简介：AbstractBackground:Ectopic pregnancy (EP) is a common complication in women undergoing assisted reproductive treatment, but the underlying causes for this remain unclear. This study aimed to explore factors affecting the incidence of EP in in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI).Methods:This was a retrospective study on the incidence of EP in IVF/ICSI cycles between January 1, 2013 and December 31, 2017. Patient age, infertility diagnosis (tubal factor or not), primary or secondary infertility, type of cycle (frozen-thawed or fresh), type of embryo(s) transferred (cleavage embryo or blastocyst), number of embryos transferred (one, two, or three), previous history of EP, and endometrial combined thickness were analyzed to explore their relationships with the incidence of EP. Based on clinical typing results, the patients were divided into an EP group or a non-EP group. Categorical variables were analyzed using Chi-squared test or Fisher exact test. Logistic regression analysis was performed to explore their associations with the incidence of EP.Results:The percentage of patients with primary infertility in EP group was significantly lower than that in non-EP group (31.3% vs. 46.7%, χ2 = 26.032, P < 0.001). The percentage of patients with tubal infertility in EP group was also significantly higher than that in non-EP group (89.2% vs. 63.6%, χ2 = 77.410, P < 0.001). The percentages of patients with transfer of cleavage-stage embryo or blastocyst (91.4% vs. 84.4%, χ2 = 10.132, P = 0.001) and different endometrial combined thickness (ECT) (χ2 = 18.373, P < 0.001) differed significantly between EP and non-EP groups. For patients who had a previous history of one to four EPs, the percentage of patients undergoing transfer of a cleavage-stage embryo was significantly higher in EP group than that in non-EP group (92.2% vs. 77.6%, χ2 = 13.737, P < 0.001). In multivariate logistic regression analysis, tubal infertility was strongly associated with EP (adjusted odds ratio: 3.995, 95% confidence interval: 2.706-5.897, P < 0.001).Conclusions:In IVF/ICSI cycles, transfer of a blastocyst-stage embryo, especially for patients with a previous history of EP, reduced the rate of EP. Tubal infertility was strongly associated with EP.

简介：Pregnancyprofoundlyaffectscarbohydratemetabolism.Thesechangesareimportantinwomenwithdiabetes(typicallytype1,butmoreyoungtype2patientsarebeingencountered)whoareplanningpregnancy,andinwomenwhodevelopgestationaldiabetesmellitus(GDM-glucoseintolerancefirstrecognizedduringpregnancy).Inallcases,acompmherlsiveapproachinvolx4ngexpertiseinobstetrics,diabetology,nursinganddieteticsishighlydesirable.

简介：AbstractInnate lymphoid cells (ILCs) are a group of lymphocytes without diversified antigen receptors encoded by gene rearrangement on T and B cells. ILCs, which are tissue-resident innate immune cells, expressed particularly in the mucosa or the barrier surface, contribute to the formation of lymphoid organs, the maintenance of tissue homeostasis, and the regulation of antimicrobial defenses. It has been recently reported that ILCs were enriched at the maternal-fetal interface. During a successful pregnancy, the maternal immune system must tolerate a fetus as an allograft. With the new defined of ILCs, a number of studies have shown that three types of ILCs are involved in embryonic development and pregnancy maintenance as well as the occurrence and development of pregnancy-related complications. This article reviews the types and roles of ILCs in normal pregnancy and pregnancy-related diseases.

