ObjectiveTo explore the interactions between cervical length (CL) and placenta accreta spectrum (PAS) on severe postpartum hemorrhage (SPPH) in patients with placenta previa. MethodsA retrospective case-control study was conducted at four medical centers in China, and 588 patients with placenta previa were included. The logistic regression analysis and restricted cubic splines (RCS) were used to evaluate the association between CL and SPPH. Furthermore, the joint effect of CL and PAS on SPPH was assessed, and the additive and multiplicative interactions were calculated. ResultsAfter adjusting for potential confounders, the negative linear dose-response relationship was confirmed by RCS, and the change of odds ratio (OR) was more significant when CL was 2.5 cm or less. The risk of SPPH was significantly higher when CL of 2.5 cm or less co-existed with placenta increta/percreta than when CL of 2.5 cm less, or placenta increta/percreta existed alone (adjusted OR [aOR](CL <= 2.5cm&placenta accreta/non-PAS) 3.40, 95% confidence interval [CI] 1.37-8.45; aOR(placenta increta/percreta&CL >2.5cm) 4.75, 95% CI 3.03-7.47; aOR(CL <= 2.5cm&placenta increta/percreta) 14.51, 95% CI 6.08-34.64), and there might be additive interaction between CL and placenta increta/percreta on SPPH (attributable proportion due to interaction 50.7%, 95% CI 6.1%-95.3%). ConclusionIf CL was routinely performed during PAS evaluation, the increased OR of short CL and PAS could allow better patient preparation through counseling.

Fetal skeletal dysplasia is a diverse group of degenerative diseases of bone and cartilage disorders that can lead to movement disorder and even death. This study aims to evaluate the diagnostic yield of sonographic examination and genetic testing for fetal skeletal dysplasia. From September 2015 to April 2021, the study investigated 24 cases with suspected short-limb fetuses, which were obtained from Tongji Hospital affiliated to Tongji Medical College of Huazhong University of Science and Technology. To identify the causative gene, multiple approaches (including karyotype analysis, copy number variations and whole exome sequencing) were performed on these fetuses. And further segregation analysis of the candidate variant was performed in parents by using Sanger sequencing. ① Out of 24 cases, likely pathogenic variants in FGFR3, FBN2, COL1A2, CUL7 and DYNC2H1 were detected in 6 cases; pathogenic variants in FGFR3, IMPAD1 and GORAB were identified in other 6 cases; and variants in WNT1, FBN1, OBSL1, COL1A1, DYNC2H1 and NEK1, known as Variant of Undetermined Significance, were found in 4 cases. There were no variants detected in the rest 8 cases by the whole exome sequencing. ② Of 24 cases, 12 (50

To assess the efficacy of copy number variation sequencing (CNV-seq) and karyotyping for prenatal detection of chromosomal abnormalities in fetuses with increased nuchal translucency. Amniotic fluid samples were extracted from 205 fetuses with increased nuchal translucency (NT ≥ 2.5 mm), diagnosed by ultrasound between gestational ages of 11 and 13 + 6 weeks. Karyotyping and CNV-seq were performed for detecting chromosomal abnormalities. There are 40 fetuses (19.51%) showing increased NT detected with chromosomal abnormalities in karyotyping, and trisomy 21 was found to be the most common abnormalities. There are 50 fetuses (24.39%) identified with chromosomal abnormalities by CNV-seq. The detection of the applied techniques indicated that CNV-seq revealed higher chromosomal aberrations. The risk of chromosomal abnormalities was significantly increased with NT thickening, from 13.64% in the NT group of 2.5–3.4 mm, 38.64% in the NT group of 3.5–4.4 mm, and to 51.72% in the NT group of over 4.5 mm (P < 0.05). The investigated cases with increased NT with presence of soft markers in ultrasound or high risk in non-invasive prenatal testing presented chromosomal abnormalities in higher rates, comparing with those with isolated NT or low risk (P < 0.05). The results indicated that the risk of chromosomal abnormalities was associated with the NT thickness, detected by karyotype or CNV-seq. The combination application of two analysis was efficient to reveal the possible genetic defects in prenatal diagnosis. The finding suggested that the detection should be considered with ultrasonographic soft markers, and the NT thickness of 2.5–3.4 mm could be a critical value for detecting chromosomal abnormalities to prevent the occurrence of missed diagnosis.

