Feasibility study of expectant management of different degrees of vaginal fluid in pregnant women with premature rupture of membranes in the second trimester / 中华妇产科杂志

Objective:To investigate the feasibility of expectant management of different degrees of vaginal fluid in pregnant women with premature rupture of membranes in the second trimester.Methods:A retrospective cohort study was conducted to collect 103 pregnant women who were diagnosed with premature rupture of membranes in the second trimester of pregnancy and insisted on continuing the pregnancy in Shanxi Bethune Hospital from July 2012 to July 2022. According to the degree of vaginal fluid, pregnant women were divided into rupture group (with typical vaginal fluid, 48 cases) and leakage group (without typical vaginal fluid, 55 cases). The rupture latency (the time from rupture of membranes to termination of pregnancy), gestational weeks of termination, indications and methods of termination of pregnancy, maternal infection related indicators and perinatal outcomes were compared between the two groups. Univariate regression model was used to analyze the correlation between different degrees of vaginal fluid in pregnant women with premature rupture of membranes and maternal and neonatal outcomes.Results:(1) Obstetric indicators: there was no significant difference in the gestational age of rupture of membranes between the two groups ( P>0.05). However, the proportion of rupture latency >28 days in the leakage group was significantly higher than that in the rupture group [42% (23/55) vs 13% (6/48); χ2=33.673, P<0.001], and the incidence of pregnancy termination ≥28 weeks was significantly higher [47% (26/55) vs 19% (9/48); χ2=9.295, P=0.002]. (2) Indications and methods of termination: the incidence of progressive reduction of amniotic fluid as the indication for termination in the leakage group was significantly lower than that in the rupture group [22% (12/55) vs 42% (20/48); χ2=4.715, P=0.030], and the incidence of full-term termination in the leakage group was significantly higher than that in the rupture group [31% (17/55) vs 12% (6/48); χ2=5.008, P=0.025], while there were no significant differences in the indications of termination of pregnancy, including amniotic cavity infection, uterine contraction failure and fetal distress between the two groups (all P>0.05). The incidence of induced labor or spontaneous contraction in the leakage group was significantly lower than that in the rupture group [53% (29/55) vs 81% (39/48); χ2=9.295, P=0.002], while the cesarean section rate and vaginal delivery rate were similar between the two groups (both P>0.05). (3) Infection related indicators: the incidence of amniotic cavity infection in the leakage group was significantly higher than that in the rupture group [31% (17/55) vs 13% (6/48); χ2=4.003, P=0.045]. However, there were no significant differences in the elevation of inflammatory indicators, the positive rate of cervical secretion bacterial culture and the incidence of tissue chorioamnionitis between the two groups (all P>0.05). (4) Perinatal outcomes: the live birth rate in the leakage group was significantly higher than that in the rupture group [51% (28/55) vs 27% (13/48); χ2=5.119, P=0.024]. The proportion of live births with 1-minute Apgar score >7 in the leakage group was significantly higher than that in the rupture group [38% (21/55) vs 17% (8/48); χ2=4.850, P=0.028]. However, there were no significant differences in the birth weight of live births and the incidence of neonatal complications between the two groups (all P>0.05). (5) Univariate regression analysis showed that compared with the rupture group, the leakage group had a higher risk of pregnancy termination at ≥28 gestational weeks ( RR=2.521, 95% CI: 1.314-4.838; P=0.002), amniotic infection ( RR=2.473, 95% CI: 1.061-5.764; P=0.025), perinatal survival ( RR=1.880, 95% CI: 1.104-3.199; P=0.014). Conclusion:Compared with pregnant women with typical vaginal fluid in the second trimester of premature rupture of membranes, expectant treatment for pregnant women with atypical vaginal fluid is more feasible, which could effectively prolong the gestational weeks and improve the perinatal live birth rate.

Association between abnormal oral glucose tolerance test patterns in the second trimester and large for gestational age newborns / 中华妇产科杂志

Objective:To investigate the impact of abnormal patterns of 75 g oral glucose tolerance test (OGTT) in the second trimester on the risk of large for gestational age (LGA) newborn deliveries.Methods:General clinical data and OGTT results of 66 290 pregnant women who received regular prenatal care and delivered in Guangdong Maternal and Child Health Hospital from December 24, 2016 to July 26, 2022 were collected. According to the results of OGTT, the pregnant women were divided into 8 groups: normal blood glucose group (normal fasting blood glucose, 1-hour and 2-hour after oral glucose, 54 518 cases), gestational diabetes mellitus (GDM) 0 group (only abnormal fasting blood glucose, 1 430 cases), GDM 1 group (only abnormal blood glucose at 1-hour after oral glucose, 2 150 cases), GDM 2 group (only abnormal blood glucose at 2-hour after oral glucose, 3 736 cases), GDM 0+1 group (both fasting blood glucose and 1-hour after oral glucose were abnormal, 371 cases), GDM 0+2 group (both fasting blood glucose and 2-hour after oral glucose were abnormal, 280 cases), GDM 1+2 group (abnormal blood glucose at 1-hour and 2-hour after oral glucose, 2 981 cases) and GDM 0+1+2 group (abnormal fasting blood glucose, 1-hour and 2-hour after oral glucose, 824 cases). Multivariate logistic regression was used to analyze the effects of different abnormal OGTT patterns on LGA. In addition, the blood glucose measurements at the three time points of OGTT were combined and used as continuous variables in the receiver operating characteristic (ROC) curve to evaluate the predictive value of each blood glucose measurement mode for LGA and the area under the curve (AUC) was compared.Results:(1) Multivariate logistic regression analysis showed that the risks of LGA were significantly increased in GDM 0 group ( OR=1.76, 95% CI: 1.50-2.08; P<0.001), GDM 0+1 group ( OR=2.29, 95% CI: 1.72-3.04; P<0.001), and GDM 0+1+2 group ( OR=1.98, 95% CI: 1.61-2.43; P<0.001). (2) ROC curve analysis showed that fasting blood glucose, 1-hour after oral glucose, 2-hour after oral glucose, fasting+1-hour after oral glucose, fasting+2-hour after oral glucose, 1-hour+2-hour after oral glucose, and fasting+1-hour+2-hour after oral glucose had certain predictive value for LGA (all P<0.001). The AUC of fasting blood glucose measurement was higher than that of 2-hour blood glucose measurement in predicting LGA, and the difference was statistically significant ( P<0.05). There was no significant difference in the AUC between fasting blood glucose and other blood glucose measurement modes for predicting LGA (all P>0.05). Conclusions:In the abnormal OGTT patterns, pregnant women with abnormal fasting blood glucose, abnormal fasting+1-hour after oral glucose, and abnormal fasting+1-hour+2-hour after oral glucose have an increased risk of LGA. Fasting blood glucose measurement is of great significance for the prediction of LGA, and could be used as an optimal indicator to evaluate the risk of LGA in clinical practice.

