Inflammatory bowel disease (IBD) is a chronic, sometimes debilitating condition that affects mainly the young population. The effect of IBD on pregnancy is therefore an important clinical issue. Many Obstetricians are...Inflammatory bowel disease (IBD) is a chronic, sometimes debilitating condition that affects mainly the young population. The effect of IBD on pregnancy is therefore an important clinical issue. Many Obstetricians are likely to come across the occasional patient with this chronic condition. The following article discusses the salient factors which need to be considered in pregnant women with IBD and serves as a quick, practical but nevertheless comprehensive guide for the practicing Obstetrician.展开更多
Background Small for gestational age （SGA） infants are associated with a high rate of oligohydramnios, stillbirth and cesarean delivery. Among SGA patients there is a higher risk of neonatal complications, such as p...Background Small for gestational age （SGA） infants are associated with a high rate of oligohydramnios, stillbirth and cesarean delivery. Among SGA patients there is a higher risk of neonatal complications, such as polycythemia, hyperbilirubinemia, and hypothermia. Additionally, the SGA infant is prone to suffer from major neurologic sequelae, as well as cardiovascular system disease, in later life. Proper monitoring and therapy during pregnancy are, therefore, of utmost importance. The present study aimed to investigate the influential and prognostic factors of SGA infants.Methods From January 2001 to June 2007, a total of 55 SGA neonatal infants were included in a study group. All were born at Peking Union Medical College Hospital, with regular formal antenatal examinations. In addition, a total of 122 cases of appropriate for gestational age （AGA） infants were born at the same time and were registered into a control group. All cases were singleton pregnancies with detailed information of the maternal age, gravidity, parity, maternal height and weight, complications, uterine height and abdominal circumference, results from transabdominal ultrasonography between 32-38 gestational weeks, pregnancy duration, delivery manner, placenta, umbilical cord, and neonatal complications.Results Significant differences were observed in placenta weight and neonatal malformations between the study and control groups. Multivariate analysis revealed increased parity, maternal hyperthyroidism and hyperthyroidism history as risk factors. Fetal abdominal circumferences less than 30 and 32 cm at 32-38 gestational weeks respectively, as determined by ultrasonography, resulted in a Youden index of 0.62. Conclusions SGA infants were associated with a greater risk of smaller placentas and infant malformations. Increased parity, maternal hyperthyroidism, and a hyperthyroid history were risk factors for SGA infants. Fetal abdominal circumference less than 30 cm at 32 gestational weeks and less than 32 cm at 38 weeks, as determined by ultrasonograohy, was considered an effective index for SGA.展开更多
目的探讨妊娠期糖尿病(gestational diabetes mellitus,GDM)患者妊娠早期甘油三酯葡萄糖指数(the triglyceride-gluscose index,TyG指数)与分娩小于胎龄儿(small for gestational age infant,SGA)之间的关系。方法选取2018年1月至2023年...目的探讨妊娠期糖尿病(gestational diabetes mellitus,GDM)患者妊娠早期甘油三酯葡萄糖指数(the triglyceride-gluscose index,TyG指数)与分娩小于胎龄儿(small for gestational age infant,SGA)之间的关系。方法选取2018年1月至2023年6月复旦大学附属上海市第五人民医院和新疆喀什地区第二人民医院产科孕早期建档并符合纳入标准的孕妇1532例为研究对象,根据孕妇24~28周行口服葡萄糖耐量试验(oral glucose tolerance test,OGTT)结果,将其分为GDM组(754例)及非GDM组(778例)。GDM组患者根据新生儿体重,将其分为SGA组、大于胎龄儿(large for gestational age infant,LGA)组和适于胎龄儿(appropriate for gestational age infant,AGA)组。分析GDM患者分娩SGA的独立影响因素,采用Logistic回归模型分析TyG指数与发生SGA的相关性。绘制ROC曲线以分析妊娠早期TyG指数对GDM患者分娩SGA的预测价值。结果GDM患者SGA组TyG指数显著低于LGA组、AGA组及非GDM组(P<0.05);多因素Logistic回归分析结果显示,TyG指数与GDM患者分娩SGA的发生独立相关(P<0.05);ROC曲线结果显示,妊娠早期TyG指数对GDM患者分娩SGA具有较好的预测价值(AUC=0.821,95%CI:0.763~0.879,P<0.001)。结论GDM患者妊娠早期TyG指数与分娩SGA之间存在独立相关,对于GDM患者分娩SGA具有较好的预测价值。展开更多
