Preventive and therapeutic effect of N-Acetyl-L-cysteine on infection-associated preterm labor in mice

Objective:To study the preventive and therapeutic effect of N-Acetyl-L-cysteine on infectionassociated preterm labor in mice.Methods:A total of 66 C57BL/6 inbred strain pregnant mice were selected and randomly divided into groups A,B and C,with 22 cases in each group.Group A,B and C were regarded as model group,prevention group and treatment group,respectively.The model of infection-associated preterm labor was built by intraperitoneal injection of Escherichia coli.Ten mice of each group were taken and observed the preterm birth rates and live birth rates,respectively.Three mice of each group were killed at 3 h,6 h,12 h and 24 h after building the model.Their uterus tissues were collected and the expressions of the AP-1 and MCP-1 in those tissues were assayed with immunohistochemical method and the expressions of NF-κ Bp65 and TNF- protein in the placenta tissues of those mice were also detected with immunohistochemical method.Results:The preterm birth rates of mice in groups B and C were significantly lower than that in group A,while their live birth rates were distinctly higher than that in group A(P<0.05);the expressions of the AP-1 and MCP-1 in the uterus tissues and NF-κ Bp65 and TNF- protein in the placenta tissues of mice in groups B and C were evidently lower than those in group A(P<0.05);the comparison of the expressions of the NF-κ Bp65 and TNF- between group B and C showed no statistical differences(P>0.05).Conclusions:N-Acetyl-L-cysteine can lower the incidence rate of infection-associated preterm labor by prohibiting the activation of the protein AP-1/MCP-1and decreasing the expression of NF- κ Bp65 and TNF- in the pregnant tissues of premature mice to reduce the inflammatory reactions.

Accurate preterm labor diagnosis using a CD55-TLR4 combination biomarker model

We previously demonstrated immune activation in the maternal peripheral circulation associated with preterm labor (PTL). There was an elevation in WBC mRNA of anti-inflammatory complement decay-accelerating factor (CD55) and the innate-immune response activating toll-like receptor 4 (TLR4). These findings suggested that collectively, these two molecules might serve as useful biomolecules to aid in the diagnosis of PTL. In this study, we used a combined marker approach to determine whether a dual marker model utilizing both CD55 and TLR4 mRNA levels to classify PTL would increase diagnostic accuracy compared to either molecule alone. Two methods were evaluated;a linear discriminant (LD) method and a distribution free (DF) method, in order to find the optimal linear combination of TLR4 and CD55 data to diagnose PTL accurately. Our results indicated that a combined CD55-TLR4 dual marker model could provide statistically significant improve- ments compared to CD55 or TLR4 single marker models for PTL classification performance.

Prevention and not merely prediction of preterm labor and delivery

Different methods have been proposed to screen forpreterm labor and delivery; most of these aim to predict the risk that preterm delivery is going to take place.However, interesting though this knowledge might be,knowing the future is of no use when no changes canbe made. Recent publications have suggested new andexciting modalities to actually diminish the frequencyof preterm birth in patients selected by transvaginalcervical length measurement; these modalities includevaginal progesterone and vaginal pessaries. Althoughpromising, many questions remain to be answered; notleast about the long term outcome for both neonatesand mothers, but also on the eventual introduction ofsuch strategies to the general obstetric population. Oneof the main problems that urgently needs clarificationis how we are going to offer this best of medicine tothose needing it most: deprived and socially isolatedwomen who have the highest risk for preterm laborand delivery, probably not due to any congenital cervical problems, but to a combination of environmental,microbiological and social factors, including transgenerational poverty and deprivation.

