Is Induction of Labor with Early Rupture of Membranes Associated with an Increased Rate of Clinical Chorioamnionitis?

Objective: The objective of this study was to determine if early rupture of membranes (ROM) in women undergoing induction of labor (IOL) at term is associated with an increased rate of clinical chorioamnionitis. Study Design: A retrospective cohort study was performed on women undergoing IOL. Early ROM was defined as ROM at a modified Bishop score less than 5, cervical dilation less than 4 cm, or cervical effacement less than 80%. The rate of clinical chorioamnionitis was compared between women with early and late ROM. Results: The rate of clinical chorioamnionitis was 8.6% (24/279). ROM at an effacement of less than 80% was associated with a rate of clinical chorioamnionitis of 15.4% (12/78) compared to 6.0% (12/201) at an effacement of equal to or greater than 80%, p = 0.017. The rate of cesarean delivery was higher for patients with early ROM by any definition: 32% compared to 17.5% by modified Bishop score (p = 0.031), 32.4% versus 18.2% by cervical dilation (p = 0.049), and 33.3% versus 14.9% by cervical effacement (p = 0.001). Conclusions: In patients undergoing IOL, early ROM may be associated with an increased rate of clinical chorioamnionitis when performed at a cervical effacement of less than 80% and an increased rate of cesarean delivery.

Maternal anxiety associated with fetal echocardiography

Background: Women awaiting fetal echocardiography (fECHO) report high anxiety. It is unclear if anxiety decreases after performance of fECHO. Methods: At fECHO, subjects’ current (state) vs baseline (trait) anxiety was assessed using the Spielberger State-Trait Anxiety Inventory. Anxiety scores of the pre- and post-fECHO groups were compared. Results: From January 2007 to January 2009, we recruited 84 subjects: 40 pre-fECHO and 44 post-fECHO. Of the post-fECHO group, 30 had normal fetal cardiac structure and function confirmed, 12 were told of an abnormality, and 2 were told to follow up equivocal results. Anxiety scores were compared between the 40 pre-fECHO subjects and the 30 post-fECHO subjects with normal results. The mean state anxiety score of the pre-fECHO group was higher than that of the post-fECHO group (42.1 ± 15.1 vs 30.8 ± 8.5, p < 0.001);there was no difference in trait scores. Neither state nor trait anxiety was associated with maternal age, parity, history of miscarriage or known fetal anomaly. Compared to those with a normal fECHO (N = 30), subjects with an abnormal fECHO result (N = 12) had higher state anxiety (46.8 ± 15.5 vs 30.8 ± 8.5, p = 0.005). There was no difference in anxiety scores between subjects awaiting fECHO and post-fECHO subjects who had an abnormal result. Conclusion: Immediately following normal fECHO, women report low anxiety compared with women awaiting fECHO. Women awaiting fECHO report anxiety levels that are as high as women who are told there is fetal cardiac anomaly.

The impact of COVID-19 on the birth rate in Nigeria:a report from population-based registries

Background and objectives:Coronavirus disease 2019(COVID-19)is a pandemic that has become a major source of morbidity and mortality worldwide,affecting the physical and mental health of individuals influencing reproduction.Despite the threat,it poses to maternal health in sub-Saharan Africa and Nigeria,there is little or no data on the impact it has on fertility,conception,gestation and birth.To compare the birth rate between pre-COVID and COVID times using selected months of the year.Materials and methods:This was a secondary analysis of cross-sectional analytical study data from the birth registries of three tertiary hospitals,comparing two years[2019(Pre-COVID)]versus[2020(COVID era)]using three months of the year(October to December).The data relied upon was obtained from birth registries in three busy maternity clinics all within tertiary hospitals in South-East Nigeria and we aimed at discussing the potential impacts of COVID-19 on fertility in Nigeria.The secondary outcome measures were;mode of delivery,booking status of the participants,maternal age and occupation.Results:There was a significant decrease in tertiary-hospital based birth rate by 92 births(P=0.0009;95%CI:-16.0519 to-4.1481)among mothers in all the three hospitals in 2020 during the COVID period(post lockdown months)of October to December.There was a significant difference in the mode of delivery for mothers(P=0.0096)with a 95%confidence interval of 1.0664 to 1.5916,as more gave birth through vaginal delivery during the 2020 COVID-19 period than pre-COVID-19.Conclusion:Tertiary-hospital based birth rates were reduced during the pandemic.Our multi-centre study extrapolated on possible factors that may have played a role in this decline in their birth rate,which includes but is not limited to;decreased access to hospital care due to the total lockdowns/curfews and worsening inflation and economic recession in the country.