The correlation between serum vitamin D and the risk of pre-eclampsia in the early, middle and late stages of pregnancy / 中国医师进修杂志

Objective:To investigate the correlation between serum vitamin D and the risk of pre-eclampsia at the early, middle and late stages of pregnancy.Methods:Pregnant women who registered and delivered in Electric Power Teaching Hospital of Capital Medical University from August 2020 to July 2021 were included. Pregnant women with pre-eclampsia during pregnancy were selected as the case group (150 cases), while pregnant women without any complications after delivery were selected as the control group (600 cases) according to the 1∶4 matching principle (age, pre-pregnancy body mass index and last menstruation). The levels of serum vitamin D in differences stages of pregnancy between the two groups were compared. Logistic regression model was used to analyze the association between serum vitamin D levels and the risk of pre-eclampsia.Results:The levels of serum vitamin D at the early, middle and late stages of pregnancy in the case group were lower than those in the control group: (14.32 ± 3.61) μg/L vs. (18.78 ± 4.73) μg/L, (15.06 ± 3.12) μg/L vs. (19.88 ± 4.25) μg/L, (16.04 ± 3.51) μg/L vs. (22.04 ± 5.63) μg/L, there were statistical differences ( P<0.05). Taking pregnant women with adequate serum Vitamin D as a reference, and adjusting for confounding factors such as gain weight and primipara, the risk of pre-eclampsia in early stages pregnant women with serum Vitamin D serious deficiency, middle deficiency and deficiency was increased and the OR and 95% CI were 4.84(1.25 -31.42), 3.09(1.12 - 8.96), 1.48(1.12 - 13.05); the risk of pre-eclampsia in middle stages pregnant women with serum vitamin D serious deficiency, middle deficiency and deficiency was increased and the OR(95% CI) were 4.43(1.23 - 13.55), 2.22(1.05 - 6.78), 1.12(0.45 - 7.73); the risk of pre-eclampsia in late stages pregnant women with serum vitamin D serious deficiency, middle deficiency and deficiency was increased and the OR(95% CI) were 2.13(1.12 - 8.64), 1.76(1.02 - 4.98), 1.22(0.72 - 3.94). Conclusions:The level of serum vitamin D is associated with the risk of pre-eclampsia in pregnant women in the early, middle and late stages of pregnancy, and the risk of pre-eclampsia is significantly increase when the level of serum vitamin D is severely deficient or deficient during pregnancy.

Management of preterm premature rupture of membranes: controversies and challenges / 中华围产医学杂志

Preterm premature rupture of membranes (PPROM) is always an important issue in obstetric clinical studies for its high incidence and association with maternal and neonatal morbidity, such as preterm birth, infection, respiratory disease, etc. Although the management of PPROM has been updated and improved in recent years, some controversies and challenges still exist. Are PPROM women required for bed rest? Which is better for PPROM women, labor induction or expectant treatment? How to select various medications to achieve the best effect for PPROM women? Based on the newest evidence in recent years, this paper elaborates on the above issues in detail.

Transabdominal ultrasound measurement of cervical length in mid-pregnancy for prediction of spontaneous preterm birth / 中华围产医学杂志

Objective:To explore the clinical significance of cervical length (CL) measured by transabdominal ultrasound during fetal structural anomalies screeing at 20-24 +6 weeks of gestation. Methods:This was a retrospective nested case-control study based on a prospective longitudinal cohort of "Prediction and Prevention of Early-onset Preeclampsia", which recruited 4 995 singleton pregnant women at the gestational age of 11-13 +6 weeks in Nanjing Drum Tower Hospital from April 2019 to August 2022. All the subjects underwent second-trimester ultrasound screening for fetal structural anomalies in our hospital with image records. This study excluded the women who were lost to follow-up, underwent cervical cerclage, terminated the pregnancy due to personal or social factors, or had miscarriage before 20 weeks of gestation, and those with iatrogenic preterm births, intrauterine fetal death or no second-trimester cervical sonography images. Propensity score matching was used to match pregnant women with spontaneous preterm birth ( n=101) and those with full-term delivery ( n=101) in a 1∶1 ratio, with factors of maternal age, body mass index, preterm birth history, cesarean section history, and pregnancy interval ≥5 years. CL was measured based on the retained ultrasound images. Nonparametric test or Chi-square test were used for statistical analysis. Receiver operating characteristic (ROC) curve was used to evaluate the correlation between CL measured by transabdominal ultrasound in the second trimester and spontaneous preterm birth. Results:The CL measured by transabdominal ultrasound at 20-24 +6 weeks of gestation was significantly shorter in the spontaneous preterm birth group than that in the full-term group [2.8 cm (2.5-3.3 cm) vs. 3.4 cm (3.0-3.9 cm), Z=－5.85, P<0.001]. If CL<3.4 cm was used as the cut-off value for predicting spontaneous preterm birth (20-36 +6 weeks), the specificity and the sensitivity were 0.50 and 0.77, respectively, and the sensitivity reached 0.92 for predicting preterm birth before 32 weeks and 1.00 for predicting preterm birth before 28 weeks. If CL<3.7 cm was used as the cut-off value, the specificity and the sensitivity were 0.36 and 0.87, respectively, and the sensitivity was 1.00 for predicting preterm birth before 32 weeks. The efficacy of preterm birth screening at 28-36 +6 weeks of gestation was comparable to that at 20-36 +6 weeks, if CL<3.4 cm and CL<3.7 cm were used as the cut-off value, the sensitivity were 0.76 and 0.86, respectively. Conclusion:Transabdominal ultrasound measurement of CL in the second trimester can be a preliminary screening to determine whether further transvaginal ultrasound measurement of CL is needed for women without a history of preterm birth or late spontaneous abortion.

