Clinical Analysis of Placenta Previa Complicated with Previous Caesarean Section

Objective To investigate the clinical features and treatment of placenta previa complicated with previous caesarean section. Methods The clinical data of 29 patients with placenta previa complicated with a previous caesarean section (RCS group) admitted in Peking Union Medical College Hospital during a period from 2003 to 2011 were retrospectively reviewed and compared with those of 243 patients with placenta previa without a previous caesarean section (FCS group) during the same period. Results There was no difference in the mean age (28.9±3.6 vs. 28.1±4.5 years) and the average gravidity (2.35±1.48 vs. 2.21±1.53) between RCS group and FCS group (all P>0.05). The RCS group had more preterm births (24.1% vs. 13.2%), complete placenta previa (55.2% vs. 4.9%), placenta accreta (34.5% vs. 2.5%), more blood loss during caesarean section (1412±602 vs. 648±265 mL), blood transfusion (51.7% vs. 4.9%), disseminated intravascular coagulation (13.8% vs. 2.1%), and obstetric hysterectomy (13.8% vs. 0.8%) than the FCS group (all P<0.05). The preterm infant rate (30.0% vs. 13.0%), neonatal asphyxia rate (10.0% vs. 4.9%), and perinatal mortality rate (6.7% vs. 0.4%) of the RCS group were higher than those of the FCS group (all P<0.05). Conclusions More patients had complete placenta previa and placenta accreta, postpartum hemorrhage, transfusion, uterine packing, obstetric hysterectomy, and perinatal morbidity in the placenta previa patients with previous caesarean section. The patient should be informed of the risk and unnecessary first cesarean sections should be avoided.

Clinical application of Bushen Jianpi Gutai Decoction in threatened abortion

Objective:To discuss the clinical application of the"seven,five and three"odd-numbered law theory and analyze the effect on serum sex hormone level.Methods:A total of 100 patients with early threatened abortion admitted from January 2021 to October 2021 were randomly divided into study group and control group,with 50 patients in each group.Patients in the control group were treated with dydrogesterone tablets,while patients in the study group were treated with Bushen JianpiGutai Decoction combined with dydrogesterone tablets.Clinical efficacy and progesterone level before and after treatment were observed and compared between the two groups,as well as clinical symptom relief time of the two groups,including hemostasis time,abdominal pain relief time and lumbar acid relief time,and sex hormone level of the two groups were observed and compared.Results:The clinical efficacy was significantly better than control patients(P<0.05),no significant difference in progesterone level comparison before treatment(P>0.05),significantly better than control patients(P<0.05),hemostasis,abdominal pain remission and waist acid remission were significantly shorter than control patients(P<0.05),and both significantly better sex hormone levels after treatment(P<0.05).Conclusion:Traditional Chinese medicine has certain advantages in the treatment of threatened abortion,odd-numbered law theoryguidesthe regulation of Yin and Yang in the female menstrual cycle and reproductive function is mainly the regular change of Yin and Yang.Under the guidance of"seven,five,three"odd-numbered law theoryof Traditional Chinese medicine master Xia Guicheng,master the key date and the best time of its transformation,regulate Yin and Yang in the female body,to prevent the occurrence and development of menstrual diseases and adverse childbirth.Bushen Jianpi Gutai decoction can effectively treat threatened abortion,significantly improve the clinical symptoms,improve the level of serum sex hormone,worthy of clinical promotion.

