Incidence Of Premature Delivery Research Articles

Predictive values of cervix length measurement based on transvaginal ultrasonography.

Pregnancy is an important process in women's life, which is widely concerned by women. In recent years, the incidence of premature delivery (PTD) becomes more and more higher due to the development of auxiliary reproduction and ovulation induction technologies and the changes of pregnant women's lifestyle and physical quality. PTD not only affects postpartum recovery and causes great physical pains, but it also has adverse effects on the birth state of neonates and even leads to neonatal death. The predictive values of cervix length (CL) measurement based on transvaginal ultrasonography (TVUS) and pathological examination of placenta for premature delivery (PTD) were investigated and the correlation between PTD and infection was analyzed. 120 pregnant women with PTD or high-risk factors for PTD admitted to The Affiliated Hospital of Southwest Medical University between February 2020 and March 2022 were included as the subjects and underwent pathological examination of placenta and TVUS for CL measurement. The final gestational age was set as the standard for the evaluation on the predictive values of pathological examination of placenta and TVUS. What's more, 36 subjects in PTD group and 84 in normal delivery group (control group) underwent pathological examination of placenta for the analysis of the correlation between PTD and infection. The joint inspection method showed significantly better sensitivity, specificity, PPV, and NPV compared to single CL or pathological examination of the placenta (P< 0.05). Among pregnant women, those with CL ⩽ 30 mm and positive placental pathology had a higher proportion compared to those with CL > 30 mm and negative placental pathology (P< 0.05). Furthermore, the incidence of Ureaplasma Urealyticum (UU), Chlamydia Trachomatis (CT), and Chorioamnionitis (CA) in vaginal discharge of the preterm delivery (PTD) group was significantly higher than that of the control group (P< 0.05). The combination of CL ⩽ 30mm and positive placental pathology could effectively predict PTD and placental infection was notably correlated with the occurrence of PTD.

Vaginal microecological imbalance and expression of serum inflammatory factors in pregnant women with group B streptococcus infection and pregnancy outcome.

The objective of this study was to explore the correlation between vaginal microecological imbalance and the expression of related inflammatory factors in pregnant women with group B streptococcus (GBS) infection and pregnancy outcomes. For this purpose, 100 GBS-positive pregnant women were recruited as the experimental group, and 100 GBS-negative pregnant women were recruited as the controls. The balance of vaginal microecology of pregnant women in different groups was compared. Results showed that the probability of vaginal microecological imbalance in the experimental group was much higher than against the controls. Fasting venous blood was drawn from the pregnant women in two groups. After centrifugation, the expression levels of interleukin-6 (IL-6), tumor necrosis factor α (TNF-α), and interleukin-1β (IL-1β) in serum were detected. It was found that the expression levels of IL-6, IL-1β, and TNF-α in the experimental group were higher than against the controls. After delivery, it suggested that the incidence of premature delivery, neonatal infection, premature rupture of membranes, and other adverse childbirth in the experimental group was much higher in contrast to the controls, up to 87%. In conclusion, GBS infection can increase the incidence of vaginal microecological imbalance and the expression of serum inflammatory factors in pregnant women, and it can greatly raise the incidence of adverse pregnancy outcomes.

Serum ferritin and 25-hydroxyvitamin D levels as predictors for premature birth in pregnant women with preeclampsia.

This study aimed to investigate the expression levels of serum ferritin (SF) and 25-hydroxyvitamin D (25-[OH]-D) and analyze their predictive value for premature birth in pregnant women with preeclampsia. Between December 2018 and December 2021, 104 pregnant women with preeclampsia were selected as the observation group and 52 pregnant women with normal blood pressure as the control group. The observation group were divided into occurrence and nonoccurrence groups according to gestational age at birth. Relevant laboratory indicators were examined in both the occurrence and nonoccurrence groups, and the predictive value of SF and 25-(OH)-D levels for premature births in pregnant women with preeclampsia was analyzed. The incidence of premature delivery in the 104 pregnant women with preeclampsia was 20.19% (21/104). Pre-pregnancy body mass index (BMI), systolic blood pressure, diastolic blood pressure, 24 hours urinary protein, triglycerides, and SF levels of the pregnant women in the observation group were significantly higher, and the 25-(OH)-D levels were significantly lower, than those in the control group (P < .05). Furthermore, the pre-pregnancy BMI, systolic blood pressure, diastolic blood pressure, 24 hours urinary protein, and SF levels of pregnant women in the occurrence group were significantly higher, and the 25-(OH)-D levels were significantly lower, than those in the nonoccurrence group (P < .05). Logistic regression analysis showed that high pre-pregnancy BMI, systolic blood pressure, diastolic blood pressure, 24 hours urinary protein, and SF levels were risk factors for premature birth in pregnant women with preeclampsia (OR > 1, P < .05) and that high serum 25-(OH)-D was a protective factor (OR < 1, P < .05). In conclusion, SF and 25-(OH)-D levels are abnormally expressed in pregnant women with preeclampsia and are associated with premature birth in these women.

