The 2019 novel coronavirus (2019-nCoV) infection has spread throughout China since the first case was identified in Wuhan, Hubei Province, in December 2019. According to previous knowledge and experience, women during pregnancy and puerperium are a vulnerable population due to physiological changes in their immune and cardiopulmonary system, so making them more susceptible to viral infections. Based on the latest 2019-nCoV national management plan, we propose this detailed plan of care to provide better prevention and management of 2019-nCoV infection in women during pregnancy and the puerperium.

Following an outbreak of pneumonia caused by 2019 novel coronavirus (2019-nCoV) which has spread in China, the National Health Commission of China issued public health policies and implemented interventions for control and prevention of the epidemic. Given that the maternal-fetus vertical transmission caused by 2019-nCoV is still unidentified, as a special population, neonates need a targeted clinical management. This detailed plan of care is proposed to provide better prevention and control of neonatal 2019-nCoV infection.

We report a case of maternal asymptomatic COVID-19 in a patient with typical CT image of pneumonia in the third trimester, and both the mother and baby were well. The patient, a 30-year-old female, was transferred to Yichun People's Hospital at 37 +3 gestational weeks because of a positive 2019 novel coronavirus nucleic acid result over seven hours. Her husband and mother-in-law were diagnosed with COVID-19 eight days before her admission and on the same day, respectively. The patient reported no discomfort before admission, and there were no abnormalities in the prenatal course during her pregnancy. On February 13 (the second day of admission), a patchy blurred shadow was observed in the lower lobe of the right lung in chest CT scan, and a live baby girl was delivered by a precaution-based emergent cesarean section because of suspected fetal distress shown in electrical fetal heart monitoring. Both the mother and the newborn were isolated separately after the operation without etiological examination of amniotic fluid, umbilical cord blood, placenta, etc. All the medical staff involved in the cesarean section were isolated as well. The mother was healthy and remained asymptomatic after delivery, while antiviral and anti-inflammatory treatment was offered. COVID-19 nucleic acid tests of pharyngeal swab were negative on the 4 th and 6 th day after operation. Chest CT on the 5 th day after delivery showed inflammation in the lower lobe of the right lung, and reexamination on the 8 th day showed a slight absorption of the inflammation. Samples of peripheral blood and pharynx swab were obtained from the newborn on the day of birth and four and seven days after birth and novel coronavirus nucleic acid test were all negative. The mother and baby dyad were discharged nine days after operation. And novel coronavirus nucleic acid tests were all negative in all medical staff involved.

Objective To evaluate the clinical characteristics and pregnant outcomes of gravidae with COVID-19. Methods This study involved nine gravidae with COVID-19 admitted to the Renmin Hospital of Wuhan University from January 22 to February 1, 2020. Their clinical data, including epidemiological history, clinical symptoms, laboratory examinations, chest CT, treatment, delivery mode, and pregnancy outcomes, were analyzed retrospectively. Specimens of maternal vaginal swab were collected in six pregnant women, and the specimens of amniotic fluid, cord blood, neonatal throat swab and breast milk samples were collected in four pregnant women who had a delivery during our study. All samples were tested for the existence of COVID-19. Descriptive analysis was applied in this study. Results (1) Among the nine cases, five were admitted in the third trimester and four in the second trimester. The median incubation period of COVID-19 was 8 (1-14) d. Fever was presented in all cases on admission, and the other commonly seen symptoms were cough (seven cases) and diarrhea (five cases). Other signs and symptoms were also reported, including shortness of breath, myalgia and fatigue (four cases in each), nasal obstruction, pharyngalgia, chest pain, and headache/dizziness (three cases in each), rash (two cases), and chills and expectoration (one case in each). The most common laboratory abnormalities were a decreased number of lymphocytes (seven cases) and elevated C-reactive protein (six cases). Chest CT scans were performed in seven women, and all showed patchy areas or ground-glass opacity in both lungs. Oligohydramnios was detected in only one case at 37 +5 weeks, which was 7 d after the diagnosis of COVID-19. (2) All nine cases received empiric antibiotic and antiviral therapy with Chinese medicine as adjuvant treatment. Eight patients required oxygen inhalation, and eight were treated with glucocorticoid. Six cases received immunotherapy. (3) Four of the nine cases had delivered, including three cesarean sections and one spontaneous vaginal preterm birth after premature rupture of membranes, and the mother was transferred to the intensive care unit 2 d after delivery due to acute respiratory distress syndrome. One case was terminated at 26 gestational weeks. Of the four neonates, there were two term and two premature babies, and one preterm baby was small-for-gestational-age. No neonatal asphyxia was observed. Serial real-time quantitative reverse transcription-polymerase chain reaction showed negative results in the detection of 2019-novel coronavirus in all samples obtained from amniotic fluid, umbilical cord blood, neonatal nasopharynx, breast milk, and vagina. Maternal conditions were all stable in all cases, including the four continuing pregnancy, and the terminated ones, except the case mentioned above. Conclusions There is no distinguishable clinical feature between pregnant and non-pregnant COVID-19 patients. So far, there is no evidence for vertical transmission or worsening perinatal outcome in mothers and babies.

