Objective:To explore the characteristics of glucose and lipid metabolism and intrauterine growth indicators in fetuses with selective intrauterine growth restriction (sIUGR) in twins.Methods:Sixty cases of sIUGR type I twin fetuses who were registered, underwent regular prenatal care, and were hospitalized for delivery at the Fujian Maternity and Child Health Hospital from January 2021 to January 2023 were selected as the research subjects. Selected 30 fetuses with growth restriction from sIUGR pregnant patients were taken as the observation group, while the 30 fetuses with non-growth-restricted served as the control group. During cesarean section, the umbilical vein blood of two fetuses was collected after the fetus was delivered and before the placenta was delivered, and the factors regulating growth, development and metabolism in the umbilical vein blood were detected: adiponectin, leptin, insulin-like growth factor-1 (IGF-1), blood glucose, total cholesterol, triglycerides, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), apolipoprotein A1, apolipoprotein B and other indicators. The measurement data of normal distribution are presented as xˉ± s, and the comparison of means between the two groups is performed using paired t-tests. P<0.05 was considered statistically significant. Results:(1) The levels of adiponectin (83.60±8.91) μg/L, leptin (7.11±0.53) μg/L, and IGF-1 (43.43±0.68) μg/L in the umbilical cord blood of the case group were significantly lower than those of the control group (92.50±10.52) μg/L, leptin (12.00±0.66) μg/L, and IGF-1 (70.34±1.44) μg/L, with statistically significant differences ( t-values of 2.94, 31.33, 99.70, respectively; P values of 0.006, <0.001, <0.001, respectively). (2) There was no statistically significant difference in the levels of blood glucose, triglycerides, HDL-C, and apolipoprotein A1 in umbilical cord blood between the two groups of fetuses (all P>0.05). (3) The total cholesterol (2.626±0.764) mmol/L, LDL-C (1.168±0.482) mmol/L, and apolipoprotein B (0.359±0.133) mmol/L in the umbilical cord blood of the case group were significantly higher than those in the control group, with total cholesterol (2.351±0.725) mmol/L and LDL-C (1.043±0.418) mmol/L. Apolipoprotein B was (0.317±0.107) mmol/L, and there was a statistically significant difference between the two groups ( t-values were 3.42, 3.10, and 3.67, respectively; and P values were 0.002, 0.004, and 0.001, respectively). Conclusion:There are abnormalities in lipid metabolism present in the cord blood of growth-restricted infants. Clinically, adiponectin, leptin, IGF-1, total cholesterol, LDL-C, and apolipoprotein B in twin umbilical blood can be served as key indicators for assessing fetal intrauterine development.

Pregnancy ; Female ; Humans ; Diabetes, Gestational/diagnosis* ; Retrospective Studies ; Prognosis ; Pregnancy Outcome ; Maternal Age

Objective:To analyze the factors influencing the success rate of external cephalic version (ECV) and to create a preoperative scoring scale for stratified management of pregnant women who were preparing for ECV.Methods:This prospective study was conducted on singleton pregnant women who underwent ECV without anesthesia in Fujian Maternity and Child Health Hospital from January 1, 2017, to December 31, 2019. Univariate (two independent samples t-test, Mann-Whitney U test, and Chi-square test) and multivariate logistic regression were used to screen the clinical characteristics affecting the success of ECV, and receiver operating characteristic (ROC) curve was used to determine the cut-off value and convert quantitative variables into dichotomous variables. The independent variables were scored according to the regression coefficient in multivariate logistic regression analysis, and then a preoperative scoring scale was created. The ROC curve was used to calculate the cut-off value for the scoring scale. The subjects were divided into low and high score groups according to the cut-off value. The area under the ROC curve was used for evaluating the effectiveness of the scale in predicting the success of ECV. The success rate of ECV, difficulty of the operation and mode of delivery were compared between the two groups. Results:A total of 1 338 pregnant women met the inclusion criteria during the study period. After the exclusion of 885 women, 165 refused ECV in favor of direct cesarean section, 27 spontaneously converted to cephalic position before ECV, 261 who voluntarily accepted ECV were finally enrolled. ECV succeeded in 202 cases and failed in 59. (1) Favorable factors for ECV without anesthesia were the distance between the fetal breech and ischial spine <－3.5 cm ( OR=0.177, 95% CI: 0.071-0.438, P=0.009), the sum of the fundal height and the station of the fetal breech based on the ischial spine <30.25 cm ( OR=0.225, 95% CI: 0.094-0.537, P=0.001), amniotic fluid index ≥12 cm ( OR=0.399, 95% CI: 0.164-0.969, P=0.042), the surgeon's