The Effect of an educational Intervention on Anxiety of Pregnant Women: A Quasi-Experimental Study / El efecto de una intervención educativa sobre la ansiedad de las mujeres embarazadas: Un estudio cuasi experimental / O efeito de uma intervenção educativa na ansiedade de gestantes: um estudo quase experimental

Objective. The aim of study is the effect of educational intervention on anxiety of pregnant women. Methods. This quasi-experimental study is done on the pregnant women referring to family physician's offices in Gerash City, Iran. 62 women were selected and divided into 2 groups (control and intervention). In intervention group the anxiety reduction training classes were held as a group discussion in 4 weekly 90-minute sessions. Control group received routine care. The anxiety assessment completed by two groups before and after the educational intervention. The measurement instruments included a demographic information questionnaire and the short form of the Pregnancy Related Anxiety Questionnaire (PRAQ-17). Results. Comparison of the mean scores of different dimensions of pregnancy anxiety in the pre-intervention and post-intervention stages in the intervention group using paired t-test indicated a statistically significant difference in the dimensions Fear of childbirth, Fear of giving birth to a physically or mentally disabled child, Fear of mood swings and Fear of changes in marital relations (p < 0.05) in comparison with control group. Conclusion. Holding pregnancy-training classes using group discussion method is a good strategy to reduce anxiety in pregnant women. Therefore, it is recommended that this educational strategy classes be used with mothers from the second trimester of pregnancy in urban family physician centers or those referred to a nearby clinic.

Objetivo. Evaluar el efecto de una intervención educativa sobre la ansiedad de las mujeres embarazadas. Métodos. Estudio cuasi-experimental realizado con la participación de mujeres embarazadas que acuden a las consultas de los médicos de familia en la ciudad de Gerash, Irán. Se seleccionaron 62 mujeres y se dividieron en 2 grupos (control e intervención). En el grupo de intervención, las clases de entrenamiento para la reducción de la ansiedad se impartieron en forma de debate grupal en 4 sesiones semanales de 90 minutos. El grupo de control recibió atención rutinaria. Los dos grupos completaron la evaluación de la ansiedad antes y después de la intervención educativa. Los instrumentos de medición incluían un cuestionario de información sociodemográfica y la forma corta del Cuestionario de Ansiedad Relacionada con el Embarazo (PRAQ-17). Resultados. La comparación de las puntuaciones medias de las distintas dimensiones de la ansiedad durante el embarazo en las etapas previa y posterior a la intervención en el grupo de estudio indicó una diferencia estadísticamente significativa en las dimensiones Miedo al parto, Miedo a dar a luz a un niño discapacitado física o mentalmente, Miedo a los cambios de humor, y Miedo a los cambios en las relaciones conyugales (p < 0.05), en comparación con el grupo de control. Conclusión. La realización de clases de formación durante el embarazo utilizando el método de discusión en grupo es una buena estrategia para reducir la ansiedad en las mujeres embarazadas. Por lo tanto, se recomienda que esta estrategia educativa se emplee con las madres desde el segundo trimestre del embarazo en los centros de medicina de familia o a aquellas que sean derivadas a la consulta externa.

Objetivo. Avaliar o efeito de uma intervenção educativa sobre a ansiedade em gestantes. Métodos. Estudo quase experimental realizado com a participação de gestantes atendidas em consultórios médicos de família na cidade de Gerash, Irã. 62 mulheres foram selecionadas e divididas em 2 grupos (controle e intervenção). No grupo de intervenção, as aulas de treinamento de redução de ansiedade foram ministradas como uma discussão em grupo e em 4 sessões semanais de 90 minutos. O grupo de controle recebeu cuidados de rotina. Ambos os grupos completaram a avaliação da ansiedade antes e após a intervenção educativa. Os instrumentos de medida incluíram um questionário de informações sociodemográficas e a versão curta do Questionário de Ansiedade Relacionada à Gravidez (PRAQ-17). Resultados. A comparação das pontuações médias das diferentes dimensões da ansiedade durante a gravidez nas etapas antes e após a intervenção no grupo de estudo indicou diferença estatisticamente significativa nas dimensões; medo do parto, medo de dar à luz um filho com deficiência física ou mental, medo de mudanças de humor e medo de mudanças nas relações conjugais (p < 0,05), em comparação com o grupo de controle. Conclusão. A realização de aulas de capacitação durante a gravidez utilizando o método de discussão em grupo é uma boa estratégia para reduzir a ansiedade em gestantes. Portanto, recomenda-se que essa estratégia educativa seja utilizada com mães a partir do segundo trimestre de gestação em centros de medicina de família ou com aquelas que são encaminhadas ao ambulatório.