Objective: To investigate the effects of maternal exposure to ambient fine particles (PM_2.5) in Fuzhou during pregnancy on immune responses to ovalbumin (OVA) in neonatal rats and the possible mechanisms. Methods: Pregnant Sprague-Dawley rats were randomly assigned into four groups (ten in each): filtered air (FA) plus normal saline (NS), airborne PM_2.5 plus NS (PM_2.5-NS), FA plus OVA (FA-OVA) and PM_2.5 plus OVA (PM_2.5-OVA) groups. Pregnant dams in the PM_2.5 exposure groups were placed in a PM_2.5 exposure chamber in which the PM_2.5 concentration was equal to the ambient air from the beginning of gestation till delivery, whereas the other dams inhaling air without particulate matters were put into a clean chamber. OVA sensitization was conducted through intraperitoneal injection of OVA at 50 μg per dam at 4 and 9 days of gestation, followed by inhalation of atomized 1% OVA for 30 min at 18, 19 and 20 days of gestation. Dams without OVA sensitization were given NS in the same way. Levels of interleukin (IL)-4, IL-5 and interferon-γ (IFN-γ) in neonatal rats' plasma were measured by enzyme-linked immunosorbent assay just after birth. Protein levels of transcription factors GATA-3 and T-bet in lung were analyzed by Western-blotting. Changes in microRNA(miR)-146a and miR-146b in spleen were detected by real-time polymerase chain reaction. Histological changes in lung were observed under light microscope. One-way analysis of variance and LSD test were used as statistical methods. Results: (1) IL-4 level in plasma was significantly increased in PM_2.5-NS [(18.56±7.04) ng/L], FA-OVA [(34.04±7.06) ng/L] and PM_2.5-OVA groups [(45.67±8.18) ng/L] as compared with that in FA-NS group [(10.51±2.88) ng/L], and the level of IL-4 in PM_2.5-OVA group was higher than that in PM_2.5-NS and FA-OVA groups (F=54.667, P<0.001). Significantly increased IL-5 level in plasma was found in FA-OVA and PM_2.5-OVA groups as compared with that in FA-NS group (F=6.253, P=0.023). Among the four groups, FA-OVA group showed significantly increased IFN-γ level in plasma (F=28.604, P<0.001). (2) GATA-3 level in lung tissues was significantly increased in PM_2.5-NS (31.09±3.54), FA-OVA (35.24±5.00) and PM_2.5-OVA groups (47.81±3.63) as compared with that in FA-NS group (24.19±3.12), and higher in PM_2.5-OVA group than in PM_2.5-NS and FA-OVA groups (F=96.581, P<0.001). T-bet level was significantly lower in FA-OVA and PM_2.5-OVA groups than in FA-NS group. Moreover, PM_2.5-OVA group showed decreased T-bet level as compared with that in PM_2.5-NS and FA-OVA groups (F=30.852, P<0.001). (3) Expression of miR-146a in spleen was significantly enhanced in PM_2.5-NS (1.72±0.27), FA-OVA (1.56±0.37) and PM_2.5-OVA groups (3.06±0.52) than in FA-NS group (1.05±0.25). Moreover, PM_2.5-OVA group showed enhanced expression of miR-146a as compared with that in PM_2.5-NS and FA-OVA groups (F=42.276, P<0.001). Changes in the expressions of miR-146b were similar to those in miR-146a (F=28.776, P<0.001). (4) Stenosis or disappearance of alveolar spaces, accompanied with infiltration of inflammatory cells in interstitial substance and congestion in alveolar septum, was seen in FA-OVA and PM_2.5-OVA groups and conditions in the latter group were more severe. Conclusions Intrauterine exposure to ambient PM_2.5 negatively affects fetal lung development and immunological function in rats, especially when the dams are sensitized with OVA during pregnancy.

