Introduction Aplastic anemia (AA), a rare disorder characterized by bone marrow failure and pancytopenia, poses exceptionally high risks when it occurs during pregnancy. This condition endangers both the mother and fetus, significantly increasing the likelihood of maternal complications such as hemorrhage and infection, as well as adverse perinatal outcomes such as preterm birth and fetal growth restriction. Consequently, pregnancy with AA demands careful management. However, tools to predict these adverse outcomes in affected pregnant women are currently lacking. Here, we applied a machine learning approach to develop and validate a prediction model for adverse pregnancy outcomes in patients with AA, with the goal of guiding early clinical decision-making and improving their overall health outcomes. Methods This study was registered at Clinicaltrials.gov: NCT07101770. We collected data from 310 pregnant women with AA admitted between January 2000 and December 2024 to 15 tertiary hospitals in China. Adverse pregnancy outcomes included at least one of placental abruption, amniotic fluid embolism, postpartum hemorrhage, postpartum infection, maternal mortality, stillbirths, preterm birth, low birthweight, fetal growth restriction, neonatal intensive care unit admission, or neonatal mortality (BJOG, 2014). Feature selection was performed through least absolute shrinkage and selection operator (LASSO) regression. The reliability of the models was evaluated using the area under the receiver operating characteristic curve (AUC), sensitivity, specificity, accuracy, F1 score, calibration plots, and decision curve analysis (DCA). The SHapley Additive exPlanation (SHAP) method was used to rank the feature importance and explain the final model. Results Among the 310 patients with AA (median age, 30.2 [27.6-33.9]), 201 from 7 specialized tertiary hospitals composed the derivation cohort (training set), whereas an independent cohort of 109 patients from 8 distinct academic medical centers formed the external validation set. To ensure robust model development, the training set underwent a stratified random split, yielding a model-building subset (136 patients, 67.7%) and a hold-out internal validation subset (65 patients, 32.3%), preserving the distribution of adverse outcomes, including postpartum hemorrhage, placental abruption, fetal growth restriction, and preterm delivery. In this study, anemia was present in 280 patients (90.3%). Overall, 195 patients (62.9%) experienced adverse pregnancy outcomes. Notably, among the subgroup with severe aplastic anemia (SAA, n=8), the rate of adverse pregnancy outcomes rose significantly to 75.0% (6/8). These findings underscored the high-risk nature of this cohort, particularly those with SAA, highlighting the critical need for accurate prediction tools to guide targeted antenatal interventions. The data for the variables evaluated in this study, including demographic and clinical characteristics, laboratory results, and treatment, were obtained from patient electronic medical records. Using multivariable LASSO regression, we selected the top five features for model construction: age, hemoglobin level, platelet count, neutrophil count, and the percentage of lymphocytes. Seven state-of-the-art machine learning algorithms were rigorously trained and tuned. The RF model emerged as optimal, demonstrating good discriminative ability both in internal validation (AUC: 0.765, 95% CI: 0.737–0.851) and, crucially, in external validation (AUC: 0.743, 95% CI: 0.723–0.814), confirming its generalizability across heterogeneous health care settings. Furthermore, calibration plots revealed agreement between the predicted probabilities and observed event rates, indicating reliability across risk strata. DCA indicated that the clinical implementation of the prognostic model could benefit pregnant women with AA. Conclusions To our knowledge, it's the world's largest cohort of pregnant women with AA to date. We demonstrated that the model could predict the risk of adverse pregnancy outcomes in patients with AA. The model will help clinicians identify pregnant women at high risk early and provide a basis for individualized patient treatment plans.

Objective To analyze serum prolactin (PRL) levels during pregnancy in healthy single pregnant women of childbearing age in Suzhou, and to establish and verify the reference interval of serum PRL. Methods From January to March, 2022, the data of pregnant women with healthy single pregnancy at childbearing age were collected and prospectively followed up until delivery. According to the gestational age, the subjects were divided into early pregnancy group (less than 14 weeks), middle pregnancy group (14-27+6 weeks) and late pregnancy group (≥28 weeks). PRL was determined by Soling LIAISON XL automatic chemiluminescence immunoassay and LIAISON® prolactin. After eliminating outliers, the medical reference interval of serum PRL during pregnancy was established by percentile method (P2.5-P97.5). In addition, 20 samples of healthy single pregnant women of childbearing age were randomly collected in early, middle and late pregnancy to verify the established reference interval. When no more than two PRL measurements in each group exceeded the established reference interval, they were considered validated. Results A total of 170 participants were included in the early pregnancy group, 229 participants in the middle pregnancy group and 130 participants in the late pregnancy group. There were significant differences in serum PRL levels in pregnant women at different stages of pregnancy. With the increase of gestational age, serum PRL level increased. The reference intervals of serum PRL in early, middle and late pregnancy were 477-4270 mIU/L, 1060-6574 mIU/L and 3497-18 274 mIU/L, respectively. All the established reference intervals were verified. Conclusion This study has established the reference interval of serum PRL during pregnancy of healthy single pregnant women of childbearing age in Suzhou area, to provide help for clinical rational application of this index, and further reference for the prevention of pregnancy-related diseases.

