As maternal deaths have decreased worldwide, increasing attention has been placed on the study of severe obstetric complications, such as hemorrhage, eclampsia, and obstructed labor, to identify where improvements can...As maternal deaths have decreased worldwide, increasing attention has been placed on the study of severe obstetric complications, such as hemorrhage, eclampsia, and obstructed labor, to identify where improvements can be made in maternal health. The objective of this study was to determine pregnancy complications and prenatal care among women aged 15 - 49 in Oğuzeli, Turkey, and to provide data for prevention in the field. This descriptive, cross-sectional study was conducted between February and May 2013 in Oğuzeli distinct, Turkey. The total women registered to family doctors in Oğuzeli was listed and, 470 women were selected using a stratified and simple random sampling technique. Pregnancy complications were asked for the last pregnancy of each women. Of the women, 23.9% (n = 109) declared that they experienced pregnancy complications during their pregnancies. The most frequent problems were anemia (11.1%) hypertension (3.7%) and diabetes mellitus (2.4%) respectively. Women having chronic diseases before their pregnancy were more likely to have pregnancy complications compared to healthy women (p = 0.005). The mean number of prenatal care among women having pregnancy complications was 5.47 ± 3.57, while it was 3.84 ± 3.00 among healthy women (p = 0.000). Women having chronic diseases should be handled carefully and, pregnancy should be delayed until the chronic disease’s remission. Family planning in primary care is the key measure to archive this. Early diagnosis of hypertension among young women is highly important for the women’s and infants’s health during pregnancy, and for the women’s future heath. During prenatal care, women should be trained about correct eating habits and activity.展开更多
BACKGROUND Nickel(Ni)may accumulate in the human body and has biological toxicity and carcinogenicity.Ni has an extensive impact on the health of pregnant women and fetuses during gestation.AIM To evaluate Ni exposure...BACKGROUND Nickel(Ni)may accumulate in the human body and has biological toxicity and carcinogenicity.Ni has an extensive impact on the health of pregnant women and fetuses during gestation.AIM To evaluate Ni exposure in pregnant women in Kunming,Yunnan Province,China;to describe the distribution of Ni in the maternal-fetal system and placental barrier function;and to investigate the effect of Ni exposure on fetal health in mothers with pregnancy complications.METHODS Seventy-two pregnant women were selected using a case-control design.The women were divided into two groups:The control group(no disease;n=29)and the disease group[gestational diabetes(GDM),hypertensive disorder complicating pregnancy(HDCP),or both;n=43].The pregnant women in the disease group were further divided as follows:14 cases with GDM(GDM group),13 cases with HDCP(HDCP group)and 16 cases with both GDM and HDCP(disease combination group).Basic information on the pregnant women was collected by questionnaire survey.Maternal blood,placenta blood and cord blood were collected immediately after delivery.The Ni content in paired samples was determined using inductively coupled plasma mass spectrometry.RESULTS Compared to the control group,age was higher and body mass index was greater in pregnant women in the disease groups(28.14±2.54 vs 28.42±13.89,P<0.05;25.90±3.86 vs 31.49±5.30,P<0.05).The birth weights of newborns in the HDCP group and the control group were significantly different(2.52±0.74 vs 3.18±0.41,P<0.05).The content of Ni in umbilical cord blood in the entire disease group was higher than that in the control group(0.10±0.16 vs 0.05±0.07,P<0.05).CONCLUSION In the maternal-fetal system of women with pregnancy complications,the barrier effect of the placenta against Ni is weakened,thus affecting healthy growth of the fetus in the uterus.展开更多
Objective:Some pregnancy complications are associated with respiratory problems in infants.Early identification and implementation of respiratory support are needed for these infants.This study aimed to(1)use lung ult...Objective:Some pregnancy complications are associated with respiratory problems in infants.Early identification and implementation of respiratory support are needed for these infants.This study aimed to(1)use lung ultrasound(LU)for predicting the respiratory support requirements of infants and(2)simplify the examination method to facilitate its clinical application.Methods:Neonates underwent LU examinations within 1 hour of birth.The infants were divided into a pregnancy complication(PC)group and a control group according to their mothers'clinical data.The primary outcome measure was the need for respiratory support.Predictive models were established based on the differences in LU patterns between the two groups.The predictive value of the models was compared with that of the LU score(LUS)system,which has been widely used in other studies.Simplified models were established by analyzing the predictive effects of LU patterns in different parts of the lungs.Predictive reliability was tested using the receiver operating characteristic curve analysis.Results:PC and control groups had 29 and 117 neonates,respectively;a total of 22 neonates required respiratory support.The PC and control groups showed differences in respiratory support requirements,A-lines,and coalesced B-lines.The percentages of A-lines and coalesced B-lines were associated with respiratory support requirements.The optimal cutoff values for the percentages of the A-lines and coalesced B-lines were 55.7%and 24.5%,respectively.Similar effects were obtained by calculating the percentage of coalesced B-lines in four areas(R3,R4,L3,and L4).These methods were judged as more visual and convenient than LUS assessment.conclusion:The percentages of A-line and coalesced B-lines on LU images can be used to predict the respiratory support needs of neonates whose mothers had pregnancy complications.Only four areas(R3,R4,L3,and L4)had similar predictive values.展开更多
Decidualization is the differentiation of endometrial stromal cells into secretory decidual stromal cells.Human decidualization involves some amount of signaling molecules and pathways as well as genetic reprogramming...Decidualization is the differentiation of endometrial stromal cells into secretory decidual stromal cells.Human decidualization involves some amount of signaling molecules and pathways as well as genetic reprogramming,which is driven by the postovulatory rise in progesterone levels and local cyclic adenosine monophosphate production.Decidualization extends from the primary decidual zone to the secondary decidual zone,and then exits through apoptosis.Evidences support that decidual fibroblasts function as the pool of decidual stromal cells during pregnancy.Decidualization undergoes an acute inflammatory phase,an anti-inflammatory secretory phase to the final recession phase.The decidualization of the inner layer of endometrium,termed decidua,is the most critical determinant of pregnancy success,which can promote placenta formation,modulate immune tolerance,foster resistance to oxidative stress,sense embryo quality,and control labor.Failure to adequate decidualization in terms of hormones,biochemistry,and immunology leads to adverse pregnancy outcomes,including diseases such as preeclampsia,miscarriage,premature labor,repeated implantation failures,and some age-related decline in reproductive capacity.The development of animal models and in vitro culture systems combined with emerging technologies provides a powerful system to explore the mechanism of decidualization.However,decidualization is a dynamic,multi-step process,and translating of current research progress into disease predictions and interventions for pregnancy complications remains to be achieved.The study of periodic regeneration and spontaneous decidualization of the endometrium will be beneficial to the diagnosis and treatment of pregnancy diseases.展开更多