Differential expression of serum mir-363-3p in patients with polycystic ovary syndrome and its predictive value for their pregnancy

BackgroundThis study aimed to investigate the expression of serum miR-363-3p in patients with polycystic ovary syndrome (PCOS) and its predictive value for pregnancy after ovulation induction therapy.MethodsThe expression of serum miR-363-3p was detected by Reverse transcription quantitative polymerase chain reaction (RT-qPCR). PCOS patients were treated with ovulation induction therapy, and after the successful pregnancy was confirmed, they were followed up for 1 year in outpatient department to record the pregnancy outcomes of the patients. The Pearson correlation coefficient was used to evaluate the correlation between the expression level of miR-363-3p and biochemical indicators of PCOS patients. Logistic regression analysis was used to analyze the risk factors of pregnancy failure after ovulation induction therapy.ResultsThe serum level of miR-363-3p in PCOS group was significantly lower than that in control group. Compared with the control group, both pregnant and non-pregnant groups had lower miR-363-3p levels, while the non-pregnant group had a greater reduction in miR-363-3p levels than the pregnant group. Low levels of miR-363-3p showed high accuracy in distinguishing pregnant and non-pregnant patients. Logistic regression analysis showed that high levels of luteinizing hormone, testosterone (T), prolactin (PRL) and low level of miR-363-3p were independent risk factors for pregnancy failure after ovulation induction in PCOS patients. Additionally, compared with pregnancy outcomes of healthy women, the incidence of premature delivery, macrosomia, and gestational diabetes in PCOS patients increased.ConclusionsThe expression of miR-363-3p in PCOS patients was reduced and correlated with abnormal hormone levels, suggesting that miR-363-3p may be involved in the occurrence and development of PCOS.

Effect of different conization ranges on pregnancy outcomes

Purpose: To analyze the influence of different conization on pregnancy outcomes. Methods: The data of 78 women at childbearing age having cervical conization in our hospital from January 2013 till December 2015, was collected and analyzed. The control group comprised of 80 women of childbearing age with matched clinical data, who did not undergo cervical conization. Data on the conization procedure were analyzed and pregnancy and obstetric outcomes were assessed. using the. Comparisons were made using the 2test or the Fisher exact test and Student T-test as appropriate. Results: Cold knife cervical conization prolonged the time to conception in patients. Following the procedure, the incidence of premature delivery and premature rupture of membranes were significantly increased as also the rate of early abortions. The depth and circumference of conization was found to be directly correlated with the rate of premature delivery and premature membrane rupture, but not with fetal growth restriction and macrosomia. Conclusion: The depth and circumference of resection should be based on the type of cervical lesions as well as the prognosis and the future pregnancy plans of the patients.

Association between gestational blood lipids and TSH levels and pregnancy outcome of patients with subclinical hypothyroidism.

To investigate the association between gestational blood lipids and thyroid stimulating hormone (TSH) levels and pregnancy outcomes of patients with subclinical hypothyroidism (SCH). In this retrospective observational study, we analyzed the clinical data of 82 patients (case group) with gestational SCH treated in our hospital from January 2021 to January 2022 at gestational weeks 25-33 and grouped them according to whether SCH was well controlled by treatment (case Group-A: well controlled, n=55; case Group-B: poorly controlled, n=27), and the clinical data of 41 pregnant women (control group) undergoing physical examination during the same period. After comparing the blood lipids and TSH levels of the three groups, we compared their adverse pregnancy outcomes to assess the possible correlations between blood lipids and TSH levels and pregnancy outcomes. The levels of total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-C) and TSH in the case Group-B were significantly higher than those in the case Group-A and the control group (P<0.05). Compared with case Group-B and the control group, the incidence of premature delivery, abortion and neonatal growth restriction was higher in case Group-A (P<0.05). Among 82 patients in the case group 42 presented adverse pregnancy outcomes. The levels of TC, TG, LDL-C and TSH in mothers and infants in the adverse outcome group were significantly higher than those in the favorable outcome group (P<0.05). Our Pearson analysis results showed that the levels of TC, TG and LDL-C were positively correlated with the TSH levels and the pregnancy outcomes, and that TSH was positively correlated with pregnancy outcomes (P<0.05). The levels of TC, TG, LDL-C and TSH in patients with poorly controlled SCH were increased during pregnancy, and were associated with the pregnancy outcomes and positively correlated with each other.

