New Interpretation of Neonatal Outcomes by Phenotypically Classified Preterm Syndrome:A Retrospective Cohort Study

Objective:The global aim to lower preterm birth rates has been hampered by the insufficient and incomplete understanding of its etiology,classification,and diagnosis.This study was designed to evaluate the association of phenotypically classified preterm syndromes with neonatal outcomes;to what extent would these outcomes be modified after the obstetric interventions,including use of glucocorticoid,magnesium sulfate,and progesterone.Methods:This was a retrospective cohort study conducted at Tongji Hospital(composed of Main Branch,Optical Valley Branch and Sino-French New City Branch)in Wuhan.A total of 900 pregnant women and 1064 neonates were retrospectively enrolled.The outcomes were the distribution of different phenotypes among parturition signs and pathway to delivery,the association of phenotypically classified clusters with short-term unfavorable neonatal outcomes,and to what extent these outcomes could be modified by obstetric interventions.Results:Eight clusters were identified using two-step cluster analysis,including premature rupture of fetal membranes(PPROM)phenotype,abnormal amniotic fluid(AF)phenotype,placenta previa phenotype,mixed condition phenotype,fetal distress phenotype,preeclampsia-eclampsia&hemolysis,elevated liver enzymes,and low platelets syndrome(PE-E&HELLP)phenotype,multiple fetus phenotype,and no main condition phenotype.Except for no main condition phenotype,the other phenotypes were associated with one or more complications,which conforms to the clinical practice.Compared with no main condition phenotype,some phenotypes were significantly associated with short-term adverse neonatal outcomes.Abnormal AF phenotype,mixed condition phenotype,PE-E&HELLP phenotype,and multiple fetus phenotype were risk factors for neonatal small-for gestation age(SGA);placenta previa phenotype was not associated with adverse outcomes except low APGAR score being 0-7 at one min;mixed condition phenotype was associated with low APGAR scores,SGA,mechanical ventilation,and gradeⅢ-Ⅳintraventricular hemorrhage(IVH);fetal distress phenotype was frequently associated with neonatal SGA and mechanical ventilation;PE-E&HELLP phenotype was correlated with low APGAR score being 0-7 at one min,SGA and neonatal intensive care unit(NICU)admission;multiple fetus phenotype was not a risk factor for the outcomes included except for SGA.Not all neonates benefited from obstetric interventions included in this study.Conclusion:Our research disclosed the independent risk of different preterm phenotypes for adverse pregnancy outcomes.This study is devoted to putting forward the paradigm of classifying preterm birth phenotypically,with the ultimate purpose of defining preterm phenotypes based on multi-center studies and diving into the underlying mechanisms.

A Participant-assigned Interventional Research of Precesarean Internal Iliac Artery Balloon Catheterization for Managing Intraoperative Hemorrhage of Placenta Previa and Placenta Accreta Spectrum Disorders After Cesarean Section

Placenta accreta spectrum disorder (PASD) and placenta previa (PP) are two of the mosthideous 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 haveadverse pregnancy outcomes, including blood transfusion, hysterectomy, pelvic organs damage,postpartum hemorhage, disseminated intravascular coagulation, multi-organ dysfunction syndromeand even maternal or fetal death. This study aimed to investigate the efficacy of precesareaninternal iliac artery balloon catheterization (BC) for managing severe hemorhage caused by PASDand PP with a history of CS. This participant-assigned interventional study was conducted inTongji Hospital. We recruited 128 women with suspected PASD, PP and a history of CS. Womenin the BC group accepted precesarean BC of bilateral internal iliac arteries before the scheduledcesarean delivery. Women in the control group underwent a conventional cesarean delivery.Intraoperative hemorrhage, transfusion volume, radiation dose, exposure time, complicationsand neonatal outcomes were discussed. There were significant differences in calculated bloodloss (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 withcontrol group (799.5±136.1 vs. 1286.0±161.6 mL, P=0.02) and lessen the rate of using bloodproducts (57.1% vs. 76.4%, P=0.02). The incidence of hysterectomy was also lower in BC groupthan in control group. Postpartum outcomes showed no significant differences between the twogroups, 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 methodfor managing severe hemorrhage caused by PASD and PP with a cesarean scarred uterus, as it couldreduce intraoperative blood loss, lessen intraoperative RBC transfusions and potentially decreasehysterectomies.

Coronavirus disease 2019 in pregnant and non-pregnant women:a retrospective study

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.

Research on the Expression of HOXA10 in Placental Villi during the Onset of Labor

Objective To investigate the difference of the expression of HOXAIO gene in placental villi before and after the onset of labor. Methods Immunohistochemistry was used to detect the location of HOXAIO in placental villi. The expression of HOXAIO mRNA and protein were measured by RT-PCR and Western blotting. Results lmmunohistochemistry showed that HOXAIO was only weakly expressed in placental villi of the natural labor group. However, it was strongly expressed in placental Villi of the surgical labor group. RT-PCR and Western blotting showed that the expression of HOXAIO mRNA and protein were significantly lower in the natural labor group than in the surgical labor group （P〈0.05）. Conclusion The lower expression of HOXAIO during the onset of labor may be one of the major factors in initiating the normal labor. And to some extent, the lower expression of HOXAIO gene in the natural labor group may be related to ＂functional progesterone withdrawal＂.