A Survey of Current Treatment Practices for Postpartum Hemorrhage by Practicing Obstetricians and Hematologists

Objective: To identify current treatment strategies for postpartum hemorrhage used by obstetricians (OB/GYNs) and hematologists (HEMs). Study Design: We conducted a survey of OB/GYNs (n = 220) and HEMs (n = 30) to describe the characteristics of current treatment strategies for postpartum hemorrhage. Surveys were administered via a structured questionnaire on a secure internet website from 5 - 12 October 2009. Results: The majority of OB/GYN and HEM respondents were practicing in a community hospital environment (77%). Of the OB/GYNs, the majority practiced at hospitals with over 2000 deliveries per year (77%). A majority (58%) of OB/GYNs were affiliated with hospitals that lacked a massive transfusion protocol to treat severe postpartum hemorrhage. Subsequent to uterine massage and additional oxytocin, the majority of OB/GYNs (73%), preferred the administration of Methergine? as the next level of intervention for postpartum hemorrhage. There was considerable variability in response to specific treatment strategies for several hypothetical case scenarios;however, the large majority of OB/GYNs favored obstetrical procedures over interventional radiology or administration of rFVIIa. A large majority (77%) of physicians who are familiar with rRVIIa as treatment for postpartum hemorrhage reported being very satisfied with the agent for this indication. Conclusions: An established, systematic treatment strategy among OB/GYNs emerged only in the case of mild postpartum hemorrhage.

Quantifying Maternal Blood Loss from the Hysterotomy at Cesarean Delivery

Background: With newer protocols, such as delayed cord clamping, becoming routine practice, determining the potential maternal consequences is important. In particular, establishing normative values for blood loss from the hysterotomy would be helpful in addressing techniques to minimize total blood loss for cesarean deliveries. Objective: Blood loss from the hysterotomy during cesarean delivery has not been reported using quantitative methods. We aimed to quantify the rate of blood loss during cesarean delivery from the hysterotomy between creation and closure. Methods: This single center, prospective, case series was collected in 2018. Women with singleton pregnancies undergoing cesarean delivery at ≥37 0/7 weeks at Brigham and Women’s Hospital were included. Delayed cord clamping was performed which allowed for quantification of blood loss through gravimetric methods and descriptive statistics were performed. Results: Twenty patients were included. The mean hysterotomy closure delay for cord blood collection was 47 seconds (SD 10.2) and the mean maternal blood volume collected was 110.8 mL (SD 53.4 mL). Blood loss per minute was calculated with a median of 150 mL/minute (IQR 88.8 mL, 95% CI 109.2 - 190.4 mL). The mean post-operative hematocrit drop was 4.4%, and there were no blood transfusions. There was a single hysterotomy extension and a quantified blood loss of 413 mL per minute. Conclusion: We found a mean blood loss of 150 mL/min without hysterotomy extension. With a hysterotomy extension, the blood lost per minute was more profound. This normative data can be helpful for surgical planning with regards to delayed cord clamping or cord blood collection for banking.

