue and vitamin C,supplemental vitamin K1,an infusion of fresh frozen plasma,as well as respiratory support via orotracheal intubation and IMV.On day 3 after admission,the puerpera regained consciousness,evacuated the IMV,and resumed enteral nutrition.She was then transferred to the maternity ward 24 h later.On day 7 after admission,the woman recovered and was discharged without any sequelae.CONCLUSION MetHb can cross through the placental barrier.Level of MetHb both reflects severity of the sodium nitrite poisoning and serves as feedback on therapeutic effectiveness.展开更多
BACKGROUND Gestational diabetes mellitus(GDM)raises the risk of high blood pressure and may cause a series of life-threatening complications in pregnant women.Screening and management of GDM and gestational hypertensi...BACKGROUND Gestational diabetes mellitus(GDM)raises the risk of high blood pressure and may cause a series of life-threatening complications in pregnant women.Screening and management of GDM and gestational hypertension(GH)in pregnancy helps to control and reduce these risks and prevent adverse effects on mothers and their fetuses.Currently,the majority criteria used for screening of diabetes mellitus is oral glucose tolerance tests,and blood pressure test is usually used for the screening and diagnosis of hypertension.However,these criteria might not anticipate or detect all GDM or GH cases.Therefore,new specific predictive and diagnostic tools should be evaluated for this population.This study selected three biomarkers of osteoprotegerin(OPG),interleukin(IL)and hepatocyte growth factor(HGF)for GDM and GH predication and diagnosis.AIM To explore the feasibility of changes in placental and serum OPG,IL and HGF as tools for prediction and diagnosis of diabetes and hypertension in pregnant women.METHODS From January 2018 to January 2019,44 pregnant women with GDM and GH were selected as an observation group,and 44 healthy pregnant women were selected as a control group in the same period.Serum OPG,IL and HGF were compared between the two groups.RESULTS The levels of OPG and HGF in the observation group were lower than in the control group,and the level of IL-1βwas higher in the observation group than in the control group(all P<0.05).Furthermore,OPG and HGF were negatively associated with gestational diabetes and gestational hypertension,while IL-1βwas positively associated with GDM complicated with GH(all P<0.05).CONCLUSION The evaluation of serum OPG,HGF and IL-1βlevels in patients with coexistent gestational diabetes complicated with hypertension can predict the degree of disease and play an important role in the follow-up treatment and prognosis prediction.展开更多
Anxiety is one of the psychological problems in pregnant women that sometimes takes the form of pathological and affects the mental health of mother. The aim of this study was to determine the effects of fetal movemen...Anxiety is one of the psychological problems in pregnant women that sometimes takes the form of pathological and affects the mental health of mother. The aim of this study was to determine the effects of fetal movement counting on mental health of mother. In a randomized-controlled trial, 208 nulliparous women were randomly divided into two groups. At 28th weeks, both groups completed the GHQ-28. Then the intervention group started to count fetal movements from 28th to 37th weeks of gestation and the control group received routine prenatal care. Again, both groups completed the questionnaire at 37 weeks＇ gestation and the results were compared. Analysis was performed by SPSS and a P value 〈 0.05 was considered significant. The mean scores of mental health of mothers in 28th and 37th of pregnancy was respectively 23.52 ± 10.23 and 21.09 ± 10.12 in the intervention group and the difference was significant （P = 0.025）. The mean in the control group was 23.69 ± 9.43 and 23.88± 8.60 respectively, and the difference was not significant （P = 0.52）. In comparing the mean scores between the two groups, it was found that the difference was not significant at 28th weeks of gestation （P = 0.37）, but it was significant in 37th week （P = 0.002） and the counting of fetal movements could improve the mental health of mothers compared to control group. The women who had fetal movements counting at weeks 28 to 37 Of gestation reported better mental health than the control group. The mother renorted concerns about decreased fetal movement was similar in the two grouns.展开更多
