Perinatal factors associated with the neurologic impairment of children born preterm.

OBJECTIVE: To determine the perinatal risk factors of long-term neurologic impairment for preterm infants. METHODS: A case-control study was conducted with 60 neurologically impaired and 60 healthy children, all born prematurely. RESULTS: There was no relation between neurologic impairment and maternal pregnancy complications or prenatal steroid administration, bacteriologic content of cervical smear, fetal presentation, fetal heart rate, or mode of delivery. Cerebral palsy was associated with early neurologic signs, perinatal asphyxia, neonatal septicemia, abnormal brain ultrasound findings, prolonged interval between rupture of membranes and delivery, and multiple placental lesions. Children with minimal cerebral dysfunction were more frequently first born. Multiple placental lesions, neonatal septicemia, abnormal brain ultrasound findings, and perinatal asphyxia were independently correlated with long-term neurologic impairment. CONCLUSION: Perinatal infection, perinatal asphyxia, and abnormal brain ultrasound findings seem to be risk factors for cerebral palsy whereas primigravidity seems to be correlated with minimal cerebral dysfunction.     

不同孕周非治疗性早产患者的高危因素及妊娠结局分析

目的探讨不同孕周非治疗性早产患者的高危因素和母儿不良结局。 方法采用回顾性研究方法对2012年1月至2014年12月就诊于广州医科大学附属第三医院224例非治疗性早产患者资料进行分析,根据不同孕周分成4组：A组：28～29^＋6周(38例),B组：30～31^＋6周(32例),C组：32～33^＋6周(42例),D组：34～36^＋6周(112例);分析4组患者的高危因素、产妇及新生儿的不良结局。 结果224例非治疗性早产患者发生早产的高危因素分别为胎膜早破147例(65.6%)、不良孕产史128例(57.1%)、先兆早产病史115例(51.3%)、体外受精-胚胎移植术妊娠87例(38.8%)、未规律产检53例(23.7%)、双胎妊娠25例(11.2%)。4组总产程时间分别为(4.9±3.5) h,(7.6±3.8) h,(6.7±2.9) h,(6.8±2.9) h,A组与其他3组比较,Q＝1.762,2.719和1.847 (P值均<0.05)。4组急产发生率分别为44.7% (17例),9.4% (3例),16.7% (7例),14.3% (16例),A组与其他3组比较,Q＝21.648,8.207和9.783(P值均<0.05)。4组新生儿窒息发生率分别为31.6% (12例), 12.5% (4例),7.1% (3例),6.3% (7例),A组与其他3组比较,Q＝4.591,15.345和10.834(P值均<0.05)。4组新生儿1 min Apgar评分分别为(7.7±3.2)分,(9.1±2.4)分,(9.4±1.2)分,(9.4±1.1)分,A组与其他3组比较,Q＝2.528,3.281和2.562(P值均<0.05)。4组新生儿出生体重分别为(1 555.9±470.9) g,(1 659.3±342.2) g,(1 990.8±306.5) g,(2 515.0±473.4) g,各组间差异的两两比较均存在统计学意义(P<0.01)。 结论胎膜早破是非治疗性早产发生的最常见的高危因素,要重视28～29^＋6周早产高危患者的管理,并应警惕这些孕妇和新生儿不良结局的发生。     