目的:通过分析胎儿半椎体畸形病例的临床资料,为胎儿半椎体畸形的妊娠期管理、产前诊断和遗传咨询提供临床策略.方法:对胎儿超声检查发现胎儿半椎体畸形的孕妇进行系统超声筛查和磁共振(MRI)检查,并采集胎儿组织和夫妻双方外周血进行拷贝数变异检测(CNV-seq)及家系全外显子组检测(Trio-WES).结果:胎儿系统超声筛查和胎儿MRI结果均提示胎儿半椎体、T8-S1椎体排列不整齐,CNV-seq未检出明确致病的基因组拷贝数变异(CNVs),Trio-WES检出TBX6基因c.172dup新发致病性变异,可导致常染色体显性遗传的脊柱肋骨发育不全5型(SCD5),该变异为首次报道.结论:胎儿半椎体畸形应通过胎儿系统性超声、MRI进行检查,并建议进行产前诊断明确遗传病因.相对于常规染色体核型分析和CNVs检测,WES能提高导致胎儿半椎体畸形的基因异常检出率.

This study introduced whole-exome sequencing (WES) in prenatal diagnosis of fetal bowel dilatation to improve the detection outcome when karyotype analysis and copy number variation sequencing (CNV-seq) were uninformative in detecting pathogenic variants. The work reviewed 28 cases diagnosed with fetal bowel dilatation and analyzed the results of karyotype analysis, CNV-seq, and WES. Among the 28 cases, the detection rate in cases with low risk of aneuploidy was 11.54% (3/26), which is lower than 100% (2/2) in cases with high risk of aneuploidy. Ten low-risk aneuploidy cases with isolated fetal bowel dilatation had normal genetic testing results, while the remaining 16 cases with other ultrasound abnormalities were detected for genetic variants at a rate of 18.75% (3/16). The detection rate of gene variation was 3.85% (1/26) by CNV-seq and 7.69% (2/26) by WES. This study suggested that WES could reveal more genetic risk in prenatal diagnosis of fetal bowel dilatation and has value in prenatal diagnosis to reduce birth defects.

目的 探讨基因组拷贝数变异检测（CNV-seq）联合染色体核型分析在评估胎儿心室强光点超声软指标中的临床应用价值。方法 收集2017年6月至2020年12月于华中科技大学同济医学院附属同济医院妇产科胎儿系统超声诊断为心室强光点（EIF）的143例孕妇，羊膜腔穿刺术抽取羊水，羊水标本行染色体核型分析和拷贝数变异检测。结果 143例心室强光点胎儿羊水标本中，核型分析共检出8例异常结果，异常率为5.59%;CNV-seq共检出8例致病性拷贝数变异（pCNV），异常率5.59%，联合检测共发现9例异常结果，异常率6.29%。心室强光点合并其他单个和多个超声软指标组，染色体异常率分别为8.70%和25.00%，明显高于孤立性心室强光点组（0.00%），差异有统计学意义。心室强光点合并非整倍体筛查高风险时，染色体异常率25.00%，明显高于筛查低风险组（4.58%）。结论 孤立性心室强光点不会增加胎儿染色体异常的风险，心室强光点合并其他超声软指标异常或非整倍体筛查高风险时，染色体畸变的风险显著增加。此外，在核型分析的基础上应用CNV-seq能够检测出额外的染色体异常，减少漏诊和出生缺陷的发生。

Background: It is challenging to make an accurate prenatal diagnosis for congenital anomalies of the kidney and urinary tract (CAKUT) because of its pathologic diversity. This study aims to evaluate the performance of whole-exome sequencing (WES) combined with karyotype analysis and copy number variations (CNVs) in diagnosing high-risk fetal CAKUT.Methods: We conducted a retrospective study on prenatal diagnoses of CAKUT in our hospital from January 2020 to April 2021. The research studied 24 high-risk fetuses with CAKUT who were scanned by ultrasonography at the prenatal diagnosis center of Tongji Hospital affiliated to Tongji Medical College of Huazhong University of Science and Technology. The likely pathogenic gene variants were screened for the patients and their parents by multiple approaches, including karyotype analysis, CNVs and WES, and further verified with Sanger sequencing.Results: ①We detected abnormal CNVs in 20.8% (5/24) of the fetuses but only 8.3% (2/24) fetuses had abnormal karyotypes. ②Of the 15 CAKUT fetuses, positive findings (40%) were detected by WES. Of the 9 high-risk fetuses with CAKUT (negative findings in ultrasound scan but with family history), we found abnormal variants (77.8%) through WES.Conclusion: The application of CNVs and WES showed advance in prenatal diagnosis of CAKUT and the pathogenic gene variants were detectable especially for high-risk fetuses with negative ultrasound findings on CAKUT in the preliminary study. The applied strategy could be used to improve the accuracy of prenatal diagnosis for CAKUT in the future.