<p> <span style="font-family:Verdana;"><b><span style="font-family:Verdana;">Objective:</span></b></span><span><span><span style="font-...<p> <span style="font-family:Verdana;"><b><span style="font-family:Verdana;">Objective:</span></b></span><span><span><span style="font-family:""><span style="font-family:Verdana;"> To learn the epidemiological, clinical, paraclinical, therapeutical aspects and prognosis of haemorrhage of the third trimester during pregnancy. </span><b><span style="font-family:Verdana;">Methodology: </span></b><span style="font-family:Verdana;">It is about a transversal</span><b> </b><span style="font-family:Verdana;">and descriptive</span><b> </b><span style="font-family:Verdana;">study,</span><b> </b><span style="font-family:Verdana;">realized at the department of obstetrics and gynaecology from January 1</span><sup><span style="font-family:Verdana;">st</span></sup><span style="font-family:Verdana;"> to June 30</span><sup><span style="font-family:Verdana;">th</span></sup><span style="font-family:Verdana;"> 2020. Was included in the study any pregnant patient showing the third trimester bleeding (</span></span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">≥</span><span><span style="font-family:Verdana;">28 Weeks gestation) received for bleeding during our study period and has been taken in charge in our department. The parameters stu</span><span style="font-family:Verdana;">died were on the socio-demographic characteristics, the clinical and para c</span><span style="font-family:Verdana;">linical aspects, the noted diagnosis, the therapeutic aspects, maternal and perinatal prognosis. The information w</span></span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">as</span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;"> collected from an inquiry document, the clinical files, the register of delivery room and childbirth, surgery protocols. The type and the analysis of the data were done by the softwares Word, Excel 2013 and Epi Info version 7.2.3. </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">We registered 2159 deliveries and 105 cases of third trimester bleeding, so a frequency of 4.86%. The average age was 30.14</span></span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">± 6.57 [16</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">-</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">49</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">years old] and the average parity was 3 [0</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">-</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">10]. Married women represented 87.62% of all. They were in a bad condition in 41.90% of cases. Fetal heart-sound w</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">as</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> absent in 65.76% of cases. The diagnosis checked w</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">as</span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;"> abruptio placenta, placenta previa and the uterus rupture. A blood transfusion of concentrated red blood cells Isogroup and Isorhesus was performed to 45.72% of cases. Caesarean section was performed in 54.29% of cases. Complications were observed in 74.28% of cases. The maternal lethality rate was 13.33% with a perinatal mortality of 74.77%. </span><b><span style="font-family:Verdana;">Conclusion: </span></b><span style="font-family:Verdana;">The third trimester bleeding</span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> is</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> frequent in developing countries because of poor obstetric coverage in this countr</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">y</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">. The perinatal prognosis is often bad because of late diagnosis, difficult access to Health Center with adequate technical platforms, miss of blood products and miss of qualified staff to take in charge th</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">e</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">se emergencies.</span></span></span> </p>展开更多
Aims: Obstetric hemorrhage, especially during the 3rd trimester of pregnancy, causes maternal, fetal and neonatal mortality and morbidity. We attempted to characterize its clinical features in Guinea. The objectives o...Aims: Obstetric hemorrhage, especially during the 3rd trimester of pregnancy, causes maternal, fetal and neonatal mortality and morbidity. We attempted to characterize its clinical features in Guinea. The objectives of this study were to describe the socio-demographic characteristics of the patients, identify the causes and contributing factors, describe the management and evaluate the maternal-fetal prognosis in such patients. Methods: We retrieved and analyzed patients with 3rd trimester hemorrhage whom we managed at Ignace Deen National Hospital, Guinea during 1-year period (1<sup>st</sup> of December 2019-30<sup>th</sup> of November 2020). Results: We experienced recorded 401 patients with 3rd trimester obstetric hemorrhage out of 5468 deliveries during the corresponding period;the rate being 7.33%. The main causes were as follows: placental