PURPOSE

To report the technical details and outcomes of a case of cervical cancer in pregnancy treated with reduced standard radiation volume via Intensity Modulated Radiation Therapy (IMRT).

A 33-year-old G4P3 (3003) was diagnosed with cervical squamous cell carcinoma at 17 weeks of gestation. She had a 5-year history of intermittent post-coital bleeding and an incidental finding of a cervical mass during prenatal ultrasound. Internal examination revealed a 6-cm mass with no extension to the upper vagina and pliable bilateral parametria, leading to a staging of IB3. A multidisciplinary meeting with a gynecologic oncologist, radiation oncologist, medical ethicist and the patient was held wherein different treatment options were discussed. She consented to definitive external beam radiation therapy (EBRT) with concurrent cisplatin and was administered during 19-25 weeks of gestation using IMRT. A prescribed dose of 45 Gy in 25 fractions was delivered to the entire cervix with a 1-cm geometric expansion covering the lower uterus, and upper vagina as well as the pelvic lymph nodes, followed by four fractions of brachytherapy.

The patient tolerated treatment with only grade 1 gastrointestinal and genitourinary adverse effects. After completion of concurrent chemoradiation, she underwent induction of labor and delivered a nonviable fetus. Three months post-treatment, MRI found no evidence of disease. At 15 months follow-up, she remains asymptomatic with no palpable disease.

This report demonstrates that treating only the involved uterus may be considered in cases wherein giving the full radiation dose to the whole uterus may lead to significant toxicities and eventual treatment interruption.

Objective: To investigate the maternal and fetal outcomes of expectant treatment and early termination of pregnancy in pregnant women with suspected invasive placenta accreta spectrum disorders (PAS) in the second trimester. Methods: A retrospective cohort study was performed on 51 pregnant women with suspected invasive PAS (ultrasound score ≥10) evaluated by ultrasound with gestational age <26 weeks and confirmed as invasive PAS by intraoperative findings or postoperative pathology in Peking University Third Hospital from January 2015 to January 2022. According to the informed choice of pregnant women and their families, they were divided into expectant treatment group (37 cases) and mid-term termination group (14 cases). The general clinical data and outcome indexes of the two groups were analyzed by χ² test, Mann-Whitney U rank sum test, logistic regression and linear regression. Results: (1) General clinical data: among 51 pregnant women who were assessed as suspected invasive PAS by ultrasonography in the second trimester, invasive PAS was finally diagnosed by intraoperative findings and postoperative pathology, among which 46 cases (90%) were placenta percreta and 5 cases (10%) were placenta increta. (2) Outcome indicators: univariate analysis showed that there were no statistically significant differences in the intraoperative blood loss (median: 2 200 vs 2 150 ml), the proportion of blood loss >1 500 ml [73% (27/37) vs 9/14], the hysterectomy rate [62% (23/37) vs 8/14], the rate of intensive care unit (ICU) admission [78% (29/37) vs 9/14] between the expectant treatment group and the mid-term termination group (all P>0.05). Multivariate analysis showed that the rate of intraoperative blood loss >1 500 ml (aOR=0.481, 95%CI: 0.017-13.958; P=0.670), hysterectomy (aOR=0.264, 95%CI: 0.011-6.569, P=0.417) and ICU admission (aOR=1.327, 95%CI: 0.048-36.882, P=0.867) between the two groups showed no statistical differences. (3) Outcome analysis: all 37 cases in the expectant treatment group had live births and no early neonatal death. Five pregnant women (14%, 5/37) in the expectant treatment group underwent emergency cesarean section in the course of expectant treatment. In the mid-term termination group, all pregnancies were terminated by operation, including 9 cases of hysterectomy and 5 cases of placental hysterectomy. There was 1 fetal survival (gestational age of termination: 27⁺⁴ weeks) and 13 fetal death in the mid-term termination group. Conclusions: Pregnant women who are diagnosed as suspected invasive PAS, especially those with placenta percreta, have the risk of uterine rupture and emergency surgery in the course of expectant treatment. However, early termination of pregnancy does not reduce the risk of intraoperative blood loss and hysterectomy.
Infant, Newborn ; Pregnancy ; Female ; Humans ; Infant ; Placenta Accreta/surgery* ; Pregnancy Trimester, Second ; Pregnant Women ; Cesarean Section ; Retrospective Studies ; Blood Loss, Surgical ; Placenta ; Abortion, Induced ; Hysterectomy

Pregnancy ; Female ; Humans ; Turner Syndrome/diagnostic imaging* ; Pregnancy Trimester, First ; Pregnancy Trimester, Second ; Ultrasonography, Prenatal ; Risk Factors