What Happens after the Puerperium? Analysis of “Late” Postpartum Readmissions in California

Objective: Admissions to acute care hospitals represent a significant portion of healthcare utilization. Little is known regarding hospitalization in the first postpartum year beyond the traditional 6 weeks of the puerperium. We sought to investigate whether there are identifiable risk factors for hospital readmission during this time period. Study Design: We conducted a retrospective population-based study using all California birth records between 1999 and 2003. These records were linked with hospital discharge data for all admissions to California hospitals in the first 365 days after delivery. For women with a first birth during the study period, we assessed the likelihood of readmission to an acute care hospital between 42 and 365 days post-delivery. Univariate and multivariable logistic regression were used to determine risk factors for these “late postpartum” admissions. Results: Of 951,570 maternal birth admissions during the time period, 15,727 (1.7%) women were admitted in the late postpartum period. Women with an early postpartum readmission, antepartum admission, extremes of maternal age, black race, diabetes, hypertension, early preterm delivery and cesarean delivery had higher rates of late postpartum readmission. Of women with an antepartum admission for gestational diabetes or pre-existing diabetes, 6.6% and 18.5% of these women experienced a late postpartum admission for a diabetes-related diagnosis. Conclusion: Hospital readmission rates in the first year postpartum, remote from delivery, are significant. Women are at a higher risk of requiring hospital admission in the first year postpartum with select demographics and pregnancy-related diagnoses.

Distinct Placenta Increta and Percreta in the Setting of Dichorionic Diamniotic Twin Gestation: A Unique Histological Finding

Multiple gestations have been reported as a risk factor for placenta accreta spectrum (PAS) but the evidence is limited. Previous reports showed that PAS degrees (creta, increta, percreta) were similar in multiple gestation placentas. To our knowledge, there have been no reports of PAS in dichorionic placentas with different degrees of invasion. Here, we report dichorionic diamniotic placentas with two different degrees of invasion, one increta and another percreta.

Cryptogenic liver cirrhosis diagnosed in pregnancy and khat consumption

We report a case of cryptogenic liver cirrhosis likely due to khat consumption diagnosed in the setting of chronic hypertension and giving the appearance of atypical superimposed preeclampsia.

超声评估妊娠中期异常脐带旋转与妊娠不良结局的关系

Objective: The purpose of this study was to evaluate the antenatal umbilical cord coiling index obtained during the fetal anatomic survey in the second trimester as a predictor of adverse pregnancy outcome. Study design: Four hundred twenty-five consecutive women who had a fetal anatomic survey between 18 to 23 weeks of gestation were evaluated for umbilical cord coiling. The antenatal umbilical cord coiling index was calculated as a reciprocal value of the distance between a pair of coils (antenatal umbilical cord coiling index = 1/distance in cm) and was correlated with the following adverse pregnancy outcomes: (1) small for gestational age, (2) mode of delivery, (3) presence of meconium-stained amniotic fluid, (4) presence of nonreassuring fetal status in labor, and (5) Apgar scores at 1 and 5 minutes. Results: A total of 294 patients had adequate ultrasound images and all antenatal and labor data to meet the study inclusion criteria. Abnormal coiling was associated significantly with small for gestational age neonates at birth (P = .043) and nonreassuring fetal status in labor (P = .007). Nine of 58 neonates (15.5% ) with abnormal umbilical coiling were small for gestational age infants compared with 15 of 236 small for gestational age neonates (6.4% ) who had normal cord coiling. A nonreassuring fetal status in labor was observed in 25.7% of fetuses (15/58 fetuses) with abnormal umbilical coiling compared with 11.0% of fetuses (26/236 fetuses) with normal cord coiling. In contrast, no statistical difference for Apgar scores at 1 and 5 minutes or higher prevalence of interventional deliveries and meconium-stained amniotic fluid in labor between the groups with normal and abnormal umbilical cord coiling was observed. Conclusion: Abnormal umbilical cord coiling that is detected at the fetal ultrasound anatomic survey in the second trimester is associated with a higher prevalence of small for gestational age neonates and nonreassuring fetal status in labor. This observation can be used potentially as a predictor of adverse antenatal or perinatal events in future studies.

