ObjectiveTo systematically review the clinical efficacy and effects on pregnancy outcomes of S-adenosy-L-methionine combined with ursodesoxycholic acid in the treatment of intrahepatic cholestasis of pregnancy. MethodsDatabases such as PubMed, The Cochrane Library, CNKI, VIP, WanFang Data were searched for the studies about the clinical efficacy and effects on pregnancy outcomes of S-adenosy-L-methionine combined with ursodesoxycholic acid in the treatment of intrahepatic cholestasis of pregnancy up to December 31st, 2013. Two reviewers independently screened literature, extracted data and evaluated methodological quality. Then meta-analysis was conducted using RevMan 5.0.24 software. ResultsA total of 11 RCTs involving 776 patients were included. The results of meta-analysis showed that, combined medication reduced blood biochemical indexes inlcuding ALT (MD=3.63, 95%CI 0.63 to 6.64, P=0.02), TB (MD=3.70, 95%CI 1.45 to 5.96, P=0.001), and AST (MD=7.61, 95%CI 2.47 to 12.75, P=0.004). Combined therapy significantly decreased the rates of amniotic fluid contamination (OR=0.29, 95%CI 0.19 to 0.45, P=0.000 01), cesarean section (OR=0.53, 95%CI 0.36 to 0.79, P=0.002), postpartum hemorrhage (OR=0.32, 95%CI 0.12 to 0.90, P=0.03), preterm birth (OR=0.36, 95%CI 0.24 to 0.55, P < 0.000 01), fetal distress (OR=0.33, 95%CI 0.19 to 0.58, P=0.000 1) and neonates asphyxia (OR=0.30, 95%CI 0.19 to 0.47, P < 0.000 01). Combined therapy was also beneficial to improving pruritus symptoms (MD=0.20, 95%CI 0.08 to 0.31, P=0.000 08) and benefiting fetus growth (MD=0.45, 95%CI 0.23 to 0.66, P < 0.000 1). ConclusionThe combination of S-adenosy-L-methionine and ursodesoxycholic acid is superior to ursodesoxycholic acid alone in improving clinical symptoms and pregnant outcomes of patients with intrahepatic cholestasis of pregnancy.
ObjectivesTo systematically review the efficacy and safety of local endometrial mechanical stimulation in patients with recurrent embryo implantation failure in vitro fertilization.MethodsPubMed, EMbase, The Cochrane Library, CNKI, WanFang Data and VIP databases were electronically searched to collect clinical controlled studies on the efficacy and safety of local endometrial mechanical stimulation in patients with recurrent embryo implantation failure from inception to March 2018. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 10 studies, including 8 randomized controlled trials and 2 case-control studies, and involving 1 274 patients were included. The results of meta-analysis showed that: the clinical pregnancy rate of endometrial mechanical stimulation group was higher than that of control group (RR=1.40, 95%CI 1.04 to 1.89, P=0.03). However, no significant differences were found in implantation rate (RR=0.75, 95%CI 0.50 to 1.13, P=0.17), live births rate (RR=1.38, 95%CI 0.99 to 1.93, P=0.06), miscarriage rate (RR=0.83, 95%CI 0.55 to 1.24, P=0.36) and rate of multiple pregnancy (RR=0.90, 95%CI 0.61 to 1.35, P=0.63).ConclusionCurrent evidence shows that, for patients with repeated implantation failure, mechanical endometrial stimulation before re-transplantation may help to improve the clinical pregnancy rate of test-tube infants, however, it has no significant effects on implantation rate, live birth rate, abortion rate, multiple pregnancy rate and ectopic pregnancy rate. Due to limited quality and quantity of the included studies, more high quality studies are needed required to verify above conclusions.