早产临床风险因素的探讨

目的评估影响早产分娩的风险因素以及对早产干预措施影响的相关因素。方法选择2003年1月至2006年3月发生在34周前的自发性早产临产、早产胎膜早破、宫颈机能不全、先兆早产4种临床表现类型共221例,比较4种临床表现之间发病的风险因素及影响干预措施结局的相关因素。结果自发性早产临产的风险因素依次为:本次妊娠先兆流产史(OR8.917,95%CI2.308～34.457)、胎次(OR2.179,95%CI1.033～4.598)、宫颈长度改变(OR0.366,95%CI0.259～0.518);早产胎膜早破的风险因素依次为:自然流产史(OR4.922,95%CI1.115～21.720)、体外受精-胚胎移植(IVF-ET)(OR5.341,95%CI1.571～18.164);宫颈功能不全的风险因素依次为:早产史(OR9.010,95%CI2.032～39.940),IVF-ET(OR2.603,95%CI1.195～5.670)。发生早期早产分娩的影响因素依次为:血象升高(OR4.695,95%CI2.065～10.671)、宫颈长度变短(OR0.633,95%CI0.456～0.880)。对早产干预措施的影响因素为紧急宫颈环扎术(OR26.372,95%CI2.770～251.085)和血象升高(OR7.111,95%CI1.769～28.53)。结论影响早产的风险因素较多,应注重IVF-ET妊娠的早产风险;实施紧急宫颈环扎术及注重感染指标监测是减少34周前分娩的重要干预手段。     

Recurrence and prognostic factors in borderline ovarian tumors

OBJECTIVE: The purpose of this study was to evaluate the survival estimates and clinico-pathological variables in patients treated for borderline ovarian tumors. METHODS: The patients treated for borderline ovarian tumors were evaluated retrospectively. Data were obtained from hospital records and special gynecologic oncology forms. RESULTS: Overall, 100 patients were evaluated. The mean age at the time of diagnosis was 41.7 (range, 19-84). Seventy one (71%) patients underwent surgical staging including 49 (49%) of them with comprehensive surgical staging, 22 (22%) with fertility-sparing surgery. Only 30 (30%) patients were unstaged. The histopathological diagnosis was serous, mucinous, and the other types of borderline ovarian tumor in 54 (54%), 39 (39%), and 7 (7%) of the patients, respectively. Seventy patients had stage IA (70%), 10 had stage IB (10%), 9 had stage IC (9%), 3 had stage IIIA (3%), and 8 had stage IIIC (8%) disease. The stage of only four patients in which disease confined to ovary was upgraded as stage IIIC following surgical staging procedure. The recurrence rate was found 3% (3). The overall disease-free survival rates of BOT in surgically staged (comprehensive, fertility-sparing surgery) and unstaged patients were 97.92%, 95.00%, and 96.30%, respectively. But, the overall tumor-free survival was significantly found to be decreased in cases of young age (<30 years old), performing fertility-sparing surgery and presence of micropapillary architecture or peritoneal implants. Overall survival rates of BOT in surgically staged (comprehensive, fertility-sparing surgery) and unstaged patients were 97.9%, and 100% and 100%, respectively. CONCLUSION: Low malignant potential ovarian tumors have excellent survival, and the patients can be treated safely by conservative surgery.     

The possible preterm birth preventive effect of ampicillin during pregnancy

Objective: To study the possible association between oral ampicillin treatment during pregnancy and pregnancy complications, in addition to birth outcomes, particularly preterm birth. Methods: We evaluated newborn infants without congenital abnormalities born to mothers with or without ampicillin treatment during pregnancy in the population-based large data set of the Hungarian Case-Control Surveillance of Congenital Abnormalities. Results: Of 38,151 newborn infants, 2,630 (6.9%) had mothers with ampicillin treatment during pregnancy. Some pregnancy complications, particularly preeclampsia, showed a higher prevalence in pregnant women with ampicillin treatment. Mean gestational age was slightly longer (0.2 week) but it resulted in a significant reduction in the prevalence of preterm birth (7.1 vs 9.3%; adjusted POR with 95% CI: 0.8, 0.7–0.9). The preterm birth preventive effect of ampicillin was most obvious after the use of the drug in the first trimester of pregnancy. Similar difference was not seen in the reduction of low birth weight. The rate of preterm birth was lower in newborn infants born to mothers with acute infectious diseases of both the genitourinary and respiratory systems if they were treated by ampicillin. Conclusions: Ampicillin treatment, particularly in the first trimester of gestation, can reduce the proportion of preterm birth in pregnant women with acute infectious diseases of the genitourinary and respiratory system.     