Maternal stress perception in the first or second trimester affects breastfeeding behavior: a prospective cohort study / 中华围产医学杂志

Objective:To explore the effect of maternal stress perception and plasma serotonin level in the first or second trimester on breastfeeding behavior, and to provide evidence for promoting exclusive breastfeeding.Methods:This prospective cohort study recruited pregnant women (≤20 gestational weeks) from Maternal and Child Health Center of Gulou District from April 2019 to March 2020. Stress perception at study enrollment was evaluated using Perceived Stress Scale (PSS) and the maternal plasma serotonin level was detected. Telephone interviews were conducted 42 d after delivery to collect information on childbirth and breastfeeding. Chi-square test, two independent samples t-test, and logistic regression model were used to analyze the risk factors of non-exclusive breastfeeding. Results:A total of 366 pregnant women were enrolled and 353 (96.4%) of them completed telephone interviews, who were divided into the exclusive ( n=194) and non-exclusive breastfeeding group ( n=159). Univariate analysis showed that the PSS scores [(19.4±6.9) vs (21.1±6.9) scores, t=－2.25, P=0.026] and the proportion of high-stress perception [23.7% (46/194) vs 34.0% (54/159), χ 2=4.03, P=0.045] in the exclusive group were all significantly lower than those in non-exclusive group. In the logistic regression analysis, exclusive breastfeeding was set as the dependent variable and the independent variables included factors with P<0.200 in the univariate analysis (PSS scores or PSS rating, plasma serotonin level, age, delivery mode) and potential clinical risk factors (parity, preterm birth). The results showed that when PSS was considered as a continuous variable, total PSS scores in the first or second trimester was an independent risk factor for non-exclusive breastfeeding ( OR=1.043, 95% CI: 1.010-1.077, P=0.011) and so was the high-stress perception when PSS was considered as a categorical variable (PSS rating) ( OR=1.765, 95% CI: 1.097-2.854, P=0.020). Conclusions:Overstress in the first or second trimester will affect breastfeeding patterns. Mental health counseling may help relieve perinatal stress, which will further increase the exclusive breastfeeding rate.

Fetal cervical aortic arch with closure of ductus arteriosus: a case report / 中华围产医学杂志

This paper reported the ultrasonographic findings and pregnancy outcome in a case of fetal cervical aortic arch complicated by premature closure of ductus arteriosus. Ultrasound at 22+6weeks of gestation showed that the apex of fetal aortic arch reached the level of left clavicle, but no obvious abnormality in fetal intracardiac structure was found. Ultrasound examinations showed premature contraction of the fetal ductus arteriosus at 25+ 4 weeks of gestation and premature closure at 27+6 weeks. The pregnant woman was hospitalized due to the aggravation of fetal right heart failure at 34+1 gestational weeks and delivered by cesarean section at 34+3weeks. After 17 d of intensive care, the newborn was discharged in good condition. Ultrasound examination performed three months after birth showed that the aortic arch was at the level of left clavicle and the right cardiac system recovered well.

Clinical value of echocardiography in the diagnosis of fetal arrhythmia / 中国基层医药

Objective:To investigate the clinical value of echocardiography in the diagnosis of fetal arrhythmia.Methods:1 500 pregnant women who underwent a regular prenatal examination in Cangnan Hospital Affiliated to Wenzhou Medical University from March 2018 to March 2020 were included in this study. These pregnant women underwent fetal echocardiography in the second trimester of pregnancy (24-26 weeks). We evaluated the condition of, and calculated the incidence of, fetal arrhythmia complicated by fetal cardiac structure abnormality . The diameters of the descending aorta, umbilical artery, and middle cerebral artery were compared between normal fetuses and arrhythmia fetuses.Results:Fetal arrhythmia was found in 131 pregnant women who were in the second trimester of pregnancy, with an incidence of fetal arrhythmia of 8.73%. Fetal arrhythmia and cardiac structure abnormality were detected in 19 pregnant women, with an incidence of fetal arrhythmia and cardiac structure abnormality of 1.27%. Fetal arrhythmia was detected in 131 (8.73%) pregnant women who were in the second trimester of pregnancy and it was detected in 32 (2.13%) pregnant women who were in the third trimester of pregnancy. Arrhythmia was detected in 18 (1.2%) newborns. Only 5 (0.33%) fetuses died during the perinatal period. Four (0.27%) fetuses had arrhythmia complicated by cardiac structure abnormality. One (0.07%) fetus was normal. The diameters of the descending aorta and middle cerebral artery were greater in normal fetuses than in arrhythmia fetuses in pregnant women who were in the second trimester of pregnancy, and the diameter of the umbilical artery was significantly smaller in normal fetuses than in arrhythmia fetuses ( t = -8.27-19.62, all P < 0.001). Conclusion:Echocardiography can effectively help diagnose fetal arrhythmia and observe abnormal cardiac structure. The imaging technique is of great clinical value in improving the diagnosis and treatment of fetal arrhythmia.

The predictive value of the distance between the placenta and the internal os of the cervix in second trimester to placenta previa / 中国医师杂志

Objective:To explore the predictive value of the distance between the placenta and the internal os of the cervix (IOD) in second trimester to placenta previa.Methods:476 pregnant women with placenta previa diagnosed by systematic ultrasound in the Affiliated Hospital of North Sichuan Medical College from May 2016 to June 2020 were analyzed retrospectively. The ultrasonic parameters such as IOD, cervical length and placental main attachment position were measured, and the clinical characteristics and pregnancy outcome were recorded. Logistic regression analysis was used to analyze the influencing factors of placenta previa from mild pregnancy to late pregnancy. The receiver operating characteristic (ROC) curve was used to analyze the predictive value of IOD value for placenta previa.Results:197 cases of placenta previa were diagnosed in this study. Multivariate regression analysis showed that the number of previous pregnancies, IOD and history of cesarean section were the related factors of placenta previa from mid pregnancy to late pregnancy ( P<0.05). The risk of placenta previa in pregnant women ≥3 pregnancies was 1.826 times that in pregnant women with less than 3 pregnancies. The risk of placenta previa when the lower edge of placenta covers and crosses the internal orifice of cervix (IOD<0 mm) was 11.494 times that of IOD=0 mm and 22.222 times that of IOD>0 mm<20 mm (low placenta). The risk of placenta previa in pregnant women with a history of cesarean section was 1.908 times that of pregnant women without a history of cesarean section. When the cutoff value of IDO was 20 mm, all pregnant women with placenta previa could be screened out in the group with cesarean section history and the area under the curve (AUC) was 0.840 (95% CI: 0.783-0.896, P<0.05); When the cutoff value of IOD was 13.5 mm, all pregnant women with placenta previa could be screened in the group without cesarean section history, and the AUC was 0.814 (95% CI: 0.759-0.869, P<0.05). Conclusions:The second trimester IOD has a good predictive value for placenta previa.