Accessory Breast Tissue in Pregnancy

Accessory breast tissue development frequently occurs in addition to physiologic breast development and is a common congenital condition with an occurrence of 0.4% to 6% in women and 1% - 3% in men. A 31-year-old G1P0 female presented to our triage at 20 + 4 weeks gestation with a one-week history of painful bilateral axillary lumps. Her last menstrual period was consistent with an estimated gestational age of 39 + 3 weeks by LMP. She had emigrated from Bengal three years earlier with no other gynecological complaints and knew of no abnormalities on physical exam. The painful axillary lumps were found to be accessory breast tissue. This entity is presented as a palpable thickening that is most prevalent along the milk line in the region immediately below the breasts, along the abdomen, in the axilla and in the groin region adjacent to the vulva. Affected individuals may undergo premenstrual changes such as tenderness, swelling, and difficulty with shoulder range of motion and irritation. The onset of pregnancy stimulates the tissue and makes it more evident as it did with our patient.

Antenatal corticosteroids in COVID-19 perspective

The aim of this manuscript is to discuss the practice of antenatal corticosteroids administration for fetal maturation in severe acute respiratory syndrome coronavirus 2 positive pregnant women.Recent high-quality evidence supports the use of dexamethasone in the treatment of hospitalized patients with coronavirus disease 2019(COVID-19).Randomized disease outcome data have identified an association between disease stage and treatment outcome.In contrast to patients with more severe forms who benefit from dexamethasone,patients with mild disease do not appear to improve and may even be harmed by this treatment.Therefore,indiscriminate usage of fluorinated corticosteroids for fetal maturation,regardless of disease trajectory,is unadvisable.Obstetrical care needs to be adjusted during the COVID-19 pandemic with careful attention paid to candidate selection and risk stratification.

评价轻度和重度先兆子痫患者胎盘生长因子及可溶型Fms样酪氨酸激酶1受体水平

Objective: The purpose of this study was to determine if maternal serum concentrations of placenta growth factor(PlGF) and soluble Fms-like tyrosine kinase 1 receptor(s-Flt1) are more abnormal in patients with severe preeclampsia compared with mild preeclampsia. Study design: Serum samples were collected from 32 control patients and 80 patients with mild or severe preeclampsia. PlGF and s-Flt1 concentrations were quantitated by enzyme-linked immunosorbent assay (ELISA). Results are expressed as median(Q1-Q3) unless stated otherwise. After normalization, serum markers were compared using one-way analysis of covariance (ANCOVA). Results: Patients with preeclampsia had decreased levels of PlGF(75.1±14 vs 391±54 pg/mL, P< .0001) and elevated s-Flt1 concentration(1081±108 vs 100.1±26.9 pg/mL, P< .0001) compared with the respective controls(mean±SEM). PlGF concentration was lower in patients with mild preeclampsia compared with severe, respectively(67 pg/mL [39-158] vs 24 pg/mL [4-57], P< .02). s-Flt1 was not different between mild and severe preeclampsia(674 pg/mL [211-1297] vs 1015 pg/mL [731-1948], P=.08). Conclusion: PlGF and s-Flt1 serum levels are abnormal in patients with preeclampsia compared with controls, but only PlGF is more abnormal in severe preeclampsia compared with mild preeclampsia.