The Combination of the Fetal Fibronectin Bedside Test and Cervical Length in Preterm Labor Is Useful for Prediction of Preterm Birth

Objective: To determine the value of fetal fibronectin (FFN), cervical length (CL) measurement and their combination as binary predictors for preterm birth (PB) in women with preterm labour (PTL) between 24 + 0 and 34 + 0 weeks. Methods: One hundred fifty-nine patients with signs of PTL (singleton pregnancies (SP) = 125, twin pregnancies (TP) = 34) were evaluated in a retrospective study. Inclusion criteria were contractions > 4/20 min, intact membranes, no bleeding. The cut-off was ≥50 ng/ml for FFN and ≤20 mm for CL measured by transvaginal ultrasound. The primary outcome variable was delivery within 7 days from admission. Results: We evaluated 125 SPs and 34 TPs. In SPs, both methods had a sensitivity of 80%;the specificity was 82% for FFN, and 50% for CL. For the combination of both tests sensitivity was 80% and specificity 88%. In TPs, the sensitivity of both tests was lower (FFN 33%, CL 67%) but the combination of both tests represented the highest result for specificity (77% compared to 68% for FFN alone and 32% for CL alone). Conclusion: The combination of FFN and CL in PTL results in a significant higher specificity in SPs. In TPs the performance of the tests is less accurate.

Comparison of PAMG-1 and phIGFBP-1 Tests for the Prediction of Preterm Delivery in Patients with Preterm Labor

Objective: To compare PAMG-1 and phIGFBP-1 tests in predicting impending spontaneous preterm delivery within 7 days upon presentation in pregnant women with symptoms of preterm labor. Study Design: From September 2014 to April 2015 women with singleton gestation, symptoms of preterm labor, GA 22 - 35, participated in this prospective cohort study upon admission. Recruited patients had intact membranes and a minimal cervical dilatation of ≤3 cm. Vaginal swabs for phIGFBP-1 and PAMG-1 were taken in addition to routine treatment. Biochemical test results were blinded and had no effect on management of patients. Results: A total of 96 patients were screened for inclusion into the trial;57 met the inclusion criteria for final analysis. The PAMG-1 test was positive in 5.7% of patients, while phIGFBP-1 test was positive in 29.8% of patients. The prediction of spontaneous preterm delivery within 7 days of admission in patients with a cervical length Conclusion: Our study supports the high negative predictability of biochemical tests to rule out spontaneous preterm labor in patients with a short cervix. However, our study strongly suggests that the PAMG-1 test is more accurate for predicting imminent spontaneous preterm delivery as compared to phIGFBP-1. These findings can significantly reduce economic burden caused by unnecessary admission and treatment of patients suspected of preterm labor. Such a reduction in the use of corticosteroids and tocolytics would lead to a reduction in the short and long term health effects associated with the use of therapeutic drugs like corticosteroids, antibiotics and tocolytics.

Diagnostic Accuracy of PremaQuick versus Actim Partus in Prediction of Preterm Labor in Symptomatic Women within 14 Days

Background: Preterm labor (PTL) remains a major source of neonatal morbidity, and mortality. Currently the trans-vaginal cervical length (TVCL), and/or cervico-vaginal fetal fibronectin (fFN) are the common diagnostic tools used for prediction of PTL. Consequently, many women and their fetuses are exposed unnecessarily tocolysis and hospital admission. Objectives: This study was designed to compare the diagnostic accuracy of PremaQuick versus Actim Partus in prediction of PTL in symptomatic women within 14 days. Patients and Methods: Two-hundred and twenty women (220) were included in this comparative prospective study and classified into two groups: 110 women with threatened preterm labor (TPTL) in the study group, and 110 controls (no TPTL). Women included in the study were subjected to: through history, collection of the cervico-vaginal fluid (CVF) samples for assessment by PremaQuick and Actim Partus tests, followed by trans-vaginal cervical length (TVCL) assessment. Studied women managed according to the hospitals protocol, with follow-up weekly in the obstetrics outpatients’ clinic after discharge from the hospital until delivery. The main outcome measures the diagnostic accuracy of PremaQuick versus Actim Partus in prediction of PTL in symptomatic women within 14 days of admission. Results: PremaQuick test was significantly more specific with higher positive predictive value (PPV) in prediction of PTL in symptomatic women within 14 days (95.5% and 89.6%;respectively) compared to CL 25 mm (56.3% and 54.6%;respectively), (P = 0.02 and 0.03;respectively). In addition, PremaQuick test was significantly more sensitive with higher positive predictive value (PPV) in prediction of PTL in symptomatic women within 14 days (39.8% and 89.6%;respectively) compared to Actim Partus (13.9% and 55.5%;respectively), (P = 0.001 and 0.01;respectively). The Odds ratio and the relative risk for prediction of PTL in symptomatic women within 14 days were significantly high for PremaQuick compared to the CL 25 mm, and Actim Partus. Conclusion: PremaQuick test seems to be the best complementary test to the CL 25 in prediction of PTL in symptomatic women within 14 days. PremaQuick test compensates the low specificity and low PPV of the CL 25 mm in prediction of PTL.