The study utilized non-invasive myocardial work indices to investigate myocardial injury in infants born to mothers with severe preeclampsia (SPE) and to explore the duration of this myocardial damage during the neonatal period. This prospective study included 34 preterm infants born to mothers with SPE and 28 preterm infants born to mothers without severe pregnancy complications (termed “controls”). Echocardiography was performed in infants within 24 h of birth, then again at 48–72 h and 14–28 days, to obtain echocardiographic parameters. Two-dimensional speckle-tracking echocardiography (2D STE) was performed to construct a non-invasive left ventricular pressure–strain loop based on two-dimensional myocardial strain and non-invasive left ventricular systolic pressure measurements, allowing for the calculation of myocardial work indices. Within 24 h after delivery, left ventricular stroke volume (SV), cardiac output (CO), and left ventricular global work index (GWI) in newborns born of mothers with SPE were significantly reduced compared to controls, while mitral E/e′ and left ventricular longitudinal strain were increased. At 48–72 h after birth, mitral E/e′ and left ventricular global waste work (GWW) increased, and global work efficiency (GWE) was reduced in infants of mothers with SPE. During the 14–28 days of the neonatal period, left ventricular SV and CO were reduced in the offspring of mothers with SPE and mitral E peak velocity, and E/e′ and left ventricular GWW were increased. The adverse intrauterine environment caused by SPE can lead to persistent impaired left ventricular function in preterm infants during the neonatal period.

Background: Nausea and vomiting are common and unpleasant symptoms for pregnant women during cesarean section, which can lead to aspiration, a serious complication that can cause pneumonia. This study aimed to evaluate the effects of oral multi-vitamin carbohydrate beverage on maternal intraoperative nausea and vomiting by gastric ultrasound. Methods: This was a single-center, randomized controlled trial. According to their diet, pregnant women who were converted from vaginal delivery to cesarean section were divided into two groups: the observation group (multi-vitamin carbohydrate beverage) or the control group (semi-solid food). The cross-sectional area (CSA) of the gastric antrum was measured by ultrasound before cesarean section, and the occurrence of intraoperative nausea, vomiting, and aspiration was recorded in both groups. Results: The CSA of the gastric antrum at 1 h, 2 h, after eating, and before cesarean section in the observation group was significantly smaller than that in the control group. This suggests that an oral multi-vitamin carbohydrate beverage needs less gastric emptying time. The incidence of vomiting in the observation group was significantly lower than that in the control group. Moreover, the pH of the vomited fluid in the observation group was higher than that in the control group, indicating that oral multi-vitamin carbohydrate beverage may reduce the acidity of stomach contents, which can further reduce the risk and severity of vomiting. Conclusions: Oral multi-vitamin carbohydrate beverage can promote gastric emptying and reduce the incidence and harm of vomiting during urgent cesarean section. This dietary intervention may be a simple and effective way to improve maternal outcomes during cesarean section. Clinical Trial Registration: The study has been registered on https://classic.clinicaltrials.gov/ (registration number: NCT06333626).

Background: Labor epidural analgesia (LEA) may influence gut microbiota. We explored the association between LEA and gut microbiota for both mothers and their newborns. Methods: In this prospective cohort study, parturients aged 25-35 years with a gestational age of 37-42 weeks and planned vaginal delivery were recruited. Twenty-one parturients received LEA (the LEA group), and 24 did not (the control group). Maternal and neonatal fecal samples were collected, and the gut microbiota profiles were analyzed using the 16S rRNA gene sequencing. The impact of LEA on gut microbiota was assessed using the general liner models. Results: We showcased the gut microbiota profile from the phyla to species levels based on data on 45 mother-newborn dyads. The results of alpha- and beta-diversity suggested significant changes in gut microbiota between the LEA and control groups. After adjusting for baseline confounders, the administration of LEA had positive correlations with R. ilealis (beta = 91.87, adjusted P = 0.007) in mothers; LEA also had negative correlations with A. pittii (beta = -449.36, adjusted P = 0.015), P. aeruginosa (beta = -192.55, adjusted P = 0.008), or S. maltophilia (beta = -142.62, adjusted P = 0.001) in mothers, and with Muribaculaceae (beta = -2702.77, adjusted P = 0.003) in neonates. Conclusion: LEA was associated with changes in maternal and neonatal gut microbiota, and future studies are still required to assess their impact on clinical outcomes and explore the mechanisms.

This paper reports a case of neonatal lupus syndrome manifested by metabolic disease. A male neonate was admitted to the Children's Hospital of Soochow University due to poor response and vomiting for 1 day. Based on the clinical symptoms, including the patterned skin and a full anterior fontanelle, and a result of leukocytosis, neonatal sepsis was considered. Lysinuric protein intolerance was not excluded from the genetic metabolic disorders screening. The patient was positive for lupus-related autoantibodies and antinuclear antibodies, which were also found in his mother and elder sister. He had no functional variant of the SCL7A7 gene, a gene related to lysinuric protein intolerance, thereby the diagnosis of neonatal lupus syndrome manifested by metabolic disorders was confirmed. After treatment with methylprednisolone, the patient recovered well with no specific change in blood genetic metabolism at re-examination. Monthly follow-up after discharge found decreased antibody titers.