AIM To study liver stiffness(LS) during pregnancy and its association with complications during pregnancy.METHODS In this observational, diagnostic study, 537 pregnant women were prospectively enrolled at the Departme...AIM To study liver stiffness(LS) during pregnancy and its association with complications during pregnancy.METHODS In this observational, diagnostic study, 537 pregnant women were prospectively enrolled at the Department of Obstetrics and Gynecology, University hospital Heidelberg and Salem Medical Center. LS was measured using the Fibroscan device(Echosens, Paris) in all women and in 41 cases 24 h after delivery. Clinical and morphological data were recorded and abdominal ultrasound and standard laboratory tests were performed. No complications were observed in 475 women(controls) while preeclampsia and intrahepatic cholestasis of pregnancy(ICP) developed in 22 and 40 women, respectively.RESULTS In controls, LS increased significantly from initially 4.5 ± 1.2 kPa in the second trimester to 6.0 ± 2.3 kPa(P < 0.001) in the third trimester. In the third trimester, 41% of women had a LS higher than 6 kPa. Elevated LS in controls was significantly correlated with alkaline phosphatase, leukocytes, gestational age and an increase in body weight and body mass index(BMI). In women with pregnancy complications, LS was significantly higher as compared to controls(P < 0.0001). Moreover, in multivariate analysis, LS was an independent predictor for preeclampsia with an odds ratio of 2.05(1.27-3.31) and a cut-off value of 7.6 kPa. In contrast, ICP could not be predicted by LS. Finally, LS rapidly decreased in all women within 24 h after delivery from 7.2 ± 3.3 kPa down to 4.9 ± 2.2 kPa(P < 0.001).CONCLUSION During pregnancy, LS significantly and reversibly increases in the final trimester of pregnant women without complications. In women with preeclampsia, LS is significantly elevated and an independent noninvasive predictor.展开更多
Obstetric cholestasis (also referred to as intrahepatic cholestasis of pregnancy—ICP) is a pruritic form of reversible cholestasis that is associated with significant fetal risks. There is a paucity of research regar...Obstetric cholestasis (also referred to as intrahepatic cholestasis of pregnancy—ICP) is a pruritic form of reversible cholestasis that is associated with significant fetal risks. There is a paucity of research regarding pregnancy outcomes of the mothers with obstetric cholestasis in the South Asian setting. Hence, the objective of this study was to determine the prevalence of obstetric cholestasis among mothers presenting with pruritus during pregnancy and to describe the characteristics and outcomes for those diagnosed with ICP in comparison with those with pruritus in the absence of ICP. Methods: All mothers presenting with pruritus to De Soyza Maternity hospital in Colombo Sri Lanka, between 1st January 2011 to 1st January 2014, were recruited for the study. A standard set of biochemical tests were used for diagnosis of ICP. An interviewer administered questionnaire and patient records were used for data collection. Presentation, characteristics and pregnancy outcomes were assessed and compared for mothers with ICP against those with pruritus in the absence of ICP. Results: The prevalence of ICP in the study population was found to be 27% (n = 27). Generalized pruritus with pruritus of the palms and soles was identified as the commonest pattern of pruritus for diagnosed with ICP. Delivery before 37 weeks (p = 0.001), meconium stained liquor (p = 0.004), placental abruption (p = 0.005), postpartum hemorrhage (p = 0.005), bleeding manifestation (p = 0.006), preterm labor (p = 0.031) and fetal distress (p = 0.035) were found to be significantly associated with the presence of ICP. Conclusions: Nearly 1/3 of mothers presenting with pruritus in pregnancy in Sri Lanka are affected by ICP which is associated with an increase in a wide range of adverse maternal and fetal outcomes compared to those with pruritus in the absence of ICP.展开更多
BACKGROUND Data that assess maternal and infant outcomes in hepatitis C virus(HCV)-infected mothers are limited.AIM To investigate the frequency of complications and the associated risk factors.METHODS We performed a ...BACKGROUND Data that assess maternal and infant outcomes in hepatitis C virus(HCV)-infected mothers are limited.AIM To investigate the frequency of complications and the associated risk factors.METHODS We performed a cohort study to compare pregnancy and fetal outcomes of HCVviremic mothers with those of healthy mothers.Risk factors were analyzed with logistic regression.RESULTS Among 112 consecutive HCV antibody-positive mothers screened,we enrolled 79 viremic mothers.We randomly selected 115 healthy mothers from the birth registry as the control.Compared to healthy mothers,HCV mothers had a significantly higher frequency of anemia[2.6%(3/115)vs 19.0%(15/79),P<0.001]during pregnancy,medical conditions that required caesarian section[27.8%(32/115)vs 48.1%(38/79),P=0.004],and nuchal cords[9.6%(11/115)vs 34.2%(27/79),P<0.001].In addition,the mean neonatal weight in the HCV group was significantly lower(3278.3±462.0 vs 3105.1±459.4 gms;P=0.006),and the mean head circumference was smaller(33.3±0.6 vs 33.1±0.7 cm;P=0.03).In a multivariate model,HCV-infected mothers were more likely to suffer anemia[adjusted odds ratio(OR):18.1,95%confidence interval(CI):4.3-76.6],require caesarian sections(adjusted OR:2.6,95%CI:1.4-4.9),and have nuchal cords(adjusted OR:5.6,95%CI:2.4-13.0).Their neonates were also more likely to have smaller head circumferences(adjusted OR:2.1,95%CI:1.1-4.3)and lower birth weights than the average(≤3250 gms)with an adjusted OR of 2.2(95%CI:1.2-4.0).The vertical transmission rate was 1%in HCV-infected mothers.CONCLUSION Maternal HCV infections may associate with pregnancy and obstetric complications.We demonstrated a previously unreported association between maternal HCV viremia and a smaller neonatal head circumference,suggesting fetal growth restriction.展开更多
Bangladesh, a developing country, gained success towards the fifth-millennium development goals target of reducing its maternal mortality ratio by three quarters by 2015, but yet worked more on it for further reductio...Bangladesh, a developing country, gained success towards the fifth-millennium development goals target of reducing its maternal mortality ratio by three quarters by 2015, but yet worked more on it for further reduction of maternal mortality. In this light, though Bangladesh is committed to the sustainable development goals target of reducing its maternal mortality ratio to be reduced from 170 to 105 per 100,000 live births, the scope of research on this issue is limited because the maternal morbidity data is scarce in Bangladesh. In this paper, the prospective data on maternal morbidity in rural Bangladesh (collected by BIRPERHT) have been employed to trace out the high-risk and life-threatening factors associated with pregnancy-related complications. The subject-specific generalized estimating equations (SS-GEE) model with random effect structure is used for multivariate binary data for the repeated observations. The findings indicate that the risk of suffering from pregnancy complications is higher for high economic status, lower age at marriage, not visited for medical check-ups, outside home workers, and having miscarriage or abortion. Comparing the SS-GEE model with other correlation structures and relative efficiency factors, the SS-GEE model with random effect structure is well fitted for the prospective repeated observation data.展开更多
<strong>Objective: </strong><span><span><span style="font-family:""><span style="font-family:Verdana;">To review a case series of 12 women with unexpected h...<strong>Objective: </strong><span><span><span style="font-family:""><span style="font-family:Verdana;">To review a case series of 12 women with unexpected heart and lung disorders that occurred during pregnancy and the puerperium, describing for teaching purposes the pitfalls in practice and the lessons learned from this experience. </span><b><span style="font-family:Verdana;">Materials & Methods: </span></b><span style="font-family:Verdana;">We reviewed case files of women with medical and/or hypertensive complications of pregnancy that were evaluated </span><span style="font-family:Verdana;">for medicolegal defense purposes by the first author between 1986-2015.</span> <span style="font-family:Verdana;">Twelve women in these case files experienced unexpected cardiovascular</span><span style="font-family:Verdana;"> and/or cardiopulmonary complications late in pregnancy or early in the puerperium. For each case, the pertinent medical record information was extracted. Im</span><span style="font-family:Verdana;">portant concepts as lessons learned are summarized and referenced for</span><span style="font-family:Verdana;"> teaching purposes. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> Five women had undetected preexisting heart disease which acutely deteriorated during the third trimester, four women developed postpartum heart failure related to pregnancy and delivery, and three women </span><span style="font-family:Verdana;">suffered an intrapartum cardiac arrest;none survived. Their case presenta</span><span style="font-family:Verdana;">tions illustrate the importance of obstetric health care professionals being alert to the signs/symptoms of developing cardiopulmonary disease late in pregnancy and following delivery so that timely evaluation and intervention can be accomplished to potentially avoid morbidity and mortality. Diagnostic categories include peripartum heart failure, high-risk chronic hypertension, superimposed preeclampsia, amniotic fluid embolism, pulmonary embolism and Raynaud’s with occult pulmonary hypertension. </span><b><span style="font-family:Verdana;">Conclusion: </span></b><span style="font-family:Verdana;">These cases illustrate the diversity of ways that cardiovascular disease can suddenly complicate pregnancy and the early postpartum period. A major part of any effort to enhance safer motherhood is a heightened awareness by obstetric specialists to consider the possibility of heart disease in all maternity patients so that appropriate consultation and collaboration with other specialists might help avoid major maternal morbidity or mortality.</span></span></span></span>展开更多