Predictive value of transvaginal ultrasound measurement of cervical length in first and second trimester on spontaneous preterm birth in singleton pregnancies / 中华围产医学杂志

Objective:To explore the predictive value of transvaginal ultrasound measurement of cervical length (CL) in the first and second trimester on spontaneous preterm birth in singleton pregnant women.Methods:This study retrospectively recruited 2 254 singleton pregnancies without severe comorbidities at Peking University First Hospital from January 2019 to June 2019. CL was measured for all subjects using transvaginal ultrasound in the first (11-13 +6 weeks) and second trimester (21-23 +6 weeks). Differences in CL between women with preterm (preterm group) and full-term delivery (full-term group) as well as the CL during the first and second trimester were compared. The independent risk factors for preterm birth and the predictive value of CL in the first and second trimester for spontaneous preterm birth were also explored. Fisher's exact test, t-test, χ2 test, and logistic regression analysis, etc, were adopted for statistical analysis. Results:(1) For the 2 254 subjects, CL measured in the first trimester and second trimester were (36.1±4.2) mm (22.4-52.6 mm) and (36.9±5.3) mm (2.9-59.7 mm), respectively. The incidence of short cervix in the first trimester and second trimester were 0.31% (7/2 254) and 1.46% (33/2 254), respectively. When CL was ≤25.0 mm ( OR=43.92, 95% CI:6.83-282.49) or >25.0-≤30.3 mm ( OR=6.59, 95% CI:1.97-22.0) in the first trimester, the risk of short cervix increased in the second trimester (both P<0.05). (2) The total incidence of preterm delivery was 3.06% (69/2 254). CL and the incidence of short cervix did not differ significantly in the first trimester between the preterm and full-term group [(35.2±4.5) and (36.1±4.1) mm, t=－1.78, P=0.076; 1.5% (1/69) and 0.3% (6/2 185), χ 2=2.98, P=0.084]. Compared with the full-term group, CL was shorter and the incidence of short cervix was higher in the second trimester in the preterm group [(33.6±6.7) vs (37.0±5.2) mm, t=－5.12;8.7% (6/69) vs 1.2% (27/2 185), χ 2=25.80, P<0.001]. (3) Multivariate regression analysis showed that age ≥35 years ( OR=2.05, 95% CI:1.22-3.46), history of spontaneous preterm birth ( OR=25.25, 95% CI:5.01-127.28), conception assisted by reproductive technology ( OR=10.39, 95% CI:2.39-50.33), and short cervix during the second trimester were independent risk factors for premature delivery. (4) There was no significant difference in the risk of preterm delivery when comparing to those with CL≤25.0 mm, >25.0-≤30.3 mm, >30.3-≤33.0 mm, >33.0-≤35.7 mm, >35.7-≤38.7 mm women with CL>38.7 mm during the first trimester (all P>0.05). The risk of premature delivery was relatively increased for those with CL≤25.0 mm,>25.0-≤29.5 mm, >29.5-≤33.6 mm, >33.6~≤36.8 mm, >36.8~≤40.1 mm during the second trimester compared to those with CL>40.1 mm [ OR (95% CI):17.64 (4.99-62.32), 6.89 (2.11-22.55), 3.58 (1.34-9.59), 4.04 (1.58-10.32), 3.34 (1.28-8.67), respectively , all P<0.05]. (5) When CL≤25.0 mm and ≤29.5 mm in the second trimester were used as the cut-off value, the prediction of preterm delivery was with a sensitivity of 8.70% and 17.39%, specificity of 98.80% and 95.29%, positive predictive value of 18.20% and 10.43%, negative predictive value of 97.16% and 97.34%, and the accuracy rate of 96.01% and 92.90%, respectively. Conclusions:There were no significant differences in CL and the incidence of short cervix during the first trimester among women with preterm or full-term delivery. CL in the first trimester is not an independent risk factor for preterm birth, but the risk of short cervix in the second trimester is increased when CL≤30.3 mm in the first trimester. The shorter the cervix during the second trimester, the greater the risk of preterm birth.

Clinical analysis of pregnancy termination in 167 pregnant women with cardiovascular disease during the first and second trimester / 中华妇产科杂志

Objective:To study the risk assessment, method selection and clinical management of pregnancy termination during the first and second trimester of pregnant women with cardiovascular disease.Methods:This study focused on pregnant women with cardiovascular diseases who were admitted to Beijing Anzhen Hospital during the first and second trimester of pregnancy from January 2016 to September 2019, to summarize their clinical characteristics, reasons and methods of pregnancy termination, management and outcomes.Results:Among 167 pregnant women, 119 cases (71.3%, 119/167) were in early pregnancy and 48 cases (28.7%, 48/167) were in middle pregnancy. The reasons for termination of pregnancy were cardiovascular disease (109 cases; 65.3%, 109/167), unwanted pregnancy (54 cases; 32.3%, 54/167) and other reasons (4 cases). Vacuum aspiration was performed in 98 cases and forceps curettage was performed in 19 cases, medical abortion was performed in 2 cases in early pregnancy. There was no change in cardiac function after pregnancy termination and all survived in early pregnancy. In the second trimester, 16 cases were induced by intraamniotic injection of ethacridine, 2 cases by water balloon, 1 case by oxytocin intravenous drip, and 29 cases by hysterotomy delivery. The ratio of patients with hysterotomy delivery with cardiac function grade Ⅲ-Ⅳ was significantly higher than that in the patients with vaginal labor induction in the second trimester [79% (23/29) vs 4/19; P<0.01]; the ratio of pregnancy risk grade Ⅳ-Ⅴ was also significantly higher [100% (29/29) vs 14/19; P=0.007]. The mean length of hospital stay of patients with hysterotomy delivery was significantly longer than that in the patients with vaginal labor induction [(7.1±3.4) vs (2.4±1.8) days; P<0.01]. Cardiac function was improved in 4 patients induced by ethacridine and rapid recovery without serious complications. Cardiac function decreased in 5 cases and 1 case died on the first day after hysterotomy delivery. Conclusions:Pregnancy risk assessment should be conducted as early as possible in patients with cardiovascular disease. If it is not suitable to continue the pregnancy, terminate pregnancy as early as possible to reduce the risk. Pregnancy termination methods and analgesic methods should be selected according to different gestational age and complications. The indications for hysterotomy delivery should not be relaxed at will, so as to minimize trauma and hemodynamic changes. After the termination of pregnancy, contraceptive measures should be implemented and the next treatment plan should be guided.

