ABSTRACT Spontaneous preterm birth (sPTB) often results from ascending intra-amniotic infections originating from the vaginal microbiota. This study aimed to characterize vaginal microbial features and identify specific taxa associated with sPTB in a Chinese population. In this prospective cohort study, pregnant women were recruited from Peking Union Medical College Hospital. Vaginal swabs were collected longitudinally at 11–16, 22–28, and 34–37 weeks of gestation. DNA was analyzed using targeted real-time PCR (30 pathogens) and 16S rRNA gene sequencing (V3–V4). Community State Types (CSTs) were defined by enterotype-like clustering. Differential abundance was assessed using MaAsLin3 with Benjamini-Hochberg correction, adjusting for maternal age, BMI, and obstetric history. Among 273 women (26 sPTB, 247 term), no CST was significantly associated with sPTB after multivariable adjustment and false discovery rate (FDR) correction (all q > 0.05). Alpha and beta diversity also showed no significant between-group differences (all q > 0.05). However, longitudinal CST stability was significantly lower in the sPTB group ( P < 0.05). Nominally significant associations were observed for Ureaplasma urealyticum (first trimester), Mycoplasma hominis , and Bacteroides fragilis (second trimester), but none survived FDR correction (all q > 0.05). In this Chinese cohort, sPTB was not associated with static CST profiles but with reduced microbial stability over time. Although no single taxon remained significant after correction, several pathogens showed nominal associations, warranting further investigation in larger studies. IMPORTANCE Preterm birth (PTB) is a global maternal and infant health issue affecting approximately 11% of newborns worldwide. In China, the prevalence of PTB was 6.1%. Abnormal vaginal microbiota has been demonstrated to be a risk factor for PTB. Our study is one of the largest studies performed to date to investigate the associations between vaginal microbiome and spontaneous PTB (sPTB) in the Chinese cohort. We found that vaginal microbiome dynamics changes in Community State Types (CSTs) were significantly associated with sPTB. Furthermore, we also found that the microbial risk for sPTB appeared to be the enrichment of specific taxa, suggesting that vaginal dynamics and fine-scale features are important factors to consider in future studies.

Objective: With a global incidence of more than 10%, preterm birth (PTB) remains a significant concern. The vaginal microbiome strongly influences the well-being of the female reproductive tract. This study examines the correlation between changes in Lactobacillus vaginal microbiota and the PTB risk. Materials and Methods: A thorough search of PubMed, Web of Science, Cochrane Library, and EMBASE was conducted to locate studies that examined the association between changes in Lactobacillus vaginal microbiota and the risk of PTB from January 1, 2010, to January 30, 2023. The risk of PTB was determined by calculating odds ratios (ORs) with 95% confidence intervals (CIs). Results: In our analysis, there were 11 studies with 1577 pregnant women. The findings revealed a significant negative correlation between higher Lactobacillus abundance and the PTB risk (OR = 0.49, 95% CI: 0.29-0.84, p = 0.009 < 0.05). Similarly, the four individual dominant species, Lactobacillus crispatus (OR = 0.3, 95% CI: 0.14-0.67, p = 0.003 < 0.05), Lactobacillus gasseri (OR = 0.34, 95% CI: 0.17-0.69, p = 0.003 < 0.05), Lactobacillus iners (OR = 0.68, 95% CI: 0.49-0.93, p = 0.016 < 0.05), and Lactobacillus jensenii (OR = 0.43, 95% CI: 0.21-0.89, p = 0.024 < 0.05), were also negatively associated with the PTB risk. The risk of Lactobacillus for PTB was significant in both America (OR = 0.67; 95% CI: 0.50-0.92) and Asia (OR = 0.20; 95% CI: 0.09-0.47), whereas no significant risk was found in Europe (OR = 0.49; 95% CI: 0.11-2.15). Conclusions: Our study demonstrated that the abundance of Lactobacillus and the four dominant individual species (L. crispatus, L. jensenii, L. iners, and L. gasseri) were significantly and negatively associated with the PTB risk.

