Treatment of congenital pulmonary airway malformation with rare high cystic volume ratio: A case report and literature review.

RATIONALE: Congenital pulmonary airway malformation (CPAM) is a rare congenital dysplastic malformation and accounts for 25% of congenital lung lesions. Commonly, it is diagnosed prenatally in ultrasound. The CPAM volume ratio (CVR) is a well-recognized predictor of fetal prognosis, and when the CVR is >1.6 cm2, the fetus is very likely to develop hydrops and even intrauterine deaths. However, the association of CVR with a wide range of complications and neonatal prognosis is unclear. PATIENT CONCERNS: Cystic lesions in the right thorax of the fetus detected by ultrasound at 19 weeks of gestation, with a CVR of 0.88 cm2. The CVR grew progressively with increasing gestational weeks, reaching a maximum of 5.2 cm2 at 35 gestational weeks. However, there were no complications with the fetus other than polyhydramnios. DIAGNOSIS: Imaging and pathological findings confirmed the diagnosis of CPAM. INTERVENTIONS: During pregnancy, a multidisciplinary team was involved in the management and the prenatal visits increased to weekly from 31 weeks of gestation. During the cesarean section, neonatologists and pediatric surgeons were present for timely evaluation of newborns. The neonate was admitted to the neonatal intensive care unit for monitoring immediately after birth and underwent thoracoscopic right lower lobectomy at 57th days old. OUTCOMES: The neonate recovered without any respiratory symptoms and no abnormality on chest computed tomography (CT) at the 3-month postoperative follow-up. LESSONS: During pregnancy, in addition to monitoring CVR, a multidisciplinary team should join in the management of CPAM patients. And as for the fetus with increased CVR, a closely monitoring after birth is necessary even if the general condition of the pregnancy is well. In particular, timely intervention should be made at the onset of respiratory symptoms.

[Analysis of Pregnancy Outcomes After Fetal Reduction in Monochorionic, Dichorionic, and Trichorionic Triplet Pregnancies].

Objective: To compare the pregnancy outcomes of pregnancy outcomes after selective fetal reduction treatment in monochorionic, dichorionic, and trichorionic triplet pregnancies. Methods: We conducted a retrospective analysis of the clinical data of 118 pregnant women carrying triplets. All subjects underwent regular prenatal check-ups and were admitted for delivery at West China Second University Hospital, Sichuan University between January 1, 2012 and January 31, 2021. According to the chorionicity, the subjects were divided into a monochorionic group ( n=13), a dichorionic group ( n=44), and a trichorionic group ( n=61). Within each group, the subjects were further divided into two subgroups, a reduction group and an expectant treatment group, according to whether they underwent fetal reduction or not. The clinical data and pregnancy outcomes were compared between the subgroups within each group. Results: In the monichorionic group, the reduction subgroup had a lower preterm birth rate and higher neonatal birth body mass than those of the expectant management subgroup, but the differences were not statistically significant. In the dichorionic and trichorionic groups, the rates of preterm delivery, neonatal hospitalization, and serious complications of the reduction subgroups were lower than those of the expectant subgroups ( P<0.05), while the neonatal birth body mass was higher in the reduction subgroups than that in the expectant subgroups ( P<0.05). In the dichorionic group, the incidence of intrahepatic cholestasis during pregnancy was lower in the reduction subgroup than that in the expectant treatment subgroup. In all 3 groups, there was no statistically significant difference between the subgroups in the incidence of gestational diabetes, hypertensive disorders of pregnancy, premature rupture of membranes, and postpartum hemorrhage. The survival curve analysis showed that women receiving fetal reduction during the first trimester had a lower risk of pregnancy loss and more significant prolonged of gestational age than those undergoing the procedure during the second trimester. Conclusion: Fetal reduction of triplets can significantly prolong the gestational age and improve the perinatal prognosis. In addition, selective reduction in the first trimester may lead to greater benefits than selective reduction in the second trimester does.

