Hypoglycaemia in screening oral glucose tolerance test in pregnancy with low birth weight fetus

Maternal hypoglycemia,a condition characterized by lower than normal blood glucose levels in pregnant women,has been increasingly associated with adverse pregnancy outcomes,including low birth weight(LBW)in neonates.LBW,defined as a birth weight of less than 2500 g,can result from various factors,including maternal nutrition,health status,and metabolic conditions like hypoglycemia.Maternal hypoglycemia may affect fetal growth by altering the supply of essential nutrients and oxygen to the fetus,leading to restricted fetal development and growth.This condition poses significant risks not only during pregnancy but also for the long-term health of the child,increasing the likelihood of developmental delays,health issues,and chronic conditions later in life.Research in this area has focused on understanding the mechanisms through which maternal hypoglycemia influences fetal development,with studies suggesting that alterations in placental blood flow and nutrient transport,as well as direct effects on fetal insulin levels and metabolism,may play a role.Given the potential impact of maternal hypoglycemia on neonatal health outcomes,early detection and management are crucial to minimize risks for LBW and its associated complications.Further investigations are needed to fully elucidate the complex interactions between maternal glucose levels and fetal growth,as well as to develop targeted interventions to support the health of both mother and child.Understanding these relationships is vital for improving prenatal care and outcomes for pregnancies complicated by hypoglycemia.

Effects of Health Education with Problem-Based Learning Approaches on the Knowledge, Attitude, Practice and Coping Skills of Women with High-Risk Pregnancies in Plateau Areas

Objective: Given the unique cultural background, way of life, and physical environment of the Tibetan Plateau, this study aims to investigate the effects of health education using problem-based learning (PBL) approaches on the knowledge, attitude, practice, and coping skills of women with high-risk pregnancies in this region. Methods: 76 high-risk pregnancy cases were enrolled at Tibet’s Linzhi People’s Hospital between September 2023 and April 2024. 30 patients admitted between September 2023 and December 2023 were selected as the control group and were performed with regular patient education. 46 patients admitted between January 2024 and April 2024 were selected as the observation group and were performed regular patient education with problem-based learning approaches. Two groups’ performance on their health knowledge, attitude, practice and coping skills before and after interventions were evaluated, and patient satisfaction were measured at the end of the study. Results: There was no statistical significance (P P P Conclusions: Health education with problem-based learning approaches is worth promoting as it can help high-risk pregnant women in plateau areas develop better health knowledge, attitude and practice and healthier coping skills. Also, it can improve patient sanctification.

Hereditary Angioedema in Pregnancy and Management without Recombinant Human C1-INH

A pregnant woman diagnosed with type 1 angioedema seeks care at a public hospital for planning the delivery. This report presents ways to prevent and manage an acute HAE crisis during childbirth and early postpartum without the availability of first-line medications, such as plasma-derived human C1-INH concentrate.

Exploring Experiences with "321" Model Management for High-Risk Pregnancy: A Qualitative Study

To editor:In recent years,obstetricians have needed to managemore complex pregnancies involving acute and chronicmedical disorders,and a greater number of pregnancieseach year are now delivered by critical care services.1Datafrom the United States show that poorly controlled maternal medical conditions can have an adverse impact on preg-nancy outcomes.

Effect of antioxidants on amelioration of high-risk factors inducing hypertensive disorders in pregnancy