In this article, we report a case of spontaneous ruptured pyomyoma during pregnancy with successful delivery after myomectomy. A 35-year-old pregnant female (27 weeks of gestation) presented with lower abdominal pain. The patient had a history of uterine fibroids. Ultrasound, computed tomography, and magnetic resonance imaging confirmed a spontaneous ruptured pyomyoma (maximum diameter: 12.6 cm). Myomectomy was performed, and her abdominal distension and pain were significantly improved within 1 day; the condition of the fetus was normal. One month after surgery, severe tenderness was detected in the lower right side of the uterus. Considering the higher risk of uterine rupture and associated complications, a cesarean section was performed. The mother and neonate were discharged 3 and 42 days after delivery, respectively, in good condition. Myomectomy for spontaneous ruptured pyomyoma during pregnancy may be feasible and extend gestational age to improve outcomes for the mother and neonate.

Pregnancy with solid pseudopapillary tumor of the pancreas (SPTP) is rare. Because pregnancy hormones may cause tumor progression, the management and treatment of SPTP need to balance the safety of pregnant women and fetuses with surgical treatment. We reported a case of a giant pancreatic tumor diagnosed during pregnancy that was considered to be SPTP. Examinations also showed hepatitis B virus infection and severe decompensation of liver cirrhosis. Medical termination of pregnancy was performed. The patient has lived with the tumor until now without surgery. We retrieved the published case reports, summarized the clinical characteristics of pregnancy with SPTP, and explored its management during the perinatal period. Most patients with SPTP have a good prognosis with good maternal and fetal outcomes, and it is important to choose an appropriate treatment method and timing. However, pregnancy combined with decompensated liver cirrhosis needs to be terminated in a timely manner because of its high-risk status.

目的 探讨中孕期合并肺动脉高压(PAH)患者的临床特点和诊疗方案.方法 回顾性分析北京协和医院2000年1月至2021年3月收治的12例中孕期合并PAH的患者病历资料,按照肺动脉收缩压高低分为轻度、中度、重度三组,结合其原发病分析其临床特点、诊断、治疗和妊娠结局.结果 患者平均年龄29岁(17～41岁),经产妇3例、初产妇9例.12例患者中5例合并免疫系统疾病、2例合并先天性心脏病、2例既往心肌炎史、1例合并肾功能不全、1例合并高血压病,1例无原发疾病.3例孕前诊断PAH(2例孕前为重度PAH、1例为中度PAH),1例孕早期诊断中度PAH,其余8例于中孕期出现临床症状后诊断.12例患者中重度6例、中度5例,轻度1例.8例经剖宫产终止妊娠,3例选择药物引产,1例轻度者继续妊娠中.共3例PA H孕妇死亡(重度组2例、中度组1例).结论 中孕期合并PAH患者中死亡率高(3/12),属于极高危孕妇;肺动脉高压越重,孕妇死亡风险越高;中重度PAH合并妊娠患者建议及时终止妊娠以改善妊娠结局.

BACKGROUND:Pulmonary arterial hypertension (PAH) is an uncommon type of pulmonary hypertension (PH) disease characterized by progressive remodeling of distal pulmonary arteries. It could inevitably lead to pulmonary vascular resistance and even right ventricular failure. Biologists have explored the basic pathobiology of PAH, but its functional mechanism and effect in pregnant people remain unknown. This study was designed to investigate the maternal and fetal outcomes of pregnancy-related PAH.METHODS:Clinical data of 59 pregnant women with PAH who were admitted to Peking Union Medical College Hospital from Jan. 2000 to Dec. 2018 were retrospectively reviewed and analyzed. Multiple parameters, including age, gestational week, the New York Heart Association (NYHA) cardiac functional classification, ultrasonic cardiogram (UCG), blood test, pregnancy complications, pulmonary arterial systolic pressure, maternal and fetal outcomes, were comprehensively investigated and analyzed.RESULTS:According to the pulmonary arterial systolic pressure, all 59 pregnant women were divided into mild PAH (30-49 mmHg, n=18), moderate PAH (50-79 mmHg, n=17) and severe PAH (>79 mmHg, n=24). Five patients died, and the mortality rate was 8.5%. Compared with the mild and moderate groups, the mean gestational week, age of the pregnancy, and NYHA cardiac functional classification grade in the severe PAH group were dramatically different (all P<0.05). The incidence of pregnancy-related complications in the severe PAH group was significantly higher than those in the mild and moderate PAH groups (both P<0.05).CONCLUSIONS:The blood parameters, PAH, and NYHA cardiac functional classification grade were significantly changed before and after surgery. We found that the severity of PAH was a major factor of maternal and fetal outcomes. Strengthening the nursing care for pregnant women with PAH is of great clinical significance.