ObjectiveTo observe the image characteristics of multispectral scanning laser imaging (MSLI) and OCT in patients with pregnancy induced hypertension syndrome (PIHS).MethodsA total of 112 patients (224 eyes) of PIHS patients diagnosed in Obstetrics Department of Tianjin First Central Hospital from May 2016 to May 2017 were included in this study. The average age of the patients was 27.00±2.14 years. The average course of the disease was 15.00±8.27 days. There were 174 eyes in 87 patients of blurred vision, dazzling and visual fatigue consciously. All patients performed BCVA, direct ophthalmoscope, B ultrasound, confocal scanning laser Ophthalmoscope (cSLO) and spectral-domain OCT (SD-OCT). SD-OCT was performed with Spectralis HRA+OCT from Heidelberg Company in Germany to acquire tomographic images. Using Herdelberg's colorful program (MultiColor) based on cSLO and operating in accordance with standard methods, one scan simultaneously obtained blue light reflection based on 488 nm, green light reflection based on 515 nm, and infrared reflection based on 820 nm, synthesis to MSLI. Fundus abnormalities were classified into arterial spasm (stage Ⅰ), arteriosclerosis (stage Ⅱ), and retinopathy (stage Ⅲ). OCT examination was divided into normal and abnormal cases according to the abnormality of retinal morphology and thickness.ResultsOf the 224 eyes, 68 eyes (30.36%) showed normal fundus examination and 156 eyes (69.64%) showed abnormal fundus performance. Among them, 28 eyes were stage Ⅰ (17.95%); 40 eyes were stage Ⅱ (25.64%); 88 eyes were stage Ⅲ (56.41%). Thirty-six eyes (16.07%) showed normal fundus and 188 eyes (83.93%) showed abnormal performance with OCT. Of the 188 eyes with abnormal fundus performance, 86 eyes (45.74%) had retinal neuroepithelial serous detachment; 56 eyes (29.79%) had RPE detachment; optic disc edema, bulge, and local reflexes in the retinal nerve fiber layer were enhanced and/or the thickness increased in 46 eyes (24.47%). In MSLI, 48 eyes (21.43%) showed normal fundus; 176 eyes (78.57%) showed abnormal performance. Retinal edema was showed in green on MSLI, serous retinal neuroepithelial layer detachment, RPE layer detachment, retinal nerve fiber layer thickening, accompanied by changes in local retinal structure. The higher the degree of bulge, the darker the color. Consistent with the range of retinal edema revealed by SD-OCT.ConclusionsMSLI and SD-OCT images show highly consistent lesions in PIHS patients. MSLI can more clearly show superficial and deep retinal lesions.
Objective To study the clinical characteristics, therapy strategies and the outcomes of female patients with acute aortic dissection during late pregnancy and puerperal period. Methods We retrospectively analyzed the clinical data of 7 patients with acute aortic dissection during late pregnancy and puerperal period in Shanghai Changhai Hospital between August 2012 and June 2017. Five of the 7 patients were late stage pregnancy, 2 were puerperal period (1 at the postpartum night, 1 in 18 days after delivery). There were 6 patients of Stanford type A aortic dissection (85.7%), and 1 patient of type B aortic dissection (14.3%). The age of the patients ranged from 26 to 34 (30.8±3.1) years. Cardiac ultrasonography of patients with type A showed that the maximum diameter of the ascending aortas was 4.2–5.7 (4.7±0.6) cm, of which 2 patients were aneurysm of aortic sinus, 3 patients were with Marfan syndrome. Bentall procedure was conducted in 1 patient, Bentall+Sun’s surgery in 2 patients, ascending aorta replacement+Sun’s+coronary artery bypass grafting surgery in 1 patient, aortic root remodeling+ascending aorta replacement+Sun’s surgery in 2 patients. One patient with Stanford type B acute aortic dissection was performed with thoracic endovascular aortic repair (TEVAR) after cesarean section. Results Aortic blocking time ranged from 51 to 129 (85.5±22.9) min. Cardiopulmonary bypass time was 75–196 (159.0±44.0) min. Moderate hypothermic circulation arrest with selective cerebral perfusion time was 20–30 (23.8±3.5) min. All maternal and fetuses survived. The infant whose mother received aortic repair in early stage and then received cesarean section was diagnosed with cerebral palsy. Maternal and fetuses were followed up for 9 months to 4 years. During the follow up period, all the fetuses grew well except the cerebral palsy one, and all maternal recovered well. The patient who received aortic repair in the early stage, had a sigmoid rupture during cesarean section and was treated with sigmoid colostomy. Another patient with Stanford type A dissection was diagnosed as left renal vein entrapment syndrome after 2 years. Conclusion Type A aortic dissection is more common in late pregnancy and puerperal patients. And Marfan syndrome is a high-risk factor for acute aortic dissection in pregnancy women. Early and appropriate surgical treatment strategy based on the type of aortic dissection and gestational age are the key points to achieve good outcomes both for maternal and fetus.