Evaluation of the diagnosis and treatment of cesarean scar pregnancy induced in the second trimester: a national multicenter retrospective study / 中华妇产科杂志

Objective:To study the risk factors of adverse pregnancy outcomes for induced abortion of cesarean scar pregnancy in midtrimester.Methods:A national multicenter retrospective study was conducted. A total of 154 singletons pregnant women with cesarean scar pregnancy during the second trimester induced abortion by various reasons in 12 tertiary A hospitals were selected, their pregnant outcomes were observed and the risk factors of serious adverse outcomes were analyzed with univariate and multivariate logstic regression; the role of ultrasound and MRI in predicting placenta accreta and severe adverse outcomes was evaluated, the effectiveness of uterine artery embolization (UAE) in preventing hemorrhage in pregnant women with and without placenta accreta was compared.Results:Among 154 subjects, the rate of placenta accreta was 42.2% (65/154), the rate of postpartum hemorrhage≥1 000 ml was 39.0% (60/154), the rate of hysterectomy was 14.9% (23/154), the rate of uterine rupture was 0.6% (1/154). The risk factor of postpartum hemorrhage≥1 000 ml and hysterectomy was placenta accreta ( P<0.01). For each increase in the number of parity, the risk of placenta accreta increased 2.385 times (95% CI: 1.046-5.439; P=0.039); and the risk of placenta accreta decreased with increasing ultrasound measurement of scar myometrium thickness ( OR=0.033, 95% CI: 0.001-0.762; P=0.033). The amount of postpartum hemorrhage and hysterectomy rate in the group with placenta accreta diagnosed by ultrasound combined with MRI were not significantly different from those in the group with placenta accreta diagnosed by ultrasound only or MRI only (all P>0.05). For pregnant women with placenta accreta, there were no significant difference in the amount of bleeding and hysterectomy rate between the UAE group [median: 1 300 ml; 34% (16/47)] and the non-embolization group (all P>0.05); in pregnant women without placenta accreta, the amount of bleeding in the UAE group was lower than that in the non-embolization group (median: 100 vs 600 ml; P<0.01), but there was no significant difference in hysterectomy rate [2% (1/56) vs 9% (3/33); P>0.05]. Conclusions:(1) Placenta accreta is the only risk factor of postpartum hemorrhage≥1 000 ml with hysterectomy for induced abortion of cesarean scar pregnancy in midtrimester; multi-parity and ultrasound measurement of scar myometrium thickness are risk factors for placenta accreta. (2) The technique of using ultrasound and MRI in predicting placenta accreta of cesarean scar pregnancy needs to be improved. (3) It is necessary to discuss of UAE in preventing postpartum hemorrhage for induced abortion of cesarean scar pregnancy in midtrimester.

Survival of mother and infant following treatment of acute Stanford type B aortic dissection with endovascular repair under local anesthesia in second trimester: a case report / 中华围产医学杂志

We report the diagnosis and treatment of a pregnant woman with acute Stanford type B aortic dissection in the second trimester who underwent thoracic endovascular aortic repair under local anesthesia and later gave birth to a live neonate. The patient was admitted due to acute upper back pain at 27 weeks of gestation, who was diagnosed as acute Stanford type B aortic dissection. Thoracic endovascular aneurysm repair was performed with low radiation dose under local anesthesia. A live neonate was born through cesarean section at 33 +6 gestational weeks due to the flat baseline of the fetal heart monitor, with a birth weight of 1 840 g and Apgar score of 9 at 1 min. The neonate was discharged after a 20-day treatment. During the follow-up of 12 months, the infant grew and developed well, and covered stent was well placed in the mother without leakage in the distal or proximal ends of the stent or any other complications.

Second-trimester termination due to conjoined twins in a woman with twice previous cesarean sections / 中华围产医学杂志

We report the induced labor of conjoined twins in the second trimester in a woman with a history of two previous cesarean sections, the last one of which was performed in 2017. This 25-year-old patient was found to have thoracolumbar conjoined fetuses with one heart and polyhydramnios through the routine ultrasound examination at 19 +5 gestational weeks and was admitted at 20 +1 gestational weeks. After a full assessment of the fetal and maternal condition through multidisciplinary consultation, it was determined to attempt a vaginal delivery as no absolute contraindication for induction of labor. The patient was given 300 mg mifepristone orally plus an amniotic cavity injection of 100 mg ethacridine lactate. Regular contractions occurred 28 hours after medication. The patient delivered a pair of dead female conjoined twins at 20 +6 gestational weeks following successful induction of labor, with an assisted vaginal breech delivery. There was no soft tissue damage in the birth canal, and the estimated blood loss was 150 ml. Pathological examination and autopsy showed thoracolumbar conjoined deformity twins with a common heart and liver. Adequate prenatal evaluation, a detailed understanding of the indications for induction of labor and vaginal delivery, closed monitoring during labor, and preparation for emergency cesarean section, are essential safety measures for induced labor of conjoined twins in women with a scarred uterus in the second trimester.

