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Objective:To evaluate the effects of physician skills on the success rate of the external cephalic version (ECV) and investigate the learning curve for ECV.Methods:A retrospective study of 97 pregnant women who underwent ECV at the First Affiliated Hospital of Nanjing Medical University from March 2019 to August 2021 was performed. Patients were divided into multipara and primipara groups. The success rate of ECV and morbidity were compared between the two groups, and the learning curve for ECV was evaluated using cumulative sum analysis (CUSUM).Results:(1) Patients in the multipara group were older than those in the primipara group [(33.0±3.4) vs (29.2±3.0) years, t=－5.57, P<0.001]. No significant difference was found in other baseline data between the two groups. (2) The overall ECV success rate was 61.9% (60/97), and a higher success rate was observed in the multipara group [93.3% (28/30) vs 47.8% (32/67), χ 2=18.24, P<0.001]. Fetal heart rate deceleration (5.2%, 5/97), vaginal bleeding (1.0%, 1/97), premature rupture of membranes (1.0%, 1/97), and fetal distress (1.0%, 1/97) were the main complications. (3) The CUSUM analysis showed that it needed 53 primiparas for a physician to obtain a 50% consistent success rate ( R2=0.91, H=－3.27, Y=52.16) and seven multiparas to achieve a 70% consistent success rate ( R2=0.99, H=－1.635, Y=6.60). Conclusions:Parity and operator skills have a significant influence on the success of ECV. A physician with standardized training will manage non-anesthesia ECV skillfully in full-term and near-term pregnancies after practice on 50 primiparae or approximately ten multiparae. It is recommended to start with the multiparae for learning ECV to build up confidence and promote the implementation of ECV.
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ObjectiveTo investigate the relationship between levels of inflammatory cytokines, Ureaplasma infection in midtrimester amniotic fluid and spontaneous preterm delivery.MethodsFrom April 2009 to March 2012, a total of 1 865 pregnant women who underwent amniocentesis in midtrimester with known pregnant outcomes in Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, among whom 43 cases who delivered spontaneously before 37 weeks, were classified as preterm group, and the control group consisted of 373 normal term delivery women selected from the other 1 785 cases who term delivered during the same period. Cytokines, including interleukin (IL)-10, IL-1β, IL-6, monocyte chemotactic protein-1 (MCP-1) and tumor necrosis factor-α (TNF-α) in amniotic fluid, were measured by MILLIPLEX MAP Human Cytokine/Chemokine Magnetic Bead Panel and analysis system for liquid phase chips.Ureaplasma DNA was detected by polymerase chain reaction. Sum-rank test was used to compare the difference of cytokines between the two groups and receiver-operating characteristic curve and Logistic analysis were used to analyze the value of cytokines to predict spontaneous preterm delivery.ResultsThe median maternal age in preterm group was higher than in the control group [34(24-49) vs 29(20-47) years] (Z=-3.107,P=0.002), but there was no significant difference in levels of the five cytokines among women with different age in control group(20-24, 25-29, 30-34 and≥35 years old) (allP>0.05). The levels of IL-1β and IL-6 were not significantly different between two groups (allP>0.05), but levels of IL-10, MCP-1 and TNF-α in the preterm group were much higher than in the control group [11.22(4.79-468.73) vs 7.87(0.93-26.62), 1 358.86(553.16-7 635.81) vs 1 137.98 (311.80-5 196.33), 9.78(5.72-106.51) vs 8.37(2.56-30.20) pg/ml, respectively;Z were-4.333,-2.820 and-3.390, allP<0.01]. The areas under receiver-operating characteristic curve of IL-10, MCP-1 and TNF-αwere 0.70, 0.63 and 0.66. The appropriate cut-off level of IL-10 in amniotic fluid for prediction of preterm birth was 9.06 ng/ml, with a sensitivity of 74.4% and a specificity of 57.6%, and the latter increased to 100.0% when combined with IL-10, MCP-1 and TNF-α, but the sensitivity declined to 16.3%.Ureaplasma was identified in only two preterm cases and none in the controls. However, the levels of the five cytokines in the two infected cases in preterm group were 2.12–43.00 times of the rest cases in the same group, and 2.26–60.00 times of the controls.ConclusionsAlthough IL-10, MCP-1 and TNF-α levels in midtrimester amniotic fluid are increased, it is not able to predict spontaneous preterm birth neither independently nor combined together. Ureaplasma infection rate in amnion cavity is low, but may related to parts of spontaneous preterm delivery.
ABSTRACT
Objective The concentration of cytokines in the amniotic fluid ( AF) may reflect the immune state of maternal-fetal interface .This study aimed to investigate the level of inflammation -related cytokines in the mid-trimester AF of normal pregnant women. Methods This study included 263 pregnant women undergoing mid-trimester genetic amniocentesis , and all of them had normal pregnancy outcomes .Using MILLIPLEX MAP and Luminex, we measured the concentrations of interleukin IL-10, IL-1β, IL-6, monocyte chemotactic MCP-1, and tumor necrosis factor TNF-αin the AF collected from the women at 18-22 +6 weeks′gesta-tion.We analyzed the correlation of their concentrations with maternal age , gestational age , and fetal gender by rank sum test . Results The median concentrations of IL-10, IL-1β, IL-6, MCP-1, and TNF-αin AF at mid-trimester were 7.91, 0.97, 78.15, 1 135.57, and 8.47 pg/mL, respectively.The levels of IL-10 and IL-1βwere higher in the pregnancies with male fetuses than in those with female fetuses (8.54 and 1.18 pg/mL vs 7.72 and 0.85 pg/mL, P=0.043 and 0.008).Maternal age or gestational week at the mid-trimester exhibited no influence on the concentrations of the 5 cytokines. Conclusion The levels of IL-10, IL-1β, IL-6, MCP-1 and TNF-αremain stable in AF at mid-trimester and the former 2 are higher in pregnancies with male fetuses .