hematoma (65.33%), placenta previa (27.68%) and uterine rupture (6.99%). The socio-demographic profiles were as follows: the age group of 25 - 29 years (28.42%), married (94.51%), uneducated (50.12%), and with a liberal profession. (43.64%) and pauciparous (30.42%). The conditions were considered to be preventable by managing risk factors during the prenatal consultation (PNC): 7.73% underwent no PNC. Cesarean accounted for 84.78% of patients. Prognosis was as follows: 14 maternal deaths (3.45% of a fatality), 34.66% of anemia, and 16.95% of hemorrhagic shock. Fetal/neonatal prognoses were poor. Conclusion: Obstetric hemorrhage during 3rd trimester remains the main cause of poor outcomes in Guinea. This study identified that this type of hemorrhage still represents an important cause of maternal and fetal morbidity and mortality in developing countries.展开更多
Background:Preeclampsia(PE)is a serious complication that affects maternal and perinatal outcomes.However,the mechanisms have not been fully explained.This study was designed to analyze longitudinal gut microbiota alt...Background:Preeclampsia(PE)is a serious complication that affects maternal and perinatal outcomes.However,the mechanisms have not been fully explained.This study was designed to analyze longitudinal gut microbiota alterations in pregnant women with and without PE in the second(T2)and third trimesters(T3).Methods:In this nested case-control study,which was conducted at Nanjing Maternity and Child Health Care Hospital,fecal samples from 25 PE patients(25 fecal samples obtained in T2 and 15 fecal samples obtained in T3)and 25 matched healthy controls(25 fecal samples obtained in T2 and 22 fecal samples obtained in T3)were collected,and the microbiota were analyzed using 16S rRNA gene sequencing.The diversity and composition of the microbiota of PE cases and controls were compared.Results:No significant differences in diversity were found between the PE and control groups(P>0.05).In the control group,from T2 to T3,the relative abundances of Proteobacteria(median[Q1,Q3]:2.25%[1.24%,3.30%]vs.0.64%[0.20%,1.20%],Z=-3.880,P<0.05),and Tenericutes(median[Q1,Q3]:0.12%[0.03%,3.10%]vs.0.03%[0.02%,0.17%],Z=-2.369,P<0.05)decreased significantly.In the PE group,the relative abundance of Bacteroidetes in T2 was lower than in T3(median[Q1,Q3]:18.16%[12.99%,30.46%]vs.31.09%[19.89%,46.06%],Z=-2.417,P<0.05).In T2,the relative abundances of mircrobiota showed no significant differences between the PE group and the control group.However,in T3,the relative abundance of Firmicutes was significantly lower in the PE group than in the control group(mean±standard deviation:60.62%±15.17%vs.75.57%±11.53%,t=-3.405,P<0.05).The relative abundances of Bacteroidetes,Proteobacteria,and Enterobacteriaceae were significantly higher in the PE group than in the control group(median[Q1,Q3]:31.09%[19.89%,46.06%]vs.18.24%[12.90%,32.04%],Z=-2.537,P<0.05;1.52%[1.05%,2.61%]vs.0.64%[0.20%,1.20%],Z=-3.310,P<0.05;0.75%[0.20%,1.00%]vs.0.01%[0.004%,0.023%],Z=-4.152,P<0.05).Linear discriminant analysis combined effect size measurements analysis showed that the relative abundances of the phylum Bacteroidetes,class Bacteroidia and order Bacteroidales were increased in the PE group,while those of the phylum Firmicutes,the class Clostridia,the order Clostridiales,and the genus unidentified Lachnospiraceae were decreased in the PE group;and these differences were identified as taxonomic biomarkers of PE in T3.Conclusion:From T2 to T3,there was an obvious alteration in the gut microbiota.The gut microbiota of PE patients in T3 was significantly different from that of the control group.展开更多
Objective: to explore the optimal initiating and withdrawing time of antiviral therapy for pregnant women in the immune-tolerant phase of chronic HBV infection. Methods: from January 2017 to December 2020, a total of ...Objective: to explore the optimal initiating and withdrawing time of antiviral therapy for pregnant women in the immune-tolerant phase of chronic HBV infection. Methods: from January 2017 to December 2020, a total of 104 pregnant women with immune tolerance to chronic HBV infection who were treated in the outpatient department of infectious diseases of Southwest Hospitalwere recruited. They recieved TDF/LdT at the 24th or 28th week of gestation, and withdrawed the treatment at delivery or one month after delivery. According to the beginning time of antiviral therapy, the subjects were divided into group A (24th week of gestation) and group B (28th week of gestation). The changes of HBsAg, HBeAg, HBV DNA and ALT levels in the two groups before delivery were compared, and further subgroup analysis was carried out according to different antiviral schemes. According to the withdraw time of antivirals, they were divided into group C (at delivery) and group D (one month