Comparison of the Predictive Value of Antral Follicle Count, Anti-Müllerian Hormone and Follicle-Stimulating Hormone in Women Following GnRH-Antagonist Protocol for Intracytoplasmic Sperm Injection

Background: Prediction of ovarian response is one of the prerequisites for women undergoing intracytoplasmic sperm injection (ICSI) treatment prior to the first controlled ovarian stimulation (COS) cycle. Predictive factors may be variable in patients pre-treated with oral contraceptives (OC) for scheduling purposes. Objective: To evaluate antral follicle count (AFC), anti-müllerian hormone (AMH) and basal follicle stimulating hormone (FSH) for predicting ovarian responses in patients under controlled ovarian hyperstimulation randomized to receive either oral contraceptives (OC) or no treatment (non-OC) prior to their first controlled ovarian stimulation (COS) cycle. Study Design: One hundred infertile women randomized to receive OC treatment or no treatment, prior to their first COS cycle;were stimulated with Gonadotropin Releasing Hormone (GnRH) antagonist protocol. During the early follicular phase (day 2) of the two subsequent cycles (cycle A & cycle B) sonographic (AFC, ovarian volume) and endocrine data (AMH, basal FSH) were recorded. Transvaginal ultrasound was performed for all patients to monitor the ovarian response. Total number of oocytes retrieved and number of generated embryos were recorded and patients were categorized according to retrieved oocytes as poor (oocytes 12). Result(s): AFC, AMH and basal FSH were lower in users than in non-users of hormonal contraception. Poor responders showed less number of oocytes retrieved and had lower AFC and AMH but a higher basal FSH level was recorded in both groups (OC and non-OC). Conclusion: The better predictive value of AMH or AFC, as a single test or in combination will prevent cycle cancellations due to too low or too high ovarian response. AMH in OC group is not affected by OC pretreatment and is superior to other parameters, while AFC is superior to AMH and basal FSH in non-OC group.

Detection of Human Parvovirus B19 Nonstrutural Protein DNA by Nested-Polymerase Chain Reaction in Gravida Serum and Pregnant Tissues

A new nested-polymerase chain reaction （nested-PCR） assay was developed to detect human parvovirus B19 DNA corresponding to the nonstructural protein in clinical specimens in a routine diagnostic laboratory. The sensitivity of this highly specific assay was up to 0. 005 fg of B19 DNA. Parvovirus B19 was identified in sera of 20 pregnant women with abnormal pregnant outcome. Among these 20 cases, intrauterine parvovirus infection did exist in 7 pregnant women because parvovirus B19 DNA was detected in the pregnant tissues of them such as placenta tissues, chorionic villi, amniotic fluid, fetal spleen, liver and abdominal fluids.

Association of Body Mass Index and Lipid Profiles in Children

We examined the lipid values of obese and normal-weight children, to look if there is an association between Body Mass Index (BMI) and lipid profiles. Our study group included 100 volunteers (50 children with normal BMI and 50 with high BMI) who were admitted to Kagithane State Hospital Pediatrics Clinic for various reasons between July 2010 and May 2011. The inclusion criteria were as follows: age between 2 and 14 years, no chronic disease and no developmental defects. The high BMI group had significantly higher Low Density Lipoprotein (LDL) levels in comparison to the normal BMI group (p?< 0.05). We also found that the high BMI group had higher cholesterol levels close to upper limit than the normal BMI group. We found high triglyceride levels not only in the high BMI group but also in the normal BMI group with a rate of 26% and 24% respectively. The difference of 2% was not significant. We advise that identification and treatment of elevated LDL cholesterol levels is of tremendous significance for obese children or adolescents for future cardiovascular disease risk in adulthood. In the light of these findings, we must not overlook cardiovascular risk in the normal BMI group children. We believe that necessary precautions must be taken for preventing overweight and dyslipidemia in early childhood. Accordingly, it is of paramount importance not only to reduce obesity in children and adolescents but also to monitor dyslipidemia in normal BMI children to avoid the subsequent risk for cardiovascular disease.