[Perinatal Outcomes of Using Ursodeoxycholic Acid to Treat Monochorionic and Dichorionic Twin Pregnancy Complicated by Intrahepatic Cholestasis of Pregnancy].

OBJECTIVE: To study the effect of using ursodeoxycholic acid (UDCA) to treat monochorionic and dichorionic twin pregnancies complicated by intrahepatic cholestasis of pregnancy (ICP) and to examine the differences in perinatal outcomes. METHODS: A total of 406 twin-carrying pregnant women who had ICP and received care at West China Second Hospital, Sichuan University between January 1, 2015 and November 1, 2018 were included in the study. The clinical data of monochorionic diamniotic (MCDA) and dichorionic diamniotic (DCDA) twins with ICP were analyzed. Analysis was done to compare the treatment effect for lowering serum total bile acid (TBA) and the perinatal outcomes with simple UDCA medication or combination medication. RESULTS: There were no statistically significant differences in TBA levels, early-onset ICP, simple UDCA medication or combination medication, neonatal Apgar score, birth weight, length of hospital stay, C-section rate, and perinatal mortality between the MCDA and the DCDA twin groups with ICP. However, maternal age, BMI, scarred uterus, in vitro fertilization-embryo transfer, preeclampsia, twin comorbidity rate of the two groups showed statistical differences. Further comparison between twin pregnancies with mildly-elevated TBA and those with severely-elevated TBA showed significant difference in preterm birth rate ( P<0.05). CONCLUSION: Simple UDCA medication or combination medication may have the same therapeutic effect on MCDA and DCDA twin pregnancies with ICP. Monochorionic twin pregnancy, twin comorbidities and pregnancy complications were still important factors affecting pregnancy outcomes of twin pregnancies with ICP. Twin pregnancies with slightly elevated TBA have been managed as severe ICP, which may be associated with increased iatrogenic preterm births.

[Associations of Pre-pregnancy Body Mass Index and Gestational Weight Gain with Gestational Diabetes Mellitus: a Cohort Study in Southwest China].

OBJECTIVE: To determine the associations of pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) with gestational diabetes mellitus (GDM). METHODS: A prospective cohort of pregnant women were screened for GDM at 24-28 weeks of gestation between 2013 and 2015, resulting in a sample of 3 593 with GDM and 15 346 without GDM. The body mass, plasma glucose, and height data of the participants were collected by the local medical workers. Multivariate logistic regression analyses were performed to determine the associations of pre pregnancy body mass index and weight gain during pregnancy with GDM. RESULTS: The participants with pre pregnancy overweight [odds ratio(OR)=2.44, 95% cofidence interval(CI)1.98-2.99] and obesity (OR=4.98, 95%CI 2.52-9.91) were more likely to develop GDM. According to the Institute of Medicine (IOM) criteria, excessive GWG in the first trimester occurred in 8.46% of the women, compared with 55.07% in the second trimester. After adjustment for age at delivery and pre pregnancy BMI, high GWG in the first trimesters in advanced maternal age (age at delivery≥35 yr.) group (OR=1.42, 95%CI 1.02-2.28) was a risk factor for GDM while the OR value of the non-advanced maternal age (age at delivery≤35 yr.) group was not statistically significant. In second trimesters, both advanced maternal age group (OR=1.59, 95%CI 1.14-1.88) and non-advanced maternal age group (OR=1.49, 95%CI 1.20-1.72) in high GWG were associated with high risk of GDM. CONCLUSION: Pre pregnancy overweight and obesity and excessive GWG during early and second trimesters of pregnancy may increase the risk of GDM in women in Southwestern China.

[Eating Frequency and Gestational Weight Gain and Its Association with Birth Body Mass of Neonates: a Birth Cohort Study].