A novel heterozygous mutation (c.325dup) was identified in EXT1 gene from the proband and the affected family members; this mutation was absent in all the unaffected family members. The identification of the novel frameshift insertion mutation (c.325dup) expands the mutation spectrum of HME, which provides new evidence for HME diagnosis.

The maternal-fetal immune disorder is considered to be an important factor of preterm birth (PTB); however, the underlying mechanism is still not fully understood. This study was designed to explore the innate and adaptive immune features in the decidua during term and preterm labor. Women delivered at term or preterm were classified into four groups: term not in labor (TNL, N=19), term in labor (TL, N=17), preterm not in labor (PNL, N=10), and preterm in labor (PIL, N=10). Decidua basalis and parietalis were collected and analyzed for macrophage subtypes (M1 and M2) as well as T helper 1 (Th1), Th2, Th17 and regulatory T (Treg) cells by flow cytometry and immunohistochemistry. Our results demonstrated significantly decreased frequencies of M2 cells and elevated M1/M2 ratio in the PIL group compared to that in the PNL group in both decidua basalis and parietalis, whereas no significant differences were found between the above two groups in both sites in terms of the polarization status of Th cells. On the contrary, macrophage subsets were comparable in the TL and TNL groups, whereas elevated Th1 percentages and Th1/Th2 ratio were observed in TL women compared to that in TNL women in the decidua. Interestingly, although the frequencies and ratios of Th17 and Treg were comparable among the four groups, the Th17/Treg ratios of these groups were significantly increased in decidua basalis than that in decidua parietalis. Collectively, the M1/M2 imbalance is associated with the breakdown of maternal-fetal immune tolerance during PTB, whereas the aberrant Th1/Th2 profile plays an important role in immune disorder during term labor. Moreover, Th17/Treg deviation is more remarkable in decidua basalis than in decidua parietalis.

AIM:To compare and evaluate the validity of the existing risk prediction models for severe postpartum hemorrhage (SPPH) in patients with placenta previa. METHODS:We conducted a systematic literature review to collect the existing risk prediction models for SPPH in patients with placenta previa, and recruited patients with placenta previa who underwent cesarean section in Tongji Hospital (Wuhan, China) and 4 cooperative hospitals from January 2018 to June 2021. We defined SPPH as total blood loss ≥1500 mL or transfusion packed red blood cell ≥4 U. The risk of SPPH of each patient was predicted by the collected models, respectively. Then we calculated the sensitivity, specificity, coincidence rate (CCR), positive predictive value (PPV), negative predictive value (NPV) and drawn the receiver operating characteristic (ROC) curve and decision curve analysis (DCA) curve of each model. RESULTS:This external cohort contained 1172 patients of whom 284 patients (24.23%) experienced SPPH, and 4 risk prediction models were collected in this study. After evaluated by this external cohort, the area under the ROC curve (AUC), sensitivity, specificity, CCR, PPV and NPV of the four models ranged from 0.644 to 0.755, 38.38% to 86.31%, 42.75% to 86.49%, 56.23% to 74.83%, 38.68% to 47.60%, 81.15% to 87.45%, respectively. The model established by Kim JW et al. had the highest sensitivity, NPV, AUC and net benefit, the model established by Lee JY et al. had the highest specificity, CCR and PPV. CONCLUSIONS:The four prediction models showed moderate predictive performance, the discrimination indicators and benefit indicators of each model were not simultaneously ideal in this population. The prediction models should be further optimized to improve the discrimination ability and benefit, and prospective external validation studies should also be carried out before they are applied to clinical practice.

