Correlation of 24-h Urinary Protein Excretion, Serum Indicators, and Placental Growth Factor in Patients with Preeclampsia and their Adverse Outcome.

Introduction: Preeclampsia (PE) is a fundamental cause of preterm labor, intrauterine growth restriction, and persistent postpartum hypertension. In the present study, we aimed to investigate the correlation between 24-h urinary protein excretion, serum markers, and placental growth factor and their adverse pregnancy outcomes in patients with PE. Methods: A total of 126 pregnant women with PE (86 cases of mild PE and 40 cases of severe PE, assigned to the observation group) who came to our hospital from March 2019 to December 2021 for regular obstetric checkups and delivery were selected, with 60 healthy pregnant women assigned to the control group. Routine biochemical parameters, 24-h urinary protein quantification, serum parameters, and placental growth factor levels were recorded. The incidence of adverse neonatal pregnancy outcomes and abnormal fetal heart monitoring, neonatal body mass, 1 min Apgar score, and other adverse pregnancy outcomes were also analyzed in the different groups. Results: In comparison with healthy pregnant subjects, PE patients had earlier delivery gestational weeks (P < .05), significantly higher systolic blood pressure (SBP), diastolic blood pressure (DBP), 24-h urinary protein excretion, total cholesterol (TC), triglyceride (TG), D-Dimer and human chorionic gonadotropin (ß-hCG) levels (P < .05), lower albumin (ALB), platelet count, pregnant associated plasma protein A (PAPP-A) and placental growth factor (PLGF) (P < .05), and higher incidence of maternal and perinatal adverse outcomes (P < .05). Conclusions: Combined screening of 24-h urinary protein, PAPP-A, ß-hCG, PLGF, and serum indicators in early pregnancy are essential in predicting PE, allowing timely assessment of the risk of adverse pregnancy, and providing a basis for clinical intervention.

Study on the Relationship Between Uncertainty Tolerance and Positive Acceptance in Postoperative Patients With Cervical Cancer.

OBJECTIVE: The objective of this study is to clarify the correlation between uncertainty tolerance (UT) and positive acceptance (PA) in patients with cervical cancer (CC) after surgical treatment. METHODS: A total of 233 patients with CC who had undergone surgery were included and were scored on the UT Scale and Positive Acceptance Scale. In addition, patients were classified according to the length of stay ≥1 week and length of stay <1 week, and the UT score and satisfaction and enterprising score of the two groups were compared. This was performed in order to analyze the effect of length of hospital stay on UT and PA. RESULTS: The mean UT score of 233 patients was 3.74±0.34 and the mean PA score was 1.96±0.20, with a negative correlation and a significant correlation coefficient (r=-0.342, P 0.05). The UT score of post-operative CC patients with length of stay ≥1 week was significantly higher than that of patients with length of stay <1 week, P<0.05. The score of PA in patients with post-operative CC whose hospital stay was ≥1 week was significantly lower than for patients with hospital stays <1 week (P<0.05). UT was negatively correlated with PA in patients with hospital stays < 1 week (r=-0.358, P<0.05). There was a significant negative correlation between UT and PA in patients with hospital stay ≥1 week (r =-0.493, P<0.05). Increased hospitalization time correlated with increased scores of UT, with reductions in scores of PA. CONCLUSION: Post-operative patients with CC had higher scores of UT and lower scores of PA, which were negatively correlated. Increased hospitalization time was linked to a detriment in patient UT and reduced PA. Targeted interventions to improve the level of UT and PA within postoperative CC cases should be developed.

Evaluation of perineal wound healing and pain outcomes after low-angle mediolateral episiotomy in women undergoing vaginal childbirth: A systematic review and meta-analysis.

The efficacy of episiotomy, particularly the angle of incision in mediolateral episiotomies, remains a significant area of inquiry in obstetrics. This meta-analysis aimed to evaluate the impact of low-angle mediolateral episiotomy on perineal wound healing and pain outcomes in women undergoing vaginal childbirth. Adhering to PRISMA guidelines, a systematic review was conducted using the PICO framework. Studies were selected based on predefined inclusion and exclusion criteria, focusing on randomised controlled trials (RCTs) involving low-angle mediolateral episiotomies. Comprehensive literature searches were performed across major electronic databases including PubMed, Embase, Web of Science and Cochrane Library. Data extraction and quality assessments were meticulously carried out by independent reviewers, employing the Cochrane Collaboration's risk of bias tool. A total of 1246 articles were initially identified, with 8 articles meeting the strict inclusion criteria for the final analysis. The meta-analysis revealed significant heterogeneity among studies regarding postoperative pain (p < 0.0001, I2 = 77.5%), and employed a random-effects model. Results showed that low-angle episiotomies significantly reduced postoperative pain (OR = 0.27, 95% CI: 0.17-0.42, p < 0.001), and increased first-degree healing rates (OR = 2.95, 95% CI: 2.20-3.96, p < 0.001) compared to traditional angles. Sensitivity analyses confirmed the stability of these findings, and no significant publication bias was detected. The analysis suggests that low-angle episiotomies can potentially reduce postoperative perineal pain and enhance wound healing. However, the limited number and varying quality of the included studies warrant cautious interpretation of these results. Further well-designed studies are needed to corroborate these findings and guide clinical practice.