OBJECTIVE: To assess the influence of thyroid function on the fetal fraction (FF) during the second trimester of pregnancy. METHODS: A total of 1 861 pregnant women undergoing non-invasive prenatal testing (NIPT) and thyroxine function testing at 12 ~ 26 gestational weeks at the Affiliated Suzhou Hospital of Nanjing Medical University/Suzhou Municipal Hospital from January 2016 to December 2020 were selected as the study subjects. Univariate analysis and multivariate regression models were used to assess the correlation between free thyroxine 4 (FT4) levels and FF. RESULTS: Univariate linear regression analysis indicated that the FF is correlated to the level of FT4 (b = 0.035, P < 0.001). The median fetal FF was 10.78% (IQR: 8.2%, 13.82%), and this has increased along with the level of FT4 from 10.58% at <= 12.0 pmol/L to 11.77% at > 16.0 pmol/L. After further adjustment of gestational age and body mass index (BMI), the FF showed an increase trend along with the increase of FT4 levels, and a trend test also showed a statistical significance (Ptrend < 0.001). CONCLUSION Maternal FF can be affected by the level of free thyroxine during the second trimester of pregnancy.
Pregnancy ; Female ; Humans ; Pregnancy Trimester, Second ; Thyroid Gland ; Thyroxine ; Fetus ; Gestational Age

Objective: To examine the associations between plasma n-3 polyunsaturated fatty acids (PUFAs) in the second trimester and gestational diabetes mellitus (GDM) among Chinese pregnant women. Methods: Based on data from the Tongji-Shuangliu Birth Cohort enrolled from 2017 to 2019 in the Shuangliu Maternal and Child Health Hospital, it conducted a case-control study among 269 GDM cases who were diagnosed by 75 g oral glucose tolerance test, and 538 non-GDM controls matched at a 1∶2 ratio on maternal age and gestational weeks. The age range of the 807 women was 18-40 years. Fasting plasma n-3 PUFAs were determined by gas chromatography-mass spectrometry in the second trimester (24-28 weeks). Participants were categorized into quartiles (Q1-Q4) of plasma n-3 PUFAs based on distributions in the control group. Conditional logistic regression models were applied to estimate the associations between plasma n-3 PUFAs and GDM. Results: The median (interquartile) relative concentrations of plasma n-3 PUFA C22∶5n-3 was significantly lower in women with GDM 0.87 (0.72, 1.07) compared with women without GDM 0.94 (0.75, 1.19)(P=0.001). Plasma n-3 PUFA C22∶5n-3 was inversely associated with GDM, with an OR (95%CI) of 0.75 (0.62-0.90) for each SD increase of relative concentration. Compared with the Q1 group, the OR values and 95%CIs of Q2, Q3, and Q4 groups were 0.97 (0.62-1.51), 0.72 (0.45-1.15), and 0.54 (0.32-0.90), respectively (P_trend<0.05). However, there were no significant associations of C18∶3n-3, C20∶5n-3, C22∶6n-3, and total n-3 PUFAs with GDM. Conclusion: Plasma n-3 PUFA C22∶5n-3 was inversely associated with GDM during the second trimester.
Case-Control Studies ; Child ; Diabetes, Gestational ; Fatty Acids, Unsaturated ; Female ; Glucose Tolerance Test ; Humans ; Pregnancy ; Pregnancy Trimester, Second