To identify the pathogenic gene variation in a Chinese family with Hereditary Multiple Exostoses (HME). By examining blood-sourced DNA and clinical manifestations of the proband and his family members, the whole exome sequencing (WES) and Sanger sequencing were used to detect possibly pathogenic mutations. A novel heterozygous mutation (c.325dup) was identified in exon 1 of the exostosin 1 (EXT1) gene from the proband and the affected family members. And we found this mutation was absent in all the unaffected family members. This c.325dup mutation is in the exon 1 domain of the EXT1 gene and the change of p.C109Lfs*80 cause the early termination of protein translation. The identification of the novel frameshift insertion mutation (c.325dup) expands the mutation spectrum of HME, which provides new evidence for HME diagnosis.

降低孕产妇死亡率的关键之一是提高危重症孕产妇的救治水平,同时建立多学科团队(MDT)的合作机制,加强孕期规范检查,完善预警分类管理以及转诊制度.对急危重症孕产妇收治ICU并行多学科团队管理,改善围产期结局,达到降低孕产妇死亡的目标.

Recent research has suggested that 6 cm of cervical dilation should be the threshold for the active labor phase, and it has confirmed that epidural analgesia (EA) is a safe method of pain relief during labor. However, the evidence provided for these findings comes mainly from randomized controlled clinical trials (RCTs), which suffer from the limitation of real-world generalizability. To test the generalizability of the conclusions from these previous RCTs, we conducted a prospective cohort, real-world study (RWS) on 400 Chinese term nulliparas. A total of 200 of the participants (the EA group) received EA upon request. The participants in the EA group were further subdivided as follows according to their cervical dilation when the EA administration was initiated (CDE): [EA1 group (CDE < 3 cm), EA2 group (3 cm <= CDE < 6 cm), and EA3 group (CDE >= 6 cm)]. We compared the labor duration of the EA group versus the non-EA (NEA) group, and the NEA group versus the 3 EA subgroups. We also compared delivery outcomes between the EA and NEA groups. The median total labor duration for the EA group [676 (511-923) minutes] was significantly longer than that of the NEA group [514 (373-721) minutes] (P < 0.001). The median durations of both the first- and second-stages of labor for the EA group [600 (405-855) minutes, 68 (49-97) minutes] were longer than those of the NEA group [420 (300-630) minutes, 50 (32-85) minutes] (P < .001, P < .001)]. In addition, the median total labor durations in both the EA1 [720 (548-958) minutes] and EA2 groups [688 (534-926) minutes] were longer than in the NEA group (P P < .001, respectively), and the first- and second-stage labor durations of these subgroups were similar to their total labor durations. A Cox regression analysis showed that EA was associated with longer first-stage labor [hazard ratio (HR) 0.55, 95% confidence interval (CI) 0.42-0.71, P < .001] and longer second-stage labor (HR 0.66, 95% CI 0.51-0.85, P = .001). The delivery modes and neonatal outcomes between the EA and NEA groups were not statistically different, however. Our findings suggest that EA administered before a cervical dilation of 6 cm may be associated with longer total, first-, and second-stage labor durations compared with no EA, while later EA administration is not. In addition, though EA prolongs labor duration, it does not impact delivery outcomes. These results confirm the significance of a 6 cm cervical dilation threshold in real-world labor settings.

目的:利用全外显子测序(WES)技术分析胎儿肠管增宽的致病性突变,为产前诊断及遗传咨询提供帮助.方法:对3例肠管增宽的胎儿进行染色体核型分析、拷贝数变异(CNV)及WES检测.结果:3例胎儿染色体核型分析结果均正常,1例胎儿CNV检出15号染色体微重复,3例胎儿WES结果均发现与肠管增宽相关的基因突变.病例1为GDNF基因c.329G>A杂合变异,遗传自其父亲,可引起先天性巨结肠症3型,该病为常染色体显性遗传,并具有低外显率的特点;病例2为NOTCH2基因的c.1310A>C新发变异,与Alagille综合征2型、Hajdu-Cheney综合征相关,均为常染色体显性遗传;病例3为SLC26A3基因复合杂合突变,包括来自父亲的c.1427del突变和来自母亲的c.269_270 dup突变,可导致常染色体隐性遗传的先天性失氯性腹泻1型.经Sanger验证病例1为临床意义未明突变,根据既往病史判断该突变可能致病,病例2及病例3均为致病性突变.结论:WES技术对于分析胎儿肠管增宽的遗传变异具有重要的诊断价值.