The association of fFN testing on hospital admissions for preterm labor

Objective: To determine if the use of fetal fibronectin (fFN) testing has affected hospital admissions for preterm labor. Methods: ICD-9 and CPT codes from all admissions to Brigham & Women’s Hospital between January 1, 1995 and December 31, 2010 were evaluated. Data recorded included total deliveries, admissions for preterm labor (PTL) without delivery, length of stay (days) for PTL admissions, preterm deliveries, and number of fFN tests performed. The data was evaluated using a Wilcoxon test of trend and least squares regression. Results: Fetal fibronectin testing was introduced mid-year 2001. As a percentage of total deliveries, the number of admissions for PTL without delivery decreased from 3.97% in 1995 to 2.16% in 2010

5<i>β</i>-Dihydroprogesterone and Human Preterm Labor

We previously investigated the progesterone metabolite 5β-dihydroprogesterone (5βDHP) in relation to human parturition at term, demonstrating that peripheral venous concentrations decrease in association with the onset of spontaneous labour. In this study our aim was to determine if 5βDHP concentrations were lower in women presenting in spontaneous preterm labour than in controls matched for gestational age. Blood samples were obtained from women presenting in spontaneous preterm labour (n = 20). The diagnosis was made on the presence of regular contractions and cervical effacement and dilatation of at least 3 cms. All women in the preterm labour group delivered before 37 weeks gestation. Blood samples were then obtained from controls, closely matched for gestational age with uncomplicated pregnancies. The preterm labour group was further stratified by cause into three groups, chorioamnionitis (n = 5), abruption (n = 4) and idiopathic (n = 11). Following organic solvent extraction, steroids were separated by HPLC and 5βDHP quantified by radioimmunoassay. Women in the idiopathic preterm labour group were found to have significantly lower circulating concentrations of 5βDHP than controls

Role of Vaginal Progesterone in Prevention of Preterm Labor in Women with Previous History of One or More Previous Preterm Births

Objective: To evaluate whether prophylactic administration of 200 mg vaginal progesterone can reduce the incidence of preterm birth in women with documented history of preterm birth Setting: Obstetrics and Gynecology Department, Zagazig University Hospital, Egypt. Methods: Ninety patients with previous history of preterm birth prior to 37 week presenting with singleton pregnancy between 20 - 24 weeks were randomly allocated to receive either the progesterone 200 mg vaginal suppository or no treatment. Results: The incidence of preterm labor before 37 weeks of gestation was significantly lower in the study group than in the control group (22.2% vs. 53.3%) especially in earlier gestational ages. While, the mean birth weight was significantly higher in the study group than in control group (2872.67 ± 565.76 gm vs. 2487.78 ± 742.40 gm). The neonatal morbidities and mortality associated with preterm labor were significantly lower in the study group than in the control group as shown by lower incidence of neonatal RDS (13.3% vs. 31.1%;P = 0.043) and lower incidence of the need for NICU admission (15.6% vs. 35.5%;P = 0.03). Conclusion: Administration of prophylactic vaginal progesterone (200 mg, daily) can significantly reduce the rate of preterm birth before 37, 32 and 28 wks of gestation among women with previous spontaneous preterm birth. In addition, the rates of RDS and admission to NICU were significantly decreased among infants of women assigned to progesterone treatment. Also, there was an additional benefit of vaginal progesterone for prevention of preterm birth in women who had prior spontaneous preterm birth and cervical length 25 mm.

