Objective To determine the prevalence of vulvovaginal candidiasis(VVC) in pregnant women,to test its antifungal susceptibility to miconazole,clotrimazole,fluconazole, itrocona- zole,and nystatin and to treat VVC with miconazole in pregnancy. Methods Vaginal swabs were collected from unselected pregnant women in prenatal clinic. The antifungal susceptibility of 131 strains of Candidas to miconazole,clotrimazole,fluconazole,itroconazole,and nystatin were detected by Neo-Sensitabs susceptibility testing. 66 cases of VVC were treated with 6 day-course of miconazole(400 mg/d). Results The prevalence of VVC in pregnant women was 12.7%(127/1000). 37.4%(374/1000) had previous VVC. 0.6%(6/1000)of women were recurrent VVC(RVVC),which occupied 4.7%(6/127) of VVC. C. albicans was the most frequently(87.1%) isolated pathogen followed by C. glabrata (9.9%) ,C. tropicalis(1.5%),and C. krsei(1.5%). The resistant rate of C. albicans to miconazole,clotrimazole,fluconazole,itroconazole,and nystatin was 10.5%、2.6%、 6.1%、 7.9%,and 0. All 13 strains of C. glabrata was susceptible to miconazole,nystatin and susceptible or susceptible-dependent-upon-dose (SDD) to clotrimazole,fluconazole,and itroconazole. The mycological cure rate of miconazole on day 7～14 and day 28～42 was 84.8%(56/66 cases) and 80.3% (53/66 cases). Conclusions VVC is very common in pregnancy. C. albicans is the predominant Candida species in VVC and has some resistance to miconazole,clotrimazole,fluconazole,itroconazole,and nystatin. Miconazole therapy is effective on VVC treatment in pregnant women. Non-effective treatment might be associated with Candidas resistance.

OBJECTIVE To analyze the clinical cases of fungal infections and drug resistance to provide a basis for the treatment of mycotic infection.METHODS A total of 215 cases of fungal strains were identified by API 20C AUX.Drug susceptibility was determined by Rosco slip diffusion.RESULTS In 215 fungal strains of specimens,Candida accounted for 87.9%,of which C.albicans accounted for 37.2%.The yeast-like fungi sensitivity rate to amphotericin B,nystatin and ketoconazole respectively was 100.0%,97.9% and 93.5%.CONCLUSIONS Candida are the most common pathogens in the 215 fungal stains.Yeast-like fungi is sensitive to amphotericin B,nystatin and ketoconazole.

Objective To determine the incidence of pregnancy complicated with heart disease and assess the current obstetric management principles of pregnancy complicated with heart disease. Methods 428 cases of pregnancy complicated with heart disease were reviewed.54 cases were sur- gically corrected heart disease.Results:The incidence of pregnancy complicated with heart dis- ease,during January,1973 to December,1982 and January,1983 to December,1992,were 1.2% (254/21 221) and 0.9% (174/18 726)respectively.The ratio of rheumatic heart disease and congenital heart disease were 4:1 and 1:2 in two periods.There were 37 cases of heart failure and 4 cases of ma- ternal deaths occured.No heart failure and maternal death occured in cases with surgically corrected heart disease.In the two periods,the cesarean section rate were 16.9%(43/254),and 33.3% (58/74) ,P

Mother to child transmission(MTCT)is a major route oftransmission of acquired immunodeficiency syndrome(AIDS),syphilis and hepatitis B.MTCT of AIDS,syphilis and hepatitis B can lead to many adverse pregnancy outcomes,seriously affacting maternal andinfant healthand has become a severe public health and social problem.The risk of MTCT of AIDS, syphilis and hepatitis Bis associated with stage of pregnancy,receiving or not receiving treatment.The prevention for MTCT of AIDS,syphilis and hepatitis B has becoming increasingly important.To learnthe epidemiology,diagnosis, maternal-fetal hazardsand anti-MTCT therapy of AIDS, syphilis and hepatitis Bwill undoubtedly facilitate the development of strategies for MTCT of AIDS,syphilis and hepatitis Bprevention and control.(Chin J Lab Med,2018,41:259-262)

