Preterm Births in Peking Union Medical College Hospital in the Past 25 Years / 中国医学科学院学报

Objective To investigate the changes in preterm birth rate,its gestational age distribution,and possible contributors in Peking Union Medical College Hospital (PUMCH) over the last 25-year period. Methods The clinical data of premature deliveries,both singleton and twins,in PUMCH from January 1,1990 to December 31,2014 were retrospectively analyzed. We counted the number of premature fetuses and assessed the changes of preterm birth rate and its gestational age distribution (including extremely preterm birth,early preterm birth,and late preterm birth) over time. The etiologies (including spontaneous and iatrogenic) of preterm birth were also surveyed. Results The overall preterm birth rate was 7.8% in PUMCH,showing a slightly up-trend in both singletons and twins. Twin prematurity accounted for 23.8% of total preterm births,increased from 15.1% to 28.5%. Preterm births subgrouped by gestational age included 26 cases (0.7%) of extreme prematurity (<28 weeks),1199 cases (33.9%) of early preterm birth (28- 33weeks),and 2310 cases (65.3%) of late preterm birth (34- 36weeks). The gestational age distribution in singletons and twins showed no significant difference(z=0.844,P=0.398). Changes in the proportion of preterm birth before 28 weeks was little,gradually increased in the 28- 33weeks group (from 23.8% to 36.1%) and gradually decreased in the 34- 36weeks group (from 75.5% to 63.3%). Trends of gestational age distribution of singleton and twins were similar to that of the total. Spontaneous preterm labor,preterm premature rupture of membrane,and medically indicated (iatrogenic) preterm birth accounted for 20.2%,38.9%,and 40.9% respectively. There was no difference in singletons and twins(χ=1.071,P=0.301).The proportion of iatrogenic preterm was increased. Common reasons for iatrogenic preterm birth included gestational hypertension,fetal indications (including fetal distress,fetal growth restriction),placenta previa,and pregnancy complicated by heart disease. Conclusions The overall preterm birth rate shows an upward trend in the general hospital as a result of more multifetal gestations and more medically indicated preterm births. Reducing multifetal gestations and effective control of pregnancy complications should be the priorieties in preterm birth intervention.

Influential and prognostic factors of small for gestational age infants / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Small for gestational age (SGA) infants are associated with a high rate of oligohydramnios, stillbirth and cesarean delivery. Among SGA patients there is a higher risk of neonatal complications, such as polycythemia, hyperbilirubinemia, and hypothermia. Additionally, the SGA infant is prone to suffer from major neurologic sequelae, as well as cardiovascular system disease, in later life. Proper monitoring and therapy during pregnancy are, therefore, of utmost importance. The present study aimed to investigate the influential and prognostic factors of SGA infants.</p><p><b>METHODS</b>From January 2001 to June 2007, a total of 55 SGA neonatal infants were included in a study group. All were born at Peking Union Medical College Hospital, with regular formal antenatal examinations. In addition, a total of 122 cases of appropriate for gestational age (AGA) infants were born at the same time and were registered into a control group. All cases were singleton pregnancies with detailed information of the maternal age, gravidity, parity, maternal height and weight, complications, uterine height and abdominal circumference, results from transabdominal ultrasonography between 32 - 38 gestational weeks, pregnancy duration, delivery manner, placenta, umbilical cord, and neonatal complications.</p><p><b>RESULTS</b>Significant differences were observed in placenta weight and neonatal malformations between the study and control groups. Multivariate analysis revealed increased parity, maternal hyperthyroidism and hyperthyroidism history as risk factors. Fetal abdominal circumferences less than 30 and 32 cm at 32 - 38 gestational weeks respectively, as determined by ultrasonography, resulted in a Youden index of 0.62.</p><p><b>CONCLUSIONS</b>SGA infants were associated with a greater risk of smaller placentas and infant malformations. Increased parity, maternal hyperthyroidism, and a hyperthyroid history were risk factors for SGA infants. Fetal abdominal circumference less than 30 cm at 32 gestational weeks and less than 32 cm at 38 weeks, as determined by ultrasonography, was considered an effective index for SGA.</p>

Pregnancy outcomes of repeat cesarean section in Peking Union Medical College Hospital / 中国医学科学杂志(英文版)

<p><b>OBJECTIVE</b>To evaluate the effect of elective repeat cesarean section on the maternal and neonatal outcomes.</p><p><b>METHODS</b>A retrospective clinic- and hospital-based survey was designed for comparing the maternal and neonatal outcomes of elective repeat cesarean section [RCS group (one previous cesarean section) and MRCS group (two or more previous cesarean sections)] and primary cesarean section (FCS group) at Peking Union Medical College Hospital from January 1998 to December 2007.</p><p><b>RESULTS</b>The incidence of repeat cesarean section increased from 1.26% to 7.32%. The mean gestational age at delivery in RCS group (38.1+/-1.8 weeks) and MRCS group (37.3+/-2.5 weeks) were significantly shorter than that in FCS group (38.9+/-2.1 weeks, all P<0.01). The incidence of complication was 33.8% and 33.3% in RCS group and MRCS group respectively, and was significantly higher than that in FCS group (7.9%, P<0.05). Dense adhesion (13.5% vs. 0.4%, OR=7.156, 95% CI: 1.7-30.7, P<0.01) and uterine rupture (1.0% vs. 0, P<0.05) were commoner in RCS group compared with FCS group. Neonatal morbidity was similar among three groups (P>0.05).</p><p><b>CONCLUSIONS</b>Repeat cesarean section is associated with more complicated surgery technique and increased frequency of maternal morbidity. However, the incidence of neonatal morbidity is similar to primary cesarean section.</p>