Prediabetes and the risk of breast cancer: a meta-analysis.

Background: Diabetes has been related to a higher risk of breast cancer (BC) in women. However, it remains unknown whether the incidence of BC is increased in women with prediabetes. A systematic review and meta-analysis was therefore performed to evaluate the relationship between prediabetes and risk of BC. Methods: Observational studies with longitudinal follow-up relevant to the objective were found via searching Medline, Embase, Cochrane Library, and Web of Science. A fixed- or random-effects model was used to pool the results depending on heterogeneity. Results: Eight prospective cohort studies and two nest case-control studies were included. A total of 1069079 community women were involved, and 72136 (6.7%) of them had prediabetes at baseline. During a mean duration follow-up of 9.6 years, 9960 (0.93%) patients were diagnosed as BC. Pooled results with a fixed-effects model showed that women with prediabetes were not associated with a higher incidence of BC as compared to those with normoglycemia (risk ratio: 0.99, 95% confidence interval: 0.93 to 1.05, p = 0.72) with mild heterogeneity (p for Cochrane Q test = 0.42, I2 = 3%). Subgroup analyses showed that study characteristics such as study design, menopausal status of the women, follow-up duration, diagnostic criteria for prediabetes, methods for validation of BC cases, and study quality scores did not significantly affect the results (p for subgroup analyses all > 0.05). Conclusion: Women with prediabetes may not be associated with an increased risk of BC as compared to women with normoglycemia.

Construction of a nomogram model for predicting infectious intrapartum fever. / å®«å† æ„ŸæŸ“æ‰€è‡´äº§æ—¶å‘çƒ­çš„å½±å“å› ç´ åŠåˆ—çº¿å›¾é¢„æµ‹æ¨¡åž‹æž„å»º.

OBJECTIVES: To investigate influencing factors of intrapartum fever during vaginal delivery and to construct a prediction model for infectious intrapartum fever. METHODS: A total of 444 patients with intrapartum fever admitted in Ningbo Women and Children's Hospital from January 2020 to December 2021 were enrolled. The clinical data and laboratory findings were compared between patients with infectious intrapartum fever and non-infectious intrapartum fever, and the factors associated with intrapartum fever were analyzed with a multivariate logistic regression model. A prediction nomogram model was constructed based on the factors of intrapartum fever and its predictive efficiency was evaluated by correction curve and receiver operator characteristic curve. RESULTS: In the 444 cases, 182 (41.0%) had definite intrauterine infection and 262 (59.0%) had no infectious intrapartum fever. Univariate analysis showed that the length of hospital stay before induced labor, the time of induced abortion, misoprostol administration, autoimmune diseases, white blood cell count (WBC) and hypersensitive C-reactive protein (hs-CRP) levels were significantly different between the two groups (all P<0.05). Multivariate analysis showed that misoprostol administration and autoimmune diseases were protective factors (OR=0.31 and 0.36, both P<0.05) for infectious intrapartum fever, while high WBC and hs-CRP were risk factors (OR=1.20 and 1.09, both P<0.05). The area under the curve of nomogram model for predicting infectious intrapartum fever was 0.823, and the calibration curve validation showed that the predicted and measured values were in general agreement. CONCLUSIONS: Multiple factors cause intrapartum fever. The nomogram model constructed in this study has good predictive accuracy for infectious intrapartum fever.

[Non-Invasive Prenatal Testing:Results in 3733 Cases of Twin Pregnancy and Association With Factors Such as Age].

Objective To explore the clinical significance of non-invasive prenatal testing(NIPT)for fetal chromosomal abnormalities in the cases of twin pregnancy and its relationship with age and other related factors.Methods A total of 3733 women with twin pregnancy of 12-26+6 weeks who voluntarily underwent NIPT in the Ningbo Women and Children's Hospital from January 2018 to December 2022 were selected.The results of NIPT and amniocentesis were compared and all the participants were followed up.The detection rate of chromosomal abnormalities by NIPT was calculated,and its correlations with age,gestational weeks,chorionicity,and pregnancy type were analyzed.Results Among the 3733 cases,71 cases of fetal chromosome abnormality were indicated by NIPT,including 13 cases of trisomy 21,19 cases of trisomy 18,5 cases of trisomy 13,18 cases of sex chromosome abnormality,and 16 cases of chromosome microdeletion/duplication(excluding 21,18,13,and sex chromosomes),among which 34 cases were true positive and 37 cases were false positive.The overall sensitivity,specificity,and positive predictive value(PPV)of NIPT for chromosomal abnormalities in the cases of twin pregnancy were 100%,98.99%,and 47.89%(34/71),respectively.NIPT showed the sensitivity,specificity,and PPV of 100%,99.78%,and 78.38%(29/37)for trisomy 21,18,and 13,100%,99.56%,and 16.67%(3/18)for sex chromosome abnormalities,and 100%,99.62%,and 12.5%(2/16)for chromosome microdeletion/duplication,respectively.In the age group of ≥40 years,the NIPT for chromosomal abnormalities showed the PPV of 66.67%,the sensitivity of 100%,and the misdiagnosis rate of 30%。However,the NIPT for trisomy 21,18,and 13 showed the PPV of 100%,the misdiagnosis rate of 0,and the sensitivity and specificity of 100%.In terms of grouping based on gestational weeks,the NIPT for chromosomal abnormalities showed the highest PPV(51.28%)in the women with twin pregnancy for 14-17+6 weeks,followed by that(50.00%)in the women with twin pregnancy for 22-26+6 weeks;the NIPT for trisomy 21,18,and 13 showed the highest PPV of 94.74% in the gestation group of 14-17+6 weeks,followed by that(83.33%)in the gestation group of 18-21+6 weeks.The rate of dichorionic diamniotic twins was higher in assisted pregnancies than in natural pregnancies,and NIPT showed the same detection efficiency for dichorionic diamniotic twins and monochorionic diamniotic twins and the same detection efficiency for different pregnancy types.Conclusions NIPT has high accuracy in the diagnosis of twin pregnancy and high sensitivity and high specificity for different ages and gestational weeks,especially for trisomy 21,18,and 13.NIPT is suitable for assisted pregnancy and natural pregnancy,and it is of high value in clinical application.However,extensive application needs a large population-based study.

