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The association between different clinical states of chronic HBV infection and preterm birth (PTB) is still controversial. A retrospective cohort study among 57,386 pregnant women was conducted to examine the impact of chronic HBsAg positive, both HBsAg and HBeAg positive, and chronic active hepatitis on pregnancy complications related to the overall PTB and its subtypes (spontaneous and iatrogenic). A total of 54,245 pregnancies were included in the final study cohort, among which 2,151(4.0%) pregnant women were HBsAg positive. The PTB rate was 6.0% (129/2151) for HBV-infected women while 4.5% (2319/52094) for those not. Compared with women not infected with HBV, multivariable-adjusted analyses showed HBV-infected women had a 33% higher risk of overall PTB (aRR 1.33 95%CI, 1.11-1.60), a 27% higher risk of spontaneous PTB (aRR 1.27, 95% CI, 1.02-1.57) and a 50% higher risk of iatrogenic PTB (aRR 1.50, 95%CI, 1.07-2.11). The PTB rate was 8.9% (35/395) for both HBsAg and HBeAg-positive women and 16.2% (22/136) for women with active chronic hepatitis. Multivariable-adjusted analyses showed women who were both HBsAg and HBeAg positive had a 47% higher risk of overall PTB (aRR 1.47, 95%CI, 1.04-2.09), a 2.03 times higher risk of spontaneous PTB (aRR 2.03, 95%CI, 1.38-2.99) and a 32% higher risk of iatrogenic PTB (aRR 1.32, 95%CI, 0.62-2.81), while women with chronic active hepatitis had a 3.84 times higher risk of overall PTB (aRR 3.84, 95%CI, 2.42-6.10), a 3.88 times higher risk of spontaneous PTB (aRR 3.88, 95%CI, 2.32-6.45) and a 3.01 times higher risk of iatrogenic PTB (aRR 3.01, 95%CI, 1.22-7.44). Different maternal clinical states of chronic HBV infection are independently associated with an increased risk of overall PTB and its subtypes (spontaneous and iatrogenic).

Aims To explore the association between thyroid function and gestational diabetes mellitus (GDM) risk in assisted pregnancies. Methods We screened 57,386 pregnant women treated from February 2013 to October 2017, and 2211 patients were retrospectively enrolled, and their data were analyzed based on quintile groups constituted based on serum thyroid-stimulating hormone (TSH), free thyroxine (FT4), and thyroid peroxidase antibody (TPOAb) levels. Odds ratios (ORs) of GDM were analyzed by multivariate logistic regression, adjusted for maternal age and pre-pregnancy body mass index (BMI). Results The prevalence rate of GDM was 20.1%. Lower FT4 levels were associated with an increased risk of GDM (ORQ2 = 1.512, 95% confidence interval [CI] 1.073–2.132, p = 0.018; ORQ1 = 1.620, 95% CI 1.161–2.261, p = 0.005), but this association disappeared after adjustments. TPOAb+ titer was associated with an increased risk of GDM (aOR = 1.472, 95% CI 1.068–2.028, p = 0.018). Higher TSH (aORQ5 = 2.882, 95% CI 1.919–6.975, p = 0.019) or lower FT4 (aORQ1 = 3.156, 95% CI 1.088–9.115, p = 0.034) levels were associated with an increased risk of GDM in assisted pregnancies for TPOAb+ patients. Conclusion TPOAb+ is an independent risk factor for GDM in patients with assisted pregnancies. Higher TSH or lower FT4 levels, with TPOAb+ detection, are risk factors for GDM in assisted pregnancies.