BACKGROUND Umbilical cord milking(UCM)is an alternative placental transfusion method for delayed umbilical cord clamping in routine obstetric practice,allowing prompt resuscitation of an infant.Thus,UCM has been adopt...BACKGROUND Umbilical cord milking(UCM)is an alternative placental transfusion method for delayed umbilical cord clamping in routine obstetric practice,allowing prompt resuscitation of an infant.Thus,UCM has been adopted at some tertiary neonatal centers for preterm infants to enhance placental-to-fetal transfusion.It is not suggested for babies less than 28 wk of gestational age because it is associated with severe brain hemorrhage.For late preterm or term infants who do not require resuscitation,cord management is recommended to increase iron levels and prevent the development of iron deficiency anemia,which is associated with impaired motor development,behavioral problems,and cognitive delays.Concerns remain about whether UCM increases the incidence of intraventricular hemorrhage.However,there are very few reports of late preterm infants presenting with neonatal hemorrhage stroke(NHS)and severe coagulopathy after receiving UCM.Here,we report a case of a late preterm infant born at 34 wk of gestation.She abruptly deteriorated,exhibiting signs and symptoms of NHS and severe coagulopathy after receiving UCM on the first day of life.CASE SUMMARY A female preterm infant born at 34 wk of gestation received UCM after birth.She was small for her gestational age and described as vigorous with Apgar scores of 9 and 10 at one minute and five minutes of life,respectively.After hospitalization in the neonatal intensive care unit,she showed hypoglycemia and metabolic acidosis.The baby was administered glucose and sodium bicarbonate infusions.Intramuscular vitamin K1 was also used to prevent vitamin K deficiency.The baby developed umbilical cord bleeding and gastric bleeding on day 1 of life;a physical examination showed bilateral conjunctival hemorrhage,and a blood test showed thrombocytopenia,prolonged prothrombin time,prolonged activated partial thromboplastin time,low fibrinogen,raised D-dimer levels and anemia.A subsequent cranial ultrasound and computed tomography scan showed a left parenchymal brain hemorrhage with extension into the ventricular and subarachnoid spaces.The patient was diagnosed with NHS in addition to disseminated intravascular coagulation(DIC).Fresh frozen plasma(FFP)and prothrombin complex concentrate were given for coagulopathy.Red blood cell and platelet transfusions were provided for thrombocytopenia and anemia.A bolus of midazolam,intravenous calcium and phenobarbital sodium were administered to control seizures.The baby’s clinical condition improved on day 5 of life,and the baby was hospitalized for 46 d and recovered well without seizure recurrence.Our case report suggests that preterm infants who receive UCM should undergo careful clinical assessment for intracranial hemorrhage,NHS and severe coagulopathy that may develop under certain circumstances.Supportive management,such as intensive care,FFP and blood transfusion,is recommended when the development of massive NHS and associated DIC is suspected.CONCLUSION Our case report suggests that for late preterm infants who are small for gestational age and who receive UCM for alternative placental transfusion,neonatal health care professionals should be cautious in assessing the development of NHS and severe coagulopathy.Neonatal health care professionals should also be more cautious in assessing the complications of late preterm infants after they receive UCM.展开更多
Technological advances, a deeper understanding of disease processes and increased sophistication of therapeutic methods have all led to better outcomes in rare diseases which previously had devastating effects on many...Technological advances, a deeper understanding of disease processes and increased sophistication of therapeutic methods have all led to better outcomes in rare diseases which previously had devastating effects on many women’s lives. The inevitable result of this progress is that women, who in the past did not contemplate pregnancy because of significant morbidity, now get to adulthood and are reasonably “disease free” enough to have their own families. The ever expanding, but relatively new specialty of Obstetric medicine seeks to further improve the outcome in pregnant women with intercur</span><span style="font-family:"">r</span><span style="font-family:"">ent disease by enhancing the literature base, thereby contributing to the creation of appropriate guidance in the management of these patients. This article is a brief but useful guide for the busy obstetrician who may have limited experience in dealing with multiple sclerosis in pregnant women.展开更多
目的·探讨不同程度小于胎龄儿(small for gestational age infant,SGA)母体的孕前及孕期高危因素。方法·纳入2013年9月—2016年12月在上海交通大学医学院附属新华医院分娩的母体及单胎新生儿,根据子代不同出生体质量所在百分...目的·探讨不同程度小于胎龄儿(small for gestational age infant,SGA)母体的孕前及孕期高危因素。方法·纳入2013年9月—2016年12月在上海交通大学医学院附属新华医院分娩的母体及单胎新生儿,根据子代不同出生体质量所在百分位分为4组:轻度SGA组(SGA5^th^10^th)、中度SGA组(SGA3^rd^5^th)、重度SGA组(<SGA3^rd)、正常对照组。采用多变量Logistic回归分析SGA母体孕期及孕前高危因素与不同程度SGA发生的相关性。结果·母体的年龄、产次、受教育程度、早产发生率、胎儿性别与SGA无相关性。母体体质量指数(body mass index,BMI)、妊娠高血压和接受辅助生殖与SGA显著相关(均P<0.05)。孕前低BMI和妊娠高血压的母体中度SGA的发生率分别为无相关危险因素者的3.6倍和4.0倍。母体接受辅助生殖,其子代重度SGA的发生率是未接受辅助生殖者的6.4倍。轻度SGA与母体BMI、妊娠高血压、接受辅助生殖因素均无相关性。结论·母体低BMI、妊娠高血压是中度SGA的高危因素,接受辅助生殖是重度SGA的高危因素;不同程度SGA的高危因素并不相同。展开更多