Background This is a prospective clinical study based on a large sample gathered from multiple centers in China, subordinating to 10th Five-Year Plan of National Science ＆ Technology Progression. We analyzed the high-risk factors inducing hypertensive disorders in pregnancy （HDP） and estimated the potential effect of anti-oxidants administration, including vitamin C （VC）, vitamin E （VE） and Salvia Miltiorrhiza L （SML）, a Chinese herb medicine, in amelioration of the high-risk factors in pregnancy. Methods From April 2005 to July 2006, 4814 pregnant women from 24 national wide cooperative hospitals were involved in this prospective research. The participants were randomly divided into two groups： 1607 cases were in anti-oxidants group with administration of vitamins and SML; 3207 cases were in control group without any medicine given. Every participant was under monitoring for the morbidity of HDP and the high-risk factors were investigated in HDP cases in each group. Results （1）The morbidity of HDP was 3.55% in anti-oxidants group vs. 4.18% in control group. No statistical difference existed between the two groups （P〉0.05）. （2） In anti-oxidants group, the HDP morbidities among three subgroups： VC ＋ VE ＋ SML, VC ＋ VE and SML only, were 5.51%, 3.05% and 5% respectively. It showed no statistical difference among three remedies （P 〉0.05）. （3） The related index of factors affecting HDP showed in intensity sequence as follows： family HDP history 〉 profession 〉 education level 〉 age 〉 body weight. The incidence of HDP in normal population was 3.51%, and the incidence of HDP in high-risk pregnant women （family HDP history, heavy physical labor, low education level （middle school and below）, age 〉40, body mass index 〉24） was 5.84%, which was obviously higher than that in normal population （P 〈0.01）. In anti-oxidants group, the probability of HDP in women with high-risk factors was 3.81%, which was obviously lower than that in control group with high-risk factors at 7.14% （P〈0.01）. （4） In control group, the morbidity of HDP in women with family HDP history （especially with sisters＇）, heavy physical labor, middle school and below, age 〉35 was： 50.00%, 15.22%, 6.33%, 26.28% and 5.75%, respectively, and that in anti-oxidants group was 0, 7.69%, 3.74%, 9.27% and 2.67%, respectively, which was obviously lower than that in control group. Conclusions The high-risk factors prone to induce HDP included： family history of HDP, heavy physical labor, low education level, aging and obesity. No impressive effect of anti-oxidants application was found in preventing HDP in general population but the remedy demonstrated positive effect on preventing HDP in pregnant women with high-risk factors.

Hemodynamic Fetal Response to Maternal Isometric Exercise in Pregnant Patients with Hypertension

Objective: to evaluate the maternal-fetal hemodynamic response with Doppler in pregnant women with chronic arterial hypertension and preeclampsia submitted to controlled isometric activity. Methods: experimental study comparing 50 healthy and 26 hypertensive and 24 preeclamptic pregnant women, from 26 to 36 weeks of gestational age, submitted to isometric contraction with handgrip dynamometer. Maternal hemodynamic parameters (systolic and diastolic blood pressure;heart rate;uterine arteries Doppler) and fetal (heart rate;umbilical artery, middle cerebral and venous duct Doppler) were evaluated before, during and post-isometry. Results: in preeclampsia were observed higher values of blood pressure and uterine artery indexes in all times;middle cerebral artery indexes in the pre and post-isometry;and of maternal heart rate post-isometry. In hypertensive women, systolic blood pressure is increased all the times, with indexes of the right uterine and middle cerebral arteries higher in pre-isometry;middle cerebral and umbilical arteries greater during isometry;and maternal heart rate and umbilical artery indexes bigger after isometry. Conclusion: blood pressure is higher in preeclamptic and hypertension women. The right uterine artery has more resistance in preeclampsia, with a significant decrease in pre to isometry in hypertensive and preeclamptic women;and increased in contraction to post-isometry in healthy and hypertensive women. The left uterine artery increases resistance post-isometry in all groups. The fetal hemodynamic parameters did not show significant differences when comparing the before, during and post-isometry.

Clinical analysis of the delivery outcomes of women with abnormal uterus

Objective:To guide the pregnancy and delivery of patients with abnormal uterus through analyzing the delivery outcomes of them.Methods:A total of 32 pregnant cases with abnormal uterus were collected in the North China University of Science and Technology Affiliated Hospital from 2011 to 2018.7615 cases with normal uterus who visited the hospital and delivered during the same period were also collected.The rate of abnormal fetal position,premature rupture of membranes,premature delivery,postpartum complications,and caesarean section,were compared between the two groups by the χ^2 test through SPSS.P values less than 0.05 were considered statistically significant.Results:There were significant differences in abnormal fetal position,premature rupture of membranes,premature delivery and spontaneous birth rate between the two groups(P<0.05),but there was no significant difference in the incidence of postpartum hemorrhage between the two groups(P>0.05).In the cause of cesarean section,there was significant difference in abnormal fetal position and scarred uterus(P<0.05),but no significant difference in placenta previa and other causes(P>0.05).Conclusion:Abnormal fetal position,premature rupture of membranes and premature delivery are more likely to occur in pregnant women with abnormal uterus than in normal ones.The rate of cesarean section in patients with abnormal uterus is significantly higher than that of normal uterus,due to the main reason of abnormal fetal position.Abnormal uterus is a high-risk factor for pregnant women,and patients with abnormal uterus should be strengthened the management of pregnancy and relaxed the indications of cesarean section.