Meckel’s diverticulum complicating pregnancy is indeed a rare occurrence. The anatomical and physiological changes that occur in pregnancy make the clinical presentation and preoperative diagnosis of an acute abdomen...Meckel’s diverticulum complicating pregnancy is indeed a rare occurrence. The anatomical and physiological changes that occur in pregnancy make the clinical presentation and preoperative diagnosis of an acute abdomen extremely difficult. Even imaging modalities have to be used with caution keeping in mind the risks associated for both mother and fetus. Treatment of such cases must be prompt and accurate with a high index of suspicion in order to prevent high rate of maternal and fetal morbidity. We report one such case of bleeding of Meckel’s diverticulum. The most common cause of bleeding in a Meckel’s is ectopic gastric mucosa. When we performed an exploratory laparotomy we found to our surprise a bleeding Meckel’s diverticulum. Further investigations revealed a very interesting histopathological report of endometriosis as the cause of bleed.展开更多
BACKGROUND Cervical pregnancies,interstitial tubal pregnancies,and cesarean scar pregnancies,which are ectopic pregnancies with intrauterine implantation sites exhibit increasing trends with the recent widespread use ...BACKGROUND Cervical pregnancies,interstitial tubal pregnancies,and cesarean scar pregnancies,which are ectopic pregnancies with intrauterine implantation sites exhibit increasing trends with the recent widespread use of assisted reproductive technologies and increased rate of cesarean deliveries.The development of highsensitivity human chorionic gonadotropin testing reagents and the increased precision of transvaginal ultrasonic tomography have made early diagnosis possible and have enabled treatment.Removal of ectopic pregnancies using methotrexate therapy and/or uterine artery embolization has been reported.However,delayed resumption of infertility treatments after methotrexate therapy is indicated,and negative effects on the next pregnancy after uterine artery embolization have been reported.AIM To examine the efficacy and safety of ultrasound-guided topical absolute ethanol injection in ectopic pregnancies with an intrauterine implantation site.METHODS In this study,we retrospectively examined the medical records of 21 patients who were diagnosed with an ectopic pregnancy with an intrauterine implantation site at our hospital,between April 2010 and December 2018,and underwent transvaginal ultrasound-guided local injections of absolute ethanol to determine the treatment outcomes.We evaluated the treatment methods,treatment outcomes,presence of bleeding requiring hemostasis measures and blood transfusion,complications,and treatment periods.Successful treatment was defined as the completion of treatment using transvaginal ultrasound-guided local injections of absolute ethanol alone.RESULTS There were 21 total cases comprising 10 cervical pregnancies,10 interstitial tubal pregnancies,and 1 cesarean scar pregnancy.All patients completed treatment with this method.No massive hemorrhaging or serious adverse reactions were observed during treatment.The mean gestation ages at the time of diagnosis were 5.9 wk(SD,±0.9 wk)for cervical and 6.9 wk(SD,±2.1 wk)for interstitial tubal pregnancies.The total ethanol doses were 4.8 mL(SD,±2.2 mL)for cervical pregnancies and 3.3 mL(SD,±2.2 mL)for interstitial pregnancies.The treatment period was 28.5days(SD,±11.7 d)for cervical pregnancies and 30.0±8.1 d for interstitial pregnancies.Positive correlations were observed between the bloodβ-human chorionic gonadotropin level at the beginning of treatment and the total ethanol dose(r=0.75;P=0.00008),as well as between the total ethanol dose and treatment period(r=0.48;P=0.026).CONCLUSION Transvaginal ultrasound-guided local injections of absolute ethanol could become a new option for intrauterine ectopic pregnancies when fertility preservation is desired.展开更多
Pregnancy with solid pseudopapillary tumor of the pancreas(SPTP)is rare.Because pregnancy hormones may cause tumor progression,the management and treatment of SPTP need to balance the safety of pregnant women and fetu...Pregnancy with solid pseudopapillary tumor of the pancreas(SPTP)is rare.Because pregnancy hormones may cause tumor progression,the management and treatment of SPTP need to balance the safety of pregnant women and fetuses with surgical treatment.We reported a case of a giant pancreatic tumor diagnosed during pregnancy that was considered to be SPTP.Examinations also showed hepatitis B virus infection and severe decompensation of liver cirrhosis.Medical termination of pregnancy was performed.The patient has lived with the tumor until now without surgery.We retrieved the published case reports,summarized the clinical characteristics of pregnancy with SPTP,and explored its management during the perinatal period.Most patients with SPTP have a good prognosis with good maternal and fetal outcomes,and it is important to choose an appropriate treatment method and timing.However,pregnancy combined with decompensated liver cirrhosis needs to be terminated in a timely manner because of its high-risk status.展开更多
In recent years,immune checkpoint molecules have made breakthroughs in the fields of inducing graft tolerance,tumor immune escape and preventing autoimmunity.These immunoregulatory factors,when combined with ligand,ca...In recent years,immune checkpoint molecules have made breakthroughs in the fields of inducing graft tolerance,tumor immune escape and preventing autoimmunity.These immunoregulatory factors,when combined with ligand,can transduce the inhibitory signal into cells to negatively regulate the immune response,which brings new enlightenment for the immune research of pregnancy and pregnancy complications.In this review,we reviewed the immunomodulatory effects of CTLA-4,PD-1 and Tim-3 in pregnancy,in order to evaluate their potential effects in pregnancy,and to provide a new direction for the immunotherapy of pregnancy complications.展开更多
<strong>Objective</strong><strong>:</strong><span style="font-family:""><span style="font-family:Verdana;"> To compare between the efficacy of the use of or...<strong>Objective</strong><strong>:</strong><span style="font-family:""><span style="font-family:Verdana;"> To compare between the efficacy of the use of oral sildenafil plus low dose aspirin versus the use of oral low dose aspirin alone in pregnancy as preventive measure in women at risk for preeclampsia (PE). </span><b><span style="font-family:Verdana;">Design: </span></b><span style="font-family:Verdana;">A randomized clinical trial. </span><b><span style="font-family:Verdana;">Setting: </span></b><span style="font-family:Verdana;">Outpatient Obstetric clinic of Ain Shams University Maternity Hospital. </span><b><span style="font-family:Verdana;">Population or sample: </span></b><span style="font-family:Verdana;">Women at gestational age of </span></span><span style="font-family:""><span style="font-family:Verdana;">≤</span><span><span style="font-family:Verdana;">16 weeks who at risk for PE between June 2018 and June 2019. </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> Participants were randomly allocated into two groups: Group I Included 200 women who received a 25 mg tablet of oral sildenafil citrate tid until delivery plus 100 mg tablet of aspirin orally once daily until gestational age of 36 weeks, Group II Included 200 women who received a 100 mg tablet of aspirin orally once daily until gestational age of 36 weeks. </span><b><span style="font-family:Verdana;">Main Outcome Measures: </span></b><span style="font-family:Verdana;">Incidence of preeclampsia diagnosed per ACOG criteria. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> The incidence of PE in both groups showed no statistically significant difference. The incidence of PE in the first group is 11.0%, and it is 12.0% in the second group (p-value 0.754). </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> The addition of sildenafil citrate to low dose aspirin had no impact on the prevention of preeclampsia for women at risk of PE, in addition, sildenafil did not improve maternal and fetal outcomes.</span></span></span>展开更多