早产史、宫颈长度与引起的复发早产的关系

This study was undertaken to determine rates of recurrent preterm birth according to number of prior preterm births, 1 versus 2 or more and cervical length by endovaginal ultrasound at 220 to 246 weeks, less than 25 mm versus more than 25 mm. Study design: We retrospectively analyzed data from charts of women with prior spontaneous preterm birth seen in a Prematurity Prevention Clinic from 1998 through 2004. Women with a history of 1 or more spontaneous preterm births (180- 366 weeks) were included. Women with multiple gestations, uterine anomalies, and prior cervical surgery were excluded. Transvaginal sonography was used to evaluate each woman’ s cervical length at 220 to 246 weeks. Cerclage, bed rest, tocolysis, and steroids were used when clinically appropriate. Primary outcome was gestational age at delivery less than 32 and less than 35 weeks. Data were analyzed according to number of prior preterm births (1 vs ≥ 2) and sonographic cervical length at 220 to 246 weeks (< 25mm vs ≥ 25 mm). Results: A total of 188 eligible women were evaluated. Median gestational age of earliest preterm birth was 26.3 weeks. Of the total 188, 118 (62.8% ) women had 1 prior and 70 (37.2% ) had 2 or more preterm births. Thirty-eight (20.2% ) of the women had a cervical length less than 25 mm and 150 (79.8% ) had a cervical length 25 mm or greater. A higher percentage of women with a cervical length less than 25 mm and 2 or more preterm births delivered less than 32 weeks compared with women with 1 prior preterm birth, although this did not reach statistical significance (21.5% vs 12.5% , P = .47). Rates of delivery less than 35 weeks in women with a cervical length less than 25 mm were similar in those with a history of 1 and 2 or more preterm births. Women who had 2 or more prior preterm births were analyzed separately to identify if a cervical length greater than 30 mm or greater than 35 mm could be reassuring for decreasing the risk of recurrent preterm birth. Conclusion: Rates of preterm birth less than 32 and less than 35 weeks were similar in women whose cervical length was less than 25 mm at 220 to 246 weeks, regardless of number of prior preterm births. Women with 2 prior preterm births and a cervix greater than 35 mm were at low risk for subsequent preterm birth less than 35 weeks.

初产妇分娩异常是否与肩难产有关

Objective This study was undertaken to examine the relationship betwe en labor abnormalities and shoulder dystocia in nulliparous women. Study design Nulliparo us women whose delivery was complicated by shoulder dystocia were studied and co mpared with a control group selected based on the best possible match for race, labor type (spontaneous or induced), and birth weight. The duration of first and second stage of labor, as well as the rates of labor progress, were calculated and compared between groups. Results During this 4-year study period, there wer e 8010 nulliparous singleton deliveries of which 65 (0.8%) were complicated by shoulder dystocia. Compared with controls, there was no difference in the rate o f cervical dilation in the active phase of the first stage of labor. In the shou lder dystocia group, more patients had a second stage of labor greater than 2 ho urs (22%vs 3%; P < .05) and had operative vaginal deliveries (26%vs 1.5%; P < .001). In shoulder dystocia cases with birth weight greater than 4000 g, 33%h ad a second stage of labor greater than 2 hours. Conclusion In our population, t he combination of fetal macrosomia, second stage of labor longer than 2 hours an d the use of operative vaginal delivery were associated with shoulder dystocia i n nulliparous women.

1h糖负荷试验假阳性与围生期不良预后的相关性

OBJECTIVE: To determine whether a false- positive 1- hour glucose challenge test (GCT) is associated with perinatal complications. METHODS: We performed a retrospective cohort study of 1825 eligible pregnantwomen among a cohort of 1998 patients. Patients were screened for gestational diabetes mellitus (GDM) with the 1- hour 50- g GCT at 24- 28 gestational weeks. A false- positive GCT was defined as a result greater than or equal to 135 mg/dL followed by a normal 3- hour glucose tolerance test (GTT).We compared the negative GCT and false- positive GCT cohorts for a composite perinatal outcome variable that included fetal macrosomia, antenatal death, shoulder dystocia, chorioamnionitis, preeclampsia, intensive care nursery admission, and postpartum endometritis. Secondary outcomes included cesarean delivery and each component variable of the composite. Unadjusted, stratified, and multiple logistic regression analyses were used to investigate the association between a false- positive GCT and the development of perinatal complications. RESULTS:We identified 164 patients with a false- positiveGCT and 50 patientswith GDM. The falsepositive GCT cohort on average was older, of higher parity, had a higher body mass index, and more frequently had chronic hypertension, sickle cell trait, and elevatedmidtrimester human chorionic gonadotropin levels. The false- positive GCT cohort more frequently had adverse perinatal outcomes, including the composite perinatal outcome (odds ratio 5.96, 95% con- fidence interval 1.47, 24.16), macrosomia greater than 4500 g (OR 3.66, 95% CI 1.30, 10.32), antenatal death (OR 4.61, 95% CI 0.77, 27.48), shoulder dystocia (OR 2.85, 95% CI 1.25, 6.51), endometritis (OR 2.18, 95% CI 1.03, 4.63), and cesarean delivery (OR 1.76, 95% CI 0.99, 3.14). CONCLUSION: A false- positive GCT is an independent risk factor for adverse perinatal outcomes.