Objective To investigate the profile of local immunity of vagina and the immune defense mechanisms against lower genital tract infections. Methods Vaginal lavage was collected from healthy women and patients of vulvovaginal candidiasis, bacterial vaginosis, Trichomonol vaginitis, human papilloma virus infection(VVC), and chlamydia trachomatis infection. Each group included 60 cases. The level of interleukin (IL) 2,4,5, 13,8 and human defensin 5 (HD5) were detected by enzyme linked immunosorbent assay(ELISA). Results (1) Cytokine of helper T cell 1(Th1): the level of IL-2 between healthy women and VVC/ bacterial vaginosis (BV)/ trichomonol vaginitis (TV)/ chlamydia trachomatis (CT) patients had no significant difference. The IL-2 level(96±33 )×10-3 pg/L of human papilloma virus (HPV) infection patients was significantly higher than that of healthy women( P<0.05). (2)Cytokine of helper T cell 2 (Th2) : the level of IL-4 between healthy women and VVC/CT patients had no significant difference. The level of IL-5 between healthy women and BV patients had no significant difference. The IL-13 level(42±15)×10-3 pg/L of TV patients was significantly higher than that of healthy women (30±29)×10-3 pg/L (P<0.05). The IL-4 level (103±28)×10-3 pg/L of HPV infection patients was significantly higher than that of healthy women (36±22)×10-3 pg/L (P<0. 05 ). (3) IL-8 : the IL-8 level (5.8± 2.7) pg/L of TV infection patients was significantly higher than that of healthy women (2. 6±2.4) pg/L (P<0.05). The level of IL-8 between healthy women and BV patients had no significant difference. (4)HD5:the HD5 level of TV , BV, VVC, HPV and CT infection patients were significantly higher than that of healthy women (P<0.05). Conclusions (1) HD5 plays an important role in the defence of vaginal epithelial cell. (2) Th2 may be more important than Thl in lower genital tract infections.(3) IL-8 plays an important role in extrinsic source infections.

Objective To investigate the correlated pathogenetic factors and vaginal local immunity in vulvovaginal candidiasis (VVC). Methods A case control study was conducted to compare VVC group (60 cases) with normal group (60 cases). All of the women filled up the specific questionnaires. Routine examination, pH test and bacterial culture were done on the vaginal discharge. Cytokines of the vaginal lavage were measured by enzyme linked immanosorbent assay. Results (1) Outcomes of the questionnaires: there was no significant difference between the two groups in educational background,knowledge of gynecologic infection, history of gynecologic infection, hygienic habit, sex life, or use of medicine (P >0. 05). The incidence of chronic cervicitis in normal group (43%, 26/60) was higher than in VVC group (22%, 13/60; P <0.05). (2) There was no difference in vaginal pH between the two groups ( P > 0. 05 ). (3) Detection rate of candida albicans by vaginal discharge routine examination was 72% (43/60). (4) The concentrations of interleukin (IL) 2, and IL-4 in vaginal lavage did not show significant difference between the two groups ( P > 0. 05 ), but the concentrations of human defensin 5,human beta-defensin (HBD) 1, and HBD2 in WC group [(0.94±0.44) mg/L, (3.1±0.4) μg/L,(10±6) μg/L] were higher than normal group (P < 0.05). Conclusions VVC is a common vulvovaginitis. There is no significant correlation between the incidence of VVC and educational background,knowledge of gynecologic infection, history of gynecologic infection, hygienic habit, sex life, or use of medicine in the child-bearing period. Human defensin may be closely correlated with the pathogenesis of VVC.

Objective To evaluate the efficiency of matrix assisted laser analytical ionization time of flight mass spectrometry(MALDI-TOF-MS)for identification of Candida species which caused vulvovaginal candidiasis(VVC).Methods Candida strains from VVC were first identified by PCR amplification of the ITS regions and transposable intron of DNA and sequencing analysis.MALDI-TOF-MS wasfurther performed to identify the strainsconfirmedby molecular methods, and at the same time the MALDI-TOF-MS identification database of C.albicans complex was set up.Results In total, 324 Candida strains were identifiedby molecular methods from VVC samples,which encompassed20 different yeast species, including C.albicans,C.africana,C.dubliniesis, C.glabrata, C.bracarensis, C.nivariensis, C.guilliermondii, C.lusitaniae,C.krusei,C.kefyr,C.parapsilosis,C.metapsilosis,C.tropicalis,Kodamaea ohmeri,C. fabianii, Rhodotorula mucilaginosa, Saccharomyces cerevisiae, and Trichosporon asahii.314of all 324 Candida strains were correctly identified by MALDI-TOF-MS.3 C.albicans,1 C.africana,1 C.glabrata, 2 C.metapsilosis,1 C.guilliermondii and 1 Saccharomyces cerevisiae were incorrectly identified, while 1 Torulaspora pretoriensiscannot identified.The accuracy ofidentification was 96.91 %(314/324).97.95%(191/195)of Candida strains, including 153(98.08%)C.albicans, 37(97.37%)C.africanaand 1 (100%)C.dubliniesis, can be correctly identifiedby the newbuiltC.albicans complex database. Conclusion MALDI-TOF-MS is proved to be a rapid and reliable method for identification of Candida strains from VVC,which also has advantages of identification of Candida complex.(Chin J Lab Med,2018, 41:296-299)