The epidemiological associations between the prenatal perfluoroalkyl substances(PFASs)exposure and the reproductive outcomes remain controversial.A continuous evaluation is needed to combine the inconsistent results.I...The epidemiological associations between the prenatal perfluoroalkyl substances(PFASs)exposure and the reproductive outcomes remain controversial.A continuous evaluation is needed to combine the inconsistent results.In this study,we explored the associations between PFASs exposure and the low birth weight(LBW),preterm birth and small for gestational age(SGA).The quality of selected literature,quantitative estimates,publication bias and subgroup analysis were performed on the basis of 17 retrieved articles published before December 2020.The results showed a significant positive association between the perfluorooctane sulfonate(PFOS)exposure and the risk of LBW[Odds ratio(OR)=1.17;95%confidence interval(CI):1.01,1.36;heterogeneity:P=0.30,I2=17%].The positive association was also observed between the PFOS and the risk of preterm birth(OR=1.19;95%CI:1.01,1.39,P=0.007;I2=62%).There was a paucity of evidence regarding the negative effects of perfluorooctanoic acid(PFOA),perfluorohexanesulfonic acid(PFHxS)and perfluorononanoic acid(PFNA)on the pregnancy outcomes.The findings from the subgroup analysis(the sampling period,the birth gender and biologic specimens)did not substantially altered the results of the overall pooled estimate ORs.The increased prevalence of negative birth outcomes with gestational PFASs exposure warrants further explorations from biological process perspective.展开更多
小于胎龄儿(small for gestational age,sga)是指出生体重低于同胎龄儿平均体重的第10百分位,或低于平均体重的2个标准差的新生儿,包括早产、足月、过期产小于胎龄儿.其中由于早产小于胎龄儿受早产和宫内生长发育迟缓双重不利因素的影响...小于胎龄儿(small for gestational age,sga)是指出生体重低于同胎龄儿平均体重的第10百分位,或低于平均体重的2个标准差的新生儿,包括早产、足月、过期产小于胎龄儿.其中由于早产小于胎龄儿受早产和宫内生长发育迟缓双重不利因素的影响,各系统及脏器功能发育不够完善,是造成围生儿死亡的主要原因之一[1].本文通过对243例sga的发病原因进行探讨,为科学加强围产期保健工作提供理论依据.展开更多
文摘Inflammatory bowel disease (IBD) is a chronic, sometimes debilitating condition that affects mainly the young population. The effect of IBD on pregnancy is therefore an important clinical issue. Many Obstetricians are likely to come across the occasional patient with this chronic condition. The following article discusses the salient factors which need to be considered in pregnant women with IBD and serves as a quick, practical but nevertheless comprehensive guide for the practicing Obstetrician.
文摘Background Small for gestational age （SGA） infants are associated with a high rate of oligohydramnios, stillbirth and cesarean delivery. Among SGA patients there is a higher risk of neonatal complications, such as polycythemia, hyperbilirubinemia, and hypothermia. Additionally, the SGA infant is prone to suffer from major neurologic sequelae, as well as cardiovascular system disease, in later life. Proper monitoring and therapy during pregnancy are, therefore, of utmost importance. The present study aimed to investigate the influential and prognostic factors of SGA infants.Methods From January 2001 to June 2007, a total of 55 SGA neonatal infants were included in a study group. All were born at Peking Union Medical College Hospital, with regular formal antenatal examinations. In addition, a total of 122 cases of appropriate for gestational age （AGA） infants were born at the same time and were registered into a control group. All cases were singleton pregnancies with detailed information of the maternal age, gravidity, parity, maternal height and weight, complications, uterine height and abdominal circumference, results from transabdominal ultrasonography between 32-38 gestational weeks, pregnancy duration, delivery manner, placenta, umbilical cord, and neonatal complications.Results Significant differences were observed in placenta weight and neonatal malformations between the study and control groups. Multivariate analysis revealed increased parity, maternal hyperthyroidism and hyperthyroidism history as risk factors. Fetal abdominal circumferences less than 30 and 32 cm at 32-38 gestational weeks respectively, as determined by ultrasonography, resulted in a Youden index of 0.62. Conclusions SGA infants were associated with a greater risk of smaller placentas and infant malformations. Increased parity, maternal hyperthyroidism, and a hyperthyroid history were risk factors for SGA infants. Fetal abdominal circumference less than 30 cm at 32 gestational weeks and less than 32 cm at 38 weeks, as determined by ultrasonograohy, was considered an effective index for SGA.
