ObjectivesTo systematically review the perinatal outcomes after laparoscopic myomectomy versus transabdominal myomectomy.MethodsPubMed, Web of Science, Elsevier, The Cochrane Library, CNKI, VIP and WanFang Data databases were searched from inception to July 2017, to collect randomized controlled trials or cohort studies comparing the perinatal outcomes after laparoscopic myomectomy and transabdominal myomectomy. Two reviewers independently screened literature, extracted data and assessed the risk of bias of include studies. Meta-analysis was then performed by RevMan 5.3 software.ResultsEight randomized controlled trials, twenty-one cohort studies involving 4357 patients were included. The results of meta-analysis showed that: the premature birth rate (OR=0.60, 95%CI 0.38 to 0.95, P=0.03) in the laparoscopic myomectomy was lower than that in the laparotomy group. However, the rate of uterine rupture during pregnancy (OR=3.19, 95%CI 1.29 to 7.89, P=0.01) in the laparoscopic myomectomy was higher than that in the laparotomy group. There were no significant differences between two groups in the myoma residual (OR=1.00, 95%CI 0.37 to 2.65, P=0.99), recurrence (OR=0.92, 95%CI 0.68 to 1.25, P=0.60), abortion (OR=0.90, 95%CI 0.63 to 1.28, P=0.56), ectopic pregnancy (OR=1.11, 95%CI 0.54 to 2.26, P=0.78), pregnancy rate (OR=1.06, 95%CI 0.89 to 1.27, P=0.52), cesarean (OR=0.82, 95%CI 0.57 to 1.19, P=0.31), and pregnancy complications (OR=0.84, 95%CI 0.45 to 1.59, P=0.60).ConclusionsCurrent evidence shows that there are no significant differences between two groups in the myoma residual, myoma recurrence, abortion, ectopic pregnancy, pregnancy rate, cesarean and pregnancy complications. While the rate of uterine rupture during pregnancy in the laparoscopic myomectomy is higher than that in the laparotomy group, the premature birth rate after operation in the laparoscopic myomectomy is lower and shorter than that in the laparotomy group. Due to the limited quantity and quality of the included studies, more high quality studies are required to verify the above conclusion.
ObjectiveTo systematically review the association between maternal folate supplementation during pregnancy and the risk of autism spectrum disorder (ASD) in the offspring.MethodsPubMed, EMbase, Web of Science, The Cochrane Library, Scopus, CNKI, WanFang Data, VIP and CBM databases were electronically searched to collect case-control and cohort studies on the association between maternal folate supplementation during pregnancy and the risk of ASD in the offspring from inception to December 2020. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta-analysis was then performed using RevMan 5.3 and Stata 14.0 software.ResultsA total of 17 studies involving 10 812 cases and 876 241 controls were included. The results of meta-analysis showed that there was no significant association between maternal folate supplementation during pregnancy and the risk of ASD in the offspring in the total population. The subgroup analysis revealed that maternal folate supplementation during pregnancy was statistically associated with a reduced risk of ASD in the offspring in the Asian population (OR=0.71, 95%CI 0.53 to 0.96, P=0.03). However, there were no statistical correlations in European and American populations.ConclusionsCurrent evidence shows that maternal folate supplementation during pregnancy may reduce the risk of ASD in the offspring in the Asian population. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify the above conclusions.
Inflammatory bowel disease (IBD) is a group of chronic, recurrent, and non-specific intestinal inflammatory diseases. It usually occurs between 20 and 40 years old, overlapping with the patient’s childbearing age. Active IBD may lead to decreased fertility and adverse pregnancy outcomes, and pregnancy may also lead to recurrence of IBD. Through studying domestic and foreign related literature on pregnancy and IBD, this article elaborates on the guidance and management of IBD before pregnancy, the disease management of IBD during pregnancy, the disease management of IBD during lactation, and the current status and prospects of traditional Chinese medicine treatment. It aims to provide references for patients and clinicians to have a more scientific understanding of pregnancy with IBD.