Common risk factors of breast and ovarian cancer: recent view

Clinicians, epidemiologists, and public health specialists tend to examine breast and ovarian cancer separately. Although this seems fairly rational and expected, both malignancies are estrogen related and thus share many risk factors. In this review, we investigate the common familial, reproductive, anthropometric, nutritional, and lifestyle risk factors of breast and ovarian cancer. We believe that the parallel examination of the two cancer types could significantly contribute to an improved prevention of "gynecological cancer" as a whole.     

The significance of comprehensive staging surgery in malignant ovarian germ cell tumors

Objective

To evaluate the clinical significance of fertility-preserving comprehensive staging surgery (CSS) in the treatment of malignant ovarian germ cell tumors (MOGCTs).

Methods

A total of 92 cases of MOGCTs were retrospectively reviewed.

Results

Forty-six patients (50%) received CSS, which includes ipsilateral adnexectomy + omentectomy + retroperitoneal lymphadenectomy (appendectomy and multiple biopsies as required). Forty-six patients (50%) received USO, which includes ipsilateral adnexectomy + clinical intraoperative evaluation (including retroperitoneal lymph nodes, great omentum, peritoneal, and contralateral ovary), biopsy of suspicious sites, and excision of all visible lesions. The mean operation time (177.0 vs. 114.8 min; p < 0.0001) and the mean intraoperative blood loss (499.1 ml vs. 112.9 ml; p = 0.04) were significantly higher in the CSS group compared to those in the USO group. The complication rate (17.4% vs 0%, p = 0.003), the relapse rate (10.9% vs 2.2%, p = 0.102) and the mortality rate (4.3% vs 2.2%, p = 0.500) were higher in the CSS group compared to those in the USO group. The difference in complication rate was statistically significant. The overall 5 year survival rates were 92% and 97% in the CSS and USO groups, respectively (p = 0.575). Tumor-free survival rates at 5 years were 87% and 97% in the CSS and USO groups, respectively (p = 0.115).

Conclusions

The benefit of fertility-preserving CSS to MOGCT patients was not greater than that of USO. It is safer and more effective to perform ipsilateral adnexectomy + clinical intraoperative exploration surgery (including retroperitoneal lymph nodes, great omentum, peritoneal, and contralateral ovary), biopsy of suspicious sites, excision of all visible lesions, and adjuvant chemotherapy.     

Ovulation induction treatment and risk of borderline ovarian tumors

Aim. Research has suggested an association between the use of ovulation induction drugs and the risk of ovarian cancer. It has also been proposed that there may be pre-cancerous alterations in the ovary which themselves are the cause of infertility. The aim of the present study was to evaluate the relationship between the use of ovulation induction drugs and the appearance of borderline ovarian tumors.

Material and methods. This was a case–control study in which the study group comprised 42 women with a borderline ovarian tumor and the control group comprised 257 women with benign ovarian pathology.

Results. No differences were found between the borderline tumor and control groups (14.3% vs. 27.2%, respectively) in terms of infertility history. Nor were there any differences between the groups with respect to the type of drug used, whether clomiphene citrate (9.5% vs. 6.2%, respectively) or gonadotropins (7.1% vs. 10.1%, respectively). Analysis in terms of the number of cycles administered also failed to reveal any differences. The mean number of cycles with clomiphene citrate/gonadotropins was 2.50 ± 1.00 and 3.00 ± 2.64 in the borderline tumor group and 2.44 ± 1.75 and 3.27 ± 2.25 in the control group.

Conclusions. Our series produced no evidence that ovulation induction treatment predisposes women to the development of borderline ovarian tumors.     

A case control study of risk factors and neonatal outcomes of preterm birth

Objective

The aim is to examine risk factors and neonatal outcomes of preterm birth and to provide basis in preventing preterm birth.

Role of Toll-like receptors in cervical,endometrial and ovarian cancers: A review

Objective

The Toll-like receptors (TLRs) have been implicated in inflammation, innate immunity and cancer. The goal of this paper is to review the available published research about Toll-like receptors and their roles in gynecologic malignancies.

