Conception rates in women desiring pregnancy after levonorgestrel 52 mg intrauterine system (Liletta®) discontinuation

ObjectiveEvaluate reproductive function in nulligravid and gravid women after levonorgestrel 52 mg intrauterine system (IUS) discontinuation based on time to pregnancy.Study designWe evaluated women participating in the ACCESS IUS multicenter, Phase 3, open-label clinical trial of the Liletta(®) levonorgestrel 52 mg IUS who discontinued the IUS within 60 months of use and desired pregnancy. Study staff contacted participants every three months after IUS discontinuation for up to 12 months to determine whether pregnancy occurred. We excluded women who opted to stop attempting to conceive before 12 months. We evaluated 12-month conception rates in participants 16–35 years at IUS placement, comparing dichotomous outcomes using Fisher’s exact test. We performed a multivariable analysis to assess the association of baseline characteristics, age at discontinuation, duration of IUS use, and positive sexually transmitted infection testing during IUS use with conception.ResultsAmong 165 women who attempted to conceive, 142 (86.1%) did so within 12 months with a median time to conception of 92 days. The 12-month conception rates did not differ between nulligravid (66/76 [86.8%]) and gravid (76/89 [85.4%]) women (p = 0.83) and nulliparous (78/90 [86.7%]) and parous (64/75 [85.3%]) women (p = 0.83). In multivariable analysis, only obesity (aOR 0.3 [95% CI 0.1–0.8]) was associated with ability to conceive.ConclusionsAfter levonorgestrel 52 mg IUS discontinuation, women have rapid return of fertility in the year post-removal. Fertility rates after IUS removal do not vary based on gravidity, parity, age at discontinuation, or duration of IUS use.ImplicationsThis contemporary IUS study included a large population of nulligravid and nulliparous women. IUS use over many years does not effect spontaneous fertility after IUS discontinuation, regardless of gravidity or parity. Providers and patients should have no concern about the impact of IUS use on future fertility.     

Association between gravidity and risk of metabolic syndrome: Results of Tabari cohort study

Background and aimsThe purpose of the present study was to investigate the association of gravidity and age at first pregnancy with metabolic syndrome in a large-scale, population-based cohort study in Iran.MethodsThe present secondary analysis was conducted on a subset of the population (5739 women with at least one pregnancy) enrolled in the Tabari cohort study. Reproductive history was collected using a structured questionnaire. The relationship of gravidity and age at first pregnancy with metabolic syndrome and its components was analyzed using the logistic regression model.ResultsThe results showed that after adjustment for confounding variables, the odds of having metabolic syndrome was not significantly associated with age at first pregnancy (P = 0.269) and gravidity (P = 0.504). However, there was an association between hypertension and age at first pregnancy (OR = 0.32, 95% CI = 0.12–0.82; P = 0.03). Additionally, waist circumference was also associated with gravidity (OR = 2.17, 95% CI = 1.37–3.35).ConclusionAs the findings indicated, age at first pregnancy and gravidity were not associated with the odds of having metabolic syndrome. However, a relationship was found between first pregnancy at the age of >35 years and the decreased risk of hypertension. Gravidity was also found to be a dose-dependent risk factor for increased waist circumference.     

多学科管理下鸟氨酸氨甲酰基转移酶缺乏症妇女连续三次妊娠分娩健康儿一例

本文报告1例鸟氨酸氨甲酰基转移酶缺乏症患者3次妊娠,最终在多学科管理下分娩一健康新生儿的诊疗经过。2013年患者首次妊娠,孕28周出现急性高氨血症收入上海交通大学医学院附属新华医院,诊断为鸟氨酸氨甲酰基转移酶缺乏症。给予低蛋白饮食及降血氨治疗,并在多学科管理下于孕32周剖宫产一男婴,但该男婴生后第3天死亡。基因分析提示患者及其新生儿鸟氨酸氨甲酰基转移酶基因均存在c.583G>A(G195R)突变。2015年患者再次自然妊娠,但产前诊断提示胎儿为男性,且鸟氨酸氨甲酰基转移酶基因存在同一位点纯合突变,于孕21周引产终止妊娠。2017年借助体外受精-胚胎移植及植入前基因诊断技术第3次妊娠,并在多学科管理下最终顺利分娩一名健康男婴。     

A distinctive translocation carcinoma of the kidney [“rosette-like forming,” t(6;11), HMB45-positive renal tumor]

Objective  Recently, a novel renal carcinoma with specific clinical and histological characteristics and translocation t(6;11)(p21.1;q12 or q13) has been identified. We have found 11 cases in the literature, and we are adding another 3 cases. Materials and methods  Three cases were found in the Plzeň pathological register with approximately 15,000 cases of kidney tumors. There were two females and 1 male, aged 22, 24, and 39 years. Results  The sizes of the tumors were 40, 136, and 10 mm. Two tumors were found incidentally; the biggest one was self-palpated by a 24-year-old pregnant patient. Patients are without any signs of disease 42, 20, and 17 months after surgery. Conclusion  This tumor is a distinctive and rare translocation carcinoma of the kidney [t(6;11), HMB45 positive]. All cases with known clinical data arose in younger people. The malignant potential is probably low. The work was supported by Czech government research project MSM 0021620819.     