Instrument-Dependent or Instrument-Independent Indications and Prevalence of Chromosomal Abnormalities by Amniocentesis in China:An Analysis of 4146 Cases of Amniocentesis

Objective:There is a high incidence of birth defects in China,and prenatal diagnosis is an important method of intervention.This study aims to describe the clinical indications and cytogenetic results of amniocentesis cases in central China.Methods:We retrospectively reviewed cases at the Maternal and Child Care Service Centre in Henan Province from January 2012 to December 2014.A total of 4497 at-risk mothers(risk factors:advanced maternal age,history of intrauterine fetal death or aborted fetuses,chromosomal abnormality in one of the parents,high-risk maternal serum screening results,and abnormal ultrasonographic findings in the first or second trimester)were recruited for amniocentesis(AS).The subjects included were between 11–14 and 18–22 weeks of gestation.All cases were divided into two groups based on instrument-independent or instrument-dependent indications.Results:A total of 4146 cases were analyzed.Of these,chromosomal abnormalities were detected in 232 cases(5.6%),and autosomal aneuploidy,including trisomy 21 and trisomy 18,was found to be the most common(55.7%)chromosomal abnormality.The mean age of 29.94 years was not expected as all mothers older than 35 years old were routinely offered amniocentesis at the time of the study.Amniocentesis was carried out in 1711 cases because of instrument-independent indications,and 285 of these cases were diagnosed with chromosomal abnormality.In 2376 cases,amniocentesis was conducted because of instrumentdependent indications,and 176 of these were diagnosed with chromosomal abnormality.Thus,5.6%of the cases were diagnosed with chromosomal abnormalities,and autosomal aneuploidy,including trisomy 21 and trisomy 18,were the most common chromosomal abnormalities detected in the present study Conclusion:Our result indicated the significance of instrument-independent indications in the screening of chromosomal abnormalities,especially in developing areas.Birth defects may be reduced by paying more attention to the patients’history of medication.

Autoimmune-associated Congenital Heart Block： A New Insight in Fetal Life

Objective： Congenital heart block （CHB） is a rare but life-threatening disorder. More than half of CHB cases are associated with maternal autoimmune, which are termed as autoimmune-associated CHB. This review summarized the recent research findings in understanding autoimmune-associated CHB, discussed the current diagnostic approaches and management strategies, and summarized the problems and future directions for this disorder. Data Sources： We retrieved the articles published in English from the PubMed database up to January 2017, using the keywords including＂Autoimmune-associated＂, ＂Autoimmune-mediated＂, and ＂Congenital heart block＂. Study Selection： Articles about autoimmune-associated CHB were obtained and reviewed. Results： Observational studies consistently reported that transplacental maternal antibodies might recognize fetal or neonatal antigens in various tissues and result in immunological damages, but the molecular mechanisms underlying CHB pathogenesis still need illuminated. Multiple factors were involved in the process of atrioventricular block development and progression. While several susceptibility genes had been successfully defined, how these genes and their protein interact and impact each other remains to be explored. With currently available diagnostic tools, fetal ultrasound cardiography, and fetal magnetocardiography, most of CHB could be successfully diagnosed and comprehensively evaluated prenatally. The efficacy of current approaches for preventing the progression and recurrence of CHB and other autoimmune-mediated damages was still controversial. Conclusions： This review highlighted the relationships between autoimmune injuries and CHB and strengthened the importance of perinatal management and therapy for autoimmune-associated CHB.