Objective To discuss the characteristics of delivery and anesthesia management of pregnant women with moderate to severe scoliosis, and to summarize the anesthesia implementation strategies for pregnant women with scoliosis. Methods Pregnant women with moderate to severe scoliosis admitted to West China Second University Hospital, Sichuan University between January 2020 and January 2022 were retrospectively included. The demography information, delivery mode, anesthesia implementation plan and other relevant data of the women were analyzed. Results A total of 9 women with moderate to severe scoliosis were included, with an average age of 29.9 years. The median (lower quartile, upper quartile) of the Cobb angle of the women was 42° (35°, 54°). There were 5 women with moderate to severe impairment of lung ventilation function, 1 woman with grade Ⅲ heart function, and 8 women with comorbidities. Among the 8 women who underwent cesarean section, 3 underwent general anesthesia, 4 underwent epidural block, and 1 underwent local anesthesia with enhanced sedation. One woman who chose vaginal delivery underwent epidural labor analgesia. All women passed the surgery or delivery period safely, with 5 transferred to the intensive care unit for further treatment after surgery, and 4 safely returned to the ward after surgery. All women recovered and were discharged. Eight fetuses survived, and 1 fetus underwent lethal induced abortion. Conclusions Pregnant women with moderate to severe scoliosis during pregnancy have poor tolerance to vaginal delivery due to severe malformations and organ dysfunction, especially cardiopulmonary dysfunction. Most of them terminate pregnancy through cesarean section. When making anesthesia decisions, it is important to carefully consider the women’s own condition and surgical risks.
摘要:目的: 探讨经子宫动脉介入化疗栓塞治疗剖宫产切口瘢痕妊娠的应用价值。 方法 :回顾分析本院自2006年7月至2007年12月子宫动脉介入治疗的15例剖宫产切口瘢痕妊娠病例资料。 结果 :15例介入治疗均成功,其中8例化疗及明胶海绵栓塞后加用弹簧圈栓塞,术后阴道流血停止,孕囊明显缩小,血清人绒毛膜促性腺激素明显下降。术后清宫无大出血,病理检查示子宫瘢痕部位绒毛、蜕膜或胎盘组织,有变性、坏死。 结论 :经子宫动脉介入治疗剖宫产瘢痕妊娠,能有效预防和控制出血,减小清宫危险,并保留子宫,是剖宫产瘢痕妊娠安全、有效的治疗方法之一。 Abstract: Objective: To investigate the value of uterine artery chemotherapy and embolization in the treatment of cesarean scar pregnancy. Methods : Fifteen cases with cesarean scar pregnancy performed with uterine artery interventional therapy were retrospectively analyzed from July, 2006 to December, 2007 in our hospital. Results : All cases were treated successfully by uterine artery chemotherapy and embolism. All cases were embolized with gelatin sponge after chemotherapy, and eight with spring ring additionally. Vaginal bleedings were stopped after uterine artery embolization. Gestation sacculi deflated obviously. Serum human chorionic gonadotrophin descended dramatically. There was no severe vaginal bleeding by curettage after interventional therapy. The villi, decidua, or placental tissues were observed with degeneration and necrosis by pathology. Conclusion : Uterine artery chemotherapy and embolization was proved to be a safe and useful procedure for preventing and controlling vaginal bleeding, diminishing the risk of curettage and avoiding the loss of uterus.
ObjectiveTo explored the influence of disease changes, weight gain, eosinophil levels and other factor in pregnancy women with asthma. MethodsCase records of gestational asthma patients produced in the obstetrics department of Peking University People's Hospital from October 2010 to October 2020 were collected, and refer to electronic medical records of clinics (pre-pregnancy and pregnancy). According to the disease control (asthma related unplanned respiratory clinics, emergency or hospitalization), patients were divided into pregnancy stable group and pregnancy fluctuation group. The basic characteristics, pre-pregnancy asthma control, weight gain during pregnancy and peripheral blood eosinophil level before labor were retrospectively analyzed. The cause of asthma attacks, clinical characteristics and distribution of gestational time in pregnancy fluctuations were described. Peripheral blood eosinophil levels in different period during pregnancy in the stable group were analyzed. ResultsTotally 124 cases of natural pregnancy singleton were enrolled in the study. The age was (32.3±3.9) years old. There were 71 patients in stable group and 53 patients in fluctuation group. The proportion of pre-pregnancy instability in the fluctuating pregnancy group was higher than that in the stable pregnancy group (P<0.05). The proportion of intermittent medication before pregnancy was higher in the fluctuating pregnancy group than in the stable pregnancy group (P<0.05). Peripheral blood eosinophil count before labor and the number of cases with eosinophil count≥0.15×109/L before labor were higher in the fluctuation group (all P<0.05). The proportion of hypertentive diseases in pregnancy and fetal distress in uterus were higher in the fluctuation group (all P<0.05). The common cold was the common trigger factor (38.2%) and asthma recurrences occur between 13 and 36 weeks of gestation (65.8%) in fluctuation group. In further analysis of subgroup (the stable group), peripheral blood eosinophil count in early pregnancy (P<0.05) and pregnant metaphase (P<0.05) were higher than before delivery. The number of cases with eosinophil count>0.15×109/L in pregnant metaphase (P<0.05) was higher than before delivery. ConclusionsAsthma fluctuates during pregnancy is associated with adverse maternal and fetal outcomes. It is very important and critical that asthma control before pregnancy, weight gain management and eosinophil level monitoring of patients with asthma during pregnancy. The whole management is imperative in women with asthma during pregnancy.