米索前列醇口服及阴道分次给药促宫颈成熟的前瞻性随机临床试验

Objective: The purpose of this study was to compare the efficacy and safety of stepwise oral misoprostol vs vaginal misoprostol for cervical ripening before induction of labor. Study design: Two hundred and four women between 32 to 42 weeks of gestation with an unfavorable cervix (Bishop score ≤ 6) and an indication for labor induction were randomized to receive oral or vaginal misoprostol every 4 hours up to 4 doses. The oral misoprostol group received 50 μ g initially followed by 100 μ g in each subsequent dose. The vaginal group received 25 μ g in each dose. The primary outcome was the interval from first misoprostol dose to delivery. Patient satisfaction and side effects were assessed by surveys completed after delivery. Results: Ninety- three (45.6% ) women received oral misoprostol; 111 (54.4% ) received vaginal misoprostol. There was no difference in the average interval from the first dose of misoprostol to delivery in the oral (21.1 + 7.9 hrs) and vaginal (21.5 + 11.0 hrs, P = NS) misoprostol groups. The incidence of hyperstimulation in the oral group was 2.2% vs 5.4% in the vaginal group, P=NS. Eighteen patients in the oral group (19.4% ) and 36 (32.4% ) in the vaginal group underwent cesarean section (P <. 05). This difference was attributed to better tolerance of more doses of misoprostol by the women in the oral group. There was no difference in side effects (nausea, vomiting, diarrhea, shivering) between groups. Fourteen percent of women in the vaginal group versus 7.5% in the oral group were dissatisfied with the use of misoprostol (P = NS). Conclusion: Stepwise oral misoprostol (50 μ g followed by 100 μ g) appears to be as effective as vaginal misoprostol (25 μ g) for cervical ripening with a low incidence of hyperstimulation, no increase in side effects, a high rate of patient satisfaction, and is associated with a lower cesarean section rate.

早产对剖宫产后经阴道分娩的影响:成功率及母体发病率

OBJECTIVE: We sought to compare vaginal birth after cesarean (VBAC) success and uterine rupture rates between preterm and term gestations in women with a history of one prior cesarean delivery. Our hypothesis was that pre-term women undergoing VBAC were more likely to be successful and have a lower rate of complications than term women undergoing VBAC. METHODS: We reviewed medical records of women with a history of a cesarean delivery who either attempted a VBAC or underwent a repeat cesarean delivery from 1995 through 2000 in 17 community and university hospitals. We collected information on demographics, medical and obstetric history, complications, and outcome of the index pregnancy. The primary analysis was limited to women with singleton gestations and one prior cesarean delivery. Statistical analysis consisted of bivariate and multivariable techniques. RESULTS: Among the 20,156 patients with one prior cesarean delivery, 12,463 (61%) attempted a VBAC. Mean gestational ages for the term and preterm women were 39.2 weeks and 33.9 weeks of gestation, respectively. The VBAC success rates for the term and preterm groups were 74%and 82%, respectively (P < .001). Multivariable analysis showed that the VBAC success was higher (adjusted odds ratio 1.54, 95%confidence interval 1.27-1.86) in preterm gestations. A decreased risk of rupture among preterm gestations was suggested in these results (adjusted odds ratio 0.28, 95%confidence interval 0.07-1.17; P = .08). CONCLUSION: Preterm patients undergoing a VBAC have higher success rates when compared with term patients undergoing a VBAC. Preterm patients undergoing VBAC may have lower uterine rupture rates.