Despite extensive investigations over the last decade, preeclampsia remains an unpredictable pregnancy complication causing perinatal morbidity and mortality worldwide, particularly in twin pregnancies.This study aimed to determine the relationship between growth discordance in twin pregnancies and the risk for preeclampsia based on chorionicity.This was a retrospective single-center study that included 2122 women with twin pregnancies who were admitted to a tertiary hospital between January 2013 and June 2016. Growth discordance was defined as twin birthweight difference ≥20%. Logistic regression models were used to analyze the association between growth discordance and risk for gestational hypertension-preeclampsia in all subjects. Stratified sampling by twin chorionicity (dichorionic and monochorionic) was also conducted. Further analysis was performed to estimate the association between the degree of growth discordance and gestational hypertension-preeclampsia risk in monochorionic and dichorionic twin pregnancies.The prevalence of growth discordance was 17.6%. In all subjects, growth discordance was associated with increased risk for gestational hypertension-preeclampsia. After stratification by twin chorionicity, growth discordance was associated with an increased risk for gestational hypertension preeclampsia (adjusted odds ratio [AOR], 1.84; 95% confidence interval [CI], 1.26-2.67) and preeclampsia (AOR, 1.82; 95% CI, 1.21-2.73), including mild preeclampsia (AOR, 1.86; 95% CI, 1.02-3.37), severe preeclampsia (AOR, 1.78; 95% CI, 1.06-2.97; P.05), and early-onset preeclampsia (AOR, 2.98; 95% CI, 1.40-6.32), in the dichorionic twin pregnancy group; however, no significant association was found in the monochorionic twin pregnancy group. A 10% increment of growth discordance in the dichorionic twin pregnancy group was associated with an elevated risk for gestational hypertension preeclampsia (AOR, 1.20; 95% CI, 1.02-1.41) and preeclampsia (AOR, 1.24; 95% CI, 1.04-1.48), including severe preeclampsia (AOR, 1.28; 95% CI, 1.04-1.59) and early-onset preeclampsia (AOR, 1.47; 95% CI, 1.08-2.00), but no significant association was found in the monochorionic twin pregnancy group.Growth discordance is associated with an increased risk for preeclampsia in dichorionic but not in monochorionic twin pregnancy. In addition, the prevalence of preeclampsia increases significantly with increasing degree of growth discordance, reflecting a dose-response relationship in dichorionic twin pregnancy.

Placenta previa is often associated with preterm delivery, reduced birth weight, a higher frequency of placental accreta and postpartum haemorrhage, and increased likelihood of blood transfusion. The present study aimed to examine the expression of high mobility group box protein 1 (HMGB1) in the placenta of women with or without placenta previa. The study group consisted of placental tissues obtained from women with or without placenta previa. The expression levels of HMGB1 and vascular endothelial growth factor (VEGF) were evaluated in the placental tissues using reverse transcription‑quantitative polymerase chain reaction, western blotting and immunohistochemistry. The mRNA expression levels of HMGB1 and VEGF were significantly increased in the placenta previa group compared with in the normal group. In addition, the placenta previa group exhibited increased HMGB1 and VEGF staining in vascular endothelial cells and trophoblasts. There were no significant differences in the expression of HMGB1 or VEGF between groups with or without placenta accreta or postpartum haemorrhage. The present study hypothesised that the increased expression of HMGB1 in the placenta may be associated with the pathogenesis of placenta previa by regulating the expression of the proangiogenic factor VEGF.

Objective Vaspin is associated with metabolic parameters and insulin resistance. However, the expression of vaspin in visceral adipose tissue (VAT) in pregnant women with gestational diabetes mellitus (GDM) has not been fully explored, and the contribution of vaspin to the biological mechanisms underlying GDM remains unclear. This study aimed to compare circulating vaspin levels and its expression in different insulin target tissues including subcutaneous adipose tissue (SAT), VAT, and smooth muscle tissue (SMT) in pregnant women with and without GDM. Design A total of 37 women with GDM (GDM group) and 37 normal pregnant women (control group) were selected. Fasting plasma glucose (FPG), fasting insulin (FINS), and serum vaspin levels were quantified at term, and homeostasis model of assessment2-insulin resistance (HOMA2-IR) values were calculated. RT-qPCR and western blotting were used to measure mRNA and protein levels of vaspin in VAT, SAT, and SMT of 15 GDM women and normal pregnant women. Results In the GDM group, serum vaspin concentrations were significantly higher than in the control group. Serum vaspin levels were positively correlated with HOMA2-IR in the GDM group but not in the control group. In the GDM group, vaspin mRNA and protein expression levels in SAT and VAT were both significantly higher than in controls but no difference was found in SMT. Moreover, relative mRNA but not protein expression levels of vaspin in SAT were highest among the three tissues in both groups. Conclusions Circulating vaspin levels and expression of vaspin in SAT and VAT were higher in GDM women than in normal pregnant women. However, the specific role of vaspin from SAT and VAT in the pathogenesis of GDM needs further study. This article is protected by copyright. All rights reserved.