To editor: Glanzmann thrombasthenia (GT) is a rare autosomal recessive bleeding disorder that is characterized by a quantitative and/or qualitative defect in the platelet integrin αIIbβ3 (previously known as glycoprotein (GP)IIb/IIIa), the major platelet receptor of fibrinogen. Defective αIIbβ3 can result in the absence of platelet aggregation. Pregnancy and delivery in women with GT can present specific challenges as there is a significant risk of both maternal and fetal bleeding. Cases of pregnant women with GT have rarely been reported in China; furthermore, existing reports originating from China only refer to cases involving cesarean section. In this article, we describe the case of a Chinese primipara with GT who delivered vaginally under a multidisciplinary team approach. We reviewed the patient’s pregnancy, delivery, and postpartum details and then searched the existing literature to create new insight into the clinical management of future cases during and after pregnancy when facing this challenging situation in clinical practice. The study was approved by the ethics committee of First Affiliated Hospital of Soochow University (2022-211), and informed consent was obtained from the patient. A 29-year-old gravida 1 para 0 Chinese primigravida (spontaneous pregnancy) with GT was booked into our obstetric service in the second trimester of pregnancy. The patient was diagnosed with GT because of mucocutaneous bleeding and menorrhagia at the age of 15 years. Molecular analysis showed that she had a homozygous missense mutation of the ITGA2B gene (c.2929C>T), which is known to exert serious adverse effects on the structure or function of GP IIb. Flow cytometry showed that CD61 was 4.25%. She had a negative familial history for this condition, and no consanguineous marriages were known in her family. Her partner was non-consanguineous; as such, paternal genotyping was not performed. From puberty, she experienced repeated episodes of purpura, petechiae, or abnormally easy bruising; these conditions were controllable by irregular medication treatment. During pregnancy, the patient was regularly reviewed by a multidisciplinary team. The first multidisciplinary meeting between hematology, obstetrics, and nutrition teams was arranged for 20 weeks. The team initially discussed her diagnosis, treatment, and delivery mode, and then established follow-up projects. She subsequently developed gestational diabetes but remained stable with a controlled diet. Recurrent gingival bleeding during pregnancy was managed by topical measures and tranexamic acid. She was hospitalized for hematuria during the second and third trimester and discharged after treatment with antifibrinolytics, platelet transfusion, and recombinant activated factor VII (rFVIIa). At the gestational age of 40 weeks, she was admitted to the obstetrics department to prepare for delivery. On admission, her blood pressure was 116/69 mm Hg, heart rate was 85 beats per minute, respiratory rate was 20 breaths per minute, temperature was 36.2 °C, height was 172 cm, weight was 83 kg, fundal height was appropriate for gestational age, and clinically estimated fetal weight was 3100 g. On admission, hematological workup demonstrated a normal platelet count of 119 × 109/L, a hemoglobin level of 118 g/L, a PT of 11 seconds, and an aPTT of 24 seconds; but absent platelet aggregation responses to ADP, epinephrine, and collagen, as well as a prolonged bleeding time (>15 minutes). Thrombelastography showed hypocoagulability. In addition, she was negative for platelet-specific antibodies. The entire multidisciplinary team discussed with her the plans for delivery mode, delivery risks, and postpartum risks. Following discussion, she expressed a strong will to give birth spontaneously. The team considered that there were no contraindications for vaginal and instrumental delivery. Therefore, a clear monitoring plan was established to manage delivery, including options for various potential emergencies, blood products, hemostatic therapies, and a maternal intensive care unit. In view of her unfavorable cervical status, Prostaglandin E2 (Dinoprostone Suppositories) was used for the induction of labor. A prophylactic transfusion of one unit of single donor platelets was performed after labor induction. On the day of induction, labor was initiated. At the beginning of labor, she experienced intermittent vaginal bleeding and hematuria. A vaginal examination revealed slight bleeding on the surface of her cervix. She received transfusions of blood products transfusions and other treatments. At 3-cm cervical dilation, artificial rupture of the membranes was performed yielding clear amniotic fluid. During the first stage of labor, with an estimated blood loss of 400 mL, she received three units of single donor platelets and 12 mg of rFVIIa. During the second stage of labor, however, the fetus showed severely abnormal fetal heart rate tracings. Forceps were chosen to expedite delivery to avoid fetal hypoxia and neonatal hypoxic-ischemic encephalopathy. The baby weighed 3250 g at birth and was an apparently healthy child (Apgar scores: 7–9–10). Intramuscular injections of oxytocin (20 U) and carboprost tromethamine (0.25 mg) were given to enhance contraction of the uterus and protect her from postpartum hemorrhage. At delivery and 2 hours after delivery, the total estimated blood loss, assessed by weight, was 970 mL. The administration of four units of platelets, three units of leukocytereduced red blood cells, and 12 mg of rFVIIa led to complete hemorrhage control throughout labor. The hemoglobin monitored at this time was 98 g/L and the platelet count was 181 × 109/L. However, 3 hours after delivery, she experienced hematuria and produced temporary shapeless bloody stools. On the first day postpartum, her hemoglobin level was 69 g/L and the platelet count was 90 × 109/L. The symptoms of bleeding improved with the transfusion of red blood cells, plasma, and rFVIIa, as well as oral iron and tranexamic acid. She was discharged 9 days after delivery with a hemoglobin level of 94 g/L and a platelet count in the normal range (171 × 109/L); there was no secondary postpartum hemorrhage. GT, an inherited disorder of platelet aggregation, is rare except in populations where consanguineous marriages are common. This disease presents significant challenges to women during pregnancy, delivery, and postpartum. A systematic review of the literature (in Chinese and English) was carried out using PubMed and Web of Science without time restrictions; this identified 12 cases of women with GT who delivered a viable baby vaginally1–10; the characteristics of these women are presented in SDC Table 1, https://links.lww.com/MFM/A33. All of the reported cases delivered vaginally. Our patient was induced by Prostaglandin E2 and delivered by forceps; this is unusual and has not been reported in China. Moreover, our patient was diagnosed and treated by a multidisciplinary team during pregnancy, delivery, and postpartum, thus resulting in good pregnancy outcomes. In particular, our patient received a multidisciplinary approach with regard to the choice of delivery