文摘目的探讨妊娠期糖尿病(gestational diabetes mellitus,GDM)患者妊娠早期甘油三酯葡萄糖指数(the triglyceride-gluscose index,TyG指数)与分娩小于胎龄儿(small for gestational age infant,SGA)之间的关系。方法选取2018年1月至2023年6月复旦大学附属上海市第五人民医院和新疆喀什地区第二人民医院产科孕早期建档并符合纳入标准的孕妇1532例为研究对象,根据孕妇24~28周行口服葡萄糖耐量试验(oral glucose tolerance test,OGTT)结果,将其分为GDM组(754例)及非GDM组(778例)。GDM组患者根据新生儿体重,将其分为SGA组、大于胎龄儿(large for gestational age infant,LGA)组和适于胎龄儿(appropriate for gestational age infant,AGA)组。分析GDM患者分娩SGA的独立影响因素,采用Logistic回归模型分析TyG指数与发生SGA的相关性。绘制ROC曲线以分析妊娠早期TyG指数对GDM患者分娩SGA的预测价值。结果GDM患者SGA组TyG指数显著低于LGA组、AGA组及非GDM组(P<0.05);多因素Logistic回归分析结果显示,TyG指数与GDM患者分娩SGA的发生独立相关(P<0.05);ROC曲线结果显示,妊娠早期TyG指数对GDM患者分娩SGA具有较好的预测价值(AUC=0.821,95%CI:0.763~0.879,P<0.001)。结论GDM患者妊娠早期TyG指数与分娩SGA之间存在独立相关,对于GDM患者分娩SGA具有较好的预测价值。
基金Supported by Zhejiang Province Medical Science and Technology Foundation of China,No.2021PY057.
文摘BACKGROUND Umbilical cord milking(UCM)is an alternative placental transfusion method for delayed umbilical cord clamping in routine obstetric practice,allowing prompt resuscitation of an infant.Thus,UCM has been adopted at some tertiary neonatal centers for preterm infants to enhance placental-to-fetal transfusion.It is not suggested for babies less than 28 wk of gestational age because it is associated with severe brain hemorrhage.For late preterm or term infants who do not require resuscitation,cord management is recommended to increase iron levels and prevent the development of iron deficiency anemia,which is associated with impaired motor development,behavioral problems,and cognitive delays.Concerns remain about whether UCM increases the incidence of intraventricular hemorrhage.However,there are very few reports of late preterm infants presenting with neonatal hemorrhage stroke(NHS)and severe coagulopathy after receiving UCM.Here,we report a case of a late preterm infant born at 34 wk of gestation.She abruptly deteriorated,exhibiting signs and symptoms of NHS and severe coagulopathy after receiving UCM on the first day of life.CASE SUMMARY A female preterm infant born at 34 wk of gestation received UCM after birth.She was small for her gestational age and described as vigorous with Apgar scores of 9 and 10 at one minute and five minutes of life,respectively.After hospitalization in the neonatal intensive care unit,she showed hypoglycemia and metabolic acidosis.The baby was administered glucose and sodium bicarbonate infusions.Intramuscular vitamin K1 was also used to prevent vitamin K deficiency.The baby developed umbilical cord bleeding and gastric bleeding on day 1 of life;a physical examination showed bilateral conjunctival hemorrhage,and a blood test showed thrombocytopenia,prolonged prothrombin time,prolonged activated partial thromboplastin time,low fibrinogen,raised D-dimer levels and anemia.A subsequent cranial ultrasound and computed tomography scan showed a left parenchymal brain hemorrhage with extension into the ventricular and subarachnoid spaces.The patient was diagnosed with NHS in addition to disseminated intravascular coagulation(DIC).Fresh frozen plasma(FFP)and prothrombin complex concentrate were given for coagulopathy.Red blood cell and platelet transfusions were provided for thrombocytopenia and anemia.A bolus of midazolam,intravenous calcium and phenobarbital sodium were administered to control seizures.The baby’s clinical condition improved on day 5 of life,and the baby was hospitalized for 46 d and recovered well without seizure recurrence.Our case report suggests that preterm infants who receive UCM should undergo careful clinical assessment for intracranial hemorrhage,NHS and severe coagulopathy that may develop under certain circumstances.Supportive management,such as intensive care,FFP and blood transfusion,is recommended when the development of massive NHS and associated DIC is suspected.CONCLUSION Our case report suggests that for late preterm infants who are small for gestational age and who receive UCM for alternative placental transfusion,neonatal health care professionals should be cautious in assessing the development of NHS and severe coagulopathy.Neonatal health care professionals should also be more cautious in assessing the complications of late preterm infants after they receive UCM.