OBJECTIVE: To analyze the genomic variation characteristics of fetal with abnormal serological screening, and to further explore the value of copy number variation (CNV) detection technology in prenatal diagnosis of fetal with abnormal serological screening. METHODS: 7617 singleton pregnant women who underwent amniocentesis for prenatal diagnosis solely due to abnormal Down's serological screening were selected. According to the results of serological screening, the patients were divided into high risk group, borderline risk group and single abnormal multiple of median (MOM) group. CMA and CNV-Seq were used to detect the copy number variation of amniotic fluid cell genomic DNA and combined with amniotic fluid cell karyotype analysis for prenatal diagnosis. Outpatient revisit combined with telephone inquiry was used for postnatal follow-up. RESULTS: Among 7617 amniotic fluid samples, aneuploidy was detected in 138cases (1.81%) by CMA and CNV-Seq, 9 cases of aneuploid chimerism were detected by amniotic fluid cell karyotype analysis, and 203 cases of fetus carrying pathogenic and likely pathogenic CNV (P/LP CNV) were detected, the variant of uncertain significance (VUS) was detected in 437 cases (5.7%), the overall abnormal detection rate was 10.33%. The detection rate of aneuploidy by CMA and CNV-Seq in three group were 123 cases (2.9%), 13 cases (1.3%) and 2 cases (0.4%), respectively,and showing no significant difference (χ ²=7.469, P=0.024). The detection rate of pathogenic and likely pathogenic CNV in three group were 163cases (2.6%); 24 cases (2.6%) and 16 cases (3.3%), respectively, and showing no significant difference (χ ²=0.764, P=0.682). The CMA reported 2.9% (108/3729)P/LP CNV, and CNV-seq reported 2.4% (95/3888)P/LP CNV, both tests showed similar detective capabilities (χ ²=1.504, P=0.22).The most popular P/LP CNV in this cohort were Xp22.31 microdeletion, 16p13.11 microduplication /microdeletion, 22q11.21 microduplication /microdeletion. In fetuses with P/LP CNV CNV, 59 fetuses were terminated pregnancy, and 32 of 112 fetuses born had abnormal clinical manifestations. Non-medically necessary termination of pregnancy occurred in 11 fetuses carrying VUS CNV, 322 fetuses carrying VUS CNV were born, 4 of them presented abnormal clinical manifestations. CONCLUSION Compared with the traditional chromosome karyotype, CMA and CNV-Seq can improve the detection rate of pathogenic and likely pathogenic CNV. CMA and CNV-seq can be used for first tier diagnosis of pregnant women in the general population with abnormal Down's serological screening.
Amniotic Fluid ; Aneuploidy ; Chromosome Aberrations ; DNA Copy Number Variations ; Female ; Genomics ; Humans ; Pregnancy ; Pregnancy Trimester, Second ; Pregnant Women ; Prenatal Diagnosis/methods* ; Technology

OBJECTIVE: To evaluate the feasibility and effectiveness of fetal reduction by transabdominal intracranial KCl injection for multifetal pregnancies in the early second trimester. METHODS: The data of 363 patients who underwent transabdominal fetal reduction in the Reproductive Medical Center of Peking University Third Hospital from January 2006 to December 2019 were analyzed retrospectively. According to the location of fetal reduction, they were divided into two groups: Intracranial injection group (n=196) and intrathoracic injection group (n=167). The process of fetal reduction and pregnancy outcome of the two groups were compared. RESULTS: There was no significant difference between the two groups in the average age and the proportion of type of infertility before assisted reproductive technology, conception method, indication for fetal reduction, starting number of fetuses, reduced number of fetuses, and finishing number of fetuses (P>0.05). There was no significant difference between the two groups in the proportion of the number of puncture ≥ 2 times (12.1% vs. 8.6%, P=0.249) and the incidence of replacing puncture site (10.7% vs. 6.4%, P=0.161). The next day after fetal reduction, color Doppler ultrasound was rechecked. In the intracranial injection group and intrathoracic injection group, the incidence of fetal heartbeat recovery [3.6% (8/224) vs. 1.1% (2/187), P=0.188], the volumes of KCl used [(2.6±1.0) mL vs. (2.8±1.1) mL, P=0.079], and the abortion rate within 4 weeks after fetal reduction (1.0% vs. 0.6%, P=0.654) were of no significant difference. In addition, there was no significant difference in the total abortion rate after fetal reduction, premature delivery rate, cesarean section rate, delivery gestational week and neonatal birth weight between the two groups (P>0.05). CONCLUSION Intracranial KCl injection can be an effective alternative to intrathoracic KCl injection for multifetal pregancy reduction.
Cesarean Section ; Female ; Humans ; Infant, Newborn ; Pregnancy ; Pregnancy Outcome ; Pregnancy Reduction, Multifetal/methods* ; Pregnancy Trimester, Second ; Retrospective Studies