mode. Combined with her strong desire to have a vaginal delivery, the team discussed possible situations and countermeasures, such as whether the trial of labor and/or instrumental delivery were potential contraindications for her condition. The team also discussed emergency measures for cesarean section during the vaginal trial. After discussion, the team concluded that GT itself was not a contraindication for spontaneous vaginal delivery and instrumental delivery. Women with GT are often diagnosed at a young age with epistaxis and menorrhagia being common symptoms. These women often need to take anti-fibrinolytics and/or contraceptives, and sometimes need blood transfusions or treatment with rFVIIa to stop bleeding.11 Pregnancy is a particular challenge in women with GT. The risks of peripartum and postpartum hemorrhage are high.12 Thus, the primary goal of treatment is to control bleeding episodes. Platelet transfusion is the standard first-line therapy. However, antibodies to integrin αIIbβ3 and/or HLA antigens can be observed in pregnant women who have received platelet transfusions, thus resulting in refractoriness to such transfusions. Moreover, antibodies are capable of crossing the placenta and may cause intrauterine fetal bleeding and/or neonatal thrombocytopenia and hemorrhage.13 In a previous article, Léticée et al.14 reported a case of intrauterine death due to intracranial hemorrhage in a mother with GT and positive antibodies at 31 weeks of gestation. In another study, Barg et al.15 reported that three out of nine newborns had severe thrombocytopenia, and all three babies were delivered by mothers with positive antibodies. Studies show that large doses of uterine contractions prevent PPH. Plasmapheresis is also used for the prevention and treatment of intrapartum and postpartum bleeding as this reduces the number of antiplatelet antibodies, thus making transfusions effective.8 rFVIIa is increasingly being used to correct PPH, especially in women whose platelet transfusions have failed to arrest the hemorrhage; this is because of antiplatelet antibodies and/or patients who are refractory to platelet transfusions.16 Published data suggest that rFVIIa represents a safe and effective agent for the management of bleeding and for surgical prophylaxis. Generally, the normal dose of rFVIIa is ≥80 μg/kg every ≤2.5 hours for non-surgical bleeds and 90 to 140 μg/kg every ≤2.5 hours for more than two doses for minor surgery with additional doses for major surgery until hemostasis is secured.17 The prophylactic administration of a uterotonic agent immediately after delivery is recommended for all women with GT to prevent blood loss. Oral antifibrinolytic drugs, hormones, and prednisolone have also been used to treat secondary PPH in some centers. Sometimes, some form of hemostatic agent is also given for prophylaxis at delivery. However, a previous study by Civaschi et al.18 showed that this prophylactic therapy appears to be limited, as more than half of women with GT who had received prophylactic platelet transfusions experienced excessive bleeding requiring blood transfusion, thus suggesting that better preventive treatments are required. The optimal mode of delivery (vaginal vs. cesarean) for pregnant women with GT remains controversial. The mode of delivery does not appear to be associated with PPH. Symptomatic and asymptomatic intracranial hemorrhage of newborns have been reported in all delivery modes; higher rates have been reported after prolonged labor and instrumental delivery.19 However, during the second stage of labor, when a fetus has an abnormal fetal heart rate, it is necessary to deliver rapidly to avoid fetal hypoxia and neonatal hypoxic-ischemic encephalopathy. In such a difficult situation, instrumental delivery should be performed as this may be more beneficial to both the mother and the neonate than cesarean delivery. Vacuum extraction carries the highest risk and should be avoided. Compared with forceps, vacuum extraction increases the risk of cephalhematomas, diffuse subcutaneous hematomas of the scalp, and intracranial hemorrhage. For this reason, forceps are the better choice for instrumental delivery.10 Epidural analgesia is contraindicated because of the potential risk of epidural or spinal hematoma during insertion and removal of the catheter. Therefore, current best practice is to decide the most appropriate mode of delivery based on the specific situation of the mother and the fetus. Maternal and fetal risks and benefits must be considered in a multidisciplinary team approach and the pregnant woman and her family should be enrolled in the discussion. A prospective and individualized management plan should be established for delivery and postpartum monitoring, and should involve obstetric, hematology, neonatology, and anesthetic input. In the current case, our patient with GT received multidisciplinary management during pregnancy. She had two episodes of hematuria with no apparent cause during the second and third trimester. In her first episode of hematuria, there were no urinary tract infections, urinary tract tumors, or kidney stones. Therefore, the team considered that the hematuria was caused by GT and the bleeding was controlled by platelet transfusions. In the second episode of hematuria, the combination of platelet transfusion and antifibrinolytic drugs was not effective. First, we checked for infection. The same form of bacteriuria was found in two consecutive voided urine specimens with isolation of the same bacterial strain in quantitative counts of ≥105 colony-forming units/mL. Therefore, the patient underwent asymptomatic management for bacteriuria. This included antibiotic therapy tailored to culture results and follow-up cultures to confirm sterilization of the urine. Furthermore, following consultation with a hematologist, rFVIIa was administered and this symptom was relieved. This suggests that asymptomatic bacteriuria should be excluded in the presence of hematuria. This experience also suggests that rFVIIa may be an effective treatment for bleeding, especially when platelet transfusions are refractory. During the peripartum period, the patient also received a multidisciplinary approach. An individualized delivery plan was established to ensure optimal maternal and fetal outcomes. Finally, because of abnormal fetal heart rate tracings, we performed forceps-assisted delivery. The patient received multiple hemostatic therapies, such as platelet transfusions, red-cell transfusions, rFVIIa, uterine tonics, antifibrinolytic drugs, and uterine urination; bleeding was well controlled throughout labor and postpartum. These data emphasize the need for multidisciplinary management and antenatal delivery planning for pregnant females with GT. In conclusion, GT is a rare autosomal recessive bleeding disorder. Pregnancy and delivery represent a particular challenge for women with GT. It is important to stress the need for a multidisciplinary approach for managing these patients, and for the newborn infants, including pre-pregnancy counseling, and an individualized plan for pregnancy, delivery, and postpartum monitoring.

