Pregnancy outcomes in women with heart disease

Background As the Shanghai Obstetrical Cardiology Intensive Care Center, our hospital has accumulated a large number of clinical data of pregnant women with heart disease. This paper is a retrospective analysis of 1142 pregnancies in women with heart disease so as to evaluate the maternal and fetal outcomes of these patients.Methods A retrospective analysis was carried out for pregnancies in 1142 women with heart disease who delivered in Shanghai Obstetrical Cardiology Intensive Care Center between 1993 and 2007.Results In this study, main heart diseases in pregnancy were arrhythmia （n=359, 31.4%）, congenital heart disease （CHD; n=291,25.5%）, and myocarditis and its sequelae （n=284, 24.9%）; based on the functional classification criteria of New York Heart Association （NYHA）, more than half （n=678, 59.4%） of patients were classified NYHA Class Ⅰ; pregnant women in NHYA Class Ⅰ-Ⅱ （n=951, 83.3%） commonly had arrhythmia, myocarditis and its sequelae, while those in NHYA Class Ⅲ-Ⅳ （n=191, 16.7%） mainly had CHD, rheumatic heart disease （RHD）, cardiopathy induced by hypertensive disorders complicating pregnancy, and peripartum cardiomyopathy （PPCM）. Cardiac failure occurred in 97 （8.5%）patients, and 8 （0.7%） maternal deaths and 12 （1.1%） perinatal deaths were reported in this study. Compared with those in NHYA Class Ⅰ-Ⅱ, women in NHYA Class Ⅲ-Ⅳ had a significantly lower gestational age at birth （P 〈0.05）, lower birth weight （P 〈0.01）, and higher incidence of preterm delivery, small for gestational age and perinatal death （P 〈0.01）. The incidence of cardiac failure in pregnant women with cardiopathy induced by hypertensive disorders complicating pregnancy and PPCM was relatively high, with a rate of 80% and 52.2%, respectively. After cardiac operation, 131（90.3%） women were in classified NHYA Class Ⅰ-Ⅱ and 14 （9.7%） in NHYA Class Ⅲ-Ⅳ.Conclusions Arrhythmia is the type of heart disease that has a highest incidence in patients with heart disease in pregnancy, while main types of heart disease that impair cardiac function are CHD and RHD; cardiac failure is more frequently caused by cardiopathy induced by hypertensive disorders complicating pregnancy and PPCM; impaired cardiac function increases perinatal morbidity; cardiac surgery before pregnancy could improve the cardiac function.     

妊娠合并先天性子宫畸形对母婴结局的影响

目的探讨先天性子宫畸形妊娠对于母婴结局的影响。方法回顾性分析2008年1月至2011年6月进入围生期的子宫畸形合并妊娠患者54例（畸形组）和同期正常子宫妊娠者60例（对照组）的临床资料,比较2组的母婴结局。结果畸形组胎位异常发生率（46.3%）、胎膜早破发生率（27.8%）、剖宫产率（77.8%）、早产率（25.9%）及足月低体重儿发生率（11.1%）均显著高于对照组;平均孕周（37.1周）、新生儿平均出生体重（2728g）显著低于对照组;而胎儿宫内窘迫、新生儿窒息发生率2组差异无统计学意义（11.1%vs 8.3%,7.4%vs6.7%）。结论子宫畸形合并妊娠可对母婴结局产生不良影响,应引起临床医生足够重视,加强育龄妇女孕前检查及孕期保健。     

高龄女性累积胚胎后移植与非累积胚胎移植的妊娠结局分析

目的 比较40岁以上高龄女性累积胚胎后移植与非累积胚胎进行移植的妊娠结局。方法选择40岁以上且使用自身卵子进行冻融胚胎移植助孕229例不孕症妇女共338个周期资料,根据患者是否累积胚胎移植分为两组分析妊娠结局。 结果40~49岁女性随着年龄增高,基础卵泡刺激素水平升高（P<0.05）,获卵数减少（P<0.05）,临床妊娠率和持续妊娠率下降（P<0.05）。在40岁妇女中,累积胚胎移植组的临床妊娠率和持续妊娠率均高于非累积胚胎移植组（42.9% vs. 24.6%,P<0.05）,对于41岁、42岁、≥43岁,两组的临床妊娠率、持续妊娠率及早期流产率差异均无统计学意义（P＞0.05）。结论对于40岁不孕妇女,多次取卵累积胚胎后移植有助于提高临床妊娠率,对41岁以上女性累积胚胎对于助孕结局的益处有限。     

Pregnancy in the sixth decade of life: obstetric outcomes in women of advanced reproductive age

