Clinical analysis of incomplete rupture of the uterus secondary to previous cesarean section.

Uterine rupture is a rupture of the body or lower part of the uterus during pregnancy or delivery. Total of 98 cases with incomplete uterine rupture were classified as the incomplete uterine rupture group, 100 cases with a history of cesarean delivery without uterine rupture were classified as the non-ruptured uterus group, and controls were selected using a systematic sampling method. The maternal age ≥35 years were associated with 2.18 times higher odds of having an incomplete uterine rupture. The odd of having an incomplete uterine rupture was 3.744 times higher for a woman with delivery interval ≤36 months. Having pregnancy complication was associated with 3.961 times higher odds of having an incomplete uterine rupture. The neonatal weight was lighter in the incomplete uterine rupture group (P = 0.007). The number of preterm birth and transfer to the NICU were higher in the incomplete uterine rupture group (P ＜ 0.01). The operation time and the length of time in hospital were longer in the group with incomplete uterine rupture (P ＜ 0.01). Age ≥35 years, delivery interval ≤36 month, and pregnancy with complication were independent risk factors of incomplete rupture of the uterus secondary to previous cesarean section.

The effect of gestational diabetes mellitus on pregnancy outcomes in advanced primiparous women: A retrospective study.

Gestational diabetes mellitus (GDM) could have a variable degree of adverse effects on pregnancy outcomes for both pregnant women and newborns. The purpose of the study was to explore the effect of GDM on pregnancy outcomes in advanced primiparous women. A total of 1076 advanced primiparous women were included between January 2020 and December 2022. All these women were divided into the GDM group (n = 434) and the non-GDM group (n = 642). Variables included baseline characteristics, maternal, and newborn outcomes were collected. The risk of each adverse outcome was analyzed by multivariate logistic regression models. The effect of blood glucose control on pregnancy outcomes was further analyzed among GDM women with good glycaemic control (n = 381) and poor glycaemic control (n = 53). Analysis of baseline characteristics demonstrated a significant difference in prepregnancy body mass index (median, IQR: 22.27 [20.58-24.44] vs 21.17 [19.53-22.86], P < .01) between the GDM group and the non-GDM group. A significantly higher incidence rate of adverse pregnancy outcomes was found in advanced primiparous women with GDM, such as polyhydramniosis, premature birth, low-birth weight, macrosomia, and neonatal intensive care unit admission (all P < .05). Compared with the non-GDM group, the risk of polyhydramniosis was nearly twice as high in the GDM group (adjusted odds ratio: 1.94, 95% confidence interval: 1.01-3.72, P = .04) after adjusted baseline characteristics. Among the GDM group, the women with poor glycaemic control showed a significantly higher incidence rate of polyhydramnios, hypertensive disorders of pregnancy, cesarean delivery, premature birth, low-birth weight, macrosomia, and neonatal intensive care unit admission was significant than the women with good glycaemic control (all P < .05). GDM was an independent risk factor for polyhydramnios in advanced primiparous women. At the same time, good glycaemic control in diabetics advanced primiparous women could reduce adverse pregnancy outcomes.

Effects of Antenatal Lifestyle Interventions in Pregnant Women with Normal Body Mass Index.

Background: We aimed to explore the effect of lifestyle interventions on improving lifestyle behaviors on gestational weight gain in pregnant women with normal body mass index (BMI). Methods: The study was conducted in Maternal and Child Health Hospital of Hubei Province (Wuhan, China) between June 2020 and April 2022. A total of 355 pregnant women (<12 weeks of pregnancy) were enrolled and finally completed the program. Participants were divided into the intervention and control groups. The intervention group received an individualized lifestyle intervention focusing on healthy lifestyle, like diet, exercise, and weight monitoring as four sessions at 16-18, 20-24, 28-30 and 34 weeks' gestation. Participants in the control group received routine antenatal care. The weight of both group was recorded from pregnancy until 6-8 weeks postpartum. Results: The participants in the intervention group with normal pre-pregnancy BMI (n = 178) had lower GWG, excessive GWG, hypertension, and neonate birth weight compared to the control group (n = 177, P<0.01). There were no statistically significant differences in the occurrence of gestational diabetes, premature labor, delivery mode, preterm birth, small for gestational age, macrosomia, number of neonates referred to the NICU, and postpartum weight retention. Conclusion: Even though lifestyle intervention in pregnant women with normal BMI has a relatively limited effect, attention should still be paid to reasonable weight gain during pregnancy and the potential long-term impact of the intervention remains to be assessed.

Effect of recruitment manoeuvres under lung ultrasound-guidance and positive end-expiratory pressure on postoperative atelectasis and hypoxemia in major open upper abdominal surgery: A randomized controlled trial.

Background: Postoperative pulmonary complications (PPCs) especially atelectasis and hypoxemia are common during abdominal surgery. Studies on the effect of either recruitment manoeuvres (RMs) or positive end-expiratory pressure (PEEP) on PPCs are controversial. The objective of this study is to evaluate the effect of perioperative lung ultrasound (LUS)-guided RMs combined with PEEP on the reduction of postoperative atelectasis and hypoxemia in major open upper abdominal surgery. Methods: In this randomized controlled trial, 122 adult patients undergoing major open upper abdominal surgery were allocated into three groups: control (C) group (n = 42); PEEP (P) group (n = 40); RMs combined with PEEP (RP) group (n = 40). All patients were scheduled for general anaesthesia using the lung-protective ventilation (LPV) strategy. The levels of PEEP in the three groups were 0 cmH2O, 5 cmH2O and 5 cmH2O. LUS examination was carried out at 3 predetermined time points in each group: 5 min after intubation (T1), at the end of surgery (T2) and 15 min after extubation (T3). Patients with atelectasis on the sonogram in the RP group received LUS-guided RMs at point T2. LUS scores were used to estimate the severity of aeration loss. The P/F ratio (PaO2/FiO2) at 15min after extubation was used to assess the incidence of postoperative hypoxemia. Primary outcomes were the incidences of postoperative atelectasis and hypoxemia (PaO2/FiO2 < 300 mmHg). The secondary outcome was the distribution of LUS scores in each lung area. Results: From July 2021 to December 2021, 122 consecutive patients were enrolled. No typical atelectasis was observed 5 min after intubation. The incidence of atelectasis was 52.4%, 50.0% and 42.5% in the C group, P group and RP group at the end of surgery, respectively. The rate of atelectasis in the C group, P group and RP group (after RMs) was 52.4%, 50.0% and 17.5%, respectively, 15 min after extubation (P < 0.01). The frequency of postoperative hypoxemia was 27.5%, 15.0% and 5.0% in the C group, P group and RP group, respectively (P < 0.017). The increased LUS scores mainly occurred in the superoposterior and inferoposterior quadrants at the end of surgery. Only in the RP group demonstrated a decreased LUS score in the posteriorquadrants after extubation. Conclusions: In patients undergoing major open upper abdominal surgery, an intraoperative mechanical ventilation strategy without PEEP or with PEEP alone did not reduce PPCs. However, PEEP of 5 cmH2O combined with LUS-guided RMs proved feasible and beneficial to decrease the occurrence of postoperative atelectasis and hypoxemia in major open upper abdominal surgeries.