The authors studied retrospectively clinical data of seventy cases with breast cancer during pregnancy and lactation.They were treated and diagnosed by operation and pathology.Primary factors influencing prognosis were analyzed.It was demonstrated that 5year survival rate of the patients were significantly influenced by clinical stage , month of pregnancy and lactation, time of symptoms, type of operation, type of pathology, histological grade of malignancy, recurrence and metastasis, and estrogen receptor status (Ｐ＜0.05).Age and termination of pregnancy had no beneficial effect on survival (Ｐ＞0.05).The prognosis of pregnant and lactating breast cancer was poorer than ordinary breast cancer.Their 5year survival rate were 55.7% and 74.3%, respectively. After they were matched for stage and for age, no difference in survival was found.Early diagnosis and radical operation combined with radiotherapy, chemotherapy and hormonal therapy have better prognosis.The method can shorten time of treatment and improve survival rate.Termination of pregnancy has not been shown to improve survival and shall not be advised routinely.Future pregnancy may be detrimental and shall be discouraged.
Aortic dissection during pregnancy is rare in clinics. Because the symptoms are lack of specificity, early diagnosis is difficult. However, the progression of aortic dissection is fast, therefore, the mortality of pregnant women and fetuses is high, and half of the death in pregnant women is due to aortic dissection. Although the development of medical condition is rapid, aortic dissection of pregnancy is still a great challenge for patients and clinicians, and is one of the most important diseases in obstetric medical disputes. In this paper, combined with the literatures published in recent years, we summarized the epidemiological characteristics and related treatment suggestions of the aortic dissection in pregnancy.
ObjectiveTo discuss the value of diffusion weighted imaging (DWI) in the diagnosis of placenta increta. MethodsThe clinical data of 42 patients with placenta increta admitted to Sichuan Provincial Hospital for Women and Children between May 2012 and January 2014 were retrospectively analyzed. All the patients were examined by prenatal magnetic resonance scans and DWI scans for subsequent comparison between ADC of the local convex placental region and ADC of the normal placental region and between the results of the two imaging methods. ResultsADC of the implantation area was significantly different from that of the normal placenta, so it could be used as a quantitative index. DWI had a higher sensitivity of diagnosis than conventional MRI. ConclusionCompared with conventional magnetic resonance imaging, DWI is more valuable in the clinical diagnosis of placenta increta, which provides a reliable basis for clinical treatment.
ObjectiveTo systematically evaluate the association between passive smoking during pregnancy and adverse birth outcomes in Chinese, as well as to provide evidence for the prevention of adverse birth outcomes. MethodsWe electronically searched the CNKI, VIP, WanFang Data, PubMed and EMbase databases to collected cohort studies about the association between passive smoking during pregnancy and adverse birth outcomes in Chinese. The search date was from January 1st 1980 to 30th August, 2014. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data and assessed the risk bias of included studies. Then meta-analysis was performed using RevMan 5.1 software. ResultsA total of 24 studies were included in the meta-analysis. The results of meta-analysis showed that, the passive smoking during pregnancy was associated with increased risks of preterm (RR=1.97, 95%CI 1.38 to 2.80), low birth weight (RR=1.94, 95%CI 1.37 to 2.76), birth defects (RR=2.01, 95%CI 1.58 to 2.56), neonatal asphyxia (RR=3.34, 95%CI 1.76 to 6.33), small-for-gestational age (RR=2.62, 95%CI 1.49 to 4.63), stillbirth (RR=3.10, 95%CI 2.00 to 4.80) and spontaneous abortion (RR=1.37, 95%CI 1.19 to 1.59). ConclusionPassive smoking during pregnancy is associated with increased risks of adverse birth outcomes.