after delivery). The changes of HBsAg, HBeAg, HBV DNA and ALT in the two groups at 0 day, 4 weeks, 12 weeks and 24 weeks after the drug withdrawal were analysed to evaluate the optimal timing to discontinue antiviral therapy. All newborns were received the first dose of hepatitis B vaccine (10μg recombinant yeast vaccine) and HBIG(100 IU) within 1 hour of birth, followed by the second and third doses of vaccine at 1 and 6 months of age, respectively. Serum hepatitis B virus markers were detected when they were between 7 and 12 months. Results: HBV DNA can be effectively inhibited before delivery, no matter whether the pregnant women start antiviral therapy (LdT or TDF) at 24 or 28 weeks of gestation, and the blocking rate of mother-to-child transmission is 100%. For those who initialed treatment at 24 weeks of gestation, there was no significant difference of HBV DNA load between LdT and TDF at 36 weeks gestation (P 0.115). However, for those who initialed treatment at 28 weeks of gestation, the level of HBV DNA in TDF group was significantly lower than that in LdT group at 36 weeks gestation (P0.046). There were no significant differences of serum HBsAg, HBeAg and ALT levels between group C and group D at baseline, the time of withdrawal, and4th ,12th,24th week after withdrawal (P > 0.05), but the HBV DNA level in group C at the time of withdrawal and the 4th week after drug withdrawal were both significantly higher than that in the group D (P0.007 and P0.000, respectively). By 12 weeks after drug withdrawal, the HBV DNA load of all puerperae gradually increased to the pre-treatment level and 2 (1.9%) of them showed abnormal liver function. After re-administration of antiviral treatment, the HBV DNA was successfully inhibited and the liver function returned to normal at the 24th week.. Conclusion: For pregnant women at immune tolerance phase of HBV, antiviral therapy can effectively to prevent the mother-to-child transmission, regardless of the initial treatment time (24th or 28th week of gestation).Compared with LdT, TDF demonstrated a stronger efficacy in the suppression of HBV replication. Antiviral treatment to pregnant women at immune tolerance stage to reduce the mother-to-child transmission of HBV is effective and safe. The risk of disease relapse after antiviral treatment withdraw is low, and there is no difference of relapse risk between group C and group D.展开更多
基金Supported by the National Natural Science Foundation of China,No.82372172the Key Research and Development Plan Project of Heilongjiang Province,No.GA23C007+3 种基金the Heilongjiang Province Postdoctoral Start-up Fund,No.LBH-Q20037the Research Project of Heilongjiang Provincial Health Commission,No.20231717010461the Special Fund for Clinical Research of Wu Jie-ping Medical Foundation,No.320.6750.2022-02-16the Scientific Research Innovation Fund of the First Affiliated Hospital of Harbin Medical University,No.2021M08.
文摘BACKGROUND The common cause of sodium nitrite poisoning has shifted from previous accidental intoxication by exposure or ingestion of contaminated water and food to recent alarming intentional intoxication as an employed method of suicide/exit.The subsequent formation of methemoglobin(MetHb)restricts oxygen transport and utilization in the body,resulting in functional hypoxia at the tissue level.In clinical practice,a mismatch of cyanotic appearance and oxygen partial pressure usually contributes to the identification of methemoglobinemia.Prompt recognition of characteristic mismatch and accurate diagnosis of sodium nitrite poisoning are prerequisites for the implementation of standardized systemic interventions.CASE SUMMARY A pregnant woman was admitted to the Department of Critical Care Medicine at the First Affiliated Hospital of Harbin Medical University due to consciousness disorders and drowsiness 2 h before admission.Subsequently,she developed vomiting and cyanotic skin.The woman underwent orotracheal intubation,invasive mechanical ventilation(IMV),and correction of internal environment disturbance in the ICU.Her premature infant was born with a higher-than-normal MetHb level of 3.3%,and received detoxification with methylene blue and vitamin C,supplemental vitamin K1,an infusion of fresh frozen plasma,as well as respiratory support via orotracheal intubation and IMV.On day 3 after admission,the puerpera regained consciousness,evacuated the IMV,and resumed enteral nutrition.She was then transferred to the maternity ward 24 h later.On day 7 after admission,the woman recovered and was discharged without any sequelae.CONCLUSION MetHb can cross through the placental barrier.Level of MetHb both reflects severity of the sodium nitrite poisoning and serves as feedback on therapeutic effectiveness.
基金Supported by Hainan Province Major Program of Science and Technology Projects 2017,No.ZDKJ2017007.