Placenta accreta spectrum disorder (PASD) and placenta previa (PP) are two of the most hideous obstetric complications which are usually associated with a history of cesarean section (CS). Moreover, women with PASD, PP and/or a cesarean scarred uterus are more likely to have adverse pregnancy outcomes, including blood transfusion, hysterectomy, pelvic organs damage, postpartum hemorrhage, disseminated intravascular coagulation, multi-organ dysfunction syndrome and even maternal or fetal death. This study aimed to investigate the efficacy of precesarean internal iliac artery balloon catheterization (BC) for managing severe hemorrhage caused by PASD and PP with a history of CS. This participant-assigned interventional study was conducted in Tongji Hospital. We recruited 128 women with suspected PASD, PP and a history of CS. Women in the BC group accepted precesarean BC of bilateral internal iliac arteries before the scheduled cesarean delivery. Women in the control group underwent a conventional cesarean delivery. Intraoperative hemorrhage, transfusion volume, radiation dose, exposure time, complications and neonatal outcomes were discussed. There were significant differences in calculated blood loss (CBL) between BC group and control group (1015.0±144.9 vs. 1467.0±171.0 mL, P=0.04). Precesarean BC could reduce intraoperative red blood cell (RBC) transfusion as compared with control group (799.5±136.1 vs. 1286.0±161.6 mL, P=0.02) and lessen the rate of using blood products (57.1% vs. 76.4%, P=0.02). The incidence of hysterectomy was also lower in BC group than in control group. Postpartum outcomes showed no significant differences between the two groups, except that postoperation hospitalization was longer in BC group than in control group (6.7±0.4 vs. 5.8±0.2 days, P=0.03). Precesarean BC of internal iliac artery is an effective method for managing severe hemorrhage caused by PASD and PP with a cesarean scarred uterus, as it could reduce intraoperative blood loss, lessen intraoperative RBC transfusions and potentially decrease hysterectomies.

The proband is a five-year-old boy diagnosed with Duchenne muscular dystrophy (DMD) by clinical manifestations and laboratory examination, but clinical phenotype of his parents is normal. In the study, his mother had a second pregnancy, and they went to obstetrics for genetic counseling to make informed reproductive choices.

The Duchenne Muscular Dystrophy (DMD) gene variants are associated with the disease phenotypes. The pathogenic mutation, c.2293-1G>C, was detected in DMD gene in the proband and the fetus, which has not been reported in the literature.The minigene expression in vitro confirmed that c.2293-1G>C is responsible of aberrant splicing.

