Objective To investigate the etiology and perinatal outcome of pregnancies complicated with extremely severe thrombocytopenia [ at least two times of platelets count (PLT) < 10 × 109/L during pregnancy]. Methods Clinical data, including basic information, etiology, management and outcomes of pregnant women with extremely severe thrombocytopenia, admitted to Peking University People's Hospital from January 2004 to March 2009, were retrospectively collected. The management of these cases varied according to different etiology and the symptoms: (1) PLT were maitained > 20 × 109/L and hemoglobulin> 70 g/L in those women without spontaneous bleeding; (2) PLT transfusion would be required when PLT< 10 × 109/L or bleeding occur and RBC would be supplied when hematocrit <25% and hemoglobulin <70g/L; (3) Hemoglobulin should be > 70 g/L and PLT >30 × 109/L before cesarean section or delivery;(4) Predinisone and/or intravenous immunoglobulin G (IVIG) would be given in women complicated with idiopathic thrombocytopenic purpura (ITP) when PLT < (20-30) × 109/L or bleeding. PLT would be given if all the above management were failed, or PLT < 10 × 109/L, or bleeding. Women without bleeding would be closely monitored and delivery would be planned. Results (1) Twenty-six cases were identified among 9302 deliveries during the study period (0.28%), with an average of maternal age of 29. Seventeen were diagnosed before conception and 9 during pregnancy. Among the 26 women, half received regular prenatal check in our hospital and the average gestations at diagnosis was 24 weeks and the other half without regular prenatal visits and the average gestations at diagnosis was 32 weeks. Etiology was identified in 24 out of the 26 women, including 14(54%) ITP, 5 myelodysplastic syndrome (MDS), 4 chronic aplastic anaemia(CAA) and 1 systemic lupus erythematosus (SLE). (2) Management: All of the 26 women received blood products. Among the 14 ITP cases, 6 received predinisone and IVIG and 8 only took predinisone. Nine of the 26 patients (35%) had pregnant complications, among which 6 (6/9) were preeclampsia. The overall average gestation at delivery was 36 weeks. Only 2 delivered vaginally with the average blood loss of 83 ml and 23 cesarean sections were performed with the average blood loss of 410 ml. (3) Perinatal outcomes:There were 26 perinatal babies, among which 1 died intrauterine and 25 were born alive (12 preterm infants). The average birth weight was 2877 g. Neonatal severe thrombocytopenia presented in 2 newborns whose mother complicated with ITP. Conclusions The main cause of extremely severe thrombocytopenia during pregnancy is ITP, managed mainly by predinisone and IVIG, followed by CAA and MDS, which may require supportive treatment. Pregnancy complicated with extremely severe thrombocytopenia is not an indication of termination. Better maternal and fetal outcomes can be achieved through proper treatment based on the etiology, intensive care in prevention and management of complications and cesarean section.

Objective To evaluate the diagnosis and the optimal management of idiopathic thrombocytopenic purpura(ITP) with pregnancy and the related high risk factors with neonatal passive immune thrombocytopenia(PIT) occurring in infants born to mothers with ITP. Methods Medical records of 40 pregnant women with ITP and their neonatal outcomes were reviewed retrospectively from 1992.2 to 2001.8 in our hospital. Results The incidence of pregnancy with ITP was 3.4‰. The maternal complications included pregnancy-induced hypertension syndrome (17.5%), postpartum hemorrhage (15%), preterm labor (12.5%), gestational diabetes(7.5%) and FGR (7.5% ). One mother died at 36 weeks of gestational age. There were 13 cases delivered by vagina and 27 cases delivered by cesarean section. Nine neonates(28.1%)had neonatal PIT, Among them three neonates (9.3%) had severe PIT, One neonate(2.5%) had an intracranial hemorrhage(ICH) and two perinatal death (5%)occured in 40 neonates. No significant correlation was found between neonatal platelet counts and maternal platelet counts, maternal PAIgG values and maternal treatments respectively. Conclusion The prognosis of mothers and neonates in pregnancy with ITP are better. The incidence of severe fetal or neonatal PIT is low and not related to maternal platelet counts, maternal treatments and PAIgG values.