简介：AbstractHypertension in pregnancy is currently defined as a systolic blood pressure (BP) of 140 mmHg or more, or a diastolic BP of 90 mmHg or more. This level of BP warrants antihypertensive therapy. Treating to a target BP of 135/85 mmHg halves the risk of severe hypertension that is itself associated with adverse maternal and perinatal outcomes, similar in magnitude to preeclampsia. While based on the results of the Control of Hypertension in Pregnancy Study (CHIPS) trial, this finding is consistent with all antihypertensive trials to date. Also, in the CHIPS trial, "tight" BP control also halved the risk of progression to thrombocytopenia and elevated liver enzymes for the mother, without adverse effects for the fetus or newborn. This was true regardless of the gestational age at which BP control was instituted. While methyldopa, labetalol, and nifedipine are the most commonly-recommended oral antihypertensives, it is not clear that one antihypertensive agent has advantages over the others for treatment of non-severe hypertension in pregnancy. No antihypertensives, including renin-angiotensin-aldosterone system (RAAS) inhibitors, have been shown to be teratogenic, although there may be an increase in malformations associated with the underlying condition of chronic hypertension. Atenolol and RAAS inhibitors should not be used once pregnancy is diagnosed, based on fetotoxicity. At present, BP treatment targets used in clinic are the same as those used at home as the differences are quite variable among hypertensive women. For treatment of acute severe hypertension, the most commonly-recommended antihypertensives are oral nifedipine, IV labetalol, and IV hydralazine, although oral agents have also been shown to be effective in the majority of women; while concerns raised about IV hydralazine-induced maternal hypotension and its consequences have not been confirmed, this medication may be an inferior antihypertensive to oral nifedipine. While treatment recommendations are based on evidence, women should be engaged in decision-making, as their values may alter target BP and antihypertensive choice. Future work will clarify the optimal target BP based on home BP measurements; whether BP targets should be lowered further if the definition of hypertension is based on a lower BP; which, if any, antihypertensive medication for non-severe hypertension is better with regards to maternal and perinatal outcomes; and whether factors beyond BP level (such as variability, race, and other physiological variables) should inform antihypertensive therapy in pregnancy.

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简介：AbstractGut microbiota is symbiotic and interdependent with human body. Intestinal probiotics are colonized in the human gastrointestinal tract, which can improve the host intestinal microenvironment and enhance the intestinal function and immune function of the human body. A small number of opportunistic pathogens exist in the intestinal tract. Once the number of pathogens exceeds the threshold of intestinal tolerance, the intestinal micro-ecological balance can be destroyed, and various diseases may thus develop. Pregnancy is a special status with different physiologic changing stages. In the meanwhile, alterations in the gut microbiome populations occur, which can promote the differentiation, development, and maturation of fetal organs by affecting maternal metabolism. Compared with normal pregnant women, great changes in the gastrointestinal function and gut microbiome may take place in pregnant women with pregnancy-related complications, in which these changes include the number, species, and intestinal translocation. The composition of the maternal gut microbiome could contribute to pregnancy and obstetric outcomes, and long-term health of mother and child. The relationships of pregnancy to gut microbiome have attracted an increasing attention in recent years. This article will provide a summary review of the research studies of gut microbiome in normal pregnant women versus abnormal pregnancy women with complications.

简介：AbstractDecidualization is the differentiation of endometrial stromal cells into secretory decidual stromal cells. Human decidualization involves some amount of signaling molecules and pathways as well as genetic reprogramming, which is driven by the postovulatory rise in progesterone levels and local cyclic adenosine monophosphate production. Decidualization extends from the primary decidual zone to the secondary decidual zone, and then exits through apoptosis. Evidences support that decidual fibroblasts function as the pool of decidual stromal cells during pregnancy. Decidualization undergoes an acute inflammatory phase, an anti-inflammatory secretory phase to the final recession phase. The decidualization of the inner layer of endometrium, termed decidua, is the most critical determinant of pregnancy success, which can promote placenta formation, modulate immune tolerance, foster resistance to oxidative stress, sense embryo quality, and control labor. Failure to adequate decidualization in terms of hormones, biochemistry, and immunology leads to adverse pregnancy outcomes, including diseases such as preeclampsia, miscarriage, premature labor, repeated implantation failures, and some age-related decline in reproductive capacity. The development of animal models and in vitro culture systems combined with emerging technologies provides a powerful system to explore the mechanism of decidualization. However, decidualization is a dynamic, multi-step process, and translating of current research progress into disease predictions and interventions for pregnancy complications remains to be achieved. The study of periodic regeneration and spontaneous decidualization of the endometrium will be beneficial to the diagnosis and treatment of pregnancy diseases.