Methods

A Medline search was conducted and published articles from the late 1990s to the present (2014) were reviewed using search phrases, Toll-like receptors and cervical, endometrial and ovarian cancers.

Results

TLR4 and TLR5 are commonly absent in normal cervix, however TLR5 expression is strong in high grade cervical dysplasia as well as invasive cancer. The expression of TLR3 and TLR4 is low in endometrial cancer. TLR2, TLR3, TLR4 and TLR5 are highly expressed in normal and neoplastic ovarian epithelium. TLR3 has been shown to have a dual function: it can contribute to tumor elimination by upregulation of interferons α and β (INF) and natural killer cell (NK) activation or it can indirectly contribute to tumor progression.

Conclusions

Inflammation is an essential element in tumorigenesis. Toll-like receptors can trigger an inflammatory response and cell survival in the tumor micro-environment. TLRs are critical immunomodulators that may play an important role in the development of gynecologic cancers. Currently TLR agonists are being investigated for a potential role as an adjuvant in the treatment of gynecologic malignancies.     

Treatment Approach and Prognosis of Pediatric and Adolescent Nonepithelial Malignant Ovarian Tumors: A Retrospective Prognosis Analysis

Study Objective

Nonepithelial malignant ovarian tumors are rare in the pediatric and adolescent population. The aim of this study was to observe the spectrum of pathology, presentation, outcome, and risk factors for survival of pediatric nonepithelial malignant ovarian tumors in a Chinese pediatric population.

Identification of risk factors for requiring transfusion during front-line chemotherapy for ovarian cancer

OBJECTIVE: Anemia requiring red blood cell (RBC) transfusion is common in ovarian cancer (OC) patients receiving post-debulking surgery chemotherapy. Erythropoietin use has been shown to decrease transfusion requirements in patients receiving chemotherapy. We sought to identify pretreatment risk factors that could identify patients at increased risk for requiring RBC transfusion during first-line treatment for ovarian cancer. METHODS: One hundred seventy-five consecutive patients who received chemotherapy with either carboplatin-paclitaxel or cisplatin-paclitaxel following debulking surgery for epithelial OC from 1993 to 1996 were identified. No patient received erythropoietin. Patient characteristics recorded included: age, stage, prechemotherapy hemoglobin, nadir hemoglobin, number of cycles and doses of chemotherapy received. The outcome was requiring RBC transfusion. Independent predictors of requiring RBC transfusion were identified using multivariate analyses. RESULTS: Median age of the cohort was 62 years (range, 28-86). Seventy-one and four-tenths percent had FIGO stage III/IV disease. Median prechemotherapy hemoglobin was 11 g/dL (range, 7.1-15.4); median nadir hemoglobin was 9.3 g/dL (range, 6.6-11.1). One hundred nineteen (66%) patients received cisplatin-paclitaxel, and 61 (34%) received carboplatin-paclitaxel. Of 175 patients, 31 (18%, 95% CI = 12-23%) required RBC transfusion. Independent risk factors for RBC transfusion were prechemotherapy hemoglobin <10 g/dL (P < 0.01, odds ratio = 3.78, 95% CI = 1.52-9.44) and carboplatin-paclitaxel versus cisplatin-paclitaxel treatment (P = 0.01, odds ratio = 3.14, 95% CI = 1.27-7.76). Of 175 patients, 40 (22.8%) had a prechemotherapy hemoglobin <10 g/dL. Fifty percent of patients with prechemotherapy hemoglobin <10 g/dL who received carboplatin-paclitaxel required RBC transfusion, compared with 7.7% of patients with hemoglobin >10 g/dL who received cisplatin-paclitaxel. CONCLUSION: Ovarian cancer patients frequently require RBC transfusion during postdebulking platinum-paclitaxel chemotherapy. Patients with prechemotherapy hemoglobin <10 g/dL and those receiving carboplatin-paclitaxel are at increased risk of requiring RBC transfusion. Early initiation of erythropoietin use in such patients may reduce transfusion needs.     