Histone deacetylase inhibitors as a novel therapeutic approach for pheochromocytomas and paragangliomas

Epigenetic mechanisms,such as DNA methylation and histone modifications(e.g.,acetylation and deacetylation),are strongly implicated in the carcinogenesis of various malignancies.During transcription,the expression and functionality of coding gene products are altered following the histone acetylation and deacetylation.These processes are regulated by histone acetyltransferases(HATs)and histone deacetylases(HDACs),respectively.HDAC inhibitors(HDACis)have been developed as promising therapeutic agents,to limit exposure to traditional and toxic chemotherapies and offer more alternatives for some specific malignant diseases with limited options.Mechanistically,these agents affect many intracellular pathways,including cell cycle arrest,apoptosis and differentiation,and their mechanism of action mainly depends on the type of cancer.Currently,five HDACis have been approved for the treatment of several hematological malignancies(e.g.,T-cell lymphoma subtypes and multiple myeloma);while,many of them are tested for further therapeutic indications in solid tumors(e.g.,colorectal,thyroid,breast,lung and pancreatic cancer).Herein,we review the literature and gather all available evidence,from in vitro and in vivo data to clinical trial results,that recognizes the antitumor activity of HDACis on pheochromocytomas and paragangliomas;and supports their clinical implementation in the treatment of these rare neuroendocrine tumors at metastatic setting.

Bilateral superficial cervical plexus block for parathyroidectomy during pregnancy:A case report

BACKGROUND Primary hyperparathyroidism(PHPT)is the most common cause of pregnancyrelated hypercalcemia.PHPT can cause maternal and fetal complications in pregnant women.General anesthesia for non-obstetric surgery in pregnant women is associated with maternal hazards and concerns regarding long-term neonatal neurocognitive effects.Surgical removal of the lesion in mid-pregnancy is currently the primary treatment option for pregnant patients with PHPT.However,the blood calcium concentration at which surgery should be considered remains under discussion due to the risk of miscarriage.CASE SUMMARY A 31-year-old nulliparous woman at 11 wk of gestation was admitted to our hospital for parathyroidectomy.The patient had a history of intrauterine fetal death with unknown etiology at 16 wk of gestation 1 year prior.Her blood test results showed that the serum calcium level was elevated to 12.9 mg/dL,and the parathyroid hormone level was elevated to 157 pg/mL.In a neck ultrasound,it revealed a 0.8 cm×1.5 cm sized oval,hypoechoic mass in the upper posterior of the left thyroid gland,which was compatible with parathyroid adenoma.Superficial cervical plexus block(SCPB)for parathyroidectomy was performed.After surgery,the obstetrician checked the status of the fetus,and there were no abnormal signs.Since then her calcium level returned to normal values after one week of surgery and a healthy male neonate of 2910 g was delivered vaginally at 38 wk of gestation.CONCLUSION Our case suggests that SCPB can be an anesthetic option for parathyroidectomy during the first trimester of pregnancy.

Highly specific selenium nanosystems for fluorescent image-guided rapid diagnosis and pathological grading of ovarian malignant tumors

Comprehensive surgical staging or optimal tumor cytoreductive surgery of malignant ovarian cancer directly affects disease prognosis.Therefore,a fluorescent selenium nanoparticle(Se@RGD/S2.2)decorated with cancer-targeting Arg-Gly-Asp(RGD)peptides and GCAGTTGATCCTTTGGATACCCTGG aptamer(S2.2)was developed for use as a diagnostic agent to achieve rapid,noninvasive diagnosis and visualization of microinvasive lesions during surgery for malignant ovarian cancer.

Prediction of significant hyperbilirubinemia in term neonates by early non-invasive bilirubin measurement