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简介：AbstractHuman coronavirus (HCoV) causes potentially fatal respiratory disease. Pregnancy is a physiological state that predisposes women to viral infection. In this review, we aim to present advances in the pathogenesis, clinical features, diagnosis, and treatment in HCoV in pregnancy. We retrieved information from the Pubmed database up to June 2020, using various search terms and relevant words, including coronaviruses, severe acute respiratory syndrome coronavirus, Middle East respiratory syndrome coronavirus, 2019 coronavirus disease, and pregnancy. Both basic and clinical studies were selected. We found no evidence that pregnant women are more susceptible to HCoV infection or that those with HCoV infection are more prone to developing severe pneumonia. There is also no confirmed evidence of vertical mother-to-child transmission of HcoV infection during maternal HCoV infection. Those diagnosed with infection should be promptly admitted to a negative-pressure isolation ward, preferably in a designated hospital with adequate facilities and multi-disciplinary expertise to manage critically ill obstetric patients. Antiviral treatment has been routinely used to treat pregnant women with HCoV infection. The timing and mode of delivery should be individualized, depending mainly on the clinical status of the patient, gestational age, and fetal condition. Early cord clamping and temporary separation of the newborn for at least 2 weeks is recommended. All medical staff caring for patients with HCoV infection should use personal protective equipment. This review highlights the advances in pathogenesis, maternal-fetal outcome, maternal-fetal transmission, diagnosis and treatment in HCoV including severe acute respiratory syndrome coronavirus, Middle East respiratory syndrome coronavirus, and coronavirus disease 2019 in pregnancy.

简介：AbstractObjective:Pseudoxanthoma elasticum (PXE) is a multisystem heritable disorder caused by mutations in the Abcc6 gene. The disease is characterized by ectopic mineralization of the skin, eyes, and arterial blood vessels. Previous studies have suggested that cardiovascular complications in patients with PXE are caused in part by premature atherosclerosis. The aim of this study is to determine the effect of an atherogenic diet on ectopic mineralization.Methods:We used Abcc6tm1JfK mice (Abcc6-/- mice) as an established preclinical model of PXE. The offspring at age of 4 weeks were divided into two groups and fed the standard control laboratory diet (control group) and the atherogenic diet. Serum lipid profiles and bile acids were measured, and steatosis and tissue mineralization were evaluated by histopathologic analysis and chemical calcium quantification assay, respectively.Results:After 50-58 weeks of feeding an atherogenic diet, the concentrations of total cholesterol, low-density lipoprotein/very-low-density lipoprotein cholesterol, and bile acids were significantly higher in the Abcc6-/- mice on the atherogenic diet (180.9 ± 14.8 g/L, 145.9 ± 12.9 g/L, and 9.7 ± 1.4 μmol/L, respectively) than in Abcc6-/- mice on a control diet (85.2 ± 4.8 g/L, 25.1 ± 5.5 g/L, and 3.3 ± 0.5 μmol/L, respectively) (P < 0.001). Hypercholesterolemia was accompanied by extensive lipid accumulation in the liver and aorta, a characteristic feature of steatosis. The direct calcium assay demonstrated significantly increased mineralization of the muzzle skin containing the dermal sheath of vibrissae (57.2 ± 4.4 μmol Ca/gram tissue on the atherogenic diet and 43.9 ± 2.2 μmol Ca/gram tissue on control diet; P < 0.01), a reproducible biomarker of the ectopic mineralization process in these mice. An increased frequency of mineralization was also observed in the kidneys and eyes of mice on the atherogenic diet (P < 0.01).Conclusion:These observations suggest that the atherogenic diet caused hypercholesterolemia and accelerated ectopic mineralization in the Abcc6-/- mice. Our findings have clinical implications for patients with PXE, a currently intractable disorder with considerable morbidity and occasional mortality.