Objective To systematically review the endometrial receptivity evaluated by transvaginal ultrasound and predict the clinical pregnancy outcome of in vitro fertilization-embryo transfer (IVF-ET). Methods PubMed, The Cochrane Library, EMbase, Web of Science, CNKI, WanFang Data and VIP databases were electronically searched to collect studies on transvaginal ultrasound evaluation of endometrial receptivity to predict the clinical pregnancy outcome of IVF-ET from inception to December 1st, 2021. Two researchers independently screened literature, extracted data and evaluated the risk of bias of the included studies. RevMan 5.4 software and Stata 16.0 software were used to perform meta-analysis. Results A total of 24 cohort studies and 1 case-control study were included. The total sample size was 6 632 cases, including 3 340 in non-pregnancy group and 3 292 in pregnancy group. The results of meta-analysis showed that there was no difference in endometrial volume (MD=?0.11, 95%CI ?0.33 to 0.11, P=0.34) or uterine artery S/D (MD= ?0.04, 95%CI ?0.17 to 0.09, P=0.55) between the two groups. The endometrial thickness measured on human chorionic gonadotrophin (HCG) day in the non-pregnant group (MD=?0.48, 95%CI ?0.77 to ?0.18, P=0.001) was thinner than that in the pregnant group. On embryo transfer (ET) day, uterine artery pulsatility index (PI) (MD=0.08, 95%CI 0.02 to 0.15, P=0.01) and resistance index (RI) (MD=0.01, 95%CI 0.01 to 0.01, P<0.000 01) were higher than those in the pregnancy group. Conclusion Endometrial volume and uterine artery S/D measured during IVF-ET were not correlated with clinical pregnancy outcome, while endometrial thickness measured on HCG day and uterine artery PI and RI measured on ET day were correlated with clinical pregnancy outcome. Transvaginal ultrasound evaluation of endometrial receptivity has a certain predictive value for clinical pregnancy outcome of IVF-ET. Due to the limited quality and quantity of included studies, more high-quality studies are needed to verify the above conclusion.
ObjectiveTo observe the clinical features of retinopathy of prematurity (ROP) in multiple fetuses.MethodsRetrospective clinical study. From December 2009 to June 2018, 758 premature or low-weight multiple fetuses (multiple fetuses group) and 2363 simultaneous single fetuses (single fetuses group) who were admitted to the Department of Ophthalmology and Neonatal Department of Dongguan People’s Hospital and underwent ROP screening were included in the study. Among the multiple pregnancy group, there were 735 twins and 23 triplets; 441 males and 317 females. The mean gestational age was 32.22±2.14 weeks, and the mean body weight was 1.69±0.43 kg. There were 202 of natural births and 556 of cesarean sections. A total of 750 cases have a history of oxygen. Among the singleton group, 1421 were males and 942 were females. The mean gestational age was 32.06±2.52 weeks, and the mean body weight was 1.70±0.46 kg. There were 1146 of natural births and 1217 of cesarean sections. A total of 2333 cases have a history of oxygen. The detection rate of multiple ROP, gestational age, birth weight, sex composition ratio, mode of birth, time of first ROP diagnosis, and severity of ROP were observed. χ2 test was used to compare the rate between groups, and t test was used to compare the mean between groups.ResultsAmong the multiple pregnancy group, there were 68 cases (8.97%) of ROP. Among them, 64 twins (8.71%, 64/735), 4 triplets (17.39%, 4/23). Among the singleton group, there were 187 cases (7.91%) of ROP. With the increase of fetal number, the detection rate of ROP increased, but there was no significant difference (χ2=3.097, P=0.213). There was no significant difference in the detection rate of ROP between multiple fetuses and single fetuses (χ2=0.855, P=0.355). There was no significant difference in sex ratio (χ2=0.069), mode of production (χ2=1.900), birth weight (t=0.139), gestational age (t=－0.478), and time of first ROP diagnosis (t=0.371) between ROP cases of multiple fetuses and single fetuses (P=0.793, 0.168, 0.889, 0.633, 0.371). There was no significant difference in the constituent ratio of severity of ROP lesions between multiple fetuses and single fetuses (χ2=3.003, P=0.223).ConclusionThere is no significant difference in ROP incidence, gestational age, birth weight, diagnosis time and severity of ROP between multiple fetuses and single fetuses under the same conditions.