Coronavirus disease 2019 (COVID-19) arises from infection with the new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).[1] The susceptible population can be of any age and gender; thus, the disease threatens the health and life of everyone, including pregnant women. Pregnancy can influence the physiological function of various organs, and thus may affect the prognosis of many infectious diseases. For example, higher mortality rates and more complications were reported in pregnant patients infected with SARS-CoV than those in non-pregnant patients.[2] Clinical manifestations and treatment monitoring of pregnant women with COVID-19 have been reported in previous studies,[3] which mainly focus on maternal and neonatal outcomes by analyzing small sample size data, but studies regarding the influence of pregnancy on the progression and prognosis of COVID-19 remain relatively rare. In this study, we retrospectively analyzed clinical data from women of childbearing age with COVID-19 at Tongji Hospital to explore the impact of pregnancy on the progression of COVID-19 and provide a theoretical basis for the effective diagnosis and treatment of pregnant women with COVID-19. In this retrospective, single-center cohort study, we recruited childbearing-aged women with COVID-19 pneumonia admitted to Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (Wuhan, Hubei Province, China), from January 19 to April 1, 2020. All in-patient women in our hospital aged 15 to 45 years with COVID-19 were enrolled in this study after hiding patients’ personal data for privacy considerations. We divided these patients into a “pregnancy group” and a “non-pregnancy group” according to whether they were pregnant at admission. We further divided the pregnancy group into the “continued pregnancy group” and “terminated pregnancy group” according to whether the patient terminated the pregnancy during hospitalization. The Ethics Committee of Tongji Hospital approved this study (No. TJ-IRB2020401), and the requirement for informed consent was waived. We obtained and reviewed demographics, medical history, pre-admission information, symptoms at disease onset, laboratory findings at admission, chest computed tomographic (CT) scans, quantitative real-time reverse transcription-polymerase chain reaction (RT-PCR) assay results for SARS-CoV-2, treatments, complications, and prognosis for participants. Particularly, laboratory findings within 7 days after the termination of pregnancy were compared with laboratory findings at admission. According to the New Coronavirus Pneumonia Prevention and Control Program (5th edition),[4] we included both laboratories diagnosed cases and clinically diagnosed cases to present the complete spectrum of COVID-19 and defined the severity of COVID-19 and hospital discharge standards.[4,5] Criteria involving previous medical history were defined as follow: (1) chronic lung diseases included chronic obstructive pulmonary disease, asthma, and tuberculosis; (2) chronic kidney diseases included glomerulonephritis, pyelonephritis, and nephrotic syndrome; and (3) chronic liver diseases included hepatitis, liver cirrhosis, and fatty liver disease. Possible complications of these participants were recorded and analyzed. Abnormal liver function was defined as alanine aminotransferase >66 U/L, with or without total bilirubin >21 μmol/L. Abnormal renal function was defined as blood creatinine >84 μmol/L, or the concentration of blood urea nitrogen >7.5 mmol/L. Heart function injury was defined as hypersensitive cardiac troponin >15.6 pg/mL or N-terminal pro-brain natriuretic peptide >116 pg/mL. Digestive system injury was defined as developing severe symptoms of the digestive tract, such as nausea, vomiting, abdominal pain and diarrhea, and abnormal stool. Respiratory system injury was defined as having cough, sputum production, or hypoxia symptoms and the requirement for assisted ventilation treatment, including oxygen support, tracheal intubation and being on a ventilator. Nervous system injury was defined as developing relative symptoms, such as seizures, coma or drowsiness. We performed statistical analyses using SPSS version 26.0 (SPSS Inc., Chicago, IL, USA). Continuous variables were described as medians (Q1, Q3) when abnormally distributed, and categorical variables were described as numbers (percentages). We compared continuous variables using Mann–Whitney U test or a paired-sample Wilcoxon signed-rank test, and compared categorical variables using χ2 test or Fisher exact test. A value of P < 0.05 was considered statistically significant. From January 19 to April 1, 2020, a total of 285 women of childbearing age with COVID-19 were admitted to our hospital, including 30 pregnant women and 255 non-pregnant women. The median ages of pregnant and non-pregnant women were 31 (30, 34) years and 36 (31, 41) years (Z = −3.600, P < 0.001), respectively. Fever, cough, and sputum production were the most common initial symptoms. In addition, seven pregnant women (23.3%) presented with diarrhea at disease onset, while 30 non-pregnant women (11.8%) presented with diarrhea (χ2 = 3.180, P = 0.075) [Supplementary Table 1, https://links.lww.com/CM9/A469]. In laboratory findings, pregnant patients showed special characteristics. The pregnancy group had a higher leukocyte count (8.72 [5.96, 10.12] × 109/L vs. 5.36 [4.02, 6.97] × 109/L, Z = −5.106, P < 0.001), a higher neutrophil percentage (77.55 [70.63, 83.23]% vs. 58.90 [51.85, 68.20]%, Z = −6.328, P < 0.001), and lower percentages of lymphocytes (15.50 [12.50, 21.90]% vs. 29.60 [22.05, 36.50]%, Z = −5.820, P < 0001) and monocytes (6.15 [4.65, 7.33]% vs. 8.10 [6.60, 9.80]%, Z = −4.258, P < 0.001) compared with the non-pregnancy group. Moreover, the pregnancy group also presented with higher levels of D-dimer (1.31 [0.65, 1.95] μg/mL vs. 0.32 [0.22, 0.59] μg/mL, Z = −5.132, P < 0.001), high-sensitivity C-reactive protein (16.65 [1.68, 41.03] mg/L vs. 2.50 [0.53, 16.38] mg/L, Z = −2.932, P = 0.003), erythrocyte sedimentation rate (29.00 [21.00, 43.00] mm/1 h vs. 16.00 [8.00, 36.25] mm/1 h, Z = −2.689, P = 0.007) and interleukin-6 (14.50 [3.56, 39.75] pg/mL vs. 4.46 [2.34, 12.98] pg/mL, Z = −2.396, P = 0.017] than the non-pregnancy group [Supplementary Table 2, https://links.lww.com/CM9/A469]. As shown in Table 1, the pregnancy group presented a lower percentage of