Objective To study the vaginal microecology of the patients in the outpatient department of Obstetrics and gynecology in China.Methods A multicenter cross-sectional study was conducted in gynecologic clinic of 9 collaborative hospitals in China.200 consecutive patients were collected in each hospital and their vaginal microecology combined with related factors were analyzed.Results A total of 2 093 specimens were collected in this study.The detection rate of Trichomonas was 5.5%(115/2 093). The detection rate of Candida mycelia was 15.9%(333/2 093), with germinal spores was 4.1%(86/2093).The detection rate of bacterial vaginosis was 18.8%(394/2 093).The distribution results of vaginal flora in patients showed that the normal flora accounted for only 27.3%(571/2 093).The normal flora with the insufficiency of H2O2 accounted for 23%(480/2 093).The bacteria inhibiting flora accounted for 3.8%(79/2 093).The abnormal microflora(non BV type)accounted for 14.9%(312/2 093).The abnormal microflora(BV intermediate type)accounted for 13.4%(280/2 093).The abnormal microflora(BV type)accounted for 17.6%(369/2 093).The average pH of vaginal discharge was 4.58 ±0.495.There was no significant difference of the incidence of trichomonas and bacterial vaginosis between north and south of the Yangtze river, while the detection rate of fungal hyphae and the fungal spores is significantly higher in the south than that in the north.The analysis results of factors affecting the microecology showed that age and contraception methods were two important factors.The patients′age from bacteria inhibition group was 49.64 +16.68 which was significantly higher than that of the other microecology groups.The proportion of abnormal microflora of patients from the oral contraceptive group was 40%(20/50).The proportion of abnormal microflora of patients from IUD group was 36.6%(63/172).Compared with these two contraception methods, the proportion of abnormal microflora of patients from condoms usage group was 27.8%(91/327)which was significantly lower.The incidence of abnormal leucorrhea in the normal group was 37.7%, which was significantly lower than that of other abnormal groups.Conclusion This study showed the vaginal microecology status of the Chinese outpatient ′s clinic and found that the vagina microecology was related to age, region and contraceptive methods.The typical manifestation of microecological abnormality is the increase of leucorrhea.(Chin J Lab Med,2018, 41:287-291)

Objective:To investigate and analyze disease status and risk factors of venous thromboembolism (VTE) during pregnancy and puerperium in our country.Methods:Clinical datas were collected from 575 patients diagnosed with VTE during pregnancy and puerperium and hospitalized in nine medical institutions in our country from January 1, 2015 to November 30, 2019, and retrospectively analyzed it′s disease status and risk factors.Results:(1) The proportion of VTE in pregnancy and puerperium was 50.6% (291/575) and 49.4% (284/575), respectively. Four patients died, the mortality rate was 0.7% (4/575). The cause of death was pulmonary embolism. (2) The location of VTE during pregnancy and puerperium was mainly in the lower limb vascular (76.2%, 438/575), followed by pulmonary vessels (7.1%, 41/575). (3) In the risk factors of VTE, cesarean section accounted for 32.3% (186/575), maternal advance age accounted for 27.7% (159/575), braking or hospitalization during pregnancy accounted for 13.6% (78/575), other risk factors accounted for more than 5% were previous VTE, obesity, preterm birth, assistant reproductive technology conception and so on, pre-eclampsia and multiple pregnancy accounted for 4.9% (28/575) respectively. In addition, some patients with VTE did not have any of the above risk factors, and the incidence rate was as high as 23.1% (133/575).Conclusions:The occurrence of VTE during pregnancy and puerperium is related to multiple risk factors, and could lead to matemal death, It is very necessary to screen VTE risk factors for all pregnant women, to make corresponding prevention and control measures.

Objective To evaluate the risk factors and sonographic findings of pregnancies complicated by placenta increta or placenta percreta. Methods Totally, 2219 cases were retrospectively analyzed from 20 tertiary hospitals in China from January 2011 to December 2015. The data were collected based on the original case records. All cases were divided into two groups, the placenta increta (PI) group (79.1％, 1755/2219) and the placenta percreta (PP) group (20.9％, 464/2219), according to the degree of placental implantation. The risk factors and sonographic findings of placenta increta or percreta were analyzed by uni-factor and logistic regression statistic methods. Results The risk factors associated with the degree of placental implantation were age, gravida, previous abortion or miscarriage, previous cesarean sections, and placenta previa (all P<0.05), especially, previous cesarean sections (χ2=157.961) and placenta previa (χ2=91.759). Sonographic findings could be used to predict the degree of placental invasion especially the boundaries between placenta and uterine serosa, the boundary between placenta and myometrium, the disruption of the placental-uterine wall interface and loss of the normal retroplacental hypoechoic zone(all P<0.01). Conclusions Previous cesarean sections and placenta previa are the main independent risk factors associated with the degree of placenta implantation. Ultrasound could be used to make a prenatal suggestive diagnosis of placenta accreta spectrum disorders.