Background:Neonatal jaundice is a common problem.We evaluated the utility and best cut-off values of 24-and 48-hour transcutaneous bilirubin indices (TcBI) in predicting subsequent significant hyperbilirubinemia and evaluated various associated maternal and fetal risk factors.Methods:TcBI at 24 and 48 hours and serum bilirubin levels at 72 hours of age were obtained for healthy,term,appropriate for gestational age neonates.Neonates with prematurity,birth weight <2500 g,ABO or Rh incompatibility,onset of clinical jaundice <24 hours,clinical suspicion of septicemia,positive pressure ventilation at birth,admission in neonatal intensive care unit and contraindications for BiliChek were excluded.Twently-four and 48-hour TcB indices were assessed as predictors of subsequent hyperbilirubinemia,defined as serum bilirubin >17 mg/dL after 72 hours of life and various cut-offs,and were evaluated by calculating sensitivity,specificity and predictive values.Results:Of 500 newborns,4.6% had significant hyperbilirubinemia,27% had TcBI (mg/dL) <5 at 24 hours,and 27.4% had TeBI <8 at 48 hours.None of them had subsequent hyperbilirubinemia (100% negative predictive value).The percentage of newborns with subsequent hyperbilirubinemia increased from 3.4% to 13.2% as their 24-hour TcBI increased from 6 to above 9 mg/dL and from 4.2% to 7.4% as their 48-hour TcBI increased from 8 to above 11 mg/dL.The best cut-off value was TcBI (mg/dL) 7 (odd ratio=4.86,95% confidence interval:1.66-15.22) at 24 hours and 10 (odd ratio=2.87,95% confidence interval:1.04-8.29) at 48 hours.Area under the receiver operating characteristic curve for 24-and 48-hour measurements was 0.750 and 0.715,respectively.Maternal premature rupture of membranes,deep transverse arrest,post-date pregnancy,and fetal distress were significant risk factors for hyperbilirubinemia.Conclusions:Twenty-four and 48-hour TcB indices are good predictors of subsequent hyperbilirubinemia.Twenty-four-hour TcBI had better predictive ability than 48-hour TcBI.

Kallikrein-related peptidases 6 and 10 are elevated in cerebrospinal fluid of patients with Alzheimer’s disease and associated with CSF-TAU and FDG-PET

Background:Alterations in the expression of human kallikrein-related peptidases(KLKs)have been described in patients with Alzheimer’s disease(AD).We elucidated the suitability of KLK6,KLK8 and KLK10 to distinguish AD from NC and explored associations with established AD biomarkers.Methods:KLK levels in cerebrospinal fluid(CSF),as determined by ELISA,were compared between 32 AD patients stratified to A/T/(N)system with evidence for amyloid pathology and of 23 normal controls with normal AD biomarkers.Associations between KLK levels and clinical severity,CSF and positron emission tomography(PET)based AD biomarkers were tested for.Results:Levels of KLK6 and KLK10 were significantly increased in AD.KLK6 differed significantly between AD A+/T+/N+and AD A+/T−/N+or NC with an AUC of 0.922.CSF pTau and tTau levels were significantly associated with KLK6 in AD.Conclusions:KLK6 deserves further investigations as a potential biomarker of Tau pathology in AD.

Comparative analysis of syndromic and PCR-based diagnostic assay reveals misdiagnosis/ overtreatment for trichomoniasis based on subjective judgment in symptomatic patients