Women's obstetric history and midtrimester cervical length measurements by 2d/3d and doppler ultrasound / História obstétrica e medida do comprimento do colo uterino de mulheres no segundo trimestre gestacional por ultrassonografia bi/tridimensional e Doppler

Abstract Objective The aim of the present study was to compare the obstetric history and both two- and tri-dimensional ultrasound parameters according to different cervical lengths. Methods The present cross-sectional study analyzed 248 midtrimester pregnant women according to cervical length and compared the data with the obstetric history and 2D/3D ultrasound parameters. Patients were divided into 3 groups according to cervical length: The Short Cervix group for cervical lengths ≥ 15mm and< 25mm(n= 68), the Very Short Cervix group for cervical lengths< 15mm (n = 18) and the Control group, composed of 162 pregnant women with uterine cervical lengths ≥ 25mm. Results When analyzing the obstetric history of only non-nulliparous patients, a significant association between the presence of a short cervix in the current pregnancy and at least one previous preterm birth was reported (p = 0.021). Cervical length and volume were positively correlated (Pearson coefficient = 0.587, p < 0.0001). The flow index (FI) parameter of cervical vascularization was significantly different between the Control and Very Short Cervix groups. However, after linear regression, in the presence of volume information, we found no association between the groups and FI. Uterine artery Doppler was also not related to cervical shortening. Conclusion The present study showed a significant association between the presence of a short cervix in the current pregnancy and at least one previous preterm birth. None of the vascularization indexes correlate with cervical length as an independent parameter. Uterine artery Doppler findings do not correlate with cervical length.

Resumo Objetivo O objetivo do presente estudo foi comparar a história obstétrica e os parâmetros bi- e tridimensionais ultrassonográficos de acordo com os diferentes comprimentos cervicais. Métodos O presente estudo transversal analisou 248 gestantes no segundo trimestre de acordo com o comprimento cervical e comparou os dados com a história obstétrica e os parâmetros ultrassonográficos 2D/3D. As pacientes foram divididas em 3 grupos de acordo com o comprimento do colo uterino: grupo Colo Curto para comprimentos cervicais ≥ 15mm e < 25mm (n = 68), grupo Colo Muito Curto para comprimentos cervicais < 15mm (n = 18) e grupo Controle, composto por 162 gestantes com comprimento cervical uterino ≥ 25 mm. Resultados Ao analisar a história obstétrica apenas de pacientes não nulíparas, foi relatadauma associação significativa entre a presença de colo uterino curto na gravidez atual e pelo menos um episódio de parto prematuro anterior (p = 0,021). Comprimento e volume do colo uterino foram correlacionados positivamente (coeficiente de Pearson = 0,587, p < 0,0001). O parâmetro índice de fluxo (IF) da vascularização cervical foi significativamente diferente entre os grupos Controle e Colo Muito Curto. Entretanto, após regressão linear, na presença de informações de volume, não encontramos associação entre os grupos e o parâmetro IF. Também não foi encontrada relação entre o Doppler da artéria uterina e o encurtamento cervical. Conclusão O presente estudo mostrou uma associação significativa entre a presença de colo uterino curto na gravidez atual e pelo menos um episódio de parto prematuro anterior. Nenhum dos índices de vascularização se correlaciona com o comprimento cervical como parâmetro independente, assim como o Doppler da artéria uterina também não está relacionado ao comprimento do colo uterino.

Ovarian pregnancy rupture in second trimester manifesting mental change in pregnancy: a case report

Ovarian pregnancies comprise approximately 3% of ectopic pregnancies. Moreover, ovarian pregnancies in the second trimester are extremely rare. We herein present a case of ruptured ovarian pregnancy in the second trimester. A 26-year-old Asian woman presented to our hospital complaining of an abrupt mental change. She was pregnant; however, she had not been receiving antenatal care. Her initial vital signs were unstable, and pelvic ultrasound revealed pelvic fluid collection. We analyzed the hemoperitoneum and performed exploratory laparotomy. When her abdomen was opened, we observed that her right ovary was ruptured. Placental cord insertion originated from the ovary, and a fetus was found in the pelvic cavity. The ovarian pregnancy was detected in a delayed state. Pregnant women require appropriate antenatal care, and pelvic ultrasound should be performed in the second trimester to ensure that the fetus is in the intrauterine cavity.

Secuencia TRAP: serie de casos en el Hospital Regional de Alta Especialidad de la Mujer de Tabasco / TRAP sequence: Series of cases in Hospital Regional de Alta Especialidad de la Mujer de Tabasco

Resumen OBJETIVO: Reportar, comparar y analizar el estado posnatal de pacientes con embarazo gemelar monocorial y determinar la incidencia de secuencia TRAP. MATERIALES Y MÉTODOS: Estudio retrospectivo y descriptivo de una serie de casos de pacientes con diagnóstico de embarazo múltiple monocorial atendidas entre 2014 y 2018 en el Hospital Regional de Alta Especialidad de la Mujer de Tabasco. Se incluyeron todas las pacientes con diagnóstico de secuencia de perfusión arterial reversa gemelar con finalización del embarazo y reporte del estado posnatal. Se determinó la incidencia y se excluyeron las pacientes con expedientes incompletos y embarazos no concluidos en el Hospital Regional. RESULTADOS: Se encontraron 6 casos de embarazo gemelar monocorial con secuencia TRAP. De los casos reportados, 5 fueron gemelar doble y 1 de alto orden fetal. Solo 1 de los 6 casos recibió tratamiento intraútero. En 4 casos el gemelo bomba supervivió sin complicaciones reportadas. La incidencia de secuencia TRAP de embarazos monocoriales de la muestra de estudio fue de 5.2%. CONCLUSIÓN: Se expusieron 6 casos tratados de diferentes maneras y con mejores resultados con la conducta conservadora porque en los 4 casos que no recibieron tratamiento los gemelos bomba no sufrieron descompensaciones cardiacas y supervivieron, a diferencia del único caso con tratamiento intra-útero en el que hubo complicaciones que llevaron a la terminación del embarazo en el segundo trimestre.