Correlation Between Hypothyroidism During Pregnancy and Glucose and Lipid Metabolism in Pregnant Women and Its Influence on Pregnancy Outcome and Fetal Growth and Development.

Purpose:To observe the correlation between hypothyroidism during pregnancy and glucose and lipid metabolism in pregnant women and its influence on a pregnancy outcome and fetal growth and development.MethodsAbout 152 patients with hypothyroidism during pregnancy in our hospital from June 2017 to June 2020 were selected as the observation group and divided into the overt hypothyroidism (OH) group, the subclinical hypothyroidism (SCH) group, and the low T4 group. Another 60 pregnant women with normal antenatal examination and normal thyroid function were selected as the normal group. The glucose and lipid metabolism indexes of each group were compared. The pregnant women in the OH group and the SCH group were given levothyroxine intervention, and the pregnancy outcome and infant development of the two groups were compared.ResultsThe fasting blood glucose and hemoglobin A1c, triglyceride and low-density lipoprotein of the OH group and the SCH group were higher than the low T4 group and the normal group, and the OH group was higher than the SCH group (p < 0.05). The incidence of premature delivery and premature rupture of membranes at term (PROM at term) in the hypothyroidism non-control group was higher than the hypothyroidism control group (p < 0.05). The mental development index and the psychomotor development index in the hypothyroidism non-control group were lower than the hypothyroidism control group (p < 0.05).ConclusionPregnant women with hypothyroidism during pregnancy are more prone to glucose and lipid metabolism disorder, which increases the risk of premature delivery and PROM at term, and has certain influence on the intellectual development and psychomotor development of infants.

Application of online-offline integrated medical care management in patients with gestational diabetes.

To investigate efficacy of online-offline integrated medical care management in patients with gestational diabetes. A total of 140 patients with gestational diabetes were randomly divided into two groups: integrated management (IM) group (n = 70) and control group (n = 70). Patients in the control group were treated with routine nursing intervention, and the patients in the IM group were treated with integrated care (offline medical and nursing management combined with WeChat online management). The fasting plasma glucose (FPG), 2h postprandial plasma glucose (2hPG), Self-rating Anxiety Scale (SAS) score, Self-rating Depression Scale (SDS) score, Diabetes Care Profile (DPC) score, 36-item Short-Form (SF-36) score, and poor pregnancy outcomes were compared between the two groups. After intervention, the FPG, 2hPG, SAS score, SDS score, DPC score and SF-36 score were improved in both groups. All indicators in the IM group were better than the control group (p < 0.05). The incidence of premature delivery, polyhydramnios, neonatal respiratory distress, intrauterine distress, and postpartum hemorrhage in the IM group were lower than those in the control group (p < 0.05). The online-offline integrated medical care management effectively improved the blood glucose level, mental state, self-management behavior, quality of life and pregnancy outcomes of patients with gestational diabetes.

Clinical characteristics of children with airway malacia complicated by pneumonia