Background:Trichomoniasis,a sexually transmitted disease(STD),is caused by Trichomonas vaginalis in both men and women.Screening of trichomoniasis is problematic in resource challenged settings as currently available,inexpensive diagnostic methods are of low sensitivity and/or specificity.In India,National AIDS Control organization(NACO)recommended syndromic case management(SCM)for treatment.The objective of the present study was to compare the utility of the NACO-NACP III Algorithms for STI/RTI treatment used by clinicians with PCR based diagnosis.Methods:Patients visiting Department of Obstetrics&Gynecology,Vardhman Mahavir Medical College and Safdarjung Hospital,New Delhi from January 2011 to June 2014 were enrolled in the study to compare the diagnostic efficiency of PCR-based assays against SCM.Based on SCM,patients(n=820)were treated with antibiotics using pre-packed STI/RTI kits(sexually transmitted infection/reproductive tract infection;procured by National AIDS Control/State AIDS Control Society(NACO/SACS),Ministry of Health and Family Welfare,Govt of India.)under National AIDS Control Programme(NACP III)for syndromic case management(SCM).Ectocervical dry swab samples were also obtained from these patients and out of that 634 samples were tested by PCR.Total genomic DNA was extracted from these samples and used as template for PCR amplification using pfoB,gyrA and orf1 gene specific primers for diagnosis of T.vaginalis(TV),Chlamydia trachomatis(CT)and Neisseria gonorrhoeae(NG)respectively.Results:Out of 6000 patients who visited OPD,820(14%)female patients reported vaginal discharge and were recommended antibiotic treatment for one or more pathogens namely,TV,CT,NG and Candida or for co-infection.On the basis of signs&symptoms and NACO guidelines,the following distribution of various infections was observed:TV(46%),CT(20%),coinfection with TV and CT(12%),coinfection with CT and NG(11%),coinfection with TV,CT and Candida(7%)and coinfection with TV and NG(2%).Others were infected with NG alone(1%),coinfected with TV and Candida(0.4%)and 0.3%were coinfected with CT,NG and Candida.Based on PCR method,110(17%)women tested positive for one or more of these three pathogens while 524(83%)women were negative for any of these three pathogens but could be positive for other STIs not tested in this study.Since all the patients(634)were given antibiotics,we estimate that the over-treatment was 85%while 524(83%)patients were also misdiagnosed by SCM.Conclusions:The over-treatment and inaccurate diagnosis of pathogens due to subjective judgment based on syndromic approach in symptomatic women is a large economic wastage and may also contribute towards increased resistance.The misdiagnosed patients will also serve as a reservoir for transmission of pathogens to their sexual partner.

Self-anti-angiogenesis nanoparticles enhance anti-metastatic-tumor efficacy of chemotherapeutics

Beyond traditional endothelium-dependent vessel(EDV),vascular mimicry(VM)is another critical tumor angiogenesis that further forms in many malignant metastatic tumors.However,the existing anti-angiogenesis combined chemotherapeutics strategies are only efficient for the treatment of EDV-based subcutaneous tumors,but remain a great challenge for the treatment of in situ malignant metastatic tumor associated with EDV and VM.Here,we demonstrate a self-assembled nanoparticle(VE-DDP-Pro)featuring self-anti-EDV and-VM capacity enables to significantly enhance the treatment efficacy of cisplatin(DDP)against the growth and metastasis of ovarian cancer.The VE-DDP-Pro is constructed by patching DDP loaded cRGD-folate-heparin nanoparticles(VE)onto the surface of protamine(Pro)nanoparticle.We demonstrated the self-anti-angiogenesis capacity of VE-DDP-Pro was attributed to VE,which could significantly inhibit the formation of EDV and VM by regulating signaling pathway of MMP-2/VEGF,AKT/mTOR/MMP-2/Laminin and AKT/mTOR/EMT,facilitating chemotherapeutics to effectively suppress the development and metastasis of ovarian cancer.Thus,combing with the chemotherapeutics effectiveness of DDP,the VE-DDP-Pro can significantly enhance treatment efficacy and prolong median survival of mice with metastatic ovarian cancer.We believe our self-assembled nanoparticles integrating the anti-EDV and anti-VM capacity provide a new preclinical sight to enhance the efficacy of chemotherapeutics for the treatment malignant metastasis tumor.

Prenatal ultrasonographic characteristics and prognosis of isolated redundant foramen ovale flap