ability to hold the fetal head or breech with one hand ( OR=0.241, 95% CI: 0.098-0.589, P=0.002; OR=0.219, 95% CI: 0.087-0.546, P=0.001), and the fetal head located on the right or left upper abdomen of the mother ( OR=0.184, 95% CI: 0.059-0.568, P=0.003; OR=0.253, 95% CI: 0.084-0.760, P=0.014). (2) The area under the ROC curve of the preoperative score for predicting the success of ECV was 0.881 (95% CI: 0.821-0.941) and the cut-off value was 5.5. The subjects were divided into low (0-5 scores) and high (6-11 scores) score groups and the area under the ROC curve for predicting the success of ECV by grouping was 0.843 (95% CI: 0.774-0.912). Compared with the low score group, the high score group had a shorter ECV duration [2.0 min (0.5-10.0 min) vs 10.0 min (0.9-25.8 min), Z=－6.83, P<0.001], less attempts [1.0 times (1.0-4.0 times) vs 3.0 times (1.0-5.0 times), Z=－8.41, P<0.001], higher success rate [92.7% (190/205) vs 21.4% (12/56), χ2=127.64, P<0.001], higher rate of vaginal birth [75.4% (147/195) vs 18.5% (10/54)] and lower cesarean section rate [24.6% (48/195) vs 81.5% (44/54)] ( χ2=58.70, P<0.001). Conclusions:Preoperative scoring based on the factors influencing the success rate of ECV (the distance between the fetal breech and ischial spine, the sum of the fundal height and the station of the fetal breech based on the ischial spine <30.25 cm, amniotic fluid index ≥12 cm, the surgeon's ability to hold the fetal head or breech with one hand, and the fetal head locating on the right or left upper abdomen of the mother) is conducive to the individualized evaluation of the difficulty and the success rate of ECV as well as the success rate of vaginal delivery after ECV, which can provide a reference for clinical stratified management of ECV patients.

Objective:To explore the relative factors for best ovarian response in patients undergoing assisted reproductive technology with follicular phase long-acting long protocol, and to establish a Nomogram prediction model of ovarian response.Methods:This retrospective cohort study analyzed the clinical data of 1289 patients who received assisted reproductive treatment in the Center for Reproductive Medicine of Fujian Maternity and Child Health Hospital from July 1, 2018 to July 30, 2019. According to the number of oocytes retrieved, there were 164 cases in the low ovarian response group (≤5 oocytes retrieved), 891 cases in the normal ovarian response group (the number of retrieved oocytes was >5, and ≤18), and 234 cases in the high ovarian response group (>18 oocytes retrieved). Independent factors affecting ovarian reactivity were screened by logistic regression, which were the model entry variables, and a Nomogram prediction model was established based on the regression coefficients in the model.Results:There were statistically significant differences in age, anti-Müllerian hormone (AMH) level and antral follicle count (AFC) among the three groups [32.43±3.99, 31.48±3.89, 29.91±3.73; (2.53±1.90) μg/L, (3.79±2.20) μg/L, (5.94±3.12) μg/L; 10.24±3.10, 14.50±3.29, 19.81±3.44; all P<0.001]. There were no significant differences in body mass index (BMI), duration of infertility and causes of tubal infertility (all P>0.05). The initial dosage of gonadotropin (Gn) used for ovarian hyperstimulation among the three groups was statistically different [(182.62±53.96) U, (166.79±48.20) U, (159.13±43.92) U, P<0.001], while the duration of Gn used and clinical pregnancy rate had no significant differences (all P>0.05). Multifactorial stepwise aggression analysis showed that female age [0.93(0.90-0.96), P=0.007], AFC [1.07(1.03-1.09), P=0.001], AMH [1.29(1.20-1.39), P=0.001], basal follicle-stimulating hormone [0.79(0.73-0.86), P=0.001], luteinizing hormone value [1.11(1.06-1.23), P=0.010], initial dosage of Gn used [1.00(1.00-1.01), P=0.003], total dosage of Gn usd [1.00(0.99-1.00), P=0.001] and the presence or absence of diagnosis of endometriosis [0.63(0.47-0.86), P=0.001] and polycystic ovary syndrome [0.30(0.22-0.91), P=0.030] were independent factors for the occurrence of different ovarian responses during ovarian hyperstimulation. The prediction model of ovarian reactivity was constructed based on the above factors, and the accuracy of predicting the optimal ovarian response state was 95%. The above model was verified with 306 patients' data from August 1, 2019 to October 30, 2019 in this center, and the predicted ovarian response (number of oocytes obtained) of a total of 279 patients was consistent with the actual situation, with a coincidence degree of 91.2%. The consistency index of the model was 0.71. Conclusion:We screened out the relevant factors affecting ovarian response in patients undergoing assisted reproductive technology with follicular phase long-acting long protocol, and established a Nomogram prediction model of ovarian response, which could effectively, intuitively and visually predict ovarian reactivity in hyperstimulation.