BackgroundAirway malacia is an important cause of noisy breathing, recurrent wheezing and respiratory infections, chronic coughing, and episodes of respiratory distress in young children. As the clinical manifestations of airway malacia are not common, many clinicians have insufficient understanding of this disease. So the purpose of this study is to summarize the pathogenic bacteria and clinical manifestations of airway softening complicated with pneumonia in children.MethodsChildren hospitalized with airway malacia complicated by pneumonia were eligible for enrollment from January 1, 2013 to December 31, 2019. Medical records of patients were reviewed for etiology, clinical characteristics, and laboratory examination results.ResultsA total of 164 pneumonia patients with airway malacia were admitted. The male-to-female ratio was 3:1. The age of patients ranged from 1 month to 4 years old. The median age was 6 (3–10) months. The most commonly detected pathogen were Mycoplasma pneumoniae (25/164, 15.24%), Streptococcus pneumoniae (18/164, 10.98%), and respiratory syncytial virus (16/164, 9.76%). Common signs among the 164 patients with confirmed airway malacia included cough (98.78%), wheezing (67.07%), fever (35.37%), intercostal retractions (23.17%), dyspnea (10.98%), cyanosis (11.11%), and crackles (50%). Compared with those without airway malacia, the incidence of premature delivery and mechanical ventilation was higher, and the duration of symptoms before admission (median, 13.5 d) and hospital stay (median 10.0 d) were longer. Of the children with pneumonia, 11.59% of those with airway malacia required supplemental oxygen compared with 4.88% of those without airway malacia (p < 0.05).ConclusionThe median age of children with airway malacia was 6 months. The most common pathogen in patients with airway malacia complicated by pneumonia was Mycoplasma pneumoniae. Patients with airway malacia complicated by pneumonia often presented with a longer disease course, more severe symptoms, and had delayed recovery.

Relationship of abnormal mid-term oral glucose tolerance test and maternal weight gain with adverse pregnancy outcomes in women with gestational diabetes mellitus.

To explore the correlation of mid-term oral glucose tolerance test (OGTT) and maternal weight gain with adverse pregnancy outcomes in women with gestational diabetes mellitus (GDM). A total of 2611 pregnant women with GDM who were examined and delivered in Women's Hospital, Zhejiang University School of Medicine from July 1st 2017 to 30th June 2018 were enrolled in this study. According to the number of abnormal items of mid-term OGTT results or maternal gestational weight gain (GWG), patients were classified. The incidence of adverse perinatal outcomes in each group and its relation with OGTT results and GWG were analyzed. The incidence of gestational hypertension, premature delivery, macrosomia and large for gestational age infant (LGA) in three abnormal items GDM patients were significantly higher than those in one or two abnormal items GDM patients (all <0.017). The incidence of gestational hypertension and premature delivery in two abnormal items GDM patients were higher than those in one abnormal item GDM patients (all <0.017). The incidence of gestational hypertension and macrosomia in excessive GWG patients were significantly higher than those in inadequate and appropriate GWG patients (all <0.017), and the incidence of LGA were higher than that in inadequate GWG patients (all <0.017). The incidence of premature delivery and low birth weight infants in appropriate GWG patients were significantly lower than those in inadequate and excessive GWG patients, and the incidence of small for gestational age infant (SGA) were significantly lower than that in inadequate GWG patients (all <0.017). In one abnormal item GDM patients, inadequate GWG was a risk factor for premature delivery and SGA (=1.66, 95%: 1.10-2.52; =2.20, 95%: 1.07-4.53), and protective factor for LGA (=0.40, 95%: 0.27-0.59). And excessive GWG was a risk factor for gestational hypertension, premature delivery and low birth weight infants (=2.15, 95%: 1.35-3.41; =1.80, 95%: 1.20-2.72; =2.18, 95%: 1.10-4.30).In two abnormal items GDM patients, inadequate GWG was a protective factor for macrosomia and LGA (=0.24, 95%: 0.09-0.67; =0.54, 95%: 0.34-0.86), while excessive GWG was risk factor for premature delivery (=1.98, 95%: 1.23-3.18).In three abnormal items GDM patients, there was no significant relationship between GWG and adverse pregnancy outcomes. For GDM women with one or two items of elevated blood glucose in OGTT, reasonable weight management during pregnancy can reduce the occurrence of adverse pregnancy outcomes. For those with three items of elevated blood glucose in OGTT, more strict blood glucose monitoring and active intervention measures should be taken in addition to weight management during pregnancy.