<strong>Introduction:</strong><span style="font-family:;" "=""><span style="font-family:Verdana;"> Mullerian malformations are a group of malformations that r...<strong>Introduction:</strong><span style="font-family:;" "=""><span style="font-family:Verdana;"> Mullerian malformations are a group of malformations that result from an alteration of embryonic development. Most cases are asymptomatic, however, in pregnant </span><span style="font-family:Verdana;">patients</span><span style="font-family:Verdana;"> it has been associated with recurrent abortion or premature delivery. </span><b><span style="font-family:Verdana;">Case presentation:</span></b><span style="font-family:Verdana;"> 12 + 2 weeks pregnant woman consulted for abdominal pain, vomiting </span><span style="font-family:Verdana;">and</span><span style="font-family:Verdana;"> fever. During the study, a transvaginal ultrasound was performed, where two </span><span style="font-family:Verdana;">endometric</span><span style="font-family:Verdana;"> cavities and </span></span><span style="font-family:Verdana;">a </span><span style="font-family:Verdana;">pregnancy</span><span style="font-family:Verdana;"> in the right horn were observed. The evolution of the patient was torpid, reaching hypovolemic shock, resolved by an emergency laparotomy where the rupture of the right horn was found. </span><b><span style="font-family:Verdana;">Discu</span></b><b><span style="font-family:Verdana;">s</span></b><b><span style="font-family:Verdana;">sion</span></b><b><span style="font-family:Verdana;">: </span></b><span style="font-family:Verdana;">The bicornuate uterus is the consequence </span><span style="font-family:;" "=""><span style="font-family:Verdana;">of a partial fusion of the paramesonephric ducts </span><span><span style="font-family:Verdana;">during </span><span style="font-family:Verdana;">the fetal</span><span style="font-family:Verdana;"> development, resulting in two functional uterine horns. Pa</span></span><span style="font-family:Verdana;">tients with bicornuate uterus may be asymptomatic</span></span><span style="font-family:Verdana;">,</span><span style="font-family:;" "=""><span style="font-family:Verdana;"> a uterine rupture is a rare but potentially severe complication of the bicornuate uterus and is usually presented during </span><span style="font-family:Verdana;">first</span><span style="font-family:Verdana;"> and second trimester. </span><b><span style="font-family:Verdana;">Conclusions: </span></b></span><span style="font-family:Verdana;">Pregnancy with Mullerian anomalies often ha</span><span style="font-family:Verdana;">s</span><span style="font-family:;" "=""> <span style="font-family:Verdana;">preterm</span><span style="font-family:Verdana;"> delivery, IUGR </span><span style="font-family:Verdana;">and</span><span style="font-family:Verdana;"> malpresentation, and even </span></span><span style="font-family:;" "=""><span style="font-family:Verdana;">more severe complication as uterine </span><span style="font-family:Verdana;">ruptura</span><span style="font-family:Verdana;">, so, require</span></span><span style="font-family:Verdana;">s</span><span style="font-family:;" "=""><span style="font-family:Verdana;"> proper </span><span style="font-family:Verdana;">counselling</span><span style="font-family:Verdana;"> and close monitoring during </span><span style="font-family:Verdana;">antenatal</span><span style="font-family:Verdana;"> period.</span></span>展开更多
Expression of Toll-like receptors at the maternal-fetal interface during normal and complicated pregnancies has aroused interest in the last few years. However, despite the importance of TLR-2 and TLR-4, which recogni...Expression of Toll-like receptors at the maternal-fetal interface during normal and complicated pregnancies has aroused interest in the last few years. However, despite the importance of TLR-2 and TLR-4, which recognizes most microorganisms presenting in the amniotic cavity infections associated with prematurity, comparison of the expressions of these receptors is rare in the literature. Thus, the purpose of this study was to compare the gene expression between TLR-2 and TLR-4 in amniochorion membranes of pregnant women with preterm delivery in the presence of histologic chorioamnionitis (HCA). Amniochorion membranes were collected from 40 pregnant women with preterm delivery;20 presented HCA and 20 did not. Fragments of the membranes were submitted to total RNA extraction, followed by cDNA production by reverse transcription. Real time quantitative PCR was used to quantify the gene expression of the TLRs. mRNA concentrations between TLR-2 and TLR-4 were compared using the nonparametric Mann-Whitney test. TLR-2 expression was higher than TLR-4 expression in the presence of HCA. No difference was observed between TLR-2 and TLR-4 expression in membranes in the absence of inflammatory infiltrate. In conclusion, amniochorion membranes express TLR-2 and TLR-4 and higher TLR-2 expression in the presence of histologic chorioamnionitis suggests that microorganisms recognizable by TLR-2 play an important role in the physiopathology of preterm labor.展开更多
To editor:Wernicke encephalopathy(WE)is an acute neurological disorder caused by a deficiency of vitamin B1(thiamine),with a prevalence of 1.3%in autopsy studies.1 Eighty-four percent of patients with WE will develop ...To editor:Wernicke encephalopathy(WE)is an acute neurological disorder caused by a deficiency of vitamin B1(thiamine),with a prevalence of 1.3%in autopsy studies.1 Eighty-four percent of patients with WE will develop Korsakoff syndrome,which is characterized by amnesia and confusion.2 Although WE is more common in alcoholics,it can also be caused by vomiting,malnourishment,and other situations.展开更多
A comprehensive profiling of the vaginal microbial communities and their variability enables an accurate description of the microbiome in women.However,there is a lack of studies available on Chinese women.In the pres...A comprehensive profiling of the vaginal microbial communities and their variability enables an accurate description of the microbiome in women.However,there is a lack of studies available on Chinese women.In the present study,the composition of the vaginal microbiota during pregnancy and the 6-week postpartum period of 454 Chinese women was characterized by sequencing the V3-V4 region of the 16S ribosomal RNA(rRNA)gene.The vaginal microbiome showed variations during pregnancy and the postpartum period based on the abortion history,hypertensive disorders,delivery mode,and maternal age.Co-variation of 22 bacterial taxa,including the Lactobacillus genus and two of its species,may account for the common characteristics of the vaginal microbiome under scenarios of different medical histories and pregnancy outcomes.In contrast,discriminant bacterial species were significantly different between women who had preterm birth(PTB)with and without premature rupture of membranes(PROM),and the community state type(CST)IV-A without any predominant Lactobacillus species in the microbiota was more prevalent during pregnancy in the PROM-PTB cases,suggesting that specific bacterial species could be considered to distinguish between different types of PTB.By providing data on Chinese women,this study will enrich the knowledge of the human microbiome and contribute to a better understanding of the association between the vaginal microbiome and reproductive health.展开更多
Background:Ovarian cysts are uncommon gestational complications.Because of high-level progesterone,ovarian endometriomas may undergo decidualization during pregnancy,manifesting as enlarging cysts with papillae and ri...Background:Ovarian cysts are uncommon gestational complications.Because of high-level progesterone,ovarian endometriomas may undergo decidualization during pregnancy,manifesting as enlarging cysts with papillae and rich blood flow.Such cases can mimic malignant or borderline tumors,causing dilemmas in clinical management.Here,we present two cases of enlarging ovarian cysts during pregnancy with evidence suggesting decidualized endometrioma.The diagnosis and treatment are further discussed,which add to our limited knowledge and might help future clinical practice.Case summary:In the first case,a right ovarian cyst was detected by ultrasound in a 32-year-old pregnant woman.The cyst measured 4.2 cm in diameter at 7t6 weeks of gestation,and gradually increased to 9.6 cm7.6 cm5.6 cm at 37t5 weeks,with multiple solid papillae lining the inner wall.During cesarean section,an ovarian mass of approximately 9 cm in diameter was surgically removed,which was later identified by pathological review as an endometrioma with decidualization.The second case also presented as an enlarging ovarian mass during the first and second trimester.The size of the cyst peaked at 24t5 weeks of gestation,measuring 6.9 cm5.6 cm4.1 cm.But in the third trimester,the tumor slightly regressed.Careful follow-up was adopted after successful vaginal delivery,and the cyst was found to have undergone quick regression shortly after pregnancy.Both patients recovered well after delivery with no further complications.Conclusion:Endometriomas with decidualization during gestation may resemble borderline or malignant tumors.Close monitoring and proper management are essential for guiding clinical management.展开更多