【Abstract】ObjectiveTo investigate the indications, maternal and fetal/neonatal risks and treatments of pregnancy after liver transplantation. Methods The related published literatures were summarized and reviewed.ResultsMost females can recover a regular menstrual cycle. Hypertension, preeclampsia, bacterial and viral infection resulted from immuno-suppression therapy and increasing rate of caesarian section are the major risks for the mother. Abortion and preterm delivery, premature rupture of fetal membrane, hypoadrenalism, abnormality, immune deficiency, hepatitis virus B and cytomegalovirus and bacterial infection are the major risks for the fetus/neonate.ConclusionSatisfactory results can be obtained in most pregnancies after liver transplantation. Evaluation before gestation and surveillance during gestation by the related departments are mandatory. A guideline based on large cases is necessary for pregnancy after liver transplantation.
ObjectiveTo explored the influence of disease changes, weight gain, eosinophil levels and other factor in pregnancy women with asthma. MethodsCase records of gestational asthma patients produced in the obstetrics department of Peking University People's Hospital from October 2010 to October 2020 were collected, and refer to electronic medical records of clinics (pre-pregnancy and pregnancy). According to the disease control (asthma related unplanned respiratory clinics, emergency or hospitalization), patients were divided into pregnancy stable group and pregnancy fluctuation group. The basic characteristics, pre-pregnancy asthma control, weight gain during pregnancy and peripheral blood eosinophil level before labor were retrospectively analyzed. The cause of asthma attacks, clinical characteristics and distribution of gestational time in pregnancy fluctuations were described. Peripheral blood eosinophil levels in different period during pregnancy in the stable group were analyzed. ResultsTotally 124 cases of natural pregnancy singleton were enrolled in the study. The age was (32.3±3.9) years old. There were 71 patients in stable group and 53 patients in fluctuation group. The proportion of pre-pregnancy instability in the fluctuating pregnancy group was higher than that in the stable pregnancy group (P<0.05). The proportion of intermittent medication before pregnancy was higher in the fluctuating pregnancy group than in the stable pregnancy group (P<0.05). Peripheral blood eosinophil count before labor and the number of cases with eosinophil count≥0.15×109/L before labor were higher in the fluctuation group (all P<0.05). The proportion of hypertentive diseases in pregnancy and fetal distress in uterus were higher in the fluctuation group (all P<0.05). The common cold was the common trigger factor (38.2%) and asthma recurrences occur between 13 and 36 weeks of gestation (65.8%) in fluctuation group. In further analysis of subgroup (the stable group), peripheral blood eosinophil count in early pregnancy (P<0.05) and pregnant metaphase (P<0.05) were higher than before delivery. The number of cases with eosinophil count>0.15×109/L in pregnant metaphase (P<0.05) was higher than before delivery. ConclusionsAsthma fluctuates during pregnancy is associated with adverse maternal and fetal outcomes. It is very important and critical that asthma control before pregnancy, weight gain management and eosinophil level monitoring of patients with asthma during pregnancy. The whole management is imperative in women with asthma during pregnancy.
ObjectiveTo explore the relationship between pregnancy-associated plasma protein-A (PAPP-A) and different types of coronary heart disease (CHD) in Chinese.
MethodsThe papers about the relationship between the PAPP-A level and coronary heart disease in Chinese published before December 2013 were searched from electronic databases, including PubMed, EMbase, China National Knowledge Infrastructure, Wanfang and VIP. Statistical analysis was carried out using Stata 12.0 software.
