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Postterm births are associated with an increased risk of adverse perinatal outcomes, but few studies have investigated the epidemiological characteristics of postterm births. We aimed to estimate the prevalence of postterm births and examine the potential association between maternal sociodemographic and obstetric characteristics and postterm births. Data were collected from China’s National Maternal Near Miss Surveillance System, 2012–2016. A logistic regression was used to assess the association between sociodemographic and obstetric characteristics and postterm births. A Poisson regression was used to determine the crude and adjusted trends of postterm births over time across regions. Among the 6,240,830 singleton births with gestational periods of 37 weeks or longer, 1.16% were postterm. The prevalence of postterm births was significantly higher in the western region and among mothers who delivered at a level ≤2 hospital, had a lower education, or were younger. A reduced risk of postterm births was observed among primiparous women, mothers who previously had a caesarean section, mothers with pregnancy complications, and mothers with ten or more antenatal visits. The risk of postterm births decreased as the number of antenatal visits increased. The overall postterm birth rates significantly decreased from 1.49% in 2012 to 0.70% in 2016. The postterm birth rates were markedly reduced in the east, central, and west regions, and the rate of the decrease was greater in the east than in the west. Furthermore, substantial decreases were observed across regions in 2014 and 2016. In conclusion, multiple sociodemographic and obstetric factors are associated with the prevalence of postterm births. A significant decreasing trend in postterm birth rates was observed in China.

Cesarean section is a common obstetric operation and an important method for saving the lives of mothers and their neonates in dangerous situations. Nevertheless, cesarean section has a higher risk and might have more complications compared with natural delivery. A reasonable choice of delivery method is important for maternal and neonatal health. The incidence of complications after cesarean section for mothers and neonates during the second stage of labor significantly increases compared with planned cesarean section. During the second stage of labor, the fetal head is deep in the pelvic cavity. If a cesarean section is performed at this stage, it is prone to causing complications, including difficult delivery of the fetal head, delayed uterine incision, and massive hemorrhage, which seriously threaten the health of the mother and her neonate. For the first time, we report a case of cesarean section after complete opening of the uterine orifice, which led to almost mistakenly suturing the cervix to the uterus. This report will hopefully help surgeons anticipate such incidents during cesarean section in the future.

Additional file 1. Distribution of Apgar score groups at 5 min by gestational age.

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Background: Intravenous iron sucrose and oral iron therapy are the main therapies for iron deficiency anaemia (IDA), but there is still a debate regarding their efficacy and especially as to which one is the best choice during pregnancy. Methods: A meta-analysis of randomised controlled trials comparing patients treated with intravenous iron sucrose (intravenous group) with those treated with oral iron (oral group) for IDA during pregnancy was performed. The primary outcomes of interest were mean maternal haemoglobin and serum ferritin levels at the end of treatment. Secondary outcomes were treatment-related adverse events and foetal birth weight. Results: Six randomised controlled trials, involving a total of 576 women, were included in the present review. Significant increases in haemoglobin [mean difference (MD), 0.85; 95% confidence interval (CI), 0.31-1.39; p = 0.002] and ferritin levels (MD, 63.32; 95% CI, 39.46-87.18; p < 0.00001) were observed in the intravenous group. Compared with the oral group, there were fewer adverse events in the intravenous group (risk ratio, 0.50; 95% CI, 0.34-0.73; p = 0.0003). There was no significant difference in birth weight between the two groups. Conclusion: For pregnant women who could not tolerate the side effects of oral treatment or required a rapid replacement of iron stores, intravenous iron sucrose was associated with fewer adverse events and was more effective than regular oral iron therapy.