国内外对宫角妊娠定义不一,诊断较为困难,一次检查结果可能不足以诊断,有时也会存在一定的误导.所以动态监测对于宫角妊娠诊断以及后续患者的管理十分重要,而超声检查相比于盆腔MRI或腹腔镜检查具有更经济、方便、省时、操作性强等优势.本文报道了1例继续妊娠意愿非常强烈的宫角妊娠患者.利用超声技术对患者进行动态监测,观察其孕囊的大小、位置、与子宫内膜的关联、宫角部肌层的厚度等,后期随访超声检查均提示为偏心的宫内妊娠,最终患者成功足月分娩.本病例提示可以利用超声对这类患者进行动态监测,但应由经验丰富的医师进行标准化检查以尽早明确诊断,必要时还可采用三维超声、盆腔MRI及腹腔镜检查协助诊断.宫角妊娠需建立多学科、全方位、全程规范化的患者管理方案,以改善母婴结局.

Background A prediction algorithm to identify women with high risk of an emergency cesarean could help reduce morbidity and mortality associated with labor. The objective of the present study was to derive and validate a simple model to predict intrapartum cesarean delivery for low-risk nulliparous women in Chinese population.Methods We conducted a retrospective cohort study of low-risk nulliparous women with singleton, term, cephalic pregnancies. A predictive model for cesarean delivery was derived using univariate and multivariable logistic regression from the hospital of the First Affiliated Hospital of Soochow University. External validation of the prediction model was then performed using the data from Sihong county People’s Hospital. A new nomogram was established based on the development cohort to predict the cesarean. The ROC curve, calibration plot and decision curve analysis were used to assess the predictive performance.Results The intrapartum cesarean delivery rates in the development cohort and the external validation cohort were 8.79% (576/6,551) and 7.82% (599/7,657). Multivariable logistic regression analysis showed that maternal age, height, BMI, weight gained during pregnancy, gestational age, induction method, meconium-stained amniotic fluid and neonatal sex were independent factors affecting cesarean outcome. We had established two prediction models according to fetal sex was involved or not. The AUC was 0.782 and 0.774, respectively. The two prediction models were well-calibrated with Hosmer-Lemeshow test P=0.263 and P=0.817, respectively. Decision curve analysis demonstrated that two models had clinical application value, and they provided greatest net benefit between threshold probabilities of 4% to 60%. And internal validation using Bootstrap method demonstrated similar discriminatory ability. We external validated the model involving fetal sex, for which the AUC was 0.775, while the slope and intercept of the calibration plot were 0.979 and 0.004, respectively. On the external validation set, another model had an AUC of 0.775 and a calibration slope of 1.007. The online web server was constructed based on the nomogram for convenient clinical use.Conclusions Both two models established by these factors have good prediction efficiency and high accuracy, which can provide the reference for clinicians to guide pregnant women to choose an appropriate delivery mode.

目的 探讨低风险初产妇在分娩过程中合理的静脉入量管理方法.方法 对 2018 年 7 月至2020 年12 月苏州大学附属第一医院收治的180 例足月低风险初产妇进行研究,随机数字表法分成3 组,每组60 例.在活跃期(宫口≥5 cm)后指导口服清流质的同时开通静脉通路,分别以250 mL/hr的速度输注 5%葡萄糖氯化钠溶液(GNS组)、乳酸钠林格氏液(林格组)以及 0.9%氯化钠溶液(NS组),对比 3 组产妇总产程、第一产程、活跃期、第二及第三产程时间、分娩方式、产后出血量以及新生儿出生 1 min和 5 min Apgar评分.结果 GNS组、林格组和NS组分别有57 例、58 例和57 例经阴道分娩.3 组孕妇在总产程、第一产程、活跃期和第三产程、缩宫素使用的差异具有统计学意义(P＜0.05).GNS组与NS组比较,GNS组显著降低总产程、第一产程、活跃期和第三产程时间,降低了缩宫素的使用率(26.3%vs 61.4%).GNS组相较于林格组,两者在总产程、第一产程时长和缩宫素的使用率上无统计学差异,但GNS组显著缩短了活跃期和第三产程时间.林格组与NS组在各产程时长和缩宫素使用率的差异无统计学意义.但 3 组分娩方式、产后出血量及新生儿出生Apgar评分无统计学差异(P＞0.05).结论 GNS比单纯给予NS更有助于产妇缩短总产程、第一产程、活跃期时间,减少缩宫素的使用率,更值得临床推广应用.