Context  As a result of oocyte donation, women in their sixth decade of life are now able to conceive and carry pregnancies to term. However, little is known about pregnancy outcomes in this population. Objective  To describe pregnancy outcomes in women aged 50 years or older who conceived after in vitro fertilization with donor oocytes. Design and Setting  Retrospective analysis of cycles conducted at a US university assisted reproduction program during calendar years 1991-2001. Patients  Seventy-seven postmenopausal women with no chronic medical conditions (mean [SD] age, 52.8 [2.9] years; range, 50-63 years) who underwent 121 embryo transfer procedures (89 fresh and 32 frozen). Pregnancy outcomes were ascertained by chart review and telephone follow-up. Main Outcome Measures  Maternal and neonatal outcomes. Results  There were 55 clinical pregnancies for a total pregnancy rate of 45.5%. The live birth rate was 37.2%. Of the 45 live births, 31 were singletons, 12 were twins, and 2 were triplets, for which the mean (SD) gestational ages at delivery were 38.4 (2.1) weeks, 35.8 (2.8) weeks, and 32.2 weeks, respectively. Mean (SD) birth weights were 3039 g (703 g), 2254 g (581 g), and 1913 g, respectively. Apgar scores at 1 and 5 minutes were 8.2 (0.9) and 9.1 (0.5), respectively. Of singletons, 68% were delivered by cesarean, and all multiples were delivered by cesarean. Mild preeclampsia was noted in 25% of patients and severe preeclampsia in 10%. Gestational diabetes required diet modification in 17.5%, and 2.5% required insulin. Conclusions  Appropriately screened women aged 50 years or older can successfully conceive via oocyte donation and experience similar pregnancy rates, multiple gestation rates, and spontaneous abortion rates as younger recipients. During pregnancy, they appear at increased risk of preeclampsia and gestational diabetes. A majority can expect to deliver via cesarean. However, there does not appear to be any definitive medical reason for excluding these women from attempting pregnancy on the basis of age alone.      

Pregnancy outcomes in primigravid women aged 35 years and over in South Australia, 1986-1988

The South Australian perinatal data collection for 1986-1988 was used to compare the characteristics and outcomes of singleton pregnancies in 515 primigravid women aged 35 years and over with those in 4175 younger primigravid women aged 20-29 years. Notable differences observed were a higher prevalence of medical, obstetric and labour complications and assisted deliveries in the older group. Breech presentations were almost twice as common in the older women, as were caesarean sections. Only 27% achieved a spontaneous vaginal delivery. The mean duration of hospital stay for the older women was longer for both vaginal and caesarean deliveries. However, although their babies were more likely to be premature or of low birthweight, the perinatal mortality rate was not significantly increased and the great majority of older primigravid women managed by modern obstetric methods can expect a good pregnancy outcome.     

Pregnancy outcome in short statured women

Three hundred and forty short statured mothers (height less than 145 cm) were compared with 680 mothers (height more than 145 cm) who served as control to isolate problems associated with pregnancy and labour in the former. Short statured mothers hailed from poorer social class and had an unhealthy family and past history and higher incidence of pelvic deformities and abnormal presentations. They had a lower possibility of delivering vaginally and higher incidence of instrumental deliveries. Their offsprings were likely to be less in weight and suffered from a significantly higher incidence of stillbirth and neonatal death. All this made a short statured mother a high-risk patient.     

Hepatotoxicity from paracetamol self-poisoning in western Sydney: a continuing challenge.

OBJECTIVE: To determine the annual incidence of admissions for paracetamol overdosage in the years 1985 to 1990, morbidity and mortality rates, predictors of poor prognosis and the most appropriate use of N-acetylcysteine (NAC). DESIGN: A retrospective review of case records of all patients with a discharge diagnosis of paracetamol overdosage. SETTING: A 900-bed tertiary referral teaching hospital in western Sydney with a busy accident and emergency department. PATIENTS: 306 patient records were reviewed and details of the overdose and admission were recorded. INTERVENTIONS: NAC infusion in patients with possible paracetamol hepatotoxicity. MAIN OUTCOME MEASURES: Blood paracetamol levels; elevated alanine aminotransferase levels; prolonged prothrombin time; severe liver injury; and NAC side effects. RESULTS: Annual admission rate was constant at circa 55 per annum. Female to male ratio was 2:1. Predictors of liver injury included paracetamol dose over 10 g, presentation more than 10 hours after the overdose and chronic ingestion of more than 80 g alcohol per day. There were no deaths. Fifty-five patients (18%) had toxic paracetamol levels, 51% received treatment with NAC, including 40% of those with non-toxic levels, and 11% of those treated with NAC experienced side effects. CONCLUSION: Paracetamol overdosage continues to be a significant cause of hospital admissions in western Sydney. Severe hepatic damage occurs infrequently and the prognosis for liver injury, when it occurs, is good. Treatment with NAC should be reserved for patients with definite indications for the drug.     