Cervical Length Estimation and Cervicovaginal Fluid for Placental <i>α</i>-Microglobulin 1 Testing to Screen Women Had Threatened Preterm Labor for Time till Spontaneous Labor

Objectives: Evaluation of diagnostic performance of rapid testing of cervico-vaginal fluid (CVF) for fetal fibronectin (FFN) and placental α-microglobulin 1 (PAMG-1) as screening of women presented by threatened preterm labor (TPTL) with intact membranes for duration till getting spontaneous labor (SL). Patients & Methods: 37 women presenting with TPTL underwent CVF samplings before digital examination and then underwent transvaginal ultrasonography for estimation of cervical length (CL). All women received fluid and anxiolytic therapy and if uterine contractions persisted, all had received tocolytic therapy with oral nifedipine or intravenous magnesium sulphate according to requirements. Incidence of SL within Results: Incidence of SL was 13.5%, 35.2% and 51.3% within 48-hr, 2 - 7 and 7 - 14 days, respectively. Duration till labor after sampling was positively correlated with CL, while was negatively correlated with positive FFN and PAMG-1 tests. Positive FFN test had high specificity, while positive PAMG-1 test had high sensitivity for labor within 7 days. Regression analysis defined short CL and positive PAMG-1 test as significant predictors for short duration till SL. ROC curve analysis defined short cervix and positive PAMG-1 test as significant predictors for labor within 48-hr and within 2 - 7 days respectively and combined negative PAMG-1 test and CL of 20 - 25 mm were significant predictors for labor within 7 - 14 days. Conclusion: PAMG-1 test had high specificity, if positive, for predicting SL and high NPP, if negative, for excluding labor within 7 days, so it can be used as rapid adjuvant to clinical evaluation to help management decision-making. Moreover, PAMG-1 test is recommended screening test for being easy-to-use bedside test, provides rapid results, can be used after vaginal exam and coitus and does not require a speculum examination or specialized equipment to analyze results.

单胎妊娠24周前短宫颈孕妇不同治疗方式妊娠结局及早产影响因素分析

目的探讨单胎妊娠24周前短宫颈孕妇不同治疗方式妊娠结局及早产影响因素。方法回顾性选取2020年1月至2022年12月在温州市人民医院接受产前检查或住院,妊娠24周前经阴道或会阴超声测量宫颈长度≤25 mm并接受孕激素治疗的86例单胎孕妇为研究对象。根据宫颈长度分为≤10 mm组24例、>10~20 mm组24例、>20~25 mm组38例,每组根据治疗方式不同又分为对照组(仅黄体酮软胶囊治疗)、宫颈环扎组(黄体酮软胶囊联合宫颈环扎术治疗)、子宫托+宫颈环扎组(黄体酮软胶囊联合子宫托+宫颈环扎术治疗);比较相同宫颈长度组内3种治疗方式孕妇妊娠结局及新生儿结局,采用多因素logistic回归分析妊娠24周前短宫颈孕妇早产的影响因素。结果在宫颈长度≤10 mm组内,宫颈环扎组、子宫托+宫颈环扎组妊娠延长时间、分娩孕周以及新生儿体重均大于对照组(均P<0.05),<28周分娩比例以及新生儿死亡率均低于对照组(均P<0.05);但宫颈环扎组与子宫托+宫颈环扎组妊娠结局及新生儿结局比较差异均无统计学意义(均P>0.05)。在宫颈长度>10~20 mm组内,宫颈环扎组、子宫托+宫颈环扎组新生儿死亡率均低于对照组(均P<0.05),宫颈环扎组羊膜腔感染率高于对照组、子宫托+宫颈环扎组(均P<0.05),子宫托+宫颈环扎组新生儿体重均大于对照组、宫颈环扎组(均P<0.05);3种治疗方式妊娠延长时间,分娩孕周,<28、34、37周分娩比例以及新生儿不良结局比较差异均无统计学意义(均P>0.05)。在宫颈长度>20~25 mm组内,3种治疗方式孕妇妊娠结局及新生儿结局比较差异均无统计学意义(均P>0.05)。宫颈长度(OR=0.919,P=0.016)是妊娠24周前短宫颈孕妇早产的独立保护因素,羊膜腔感染(OR=7.064,P<0.001)是妊娠24周前短宫颈孕妇早产的独立危险因素。结论宫颈长度是妊娠24周前短宫颈孕妇早产的独立保护因素,羊膜腔感染是独立危险因素。妊娠24周前宫颈长度≤10 mm的单胎孕妇采用宫颈环扎术或子宫托+宫颈环扎术能改善妊娠结局及新生儿结局,而宫颈长度>10 mm的单胎孕妇,不同治疗方式对妊娠结局及新生儿结局影响不大。

