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ObjectiveTo explore the impact of primiparas’ intention to have a second child on their delivery mode.MethodsDuring March 1st， 2019 and November 30th， 2020， the enrolled pregnant women were investigated by questionnaires at two points， first trimester pregnancy registration and post-natal visit at maternal and child healthcare community centers of Xuhui District. Logistic regression analysis was used to examine the association of willingness of a second birth and their mode of delivery.Results2 000 questionnaires were distributed and 1 664 valid questionnaires were analyzed. The overall cesarean delivery rate in nulliparous women was 40.08% （667/1 664）， with 8.95% （149/1 664） of non-medical indication cesarean delivery. Multiple Logistic regression analysis of overall delivery rate showed that age， willingness to have more children in the future， plan of vaginal delivery at first questionnaire， and complications during pregnancy were associated with overall cesarean delivery rate， and women without the willingness to have more children in the future were more likely to undergo cesarean delivery （OR=1.350， 95%CI： 1.052-1.732）. Age， whether to have a second child in the future， plan of vaginal delivery at first questionnaire， and complications during pregnancy were all factors associated with increased risks of non-medical indicated cesarean delivery， while women with no plan of a second child in the future had nearly 2 times of risk of non-medical indicated cesarean delivery （OR=1.909， 95%CI： 1.117-3.262）.ConclusionThe mode of delivery is affected by many factors， among which willingness to have more children in the future is an important factor associated with increased risks of overall cesarean delivery and non-medical indicated cesarean delivery.

Objective·To explore the pregnancy complications and adverse pregnancy outcomes, and summarize the pregnancy characteristics of elderly primiparas. Methods·A total of 300 elderly primiparas who delivered in Shunde Women's and Children's Hospital Affiliated to Guangdong Medical University from January 2017 to December 2018 were selected to form the elderly primipara group, and a total of 2 138 elderly multiparae who gave birth to their second child in the same period were selected to form the elderly multipara group. A total of 2 088 primiparas at the appropriate age were randomly selected according to the discharge date to form the appropriate age primipara group, and 1 839 multiparae at the appropriate age who gave birth to their second child were randomly selected to form the appropriate age multipara group. Univariate analysis was performed by χ² test and analysis of variance, and multivariate analysis was performed by Logistic regression analysis. The differences among the four groups were compared and analyzed, including gestational diabetes mellitus, gestational hypertension, premature delivery, postpartum hemorrhage, and so on. Results·Multivariate Logistic regression analysis showed that the elderly primiparas group had the highest risk of gestational diabetes mellitus (aOR=2.938, 95%CI 2.240 - 3.853), gestational hypertension (aOR=8.579, 95%CI 3.082-23.887), eclampsia (aOR=6.139, 95%CI 2.400-15.985), placenta previa (aOR=3.642; 95%CI 1.551-8.552), turbid amniotic fluid (aOR=4.318, 95%CI 1.852-10.069), premature delivery (aOR=2.573, 95%CI 1.710-3.871), cesarean section (aOR=2.589, 95%CI 1.988- 3.373), low birth weight (aOR=3.317, 95%CI 2.111-5.214), neonatal asphyxia (aOR=8.175, 95%CI 2.907-22.992) and respiratory distress syndrome (aOR= 10.936, 95%CI 4.400 - 27.316), compared with the appropriate age multiparae group. The appropriate age primipara group had highest risk of premature rupture of membranes (aOR=1.635, 95%CI 1.337 - 1.999) and hydramnios/oligohydramnios (aOR=1.730, 95%CI 1.317 - 2.271), compared with the appropriate age multipara group. The elderly multipara group had the highest risk of developing pelvic adhesions (aOR=1.754, 95%CI 1.030 - 2.988) compared with the appropriate age multipara group, whereas the appropriate age primipara group had the lowest risk of developing pelvic adhesions (aOR= 0.148, 95%CI 0.050-0.439). Conclusion·Elderly primiparas confer the highest risks of gestational diabetes mellitus, gestational hypertension, eclampsia, placenta previa, turbid amniotic fluid, premature delivery, cesarean section, low birth weight, neonatal asphyxia and respiratory distress syndrome. Attention should be paid to the perinatal care of elderly primiparas, so that they can receive standardized antenatal visits to improve the quality of their delivery. [ABSTRACT FROM AUTHOR]