Perineal stress as a predictor of performing episiotomy in primiparous women: a prospective observational study.

BACKGROUND: Episiotomy is a surgical solution to relieve perineal stress, resulting in an easily repairable incision, in comparison to the risks of serious vaginal trauma during delivery. The midwife typically adopts such a clinical decision, on experience and subjective judgment. However, the association between perineal stress and episiotomy is poorly characterized. Our aim was to identify a threshold value for perineal stress leading to episiotomy, which eventually may be employed as a clinical tool for assessing whether an episiotomy is required or not. METHODS: In total, 245 nulliparous women were investigated for perineal stress during non-instrumental vaginal delivery in Ningbo Women & Children's Hospital. During the second stage of labor, a flexible membrane stress sensor was placed between the fetal head and perineal wall above the anal fissure. Once the entire fetal head pressed against the sensor, real-time perineal stress was measured, and the peak value was recorded. Cases were divided into non-episiotomy group (n = 173) and episiotomy group (n = 72). The correlations between perineal stress and episiotomy was assessed through logistic regression with adjustment for maternal age, estimated birthweight, duration of second stage of labor, maternal body mass index, and presence of analgesia. Midwives were blinded to all stress measurement values. The predictive value of perineal stress on performing episiotomy was evaluated, together with the ideal cut-off perineal stress value for performing episiotomy. A ROC analysis was also performed. RESULTS: The episiotomy group had significantly higher levels of perineal stress in comparison to the non-episiotomy group (140.50 ± 16.03 N versus 118.37 ± 19.21 N, p < 0.01). The episiotomy group was linked to significantly higher perineal stress in comparison to the non-episiotomy group (140.50 ± 16.03 VS 118.37 ± 19.21 N, p < 0.01). ROC analysis between perineal stress and episiotomy revealed a high area under the curve (AUC 0.81, 95% CI 0.75-0.86) and a cut-off value for perineal stress of 124.49 N was identified for episiotomy decision. CONCLUSION: The level of perineal stress was an independent predictor of performing episiotomy in nulliparous women during non-instrumental vaginal delivery. Perineal stress exceeding 124.49 N was identified as the cut-off prompting midwives to perform episiotomy.

[Analysis of non-invasive prenatal testing in 14 047 cases of advanced age pregnant women].

OBJECTIVE: To assess the value of non-invasive prenatal testing (NIPT) for the diagnosis of fetal chromosomal aneuploidies among women with advanced gestational age. METHODS: 14 047 pregnant women have voluntarily accepted the NIPT test. The results of NIPT and amniocytic karyotyping analysis were compared, and the outcome of pregnancy was followed up. RESULTS: NIPT has identified 104 cases with a high risk for trisomies 21, 18 and 13, and 44 cases with a high risk for sex chromosome abnormalities. After genetic consultation, 87 of 104 cases have accepted amniocyte chromosomal karyotyping. 63 cases of fetal chromosome abnormality were confirmed, including 46 cases of 21 trisomy, 11 cases of 18 trisomy and 6 cases of 13 trisomy. The positive predictive value was 83.64% (46/55), 61.11% (11/18), and 42.86% (6/14), the specificity was 99.93%, 99.95%, 99.94%, and the sensitivity was 100%. Among the 44 cases, 34 received amniocytic chromosomal karyotyping analysis, 11 cases were confirmed, the positive predictive value was only 32.35%. No aneuploidy was found in the low-risk cases. The negative predictive value was 100%. CONCLUSION: As a prenatal screening method for women with advanced gestational age, NIPT has the highest positive predictive value for trisomy 21 and trisomy 18, but a lower positive predictive value for sex chromosome abnormalities. NIPT has a very low rate of missed diagnosis of trisomies 21, 18 and 13, which can significantly reduce the number of women undergoing invasive prenatal diagnosis.