妊娠期不同程度糖代谢异常对新生儿体重的影响

目的探讨妊娠期不同程度糖代谢异常对新生儿体重的影响。方法选取我院2009年7月至2010年6月间经过系统产检发现妊娠期糖代谢异常、孕期未出现其他并发症及合并症的初产妇为研究对象共212例（注：我院仅对GDM孕妇进行血糖监测及血糖控制）。按血糖代谢异常程度分为四组,1组：确诊的妊娠期糖尿病（GDM）64例;2组：妊娠期糖耐量异常72例;3组：血糖筛查升高但OGTT结果正常（以下简称血糖筛查异常）76例;四组（对照组）：取同期健康初产妇78例做为对照。将1、2、3、四组新生儿体重及剖宫产率进行组间比较。结果仅2组和四组间即妊娠期糖耐量异常组孕妇的新生儿体重、巨大儿比率、体重介于3500～4000g新生儿比率及剖宫产率等指标明显高于正常组,且有统计学意义;其他各组间无统计学意义。结论在临床工作中加强对GIGT孕妇的血糖监测及控制以降低该类产妇新生儿体重、阴道分娩风险和剖宫产率。必要时在30～34周间再次行OGTT检测以减少对GDM的漏诊。     

新鲜周期全胚冷冻策略不影响体外受精-胚胎移植妊娠及产科结局:≤35岁患者的疗效分析

目的 比较新鲜周期行全胚冻存年轻患者和新鲜胚胎移植的临床妊娠结局及新生儿的产科结局,评价该策略的安全性及临床应用价值.方法 回顾性分析2011年1月~2015年12月在本中心进行体外受精-胚胎移植助孕治疗的卵巢功能正常的年龄≤35岁患者共2091个周期.促排卵治疗后全部胚胎冷冻,其后行第一周期冷冻复苏移植术的年轻患者796例为研究组,同期促排卵治疗后立即行新鲜周期移植的年轻患者1295例为对照组.分析比较两组间临床妊娠结局及分娩结局.结果 两组患者平均不孕年限无统计学差异(P>0.05),平均年龄全胚冷冻组低于新鲜周期移植组(29.5岁vs 30.2岁)有统计学差异(P<0.05).两组患者促排卵天数和移植时子宫内膜厚度无统计学差异(P>0.05),全胚冷冻组促排卵总促性腺激素剂量较新鲜移植组低(P<0.05),取卵前雌激素水平全胚组为12973 pmol/L,明显高于新鲜移植组8673 pmol/L,平均获卵数全胚组是新鲜组的1.5倍,差异均有显著性(P<0.05).两组患者临床妊娠率及活产率均无统计学差异(P>0.05),全胚冷冻组无卵巢过度刺激综合征发生,而新鲜移植组有20例发生中、重度卵巢过度刺激,差异有显著性(P=0.000).两组患者的分娩孕周及新生儿平均体质量均无统计学差异(P>0.05).结论 新鲜周期治疗中出现中、重度卵巢过度刺激综合征倾向取消新鲜周期移植而进行全胚冻存,择期行解冻移植,可获得满意的临床妊娠结局及产科结局,是预防晚发性卵巢过度刺激综合征的一种理想方法.     

Pregnancy and addiction: outcomes and interventions

Cocaine use by pregnant women has increased dramatically in recent years, resulting in well-documented consequences for mothers and offspring. However, even a once weekly peer-oriented intervention can have a positive impact on pregnancy outcome for drug-using women.     

妊娠合并梅毒患者的妊娠结局

目的探讨妊娠合并梅毒的筛查、治疗及妊娠结局,降低不良妊娠结局的发生率。方法对53例经血清学筛查并确诊为妊娠合并梅毒的临床资料进行回顾性分析,根据妊娠期是否行全疗程抗梅毒治疗,将其分组,比较两组孕妇的妊娠结局。结果53例中Ⅱ期梅毒3例(5.66%),余均为潜伏期梅毒(94.34%)。治疗组引产3例,妊娠至围产期的孕妇26例,其中无死胎、畸胎及新生儿死亡。先天梅毒儿1例(3.45%),不良妊娠结局发生率37.93%,而未治疗组的不良妊娠发生率为100%。结论妊娠合并梅毒的临床分期以潜伏期梅毒为主;梅毒是导致不良妊娠结局的重要因素,但妊娠期应及早进行规范的抗梅毒治疗,能很好控制死胎、畸胎和新生儿死亡的发生,以改善不良妊娠结局。