简介：AbstractObjective:Pseudoxanthoma elasticum (PXE) is a rare genetic disorder caused by loss-of-function mutations in the ABCC6 gene. While PXE is characterized by ectopic mineralization of connective tissues clinically affecting the skin, eyes, and cardiovascular system, kidney stones were reported in some individuals with PXE. The aim of this study is to determine whether kidney stones are an incidental finding or a frequent manifestation of PXE.Methods:We first investigated the genetic basis of two siblings diagnosed with PXE. The younger patient presented with recurrent kidney stones since 8 years old. Secondly, to address whether kidney stones are associated with PXE, the prevalence of kidney stones in a survey cohort of 563 respondents with PXE was compared to that of a general U.S. population survey, National Health and Nutrition Examination Survey, with 28,629 participants.Results:Genetic analysis in both patients identified compound heterozygous mutations in ABCC6, c.2787+1G>T, and c.3774_3775insC. The analysis of participants 20 years old and older revealed that 23.4% of PXE patients had previously had a kidney stone, a significant increase compared to 9.2% in the general population (P < 0.01). In addition, 17.8% of PXE patients reported their first kidney stone episode before age of 18 years old.Conclusions:PXE correlates with an increased risk of developing kidney stones with considerable morbidity and health-care cost.

简介：Thispaperreviewscurrentrecommendationsontheappropriateevaluationandmanagementofcardiacarrhythmiasinthepregnantpatient.Mostarrhythmiasduringpregnancyarebenignandrequirenointervention.Whenrequired,thedecisiontotreatshouldbebasedonsymptomseverityandtheassociatedrisktomotherandfetusposedbypotentiallyrecurringarrhythmiaepisodesthroughoutthepregnancy.Anytreatmentstrategyinthispatientpopulationhasinherentrisktobothmotherandunbornchild.Beforetheinitiationofanyintervention,documentationofaclinicalarrhythmiaandcorrelationwithclinicalsymptomsshouldbeobtained.Thereisnoroleforempirictherapy.

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简介：AIM:Toinvestigatetheclinicalcharacteristicsoffulminanthepatitisinpregnancy.METHODS:Wecomparedandanalyzedtheetiology,clinicalcharacteristics,andlaboratoryexaminationsof25casesoffulminanthepatitisinpregnancyand30casesoffulminanthepatitisnotinpregnancy.RESULTS:HBVinfectionandchronicfulminanthepatitisweremostcommonbothinthepregnantandinthenon-pregnantgroups.Jaundice,digestivetractsymptoms,increaseofbilirubinandthrombinogenactivitywerethemainmanifestations.Theincidenceofhepaticencephalopathy(HE)andhepato-renalsyndrome(HRS)wassignificantlydifferentbetweenthetwogroups.Theincidenceofpretermlabor,deadfetusandneonatalasphyxiawashigh.CONCLUSION:Fulminanthepatitisislikelytooccurinlatepregnancywithmoreseverecomplications,whichsignificantlyinfluencesmaternity,perinatalfetus,andnewborn.

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简介：AbstractServing as the interface between the fetal and maternal environments during gestation, the placenta plays critical roles in the protection of the developing fetus and the maintenance of maternal health. The placenta is primarily derived from the embryonic trophectoderm which differentiates into various subtypes of trophoblast cells through villous and extravillous pathways. The interactions among trophoblasts and multiple decidual cells and immune cells at the maternal-fetal interface fundamentally form the functional units of the placenta, which are responsible for blood perfusion and maternal-fetal material exchange, immune tolerance, and the regulation of pregnancy adaptation. Defects in placental development and functional maintenance are in tight association with adverse pregnancy outcomes such as preeclampsia. In this article, we review recent advances on human trophoblast cell differentiation and the construction of placental functional units and discuss the placental and maternal factors that may contribute to the occurrence of preeclampsia.