ObjectiveTo explore the relationship between the diet during pregnancy and gestational diabetes mellitus (GDM), and analyze the effect of GDM on weight gain, outcome and complication of mother and infant. MethodsWe selected 128 GDM pregnant women and 267 non-GDM pregnant women who were investigated by semi-quantitative food frequency method during September 2009 to March 2011. Then, we collected relevant information and the data were analyzed by t-test and chi-square test. ResultsThere were statistically significant differences between the two groups in total calorie, carbohydrate, fat and protein intakes per day (P<0.05). In general, the rates of insufficient weight gain and excessive weight gain during pregnancy in the GDM group were significantly higher than the non-GDM group (P<0.05), while proper weight gain rate was significantly lower (P<0.01). The risk of hydramnion, intrahepatic cholestasis and pregnancy-induced hypertension in the GDM group was significantly higher than the non-GDM group (P<0.05), while there was no significant difference between the two groups in premature delivery, cesarean section or premature membrane ruptures (P>0.05). Apgar scores were significantly different at minute 1 and 5 between the infants in the two groups (P<0.05). The incidence of fetal death, malformation, mild neonatal asphyxia and fetal macrosomia in the GDM group was significantly higher than the non-GDM group (P<0.05). No significant differences between the two groups in low birth weight infant, cord entanglement and fetal distress were detected (P>0.05). ConclusionGDM can lead to high incidence of poor outcome and complication. It is vital to strengthen the examination and keep balanced dietary structure, in order to reduce the complication and improve the health of mother and child.
Objective To study the clinical value and surgical procedure of laparoscopic operation for interstitial tubal pregnancy. Methods Clinical data of 36 patients of interstitial tubal pregnancy treated by laparoscopic operation were retrospectively analyzed. Results All 36 patients were operated successfully, without conversions to laparotomy and intra- or post- operative complications. The operation time was 28-85 min(mean, 41min), and the length of stay in hospital postoperative was 3-6 d (mean, 4-5 d). Conclusion Laparoscopic operation for interstitial tubal pregnancy is safe and feasible.
ObjectiveTo observe and analyze the risk factors of retinopathy in patients with hypertension in pregnancy.MethodsA retrospective clinical study. From January 2018 to December 2019, 260 patients with hypertension during pregnancy who were hospitalized in the Obstetrics Department of the Third Affiliated Hospital of Guangzhou Medical University were included in the study. All patients underwent fundus color photography examination. Their age, gestational age, course of hypertension, past history, number of pregnancy and childbirth, pre-pregnancy body mass index (BMI) and laboratory blood routine, alanine aminotransferase, aspartate aminotransferase, and urea Nitrogen, creatinine, uric acid, serum albumin concentration, and 24-hour urine protein concentration and urine protein content examination results were collected. Among the 260 patients, there were 60 and 200 patients with or without retinopathy in the fundus, respectively. Patients were divided into retinopathy group and no retinopathy group. The comparison of quantitative data between groups was performed by independent sample t test; the comparison of grade data was performed by Mann-Whitney U nonparametric test. The variable with statistical difference between the two groups was the independent variable, and the two-class logistic regression analysis was performed.ResultsGestational week (t=4.875), pre-pregnancy BMI (t=2.779), highest systolic blood pressure (t=－4.799), lowest systolic blood pressure (t=－4.797), highest diastolic blood pressure (t=－4.226), minimum diastolic blood pressure (t=－4.226), low and high platelet values and their fluctuations (t=7.701, 2.504, －6.083), serum albumin concentration (t=13.255), aspartic acid transaminase (t=－2.272), urea nitrogen (t=－5.117), creatinine (t=－2.735), uric acid (t=－2.130), 24-hour urine protein concentration (t=－7.801) and 24-hour urine protein (t=－7.567) were compared. The difference was statistically significant (P＜0.05). Logoistic regression analysis showed that pre-pregnancy BMI, maximum systolic blood pressure, low platelet value, and serum albumin were related to the occurrence of retinopathy of hypertension in pregnancy (P＜0.05).ConclusionHigh systolic blood pressure, low platelets, and low serum albumin are the risk factors for the occurrence of retinopathy of hypertension in pregnancy.