文摘BACKGROUND Gestational diabetes mellitus(GDM)raises the risk of high blood pressure and may cause a series of life-threatening complications in pregnant women.Screening and management of GDM and gestational hypertension(GH)in pregnancy helps to control and reduce these risks and prevent adverse effects on mothers and their fetuses.Currently,the majority criteria used for screening of diabetes mellitus is oral glucose tolerance tests,and blood pressure test is usually used for the screening and diagnosis of hypertension.However,these criteria might not anticipate or detect all GDM or GH cases.Therefore,new specific predictive and diagnostic tools should be evaluated for this population.This study selected three biomarkers of osteoprotegerin(OPG),interleukin(IL)and hepatocyte growth factor(HGF)for GDM and GH predication and diagnosis.AIM To explore the feasibility of changes in placental and serum OPG,IL and HGF as tools for prediction and diagnosis of diabetes and hypertension in pregnant women.METHODS From January 2018 to January 2019,44 pregnant women with GDM and GH were selected as an observation group,and 44 healthy pregnant women were selected as a control group in the same period.Serum OPG,IL and HGF were compared between the two groups.RESULTS The levels of OPG and HGF in the observation group were lower than in the control group,and the level of IL-1βwas higher in the observation group than in the control group(all P<0.05).Furthermore,OPG and HGF were negatively associated with gestational diabetes and gestational hypertension,while IL-1βwas positively associated with GDM complicated with GH(all P<0.05).CONCLUSION The evaluation of serum OPG,HGF and IL-1βlevels in patients with coexistent gestational diabetes complicated with hypertension can predict the degree of disease and play an important role in the follow-up treatment and prognosis prediction.
文摘Anxiety is one of the psychological problems in pregnant women that sometimes takes the form of pathological and affects the mental health of mother. The aim of this study was to determine the effects of fetal movement counting on mental health of mother. In a randomized-controlled trial, 208 nulliparous women were randomly divided into two groups. At 28th weeks, both groups completed the GHQ-28. Then the intervention group started to count fetal movements from 28th to 37th weeks of gestation and the control group received routine prenatal care. Again, both groups completed the questionnaire at 37 weeks＇ gestation and the results were compared. Analysis was performed by SPSS and a P value 〈 0.05 was considered significant. The mean scores of mental health of mothers in 28th and 37th of pregnancy was respectively 23.52 ± 10.23 and 21.09 ± 10.12 in the intervention group and the difference was significant （P = 0.025）. The mean in the control group was 23.69 ± 9.43 and 23.88± 8.60 respectively, and the difference was not significant （P = 0.52）. In comparing the mean scores between the two groups, it was found that the difference was not significant at 28th weeks of gestation （P = 0.37）, but it was significant in 37th week （P = 0.002） and the counting of fetal movements could improve the mental health of mothers compared to control group. The women who had fetal movements counting at weeks 28 to 37 Of gestation reported better mental health than the control group. The mother renorted concerns about decreased fetal movement was similar in the two grouns.
文摘<p> <span style="font-family:Verdana;"><b><span style="font-family:Verdana;">Objective:</span></b></span><span><span><span style="font-family:""><span style="font-family:Verdana;"> To learn the epidemiological, clinical, paraclinical, therapeutical aspects and prognosis of haemorrhage of the third trimester during pregnancy. </span><b><span style="font-family:Verdana;">Methodology: </span></b><span style="font-family:Verdana;">It is about a transversal</span><b> </b><span style="font-family:Verdana;">and descriptive</span><b> </b><span style="font-family:Verdana;">study,</span><b> </b><span style="font-family:Verdana;">realized at the department of obstetrics and gynaecology from January 1</span><sup><span style="font-family:Verdana;">st</span></sup><span style="font-family:Verdana;"> to June 30</span><sup><span style="font-family:Verdana;">th</span></sup><span style="font-family:Verdana;"> 2020. Was included in the study any pregnant patient showing the third trimester bleeding (</span></span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">≥</span><span><span style="font-family:Verdana;">28 Weeks gestation) received for bleeding during our study period and has been taken in charge in our department. The parameters stu</span><span style="font-family:Verdana;">died were on the socio-demographic characteristics, the clinical and para c</span><span style="font-family:Verdana;">linical aspects, the noted diagnosis, the therapeutic aspects, maternal and perinatal prognosis. The information w</span></span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">as</span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;"> collected from an inquiry document, the clinical files, the register of delivery room and childbirth, surgery protocols. The type and the analysis of the data were done by the softwares Word, Excel 2013 and Epi Info version 7.2.3. </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">We registered 2159 deliveries and 105 cases of third trimester bleeding, so a frequency of 4.86%. The average age was 30.14</span></span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">± 6.57 [16</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">-</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">49</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">years old] and the average parity was 3 [0</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">-</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">10]. Married women represented 87.62% of all. They