Objective To investigate the diagnosis, management, pregnancy outcome and prognosis of bieytopenia or pancytopenia during pregnancy. Methods Retrospective chart review was conducted on 24 pregnancies who were found bicytopenia or pancytopenia during pregnancy for the first time. The diagnoses were reconfirmed. The management and pregnancy outcome were collected. And the prognoses were followed. Results According to the clinical data and laboratory findings, the latter including complete blood cell count, reticulocyte count, peripheral smear, serum folate and vitamin B12 level, autoimmune antibody screening, bone marrow smear and biopsy, thirteen patients were diagnosed as having chronic aplastic anemia (CAA), six as having myelodysplastic syndromes (MDS), two as having megaloblastic anemia(MA), one as having paroxysmal nocturnal hemoglobinuria(PNH), one as having Evan's syndrome and one as having acute leukemia. The management basically consisted of supportive transfusions. Six patients suffered pregnancy complications including four with severe preeclampsia (one with intraeranial hemorrhage and one with intrauterine death concomitantly) and two with gestational diabetes. The delivery ages of the 21 patients were term or nearly term with all good neonatal outcomes. Postpartum follow-up showed the two patients with MA achieved complete remission, the one with PNH had mild anemia and that with Evan's syndrome had mild thrombocytopenia. The patient with acute leukemia died of recurrence six months postpartum. Of the thirteen patients with CAA, two achieved complete remission, six partial remission, four no remission and one was lost follow-up. Of the 6 patients with MDS, one achieved partial remission, four no remission, and one transformed into acute monocytic leukemia, then refused chemotherapy and was lost follow-up. Conclusions CAA may be one of the most common causes of bicytopenia or pancytopenia during pregnancy, MDS may be the second. Diagnosis should be made as soon as possible through appropriate and reasonable laboratory examinations. Most patients could achieve good pregnancy outcomes through supportive management. The maternal prognosis may vary widely depending on the causes.

Objective To evaluate the relationship of small heterodimer partner(SHP) gene and birth weight in China. Methods A cohort study of 191 normal pregnant women was conducted. Both maternal and cord blood samples were collected. PCR-RFLP was used to detect the polymorphism of SNP-rs7504 of SHP. Results (1) The frequency of both neonatal and maternal C allele and (TC+CC) genotype increased significantly with birth weight (P=0.004, OR=3.168; P=0.005, OR=3.315; P=0.013, OR=2.495; P=0.013, OR=2.495). (2) The babies were heavier if they were C allele carrier. The average increase of birth weight was 246.3 g comparing the neonates with TC+CC genotype with those with TT genotype [(3658.7?400.94)g vs (3412.4?444.4)g, P=0.005]. The average birth weight of those maternal C allele carriers was 210.3 g heavier than those non-C allele carriers[(3628.9?405.5) g vs (3418.6?449.0 g]. (3) The fetal C allele was associated with maternal weight in pregnancy, prepregnant BMI, paternal height and weight. Women with C allele were heavier and had higher BMI without statistical significance comparing with those non-C allele carriers. Neither neonatal nor maternal SHP gene was associated with blood glucose and insulin level. (4) Multiple factors analysis showed that birth weight was related to maternal height, weight gain during pregnancy, prepregnant BMI, maternal and cord blood insulin level. After adjustment, the neonatal birth weight remained significantly correlated with cord blood SHP (P=0.0354), but not with maternal SHP gene (P=0.0711). Conclusions SHP gene is associated with newborns birth weight and may affect fetal growth.

Objective To investigate whether insulin secretion and resistance are different in glucose tolerant and intolerant women with normal pre-pregnant body mass index (BMI) during late pregnancy and to find out if there is association between gestational diabetes and insulin resistance syndrome. Methods On the basis of a 4-hour oral glucose tolerance test (OGTT), 32 gestational diabetes mellitus (GDM) patients, 21 gestational impaired glucose tolerant (GIGT) patients, and 50 normal glucose tolerant (NGT) cases were selected from uncomplicated pregnant women. Those had normal pre-pregnant BMI who had a 1-hour 50-g glucose-screening test (≥7 2 mmol/L), performed between 24～28 weeks of gestation. During the OGTT, several indexes of insulin resistance, insulin secretion, lipid metabolism were measured in addition to the standard glucose measurements. Results Glucose area under curve (GAUC), insulin area under curve (IAUC), insulin sensitivity index (ISI) transformed to natural logarithm and triglycerides (TG) are all significantly higher ( P