Objective To investigate the relationship between abnormalities of maternal serum markers in Down syndrome screening in second trimester and adverse pregnancy outcome.Methods Totally,1935 pregnant women were screened for Down syndrome with maternal serum tri marker with time-resolved fluorescence assay,including alpha fetoprotein (AFP),free β-human chorionic gonadotropin (β-hCG) and unconjugated estriol (uE3),between 15 and 20+6 gestational weeks at Peking Union Hospital from January 1,2009 to January 31,2011,and were followed up till delivery.The relationship between incidence of adverse pregnancy outcomes and women with normal or abnormal levels of serum markers in Down syndrome screening was investigated.T-test or Chi-square test were applied for statistical comparison.Results (1) Among the 1935 pregnant women,normal levels of serum markers were found in 1255(normal group) and 680 were abnormal(abnormal group),in which 577 with only one abnormal serum marker,89 with two and 14 with three abnormal serum markers.According to the serum marker level,the 577 women with one abnormal serum marker were further divided into five groups,including high AFP group (n=17),low AFP group (n=114),high β-hCG group (n=242),low β-hCG group (n=139) and low uE3 group (n=65).The birth weight of infants in lower AFP group and the gestational age at delivery in low β-hCG group were greater than those in normal group [(61.3±9.1) kg vs (59.5±8.3) kg,(272.6±11.8) d vs (274.4±10.1) d,t=2.21 and 1.99,both P＜0.01].(2) The incidence of adverse pregnancy outcome in normal group was 42.8％(537/1255),while comparing with the abnormal group(43.7％,297/680),no statistical significance was shown (RR =1.02,P =0.71).While comparing with the normal group,the incidences of placenta previa [25.5％ (32/1255) vs 2/17,RR=4.61,P＜0.05] and abnormal placental morphology were higher in high AFP group [4.1％ (51/1255) vs 5/17,RR=7.24,P＜ 0.05],the incidence of gestational diabetes mellitus (GDM) was higher in low AFP group [8.1％ (101/1255) vs 14.4％(16/114),RR=1.74,P＜0.05],the incidence of placenta and membrane retention was higher in high β-hCG group [3.5％ (44/1255) vs 6.2％(15/242),RR=1.77,P＜0.05],the incidence of pre-eclampsia was higher in low β-hCG group [1.7％ (21/1255) vs 6.5％ (9/ 139),RR=3.87,P＜0.05].(3) There were 89 women with two abnormal serum markers.Comparing with the normal group,the incidences of small for gestional age (SGA) infants,oligohydramnios,abruptio placenta were higher in women with low AFP but high β-hCG [SGA infants:6.9％(2/29) vs 1.8％(22/1255),RR=3.94; oligohydramnios:20.7％(6/29) vs 6.4％(80/ 1255),RR=3.24; both P＜0.05],the incidences of oligohydramnios was higher in women with both low AFP and low uE3[3/14 vs 6.4％(80/1255),RR=3.36,P＜0.05],the incidence of premature birth and GDM were higher in women with both low β-hCG and low uE3 [premature birth:2/6 vs 4.3％(54/1255),RR=7.75; GDM:3/6 vs 8.0％ (101/1255),RR=6.21; both P＜0.05].(4) There were 14 women with three abnormal serum markers.The relationship between adverse outcome and abnormal serum markers did not show any statistical significance.Conclusions The abnormality of serum markers of Down syndrome screening is closely related to adverse pregnancy outcomes,and women with abnormal serum markers should be carefully monitored during pregnancy.