Clinical significance and prognosis of fetal arrhythmias / 中国医学科学杂志(英文版)

<p><b>OBJECTIVE</b>To explore fetal arrhythmia clinical significance and its correlation with fetal prognosis.</p><p><b>METHODS</b>Twenty-six cases of fetal arrhythmia detected among 12,799 pregnant women recorded over a ten-year period in Peking Uinon Medical College (PUMC) Hospital were reviewed retrospectively. Fetal arrhythmia was diagnosed by fetal auscultation, ultrasonography, electric fetal heart monitoring, and fetal echocardiography.</p><p><b>RESULTS</b>Twenty-six fetuses were documented with fetal arrhythmia (3 tachycardia, 4 bradycardia, 19 normal heart rate with irregular fetal cardiac rhythm). The incidence of fetal arrhythmia in our hospital was 0.2%. They were diagnosed at the average of 35 weeks' gestation (15 to 41 weeks). Twenty-two cases were diagnosed by antenatal fetal auscultation, 1 case was diagnosed by ultrasonography, and 3 cases were diagnosed by electric fetal heart monitoring. Fetal echocardiograms were performed on 17 fetuses, 6 cases (35.3%) of which showed that ventricular premature beats with normal structure of fetal heart. All neonates survived postnatally and 24 of them (92.3%) were followed up. Echocardiograms were performed for 16 neonates and 2 of them were identified as atrial septal defects with normal heart rhythms. The results of follow-up showed that the two patients had no apparent clinical manifestation. The echocardiogram showed that atrial septal defect obliterated already.</p><p><b>CONCLUSION</b>The prognosis is well for most of the fetuses with arrhythmias, with low incidence of heart deformation.</p>

Screening by maternal serum markers for Down's syndrome / 中国医学科学院学报

<p><b>OBJECTIVE</b>To investigate the optimal method of screening for Down's syndrome (DS) with maternal serum mankers.</p><p><b>METHODS</b>Screening by maternal serum markers for Down's syndrome was offered to all 2886 pregnant women in Peking Union Medical Hospital during 1996.11-2001.3. Alpha-fetoprotein (AFP), human chorionic gonadotrophin (free beta-HCG) were used as markers during the first year of pregnancy. Alpha-fetoprotein, free human chorionic gonadotrophin (HCG) and pregnancy-associated plasma protein A (PAPP-A) were used as mid pregnancy and first-trimester markers in next three years. Amniocentesis and (CVS) were done in those defined as risk cases.</p><p><b>RESULTS</b>The detection rate of Down's syndrome by maternal serum markers was 3.8% (11/2886). The proportion of false positive results in group of triple markers (alpha FP, free beta-HCG, PAPP-A) was 5%.</p><p><b>CONCLUSIONS</b>The PAPP-A was a good marker to detect Down's syndrome in early pregnancy and may be used to predict the outcome during mid trimester of pregnancy. The AFP and free beta-HCG can be useful markers to detect Down's syndrome and fetal abnormality. While prenatal diagnostics can be shifted to an early pregnant period.</p>

Application of intrapartum fetal oxygen saturation rate monitoring / 中国医学科学院学报

<p><b>OBJECTIVE</b>To study the accuracy of the application of the intrapartum fetal oxygen saturation (FSO2) monitoring in predicting fetal acidosis and diagnosing intrauterine fetal distress.</p><p><b>METHODS</b>Continuous FSO2 monitoring as well as internal and external fetal heart rate monitoring were applied respectively in 60 women in labor during active phase of the first stage and the second stage. All the monitoring methods were validated with standard sensitivity, specificity, positive predictive value, negative predictive value, and accuracy on the bases of Apgar score and cord artery blood analysis.</p><p><b>RESULTS</b>The mean FSO2 in the active phase of the first stage were significantly higher than in the second stage of labor. FSO2 correlated with pH, PO2, PCO2, and base excess (BE) of cord blood to a significant degree. There was linear correlation between FSO2 and cord artery blood pH. Using 30% cutoff diagnosing intrauterine fetal distress, the sensitivity, specificity, and accuracy were 80%, 100% and 98.3%, respectively.</p><p><b>CONCLUSION</b>FSO2 monitoring is an effective method diagnosing intrauterine fetal distress.</p>

Study on the correlation of serum folate and red blood cell folate level with birth defects and unexplained recurrent pregnancy loss / 中华妇产科杂志

0.05). The RBC folate level of birth defect group except the urinary defect was significantly lower compared with the control group(233-547 vs 689 nmol/L,P

Clinical analysis of maternal and neonatal outcomes in uncomplicated term nulliparous after different routes of delivery / 中华妇产科杂志

Objective To compare maternal and neonatal outcomes after induction,elective cesarean section and spontaneous onset of labor in uncomplicated term nulliparous women.Methods A total of 3751 uncomplicated term nullipara who delivered in Peking Union Medical College Hospital from Sept 2002 to April 2007 were retrospectively analyzed.They were divided into three groups:the induction group, the elective cesarean section group,and the spontaneous onset of labor group.Their general conditions (such as age,weeks of pregnancy,hospital days and cost),postpartum complications(such as postpartum hemorrhage,puerperal morbidity,urinary retention,blood transfusion,delayed healing,and trauma),and Apgar score were compared by statistic methods.Results(1)Among 3751 women,501(13.3%)of them underwent induction(the induction group),1634(43.6%)delivered by cesarean section(cesarean section group),the other 1616(43.1%)women underwent spontaneous onset of labor(the spontaneous onset of labor group).(2)Results of general conditions:the spontaneous onset of labor group had the shortest hospital days,which was longer in the induction group,and the longest in the selective cesarean section group(P