The disseminated herpes simplex virus 2(HSV-2)carries a high mortality rate in pregnant women if left unrec-ognized.It often presents as unrelieved fever and hepatitis.Diagnosis is challenging due to vague symptoms an...The disseminated herpes simplex virus 2(HSV-2)carries a high mortality rate in pregnant women if left unrec-ognized.It often presents as unrelieved fever and hepatitis.Diagnosis is challenging due to vague symptoms and potential overlap with other conditions.Pregnancy is a risk factor as it conforms to a partially immunocompro-mised state.Dissemination to the brain could be devastating,and the treatment requires intravenous antivirals like acyclovir.Fetal outcomes are variable based on previous case reports.We present a case of young female gravida 1 para 1 who presented with disseminated HSV infection mimicking HELLP(Hemolysis,Elevated Liver enzymes,and Low Platelets)syndrome.She responded well to intravenous acyclovir,and the fetus had a viable outcome at the 26th week of gestation.Early diagnosis can prevent progression to fulminant liver failure and the need for a liver transplant.展开更多
文摘As maternal deaths have decreased worldwide, increasing attention has been placed on the study of severe obstetric complications, such as hemorrhage, eclampsia, and obstructed labor, to identify where improvements can be made in maternal health. The objective of this study was to determine pregnancy complications and prenatal care among women aged 15 - 49 in Oğuzeli, Turkey, and to provide data for prevention in the field. This descriptive, cross-sectional study was conducted between February and May 2013 in Oğuzeli distinct, Turkey. The total women registered to family doctors in Oğuzeli was listed and, 470 women were selected using a stratified and simple random sampling technique. Pregnancy complications were asked for the last pregnancy of each women. Of the women, 23.9% (n = 109) declared that they experienced pregnancy complications during their pregnancies. The most frequent problems were anemia (11.1%) hypertension (3.7%) and diabetes mellitus (2.4%) respectively. Women having chronic diseases before their pregnancy were more likely to have pregnancy complications compared to healthy women (p = 0.005). The mean number of prenatal care among women having pregnancy complications was 5.47 ± 3.57, while it was 3.84 ± 3.00 among healthy women (p = 0.000). Women having chronic diseases should be handled carefully and, pregnancy should be delayed until the chronic disease’s remission. Family planning in primary care is the key measure to archive this. Early diagnosis of hypertension among young women is highly important for the women’s and infants’s health during pregnancy, and for the women’s future heath. During prenatal care, women should be trained about correct eating habits and activity.
基金Yunnan Provincial Health Committee Senior Talent Project,No.L-2018006 and No.H-2018045International Science and Technology Cooperation Special Key Research and Development Plan,No.2017IB004and Academician Expert Workstation of Yunnan Province,No.202005AF150033.
文摘BACKGROUND Nickel(Ni)may accumulate in the human body and has biological toxicity and carcinogenicity.Ni has an extensive impact on the health of pregnant women and fetuses during gestation.AIM To evaluate Ni exposure in pregnant women in Kunming,Yunnan Province,China;to describe the distribution of Ni in the maternal-fetal system and placental barrier function;and to investigate the effect of Ni exposure on fetal health in mothers with pregnancy complications.METHODS Seventy-two pregnant women were selected using a case-control design.The women were divided into two groups:The control group(no disease;n=29)and the disease group[gestational diabetes(GDM),hypertensive disorder complicating pregnancy(HDCP),or both;n=43].The pregnant women in the disease group were further divided as follows:14 cases with GDM(GDM group),13 cases with HDCP(HDCP group)and 16 cases with both GDM and HDCP(disease combination group).Basic information on the pregnant women was collected by questionnaire survey.Maternal blood,placenta blood and cord blood were collected immediately after delivery.The Ni content in paired samples was determined using inductively coupled plasma mass spectrometry.RESULTS Compared to the control group,age was higher and body mass index was greater in pregnant women in the disease groups(28.14±2.54 vs 28.42±13.89,P<0.05;25.90±3.86 vs 31.49±5.30,P<0.05).The birth weights of newborns in the HDCP group and the control group were significantly different(2.52±0.74 vs 3.18±0.41,P<0.05).The content of Ni in umbilical cord blood in the entire disease group was higher than that in the control group(0.10±0.16 vs 0.05±0.07,P<0.05).CONCLUSION In the maternal-fetal system of women with pregnancy complications,the barrier effect of the placenta against Ni is weakened,thus affecting healthy growth of the fetus in the uterus.
基金supported by the Shanghai Municipal Health Commission(202040402)。
文摘Objective:Some pregnancy complications are associated with respiratory problems in infants.Early identification and implementation of respiratory support are needed for these infants.This study aimed to(1)use lung ultrasound(LU)for predicting the respiratory support requirements of infants and(2)simplify the examination method to facilitate its clinical application.Methods:Neonates underwent LU examinations within 1 hour of birth.The infants were divided into a pregnancy complication(PC)group and a control group according to their mothers'clinical data.The primary outcome measure was the need for respiratory support.Predictive models were established based on the differences in LU patterns between the two groups.The predictive value of the models was compared with that of the LU score(LUS)system,which has been widely used in other studies.Simplified models were established by analyzing the predictive effects of LU patterns in different parts of the lungs.Predictive reliability was tested using the receiver operating characteristic curve analysis.Results:PC and control groups had 29 and 117 neonates,respectively;a total of 22 neonates required respiratory support.The PC and control groups showed differences in respiratory support requirements,A-lines,and coalesced B-lines.The percentages of A-lines and coalesced B-lines were associated with respiratory support requirements.The optimal cutoff values for the percentages of the A-lines and coalesced B-lines were 55.7%and 24.5%,respectively.Similar effects were obtained by calculating the percentage of coalesced B-lines in four areas(R3,R4,L3,and L4).These methods were judged as more visual and convenient than LUS assessment.conclusion:The percentages of A-line and coalesced B-lines on LU images can be used to predict the respiratory support needs of neonates whose mothers had pregnancy complications.Only four areas(R3,R4,L3,and L4)had similar predictive values.
基金supported by the National Key R&D Program of China(2019YFA0802600)the National Natural Science Foundation of China(32170863,31871512,and 31671199)to C.Z.Support was also received from grants from the Shanghai Commission of Science and Technology(17DZ2271100)Open Project of Shandong Provincial Key Laboratory of Reproductive Medicine(SDKL2017018).
文摘Decidualization is the differentiation of endometrial stromal cells into secretory decidual stromal cells.Human decidualization involves some amount of signaling molecules and pathways as well as genetic reprogramming,which is driven by the postovulatory rise in progesterone levels and local cyclic adenosine monophosphate production.Decidualization extends from the primary decidual zone to the secondary decidual zone,and then exits through apoptosis.Evidences support that decidual fibroblasts function as the pool of decidual stromal cells during pregnancy.Decidualization undergoes an acute inflammatory phase,an anti-inflammatory secretory phase to the final recession phase.The decidualization of the inner layer of endometrium,termed decidua,is the most critical determinant of pregnancy success,which can promote placenta formation,modulate immune tolerance,foster resistance to oxidative stress,sense embryo quality,and control labor.Failure to adequate decidualization in terms of hormones,biochemistry,and immunology leads to adverse pregnancy outcomes,including diseases such as preeclampsia,miscarriage,premature labor,repeated implantation failures,and some age-related decline in reproductive capacity.The development of animal models and in vitro culture systems combined with emerging technologies provides a powerful system to explore the mechanism of decidualization.However,decidualization is a dynamic,multi-step process,and translating of current research progress into disease predictions and interventions for pregnancy complications remains to be achieved.The study of periodic regeneration and spontaneous decidualization of the endometrium will be beneficial to the diagnosis and treatment of pregnancy diseases.
