ObjectiveTo evaluate liver perfusion in pregnant women with hepatitis between 13 and 41 weeks of gestation by three-dimensional color power Doppler angiography (3D-CPA) vascular indexes. MethodsThis study involved 73 pregnant women with hepatitis and 44 healthy pregnant women who had the pregnancy examination between February 2012 and June 2013. We sampled in the area which was near the right lobe of the pregnant women liver's portal vein branch, and obtained the vascularization index (VI), flow index (FI) and vascularization flow index (VFI) via the virtual organ computer-aided analysis (VOCAL) method. Then, we compared the liver perfusion differences between the pregnant women with hepatitis and healthy pregnant women. ResultsThe hepatic flow indexes obtained by 3D-CPA were significantly different between the HBV-DNA viral load and the control groups. The cutoff values of the three vascular indexes of patients with hepatitis with HBV-DNA viral load and the healthy pregnant women were respectively VI=8.760 (P<3×10-4); FI=22.180 (P<6×10-7); and VFI=1.575 (P<3×10-5). ConclusionApplication of the 3D-CPA on liver perfusion may differentiate pregnant women with hepatitis B from normal ones, thus offer a support for clinical prevention and treatment for pregnant women with hepatitis B.
Objective To compare the central foveal thickness (CFT) and subfoveal choroidal thickness (SFCT) in healthy pregnant women and patients with pre-eclampsia. Methods A prospective control study. Twenty normal subjects, 20 healthy pregnant women and 20 patients with pre-eclampsia were included. The difference of gestational weeks between healthy pregnant women and patients with pre-eclampsia was not significant (χ2=0.012, P=0.913). The differences of age and spherical equivalent among normal subjects, healthy pregnant women and patients with pre-eclampsia were not significant (χ2=1.760, 0.087; P=0.413, 0.957). All eyes underwent optical coherence tomography examination to measure the CFT and SFCT. Results The mean CFT of normal subjects, healthy pregnant women and patients with pre-eclampsia were (194.40±16.17), (201.2±17.33), (199.00±15.46) μm, there was no significant difference among the three groups (χ2=0.888, P=0.641). The mean SFCT of normal subjects, healthy pregnant women and patients with pre-eclampsia were (263.45±69.66), (330.00±49.20), (373.40±52.00) μm, there was significant difference among the three groups (χ2=22.818, P=0.000). The mean SFCT of healthy pregnant women was increased than that of normal subjects (Z=?2.991, P=0.002). The mean SFCT of patients with pre-eclampsia was increased than that of healthy pregnant women (Z=?2.638, P=0.007). Conclusion The mean SFCT of patients with pre-eclampsia is increased than healthy pregnant women.
Objective?To formulate an evidence-based conclusion concerning ultrasound screening for fetal malformations for a pregnant woman after 12 gestational weeks. Methods?Based on the clinical problem of whether pregnant women need ultrasound screening for fetal malformations after 11-14 gestational weeks, we used “ultrasound or sonography and prenatal or fetal at first trimester or 11-14 weeks; ultrasound exposure; fetal development” as the keywords and searched The Cochrane Library (Issue 4, 2008), MEDLINE (1981 to 2008), ACP Journal Club (1991 to 2008), and BMJ Clinical Evidence (1999 to 2008) for systematic reviews, randomized controlled trials (RCTs) and controlled clinical trials. The methodological quality of the included studies was assessed to identify the current best evidence. Results?Three systematic reviews, two RCTs and ten cohort studies were retrieved. The results showed ultrasound screening detected different fetal malformations in the first, second and third trimester. Not all of the fetal malformations could be detected through prenatal ultrasound screening. Nuchal translucency (NT) measurement as a tool for screening chromosomally abnormal fetuses and detecting fetal malformations by ultrasound proved to be effective if performed within 11-14 gestational weeks. The routine second trimester screening, however, could not be replaced by a detailed ultrasound examination at 11-14 gestational weeks. Most of the trials concluded that the effect of ultrasound on a fetus was not harmful. Conclusion?The findings of this study should reassure physicians and parents alike that ultrasound screening is an appropriate option for the pregnant women after 12 gestational weeks.
ObjectiveTo systematically review the infection and colonization of Mycoplasma genitalium (Mg) in the reproductive tract of pregnant females in China. MethodsPubMed, Web of Science, SinoMed, CNKI, VIP and WanFang Data databases were electronically searched to collect cross-sectional studies on Mg infection in pregnant females in China from inception to October 10, 2021. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies; then, meta-analysis was performed by using R1.1.463 software. ResultsA total of 23 cross-sectional studies were included. The results of meta-analysis showed that the prevalence rate of Mg infection in pregnant females was 4.86% (95%CI 2.84% to 7.38%). The prevalence rates of Mg infection in females with ectopic pregnancy, spontaneous abortion, induced abortions and PROM were 13.01% (95%CI 6.90% to 20.69%), 11.81% (95%CI 3.30% to 24.59%), 6.11% (95%CI 2.70% to 10.77%), and 12.63% (95%CI 9.56% to 16.06%), respectively. ConclusionCurrent evidence shows that the prevalence rate of Mg infection in females with ectopic pregnancy, spontaneous abortion and premature rupture of membranes are higher than those in other pregnant females. Due to limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.