INTRODUCTION: Pregnant women are reported to be at increased risk of severe coronavirus disease 2019 (COVID-19) due to underlying immunosuppression during pregnancy. However, the clinical course of COVID-19 in pregnancy and risk of vertical and horizontal transmission remain relatively unknown. We aim to describe and evaluate outcomes in pregnant women with COVID-19 in Singapore. METHODS: Prospective observational study of 16 pregnant patients admitted for COVID-19 to 4 tertiary hospitals in Singapore. Outcomes included severe disease, pregnancy loss, and vertical and horizontal transmission. RESULTS: Of the 16 patients, 37.5%, 43.8% and 18.7% were infected in the first, second and third trimesters, respectively. Two gravidas aged ≥35 years (12.5%) developed severe pneumonia; one patient (body mass index 32.9kg/m2) required transfer to intensive care. The median duration of acute infection was 19 days; one patient remained reverse transcription polymerase chain reaction (RT-PCR) positive >11 weeks from diagnosis. There were no maternal mortalities. Five pregnancies produced term live-births while 2 spontaneous miscarriages occurred at 11 and 23 weeks. RT-PCR of breast milk and maternal and neonatal samples taken at birth were negative; placenta and cord histology showed non-specific inflammation; and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-specific immunoglobulins were elevated in paired maternal and umbilical cord blood (n=5). CONCLUSION The majority of COVID-19 infected pregnant women had mild disease and only 2 women with risk factors (obesity, older age) had severe infection; this represents a slightly higher incidence than observed in age-matched non-pregnant women. Among the women who delivered, there was no definitive evidence of mother-to-child transmission via breast milk or placenta.
Abortion, Spontaneous/epidemiology* ; Adult ; COVID-19/transmission* ; COVID-19 Nucleic Acid Testing ; COVID-19 Serological Testing ; Cohort Studies ; Disease Transmission, Infectious/statistics & numerical data* ; Female ; Fetal Blood/immunology* ; Humans ; Infectious Disease Transmission, Vertical/statistics & numerical data* ; Live Birth/epidemiology* ; Maternal Age ; Milk, Human/virology* ; Obesity, Maternal/epidemiology* ; Placenta/pathology* ; Pregnancy ; Pregnancy Complications, Infectious/physiopathology* ; Pregnancy Outcome/epidemiology* ; Pregnancy Trimester, First ; Pregnancy Trimester, Second ; Prospective Studies ; RNA, Viral/analysis* ; Risk Factors ; SARS-CoV-2 ; Severity of Illness Index ; Singapore/epidemiology* ; Umbilical Cord/pathology* ; Young Adult

OBJECTIVE: To explore the mechanism and duration of false positive results of non-invasive prenatal testing (NIPT) caused by vanishing twins. METHODS: To detect the variation of cell-free fetal DNA fraction before and after the fetal death and explore its influence on the results of NIPT at different gestational weeks. Prenatal diagnosis was also carried out on amniotic fluid sample derived from the survivor twin. After birth, the two placentas and papyraceous fetus were obtained to ascertain the definitive genetic diagnosis and pathological changes through fluorescence in situ hybridization, fluorescence quantitative PCR and histopathological examination. Eight cases of vanishing twins leading to discordant NIPT results were reviewed for determining the duration of this influence. RESULTS: The vanishing twin has led to immediate flooding of cfDNA into the maternal plasma due to necrotic cytotrophoblasts, which in turn caused increased release of fetal DNA in a short time. However, this did not change the NIPT result for a period of time. The tissue and chorionic villi of perished fetus presented extensive degenerative necrosis. CONCLUSION The false positive NIPT result caused by vanishing twins may be attributed to continuous release of DNA fragments into the maternal plasma by the fetuses. The influence of the vanished fetuses, which may lead to discordant NIPT results, can last for at least 7-8 weeks but no more than 12-14 weeks during the first and second trimester.
DNA ; Female ; Fetus ; Humans ; In Situ Hybridization, Fluorescence ; Pregnancy ; Pregnancy Trimester, Second ; Prenatal Diagnosis

PURPOSE: The objective of this study was to investigate the prevalence of antenatal depression in pregnant women and its influencing factors. METHODS: With a cross-sectional survey design, a total of 396 pregnant women were recruited from a local obstetrics and gynecology clinic. Measurements included antenatal depression, perceived stress, predictors of depression during pregnancy, and demographic and obstetric characteristics. RESULTS: Mean antenatal depression score was 8.20 (standard deviation=4.95) out of 30, falling into its normal range. However, the prevalence of antenatal depression was 35.9% when cut-point of 9/10 was used. The prevalence of antenatal depression among women in the first trimester was 31.4%. It was slightly increased to 34.9% in the second trimester but significantly increased to 40.5% in the third trimester. In multiple logistic regression analysis, experiencing prenatal anxiety (odds ratio [OR], 4.16), having no job (OR, 2.90), lower self-esteem (OR, 1.62), and higher perceived stress (OR, 1.32) were significant factors influencing antenatal depression. CONCLUSION: Negative feeling such as feeling anxious, lower self-esteem, and higher perceived stress during pregnancy are key factors affecting antenatal depression. Thus, antenatal nursing intervention focusing on pregnant women's feeling upon their job status is necessary to improve their antenatal psychological well-being.
Accidental Falls ; Anxiety ; Cross-Sectional Studies ; Depression ; Female ; Gynecology ; Humans ; Logistic Models ; Maternal Health ; Nursing ; Obstetrics ; Pregnancy ; Pregnancy Trimester, First ; Pregnancy Trimester, Second ; Pregnancy Trimester, Third ; Pregnant Women ; Prevalence ; Reference Values