Mental health impact on Black,Asian and Minority Ethnic populations with preterm birth:A systematic review and meta-analysis

BACKGROUND Preterm birth(PTB)is one of the main causes of neonatal deaths globally,with approximately 15million infants are born preterm.Women from the Black,Asian,and Minority Ethnic(BAME)populations maybe at higher risk of PTB,therefore,the mental health impact on mothers experiencing a PTB is particularly important,within the BAME populations.AIM To determine the prevalence of mental health conditions among BAME women with PTB as well as the methods of mental health assessments used to characterise the mental health outcomes.METHODS A systematic methodology was developed and published as a protocol in PROSPERO(CRD420-20210863).Multiple databases were used to extract relevant data.I2 and Egger's tests were used to detect the heterogeneity and publication bias.A trim and fill method was used to demonstrate the influence of publication bias and the credibility of conclusions.RESULTS Thirty-nine studies met the eligibility criteria from a possible 3526.The prevalence rates of depression among PTB-BAME mothers were significantly higher than full-term mothers with a standardized mean difference of 1.5 and a 95%confidence interval(CI)29%-74%.The subgroup analysis indicated depressive symptoms to be time sensitive.Women within the very PTB category demonstrated a significantly higher prevalence of depression than those categorised as non-very PTB.The prevalence rates of anxiety and stress among PTB-BAME mothers were significantly higher than in full-term mothers(odds ratio of 88%and 60%with a CI of 42%-149%and 24%-106%,respectively).CONCLUSION BAME women with PTB suffer with mental health conditions.Many studies did not report on specific mental health outcomes for BAME populations.Therefore,the impact of PTB is not accurately represented in this population,and thus could negatively influence the quality of maternity services they receive.

硝苯地平联合利托君治疗先兆早产对足月分娩率的影响研究

目的研究硝苯地平联合利托君治疗先兆早产对足月分娩率的影响。方法按照随机数字表法将平顶山市妇幼保健院2022年2月至2023年10月期间收治的72例先兆早产患者分为观察1组(单一应用硝苯地平治疗),观察2组(单一应用利托君治疗)及联合组(联合硝苯地平与利托君治疗),每组各24人。观察三组患者治疗效果、生化指标、妊娠情况、用药不良反应及新生儿结局情况。结果联合组治疗有效率(91.67%)高于观察1组(66.67%)、观察2组(62.50%),三组相比较,差异有统计学意义(P<0.05)。治疗后,联合组患者白细胞介素-17、子宫内膜抗体水平下降,转化生长因子-β、可溶性人类白细胞抗原-G指标增加,三组生化指标比较,差异有统计学意义(P<0.05)。联合组患者宫缩消失时间比观察1组、观察2组短,孕期延长时间比观察1组、观察2组长,分娩孕周比观察1组、观察2组晚,且联合组保胎成功率高于观察1组、观察2组,差异有统计学意义(P<0.05)。联合组患者用药不良反应发生率与观察1组、观察2组对比,差异无统计学意义(P>0.05)。联合组新生儿死亡率(8.33%)低于观察1组(33.33%)、观察2组(37.50%),且新生儿窒息率(8.33%)低于观察1组(41.67%)、观察2组(37.50%),新生儿Apgar评分高于观察1组、观察2组,联合组新生儿情况较好,差异有统计学意义(P<0.05)。结论应用硝苯地平联合利托君治疗能有效抑制患者宫缩作用,改善临床症状以及生化指标,延长孕期,提高足月分娩率,且安全性较高,避免不良反应,新生儿情况良好,临床有一定的应用价值。