Objective:To analyze the prenatal ultrasonographic characteristics and prognosis of the isolated redundant foramen ovale flap(RFOF).Methods:From January 2014 to December 2021,we collected data on fetal echocardiography analyses and perinatal outcomes for fetuses with isolated RFOF in Peking University People's Hospital.Results:We found that 0.31%(87/28308)of participants have RFOF.The four-chamber results of the foramen ovale flap(FOF)showed that it was stiff and extended>50%or reached the lateral wall of the left atrium(LA)in diastole.As seen from the foramen ovale(FO)channel and four-chamber views,the hypermobile and redundant flap were observed shrinking and stretching with the fetal cardiac cycle,which is similar to jellyfish.The lateral displacement of flow from LA to the left ventricle(LV)around the FOF on color doppler demonstrated thin linear blood flow from the right to left and a reversal of flow across FO.A uniphasic,but not biphasic,pattern of FOF displacement was observed on M-mode.Stages I(23/87)and II(51/87)had a higher ratio of ventricular disproportion than Stage 0(11/87)and III(2/87).We observed the RA/LA(right/left atrium)>1.2 in 53 cases(60.9%),RV/LV(right/left ventricle)>1.2 in 53 cases(60.9%),PA/AO(pulmonary/aortic artery)>1.2 in 53 cases(60.9%),and moderate or severe tricuspid regurgitation in 10 cases and moderate pericardial effusion in 2 cases(2.2%).Seventy-four RFOF cases had follow-up data.Neonatal death occurred in 2 cases;72 fetuses survived with normal or minor heart defects.Conclusion:RFOF should be considered if the left side of the heart of a fetus is smaller and related to hypermobile FOF.For isolated RFOF cases,a monthly follow-up is recommended to monitor arrhythmia or fetal hydrop status.Prompt treatment is recommended for those with adequate gestational age and lung maturity.

Ovarian cancer recurrence:“is the definition of platinum resistance modified by PARP inhibitors and other intervening treatments?”

PolyADP ribose polymerase inhibitors(PARPi)have transformed the treatment of ovarian cancer.Particularly in high-grade serous ovarian cancer(HGSOC),a disease characterized by homologous recombination deficiency(HRD),PARPi have had a rapid and profound impact on the disease course,as well as biologic and biomarker definitions of HGSOC,thereby creating a paradigm shift in the approach to treatment.In this review,we discuss the role of PARPi in the maintenance treatment of HGSOC,its effect on platinum sensitivity,and cross-resistance between platinum and PARP inhibitors.

Rectus sheath hematoma combined with COVID-19:A case report

BACKGROUND Rectus sheath hematoma(RSH)is uncommon,and because people have limited knowledge about it,it is difficult to recognize the symptoms in time,often delaying optimal treatment.CASE SUMMARY Herein,we report a case of a 77-year-old female with RSH.The patient was treated at our hospital for coronavirus disease 2019.Anticoagulant treatment was administered during this period because of thrombosis.On the 8th d of treatment,the patient complained of abdominal pain.Ultrasonography revealed a solid cystic mass in the pelvic cavity.An emergency laparotomy was performed,and a huge hematoma was found in the deep layer of the rectus abdominis muscle.We used anticoagulants with caution based on the patient’s condition.CONCLUSION Optimal management of patients with RSH s depends on timely diagnosis and when to reintroduce anticoagulants.

Women’s preconception health patterns in traditional Chinese medicine as a predictor of fertility outcomes

Objective: To examine the association between traditional Chinese medicine(TCM), preconception health patterns and fertility outcomes.Methods: A community-based prospective cohort study was conducted in China. A total of 3012 newly married women who were willing to conceive within 2 years were enrolled in the study and took National Free Prepregnancy Checkups(NFPC). A reliably structured self-rating scale was used to measure the TCM preconception health patterns of the enrolled women. A 3-year follow-up was conducted to obtain the fertility outcomes, including pregnancy rate, time to pregnancy, spontaneous miscarriage and newborn status. Statistical analyses were conducted using Chi-square or Fisher’s exact tests, logistic regression models, general linear models and the Cox proportional hazard model.Results: The fertility outcomes showed no statistic correlations to the terms of NFPC in this population.Approximately a half of the women(46.66%) had unhealthy patterns. Women with qi & blood-deficiency(odds ratio [OR] = 35.19, 95% confidence interval [CI] = 1.55–801.15) or qi-stagnation(OR = 4.55, 95% CI =0.90–23.06) pattern took a longer time to get pregnant, and those with qi-stagnation(OR = 2.05, 95% CI =1.1–3.82) or yang-deficiency(OR = 1.91, 95% CI = 1.12–3.25) pattern had a higher risk of spontaneous miscarriage.Conclusion: Three unhealthy TCM patterns during the preconception period might be risk factors for low fecundity or poor pregnancy outcomes. The TCM preconception pattern identification may provide a convenient and effective way to screen for potential pregnancy risks beyond the NFPC. Further, appropriate interventions based on the TCM preconception health patterns are needed to improve quality in women’s fecundability and birth outcomes.