Objective To investigate the inductive factors, the prevention and treatment methods of pulmonary edema during pregnancy Methods The clinical materials of 21 cases of preganacy with pulmonary edema treated in our hospital from Jan 1985 to Jan 2000 were analysed retrospectively Results Among 21 patients, 26 pulmonary edema attacked, 9 of them had upper have respiratory diseases, thirteen cases caused by improper infusion Fourteen cases were well controlled quickly with antiplasm nifedipine, myocardial streng and diuretics If the symptoms could not be controlled properly, vasodilators were applicated We had 16 cesarean section under epidural anaesthesia, one vaginal birth, and the other one birth by forceps Conclusions Pulmonary edema in pregnancy usualluy followed with acute heart failure caused by sever pregnancy induced hypertension We should pay more attention to the indications of it During treatment,we should give vasodilators properly,so as to prevent pulmonary edema

Objective To investigate the incidence of the newborn's clavicle fracture,the high risk factors related to the fracture,and the possible methods to prevent and treat the fracture. Methods Forty-four newborns with fractured clavicles in our department from Sept.1994 to Dec. 1997 were analysed retrospectively.Results There were 44 newborns suffered from clavicle frac- ture in 3 135 vaginal deliveries with an incidence of 1.4%.Thirty-four cases(77.26%,34/44)were diagnosed immediately after delivery or before discharge from the hospital.The risk factors for clav- icular fracture include:high birth weight,forceps delivery,shoulder dystocia,and prolonged second stage of labor and persistent occipital transverse or posterior.However,41%(18/44)of cases had no high risk factors.The right clavicle is more likely to be affected,which may be due to the fact that the anterior shoulder was over-pressed as the infant descended through the pelvic outlet under the symphysis pubis.Conclusions Newborn's clavicle fracture is one of the common injuries in vagi- nal delivery.Close attention should be paid during delivery when any of the above mentioned high risk factor is presented,and careful examination of the newborn can not be neglected.

Objective To investigate the perinatal outcome for pregnancies complicated with chronic renal diseases,and the risk factors for the adverse outcome.Methods Retrospectively analyze the clinical data of 48 patients with chronic renal diseases complicating pregnancy admitted in Peking University People's Hospital between January 1998 and August 2010,record the pregnancy outcome and explore the risk factors for the poor outcome using multivariate regression analysis.Results Thirty-eight patients had known chronic renal disease before conception,and ten were diagnosed during pregnancy.Seven patients (15％,7/48 ) presented with obvious renal impairment [ serum creatinine (sCr) ≥ 125 μmol/L] prepregnancy,and nine (19％,9/48 ) were recorded with chronic hypertension.Thirty-three patients received regular prenatal care.Twenty-one cases ( 44％,21/48 ) developed preeclampsia.During the gestation,normal renal function (defined as sCr ＜71 μmol/L) was seen in nineteen cases (40％,19/48),mild dysfunction (sCr ranged 71 - 132 μmol/L) in twenty (42％,20/48) and moderate to severe dysfunction ( sCr ≥ 132 μmol/L) in nine cases ( 19％,9/48 ).Twenty patients had negative or mild proteinuria (24 hour urine protein ＜2000 mg),19 had moderate (24 hour urine protein ranged 2000 -5000 mg) and nine had severe proteinuria (24 hour urine protein ≥ 5000 mg).The gestational age at delivery ranged from 24 to 41 weeks and the neonatal birth weight ranged from 890 to 4150 g.A total of twenty patients (42％,20/48 ) suffered adverse perinatal outcome,including one case with late spontaneous abortion,fifteen with preterm delivery,eleven with small for gestational age,two with neonatal respiratory distress syndrome and four with perinatal death.Declined maternal renal function was seen in eight patients,and two patients progressed toward the end-stage renal failure ( the stage of uremia).Multivariate regression analysis identified that preeclampsia (OR =24.72, P =0.002 ) and the degree of proteinuria ( OR =4.24,P =0.032) were the independent risk factors for the adverse perinatal outcome. Conclusions Pregnancies complicated with chronic renal diseases have significantly high incidence of preeclampsia and adverse perinatal outcome.Preeclampsia and the degree of proteinuria are perhaps the independent risk factors for the adverse outcome.