Objective: To evaluate the accuracy of sonography-estimated fetal weight (EFW) and to determine the potential factors influencing EFW accuracy in the Chinese population. Methods: Eleven widely used formulae were chosen to evaluate the accuracy of EFW in 7016 cases in a retrospective cohort study. Nine potential factors (prenatal body mass index [BMI], gestational age [GA], birth weight [BW], fetal sex, fetal presentation, amniotic fluid volume [AFV], seniority of sonographers, the time interval between ultrasonic measurement and delivery, and diabetes mellitus) were analyzed by binary logistic regression to determine whether they influenced sonography-EFW. Results: All 11 models had high correlation coefficients between EFW and BW ( r = 0.819–0.843). Model 3 was the most accurate formula for the Chinese population. Compared to fetuses with EFW of 2500–3999 g, the accuracy of EFW decreased by 69.10% ( P <0.001) for fetuses less than 2500 g, and decreased by 54.10% ( P <0.001) for fetuses larger than 4000 g. The accuracy of EFW in female fetuses decreased by 12.70% compared with male fetuses ( P = 0.021). Compared to the EFW calculated 1-3 days before delivery, the accuracy of the EFW performed 4–7 days before delivery showed a significant decrease ( P = 0.014). The accuracy of EFW was influenced by the individual measurement accuracy of the sonographers. Maternal BMI, DM, GA, fetal presentation, and AFV did not influence the accuracy of EFW after adjustment. Conclusion: Model 3 was the most accurate model for the Chinese population. The BW, fetal sex, time interval, and technique of the sonographers had different influences on the accuracy of EFW.

Background: To investigate the associations of adjusting gestational weight gain rate (GWGr) with maternal and neonatal outcomes. Methods: We analyzed 6235 singleton pregnancies among women with normal pre-pregnancy body mass index at two medical centers in China during 2016~2018 to figure out whether pregnancy outcomes could be improved by adjusting GWGr timely when the first-trimester weight gain rate (GWGr-1) and/or the second-trimester weight gain rate (GWGr-2) were inappropriate. Results: When GWGr-1 was excessive, excessive GWGr during the second and third trimesters of pregnancy (late GWGr) was associated with a higher risk of cesarean section (CS), postpartum hemorrhage (PPH), obstructed and prolonged labor and large for gestational age (LGA), and inadequate late GWGr was associated with a lower prevalence of CS and hypertensive disorders of pregnancy (HDP). In pregnancies with inadequate GWGr-1, excessive late GWGr was related to a higher rate of CS, LGA and HDP. Among women with adequate GWGr-1, excessive GWGr in the third trimester (GWGr-3) was positively associated with CS, HDP, and obstruction and prolongation of labor if their GWGr-2 was excessive, and excessive GWGr-3 was associated with a higher risk of CS even though tFheir GWGr-2 was inadequate. Conclusions: Prompt control of GWGr, even during late pregnancy, was beneficial to improving pregnancy outcomes.

Objective: This study aimed to quantitatively assess myocardial strain in preterm children aged 5 to 8 years of pregnancy complicated by severe preeclampsia (PE) by two-dimensional (2D) speckle tracking echocardiography. Method: A cohort study of 23 preterm children delivered by severe PE pregnant women from 2010 to 2012 in the First Affiliated Hospital of Soochow University was carried out. 23 preterm children from uneventful pregnancies in the same period served as controls. Myocardial functions including left ventricular longitudinal strain, radial strain, circumferential strain, and right ventricular longitudinal strain were evaluated by conventional Doppler, tissue Doppler imaging, and 2D speckle-tracking echocardiography (2D STE). All examinations were performed by an experienced ultrasonographer using the VIVID E9 (GE Healthcare) machine, according to standard techniques. Results: Children aged 5-8 years delivered from severe PE presented less weight (24.41 vs. 20.89 kg, P < 0.05), shorter height (124.1 vs 115.6 cm, P < 0.05) and faster heart rates (84 vs. 93 bpm, P < 0.05) compared to offspring of normotensive women. There were no significant differences in global left ventricular longitudinal strain, radial strain, circumferential strain, and right ventricular longitudinal strain between the children in the experimental group and the control group (P > 0.05). Conclusion: Exposure to the intrauterine environment of severe PE during the fetal period did not have a significant impact on cardiac structure in premature children at 5-8 years old, but they had a higher resting heart rate which may be associated with cardiovascular disease in the long run.