Intravitreal anti-VEGF injection have been widely used in retinal vascular diseases and achieved good efficacy. Early pregnancy is an important period for fetal organ formation and vascular development. Studies have proved that VEGF plays an important role in maintaining the fetal and placental vascular system, and its loss or decline will affect embryonic development and lead to abortion. The use of intravitreal anti-VEGF during pregnancy is controversial, which may cause systemic side effects to the mother and fetus. This paper summarizes the literature of 23 cases on the use of anti-VEGF during pregnancy. Three cases reported loss of pregnancy with concomitant exposure to intravitreal bevacizumab, which suggested that we should be careful about the use of anti-VEGF during pregnancy and explain the possibility of ocular and systemic side effects to patients in detail. When deciding whether to use anti-VEGF, we should consider the relationship between exposure time and the critical period of vascular development and the systemic exposure of different drugs. Currently, there is a lack of large sample size studies on the use of anti-VEGF in pregnancy, and its safety needs to be further observed.
ObjectivesTo systematically review the clinical characteristics of pregnant females and juveniles (<18 years) with Middle East Respiratory Syndrome (MERS), so as to provide evidence for epidemic prevention and treatment of COVID-19.MethodsPubMed, EMbase, Web of Science, The Cochrane Library, CNKI, VIP and WanFang Data databases were electronically searched to collect studies on clinical characteristics of pregnant females and juveniles with MERS from inception to February 15th, 2020. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies. Descriptive analysis was then performed.ResultsA total of 12 studies involving 12 pregnant females, and 21 juveniles with MERS were included. The results of studies showed that the male to female ratio of juveniles patients was 1 to 1.63 and the age ranged from 9 months to 16 years. The primary transmission route of juveniles cases was family contact infection, accounting for 57.1% (12/21). Asymptomatic juveniles accounted for 57.1% (12/21), and the most common symptoms were fever, cough and shortness of breath. Some patients exhibited gastrointestinal symptoms such as vomiting and diarrhea. The positive rate of MERS-CoV RCT test was 100.0% (21/21). As for chest radiograph, 73.7% (14/19) cases showed no obvious lesions, and juveniles with lesions were mainly bilateral. 3 patients with underlying diseases developed severe cases, the mortality was 9.5% (2/21). The age range of pregnant women was 27 to 39, with the gestational age from 6 to 38 weeks. The primary transmission route for pregnant women was nosocomial infection, accounting for 57.1% (4/7). Fever, cough, shortness of breath were common manifestations, while abdominal pain occurred in two female patients. The positive rate of MERS-CoV RCT test was 100.0% (11/11). The chest radiograph findings were mainly bilateral lesions, accounting for 55.6% (5/9). 80.0% of whole pregnant females were severe cases (8/10), 4 of them died, with the 50.0% (4/8) mortality in severe pregnant cases. Among the infective pregnant women, 2 were stillborn and 10 were delivered, of which 1 died due to premature delivery. The remaining 9 surviving newborns were not infected with MERS-CoV and there was no evidence of mother-to-child transmission.ConclusionsThe clinical symptoms of MERS in juveniles are similar to those in adults, however, considerably milder. Severe case rate is higher in patients with underlying diseases. However, maternal infections could be much severe with higher mortality. It is particularly important to strengthen the management of pregnant females, especially prevent hospital infection. There is still no evidence of MERS-CoV mother-to-child transmission.
ObjectivesTo systematically review the correlation between maternal serum selenium levels during pregnancy and premature birth.MethodsDatabases including PubMed, The Cochrane Library, EMbase, Web of Science, CNKI and CBM were searched to collect studies on correlation between maternal serum selenium levels during pregnancy with preterm birth in the offspring from inception to January, 2020. Two reviewers independently screened literature, extracted data and evaluated risk of bias of the included literature. Then, meta-analysis was conducted by using RevMan 5.3 software.ResultsA total of 12 studies involving 2 484 patients were included. The results of meta-analysis showed that compared with control group, the preterm group had lower serum selenium levels in pregnant females (SMD=?0.89, 95%CI ?1.56 to ?0.22, P=0.01). The results of the subgroup analysis showed that heterogeneity among subjects was still large when grouped accorcding to the continent to which a country belongs, the time of blood sample collection and test method in pregnant females.ConclusionsLow maternal serum selenium levels during pregnancy may increase the risk of preterm birth. Due to the limitation of the quantity and quality of the included studies, the above conclusions are required to be verified by more high quality studies.