A 41-year-old G6P1 woman presented for first prenatal visit at 26 weeks gestation. It was her sixth pregnancy. The details of the previous four pregnancies cannot be acquired, but all the four pregnancies were ended by stillbirth at approximately 3, 4, 5, and 6 months gestation, respectively, and the fourth fetus was diagnosed with fetal hydrops before death. Three years ago, she was in fifth pregnancy, fetal hydrops was found at 27 weeks gestation. She was hospitalized, laboratory examination showed her blood type was O Rh-negative, and the titer of anti-RhD was 256. Amniocentesis and intrauterine transfusion were suggested to her. Being worried about neonatal adverse outcome, the patient gave up any treatment and was discharged. The fetus was dead 3 weeks later and the patient received induced labor at a village hospital. In her childhood, the patient was hospitalized and received platelet transfusion several times because of immune thrombocytopenic purpura (ITP), and Rh blood type was not analyzed at that time. This was her sixth pregnancy. She was hospitalized at 28 weeks gestation because of high-risk pregnancy. The vital signs were stable. And the BMI was 31 kg/m. OGTT test suggested she had GDM. The titer of anti-RhD was 256. Ultrasound did not find any sign of fetal hydrops. Insulin was used to control the patient’s glycemia. Rh antibody and Doppler ultrasound screening (including the peak systolic velocity in the middle cerebral artery i.e. MCA-PSV, fetal growth, and fetal hydrops) were checked every 1–2 weeks regularly (see Table 1). Anti-RhD titer rose to 512 at 30 weeks gestation, but the MoM of the MCA-PSV did not change obviously, and there was no sign of fetal hydrops from ultrasound. Single-course dexamethasone was used to enhance fetal lung maturity. Serial MCA-PSV, anti-Rh titer and fetal monitoring were screened weekly. At 34 gestational weeks, the titer of antiRhD reached 1,024, emergency caesarean section (CS) was performed. A boy was born with Apgar score 10-10-10 and weight 1.77 kg. The newborn was transmitted to NICU immediately. Laboratory test showed the baby’s blood hemoglobin was 57 g/L, total bilirubin was 292 lmol/L and unconjugated bilirubin was 283 lmol/L. Direct coombs test, indirect coombs test and ABO radiation test were all positive. The titers of anti-D in the newborn’s serum were 0 for IgM and 16 for IgG. No other disorders were found in the preterm infant. After one blood exchange transfusion (1.5 ll for leukocyte privative red blood cells of O, Rh-dccee and 75 ml for blood plasma of AB, Rhnegative) and two times transfusion of O Rh-negative leukocyte privative red blood cells (0.25 and 0.4 ll respectively), the baby was cured and discharged healthy 3 weeks later. The blood type and antibody titers of the patient’s family are shown in Table 2 and the changes of the fetus’s hemoglobin, total bilirubin and unconjugated bilirubin of pre-, intraand post-blood exchanging M. Hou A. Xing (&) Department of Obstetrics and Gynecology, West China Second Hospital, Sichuan University, Chengdu, Sichuan 610041, China e-mail: aiyun-x@126.com

Background Eisenmenger’s syndrome (ES) consists of pulmonary hypertension with a reversed or bidirectional shunt at the atrioventricular, or aortopulmonary level. The cardiovascular changes that occur during the pregnancy contribute to the high maternal morbidity and mortality in patients with ES. This study is to assess maternal and fetal outcomes in patients with ES. Methods This study is a retrospective analysis of 11 pregnancies in women with ES who delivered at a tertiary care center in west China between 2010 and 2014. Cases were divided into group I (maternal survival) and group II (maternal death). Clinical data were noted and analyzed. Results All ES patients presented with severe pulmonary arterial hypertension (PAH). Four maternal deaths were recorded (maternal mortality of 36%). Only one pregnancy continued to term. Ventricular septal defect diameter in group II was larger than that in group I (2.93 ± 0.76 cm vs. 1.90 ± 0.54 cm, p

Preterm premature rupture of the membranes (PPROM) remains the leading cause of preterm deliveries and neonatal mortality and morbidity. The current cohort study sought to retrospectively examine perinatal outcomes in cases of PPROM < 34 weeks gestation that were managed conservatively from 2010 to 2012 and to identify risk factors for short-term neonatal outcomes. Subjects were 510 pregnancies consisting of 114 twin and 396 singleton pregnancies. Clinical chorioamnionitis occurred in 17.8% of the pregnancies. Neonatal mortality was 7.4% the rate of major neonatal conditions was 40% and the rate of NICU admission was 72.9%. The latency period exceeded 48 h in 62.5% of the pregnancies and 7 days in 24.3% of the pregnancies. Twin pregnancies had a shorter latency period than singleton pregnancies (median of 2 days versus 4 days p < 0.001). Pregnancies complicated with early vaginal bleeding had a higher neonatal mortality (13.95% vs. 6.36% p = 0.013) and morbidity (51.16% vs. 38.32% p = 0.024) fewer weeks of gestation at PPROM (p = 0.029). Multivariate logistic regression analysis revealed that weeks of gestation at PPROM (OR: 0.953 95% CI: 0.939-0.966 p < 0.001) and a latency period (OR: 0.948 95%CI: 0.926-0.970 p < 0.001) were associated with neonatal mortality or morbidity. A twin pregnancy (OR: 0.319 95% CI: 0.17-0.6 p < 0.001) and weeks of gestation at PPROM (OR: 0.737 95% CI: 0.66-0.822 p < 0.001) were associated with the latency period. Gestational age at PPROM a twin pregnancy and the latency period are associated with neonatal mortality and morbidity.