硫酸镁联合孕激素治疗对先兆早产患者性激素及妊娠结局的影响

目的:探究硫酸镁联合孕激素治疗对先兆早产患者性激素及妊娠结局的影响。方法:选取2021年3月至2023年3月我院收治的78例先兆早产患者作为研究对象,按照抽签法将研究对象随机分为对照组和研究组,各39例。对照组采用硫酸镁稀释于葡萄糖注射液中治疗,研究组采用硫酸镁联合孕激素进行治疗。分析比较两组的性激素水平,妊娠结局以及不良反应发生情况。结果:治疗后,研究组孕酮激素(Progesterone,P)、雌二醇激素(Blood Serum Estradiol,E2)以及人绒毛膜促性腺激素(Human Chorionic Gonadotrophin,HCG)水平均明显高于对照组(P<0.05)。研究组足月分娩率明显高于对照组(P<0.05),新生儿窒息率明显小于对照组(P<0.05)。对照组和研究组的不良反应总发生率无明显差异(P>0.05)。结论:硫酸镁联合孕激素治疗可以有效改善先兆早产患者性激素水平与不良妊娠结局;还可以有效的改善新生儿窒息情况,提高足月分娩率;其效果显著,且无明显副作用,具有良好的安全性。

Expression of Toll-Like Receptor-2 and -4 in Amniochorion Membranes of Preterm Delivery in the Presence of Histologic Chorioamnionitis

Expression of Toll-like receptors at the maternal-fetal interface during normal and complicated pregnancies has aroused interest in the last few years. However, despite the importance of TLR-2 and TLR-4, which recognizes most microorganisms presenting in the amniotic cavity infections associated with prematurity, comparison of the expressions of these receptors is rare in the literature. Thus, the purpose of this study was to compare the gene expression between TLR-2 and TLR-4 in amniochorion membranes of pregnant women with preterm delivery in the presence of histologic chorioamnionitis (HCA). Amniochorion membranes were collected from 40 pregnant women with preterm delivery;20 presented HCA and 20 did not. Fragments of the membranes were submitted to total RNA extraction, followed by cDNA production by reverse transcription. Real time quantitative PCR was used to quantify the gene expression of the TLRs. mRNA concentrations between TLR-2 and TLR-4 were compared using the nonparametric Mann-Whitney test. TLR-2 expression was higher than TLR-4 expression in the presence of HCA. No difference was observed between TLR-2 and TLR-4 expression in membranes in the absence of inflammatory infiltrate. In conclusion, amniochorion membranes express TLR-2 and TLR-4 and higher TLR-2 expression in the presence of histologic chorioamnionitis suggests that microorganisms recognizable by TLR-2 play an important role in the physiopathology of preterm labor.