Expression of inducible nitric oxide synthase in trophoblasts and deciduas in early medical abortion

The purpose of this study was to investigate the expression of inducible nitric oxide synthase(iNOS)in trophoblasts and deciduas in early medical abortion,and study the relationship of medical abortion through mifepristone and iNOS in early pregnancy.Expression of iNOS in trophoblasts and deciduas was detected by both in situ hybridization and immunohistochemical assay in 40 patients(experimental group);the positive expression of iNOS was represented by number density(N/S)and positive unit(Pu)using computer color magic image analysis system(CMIAS).All results were compared with those obtained from vacuum aspiration.In the experi-mental group,N/S and Pu in trophoblasts were 0.120�0.010 and 15.3�2.6,respectively,while in the control group,they were 0.021�0.003 and 3.1�0.5,respectively,and there were significant differences between the two groups.By immunohistochemical assay,N/S and Pu were 0.090�0.010,10.24�1.55 vs 0.016�0.002,1.26�0.33 in the trophoblasts of the two groups;there were also significant differences between the two groups.There were lower iNOS expression in deciduas by in situ hybridization and immunohistochem-ical assay,and the difference between the two groups was not significant.It was concluded that mifepristone induced medical abortion through the expression of iNOS in trophoblasts but not in deciduas.

Application of computer-aided diagnosis of congenital heart disease in four-chamber view of fetal heart basic screening

To the Editor:Congenital heart disease(CHD)is the most common severe congenital malformation which threatens the health of the fetus and the primary factor of intrauterine death.Prenatal detection of severe CHD could reduce the neonatal mortality and morbidity.The detection rate ranges between 25.0%and 59.7%in the prenatal ultrasonographic examination.^([1])We need to identify new strategies to improve detection rates of CHD prenatally.Deep-learning(DL)-based computer-aided diagnosis(CAD)has been highly and rapidly developed in recent years.

Peripheral maternal leukocytes are activated in response to cytokines secreted by uterine tissues of pregnant women

The infiltration of leukocytes into uterine tissue is an essential step in parturition.This phenomenon,described as physiologic sterile inflammation,has been demonstrated over the past decade through the observation of multiple leukocyte subpopulations(monocytes,granulocytes and lymphocytes)migrating into various reproductive tissues such as the cervix.

Evolving Frameworks for the Foundation and Practice of Electronic Fetal Monitoring

Since the 1970s,electronic fetal monitoring(EFM)also known as cardiotocography(CTG)has been used extensively in labor around the world,despite its known failure to help prevent many babies from developing neonatal encephalopathy and cerebral palsy.Part of EFM’s poor performance with respect to these outcomes arises from a fundamental misunderstanding of the differences between screening and diagnostic tests,subjective classifications of fetal heart rate(FHR)patterns that lead to large inter-observer variability in its interpretation,failure to appreciate early stages of fetal compromise,and poor statistical modeling for its use as a screening test.We have developed a new approach to the practice and interpretation of EFM called the fetal reserve index(FRI)which does the following:(1)breaking FHR components down into 4 components,(heart rate,variability,accelerations,and decelerations);(2)contextualizing the metrics by adding increased uterine activity;(3)adding specific maternal,fetal,and obstetric risk factors.The result is an eight-point scoring metric that,when directly compared with current American College of Obstetricians and Gynecologists EFM categories,even in version 1.0 with equal weighting of variables,shows that the FRI has performed much better for identifying cases at risk before damage had occurred,reducing the need for emergency deliveries,and lowering overall Cesarean delivery rates.With increased data,we expect further refinements in the specifics of scoring that will allow even earlier detection of compromise in labor.