Objective. To explore the clinical characteristics and mortality of maternal near miss admitted to intensive care unit (ICU). Methods. A total of 283 maternal near miss admitted to ICU of Southern District of Shanghai General Hospital, Shanghai Jiao Tong University from January 2007 to December 2018 were selected. According to whether the main cause of ICU admission was related to pregnancy, the patients were divided into pregnancy complication group (175 cases) and pregnancy comorbidity group (108 cases). Statistical methods were used to compare the differences of the clinical data between the two groups. Results. The top three diseases in the pregnancy complication group were hypertensive disorders complicating pregnancy, obstetric hemorrhage and metabolic disorders caused by hyperemesis gravidarum. The top three diseases in the pregnancy comorbidity group were pregnancy with heart disease, infection and acute pancreatitis. Compared with the pregnancy comorbidity group, the average age of pregnant and postpartum women in the pregnancy complication group was older, the number of multipara and irregular birth examination were more, Acute Physiology and Chronic Health Evaluation II (APACHE II) was higher, and the number of medical puncture procedure (thoracentesis, abdominocentesis, lumbar puncture and bone marrow puncture) was less (all P<0.05). Conclusion. There are many causes of ICU admission for maternal near miss. In-depth analysis of the clinical characteristics of this kind of pregnant women will help ICU physicians better understand and manage acute critical illness in obstetrics. [ABSTRACT FROM AUTHOR]

Objective: To investigate the characteristics of pregnancy with pre-excitation syndrome and its influence on pregnancy outcomes. Methods: A retrospective analysis was made on the clinical data of 62 cases of pregnancy complicated with pre-excitation syndrome in Beijing Anzhen Hospital from Jan. 2008 to Dec. 2008. According to whether there was a supraventricular tachycardia (SVT) in pregnancy, they were divided into two groups. There were 16 pregnant women in the SVT seizure group during pregnancy, and 46 pregnant women in no SVT seizure group, with a multi-disciplinary comprehensive diagnosis and treatment model. SPSS software was used to analyze the data and compare the gestational age, age and weight of the newborn, and then compare the pregnancy outcomes. Results: (1) The total number of deliveries in Beijing Anzhen Hospital during the study period was 21 786, and the patients with pregnancy combined with pre-excitation syndrome account for 0.28% (62/21 786). (2) Totally 44 patients (71%, 44/62) were diagnosed with pre-excitation syndrome before pregnancy, and 18 patients (29%, 18/62) were diagnosed for the first-time during pregnancy. Among patients diagnosed with pre-excitation syndrome before pregnancy, 16 patients (36%, 16/44) had seizures before pregnancy, 28 patients (64%, 28/44) had asymptomatic before pregnancy, and 4 of asymptomatic patients had SVT during pregnancy. (3) Of the 16 pregnant women in the SVT seizure group during pregnancy, 2 patients (2/16) had SVT episodes in the first trimester, 5 patients (5/16) had SVT episodes in the second trimester, 9 patients (9/16) had SVT episodes in the third trimester. In the SVT seizure group, 8 patients (8/16) had SVT episodes before pregnancy, and 8 patients (8/16) had no SVT episodes before pregnancy. There were 46 patients in the SVT seizure-free group during pregnancy, including 9 patients with SVT attacks before pregnancy and 37 patients without SVT before pregnancy. (4) Compared with the pregnant women in the SVT seizure group, the age, weight gained during pregnancy, delivery gestation week, newborn weight, and the time of the first and second labors were not statistically different between the two groups of pregnant women (all P >0.05). However, the total duration of labor in the SVT seizure group during pregnancy was shorter and pre-pregnancy weight was lower (all P <0.05). The rate of cesarean section in pregnant women with SVT attack was 12/16, and the rate of cesarean section in pregnant women without SVT was 50% (23/46; P =0.051). No pregnant woman had an arrhythmia during delivery. Conclusions: SVT episode in patients during pregnancy most occurs in the third trimester. Patients who are asymptomatic before pregnancy may also have SVT during pregnancy. Pre-excitation syndrome patients with SVT attacks during pregnancy increase adverse pregnancy outcomes. Multidisciplinary comprehensive management could effectively control pregnant women with pre-excitation syndrome, effectively reduce the occurrence of serious arrhythmia risk events during pregnancy, so that most patients could get good pregnancy outcomes.