OBJECTIVES:To evaluate myocardial injury in neonates born to pregnant women with pregnancy complicated by severe preeclampsia by myocardial work indices.METHODS:A prospective cohort study was performed on 25 preterm infants born to the pregnant women with severe preeclampsia from June 2020 to April 2021 (severe preeclampsia group), and 25 preterm infants born to the pregnant women without severe complications in pregnancy were enrolled as the control group. Echocardiography was performed within 24 hours and at 48-72 hours and 14-28 days after birth to measure conventional parameters. Two-dimensional speckle-tracking echocardiography was performed to construct a noninvasive left ventricular pressure-strain loop based on two-dimensional myocardial strain and left ventricular systolic pressure noninvasively measured, so as to calculate myocardial work indices.RESULTS:Compared with the control group, the severe preeclampsia group had significant reductions in left ventricular global work index and global constructive work within 24 hours after birth (P<0.05), a significant reduction in left ventricular global work efficiency and a significant increase in global waste work at 48-72 hours after birth (P<0.05), and a significant reduction in left ventricular global work efficiency at 14-28 days after birth (P<0.05).CONCLUSIONS:Subclinical myocardial injury persists in the neonatal period in preterm infants born to pregnant women with severe preeclampsia.

Background: Some models predicting cesarean section (CS) have been proposed, with Tolcher, Levine, and Burke model well acknowledged. Tolcher model targets nulliparous women with term labor induction; Levine model targets women with term labor induction with intact membranes and an unfavorable cervix. Burke model targets term nulliparous woman with an uncomplicated pregnancy. Our objective was to assess the predictive performance of these three models, and to disclose the variables which may predict the risk of CS in Chinese population. Methods: A retrospective study was conducted on women with singleton, term, cephalic pregnancies at a tertiary academic center (2011–2017). A predicted probability for CS was calculated for women in the dataset by the algorithm of each model. The performance of the model was evaluated for discrimination. Univariate analysis was used to screen out the factors that may increase the risk of CS. Results: The three models predicted CS as following (expressed by an area under the receiver operating characteristic curve [AUC ROC]) (in the population defined/employed by each model): Tolcher model with AUC ROC of 0.659; Levine model with 0.697; and Burke model as 0.623. Different interventional measures or characteristics of labor were also evaluated; the nulliparous and multiparous were analyzed separately. Still, most of the results were unsatisfactory (AUC ROC <0.7). Univariate analyses on the clinical parameters that may affect the incidence of CS were performed. The followings affected the incidence/probability of CS: maternal age, height, body mass index (BMI), weight gain during pregnancy, gestational age, mode of labor induction, meconium-stained amniotic fluid, presence of complications, neonatal weight/gender. Conclusion: These three models may not be suitable for predicting CS for Chinese population. Some maternal and fetal characteristics increased the risk of CS, which should be taken into account in creating some appropriate models for predicting CS in Chinese population.

目的 探讨国外阴道试产失败中转剖宫产预测模型在国内的适用性,并初步探索影响中转剖宫产的危险因素.方法 回顾性分析2011年1月—2017年8月本院妇产科所有单胎头位足月妊娠初产妇的病例资料.利用Tolcher、Levine、Burke模型分别进行预测风险计算及分析,并比较预测值及实际值.结果 利用本院初产妇对Tolcher、Levine、Burke模型进行验证,其AUC ROC分别为0.659(95％CI 0.635-0.682),0.697(95％CI 0.656-0.738),0.623(95％CI 0.500-0.746).上述三种模型在Hosmer-Lemeshow goodness-of-fit检验中显示其校准能力均良好(P>0.05).对可能影响阴道试产中转剖宫产的临床参数进行单因素分析发现,当最佳临界值即孕妇年龄>26岁、身高≤160 cm、分娩孕周>40周、孕前BMI>21.3 kg/m2、孕期增重>13 kg、合并疾病、羊水粪染及男性胎儿时初产妇中转剖的风险显著增加.结论 上述三种模型均不适用于我院人群.在本研究中,产妇年龄、身高、BMI、孕期增重、孕周、引产方式、是否有羊水粪染、有无合并及并发症、新生儿体重、新生儿性别等影响了分娩方式.

Objective To explore the application value of six prediction models reported at home and abroad for adverse outcomes of hypertensive disorders of pregnancy(HDP) in eastern and western China. Methods For all patients who delivered in the First Affiliated Hospital of Soochow University and Sichuan Provincial Maternal and Child Health Care Hospital from May 1, 2011 to April 30, 2019 and were diagnosed with HDP, their clinical data were retrospectively analyzed. Six models, fullPIERS, miniPIERS, Zwertbroek, PREP, Ngwenya, and Ma Guojun, were used to predict the risk of adverse outcomes for the patients. The predictive performance of the models was evaluated in terms of discrimination and calibration. Results A total of 2978 patients were eligible. Combined adverse outcomes occurred in 13.6% (405/2978) of women within 48 h of admission, and 22.0% (655/2978) at any time during admission. The delivery < 34 weeks (49.4%, 200/405), need for blood product transfusion (43.5%, 176/405), and placental abruption (23.5%, 95/405) were the most common adverse outcomes within 48 hours of admission. The area under of the curve of the six models for predicting adverse outcomes in the patients with HDP within 48 hours of admission/during hospitalization ranged from 0.600 to 0.897, the sensitivity ranged from 57.1% to 69.5%, and the specificity ranged from 60.1% to 76.6%. The Hosmer-Lemeshow test showed that except for the PREP model (which had a small validation population and was not evaluated for calibration), the P-values of all the other 5 models were less than 0.05. Conclusions The six prediction models have certain application value in the prediction of adverse outcomes of HDP patients in the eastern and western regions of China, but the fitting is poor. The predictors involved in some models are not routine inspection indicators, and the feasibility of large-scale model application is still open to question. It is still necessary to establish a better prognostic model suitable for local areas based on Chinese characteristics.