respiratory system injury (76.7% vs. 92.5%, χ2 = 8.167, P = 0.004), a lower rate of antiviral therapy (70.0% vs. 86.7%, χ2 = 5.820 P = 0.016) and a higher rate of oxygen support (86.7% vs. 67.1%, χ2 = 4.835, P = 0.028) compared with the non-pregnancy group. Furthermore, no patient in the pregnancy group died in our study, but there were seven dead cases in the non-pregnancy group. The median symptom-to-discharge duration of the pregnancy group was significantly shorter than that of the non-pregnancy group (24 [18, 38] days vs. 31 [23, 42] days, Z = −2.143, P = 0.032). Table 1 - Complications and outcomes of childbearing-aged women with COVID-19. Items Pregnancy group (n = 30) Non-pregnancy group (n = 255) Statistics P Complications Abnormal liver function 4 (13.3) 16 (6.3) – 0.245 Abnormal renal function 0 (0) 10 (3.9) – 0.607 Heart function injury 1 (3.3) 27 (10.6) – 0.332 Digestive system injury 6 (20.0) 40 (15.7) 0.369∗ 0.544 Respiratory system injury 23 (76.7) 236 (92.5) 8.167∗ 0.004 Nervous system injury 0 (0) 5 (2.0) – 1.000 Treatments Oxygen support 26 (86.7) 171 (67.1) 4.835∗ 0.028 Tracheal intubation 0 (0) 5 (2.0) – 1.000 On a ventilator 0 (0) 14 (5.5) – 0.375 Antiviral therapy 21 (70.0) 221 (86.7) 5.820∗ 0.016 Antibiotic therapy 25 (83.3) 169 (66.3) 3.594∗ 0.058 Use of glucocorticoids 7 (23.3) 74 (29.0) 0.427∗ 0.514 Intravenous immunoglobulin therapy 4 (13.3) 41 (16.1) – 1.000 Admission to intensive care unit 0 (0) 24 (9.4) – 0.089 Terminate pregnancy 22 (73.3) – – – Continue pregnancy 8 (26.7) – – – Prognosis – 0.022 Hospital discharge 27 (90.0) 245 (96.1) Still under treatment 3 (10.0) 3 (1.2) Death 0 (0) 7 (2.7) Symptom-to-discharge duration (days) 24 (18, 38) 31 (23, 42) −2.143† 0.032 Data were shown as median (Q1, Q3) or n (%). COVID-19: Coronavirus disease 2019; –: Not applicable. ∗χ2 values. †Z values. We compared complications, hospital stay and prognosis between the continued pregnancy group (n = 8) and the terminated pregnancy group (n = 22). The results show that the complications in the continued pregnancy group did not increase compared with the terminated pregnancy group (all P > 0.05). The median duration of symptom-to-discharge in two groups were 23 (18, 42) days and 24 (18, 37) days (Z = −0.250, P = 0.803), respectively [Supplementary Table 3, https://links.lww.com/CM9/A469]. Furthermore, mild differences were detected in the laboratory characteristics between the two groups. The percentage of lymphocytes increased after the termination of pregnancy (16.40 [12.00, 22.45]% vs. 20.80 [15.65, 28.05]%, Z = −2.352, P = 0.019), while the percentage of neutrophils (77.40 [69.80, 83.45]% vs. 68.90 [62.55, 80.00]%, Z = −2.073, P = 0.038) and the high-sensitivity C-reactive protein level (16.65 [2.7, 36.35] mg/L vs. 13.1 [1.9, 20.6] mg/L, Z = −2.198, P = 0.028) both decreased after the termination of pregnancy. The epidemic of COVID-19 is spreading rapidly and has become a global health emergency. There are two main issues for pregnant patients that arouse public concern: the first is whether COVID-19 infection during pregnancy can affect the prognosis of pregnancy, the other is whether the pregnancy process would exaggerate the viral infection, and thus, lead to poor prognosis. In this retrospective single-center cohort study, there were a total of 285 women of childbearing age infected with SARS-CoV-2; 10.5% (30 cases) of them were pregnant patients. We find that pregnant and non-pregnant women with COVID-19 have similar epidemiological characteristics. However, pregnant patients seemed to have relatively mild clinical manifestations, specific laboratory characteristics, fewer deaths, and a shorter symptom-to-discharge duration. Of the clinical characteristics of childbearing-aged women with COVID-19, fever, cough, and sputum production were the most common initial symptoms in both the pregnancy and non-pregnancy groups; diarrhea may also be a common clinical manifestation in pregnant women with COVID-19. The laboratory results of pregnant women with COVID-19 showed special characteristics, including a higher leukocyte count, a higher neutrophil percentage, and higher levels of D-dimer, high-sensitivity C-reactive protein, and erythrocyte sedimentation rate. These findings may be explained by the special physiological and immunological state during pregnancy rather than bacterial co-infection, because these pregnant patients did not present other clinical manifestations associated with bacterial co-infection. Until now, there is no specific intervention recommended by reliable evidence for pregnant patients. Therefore, pregnant women with COVID-19 received similar treatments compared with non-pregnant patients. In our study, seven patients died in the non-pregnancy group, while the pregnancy group had no deaths. Comparison between the continued pregnancy group and the terminated pregnancy group showed that the complications and prognosis between the two groups were not significantly different. These results suggest that terminating a pregnancy or not did not affect the prognosis of COVID-19. To further confirm the above conclusions, we analyzed changes in laboratory indicators before and after termination of pregnancy. Soon after the termination of pregnancy, some indicators associated with the physiological characteristics and immune status of pregnancy (eg, neutrophils and high-sensitivity C-reactive protein) can quickly return to the non-pregnant state, which also indicates that the effect of pregnancy on COVID-19 is reversible. In conclusion, pregnant and non-pregnant women with COVID-19 infection had similar epidemiological characteristics, but pregnant patients presented relatively mild clinical manifestations, shorter symptom-to-discharge duration, and pregnancy-related specific laboratory examination characteristics. More data are still needed for a better in-depth understanding of these characteristics of COVID-19 infection during pregnancy, and further studies are warranted to determine the specific mechanisms behind these traits. Funding This work was supported by the National Key Research and Development Program (Nos. 2019YFC1005200, 2019YFC1005202), National Clinical Research Center of Gynecology and Obstetrics (No. 2015BAI13B05), and the Hubei Province Health and Family Planning Scientific Research Project (No. WJ2019M127). Conflicts of interest None.