Objective To investigate the perinatal outcomes of pregnancy with chronic myeloid leukemia (CML) and how to manage it during pregnancy. Methods To retrospectively analyse the clinical datas about the perinatal outcome and the obstetric management of the 16 cases of pregnancy with CML during the last 30 years in a single center. Results ( 1 ) Management ang perinatal outcomes: among the 16 pregnancies nine ended with therapeutic abortion during the first or second trimester and no CML complications were observed. The average gestation week was 7 weeks(5 - 13 weeks)when they came to our hospital. Seven pregnancies gave birth, among which CML was diagnosed during pregnancy in four patients and pregnancy was confirmed during CML in three patients. The average gestation week was 36 weeks (27 -40 weeks +2)when they came to our hospital. Among the seven women three were treated with hydroxyurea (one became pregnant while she was on hydroxyurea and she elected to continue her pregnancy and continued to use hydroxyurea), one with leukapheresis twice after her 40 weeks of gestation, one with plateletpheresis and three hadn't any treatment. In the seven pregnacies three developed severe preeclampsias, including the two had hydroxyurea during the gestation. The average delivery gestational week was 38 weeks (33 weeks +4 -41 weeks), two were premature birth. Two caesarean sections, three vaginal deliveries and two forceps deliveries. There were two postpartum hemorrhage, during the 24 hours the amount of bleeding was 1500 - 1800 ml and secondary disseminated intravascular coagulation happened. Seven patients gave birth to seven infants whose average birth weight was 2469 g( 1820 - 2810 g), of whom two were premature infants, two low birth weight infants, one had congenital malformation and two had abnormal blood routine examinations. (2) Management after delivery and prognosis: during the nine patients who ended pregnancy with therapeutic abortion during the first or second trimester four withdraw, one died whose course of disease was 3 years and the other four were alive during 5 months to 72 months, among which one had stem cell transplantation, two are taking imatinib mesylate and one takes hydroxyurea. Among the seven patients who deliveried two withdraw, two died and three are alive. Among the seven infants two withdraw,the other five have normal development following 4 months to 9 years. Conclusions CML patient may have successful pregnancy and delivery, and it is not the absolute indication for terminating pregnancy. On the other hand, CML and the treatment during pregnancy can have side effect on the mother and the fetus, so the patients should be monitored and treated in tertiary hospitals.

Objective To investigate the perinatal outcomes and management of pregnancy with leukemia.Methods From June 1,1980 to July 31,2011,23 pregnant women with leukemia,were admitted to the Department of Obstetrics of Peking University People's Hospital.Clinical data of these women were collected and analyzed retrospectively.Among the 23 cases,nine were diagnosed before pregnancy including four with acute myeloid leukemia (AML) and five with chronic myeloid leukemia (CML),and 14 diagnosed during pregnancy including eight with acute leukemia (AL) [seven with AML and one with acute lymphocytic leukemia (ALL)] and six with CML.The prognosis of the mothers and infants were followed up.Results (1)Managements during pregnancy:For the four cases with AML,two were completely recovered and the other two had completed chemotherapy five years before pregnancy,and no relapse was reported during pregnancy.The other five cases with CML were stable during pregnancy although the results of blood routine tests were abnormal.Among them,one case was treated with hydroxyurea and one with imatinib during pregnancy,while the other three women received no treatment.For those 14 cases diagnosed during pregnancy,all were recorded with abnormal white blood counts,and nine complicated with anemia and abnormal platelet count and four with either anemia or abnormal platelet count.Among the eight cases with AL,six received chemotherapy during pregnancy and two did not due to intrauterine fetal death and 40 weeks of gestation on admission,respectively.For the six CML women,two received hydroxyurea,one took imatinib,one took leukapheresis and one accepted plateletpheresis during pregnancy,but one woman received no treatment due to regular contractions on admission.(2) Perinatal outcomes:The average gestational weeks on delivery was (38.3±2.3) weeks,and the average birth weight of newborns was (2 755 ±486) g.There were two cases of disseminated intravascular coagulation,five pre-eclampsia and one placental abruption during pregnancy.Five women were complicated with postpartum hemorrhage [average bleeding volume was (1 200± 751) ml] and two cases of puerperal infection.One pregnant woman died.Among the 23 perinatal infants,there were four premature infants,four low birth weight infants,two still births,one with congenital malformations,and two infants had abnormal blood routine tests.Eight babies were delivered by caesarean section,12 through vagina and two required forceps assistants.(3) Follow-ups:Except for one woman died during pregnancy,four of the other 22 cases were lost.Among the rest 18 cases with the follow-up from three months to 13 years,11 women survived and seven died due to leukemia.All newborns were healthy.Conclusions Pregnancy with leukemia is an extremely high-risk obstetric condition,but for patients with bearing requirement,better perinatal outcome might be achieved under proper management.