The Relationship of Anemia in Pregnant Women and the Incidence of Premature Delivery: Systematic Review

The Relationship of Anemia in Pregnant Women and the Incidence of Premature Delivery: Systematic Review

Clinical characteristics and outcomes in pregnant women with epilepsy

BackgroundEpilepsy in pregnancy can lead to substantial maternal and neonatal morbidity and mortality. Early intervention in pregnant women with epilepsy (WWE), accurate assessment of the severity of their condition, and effective treatment are required to improve maternal and neonatal prognosis. Many obstetricians lack experience in monitoring and treating pregnant WWE. AimsThe aim of this study was to describe the demographic and clinical characteristics of pregnant WWE and examine maternal and neonatal outcomes. MethodsMedical records of 75 pregnant women with a history of epilepsy who delivered at Beijing Tiantan Hospital, China between January 2006 and December 2019 were retrospectively reviewed. Pregnant women with a history of epilepsy were matched 1:2 with a control group of 150 pregnant women without epilepsy who delivered at Beijing Tiantan Hospital during the same time period. Information including type and frequency of epilepsy and seizures, maternal complications, medication, delivery mode, newborn weight, and newborn Apgar score were recorded. In subgroup analyses, pregnant WWE were stratified according to presence or absence of seizures during pregnancy and generalized seizure vs. nongeneralized seizure. ResultsThe incidence of anemia, hypertensive disorder of pregnancy, premature rupture of membranes (PROM), cesarean section, and postpartum hemorrhage was significantly higher (p < 0.05), and mean newborn weight and newborn Apgar score were significantly lower (p < 0.05) in pregnant WWE compared with pregnant women without epilepsy. The incidence of premature delivery was significantly higher (p < 0.05), and mean newborn weight was significantly lower (p < 0.05) in pregnant WWE with seizures vs. without seizures. Mean newborn weight was significantly lower (p = 0.01) in pregnant WWE with nongeneralized seizures vs. generalized seizures. ConclusionPregnant WWE are at high risk of anemia, gestational hypertension, PROM, cesarean section, postpartum hemorrhage, and low newborn weight and Apgar score. Women with epilepsy who experience seizures during pregnancy are at high risk of preterm birth and having low birth weight infants. Pregnant WWE who experience nongeneralized seizures are at high risk of having low birth weight infants. These data emphasize the need to routinely monitor fetal weight on ultrasound and offer appropriate intervention. These findings highlight the need for healthcare providers to take a multidisciplinary approach to the management of pregnant WWE. SynopsisPregnant WWE are at high risk of obstetric complications. Women with epilepsy who experience seizures during pregnancy are at high risk of preterm birth and having low birth weight infants. Pregnant WWE who experience nongeneralized seizures are at high risk of having low birth weight infants. These data highlight the need for healthcare providers to take a multidisciplinary approach to the management of pregnant WWE.

Relationship between serum cystatin C level and pregnancy complications and abnormal glucose tolerance at 6-week postpartum in patients with gestational diabetes mellitus

This study aimed to investigate the relationship between serum cystatin C level and pregnancy complications and abnormal glucose tolerance at 6-week postpartum in patients with gestational diabetes mellitus (GDM). Clinical data of 298 cases of GDM delivered in Taizhou People’s Hospital from January 2017 to June 2018 were retrospectively analyzed. According to the level of cystatin C before delivery, they were divided into normal group (≤ 1.1 mg/L) and elevated group (> 1.1 mg/L). The general situation, complications of pregnancy, and the incidence of abnormal glucose tolerance at 6 weeks after delivery were compared between the two groups. According to concomitant gestational hypertension in late pregnancy, the patients were divided into group A (GDM with hypertensive disorder complicating pregnancy (HDCP)) and group B (GDM without HDCP). The differences of age, parity, body mass index (BMI) and mean arterial pressure (MAP) in the first trimester of pregnancy, levels of cystatin C, creatinine, urinary microalbumin, and glycosylated hemoglobin in 24-week gestation and before delivering were compared between the two groups. There was no significant difference in age and parity between the normal group and the elevated group (p > 0.05). The levels of BMI (25.06 ± 3.46 vs 26.34 ± 3.65 kg/m2), creatinine (38.76 ± 16.52 vs 59.75 ± 17.82 mmol/L), and urinary microalbumin (37.11 ± 49.20 vs 61.25 ± 43.52 mg/L) and the incidence of premature delivery (9.35% vs 17.8%), premature rupture of membranes (11.22% vs 20.94%), and abnormal glucose tolerance at 6-week postpartum (18.69% vs 42.93%) in the normal group of cystatin C were significantly lower than that in the elevated group of cystatin C (p 0.05). The clinical characteristics of group A (GDM with HDCP) and group B (GDM without HDCP) were compared. The results showed that the levels of age, BMI, and mean arterial pressure (MAP) were significantly different (p < 0.001). The results of binary logistic regression analysis showed that the significance value of MAP was 0.005 after controlling age factors, which indicated that MAP was an independent risk factor of GDM with HDCP, and the OR value of MAP was 1.420 (1.109–1.817). The increase of cystatin C in patients with GDM does not increase the risk of HDCP, but it does increase the risks of premature delivery, PROM, and abnormal glucose tolerance at 6-week postpartum. Cystatin C is a biological index that may be valuable in predicting the occurrence of these diseases in GDM patients. The independent risk factor of GDM complicating HDCP is MAP.