Objective: To investigate the relation between hemoglobin (Hb) levels in the third trimester and associated adverse pregnancy outcomes. Methods: A retrospective analysis was conducted on 38 624 singleton gravidas recruited from 21 hospitals in three major cities in China from June 2013 to May 2015. Hb levels of all subjects were determined in the third trimester (≥28 weeks). Demographic data and clinical information were collected individually. The recruited gravidas were divided into four groups as follows: anemic group: Hb <110 g/L (n=6 256), control group: 110 g/L≤ Hb <130 g/L (n=22 484), high-level group: 130 g/L ≤ Hb <150 g/L (n=9 460), and super high-level group: Hb ≥ 150 g/L (n=424). One-way ANOVA and Chi-square test were used for statistical analysis. Results: (1) Compared with the control group, anemic group had significantly higher incidences of preterm labor, low birth weight, neonatal admission and neonatal complications [4.9% (1 095/22 484) vs 6.9% (431/6 256), 3.1% (708/22 484) vs 4.3% (272/6 256), 6.2% (1 392/22 484) vs 9.2% (577/6 256), and 7.7% (1 741/22 484) vs 10.2% (640/6 256); χ²=930.905, 21.360,70.506 and 39.837, all P<0.001]; high-level group showed significantly increased incidences of hypertensive disorders of pregnancy and preeclampsia [2.3% (515/22 484) vs 3.2% (305/9 460) and 1.4% (313/22 484) vs 1.7% (161/9 460); χ²=23.203 and 6.072, both P<0.017], but decreased incidences of preterm labor, neonatal admission and neonatal complications [4.9% (1 095/22 484) vs 3.7% (346/9 460), 6.2% (1 392/22 484) vs 5.5% (517/9 460) and 7.7% (1 741/22 484) vs 6.7% (631/9 460); χ²=331.947, 6.245 and 11.154, all P<0.017]; super high-level group had significantly raised incidences of hypertensive disorders of pregnancy, preeclampsia and low birth weight [2.3% (515/22 484) vs 4.7% (20/424), 1.4% (313/22 484) vs 3.5% (15/424) and 3.1% (708/22 484) vs 5.2% (20/424); χ²=10.742, 13.575 and 6.512, all P<0.017]. (2) A concentration gradient analysis was performed to further analyze Hb levels in the third trimester in relation to adverse pregnancy outcomes and the results revealed that with the increase of Hb concentration, the incidences of hypertensive disorders of pregnancy, preeclampsia and low birth weight showed U-shaped distributions, while the incidences of preterm birth, neonatal admission and neonatal complications showed decreasing trends (χ²=31.233, 16.147, 25.618, 85.383, 97.824 and 68.677, respectively; all P<0.05). Conclusions Abnormal levels of Hb in the third trimester of pregnancy, including anemia and elevated Hb concentration are related to adverse pregnancy outcomes.