HIV-1感染孕妇未达到最佳病毒抑制时分娩的临床特点

This study was undertaken to determine clinical characteristics and factors associated with suboptimal viral suppression at delivery in human immunodeficiency virus (HIV)- infected women. Study design: All HIV- infected women who delivered at a single urban tertiary care center from January 1999 to June 2004 were studied. Women were divided into 2 groups based on HIV viral load (VL) proximate to delivery: VL <1000 copies per milliliter and VL ≥ 1000 copies per milliliter. Demographic and clinical factors were analyzed and compared between the 2 groups. Results: A total of 146 women had adequate data available for analysis: 102 (69.9% ) had VL < 1000 copies per milliliter and 44 (30.1% ) had VL ≥ 1000 copies per milliliter at delivery. Women with a viral load ≥ 1000 copies per milliliter at delivery were more likely to have a baseline viral load VL ≥ 10,000 copies per milliliter (66.7% vs 32% , P < .001) and less likely to report medication adherence, (50% vs 87.8% , P < .001). Conclusion: Our findings support the concept that in addition to antiviral medical therapy, intervention to improve adherence and maintaining a low baseline VL are key components to VL suppression in pregnancy.

经验性产前静脉注射免疫球蛋白治疗胎儿和新生儿同种免疫性血小板减少症经验性静脉输注免疫球蛋白产前处理的成本效益分析

The purpose of this study was to compare the cost effectiveness of empiric intravenous immunoglobulin (IVIG) with that of fetal blood sampling-indicated treatment for the antepartum care of fetal and neonatal alloimmune thrombocytopenia. Study design: We developed a decision analysis model to compare the cost effectiveness of 2 strategies for treatment of pregnancies in women with a history of fetal and neonatal alloimmune thrombocytopenia and an at-risk fetus: 1) IVIG and corticosteroids as indicated by fetal platelet levels determined by fetal blood sampling (FBS); and 2) empiric IVIG. In the first strategy, FBS is used to measure fetal platelets at 24 weeks of gestation and repeated 6 weeks later to guide pharmacotherapy. In the second strategy, weekly IVIG is empirically administered from 24 weeks’ to 37 weeks’ gestation. The main outcome measure was the marginal cost per quality-adjusted life years (QALY) gained. Results: For every 1000 women with a fetus at risk for recurrent alloimmune thrombocytopenia, empiric therapy, compared with FBS- indicated treatment, decreases perinatal deaths from 31.7 to 11.8 while increasing the number of infants with long-term neurologic deficits from 6.1 to 9.6. These health outcomes translate to 382 QALYs gained with empiric therapy and a cost effectiveness ratio of ＄ 32,747 per QALY favoring empiric therapy. In the sensitivity analysis, empiric therapy was not cost effective when the rate of perinatal ICH exceeded 28% . Conclusion: Empiric IVIG therapy is a cost-effective strategy for the treatment of women at risk for fetal and neonatal alloimmune thrombocytopenia when the rate of perinatal ICH is less than 28% .

妊娠期使用赫赛汀(曲珠单抗)治疗发生可逆性无羊水

BACKGROUND: Herceptin (trastuzumab), a new achemotherapeutic agent, is a monoclonal antibody that blocks the human epidermal growth factor receptor 2 protein. There is no reported experience with use of this agent during pregnancy and possible effects on the fetus. CASE: A patient with breast cancer was treated with Herceptin during pregnancy. This treatment was associated with anhydramnios, which resolved slowly after the drug was discontinued. CONCLUSION: Although listed as a category B drug, experience with Herceptin in human pregnancy is limited, and it should be used with caution. Investigation of the role of human epidermal growth factor receptor 2 protein in the embryonic kidney may further our understanding of amniotic fluid dynamics.