Objective:To explore the relative factors for best ovarian response in patients undergoing assisted reproductive technology with follicular phase long-acting long protocol, and to establish a Nomogram prediction model of ovarian response.Methods:This retrospective cohort study analyzed the clinical data of 1289 patients who received assisted reproductive treatment in the Center for Reproductive Medicine of Fujian Maternity and Child Health Hospital from July 1, 2018 to July 30, 2019. According to the number of oocytes retrieved, there were 164 cases in the low ovarian response group (≤5 oocytes retrieved), 891 cases in the normal ovarian response group (the number of retrieved oocytes was >5, and ≤18), and 234 cases in the high ovarian response group (>18 oocytes retrieved). Independent factors affecting ovarian reactivity were screened by logistic regression, which were the model entry variables, and a Nomogram prediction model was established based on the regression coefficients in the model.Results:There were statistically significant differences in age, anti-Müllerian hormone (AMH) level and antral follicle count (AFC) among the three groups [32.43±3.99, 31.48±3.89, 29.91±3.73; (2.53±1.90) μg/L, (3.79±2.20) μg/L, (5.94±3.12) μg/L; 10.24±3.10, 14.50±3.29, 19.81±3.44; all P<0.001]. There were no significant differences in body mass index (BMI), duration of infertility and causes of tubal infertility (all P>0.05). The initial dosage of gonadotropin (Gn) used for ovarian hyperstimulation among the three groups was statistically different [(182.62±53.96) U, (166.79±48.20) U, (159.13±43.92) U, P<0.001], while the duration of Gn used and clinical pregnancy rate had no significant differences (all P>0.05). Multifactorial stepwise aggression analysis showed that female age [0.93(0.90-0.96), P=0.007], AFC [1.07(1.03-1.09), P=0.001], AMH [1.29(1.20-1.39), P=0.001], basal follicle-stimulating hormone [0.79(0.73-0.86), P=0.001], luteinizing hormone value [1.11(1.06-1.23), P=0.010], initial dosage of Gn used [1.00(1.00-1.01), P=0.003], total dosage of Gn usd [1.00(0.99-1.00), P=0.001] and the presence or absence of diagnosis of endometriosis [0.63(0.47-0.86), P=0.001] and polycystic ovary syndrome [0.30(0.22-0.91), P=0.030] were independent factors for the occurrence of different ovarian responses during ovarian hyperstimulation. The prediction model of ovarian reactivity was constructed based on the above factors, and the accuracy of predicting the optimal ovarian response state was 95%. The above model was verified with 306 patients' data from August 1, 2019 to October 30, 2019 in this center, and the predicted ovarian response (number of oocytes obtained) of a total of 279 patients was consistent with the actual situation, with a coincidence degree of 91.2%. The consistency index of the model was 0.71. Conclusion:We screened out the relevant factors affecting ovarian response in patients undergoing assisted reproductive technology with follicular phase long-acting long protocol, and established a Nomogram prediction model of ovarian response, which could effectively, intuitively and visually predict ovarian reactivity in hyperstimulation.