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 investigate the clinical characteristics and treatment of severe H1N1 influenza during pregnancy and postpartum.Methods Clinical data of 7 pregnant women and 2 postpartum women with severe H1N1 influenza admitted from October to December 2009 were reviewed. Results Three pregnant women underwent caesarean section during hospitalization. The main symptoms included fever ( in9 cases, and fever lasted more than 3 days in 7 cases) , cough and sputum ( in 9 cases) , and dyspnea ( in 7 cases) . Asthenia and muscular soreness were not serious, and there were no accompanying symptoms of digestive tract. Moist rales were heard in 5 cases. White blood cell count decreased in 3 cases, neutrophils increased in 6 cases, and lymphocytes reduced in 7 cases. Hepatic enzymes were abnormal in 4 cases, and myocardial enzymes were abnormal in5 cases. 8 patients had hypoxemia, with PaO2 less than 40 mmHg in5 cases. Chest X-ray films and CT showed double pneumonia in 9 patients. 9 patients were given oseltamivir antiviral treatment. 8 cases were given antibiotic therapy. 5 patients with bilateral severe pneumonia and respiratory failure were given corticosteriod therapy. 5 severe patients were treated with non-invasive ventilation. One case switched to invasive ventilation and eventually died. Conclusions Pregnant and postpartum women with influenzaH1N1 are likely to develop into severe condition which is commonly rapidlyprogressive and even life-threatening. The main causes of death are pneumonia and acute respiratory distress syndrome.
ObjectivesTo systematically review the risk factors of complete uterine rupture so as to provide evidence for prevention of uterine rupture.MethodsPubMed, EMbase, The Cochrane Library, CBM and CNKI databases were electronically searched to collect case-control studies or cohort studies on the risk of complete uterine rupture from inception to October, 2019. Two reviewers independently screened literature, extracted data and assessed the quality of included studies, then, meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 18 studies, involving 2 104 607 cases were included. The results of meta-analysis showed that the risk factors of complete uterine rupture included single-layer suture of uterine incision (OR=1.78, 95%CI 1.15 to 2.78, P=0.01), induction of labor (OR=1.72, 95%CI 1.21 to 2.45, P=0.003) (case-control studies) and (OR=2.66, 95%CI 1.87 to 3.79, P<0.000 01) (cohort studies), induction with prostaglandins (OR=3.23, 95%CI 1.48 to 7.06, P=0.003), induction with oxytocin (OR=3.97, 95%CI 1.65 to 9.59, P=0.002), and augmentation of labor with oxytocin (OR=2.17, 95%CI 1.53 to 3.09, P<0.000 1) (case-control studies) and (OR=2.29, 95%CI 1.24 to 4.23, P=0.008) (cohort studies). There was no significant relationship between birth weight and complete uterine rupture (OR=1.26, 95%CI 0.74 to 2.17, P=0.40).ConclusionsCurrent evidence shows that single layer suture of uterine incision, induction of labor, induction with prostaglandins, induction with oxytocin and augmentation of labor with oxytocin are the risk factors of complete uterine rupture. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify above conclusions.
Objective To analyze the effectiveness and effect on pregnant outcome about living preparation of lactobacillus versus metronidazole in the treatment of bacterial vaginosis in pregnancy. Methods We searched PubMed, The Cochrane Library, VIP, CNKI, Wangfang, CBM, FMJS, and FEBMT to identify randomized controlled trials (RCT) of living preparation of lactobacillus versus metronidazole for bacterial vaginosis in pregnancy. The quality of the included trials was assessed. RevMan 5.0.24 software was used for meta-analysis. Results Eight trials involving 1 687 patients were included. The results of meta-analysis showed: no significant difference was found in the effectiveness between the two groups (RR=1.04, 95%CI 1.00 to 1.08, P=0.08); living preparation of lactobacillus had lower recurrence rate and lower premature delivery rate compared with metronidazole (RR=0.16, 95%CI 0.06 to 0.43, P=0.0004; RR=0.56, 95%CI 0.33 to 0.94, P=0.03); no significant differences were found in premature rupture of membrane, puerperal infection, infant of low-birth weight, infant infection, and infant jaundice between the two groups. Conclusion The effectiveness about living preparation of lactobacillus versus metronidazole for bacterial vaginosis in pregnancy is similar, but living preparation of lactobacillus has lower recurrence rate and lower premature delivery rate, the others of effect on pregnant outcome are similar.
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.
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.