简介：AbstractPerimesencephalic subarachnoid hemorrhage (P-SAH) is a benign subset of subarachnoid hemorrhage. Only two cases of P-SAH during pregnancy have been reported in the literature. We describe a case of P-SAH detected at 29 weeks’ gestation, arose with severe bilateral frontal headache, neck rigidity, and vomiting. A diagnosis of P-SAH was confirmed on magnetic resonance angiography with no evidence of vascular malformation or bleeding sources and conservatively treated. Hemorrhage, vasospasm, and cerebellar edema observed on initial magnetic resonance angiography resolved after two months. The clinical course of P-SAH during pregnancy appears to be favorable. Our case shows for the first time in literature that magnetic resonance angiography is a valid diagnostic test for P-SAH during pregnancy that circumvents radiological risk associated with conventional imaging.

简介：Acutepancreatitisduringpregnancyisarareevent,andcanbeassociatedwithhighmaternalmortalityandfetalloss.Gallstonediseaseisthoughttobethemostcommoncausativefactorofacutepancreatitis,but,inmanycases,thecauseremainsunclear.Wereportacaseofa36-year-oldwomanat35wkofgestation,whopresentedwithseverepainconfinedtotheupperabdomenandradiatingtotheback.Thepatientwasdiagnosedwithacuteidiopathicpancreatitis,whichwasmanagedconservatively;sherecoveredwithinseveraldaysandthendeliveredahealthybaby.Thereforeitisimportanttoconsideracutepancreatitiswhenapregnantwomanpresentswithupperabdominalpain,nauseaandvomitinginordertoimprovefetalandmaternaloutcomesforpatientswithacutepancreatitis.

简介：AbstractAspirin, one of the most widely applied medicines, not only possesses the effects on reducing fever, anti-vascular hyperplasia, and anti-inflammation, but also has the capacity of preventing platelet aggregation. So far, it is acceptable to adopt aspirin, especially low-dose aspirin (LDA), to prevent pregnancy-related complications, such as pregnancy complicated by antiphospholipid syndrome, systemic lupus erythematosus, or preeclampsia; unexplained recurrent spontaneous abortion; fetal growth restriction; and preterm birth. In this article, we reviewed the possible mechanism of action and applications of aspirin in these pregnancy-related complications.

简介：Managementofrheumaticmitralregurgitationinawomancontemplatingpregnancypresentsuniquechallengesfortheclinician.Whentaskedwithtakingcareofthistypeofpatient,attentionneedstobepaidtothepatient’sfunctionalstatustodetermineifsymptomsarepresent.Inadditiontothisclinicalassessment,transthoracicechocardiographyisalsocritical.Itprovidesinsightintotheetiologyofthemitralregurgitation,assessesforthepresenceofconcomitantmitralstenosisorothervalvularabnormalities,characterizestheseverityofmitralregurgitationthroughanintegrativeapproachandidentifieshighriskfindingsincludingprogressiveleftventricular(LV)dilationandLVdysfunction.SurgicalinterventionisrecommendedforsymptomaticpatientsandinasymptomaticpatientswithevidenceofprogressiveLVdilationandaLVejectionfractionoflessthan60%.Whilethepresenceofpulmonaryhypertensionandatrialfibrillationhavebeenshowntoberiskfactorsindegenerativemitralregurgitation,thesamehasnotbeendemonstratedinrheumaticmitralvalvedisease.Whilemitralregurgitationmaybereasonablywelltoleratedduringpregnancy,symptomaticpatientsareathigherriskforadversematernalandfetaloutcomes,andtherefore,itisrecommendedthatmitralvalvesurgerybeperformedpriortopregnancy.Oncethedecisionhasbeenmadetoproceedtosurgery,mitralrepair,performedataHeartValveCenterofExcellenceisrecommendedifpossibleduetoimprovedoutcomes.Mitralvalverepairispossiblein>80%casesofrheumaticmitralregurgitation.Ifrepairisnotpossible,replacementwitheitherabioprostheticormechanicalvalvearereasonableoptions.Thereareadvantagesanddisadvantagestoeachapproachandthechoiceofprosthesisshouldbeashareddecisionbetweenthepatientandhertreatmentteam.