Relationship between reproductive history and preterm births in the last pregnancy, in Shaanxi province

Objective: To analyze the incidence of preterm delivery among single live neonates and the association between maternal reproductive history and preterm birth. Methods: A questionnaire survey was conducted on reproductive history among women at childbearing age who were selected through multi-stage stratified random sampling method in Shaanxi, during 2010-2013. Samples would include women at childbearing age and in pregnancy or having had definite pregnancy outcomes. Results: A total of 29 608 women at childbearing age with their infants, were studied. The overall incidence of premature delivery among the single live birth neonates under this study, was 2.7% during 2010-2013. Results from the logistic regression model showed that factors as: having had history with preterm delivery (OR=7.99, 95%CI: 5.59-11.43), age of the mothers, older than 35 (OR= 2.03, 95% CI: 1.59-2.59) and with history of birth defects (OR=1.54, 95% CI: 1.01-2.34) were at higher risks for premature delivery in neonates. Intervals on pregnancies between 3-4 years (compared with ≤2 years, OR=0.74, 95% CI: 0.58-0.93), between 5-6 years (compared with ≤2 years, OR=0.66, 95%CI: 0.52-0.82), or> 6 years (compared with ≤2 years, OR=0.48, 95%CI:0.37-0.61) together with numbers of parity as 1 (compared with primiparas, OR=0.80, 95%CI: 0.67-0.95), as ≥2 (compared with primiparas, OR=0.62, 95% CI: 0.39-0.97) etc. were protective factors to preterm delivery. Factors as: history of preterm delivery, mothers age (older than 35 years) and intervals of pregnancy, appeared influential to the age of gestation, under the ordinal polytomous logistic regression analysis. Conclusion: The incidence of preterm births among single live birth neonates in Shaanxi was lower than the average national level. Programs related to health care services prior to conception and during pregnancy, together with increasing the self-care consciousness of childbearing aged women etc, should all be strengthened in order to reduce the occurrence of preterm birth, in Shaanxi province.

Pregnancy outcomes of twin pregnancies complicated with growth discordance

Objective To investigate clinical characteristics and outcomes of twin pregnancies complicated with growth discordance.Methods Five hundred and seventy-six twin pregnancies who delivered between January 1,2000 and July 31,2012 in Peking University First Hospital were retrospectively analyzed.Cases with twin-twin transfusion syndrome had been excluded.Fetal weight was estimated by abdominal circumference and femur length; neonatal birth weight was recorded.The weight difference between two babies was divided by the weight of the bigger one to obtain the differential ratio.Twin pregnancy complicated with growth discordance was diagnosed if the ratio was equal or greater than 25％ (discordance group,n=68),and growth concordance was diagnosed if the ratio was less than 25％ (concordance group,n=508).The incidence of twin pregnancies complicated with growth discordance was analyzed.The incidence of maternal complications,premature delivery,perinatal death and neonatal complications were compared between the two groups.Chisquare test and t test were used for statistical analysis.Results The incidence of twin pregnancies complicated with growth discordance was 11.8％ (68/576).The incidence of growth discordance in monochorionic twins was higher than that in dichorionic twins [17.6％ (40/227) vs 8.0％ (28/349),x2=11.40,P＜0.05].The gestational age at delivery in the discordance group was earlier than that in the concordance group [(35.6±4.1) weeks vs (36.6±3.2) weeks,t=-1.66,P＜0.05],and the incidence of premature delivery in the discordance group was higher than that in the concordance group [58.8％ (40/68) vs 47.6％ (242/508),x2=3.85,P＜0.05].The perinatal mortality in discordance group was higher than that in the concordance group [9.6％ (13/136) vs 4.7％ (48/1 016),x2=5.84,P＜0.05].Among babies in discordance group,the incidence of intracranial lesion in monochorionic twins was higher than that in dichorionic twins [20.9％ (14/67) vs 6.8％ (3/44),x2=4.06,P＜0.05].Conclusions Twin pregnancies with growth discordance are prone to adverse pregnancy outcomes.Prenatal care should be strengthened and fetal condition should be assessed timely.It is suggested that neonates should undergo overall checkup and long-term follow-up. Key words: Twins ; Fetal development; Pregnancy outcome