基金Supported by the Dietmar Hopp Foundation(in part,DFG),No.MU 1373/9-1
文摘AIM To study liver stiffness(LS) during pregnancy and its association with complications during pregnancy.METHODS In this observational, diagnostic study, 537 pregnant women were prospectively enrolled at the Department of Obstetrics and Gynecology, University hospital Heidelberg and Salem Medical Center. LS was measured using the Fibroscan device(Echosens, Paris) in all women and in 41 cases 24 h after delivery. Clinical and morphological data were recorded and abdominal ultrasound and standard laboratory tests were performed. No complications were observed in 475 women(controls) while preeclampsia and intrahepatic cholestasis of pregnancy(ICP) developed in 22 and 40 women, respectively.RESULTS In controls, LS increased significantly from initially 4.5 ± 1.2 kPa in the second trimester to 6.0 ± 2.3 kPa(P < 0.001) in the third trimester. In the third trimester, 41% of women had a LS higher than 6 kPa. Elevated LS in controls was significantly correlated with alkaline phosphatase, leukocytes, gestational age and an increase in body weight and body mass index(BMI). In women with pregnancy complications, LS was significantly higher as compared to controls(P < 0.0001). Moreover, in multivariate analysis, LS was an independent predictor for preeclampsia with an odds ratio of 2.05(1.27-3.31) and a cut-off value of 7.6 kPa. In contrast, ICP could not be predicted by LS. Finally, LS rapidly decreased in all women within 24 h after delivery from 7.2 ± 3.3 kPa down to 4.9 ± 2.2 kPa(P < 0.001).CONCLUSION During pregnancy, LS significantly and reversibly increases in the final trimester of pregnant women without complications. In women with preeclampsia, LS is significantly elevated and an independent noninvasive predictor.
文摘Obstetric cholestasis (also referred to as intrahepatic cholestasis of pregnancy—ICP) is a pruritic form of reversible cholestasis that is associated with significant fetal risks. There is a paucity of research regarding pregnancy outcomes of the mothers with obstetric cholestasis in the South Asian setting. Hence, the objective of this study was to determine the prevalence of obstetric cholestasis among mothers presenting with pruritus during pregnancy and to describe the characteristics and outcomes for those diagnosed with ICP in comparison with those with pruritus in the absence of ICP. Methods: All mothers presenting with pruritus to De Soyza Maternity hospital in Colombo Sri Lanka, between 1st January 2011 to 1st January 2014, were recruited for the study. A standard set of biochemical tests were used for diagnosis of ICP. An interviewer administered questionnaire and patient records were used for data collection. Presentation, characteristics and pregnancy outcomes were assessed and compared for mothers with ICP against those with pruritus in the absence of ICP. Results: The prevalence of ICP in the study population was found to be 27% (n = 27). Generalized pruritus with pruritus of the palms and soles was identified as the commonest pattern of pruritus for diagnosed with ICP. Delivery before 37 weeks (p = 0.001), meconium stained liquor (p = 0.004), placental abruption (p = 0.005), postpartum hemorrhage (p = 0.005), bleeding manifestation (p = 0.006), preterm labor (p = 0.031) and fetal distress (p = 0.035) were found to be significantly associated with the presence of ICP. Conclusions: Nearly 1/3 of mothers presenting with pruritus in pregnancy in Sri Lanka are affected by ICP which is associated with an increase in a wide range of adverse maternal and fetal outcomes compared to those with pruritus in the absence of ICP.
基金Supported by The Ministry of Science and Technology of China for the National Five-Year Key Projects in Infectious Diseases,No. 2015ZX10004801
文摘BACKGROUND Data that assess maternal and infant outcomes in hepatitis C virus(HCV)-infected mothers are limited.AIM To investigate the frequency of complications and the associated risk factors.METHODS We performed a cohort study to compare pregnancy and fetal outcomes of HCVviremic mothers with those of healthy mothers.Risk factors were analyzed with logistic regression.RESULTS Among 112 consecutive HCV antibody-positive mothers screened,we enrolled 79 viremic mothers.We randomly selected 115 healthy mothers from the birth registry as the control.Compared to healthy mothers,HCV mothers had a significantly higher frequency of anemia[2.6%(3/115)vs 19.0%(15/79),P<0.001]during pregnancy,medical conditions that required caesarian section[27.8%(32/115)vs 48.1%(38/79),P=0.004],and nuchal cords[9.6%(11/115)vs 34.2%(27/79),P<0.001].In addition,the mean neonatal weight in the HCV group was significantly lower(3278.3±462.0 vs 3105.1±459.4 gms;P=0.006),and the mean head circumference was smaller(33.3±0.6 vs 33.1±0.7 cm;P=0.03).In a multivariate model,HCV-infected mothers were more likely to suffer anemia[adjusted odds ratio(OR):18.1,95%confidence interval(CI):4.3-76.6],require caesarian sections(adjusted OR:2.6,95%CI:1.4-4.9),and have nuchal cords(adjusted OR:5.6,95%CI:2.4-13.0).Their neonates were also more likely to have smaller head circumferences(adjusted OR:2.1,95%CI:1.1-4.3)and lower birth weights than the average(≤3250 gms)with an adjusted OR of 2.2(95%CI:1.2-4.0).The vertical transmission rate was 1%in HCV-infected mothers.CONCLUSION Maternal HCV infections may associate with pregnancy and obstetric complications.We demonstrated a previously unreported association between maternal HCV viremia and a smaller neonatal head circumference,suggesting fetal growth restriction.
文摘Bangladesh, a developing country, gained success towards the fifth-millennium development goals target of reducing its maternal mortality ratio by three quarters by 2015, but yet worked more on it for further reduction of maternal mortality. In this light, though Bangladesh is committed to the sustainable development goals target of reducing its maternal mortality ratio to be reduced from 170 to 105 per 100,000 live births, the scope of research on this issue is limited because the maternal morbidity data is scarce in Bangladesh. In this paper, the prospective data on maternal morbidity in rural Bangladesh (collected by BIRPERHT) have been employed to trace out the high-risk and life-threatening factors associated with pregnancy-related complications. The subject-specific generalized estimating equations (SS-GEE) model with random effect structure is used for multivariate binary data for the repeated observations. The findings indicate that the risk of suffering from pregnancy complications is higher for high economic status, lower age at marriage, not visited for medical check-ups, outside home workers, and having miscarriage or abortion. Comparing the SS-GEE model with other correlation structures and relative efficiency factors, the SS-GEE model with random effect structure is well fitted for the prospective repeated observation data.
文摘<strong>Objective: </strong><span><span><span style="font-family:""><span style="font-family:Verdana;">To review a case series of 12 women with unexpected heart and lung disorders that occurred during pregnancy and the puerperium, describing for teaching purposes the pitfalls in practice and the lessons learned from this experience. </span><b><span style="font-family:Verdana;">Materials & Methods: </span></b><span style="font-family:Verdana;">We reviewed case files of women with medical and/or hypertensive complications of pregnancy that were evaluated </span><span style="font-family:Verdana;">for medicolegal defense purposes by the first author between 1986-2015.</span> <span style="font-family:Verdana;">Twelve women in these case files experienced unexpected cardiovascular</span><span style="font-family:Verdana;"> and/or cardiopulmonary complications late in pregnancy or early in the puerperium. For each case, the pertinent medical record information was extracted. Im</span><span style="font-family:Verdana;">portant concepts as lessons learned are summarized and referenced for</span><span style="font-family:Verdana;"> teaching purposes. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> Five women had undetected preexisting heart disease which acutely deteriorated during the third trimester, four women developed postpartum heart failure related to pregnancy and delivery, and three women </span><span style="font-family:Verdana;">suffered an intrapartum cardiac arrest;none survived. Their case presenta</span><span style="font-family:Verdana;">tions illustrate the importance of obstetric health care professionals being alert to the signs/symptoms of developing cardiopulmonary disease late in pregnancy and following delivery so that timely evaluation and intervention can be accomplished to potentially avoid morbidity and mortality. Diagnostic categories include peripartum heart failure, high-risk chronic hypertension, superimposed preeclampsia, amniotic fluid embolism, pulmonary embolism and Raynaud’s with occult pulmonary hypertension. </span><b><span style="font-family:Verdana;">Conclusion: </span></b><span style="font-family:Verdana;">These cases illustrate the diversity of ways that cardiovascular disease can suddenly complicate pregnancy and the early postpartum period. A major part of any effort to enhance safer motherhood is a heightened awareness by obstetric specialists to consider the possibility of heart disease in all maternity patients so that appropriate consultation and collaboration with other specialists might help avoid major maternal morbidity or mortality.</span></span></span></span>
文摘Meckel’s diverticulum complicating pregnancy is indeed a rare occurrence. The anatomical and physiological changes that occur in pregnancy make the clinical presentation and preoperative diagnosis of an acute abdomen extremely difficult. Even imaging modalities have to be used with caution keeping in mind the risks associated for both mother and fetus. Treatment of such cases must be prompt and accurate with a high index of suspicion in order to prevent high rate of maternal and fetal morbidity. We report one such case of bleeding of Meckel’s diverticulum. The most common cause of bleeding in a Meckel’s is ectopic gastric mucosa. When we performed an exploratory laparotomy we found to our surprise a bleeding Meckel’s diverticulum. Further investigations revealed a very interesting histopathological report of endometriosis as the cause of bleed.