Abstract OBJECTIVE: Report, compare and analyze the postnatal status of patients with monochorionic twin pregnancy and determine the incidence of TRAP sequence. MATERIALS AND METHODS: A descriptive, retrospective, case series study of patients diagnosed with monochorionic multiple pregnancy attended at the High Specialty Regional Women's Hospital of Tabasco between 2014 and 2018 was carried out. The study included all patients with the diagnosis of TRAP sequence, reported postnatal outcomes and the incidence was determined. Patients with incomplete records and unfinished pregnancies were excluded. RESULTS: Six cases of twin reversed arterial perfusion were diagnosed, five of which were twin pregnancies and one was a higher order multiple pregnancy. Only one of the patients received intra-uterine treatment. The pump twin survived without complications in four of the six cases. CONCLUSION: Six treated cases were exposed in different ways and with better results with the conservative behavior because in the 4 cases that did not receive treatment, the twin pump did not suffer cardiac decompensation and survived, unlike the only case with intra-uterine treatment in which there were complications that led to termination of pregnancy in the second trimester.

Predictive value of cervical size change rate and shape detected by mid-pregnancy ultrasound for premature delivery / 中国基层医药

Objective@#To evaluate the predictive value of cervical size change rate and morphological distribution detected by ultrasound in the second trimester of pregnancy for preterm delivery.@*Methods@#From June 2016 to June 2018, 300 pregnant women who underwent antenatal testing and gave birth in , the Integrated Traditional Chinese and Western Medicine Hospital of Wenzhou were selected in this research.The length, width and shape of cervix were measured by transvaginal color doppler ultrasonography at 14 and 28 weeks respectively.According to whether or not premature delivery occurred, they were divided into premature delivery group and full-term delivery group.The differences of cervical length, cervical inner mouth width, cervical length shortening rate, cervical inner mouth width increasing rate and cervical shape distribution between preterm and full-term pregnant women were compared, and the correlation between the above indicators and the occurrence of premature delivery were analyzed.@*Results@#The length of cervix in the preterm delivery group [(21.41±6.28)mm] was significantly shorter than that in the full-term delivery group at 28 weeks of gestation [(34.17±5.76)mm](t=10.295, P=0.000), and the width of cervical inner mouth in the preterm delivery group [(9.54±2.57) mm] was significantly longer than that in the full-term delivery group [(4.06±0.91)mm] (t=25.416, P=0.000). The shortening rate of cervical length [(39.28±8.65)%] and the increasing rate of cervical width [(149.74±15.09)%] in the preterm pregnant women during the second trimester were significantly higher than those in the full-term pregnant women [(10.15±5.29)% and (16.33±3.84)%] (t=21.471, 39.420; P=0.000, 0.000). The proportion of T-type cervix in the preterm delivery group (77.17%) was significantly higher than that in the full-term delivery group (63.28%) (χ2=10.935, P=0.001). According to the correlation analysis, the length of cervix was negatively correlated with premature birth (r=-0.612, P=0.035), and the width of cervical inner mouth, the shortening rate of cervical length in the second trimester and the increasing rate of cervical inner mouth width in the second trimester were positively correlated with premature birth (r=0.743, 0.665, 0.807; P=0.013, 0.026, 0.004).@*Conclusion@#Ultrasound monitoring of cervical size change rate and cervical morphology during the second trimester of pregnancy is helpful to the early prediction of preterm labor, which should be paid attention to clinically.

Predictive value of cervical size change rate and shape detected by mid-pregnancy ultrasound for premature delivery / 中国基层医药

Objective To evaluate the predictive value of cervical size change rate and morphological distri-bution detected by ultrasound in the second trimester of pregnancy for preterm delivery .Methods From June 2016 to June 2018,300 pregnant women who underwent antenatal testing and gave birth in ,the Integrated Traditional Chinese and Western Medicine Hospital of Wenzhou were selected in this research.The length,width and shape of cervix were measured by transvaginal color doppler ultrasonography at 14 and 28 weeks respectively.According to whether or not premature delivery occurred , they were divided into premature delivery group and full-term delivery group.The differences of cervical length ,cervical inner mouth width ,cervical length shortening rate ,cervical inner mouth width increasing rate and cervical shape distribution between preterm and full-term pregnant women were compared ,and the correlation between the above indicators and the occurrence of premature delivery were analyzed .Results The length of cervix in the preterm delivery group [(21.41 ±6.28)mm] was significantly shorter than that in the full-term delivery group at 28 weeks of gestation [(34.17 ±5.76)mm](t＝10.295,P＝0.000),and the width of cervi-cal inner mouth in the preterm delivery group [(9.54 ±2.57) mm] was significantly longer than that in the full-term delivery group [( 4.06 ±0.91 ) mm] ( t ＝25.416, P ＝0.000 ).The shortening rate of cervical length [(39.28 ±8.65)%] and the increasing rate of cervical width [(149.74 ±15.09)%] in the preterm pregnant women during the second trimester were significantly higher than those in the full-term pregnant women [(10.15 ± 5.29)%and (16.33 ±3.84)%] (t＝21.471,39.420;P＝0.000,0.000).The proportion of T-type cervix in the preterm delivery group (77.17%) was significantly higher than that in the full-term delivery group (63.28%) (χ2 ＝10.935,P＝0.001).According to the correlation analysis ,the length of cervix was negatively correlated with premature birth ( r＝-0.612,P＝0.035),and the width of cervical inner mouth ,the shortening rate of cervical length in the second trimester and the increasing rate of cervical inner mouth width in the second trimester were posi-tively correlated with premature birth (r＝0.743,0.665,0.807;P＝0.013,0.026,0.004).Conclusion Ultrasound monitoring of cervical size change rate and cervical morphology during the second trimester of pregnancy is helpful to the early prediction of preterm labor ,which should be paid attention to clinically.