Subclinical hypothyroidism is common in pregnant women and often related to adverse pregnancy outcomes, but its relationship with gestational diabetes remains controversial. In particular, the impact of thyroperoxidase antibodies status on the relationship between subclinical hypothyroidism and gestational diabetes is not clear. We investigated the association between combined thyroid stimulating hormone (TSH) level and thyroperoxidase antibodies status in early pregnancy (

Purpose The objective of this study was to estimate the combined effect of serum ferritin (SF) concentration and free thyroxine (fT4) levels on the risk of gestational diabetes mellitus (GDM). Methods Women presented for antenatal care at a tertiary hospital in Shanghai, China were included in this study from December 2012 to March 2014. Women were divided into six groups according to the SF and fT4 level. Multiple logistical regression model was used to estimate odds ratio (OR) among different groups. Relative excess risk of interaction (RERI), the attributable proportion (AP) of the interaction and the synergy index (SI) were applied to evaluate the additive interaction of SF concentration and fT4 level. Results A total of 6542 qualifying pregnant women were included in this study. We observed that a high SF concentration in early pregnancy was related to an increased risk of GDM (OR = 1.21, 95%CI: 1.02–1.43); while a low fT4 level was not (OR = 1.18, 95%CI: 0.89–1.58). There is no addictive interaction between SF and fT4 level on the presence of GDM. Conclusions The study suggests that only high serum ferritin concentration is associated with an increased risk of GDM in early pregnancy. The level of fT4 in early pregnancy might have no effect on the association between high SF and risk of GDM.

The purpose of this study was to determine which variables are associated with different levels of transfusion for cesarean delivery.This was a retrospective study conducted in a tertiary hospital. A total of 271 patients receiving blood transfusions for postpartum hemorrhage (PPH) during a cesarean section and up to 24 hours after cesarean delivery between January 2006 and December 2013 were eligible for inclusion. Women in the transfused group were stratified into three subgroups according to number of units of red blood cells transfused: fewer than 5 units (mild transfusion), 5 to 10 units (moderate transfusion), and 10 or more units (massive transfusion). An additional 271 patients who delivered by cesarean section and suffered from PPH but did not require blood transfusion were selected as the nontransfused group.There were 271 patients who required a blood transfusion for PPH. The blood transfusion rate was 0.53% (271/50,699). After potential confounders were adjusted for, when compared with the nontransfused group, assisted reproductive technologies was a risk factor for mild transfusion (adjusted odds ratio [AOR] 2.452, 95% CI 1.250-4.808) and moderate transfusion (AOR 2.075, 95% CI 1.069-4.028); placenta previa was a risk factor for moderate transfusion (AOR 2.736, 95% CI 1536-4.874); and pernicious placenta previa was a risk factor for all transfusion subgroups (AOR 14.211, 95% CI 1.452-39.089; AOR 12.462, 95% CI 1.275-121.749; AOR 73.636, 95% CI 9.041-599.742). More women were treated with intrauterine balloon pressure and uterine compression sutures in the mild, moderate, and massive transfusion groups.Placenta previa was a risk factor associated with moderate transfusion, and pernicious placenta previa was the only modifiable prepartum risk factor independently associated with all transfused subgroups.

To compare the difference in maternal outcomes between early and late use of transverse annular compression sutures (TACS) during cesarean delivery among women with complete placenta previa (CPP).A retrospective study of 36 women with CPP was conducted. Percentiles of blood loss before TACS were calculated. The transfusion rate, sensitivity, specificity, Youden index, positive predictive value, and negative predictive value were also estimated. Patients were assigned to either the early TACS group or the late TACS group based on the highest Youden index. Maternal outcomes of the 2 groups were compared.The Youden index for transfusion rate was highest when blood loss before TACS reached 500 mL. Blood loss before intervention in the late TACS group was significantly higher than in the early TACS group (735.0 ± 123.7 mL versus 396.9 ± 76.3 mL; P0.001). More women in the late TACS group than in the early TACS group required blood transfusion (60.0% versus 12.5%; P=0.004) and the volume of blood transfused was significantly lower in the early TACS group than in the late TACS group (137.5 ± 377.5 mL versus 806.7 ± 619.3 mL; P=0.001).Early implementation of TACS could lead to improved maternal outcomes.