Breast cancer during pregnancy: a retrospective study on obstetrical problems and survival

ObjectivesBreast cancer is one of the most common cancers occurring in pregnancy. Data on survival of these patients and their obstetrical complications are still limited. Study designWe conducted a case–control, retrospective study to evaluate the overall survival (OS) of 22 patients with breast cancer in pregnancy (BCP) and 45 non-pregnant women with breast cancer (BC) matched for age, stage and hormonal status. ResultsSurvival of BCP and BC patients using Kaplan–Meier analysis was similar (86.4% in cases and 80% in controls p=0.392) and BCP patients had survival consistent with the stage of the disease, providing that the treatment had been in agreement with the recommended protocols. The overall incidence of premature delivery was 54.6% and complications were observed in three newborns out of 23 (13%). ConclusionsPreterm labor induction without any obstetrical indication following woman's request to continue chemotherapy outside pregnancy can be reduced by explaining the risks of early delivery and the lack of effects of many chemotherapeutic regimens on the fetus.

Etiological factors of preterm delivery

Introduction: Preterm delivery is the delivery before 37 weeks of gestation are completed. Preterm birth is a major course of neonatal morbidity and mortality, the incidence of premature delivery in developedcountries is 5 to 9%. Aims of this study were to determine the common etiological factors for preterm delivery, most common weeks of gestation for pretern delivery, and most commom way of delivery for preterm delivery.Methods: The study included 600 patients divided into two groups, experimental group (included 300 preterm delivered pregnant women), control group (included 300 term delivered women).Results: The incidence of preterm delivery in pregnant women younger than 18 years was 4.4%, and in pregnant women older than 35 years was 14%. 44.6 % of preterm delivered women at the experimentalgroup had lower education. In the experimental group burdened obstetrical history had 29%, 17.2% had a preterm delivery, 35.6% had a premature rupture of membranes, 15% had a preterm delivery before32 weeks of gestation, 12.4% between 32-33.6 weeks of gestation, while 72.6% of deliveries were between 34- 36.6 weeks of gestation. Multiple pregnancy as an etiological factor was present in 10.07% ofcases. Extragenital diseases were present in 10.4%. In the experimental group there were 29%, while in the control group there were 15% subjects with burdened obstetrical history.Conclusions: Preterm birth more often occurs in a pregnant women younger than 18 and older than 35 years, and in a pregnant women of lower educational degree. Preterm delivery in the most commoncases was fi nished in period from 34 to 36.6 weeks of gestation. The most common etiological factor of preterm delivery in the experimental group was preterm rupture of membranes and idiopathic pretermdelivery.

Analysis of clinical characteristics and perinatal outcome of early-onset intrahepatic cholestasis of pregnancy