were in a bad condition in 41.90% of cases. Fetal heart-sound w</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">as</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> absent in 65.76% of cases. The diagnosis checked w</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">as</span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;"> abruptio placenta, placenta previa and the uterus rupture. A blood transfusion of concentrated red blood cells Isogroup and Isorhesus was performed to 45.72% of cases. Caesarean section was performed in 54.29% of cases. Complications were observed in 74.28% of cases. The maternal lethality rate was 13.33% with a perinatal mortality of 74.77%. </span><b><span style="font-family:Verdana;">Conclusion: </span></b><span style="font-family:Verdana;">The third trimester bleeding</span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> is</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> frequent in developing countries because of poor obstetric coverage in this countr</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">y</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">. The perinatal prognosis is often bad because of late diagnosis, difficult access to Health Center with adequate technical platforms, miss of blood products and miss of qualified staff to take in charge th</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">e</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">se emergencies.</span></span></span> </p>
文摘Aims: Obstetric hemorrhage, especially during the 3rd trimester of pregnancy, causes maternal, fetal and neonatal mortality and morbidity. We attempted to characterize its clinical features in Guinea. The objectives of this study were to describe the socio-demographic characteristics of the patients, identify the causes and contributing factors, describe the management and evaluate the maternal-fetal prognosis in such patients. Methods: We retrieved and analyzed patients with 3rd trimester hemorrhage whom we managed at Ignace Deen National Hospital, Guinea during 1-year period (1<sup>st</sup> of December 2019-30<sup>th</sup> of November 2020). Results: We experienced recorded 401 patients with 3rd trimester obstetric hemorrhage out of 5468 deliveries during the corresponding period;the rate being 7.33%. The main causes were as follows: placental hematoma (65.33%), placenta previa (27.68%) and uterine rupture (6.99%). The socio-demographic profiles were as follows: the age group of 25 - 29 years (28.42%), married (94.51%), uneducated (50.12%), and with a liberal profession. (43.64%) and pauciparous (30.42%). The conditions were considered to be preventable by managing risk factors during the prenatal consultation (PNC): 7.73% underwent no PNC. Cesarean accounted for 84.78% of patients. Prognosis was as follows: 14 maternal deaths (3.45% of a fatality), 34.66% of anemia, and 16.95% of hemorrhagic shock. Fetal/neonatal prognoses were poor. Conclusion: Obstetric hemorrhage during 3rd trimester remains the main cause of poor outcomes in Guinea. This study identified that this type of hemorrhage still represents an important cause of maternal and fetal morbidity and mortality in developing countries.
基金The work was supported by grants from the Beijing Natural Science Foundation-Sanyuan Corporation Co-sponsored Project(No.S150001)National Natural Science Foundation Project(No.81490745)。
文摘Background:Preeclampsia(PE)is a serious complication that affects maternal and perinatal outcomes.However,the mechanisms have not been fully explained.This study was designed to analyze longitudinal gut microbiota alterations in pregnant women with and without PE in the second(T2)and third trimesters(T3).Methods:In this nested case-control study,which was conducted at Nanjing Maternity and Child Health Care Hospital,fecal samples from 25 PE patients(25 fecal samples obtained in T2 and 15 fecal samples obtained in T3)and 25 matched healthy controls(25 fecal samples obtained in T2 and 22 fecal samples obtained in T3)were collected,and the microbiota were analyzed using 16S rRNA gene sequencing.The diversity and composition of the microbiota of PE cases and controls were compared.Results:No significant differences in diversity were found between the PE and control groups(P>0.05).In the control group,from T2 to T3,the relative abundances of Proteobacteria(median[Q1,Q3]:2.25%[1.24%,3.30%]vs.0.64%[0.20%,1.20%],Z=-3.880,P<0.05),and Tenericutes(median[Q1,Q3]:0.12%[0.03%,3.10%]vs.0.03%[0.02%,0.17%],Z=-2.369,P<0.05)decreased significantly.In the PE group,the relative abundance of Bacteroidetes in T2 was lower than in T3(median[Q1,Q3]:18.16%[12.99%,30.46%]vs.31.09%[19.89%,46.06%],Z=-2.417,P<0.05).In T2,the relative abundances of mircrobiota showed no significant differences between the PE group and the control group.However,in T3,the relative abundance of Firmicutes was significantly lower in the PE group than in the control group(mean±standard deviation:60.62%±15.17%vs.75.57%±11.53%,t=-3.405,P<0.05).The relative abundances of Bacteroidetes,Proteobacteria,and Enterobacteriaceae were significantly higher in the PE group than in the control group(median[Q1,Q3]:31.09%[19.89%,46.06%]vs.18.24%[12.90%,32.04%],Z=-2.537,P<0.05;1.52%[1.05%,2.61%]vs.0.64%[0.20%,1.20%],Z=-3.310,P<0.05;0.75%[0.20%,1.00%]vs.0.01%[0.004%,0.023%],Z=-4.152,P<0.05).Linear discriminant analysis combined effect size measurements analysis showed that the relative abundances of the phylum Bacteroidetes,class Bacteroidia and order Bacteroidales were increased in the PE group,while those of the phylum Firmicutes,the class Clostridia,the order Clostridiales,and the genus unidentified Lachnospiraceae were decreased in the PE group;and these differences were identified as taxonomic biomarkers of PE in T3.Conclusion:From T2 to T3,there was an obvious alteration in the gut microbiota.The gut microbiota of PE patients in T3 was significantly different from that of the control group.