Objective: To evaluate the characteristics and performance of various prediction models for early-onset preeclampsia, and to provide a reference for further study of preeclampsia prediction methods. Methods: (1) Databases of PubMed, Medline, Embase, China National Knowledge Infrastructure (CNKI) and Wanfang Database were searched since their inception to October 2016. Studies in models for predicting early-onset preeclampsia during the first trimester were included. (2) Two reviewers independently checked potentially eligible articles, assessed risk of bias and extracted data. (3) Subtotals for the performance of different models were created and their properties were analyzed. Differences between simple models (based upon high risk factors such as demographic figures, medical history and family history, etc) and complex models (based upon blood pressure, uterine artery Doppler and biomarkers) were compared by analyzing forest plot created by SAS 9.4. Results: (1) Seventeen studies met the inclusion criteria were screened out, including nine prospective cohort studies, two case-control studies and six nested case-control studies. A total of 76 436 gravidas from tendifferent populations were assessed by the established models in these studies. (2) The area under the curve (AUC) of 13 simple models ranged from 0.64 to 0.81 with the sensitivity of 21%-60% when the false positive rate (FPR) was 10%. The AUC of 17 complex models ranged from 0.77 to 0.98 and the sensitivity was between 48.0% and 95.2% at a fixed FPR of 10%. (3) Compared with the simple models, the best complex models could ensure a promotion of 0.171 (range from 0.060 to 0.245) in median AUC, and a promotion of 40.8% (16.0% to 52.2%) in sensitivity at a FPR of 10%. Based on the simple models, additional mean arterial pressure (MAP) would increase the AUC and sensitivity by 0.092 (0.079 to 0.104) and 28.7% (16.2% to 55.0%), respectively, while additional uterine artery pulsatility index (UtA-PI) would bring an increase of 0.106 (0 to 0.137) and 31.8% (-1.0% to 41.9%), respectively. Moreover, when both MAP and UtA-PI were included into the simple models, the AUC and sensitivity would increase by 0.157 (0.094 to 0.218) and 31.6% (12.0% to 52.2%). Conclusions Complex prediction models perform better than simple models in prediction of early-onset preeclampsia. However, further confirmation is required in different population.

Objective: To investigate the mortality and incidence of major diseases in preterm very low birth weight infants (VLBWI) in order to provide baseline data for clinical decision making and further epidemiological studies. Methods: This was a multicentered cross-sectional study and a sub-analysis of baseline data from "REduction of Infection in Neonatal intensive care units using the Evidence-based Practice for Improving Quality (REIN-EPIQ)" study, which was a multicentered cluster-randomized controlled study. This study was conducted in 25 tertiary neonatal intensive care unit (NICU) in 19 provinces and major cities of China. All infants with gestational age less than 34 weeks, birth weight less than 1 500 g and admission within the first seven days of life from May 2015 to April 2016 were enrolled. Clinical information of those enrolled infants was extracted from the standardized database. Descriptive statistical analysis was used. Results: A total of 2 956 VLBWI were enrolled with 446 (15.1%) extremely low birth weight infants (ELBWI). Overall, 22.6% (668/2 956) infants were brought home by their parents against medical advice. Among those stayed in the hospital, the in-hospital mortality of VLBWI was 8.0% (182/2 288), and that of ELBWI was 27.3% (83/304). The in-hospital mortality of infants with birth weight between 1 000 and 1 499 g was 5.0% (99/1 984). The estimated overall mortality, was 23.9% (705/2 956) and 47.5% (212/446) for ELBWI. Incidences of sepsis, bronchopulmonary dysplasia, intraventricular hemorrhage (gradeⅢ or above) or periventricular leucomalacia, necrotizing enterocolitis (stageⅡ or above) and retinopathy of prematurity (stageⅢor above) were 23.9% (707/2 956), 18.9% (432/2 288), 11.5% (283/2 469), 5.6% (144/2 561) and 3.4% (61/1 795) in VLBWI, respectively, and 28.9% (129/446), 49.0% (149/304), 21.6% (68/315), 7.2% (23/318) and 13.9% (29/208) in ELBWI. Among infants who received active care, 45.9% (1 050/2 288) died or had at least one major preterm disease during hospitalization, and that of ELBWI was 76.0% (231/304). Conclusion The mortality and incidences of major preterm diseases are significantly high among VLBWI in NICU. Further investigations on current practices and quality improvement are needed to improve the overall outcome of VLBWI.