OBJECTIVE: To determine the association of eating frequency (EF) and gestational weight gain (GWG) with birth body mass of neonates. METHODS: A prospective cohort study was conducted on 578 healthy pregnant women from April to October 2015. Dietary intake and physical activity data per trimester were collected using a questionnaire. Data in relation to gestational body mass,gestational stage and birth body mass of neonates were obtained from clinical records. Multiple logistic regression models were established to test the impacts of EF and GWG on appropriate for gestational age (AGA). Multiple linear regression analyses were performed to determine the association between EF and birth body mass of neonates. RESULTS: A final sample of 503 eligible pregnant women (87.02%) was included in data analyses. Higher EF [odds ratio (OR)=2.03; 95% confidence interval (CI): 1.18-3.47] and snacks (OR=1.84; 95%CI: 1.08-3.15) in the first trimester were associated with increased risk of excessive GWG,after controlling for maternal age,education,average household income,physicalactivity,numbers of pregnancy,numbers of delivery,and dietary intake (protein,fat,carbohydrate). A meal frequency greater (OR=2.83; 95%CI: 1.07-4.58) or less (OR=1.92; 95%CI: 1.08-3.61) than three in the first trimester was also associated with increased risk of large or small for gestational age. Meal frequency in the first trimester was positively correlated with birth body mass of neonates (ß=236.17; P<0.01). CONCLUSION: Frequent eating and snacks in the first trimester are associated with increased risks of excessive GWG. Meal frequency in the first trimester is also positively correlated with birth body mass of neonates: three meals per day is a protective factor of AGA.

Dietary energy density is positively associated with body composition of adults in Southwest China.

OBJECTIVE: Dietary energy density (ED) might have influences on body composition. We therefore examined whether ED is associated with body composition among Chinese adults. DESIGN: We collected dietary data through validated two-day 24 h recalls. ED, defined as the amount of energy per unit weight of food consumed, was calculated based on five methods. Multiple linear regression analyses were performed to explore the associations between ED and body composition parameters, including BMI, fat mass index (FMI), fat-free mass index (FFMI), percentage body fat (%BF) and waist circumference (WC). SETTING: Southwest China. SUBJECTS: Chinese adults (n 1933) in 2013. RESULTS: After adjusting the covariates, all ED definitions were positively associated with BMI, FMI, FFMI, %BF and WC among women (P<0·01). In men, however, ED with foods only was positively associated with BMI, FMI, FFMI and %BF (P<0·05), but not with WC (P=0·07); we also found null associations between ED with foods and all beverages and body composition among men. Additionally, ED contributed to higher increases of body composition in women than in men (P<0·01). CONCLUSIONS: The present study supports the positive association between ED and body composition among adults in Southwest China, in which beverages may play an important role.

Acute Fatty Liver of Pregnancy: A Retrospective Analysis of 56 Cases.

BACKGROUND: Acute fatty liver of pregnancy (AFLP) is a rare but life-threatening complication occurring in the third trimester. It is often fatal to both mother and fetus. The complicated clinical manifestations as well as an insufficient understanding of the disease make the precise diagnosis and effective treatment of AFLP challenging. A full understanding of the risk factors, clinical features, and test findings of AFLP is critical for its timely diagnosis and treatment. METHODS: We performed a retrospective study of 56 patients with AFLP between June 2008 and July 2013. We analyzed the clinical features, laboratory results, perioperative management, and patient outcomes. RESULTS: The initial symptoms varied considerably, with nausea and vomiting (13/56, 23%) being the most common. Liver-function indexes were remarkable, including elevated levels of serum alanine aminotransferase (262.16 ± 281.71 U/L), aspartate aminotransferase (260.98 ± 237.91 U/L), lactic dehydrogenase (1011.76 ± 530.34 U/L), and direct bilirubin (85.59 ± 90.02 µmol/L). Coagulation disorders were indicated by abnormal levels of fibrinogen (245.95 ± 186.11 mg/dL), D-dimer (2.46 ± 4.01 mg/L), and fibrin degradation products (43.62 ± 48.71 mg/L). The main maternal complications were hypoproteinemia (75%), coagulopathy (54%), and acute renal failure (39%). Multivariate logistic regression analysis identified prothrombin time (PT; odds ratio [OR] = 1.558, 95% confidence interval [CI] =1.248-1.946, PORCIP= 0.009) as risk factors. The perinatal infant death rate was related to gestational age at delivery (ORCI PORCI PORCI PConclusions: Nausea and vomiting may be the most common symptoms of AFLP. Indexes of liver dysfunction and coagulation disorders should also be considered. PT and INR are risk factors for fatal complications in patients with AFLP, and perinatal mortality is linked to the level of fibrin degradation products. Timely delivery is crucial to controlling the development of AFLP.