文摘Objective: to explore the optimal initiating and withdrawing time of antiviral therapy for pregnant women in the immune-tolerant phase of chronic HBV infection. Methods: from January 2017 to December 2020, a total of 104 pregnant women with immune tolerance to chronic HBV infection who were treated in the outpatient department of infectious diseases of Southwest Hospitalwere recruited. They recieved TDF/LdT at the 24th or 28th week of gestation, and withdrawed the treatment at delivery or one month after delivery. According to the beginning time of antiviral therapy, the subjects were divided into group A (24th week of gestation) and group B (28th week of gestation). The changes of HBsAg, HBeAg, HBV DNA and ALT levels in the two groups before delivery were compared, and further subgroup analysis was carried out according to different antiviral schemes. According to the withdraw time of antivirals, they were divided into group C (at delivery) and group D (one month after delivery). The changes of HBsAg, HBeAg, HBV DNA and ALT in the two groups at 0 day, 4 weeks, 12 weeks and 24 weeks after the drug withdrawal were analysed to evaluate the optimal timing to discontinue antiviral therapy. All newborns were received the first dose of hepatitis B vaccine (10μg recombinant yeast vaccine) and HBIG(100 IU) within 1 hour of birth, followed by the second and third doses of vaccine at 1 and 6 months of age, respectively. Serum hepatitis B virus markers were detected when they were between 7 and 12 months. Results: HBV DNA can be effectively inhibited before delivery, no matter whether the pregnant women start antiviral therapy (LdT or TDF) at 24 or 28 weeks of gestation, and the blocking rate of mother-to-child transmission is 100%. For those who initialed treatment at 24 weeks of gestation, there was no significant difference of HBV DNA load between LdT and TDF at 36 weeks gestation (P 0.115). However, for those who initialed treatment at 28 weeks of gestation, the level of HBV DNA in TDF group was significantly lower than that in LdT group at 36 weeks gestation (P0.046). There were no significant differences of serum HBsAg, HBeAg and ALT levels between group C and group D at baseline, the time of withdrawal, and4th ,12th,24th week after withdrawal (P > 0.05), but the HBV DNA level in group C at the time of withdrawal and the 4th week after drug withdrawal were both significantly higher than that in the group D (P0.007 and P0.000, respectively). By 12 weeks after drug withdrawal, the HBV DNA load of all puerperae gradually increased to the pre-treatment level and 2 (1.9%) of them showed abnormal liver function. After re-administration of antiviral treatment, the HBV DNA was successfully inhibited and the liver function returned to normal at the 24th week.. Conclusion: For pregnant women at immune tolerance phase of HBV, antiviral therapy can effectively to prevent the mother-to-child transmission, regardless of the initial treatment time (24th or 28th week of gestation).Compared with LdT, TDF demonstrated a stronger efficacy in the suppression of HBV replication. Antiviral treatment to pregnant women at immune tolerance stage to reduce the mother-to-child transmission of HBV is effective and safe. The risk of disease relapse after antiviral treatment withdraw is low, and there is no difference of relapse risk between group C and group D.