羊膜腔灌注治疗未足月羊水过少的价值

目的观察未足月羊水过少和羊水偏少孕妇羊膜腔灌注(AI)后的妊娠和新生儿结局,探讨AI治疗未足月羊水过少和羊水偏少的意义。方法选择2006-2007年在我院诊治,孕周28~34W,B超提示羊水过少或偏少孕妇共48例。其中接受羊膜腔灌注25例(治疗组),未采取治疗措施23例(对照组),观察母儿分娩结局及相关并发症。结果治疗组25例孕妇共接受羊膜腔灌注33次,最少1次,最多4次,1例穿刺失败。羊膜腔灌注后,治疗组羊水指数(AFI)平均从(5.11±0.94)cm升到(8.78±0.98)cm,差异有显著性(P<0.05);治疗组妊娠时间延长(30.4±8.9)d,显著高于对照组(12.4±3.3)d,(P<0.05);治疗组新生儿送NICU 5例,占20.0%,而对照组12例,占52.2%,两组间有显著差异性(P<0.05);治疗组剖宫产7例,而对照组14例,治疗组剖宫产率显著低于对照组(P<0.05)。治疗组1例行羊膜腔灌注后证实为胎膜早破,2例行羊膜腔灌注后诊断为胎儿畸形行引产,1例行羊膜腔灌注后出现胎膜早破,但无胎盘早剥、羊水栓塞、穿刺感染等并发症发生。结论羊膜腔灌注能有效扩充羊水,延长孕周,改善围产儿结局,...     

巨大胎儿相关因素及分娩结局的临床分析

目的 分析巨大胎儿的相关因素及分娩方式,降低母婴并发症。方法 回顾性分析152例巨大胎儿的临床资料,并抽取同期分娩正常体重儿的足月孕妇作为对照组。结果 巨大胎儿的发生与孕期孕妇体重超重,妊娠合并糖尿病,遗传因素,孕妇饮食摄入过多而活动太少有关。巨大胎儿组较对照组易发生难产,巨大胎儿剖宫产较阴道分娩产时出血、新生儿窒息及产伤发生率均明显减少（P〈0．01,0．05）。结论 关注巨大胎儿的发生相关因素,预防其发生,适时采取适当的分娩方式,避免困难的阴道手术助产。     

妇女既往孕次及产次对新生儿出生体重影响的队列研究

目的 探讨妇女既往孕次及产次对新生儿出生体重的影响。方法 基于东莞市免费婚前健康检查和孕前优生健康检查项目,获取受检对象检查结果,追踪随访获取其妊娠结局情况。采用无序多分类logistic回归探讨妇女既往孕次及产次与小于胎龄儿（SGA）、大于胎龄儿（LGA）、低体重出生儿（LBWI）及巨大儿发生率的关系。结果 共有17 783名对象参与;调整相关混杂因素后,妇女既往孕次＞1次是分娩LGA（RR = 1.59,95%CI:1.36～1.85）和巨大儿（RR = 1.87,95%CI:1.49～2.35）的危险因素,但可降低分娩SGA（RR = 0.70,95%CI:0.60～0.81）和LBWI（RR = 0.73,95%CI:0.60～0.89）的风险;妇女既往产次＞1次增加分娩LGA（RR = 1.74,95%CI:1.40～2.17）和巨大儿（RR = 1.98,95%CI:1.45～2.71）的风险,但可降低分娩SGA（RR = 0.70,95%CI:0.54～0.90）和LBWI（RR = 0.63,95%CI:0.44～0.91）的风险。结论 妇女既往孕次、产次对新生儿出生体重有影响,应做好产前保健和健康教育工作。     

血清胆汁酸在妊娠期间的变化

目的监测血清胆汁酸在孕妇妊娠期间的变化。方法对221例不同孕期的孕妇空腹取静脉血,分离血清后检测丙氨酸转氨酶、天冬氨酸转氨酶、总蛋白、清蛋白、总胆红素及胆汁酸等6项指标。结果随着妊娠周数的增加,肝胆汁分泌和排泄受到影响,胆汁酸排泄受阻,导致血清胆汁酸增加。结论胆汁酸是妊娠期非损伤性肝功能改变监测的一个良好指标。     

妊娠肝内胆汁淤积症胎盘病理研究

妊娠合并肝内胆汁淤积症(ICP)是高危妊娠之一,可引起多种不良妊娠结局,多年来研究认为与高浓度胆盐沉积在胎盘绒毛板下致绒毛间隙狭窄、胎盘血流灌注不足,致胎儿宫内急、慢性缺氧相关。复习近几年来相关文献,综合ICP胎盘病理研究进展,试图从胎盘病理变化入手,阐述ICP时高浓度胆汁酸和胆红素的毒性作用及其致多种不良妊娠结局的机制。     

宫颈癌患者冷刀锥切术后妊娠情况分析

目的：探讨宫颈癌冷刀锥切手术后生育能力及妊娠结局情况。方法收集有生育需求的宫颈癌患者44例,按不同手术方式分冷刀锥切手术23例（观察组）和根治性子宫颈切除手术21例（对照组）,随访两组妊娠情况、分娩情况和围生儿情况。结果妊娠情况比较：对照组妊娠15例,妊娠率71．43％,观察组19例,妊娠率82．6％,差异有统计学意义（χ2＝8．654, P ＝0．002）;分娩情况比较：对照组流产2例（13.33％）,剖宫产4例（30．77％）,阴道分娩9例（69．23％）,平均产程（8．1±1．6） h;观察组流产3例（15.79％）,剖宫产6例（37．50％）,阴道分娩10例（62．50％）,平均产程（7．9±1．5）h;两组比较：χ2分别为1．62、19．654、9．654、0．984;P值分别为0．095、0．000、0．000、0．684。围生儿情况比较：对照组早产2例,胎膜早破1例,出生体质量（3．27±1．15）kg,观察组早产3例,胎膜早破1例,出生体质量（2．81±0．96）kg,两组比较：P值均＜0．01。结论与根治术治疗相比,冷刀锥切术术后妊娠率高,剖宫产率高。