文摘BACKGROUND Cervical pregnancies,interstitial tubal pregnancies,and cesarean scar pregnancies,which are ectopic pregnancies with intrauterine implantation sites exhibit increasing trends with the recent widespread use of assisted reproductive technologies and increased rate of cesarean deliveries.The development of highsensitivity human chorionic gonadotropin testing reagents and the increased precision of transvaginal ultrasonic tomography have made early diagnosis possible and have enabled treatment.Removal of ectopic pregnancies using methotrexate therapy and/or uterine artery embolization has been reported.However,delayed resumption of infertility treatments after methotrexate therapy is indicated,and negative effects on the next pregnancy after uterine artery embolization have been reported.AIM To examine the efficacy and safety of ultrasound-guided topical absolute ethanol injection in ectopic pregnancies with an intrauterine implantation site.METHODS In this study,we retrospectively examined the medical records of 21 patients who were diagnosed with an ectopic pregnancy with an intrauterine implantation site at our hospital,between April 2010 and December 2018,and underwent transvaginal ultrasound-guided local injections of absolute ethanol to determine the treatment outcomes.We evaluated the treatment methods,treatment outcomes,presence of bleeding requiring hemostasis measures and blood transfusion,complications,and treatment periods.Successful treatment was defined as the completion of treatment using transvaginal ultrasound-guided local injections of absolute ethanol alone.RESULTS There were 21 total cases comprising 10 cervical pregnancies,10 interstitial tubal pregnancies,and 1 cesarean scar pregnancy.All patients completed treatment with this method.No massive hemorrhaging or serious adverse reactions were observed during treatment.The mean gestation ages at the time of diagnosis were 5.9 wk(SD,±0.9 wk)for cervical and 6.9 wk(SD,±2.1 wk)for interstitial tubal pregnancies.The total ethanol doses were 4.8 mL(SD,±2.2 mL)for cervical pregnancies and 3.3 mL(SD,±2.2 mL)for interstitial pregnancies.The treatment period was 28.5days(SD,±11.7 d)for cervical pregnancies and 30.0±8.1 d for interstitial pregnancies.Positive correlations were observed between the bloodβ-human chorionic gonadotropin level at the beginning of treatment and the total ethanol dose(r=0.75;P=0.00008),as well as between the total ethanol dose and treatment period(r=0.48;P=0.026).CONCLUSION Transvaginal ultrasound-guided local injections of absolute ethanol could become a new option for intrauterine ectopic pregnancies when fertility preservation is desired.
基金supported by the National Key R&D Program of China (grant no.2019YFC1005105).
文摘Pregnancy with solid pseudopapillary tumor of the pancreas(SPTP)is rare.Because pregnancy hormones may cause tumor progression,the management and treatment of SPTP need to balance the safety of pregnant women and fetuses with surgical treatment.We reported a case of a giant pancreatic tumor diagnosed during pregnancy that was considered to be SPTP.Examinations also showed hepatitis B virus infection and severe decompensation of liver cirrhosis.Medical termination of pregnancy was performed.The patient has lived with the tumor until now without surgery.We retrieved the published case reports,summarized the clinical characteristics of pregnancy with SPTP,and explored its management during the perinatal period.Most patients with SPTP have a good prognosis with good maternal and fetal outcomes,and it is important to choose an appropriate treatment method and timing.However,pregnancy combined with decompensated liver cirrhosis needs to be terminated in a timely manner because of its high-risk status.
基金National Natural Science Foundation of China(No.81974577)。
文摘In recent years,immune checkpoint molecules have made breakthroughs in the fields of inducing graft tolerance,tumor immune escape and preventing autoimmunity.These immunoregulatory factors,when combined with ligand,can transduce the inhibitory signal into cells to negatively regulate the immune response,which brings new enlightenment for the immune research of pregnancy and pregnancy complications.In this review,we reviewed the immunomodulatory effects of CTLA-4,PD-1 and Tim-3 in pregnancy,in order to evaluate their potential effects in pregnancy,and to provide a new direction for the immunotherapy of pregnancy complications.
文摘<strong>Objective</strong><strong>:</strong><span style="font-family:""><span style="font-family:Verdana;"> To compare between the efficacy of the use of oral sildenafil plus low dose aspirin versus the use of oral low dose aspirin alone in pregnancy as preventive measure in women at risk for preeclampsia (PE). </span><b><span style="font-family:Verdana;">Design: </span></b><span style="font-family:Verdana;">A randomized clinical trial. </span><b><span style="font-family:Verdana;">Setting: </span></b><span style="font-family:Verdana;">Outpatient Obstetric clinic of Ain Shams University Maternity Hospital. </span><b><span style="font-family:Verdana;">Population or sample: </span></b><span style="font-family:Verdana;">Women at gestational age of </span></span><span style="font-family:""><span style="font-family:Verdana;">≤</span><span><span style="font-family:Verdana;">16 weeks who at risk for PE between June 2018 and June 2019. </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> Participants were randomly allocated into two groups: Group I Included 200 women who received a 25 mg tablet of oral sildenafil citrate tid until delivery plus 100 mg tablet of aspirin orally once daily until gestational age of 36 weeks, Group II Included 200 women who received a 100 mg tablet of aspirin orally once daily until gestational age of 36 weeks. </span><b><span style="font-family:Verdana;">Main Outcome Measures: </span></b><span style="font-family:Verdana;">Incidence of preeclampsia diagnosed per ACOG criteria. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> The incidence of PE in both groups showed no statistically significant difference. The incidence of PE in the first group is 11.0%, and it is 12.0% in the second group (p-value 0.754). </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> The addition of sildenafil citrate to low dose aspirin had no impact on the prevention of preeclampsia for women at risk of PE, in addition, sildenafil did not improve maternal and fetal outcomes.</span></span></span>
文摘<strong>Introduction:</strong><span style="font-family:;" "=""><span style="font-family:Verdana;"> Mullerian malformations are a group of malformations that result from an alteration of embryonic development. Most cases are asymptomatic, however, in pregnant </span><span style="font-family:Verdana;">patients</span><span style="font-family:Verdana;"> it has been associated with recurrent abortion or premature delivery. </span><b><span style="font-family:Verdana;">Case presentation:</span></b><span style="font-family:Verdana;"> 12 + 2 weeks pregnant woman consulted for abdominal pain, vomiting </span><span style="font-family:Verdana;">and</span><span style="font-family:Verdana;"> fever. During the study, a transvaginal ultrasound was performed, where two </span><span style="font-family:Verdana;">endometric</span><span style="font-family:Verdana;"> cavities and </span></span><span style="font-family:Verdana;">a </span><span style="font-family:Verdana;">pregnancy</span><span style="font-family:Verdana;"> in the right horn were observed. The evolution of the patient was torpid, reaching hypovolemic shock, resolved by an emergency laparotomy where the rupture of the right horn was found. </span><b><span style="font-family:Verdana;">Discu</span></b><b><span style="font-family:Verdana;">s</span></b><b><span style="font-family:Verdana;">sion</span></b><b><span style="font-family:Verdana;">: </span></b><span style="font-family:Verdana;">The bicornuate uterus is the consequence </span><span style="font-family:;" "=""><span style="font-family:Verdana;">of a partial fusion of the paramesonephric ducts </span><span><span style="font-family:Verdana;">during </span><span style="font-family:Verdana;">the fetal</span><span style="font-family:Verdana;"> development, resulting in two functional uterine horns. Pa</span></span><span style="font-family:Verdana;">tients with bicornuate uterus may be asymptomatic</span></span><span style="font-family:Verdana;">,</span><span style="font-family:;" "=""><span style="font-family:Verdana;"> a uterine rupture is a rare but potentially severe complication of the bicornuate uterus and is usually presented during </span><span style="font-family:Verdana;">first</span><span style="font-family:Verdana;"> and second trimester. </span><b><span style="font-family:Verdana;">Conclusions: </span></b></span><span style="font-family:Verdana;">Pregnancy with Mullerian anomalies often ha</span><span style="font-family:Verdana;">s</span><span style="font-family:;" "=""> <span style="font-family:Verdana;">preterm</span><span style="font-family:Verdana;"> delivery, IUGR </span><span style="font-family:Verdana;">and</span><span style="font-family:Verdana;"> malpresentation, and even </span></span><span style="font-family:;" "=""><span style="font-family:Verdana;">more severe complication as uterine </span><span style="font-family:Verdana;">ruptura</span><span style="font-family:Verdana;">, so, require</span></span><span style="font-family:Verdana;">s</span><span style="font-family:;" "=""><span style="font-family:Verdana;"> proper </span><span style="font-family:Verdana;">counselling</span><span style="font-family:Verdana;"> and close monitoring during </span><span style="font-family:Verdana;">antenatal</span><span style="font-family:Verdana;"> period.</span></span>
基金São Paulo Research Foundation(Fapesp)grants numbers 2008/55418-1 and 2008/53382-0.