“Dermal Nitroglycerin Patch” in Treatment of Preterm Labour

Although preterm birth is the delivery before 37 + 0 weeks of gestation, the majority of prema-turity-related complications occur before 33 + 0 weeks of gestation. The need of today is to select the best agent out of the broad spectrum of available tocolytic agents, for providing maximum benefit to unfortunate sufferers of prematurity. The study aims to assess the role of “Dermal Nitroglycerin Patch” in treatment of preterm labour. Method: Study conducted in Department of Obstetrics & Gynecology, NIMS Medical College & Hospital, Jaipur from July 2014-December 2014. A prospective randomized study of 50 women of preterm labor was enrolled after informed consent. Patients were given dermal nitroglycerin patch as tocolytic agent according to study protocol. Result: 1) Results of NTG PATCH are comparable with other tocolytic drugs in terms of successful tocolysis;2) Maternal and fetal outcome is favourable in cases of NTG PATCH USE in preterm labour;3) Side effect profile was also better with NTG Patch. Conclusion: This randomized prospective study lends support to the proportion that Transdermal Nitroglycerine (NTG Patch) may be promising safe, effective, well tolerated, cost effective and non invasive method of tocolysis.

Heterotopic pregnancy after assisted reproductive techniques with favorable outcome of the intrauterine pregnancy:A case report

BACKGROUND Heterotopic pregnancy(HP)is a rare condition in which both ectopic and intrauterine pregnancies occur.HP is uncommon after natural conception but has recently received more attention due to the widespread use of assisted reproductive techniques(ART)such as ovulation promotion therapy.CASE SUMMARY Here,we describe a case of HP that occurred after ART with concurrent tubal and intrauterine singleton pregnancies.This was treated successfully with surgery to preserve the intrauterine pregnancy,resulting in the birth of a low-weight premature infant.This case report aims to increase awareness of the possibility of HP during routine first-trimester ultrasound examinations,especially in pregnancies resulting from ART and even if multiple intrauterine pregnancies are present.CONCLUSION This case alerts us to the importance of comprehensive data collection during regular consultations.It is important for us to remind ourselves of the possibility of HP in all patients presenting after ART,especially in women with an established and stable intrauterine pregnancy that complain of constant abdominal discomfort and also in women with an unusually raised human chorionic gonadotropin level compared with simplex intrauterine pregnancy.This will allow symptomatic and timeous treatment of patients with better results.

Pregnancy Outcomes in Pregnant Patients with COVID-19: A Multicenter Study

Introduction: Acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was declared a pandemic by the World Health Organization (WHO) on March 11, 2020. The presence of COVID-19 in a pregnant patient can raise concerns, as other types of coronaviruses were associated with many adverse outcomes. This study aims to study the effect of COVID-19 on pregnancy outcomes. Methods: A prospective cross-sectional cohort study within Central First Health Care Cluster (multicentric), Riyadh, included all pregnant women with a singleton pregnancy diagnosed as COVID-19-positive. The primary outcome is the severity of COVID during pregnancy in terms of ICU admission and mortality. The participants were divided into three groups (preterm less than 37 weeks, the term from 37 - 40 weeks, and late-term after 40 weeks. In addition, parameters included: Gestational age at diagnosis, symptoms at presentation (cough, fever), presence of congenital anomalies, IUFD, mode of delivery, presence of PPH, newborn Apgar score, cord PH, need for NICU admission, and the newborn becoming infected with COVID-19 were also measured as secondary outcomes. Results: One hundred pregnant, COVID-19-positive women met the inclusion criteria;the average age of participants was 31.2 years (SD ± 6.4). Asymptomatic patients represented 54% of participants. Most of the deliveries occurred at 36 weeks or less as preterm delivery. Cesarean sections represented 55% of our population. Four-term mothers (12.5%), more than 37 weeks, need ICU admission compared to 13 (25%) preterm cases diagnosed with preeclampsia. No maternal death. Conclusion: COVID-19 during pregnancy can increase ICU admission. A high rate of preterm labor, miscarriage, cesarean section, and newborn testing positive for COVID-19 were observed among our population. No congenital anomalies related to COVID-19 were observed.