Obstetrical specificities of Ivorian adolescent mothers on a single-center hospital series of 1040 cases

Overview and aim:The precocity of sexual intercourse among adolescent girls is a prominent source of unwanted pregnancy.Here,we aim to survey the past issues relating to the pregnancy,childbirth,and materno-fetal prognosis of Ivorian adolescent women.Methods:We conducted a retrospsective study with adolescent group(n=1040)versus young adult group aged 20 to 24(n=736)over three years from1st January 2016 to 31rd December 2018 at the Department of Obstetrics and Gynecology at the University of Abidjan-Yopougon Hospital.Maternal and fetal outcomes of the two groups were analyzed and compared by using Pearson's Chi2 tests and Fisher's exact tests,followed by multivariate analysis and logistic regression using Stata software version 20.Results:The average age of adolescent girls in our study was 17.45 years(SD=1.39)and a minimum of 12 years.Adolescents consulted less(P<0.0001)and later(P<0.0001)versus young adults aged 20 to 24.The proportion of adolescent girls(47.6%)versus young adults(39.1%)who had underwent caesarean section was significantly higher(P=0.0004).These adolescents were 3.5-fold more likely to develop hypertension and its complications in the postpartum period and 2.5-fold more likely to contract a postpartum infection.Maternal mortality was not significantly associated with adolescence(OR=0.52)(95%CI:0.22–1.19;P=0.0891).The risk of prematurity,early neonatal death,and neonatal admission were 2.02(95%CI:1.56–2.63;P<0.0001),1.55(95%CI:1.14–2.13;P=0.0040),and 1.73(95%CI:1.12–2.71;P=0.0097)in adolescence,respectively.Conclusion:Adolescent childbirth remains associated with a poor prognosis.

The Clinical Value of Artery Umbilical Cord Blood Gas in Predicting Neonate Condition:A Prospective Cohort Study

Objective:To evaluate the predictive ability of neonate condition through the traditional parameters and artery umbilical cord blood gas(aUCBG).Methods:A prospective cohort study was conducted in obstetrics and gynecology department between October 2017 and August 2018 at Tongji Hospital in Wuhan,China,and 360 aUCBG samples were collected.The average age of pregnant women was(29.50±4.42)years,range from 19 to 48 years old.The gestational age range from 28+4 weeks to 41+3 weeks at admission.Logistic regression and area under the curve(AUC)from Receiver operating characteristic curves were used to identify risk factors,such as,premature rupture of membranes(PROM),high blood pressure,premature delivery(PD),low 1-minute Apgar scores(Apgar 1),low 5-minute Apgar scores(Apgar 5),pH,base excess,bicarbonate,neonatal blood sugar(NBS),and so on,to predict neonatal condition and evaluate the predictive ability of traditional and aUCBG parameters.Results:In all cases,PROM,PD,Apgar 1,Apgar 5,pH,base excess,bicarbonate,total carbon dioxide,and neonatal blood sugar were risk factors and were associated with poor condition of neonate.Apgar 1 were an independent risk factor.Combined traditional and aUCBG parameters had higher AUC of 0.895(95%confidence interval(C/):0.830-0.960,P<0.001).In cesarean section subgroup,high blood pressure,PD,and Apgar 1 were risk factors and were associated with poor condition of neonate.Apgar 1 and low pH were the independent risk factors.Combined traditional and aUCBG parameters had highest AUC of 0.940(95%C/:0.886-0.993,P<0.001).In vaginal delivery subgroup,maternal age above 35 years,PROM,PD,Apgar 1,Apgar 5,and male newborn were risk factors and were associated with poor condition of neonate.Maternal age above 35 years was an independent risk factor.Combined traditional and aUCBG parameters had highest AUC of 0.897(95%Cl:0.828-0.965,P<0.001).For pregnant women without comorbidities and complications of pregnancy,aUCBG may not be necessat7.Conclusion:In high-risk pregnancies,especially lower Apgar scores,PD,and maternal age above 35-year old,aUCBG is recommended.Traditional parameters combined with aUCBG might increase the predicting ability of neonate condition.