To investigate the factors that affect the outcome of pregnancies complicated with critically heart disease admitt ed to obstetric Intensive Care Unit (ICU).A retrospective study was conducted for 188 pregnant and postpartum patients complicated with heart disease who were admitted to the ICU in West China Second University Hospital from July 2009 to March 2013.During the 4 years, there were 619 cases of pregnancy complicated with heart disease hospitalization. Among them, 188 (30.37%) patients complicated with severe heart disease were admitted to the ICU, accounting for 39.17% of the total ICU admission (480); the mean maternal age was (28.45 ± 6.08) years old and the mean gestational time was (36.03 ± 4.19) weeks. 23 (12.23%) patients received regular antenatal care in our hospital. 61 (32.45%) patients never received antenatal care before hospitalization. Among them, 5 patients were dead. The ratio for diagnosis of heart disease before pregnancy, during pregnancy and after admission were 39.89%, 25.54% and 34.57%, respectively; the most common heart diseases during pregnancy were congenital cardiac disease (80, 42.55%) and rheumatic heart disease (45, 23.94%) followed by arrhythmias (20, 10.64%). The most common complication were pulmonary arterial hypertension (51, 27.13%), arrhythmias (47, 25.00%) and severe heart failure (30, 15.96%); the cardiac function of 164 (87.23%) patients was at stage I-II and 5 (2.66% ) patients died when discharged from hospital. 151 (80.32%) patients received multidisciplinary consultation and 34 (18.09%) used central venous catheterization to control central venous pressure (CVP). 21 (11.17%) patients required mechanical ventilation. 11 (5.85%) patients required emergency life support (cardiopulmonary resuscitation 9 + electric defibrillation 3).Pregnancy complicated with heart disease is the leading reason for admission to ICU. The congenital cardiac disease, rheumatic heart disease and arrhythmias are the main heart diseases during pregnancy. Multidisciplinary cooperation and intensive care are the key measures to improve the outcomes of patients with critically illness. It is very important for reduction of the maternal mortality rate through strengthening preconception care and antenatal care.

To review the evidence concerning the efficacy of levonorgestrel-releasing intrauterine system (LNG-IUS) in preventing endometrial pathology in women treated with tamoxifen.Randomized controlled trials (RCTs) of women with breast cancer on tamoxifen that compared endometrial surveillance or placebo alone vs. the LNG-IUS were reviewed. The eligible trials were identified from the following electronic databases: Cochrane CENTRAL, Medline, and EMBASE. The authors extracted data on all reported outcomes and conducted meta-analyses on the endometrial polyps, endometrial hyperplasia, proliferative endometrium, and endometrium thickness.According to the subgroup analysis, a significant reduction of endometrial polyps was obtained (OR = 0.22, 95% CI 0.13-0.37, p0.00001). The use of LNG-IUS reduced the incidence of endometrial hyperplasia (OR = 0.13, 95% CI 0.03-0.58, p = 0.007). Increased abnormal vaginal bleeding for LNG-IUS users may be an adverse aspect of LNG-IUS.This meta-analysis confirms that endometrial hyperplasia is also reduced as well as endometrial polyp formation reduced after long-term follow-up.

Gene delivery to the placenta is one potential way of specifically modifying placental biological processes and fetal development. The aim of this study was to determine the most efficient and least invasive route of placental adenovirus delivery. The feasibility of adenovirus-mediated gene transfer to the rat placenta was addressed by maternal intravenous or direct intraplacental injection of adenoviral vectors expressing the glucose transporter GLUT3, a noncirculating integral membrane protein. Both routes led to transgene expression in the placenta. However, direct intraplacental delivery on day 14 of gestation yielded a higher transduction efficiency than maternal intravenous administration, and markedly reduced transgene expression in maternal liver. Most importantly, the amount of the GLUT3 transgene and the adenovirus itself in fetal tissues was only 1 to 3% of that found in the placenta. These results indicate that the nature of the transgene and the route of adenovirus administration are key parameters in selective placental somatic gene transfer. This novel strategy may prove useful for modifying a placental function without altering the fetal genome.

Silent uterine rupture in an unscarred uterus during pregnancy is rare. We present a case of silent uterine rupture in an unscarred uterus at third-trimester abortion by use of mifepristone and misoprostol in a patient who had a history of intrauterine procedures. The absence of clinical symptoms suggests that this uterine rupture resulted from an unrecognized perforation in a previous intrauterine manipulation. Routine sonographic follow-up examinations and careful clinical observations are especially recommended for women with previous intrauterine manipulations.

To analyze the expression of bile acid transport correlative proteins in the placenta of patients with intrahepatic cholestasis of pregnancy (ICP).This case-control study was performed in the Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China from March 2007 to October 2008. Real time reverse transcriptase polymerase chain reaction was applied for the mRNA expression measurement of 8 bile acid transport correlative proteins, organic anion transporting polypeptide (OATP)1A2, OATP1B1, multidrug resistance protein (MRP)1, MRP2, anion exchanger (AE)2, bile salt export pump (BSEP), multidrug resistance 3, and familial intrahepatic cholestasis (FIC)1, in normal human placentas (n=20) and those with ICP (n=20).All the transcripts except OATP1B1 and BSEP were detected. Both OATP1A2 and AE2 mRNA were higher while FIC1 was lower in ICP patients.The alteration of bile acid transport correlative proteins OATP1A2, AE2, and FIC1 may be involved in the fetal cholestasis of ICP.