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Background The incidence rate of missed abortion is increasing year by year, but the etiology has not been fully elucidated. Adverse pregnancy history and exposure to polycyclic aromatic hydrocarbons (PAHs) may increase the risk of missed abortion. Objective To investigate the interaction between adverse pregnancy history and PAHs exposure on missed abortion in early pregnancy, and to provide evidence for the etiologic research of missed abortion. Methods A total of 114 pregnant women diagnosed with missed abortion in the Department of Obstetrics of the First Hospital of Shanxi Medical University from March to December 2019 were selected as the case group, and 139 pregnant women who visited the same hospital for voluntary induced abortion in the same period as the control group, to collect basic information and medical information of abortion, stillbirth, intrauterine growth retardation, and other adverse pregnancy history. Abortion villus tissues were collected to detect PAH-DNA adducts levels, stratified by pregnancy and adverse pregnancy history and grouped by quartile method: Q1 (< 404.61 ng·L−1), Q2 (404.61−453.75 ng·L−1), Q3 (453.76−506.72 ng·L−1), and Q4 (≥506.73 ng·L−1). SPSS 25.0 statistical software was used for χ2 test and multiple logistic regression, and additive and multiplicative models were used to investigate the interaction between adverse pregnancy history and PAH-DNA adducts level on missed abortion. The PAH-DNA adducts were grouped by tertiles and quartiles, and P33, P50, P67 and P75 were used as data cut points for sensitivity analysis. Results The proportion of adverse pregnancy history in the case group (32.46%) was higher than that in the control group (12.23%) (P < 0.001). Among 160 subjects with≥2 pregnancies, the proportion of adverse pregnancy history in the case group (57.81%) was higher than that in the control group (17.71%) (P < 0.001). The results of χ2 test stratified by pregnancy for different PAH-DNA adducts levels between the two groups showed that the PAH-DNA adducts level was associated with missed abortion in subjects with≥2 pregnancies (χ2=10.14, P=0.017). Being further stratified by adverse pregnancy history, the PAH-DNA adducts level in subjects with no adverse pregnancy history was associated with missed abortion (χ2=9.70, P=0.021). The results of logistic regression analysis showed that adverse pregnancy history (OR=5.88, 95%CI: 2.79−12.39) and PAH-DNA adducts (OR=3.01, 95%CI: 1.22−7.40) increased the risk of missed abortion, but no interaction between them was found. The relative excess risk of interaction (RERI), the attributable percentage of interaction (AP), and the synergy index (SI) and its 95%CI were 0.60 (95%CI: −0.58−1.77), 0.74 (95%CI: −0.83−2.30), and 0.20 (95%CI: 0.01−5.43), respectively. Conclusions Adverse pregnancy history and PAH-DNA adducts in pregnant women may increase the risk of missed abortion. The effect of the interaction between them on the occurrence of missed abortion is not supported by the current study.
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Objective To explore the option and feasibility of the uterine scar pregnancy again and reduce the rate of cesarean delivery. Methods A total of 615 cases of puerperal clinical patients in the hospital from January 2011 to De-cember 2013 were analyzed. According to the pregnancy type, cesarean section again included 536 cases and vaginal delivery included 79 cases. And 3470 cases of vaginal delivery were selected by compared 117 cases uterine scar vagi-nal delivery, plus 2274 cases of cesarean delivery for the first time were selected by compared 536 cases of cesarean section again. Results Cesarean section again group and vaginal delivery group in the Apgar score, weight, the differ-ence was not statistically significant(P>0.05); The postpartum hemorrhage rate in uterine scar vaginal delivery group were significantly smaller than the cesarean sections again group (P<0.05);Success ratio and natural delivery in uterine scar vaginal delivery group were smaller than the vaginal delivery group (P<0.05); The episiotomy, the use of for-ceps and the postpartum hemorrhage were no significantly between uterine scar vaginal delivery group and vaginal de-livery group (P>0.05); Incision infection, interventional surgery and amniotic fluid embolism were no significantly be-tween cesarean sections again group and cesarean delivery for the first time group (P>0.05); The uterus resection rate and the postpartum hemorrhage of cesarean sections again group were significantly higher than the cesarean deliv-ery for the first time group (P<0.05). Conclusion It has to master the indications of uterine scar pregnancy again vagi-nal delivery, and keep to closely watch over the situation that meets the conditions for the trial production, in addition, the first cesarean section should be strictly controlled.