Possible association of folic acid supplementation during pregnancy with reduction of preterm birth: a population-based study

Objective

Periconceptional folic acid or multivitamin supplementation is recommended for prospective pregnant women to prevent neural-tube defects. The question is whether it is worth continuing these supplementations after the first trimester of pregnancy or not. Thus the possible fetal growth promoting and/or preterm birth reducing effect of vitamin supplements in the second and mainly in the third trimester was studied.

Study design

Comparison of birth outcomes of singletons born to primiparous pregnant women with prospectively and medically recorded vitamin supplement in the population-based data set of the Hungarian Case-Control Surveillance of Congenital Abnormalities (HCCSCA), 1980–1996 contained 6293, 169, and 311 primiparae with folic acid alone, multivitamins and folic acid + multivitamin supplementation, respectively, and their data were compared to the data of 7319 pregnant women without folic acid and folic acid-containing multivitamin supplementation as reference.

Results

Mean gestational age was 0.3 week longer and mean birth weight was by 37 g higher in the group of folic acid alone, than in the reference group (39.2 weeks; 3216 g). The rate of preterm births (7.6%) was significantly lower compared with the reference sample (11.8%), but the rate of low birth weight newborns did not show significant reduction. Folic acid alone in the third trimester associated with 0.6 week longer gestational age and a more significant reduction in the rate of preterm births (4.8%).

Conclusions

Minor increase in mean birth weight after high dose of folic acid supplementation during pregnancy would not be expected to result in too large babies; however, the significant reduction in the rate of preterm births may have great public health benefit.     

Low pre-pregnancy body mass index and risk of medically indicated versus spontaneous preterm singleton birth

Objective(s)

There were three primary objectives of this study: (1) to estimate the risk of preterm and very preterm birth by severity of low pre-pregnancy body mass index (BMI), (2) to determine if the risk in preterm and very preterm birth by severity of low pre-pregnancy BMI differs for spontaneous versus medically indicated preterm delivery, and finally (3) to determine if there is a difference in the risk for preterm and very preterm birth by severity of low pre-pregnancy BMI across gradations of gestational weight gain.

Study design

This study utilized the Missouri maternally linked cohort files from 1989 to 1997. After restricting analyses to singleton live births (gestational age 20–44 weeks) and women with either a low or normal BMI, the final study population consisted of 437,403 births. Pre-pregnancy BMI was categorized as normal (19.5–24.9), mild thinness (17.0–18.5), moderate thinness (16.0–16.9) and severe thinness (≤15.9). Statistical analyses included chi-square tests and logistic regression with generalized estimating equations (GEE).

Results

Underweight mothers were more likely to experience a preterm delivery. For all preterm births, the risk among underweight mothers increased with ascending underweight severity (p < 0.01). Higher risk estimates were observed for spontaneous than for medically indicated preterm birth. For each BMI category, extreme risk values for spontaneous preterm births were observed among women with very low gestational weight gain (<0.12 kg/week). Severely thin mothers with very low and very high pregnancy weight gain were at the greatest risk for spontaneous preterm birth. By contrast, underweight women with moderate gestational weight gain (0.23–0.68 kg/week) had the lowest risk for spontaneous preterm birth with the sole exception of moderately underweight gravidas.

Conclusions

These findings suggest that women with low or normal pre-pregnancy BMI should be counseled to maintain a moderate level of gestational weight gain (0.23–0.68 kg/week) in order to reduce their risk for preterm birth. Further, our observation that severity of low pre-pregnancy BMI was associated directly (in a dose–response pattern) with preterm birth highlights the importance of preconceptional counseling for women—specifically the importance of women achieving or maintaining a normal weight status prior to pregnancy.     