文摘Expression of Toll-like receptors at the maternal-fetal interface during normal and complicated pregnancies has aroused interest in the last few years. However, despite the importance of TLR-2 and TLR-4, which recognizes most microorganisms presenting in the amniotic cavity infections associated with prematurity, comparison of the expressions of these receptors is rare in the literature. Thus, the purpose of this study was to compare the gene expression between TLR-2 and TLR-4 in amniochorion membranes of pregnant women with preterm delivery in the presence of histologic chorioamnionitis (HCA). Amniochorion membranes were collected from 40 pregnant women with preterm delivery;20 presented HCA and 20 did not. Fragments of the membranes were submitted to total RNA extraction, followed by cDNA production by reverse transcription. Real time quantitative PCR was used to quantify the gene expression of the TLRs. mRNA concentrations between TLR-2 and TLR-4 were compared using the nonparametric Mann-Whitney test. TLR-2 expression was higher than TLR-4 expression in the presence of HCA. No difference was observed between TLR-2 and TLR-4 expression in membranes in the absence of inflammatory infiltrate. In conclusion, amniochorion membranes express TLR-2 and TLR-4 and higher TLR-2 expression in the presence of histologic chorioamnionitis suggests that microorganisms recognizable by TLR-2 play an important role in the physiopathology of preterm labor.
文摘To editor:Wernicke encephalopathy(WE)is an acute neurological disorder caused by a deficiency of vitamin B1(thiamine),with a prevalence of 1.3%in autopsy studies.1 Eighty-four percent of patients with WE will develop Korsakoff syndrome,which is characterized by amnesia and confusion.2 Although WE is more common in alcoholics,it can also be caused by vomiting,malnourishment,and other situations.
基金supported by the National Natural Science Foundation of China(Grant Nos.81825019,31722031,31670119,and 31870107)the Beijing Leading Talents in Science and Technology(Grant No.Z181100006318008)+1 种基金the China Mega-Project on Infectious Disease Prevention(Grant Nos.2018ZX10713002-002,2018ZX10101003-002,and 2018ZX10301401)the National Key R&D Program of China(Grant No.2016YFC1000705).
文摘A comprehensive profiling of the vaginal microbial communities and their variability enables an accurate description of the microbiome in women.However,there is a lack of studies available on Chinese women.In the present study,the composition of the vaginal microbiota during pregnancy and the 6-week postpartum period of 454 Chinese women was characterized by sequencing the V3-V4 region of the 16S ribosomal RNA(rRNA)gene.The vaginal microbiome showed variations during pregnancy and the postpartum period based on the abortion history,hypertensive disorders,delivery mode,and maternal age.Co-variation of 22 bacterial taxa,including the Lactobacillus genus and two of its species,may account for the common characteristics of the vaginal microbiome under scenarios of different medical histories and pregnancy outcomes.In contrast,discriminant bacterial species were significantly different between women who had preterm birth(PTB)with and without premature rupture of membranes(PROM),and the community state type(CST)IV-A without any predominant Lactobacillus species in the microbiota was more prevalent during pregnancy in the PROM-PTB cases,suggesting that specific bacterial species could be considered to distinguish between different types of PTB.By providing data on Chinese women,this study will enrich the knowledge of the human microbiome and contribute to a better understanding of the association between the vaginal microbiome and reproductive health.
基金the National Key Technology R&D Program of China(2019YFC1005200 and 2019YFC1005201).
文摘Background:Ovarian cysts are uncommon gestational complications.Because of high-level progesterone,ovarian endometriomas may undergo decidualization during pregnancy,manifesting as enlarging cysts with papillae and rich blood flow.Such cases can mimic malignant or borderline tumors,causing dilemmas in clinical management.Here,we present two cases of enlarging ovarian cysts during pregnancy with evidence suggesting decidualized endometrioma.The diagnosis and treatment are further discussed,which add to our limited knowledge and might help future clinical practice.Case summary:In the first case,a right ovarian cyst was detected by ultrasound in a 32-year-old pregnant woman.The cyst measured 4.2 cm in diameter at 7t6 weeks of gestation,and gradually increased to 9.6 cm7.6 cm5.6 cm at 37t5 weeks,with multiple solid papillae lining the inner wall.During cesarean section,an ovarian mass of approximately 9 cm in diameter was surgically removed,which was later identified by pathological review as an endometrioma with decidualization.The second case also presented as an enlarging ovarian mass during the first and second trimester.The size of the cyst peaked at 24t5 weeks of gestation,measuring 6.9 cm5.6 cm4.1 cm.But in the third trimester,the tumor slightly regressed.Careful follow-up was adopted after successful vaginal delivery,and the cyst was found to have undergone quick regression shortly after pregnancy.Both patients recovered well after delivery with no further complications.Conclusion:Endometriomas with decidualization during gestation may resemble borderline or malignant tumors.Close monitoring and proper management are essential for guiding clinical management.
文摘The disseminated herpes simplex virus 2(HSV-2)carries a high mortality rate in pregnant women if left unrec-ognized.It often presents as unrelieved fever and hepatitis.Diagnosis is challenging due to vague symptoms and potential overlap with other conditions.Pregnancy is a risk factor as it conforms to a partially immunocompro-mised state.Dissemination to the brain could be devastating,and the treatment requires intravenous antivirals like acyclovir.Fetal outcomes are variable based on previous case reports.We present a case of young female gravida 1 para 1 who presented with disseminated HSV infection mimicking HELLP(Hemolysis,Elevated Liver enzymes,and Low Platelets)syndrome.She responded well to intravenous acyclovir,and the fetus had a viable outcome at the 26th week of gestation.Early diagnosis can prevent progression to fulminant liver failure and the need for a liver transplant.