Outcome and risk factors of early onset severe preeclampsia.

BACKGROUND: Early onset severe preeclampsia is a specific type of severe preeclampsia, which causes high morbidity and mortality of both mothers and fetus. This study aimed to investigate the clinical definition, features, treatment, outcome and risk factors of early onset severe preeclampsia in Chinese women. METHODS: Four hundred and thirteen women with severe preeclampsia from June 2006 to June 2009 were divided into three groups according to the gestational age at the onset of preeclampsia as follows: group A (less than 32 weeks, 73 cases), group B (between 32 and 34 weeks, 71 cases), and group C (greater than 34 weeks, 269 cases). The demographic characteristics of the subjects, complications, delivery modes and outcome of pregnancy were analyzed retrospectively. RESULTS: The systolic blood pressure at admission and the incidence of severe complications were significantly lower in group C than those in groups A and B, prolonged gestational weeks and days of hospitalization were significantly shorter in group C than those in groups A and B. Liver and kidney dysfunction, pleural and peritoneal effusion, placental abruption and postpartum hemorrhage were more likely to occur in group A compared with the other two groups. Twenty-four-hour urine protein levels at admission, intrauterine fetal death and days of hospitalization were risk factors that affected complications of severe preeclampsia. Gestational week at admission and delivery week were also risk factors that affected perinatal outcome. CONCLUSIONS: Early onset severe preeclampsia should be defined as occurring before 34 weeks, and it is featured by more maternal complications and a worse perinatal prognosis compared with that defined as occurring after 34 weeks. Independent risk factors should be used to tailor the optimized individual treatment plan, to balance both maternal and neonatal safety.

[Association between osteoprotegerin gene polymorphisms and severe pre-eclampsia in Chinese women].

OBJECTIVE: To investigate the potential association between 163A/G and 950T/C polymorphisms of osteoprotegerin (OPG) gene and severe pre-eclampsia. METHODS: Eighty-five severe pre-eclamptic patients and 81 normal term pregnant women (as control group) were recruited from the Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University during the period from July 2007 to March 2009, and they were all Han population living in Chengdu, China. Genotype and allele frequencies of 163A/G and 950T/C were determined by the PCR-restriction fragment length polymorphism (RFLP) assay. Clinical and biochemical parameters for different alleles between the patients and controls were compared for statistical significance respectively, such as blood pressure, serum creatinine and 24-hour urine protein. RESULTS: The observed and expected genotype counts were consistent with Hardy-Weinberg equilibrium. No significant differences were found in the genotype and allele frequencies of 163A/G and 950T/C polymorphisms between the two groups (P > 0.05). However, in the preeclamptic group, serum creatinine was significantly higher in women with the AG + GG genotypes [(76 ± 24) µmol/L] compared with AA genotype [(56 ± 18) µmol/L]. Reversely, birth weight was lower in the AG + GG genotypes [(2040 ± 721) g] than those in the AA genotype [(2520 ± 810) g], and the P < 0.05, respectively. In the severe pre-eclampsia, 950T/C TT genotype carriers exhibited significantly higher systolic blood pressure [(153 ± 16) mm Hg (1 mm Hg = 0.133 kPa)] and 24-hour urine protein [(4.0 ± 2.5) g] compared with TT + TC carriers [(145 ± 17) mm Hg, (2.9 ± 1.8) g], respectively, furthermore the P < 0.05. CONCLUSIONS: In severe pre-eclampsia, carriers with G allele at position 163A/G has more genetic predisposition than A allele carriers, as well as 950T/C T allele carriers compared with C carriers. Taken together, this study suggested that OPG gene polymorphisms might be associated with some clinical parameters of severe pre-eclampsia.