文摘Technological advances, a deeper understanding of disease processes and increased sophistication of therapeutic methods have all led to better outcomes in rare diseases which previously had devastating effects on many women’s lives. The inevitable result of this progress is that women, who in the past did not contemplate pregnancy because of significant morbidity, now get to adulthood and are reasonably “disease free” enough to have their own families. The ever expanding, but relatively new specialty of Obstetric medicine seeks to further improve the outcome in pregnant women with intercur</span><span style="font-family:"">r</span><span style="font-family:"">ent disease by enhancing the literature base, thereby contributing to the creation of appropriate guidance in the management of these patients. This article is a brief but useful guide for the busy obstetrician who may have limited experience in dealing with multiple sclerosis in pregnant women.
文摘目的·探讨不同程度小于胎龄儿(small for gestational age infant,SGA)母体的孕前及孕期高危因素。方法·纳入2013年9月—2016年12月在上海交通大学医学院附属新华医院分娩的母体及单胎新生儿,根据子代不同出生体质量所在百分位分为4组:轻度SGA组(SGA5^th^10^th)、中度SGA组(SGA3^rd^5^th)、重度SGA组(<SGA3^rd)、正常对照组。采用多变量Logistic回归分析SGA母体孕期及孕前高危因素与不同程度SGA发生的相关性。结果·母体的年龄、产次、受教育程度、早产发生率、胎儿性别与SGA无相关性。母体体质量指数(body mass index,BMI)、妊娠高血压和接受辅助生殖与SGA显著相关(均P<0.05)。孕前低BMI和妊娠高血压的母体中度SGA的发生率分别为无相关危险因素者的3.6倍和4.0倍。母体接受辅助生殖,其子代重度SGA的发生率是未接受辅助生殖者的6.4倍。轻度SGA与母体BMI、妊娠高血压、接受辅助生殖因素均无相关性。结论·母体低BMI、妊娠高血压是中度SGA的高危因素,接受辅助生殖是重度SGA的高危因素;不同程度SGA的高危因素并不相同。
基金National Natural Science Foundation of China(No.22006010)Shanghai Sailing Program,China(No.19YF1400500)。
文摘The epidemiological associations between the prenatal perfluoroalkyl substances(PFASs)exposure and the reproductive outcomes remain controversial.A continuous evaluation is needed to combine the inconsistent results.In this study,we explored the associations between PFASs exposure and the low birth weight(LBW),preterm birth and small for gestational age(SGA).The quality of selected literature,quantitative estimates,publication bias and subgroup analysis were performed on the basis of 17 retrieved articles published before December 2020.The results showed a significant positive association between the perfluorooctane sulfonate(PFOS)exposure and the risk of LBW[Odds ratio(OR)=1.17;95%confidence interval(CI):1.01,1.36;heterogeneity:P=0.30,I2=17%].The positive association was also observed between the PFOS and the risk of preterm birth(OR=1.19;95%CI:1.01,1.39,P=0.007;I2=62%).There was a paucity of evidence regarding the negative effects of perfluorooctanoic acid(PFOA),perfluorohexanesulfonic acid(PFHxS)and perfluorononanoic acid(PFNA)on the pregnancy outcomes.The findings from the subgroup analysis(the sampling period,the birth gender and biologic specimens)did not substantially altered the results of the overall pooled estimate ORs.The increased prevalence of negative birth outcomes with gestational PFASs exposure warrants further explorations from biological process perspective.
文摘小于胎龄儿(small for gestational age,sga)是指出生体重低于同胎龄儿平均体重的第10百分位,或低于平均体重的2个标准差的新生儿,包括早产、足月、过期产小于胎龄儿.其中由于早产小于胎龄儿受早产和宫内生长发育迟缓双重不利因素的影响,各系统及脏器功能发育不够完善,是造成围生儿死亡的主要原因之一[1].本文通过对243例sga的发病原因进行探讨,为科学加强围产期保健工作提供理论依据.