Relationships between physical abuse during pregnancy and risk factors for preterm birth among women in Manitoba

OBJECTIVE: To describe the prevalence and correlates of physical abuse during the year of pregnancy and to explore the association between physical abuse and other risk factors for preterm birth. DESIGN: Secondary analysis of data from a case-control study of risk factors for preterm birth. SETTING: Two tertiary care hospitals in the Canadian province of Manitoba. PARTICIPANTS: Six hundred eighty postpartum women who delivered a live singleton newborn after spontaneous onset of labor. MAIN OUTCOME MEASURES: Instruments included the Abuse Assessment Screen, Prenatal Psychosocial Profile, Perceived Stress Scale, and a questionnaire to collect data on demographic characteristics, complications during pregnancy, and lifestyle behaviors. RESULTS: Sixty-four women (9.4%) reported being physically abused during the year of pregnancy. Abused women were significantly more likely to be younger, single, of lower income, and less educated than nonabused women. Significant correlates of abuse, after adjusting for other factors in a logistic regression, included the following: illicit drug use, low support from partner, moving two or more times in the past year, high life event stress, bladder infection during pregnancy, Aboriginal race/ethnicity, and single marital status. CONCLUSION: This study suggests that physical abuse during pregnancy is associated with other risk factors for preterm birth, particularly stress and behavioral risk factors such as substance abuse.     

Paternal involvement and support and risk of preterm birth: findings from the Boston birth cohort

Objective: To investigate to what extent paternal involvement and support during pregnancy were associated with preterm (PTB) and small-for-gestational age (SGA) births.

Methods: Using data from the Boston Birth Cohort (n?=?7047), multiple logistic regression models were performed to estimate the log odds of either PTB or SGA birth, with paternal involvement, paternal social support, and family and friend social support variables as the primary independent variables.

Results: About 10% of participating mothers reported their husbands not being involved or supportive during their pregnancies. Lack of paternal involvement was associated with 21% higher risk of PTB (OR?=?1.21, 95% CI: 1.01–1.45). Similarly, lack of paternal support was borderline associated with PTB (OR?=?1.13, 95% CI: 0.94–1.35). Also marginally significant, lack of paternal involvement (OR?=?1.18, 95% CI: 0.95–1.47) and father’s support (OR?=?1.19, 95% CI: 0.96–1.48) were associated with higher odds of SGA birth. No associations were found between familial and friend support during pregnancy and PTB or SGA.

Conclusions: Among predominantly low-income African Americans, lack of paternal involvement and lack of paternal support during pregnancy were associated with an increased risk of PTB, and suggestive of SGA birth. These findings, if confirmed in future research, underscore the important role a father can play in reducing PTB and/or SGA.     

子痫前期及其高危因素对围产儿结局的不良影响

目的:探讨子痫前期(PE)及其高危因素对围产儿结局的影响.方法:根据国内外资料统计的PE高危因素,筛选2011年4月至2012年1月在上海交通大学医学院附属仁济医院妇产科产检和分娩的正常及存在高危因素的孕妇154例,最终发展为PE的孕妇50例,非PE孕妇104例.通过采集病史及实验室检查,追踪妊娠结局,分析PE及存在高危因素PE孕妇的围产儿结局.结果:(1)PE组的新生儿体重及分娩孕周显著小于非PE组(P＜0.05).(2)PE组的胎儿生长受限(FGR)、胎儿窘迫、早产、死胎、新生儿窒息发生率分别是非PE组的4.64倍、2.32倍、4.61倍、2.66倍、6.38倍.两组的FGR、胎儿窘迫、早产的发病率有显著差异(P＜0.05).(3)当MAP≥85 mmHg、蛋白尿、子宫/脐动脉血流异常、D-D＞0.246μg/ml、FDP＞4μg/ml、PAGT＞40％时,易发生围产儿不良结局(P均＜0.05).不同高危因素对围产儿结局的威胁程度不同,其中子宫/脐动脉血流异常时围产不良结局发生率均较高(P＜0.05).结论:PE对围产儿结局有不良影响.孕期可针对高危孕妇进行严格有效的筛查,严密监测围产儿生长发育,警惕PE及围产儿不良结局的发生.