Complete placenta previa (CPP) is an important cause of life threatening postpartum hemorrhage (PPH) [1]. Bleeding can be severe and uncontrollable because there is less musculature in the lower uterine segment. The aim of the present study was to retrospectively evaluate the efficacy of transverse annular compression sutures (TACS) in achieving hemostasis after traditional conservative methods had failed to control bleeding during cesarean delivery in women with CPP. A total of 41 pregnant women with CPP were included in the study. Eligibility criteria were: (1) persistent bleeding from the separated placental surface of the lower uterine segment at cesarean delivery after successive use of uterotonics, local suturing, and ligation of uterine arteries; and (2) subsequent administration of either uterine packing (UP) or TACS (Fig. 1). There were 24 patients in the UP group and 17 patients in the TACS group. Primary outcome was blood loss reported at the different phases of the cesarean delivery procedure. Pb0.05 was considered statistically significant. Differences between the 2 groups were assessed using the t test, χ or Fisher exact tests. The Institutional Ethical Committee approved the study. There was no significant difference at baseline in age, body mass index (calculated as weight in kilograms divided by height in meters squared), gravidity, parity, gestational age at delivery, birth weight, doses of uterotonics, and incidence of placenta accreta (Table 1). Overall, there was greater blood loss throughout the cesarean delivery procedure in the UP group compared with the TACS group (1670.0±447.7 mL vs 978.2±142.9 mL; Pb0.05). No difference in blood loss was found between the groups both before and after the intervention (The intervention was defined as either uterine packing or TACS in the study). The difference in blood loss occurred during the intervention, with 845.8±311.3 mL of blood loss in the UP group compared with 142.9±64.5 mL in the TACS group (Pb0.05). Interestingly, the time taken to perform uterine packing was significantly longer than the time taken to perform TACS (22.0± 5.6 min vs 2.9±1.0 min; Pb0.05). The quantity of blood transfused was also significantly higher in the UP group than in the TACS group (1541.7±792.3 mL vs 1008.3±516.0 mL; Pb0.05). Hysterectomy was unavoidable in 2 (8.3%) patients in the UP group because of intractable bleeding. TACS failed to stop bleeding in 1 (5.9%) patient in the TACS group and the patient's uterus was preserved using multiple uterine compression sutures. Ultrasound results showed no uterine abnormalities on day 42 post delivery in the TACS group. No difference was found in the incidence of complications between the 2 groups. Normal menstruation resumed for all women, except for those who underwent hysterectomy. It is difficult to control the bleeding from the separated placental surface during cesarean delivery inwomenwith CPP [2,3]. The present study indicates that both UP and TACS were effective in controlling bleeding. The success rates (i.e., achievement of hemostasis) were 91.7% and 94.1% for UP and TACS, respectively. However, the mean blood loss during cesarean delivery and the quantity of blood transfused were higher in the UP group than in the TACS group. A partial explanation might be that the greater blood loss was related to the longer time taken to complete the intervention since it took more time to performuterine packing than to performTACS. Furthermore, in the only participant for whom TACS failed to control bleeding, the uterus was successfully preserved using another technique. Hysterectomy was required for the 2 patients in whom uterine packing was ineffective. TACS may be particularly useful in low-resource areas because it is technically less challenging and requiresminimal training and equipment. In 1997, B-Lynch et al. [4] first described the use of uterine compression sutures to treat PPH, primarily for uterine atony. In placenta previa cases, B-Lynch suturingwas described following afigure-of-eight suture in the lower uterine segment. Hwu et al. [3] andHayman et al. [5] International Journal of Gynecology and Obstetrics 108 (2010) 247–257BRIEF COMMUNICATIONS