ObjectiveTo explore the relationship between the diet during pregnancy and gestational diabetes mellitus (GDM), and analyze the effect of GDM on weight gain, outcome and complication of mother and infant. MethodsWe selected 128 GDM pregnant women and 267 non-GDM pregnant women who were investigated by semi-quantitative food frequency method during September 2009 to March 2011. Then, we collected relevant information and the data were analyzed by t-test and chi-square test. ResultsThere were statistically significant differences between the two groups in total calorie, carbohydrate, fat and protein intakes per day (P<0.05). In general, the rates of insufficient weight gain and excessive weight gain during pregnancy in the GDM group were significantly higher than the non-GDM group (P<0.05), while proper weight gain rate was significantly lower (P<0.01). The risk of hydramnion, intrahepatic cholestasis and pregnancy-induced hypertension in the GDM group was significantly higher than the non-GDM group (P<0.05), while there was no significant difference between the two groups in premature delivery, cesarean section or premature membrane ruptures (P>0.05). Apgar scores were significantly different at minute 1 and 5 between the infants in the two groups (P<0.05). The incidence of fetal death, malformation, mild neonatal asphyxia and fetal macrosomia in the GDM group was significantly higher than the non-GDM group (P<0.05). No significant differences between the two groups in low birth weight infant, cord entanglement and fetal distress were detected (P>0.05). ConclusionGDM can lead to high incidence of poor outcome and complication. It is vital to strengthen the examination and keep balanced dietary structure, in order to reduce the complication and improve the health of mother and child.
Objective To investigate the methodological characteristics of observational studies on the correlation between drug exposure during pregnancy and birth defects. Methods The PubMed database was searched from January 1, 2020 to December 31, 2020 to identify observational studies investigating the correlation between drug use during pregnancy and birth defects. Literature screening and data extraction were conducted by two researchers and statistical analysis was performed using R 3.6.1 software. Results A total of 40 relevant articles were identified, of which 8 (20.0%) were published in the four major medical journals and their sub-journals, 21 (42.5%) were conducted in Europe and the United States, and 4 were conducted (10.0%) in China. Cohort studies (30, 75.0%) and case-control studies (10, 25%) were the most commonly used study designs. Sixteen studies (40.0%) did not specify how the databases were linked. Sixteen studies (40.0%) did not report a clear definition of exposure, while 17 studies (42.5%) defined exposure as prescribing a drug that could not be guaranteed to have been taken by the pregnant women, possibly resulting in misclassification bias. Six studies (15.0%) did not report the diagnostic criteria for birth defects and 18 studies (45.0%) did not report the types of birth defects. In addition, 33 studies (82.5%) did not control for confounding factors in the study design, while only 19 studies (47.5%) considered live birth bias. Conclusion Improvements are imperative in reporting and conducting observational studies on the correlation between drug use during pregnancy and birth defects. This includes the methods for linking data sources, definition of exposure and outcomes, and control of confounding factors. Methodological criteria are needed to improve the quality of these studies to provide higher quality evidence for policymakers and researchers.
ObjectiveTo discuss clinical characteristics and nursing countermeasure of pregnant/delivery women with tuberculosis. MethodsFrom January 2012 to December 2013, 52 cases of pregnant women complicated with tuberculosis were included. We offered specific nursing according to the psychological counseling, reasonable administration, diet nursing, fever and prevention of hospital infection on the base of their clinical features, and then analyzed the effect. ResultsIn 52 patients who had undergone the tuberculosis and obsterrics and gynecology treatment, 4 puerperal patients died of severe pneumonia and multiple organ failure; in 48 gestational patients with tuberculosis, 23 early-middle term patients accept termination of pregnancy, and in 25 middle-late term patients, 3 had full-term natural labor, 4 underwent full-term cesarean section, 5 had premature labor, and 13 continued the pregnacy. Sixteen neonatus (including 4 given at the other hospitals) had normal results of physical examination without any deformity, in whom 5 had low body weight (body weight less than 2500 g), with negative results of tuberculin test and the result of 3-moth follow-up was normal. Three months after the anti-tuberculosis treatment, the lesion was obviously absorbed in 25 patients and in 23 patients within half of a year. No patients had hospital infection. ConclusionNursing care of pregnant patients with tuberculosis should strengthen the guidance on the patients health education, improve their compliance and self-protection knowledge. Also should strengthen the basic level medical personnel training and improve the ability of early diagnosis of tuberculosis and early treatment to reduce maternal mortality.