Objective:To develop and validate a predictive model for adverse outcomes in women with hypertensive disorders of pregnancy (HDP).Methods:We retrospectively analyzed the clinical data of patients diagnosed with HDP and delivered at the First Affiliated Hospital of Soochow University or Sichuan Provincial Maternity and Child Health Care Hospital between May 1, 2011, and April 30, 2019. These patients were categorized as the adverse outcome group or the control group with adverse outcomes within 48 h after admission. Univariate analysis, least absolute shrinkage, selection operator (LASSO), and multivariable logistic regression were employed to analyze factors influencing the adverse outcomes and develop a predictive model. The receiver operating characteristic (ROC) curve and calibration plot was used to assess the predictive performance. Bootstrapping was used for the internal validation and the retrospective dataset of patients with HDP from the First Affiliated Hospital of Soochow University from May 1, 2019, to April 30, 2020, for the external validation. A graphic nomogram was created through R software based on the model.Results:(1) Of the 2 978 HDP patients who were included in the development set, 356 were in the adverse outcome group, accounting for 12.0%; of the 233 patients who were included in the external validation set, 40 presented with adverse outcomes within 48 h after admission, accounting for 17.2%. (2) Nine optimal predictors were identified based on the LASSO regression analysis and multivariable logistic regression, consisting of gestational age on admission, routine prenatal care, number of symptoms, mean arterial pressure, platelet count, fibrinogen, albumin, serum urea, and serum creatinine, based on which the logistic predictive model was established. (3) The ROC curve for this predictive model achieved an area under the curve (AUC) of 0.878 (95% CI: 0.858-0.897), and the ideal cut-off value for predicted probability was 0.136, with a sensitivity of 0.778 (95% CI: 0.731-0.820) and specificity of 0.848(95% CI: 0.834-0.862). The model was well-calibrated as the Hosmer-Lemeshow test showed that P>0.05. The calibration plot of the model had a slope of 1 and an intercept of 0. (4) The model showed good consistency in the internal validation and had an AUC of 0.872 (95% CI: 0.807-0.937) in the external validation. The Hosmer-Lemeshow test showed that the P value was >0.05, and the calibration slope was 1.001. (5) A nomogram was constructed for convenient clinical use. Conclusion:A relatively accurate prediction model for adverse outcomes in HDP patients was established, which could be used as a valuable quantitative tool for assessing HDP-related complications.

Objective: To explore the genetic bias in a Chinese family suspected of having congenital nephrotic syndrome of the Finnish type (CNF). Case report: We developed a prenatal genetic diagnosis in a Chinese family with CNF. A single heterozygous mutation (c.3213delG) was found in the foetus IId and we presumed that it was an asymptomatic carrier of the normal phenotype. Additionally, two compound heterozygous variants (c.3213delG and c.3478C > T) were discovered in the foetus IIe, which were inherited from the mother and father, respectively. We performed further pathological examinations after medical abortion. Kidney histopathology and immunofluorescence results were similar to those reported in previous studies. Conclusion: Prenatal genetic diagnosis of CNF still requires further research to explore the pathogenicity of suspected mutations. (c) 2021 Taiwan Association of Obstetrics & Gynecology. Publishing services by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Background Associations between trajectories of systolic blood pressure (SBP) during pregnancy and pregnant outcomes remain unclear and disparate. Methods Data of 20,353 mothers without chronic hypertension and who delivered live singletons between January, 2014 and November, 2019, was extracted from Taicang register-based cohort. Based on SBP measured during 10 to 40 weeks of gestation, SBP trajectories were explored using latent class growth mixture model, and their associations with maternal and neonatal outcomes were assessed by logistic regression analyses. Results Six heterogeneous SBP trajectories were identified: low delayed-increasing (7.47%), low reverse-increasing (21.88%), low-stable (19.13%), medium-stable (21.64%), medium reverse-increasing (16.47%), and high stable (13.41%) trajectories. The high-stable trajectory had SBP around 125 mmHg in the 10th gestational week, and increased slightly onwards. When compared with the low-stable trajectory, the high-stable trajectory had maximally adjusted odds ratio (95% confidence interval) of 5.28 (2.76–10.10), 1.30 (1.13–1.50), 1.53 (1.12–2.08), 1.32 (1.06–1.65) and 1.64 (1.08–2.48) for gestational hypertension (GH), early-term delivery (ETD), preterm delivery (PTD), small for gestational age and low birth weight (LBW), respectively. Besides, the medium reverse-increasing trajectory showed significantly increased risk of GH and ETD, while the medium-stable trajectory had significantly elevated risk of ETD and PTD. Notably, SBP trajectories slightly but significantly improved risk discrimination of GH, ETD and LBW, over traditional risk factors. Conclusion Women with different SBP trajectories were at varied risk of adverse maternal and fetal outcomes. Meanwhile, our study suggested that BP monitoring during pregnancy is necessary, especially for women with high SBP in early pregnancy or upward trajectory.