子宫宫颈角与子宫颈长度的早产预测分析

目的研究子宫颈长度(CL)与子宫宫颈角(前角aUCA和后角pUCA)的早产预测价值,探索宫颈超声预测早产的新指标,以提供新的早产预测思路。方法对孕24~27+6周的252例妇女进行前瞻性队列研究,经阴道测量CL、aUCA和pUCA,根据分娩时间分为足月组和早产组,比较2组间各项指标的差异及彼此间的早产预测效能。结果236例足月产,16例早产,2组间aUCA和pUCA差异均存在统计学意义(P<0.05),而CL无统计学意义(P>0.05);计算出3项子宫颈超声指标的ROC曲线下面积(AUC),只有aUCA的AUC明显大于0.5,其阈值为102.22°;aUCA联合CL预测早产的ROC曲线下面积为0.715,联合因子的阈值为-2.385。结论孕24~27^(+6)周单活胎孕妇CL的早产预测性欠佳,当aUCA≥102.22°需警觉自发性早产的发生,推荐联合aUCA和CL对无症状的孕妇进行早产预测;CL、pUCA的早产预测价值有待进一步研究。

先兆早产孕妇的临床特征及自发性早产发生风险模型的构建与验证

目的探讨先兆早产孕妇的临床特征及其对自发性早产发生风险的预测价值。方法回顾性分析2019年5月至2022年5月安庆市立医院收治的135例先兆早产孕妇的临床资料。采用随机数字法将就诊患者以2∶1的比例分为训练集(90例)与验证集(45例)。根据是否发生自发性早产,将训练集患者分为自发性早产组(58例)与非自发性早产组(32例),比较自发性早产组与非自发性早产组患者的临床特征及妊娠结局。采用多因素Logistic回归分析影响先兆早产孕妇发生自发性早产的危险因素。应用R软件构建贝叶斯网络模型,用Netica软件进行贝叶斯网络模型的推理预测;采用训练集数据做受试者工作特征(ROC)曲线和校正曲线,对模型的区分度和准确度进行评价,用验证集数据对模型进行外部评价;采用ROC曲线评估各危险因素对先兆早产孕妇发生自发性早产的预测价值。结果自发性早产组的胎儿纤维连接蛋白(fFN)、宫颈长度(CL)、胎盘α1-微球蛋白(PAMG-1)水平异常、基质金属蛋白酶抑制剂-1(TIMP-1)水平异常、白细胞介素-8(IL-8)水平异常、羊水过多、妊娠期糖尿病、胎膜早破的分布与非自发性早产组比较差异均有统计学意义(χ^(2)值分别为5.792、32.620、8.753、8.459、6.842、6.298、7.429、16.703,P<0.05)。多因素Logistic回归分析显示,fFN(OR=2.975,95%CI:1.207~7.332)、CL(OR=20.236,95%CI:6.270~65.314)、PAMG-1水平异常(OR=3.876,95%CI:1.545~9.722)、TIMP-1水平异常(OR=3.960,95%CI:1.525~10.281)、IL-8水平异常(OR=3.248,95%CI:1.323~7.976)、羊水过多(OR=3.101,95%CI:1.262~7.616)、妊娠期糖尿病(OR=3.421,95%CI:1.389~8.428)、胎膜早破(OR=8.217,95%CI:2.764~24.432)均为发生自发性早产的独立危险因素(P<0.05)。ROC曲线分析显示,8项指标联合对自发性早产的预测价值[曲线下面积(AUC)=0.844]高于fFN(AUC=0.819)、CL(AUC=0.718)、PAMG-1水平异常(AUC=0.795)、TIMP-1水平异常(AUC=0.817)、IL-8水平异常(AUC=0.733)、羊水过多(AUC=0.789)、妊娠期糖尿病(AUC=0.743)、胎膜早破(AUC=0.807)各单项指标。训练集与验证集ROC曲线和校正曲线均显示贝叶斯网络模型具有较好的区分度和准确度。非自发性早产组的延长妊娠时间、新生儿体重、新生儿5min Apgar评分均明显高于自发性早产组(t值分别为7.041、14.045、6.027,P<0.05)。结论先兆早产孕妇的临床特征对自发性早产发生风险可能有一定的预测参考。