ResultsA total of 44 papers were included in this meta-analysis. The number of cases was 3 628, including 1 137 stable angina pectoris (SAP) patients, 1 368 unstable angina pectoris (UAP) patients and 1 123 acute myocardial infarction (AMI) patients. The number of control was 1 177. This meta-analysis indicated that the levels of PAPP-A were higher in different types of CHD patients than those in the control group[SAP group:SMD=0.38, 95% CI (0.25, 0.50), P < 0.001; UAP group:SMD=2.84, 95% CI (2.36, 3.32), P < 0.001; AMI group:SMD=3.31, 95% CI (2.78, 3.85), P < 0.001, respectively]. The levels of PAPP-A were higher in AMI group than UAP group[SMD=0.56, 95% CI (0.33, 0.80), P < 0.001]. At the same time, the levels of PAPP-A in patients with disease of one, two and three coronary arteries were higher than those in the control group[SMD=2.40, 95% CI (1.49, 3.31), P < 0.001; SMD=2.27, 95% CI (1.44, 3.09), P < 0.001; SMD=2.30, 95% CI (1.35, 3.24), P < 0.001, respectively]. The levels of PAPP-A were higher in patients with disease of two arteries than in those of one artery[SMD=0.29, 95% CI (0.01, 0.58), P=0.042], but there was no significant difference between patients with disease of three arteries and those of 1 or 2 arteries(P > 0.05).
ConclusionsThe levels of PAPP-A are significantly higher in CHD patients and are positively related with the severity of CHD. The levels of PAPP-A can be regarded as the indicator for judging the severity of CHD
Objective To discuss how is the perinatal infant’s prognosis influenced by different cardiac function and types of heart disease in pregnant women with heart disease, and to check the importance of antenatal examination. Method Retrospective analyses were conducted on the clinical records of 102 pregnant women hospitalized due to heart disease from February 2002 to February 2011 in the First Affiliated Hospital of Xinjiang Medical University. According to the level of cardiac function, 61 patients were divided into the Level I-II group and the other 41 patients were in the Level III-IV group. Results Of all cases, 38 were congenital heart disease (37.25%), followed by 22 arrhythmia (21.57%), 17 rheumatic heart disease (16.67%), 15 perinatal cardiomyopathy (14.71%), 7 hypertensive heart disease and 3 other types of heart disease. The average gestational weeks were shorter and the neonate’s weight was lower in the Level III-IV group than the Level I-II group, with a significant difference (Plt;0.05); the incidence of premature delivery, low birth weight infant at normal gestational age, neonatal asphyxia and perinatal mortality was higher in the Level III-IV group than the Level I-II group, with a significant difference (Plt;0.05); the rate of regular antenatal examination was higher in the Level III-IV group than the Level I-II group, with a significant difference (P=0.008); and there were significant differences between the regular and irregular examination groups in the incidence of premature delivery and low birth weight infant at normal gestational age (Plt;0.05), but no significant differences were found in the incidence of asphyxia and perinatal mortality (Pgt;0.05). Conclusions Congenital heart disease is the most commonly-seen type in the pregnant women with heart disease. The maternal cardiac function directly impact the prognosis of perinatal infant, and the regular antenatal examination, timely diagnosis and treatment can improve pregnancy outcome.
ObjectiveTo investigate the effect of behavior intervention through diets and exercises on blood glucose controlling in patients with gestational diabetes mellitus (GDM), and to provide the basis for GDM therapy.
MethodsA total of 116 patients with GDM diagnosed and treated in the Sixth Affiliated Hospital of Sun Yat-sen University between March 2011 and December 2012 were taken as our study objects, including 72 patients in the study group and 44 patients in the control group, based on their will. For patients in the study group, we carried out behavior interventions through diets and exercises, including dietary guidance, giving pamphlet and formulating exercise plan, while for patients in the control group, we only gave them oral guidance and publicity materials. The same questionnaire was used to collect all the patients' information. Follow-up was done once in every 3 days, and rechecking was performed 2 weeks later. The results of oral glucose tolerance test and the rate of pathoglycemia were compared in these groups before and after intervention.
ResultsThe fasting blood glucose, 1- and 2-hour blood glucose were lowered after the behavior intervention in the study group (P<0.05), which were also significantly lower than the control group (P<0.05). Fasting blood glucose, 1- and 2-hour pathoglycemia was significantly lower in the study group than that in the control group and that before intervention (P<0.05).
ConclusionCombination of diets and exercises can control levels of blood glucose in GDM patients, and is an important therapy for GDM.