Objective: To explore the mechanisms of vascular endothelial growth factor receptor 2 (VEGFR2) expression regulated by recombinant human erythropoietin (rh-EPO) in a premature rat model of periventricular white matter damage. Methods: Sprague-Dawley rats aged three days were randomly divided into five groups: sham group without hypoxia-ischemia (HI), HI group (HI with saline administration), HI+erythropoietin (EPO) group, HI+erythropoietin receptor (EPOR) antagonist group and HI+EPO+EPOR antagonist group. Rat pups were either subjected to permanent ligation of the right common carotid artery and 6% O₂+94% N₂ for two hours (HI) or sham operated and exposed to normal air (sham). After the operation, rats in the HI+EPOR antagonist and HI+EPO+EPOR antagonist groups received a single intraventricular injection of EPOR antagonist (5 μl). Four hours after the operation, rats in the HI+EPO and HI+EPO+EPOR antagonist groups received a single intraperitoneal injection of rh-EPO (5 U/g). Western-blot was performed to detect EPOR, phosphorylated EPOR (p-EPOR), extracellular regulated protein kinases (ERK) and phosphorylated ERK (p-ERK) at 60 and 90 minutes after the models were established successfully, and also used to analyze the expression of VECFR2 on day 2 and 4. Analysis of variance and SNK test were used as statistical methods. Results: At 60 and 90 minutes after model establishment, the expression of EPOR protein in rat brain tissues was increased in HI (1.717±0.206 and 1.416±0.242), HI+EPO (2.557±0.222 and 2.111±0.159) and HI+EPO+EPOR antagonist (1.547±0.170 and 1.452±0.250) groups as compared with that in sham group (1.095±0.182 and 0.751±0.136), that in HI+EPO group was higher than that in HI and HI+EPO+EPOR antagonist groups, and that in HI+EPOR antagonist group (1.088±0.160 and 1.020±0.174) was lower than that in HI group. All differences were statistically significant (F=30.154 and 20.265, both P<0.05). The expressions of p-EPOR, p-ERK and VEGFR2 in the five groups were consistent with the expression of EPOR, and the differences were also statistically significant (all P<0.05). In addition, the expression of VEGFR2 in HI+EPO+EPOR antagonist group was lower than that in HI group on day 4 (1.053±0.118 vs 1.439±0.074, F=54.248, P<0.05). No statistically significant difference in ERK expression was found among all groups at 60 or 90 minutes after modeling (F=1.117 and 0.734, both P>0.05). Conclusions ERK signaling pathways will be affected by EPO binding to EPOR. As a result, VEGFR2 expression was increased leading to enhanced angiogenesis in a premature rat model of periventricular white matter damage.

Objective: To investigate the clinical significance and prognosis of ultrasound-identified asymmetric ventricles in fetuses, and to provide evidences for clinical consultation and management. Methods: From January 2014 to May 2017, 142 singleton fetuses were enrolled who were diagnosed with asymmetric ventricles through prenatal ultrasound in Peking University First Hospital and successfully followed up after birth. Asymmetric ventricles included simple lateral ventricular asymmetry [lateral ventricular widths were normal (<10 mm) but with a difference of ≥2 mm between the two lateral ventricles and unilateral ventricular widening (only one lateral ventricle was ≥10 mm in width and the other was <10 mm). All 142 fetuses were divided into two groups according to whether they had other abnormalities (including abnormal ultrasound soft markers and structural abnormalities) or not. Clinical and imaging data of them were analyzed retrospectively. They were followed up for at least six months after birth. Neurological development regarding language, behavior and motor was evaluated using Denver Developmental Screening Test. Results: There were 109 cases without other abnormalities and among them, 38 (35%) spontaneously recovered in utero, two (2%) became worse, and 69 (63%) remained unchanged. Thirty-one of the 109 cases received fetal cranial MRI and abnormal brain development was found in only one case. No abnormal findings were reported in karyotyping in 38 cases and viral detection in 31 cases. One hundred and five fetuses were successfully delivered and four were induced including two cases for wider in unilateral lateral ventricle, one of continued widening, and one with abnormal brain development suggested by fetal cranial MRI. Among the 33 cases with other abnormalities, two were spontaneously recovered in utero, one became worse , 15 unchanged and 15 were induced. Of the 20 cases underwent chromosomal examination, one unbalanced chromosome translocation was identified. Twelve fetuses underwent cranial MRI among which two were found abnormal (periventricular cyst and brain asymmetry). Sixteen cases were aborted including 15 with major abnormalities (major deformity or absence of extremities) and one with mild abnormality (abnormal ultrasound soft markers with progression in lateral ventricular width ≥15 mm in in-utero follow-up). Seventeen cases were born including 16 with mild abnormalities and one with severe abnormality (unilateral renal cystic disease without chromosome abnormality). No significant developmental abnormality in language, behavior and motor was reported during follow-up. Conclusions Asymmetric ventricles have no significant impact on fetal growth and postnatal development. The prognosis of asymmetric ventricles mainly depends on the width of lateral ventricles in utero and concomitant abnormalities. Therefore, close attention should be paid on monitoring and follow-up.