To analyze the clinical characteristics and perinatal outcome of early-onset intrahepatic cholestasis of pregnancy (ICP). A total of 305 ICP cases were collected in the First Affiliated Hospital of Chongqing Medical University between June 2006 and May 2012. According to the onset time of ICP, patients were divided into early-onset ICP group (onset time < 28 gestational weeks) and late-onset ICP group (onset time ≥ 28 gestational weeks). The late-onset ICP group was further divided into 28 - 31(+6) gestational weeks and ≥ 32 gestational weeks according to the onset time. The biochemical indices and perinatal outcome of each group were assessed. (1) When the diagnosis was made for the first time, the maternal serum concentrations of total bile acid (TBA) and total bilirubin (TBIL) in early-onset ICP group were (41 ± 9) and (32 ± 9) µmol/L, respectively; while TBA and TBIL in late-onset ICP group were (32 ± 6) and (22 ± 9) µmol/L, and the difference between the two groups was statistically significant (P < 0.05). (2) There was no significant difference in alanine aminotransferase (ALT) and aspartate aminotransferase (AST) between early-onset ICP group and late-onset ICP group (P > 0.05). The ALT of early-onset ICP group and late-onset ICP group were (159 ± 50) and (145 ± 52) U/L, respectively; and AST were (151 ± 49) and (138 ± 44) U/L, respectively. (3) The early-onset ICP group had significant higher (P < 0.05) incidence of meconium staining (18.8% vs. 7.4%), fetal distress (22.9% vs. 8.9%), newborn asphyxia (14.6% vs. 5.4%), premature delivery (33.3% vs. 15.6%), developing into severe ICP (41.7% vs. 25.3%) and cesarean section (91.7% vs. 78.6%) when compared to the late-onset ICP group. No significant difference in the incidence of premature delivery, developing into severe ICP and cesarean section was found between the two types of late-onset ICP. (4) There was significant differences in average birth weight and gestational weeks at delivery between the two groups [early-onset ICP group: (3113 ± 443) g and (36.3 ± 2.6) weeks]; late-onset ICP group: [(3513 ± 450) g and (37.7 ± 1.6) weeks]. The early-onset ICP patients presented worse clinical manifestations than late-onset ICP patients, and early-onset ICP is more likely to lead to premature delivery and fetal distress.

The kidney in pregnancy: A journey of three decades.

The spectrum of kidney disease occurring during pregnancy includes preeclampsia, hypertensive disorders of pregnancy, urinary tract infection, acute kidney injury, and renal cortical necrosis (RCN). Preeclampsia affects approximately 3–5% of pregnancies. We observed preeclampsia in 5.8% of pregnancies, and 2.38% of our preeclamptic women developed eclampsia. Severe preeclampsia and the eclampsia or hemolysis, elevated liver enzymes levels, and low platelets count (HELLP) syndrome accounted for about 40% of cases of acute kidney injury (AKI) in pregnancy. Preeclampsia/eclampsia was the cause of acute renal failure (ARF) in 38.3% of the cases. Preeclampsia was the most common (91.7%) cause of hypertension during pregnancy, and chronic hypertension was present in 8.3% of patients. We observed urinary tract infection (UTI) in 9% of pregnancies. Sepsis resulting from pyelonephritis can progress to endotoxic shock, disseminated intravascular coagulation, and AKI. The incidence of premature delivery and low birth weight is higher in women with UTI. The incidence of AKI in pregnancy with respect to total ARF cases has decreased over the last 30 years from 25% in 1980s to 5% in 2000s. Septic abortion-related ARF decreased from 9% to 3%. Prevention of unwanted pregnancy and avoidance of septic abortion are key to eliminate abortion-associated ARF in early pregnancy. The two most common causes of ARF in third trimester and postpartum periods were puerperal sepsis and preeclampsia/HELLP syndrome. Pregnancy-associated thrombotic thrombocytopenic purpura/hemolytic uremic syndrome and acute fatty liver of pregnancy were rare causes of ARF. Despite decreasing incidence, AKI remains a serious complication during pregnancy.

Obstetric and perinatal outcomes among women with blood- and injection phobia during pregnancy

Background Little is known about how anxiety disorders affect pregnancy outcomes. Therefore we investigated the impact of one anxiety disorder, blood- and injection phobia, on obstetric and neonatal outcomes. Methods From a population-based prospectively collected cohort we compared an index group of 110 women with blood- and injection phobia with a control group of 220 women. Standardized medical records were used to collect data. Obstetric and neonatal outcomes e.g. elective cesarean, prematurity, and small for gestational age were used as the main outcome measures. Results Women with blood- and injection phobia stated more often a fear of childbirth (p < 0.001) and were more frequently delivered by elective cesarean section (p = 0.032). The incidence of premature delivery (p = 0.028), neonatal morbidity (p = 0.001) and the risk of having a baby born small for gestational age (p = 0.009) was higher among women with blood- and injection phobia. Limitations The medical records, from which all information is drawn, despite standardization, sometimes may lack some information. However, this dilemma exists in both groups. Conclusions Women with an anxiety disorder such as blood- and injection phobia are at increased risk for adverse obstetric outcomes, premature delivery and for having a baby born with higher neonatal morbidity. It therefore seems important to identify and treat women with anxiety disorders without delay early during pregnancy in an effort to minimize risks of complications for the woman herself and the child.