OBJECTIVE:To investigate the clinical features and pregnant outcomes of the pregnant women with congenital adrenal hyperplasia (CAH) 21-hydroxylase deficiency (21-OHD).METHODS:The clinical features, therapies, pregnant outcomes of the pregnant women with 21-OHD were retrospectively reviewed in Peking Union Medical College Hospital, from January 2005 to April 2011.RESULTS:There were 8 pregnant women with 21-OHD including 5 simple virilizing patients and 3 nonclassical 21-OHD women. Eight patients were accepted progestational and prenatal continual lower glucocorticoid treatment. During the gestational period, the dosage of glucocorticoid was adjusted in one pregnancy. The serum level of 17-alpha hydroxyprogesterone (17-OHP) were elevated after pregnancy [(70 ± 38) versus (24 ± 23) nmol/L, P < 0.05]. The fertility and offspring rate of 8 patients was 8/12, the fertility and offspring rate of patients who started treatment at preadolescence was significantly increased (4/5 versus 4/7). Four patients were accepted genital reconstructive surgery (clitorectomy, clitoroplasty, vulvoplasty) before pregnancy. The incidence of GDM was 1/8. All patients selected caesarean at from 37(+6) gestation weeks to 39(+6) gestation weeks. The average newborn birth weight was (3210 ± 447) g, and height was (48 ± 2) cm of 8 neonates, none of them was CAH.CONCLUSIONS:Medical and surgical therapy provides satisfactory fertility and pregnancy outcomes for women with 21-OHD. It is safe to pregnant women with 21-OHD and their fetus in continual lower glucocorticoid treatment. The dosage of glucocorticoid should be carefully adjusted during the pregnancy individually according to serum level of 17-OHP.

BACKGROUND:Array-based comparative genomic hybridization (aCGH) is a new technique for detecting submicroscopic deletions and duplications, and can overcome many of the limitations associated with classic cytogenetic analysis. However, its clinical use in spontaneous abortion needs comprehensive evaluation. We used aCGH to investigate chromosomal imbalances in 100 spontaneous abortions and compared the results with G-banding karyotyping and fluorescence in situ hybridization (FISH). Inconsistent results were verified by quantitative fluorescence PCR.RESULTS:Abnormalities were detected in 61 cases. aCGH achieved the highest detection rate (93.4%, 57/61) compared with traditional karyotyping (77%, 47/61) and FISH analysis (68.9%, 42/61). aCGH identified all chromosome abnormalities reported by traditional karyotyping and interphase FISH analysis, with the exception of four triploids. It also detected three additional aneuploidy cases in 37 specimens with 'normal' karyotypes, one mosaicism and 10 abnormalities in 14 specimens that failed to grow in vitro.CONCLUSIONS:aCGH analysis circumvents many limitations in traditional karyotyping or FISH. The accuracy and efficiency of aCGH in spontaneous abortions highlights its clinical usefulness for the future. As aborted tissues have the potential to be contaminated with maternal cells, the threshold value of detection in aCGH should be lowered to avoid false negatives.

Objective To discuss the interaction between pregnancy and ankylosing spondylitis, and the management of pregnancy with ankylosing spondylitis. Methods Twelve cases of pregnancy with ankylosing spondylitis in Peking Union Medical College Hospital from September 2004 to July 2011 were analyzed retrospectively, focusing on the arteritis condition, pregnancy complications, and outcomes. Results All the 12 patients had full-term pregnancy. Five cases gave birth naturally, and 7 cases received cesarean section for maternity factors. No adverse pregnancy outcomes were encountered. Waist pain appeared in 2 cases in the second trimester, for both of which medication failed. One of the 2 cases had natural childbirth, while the other maintained pregnancy smoothly to cesarean section. Conclusions Pregnancy monitoring can help obtain favorable pregnancy outcomes. Attention should be paid to postpartum change of the illness.