目的 探讨双绒毛膜双羊膜囊双胎妊娠一胎畸形在孕中晚期实施经腹选择性药物减胎术的临床特点、减胎时机、安全性及妊娠结局.方法 回顾性分析2017年5月至2019年3月华中科技大学同济医学院附属同济医院产科收治的12例双胎妊娠一胎畸形经腹选择性减胎孕妇的临床资料.结果 所有接受选择性减胎术的孕妇绒毛膜性均为双绒毛膜双羊膜囊,减胎时平均孕周为(24.68±3.22)周.受孕方式为自然受孕6例,体外受精-胚胎移植辅助生殖技术5例,使用促排卵药物1例.减胎指征:系统胎儿超声筛查提示一胎儿严重畸形者9例,产前诊断提示一胎儿染色体异常者5例.减胎方式均采取B超引导下经腹胎儿心脏或脐静脉内注射10％氯化钾溶液,减胎成功率为100％,未见感染、流产、死胎等并发症.妊娠结局:4例发生早产,8例足月分娩,新生儿Apgar评分均在7分以上.结论 对双绒毛膜双羊膜囊的双胎妊娠一胎畸形的孕妇于孕中晚期实施经腹选择性药物减胎术是安全可行的,但对操作人员的技术有较高要求,尽早实施减胎术有利于成功减除畸形胎儿、得到良好的妊娠结局,对家庭及社会都有重要意义.

目的:探讨妊娠合并肺动脉高压(PAH)患者妊娠结局.方法:汇总2012年10月一2018年12月在本院确诊为妊娠合并PAH的49例临床资料,对相关项目进行统计分析.结果:49例孕妇中,原发PAH 10例,心功能Ⅲ-Ⅳ级4例,死亡1例;继发PAH39例,心功能Ⅲ-Ⅳ级10例,死亡6例.死亡7例均为重度PAH,心功能Ⅲ-Ⅳ级,手术终止妊娠,术后3d内死亡.早中孕期终止妊娠11例,晚孕期分娩者38例,共获新生儿39例,足月分娩18例,早产21例,其中新生儿窒息7例,小于胎龄儿4例,原发及继发PAH孕妇早产及新生儿并发症发生率无差异(P>0.05).结论:原发或继发PAH孕妇母儿不良结局发生率均较高.心功能Ⅲ-Ⅳ级及重度PAH患者应尽量避免妊娠.对心功能I-Ⅱ级、轻度PAH孕妇应予综合评估,决定终止妊娠方式及时机,以改善母儿结局.