Objective To discuss the influence of bath frequency on neonatal skin condition and body temperature. Methods 108 newborns from obstetrics of People′s Hospital of Peking University during November 2015 to December 2015 were selected, and were randomly distributed t into two groups by lottery. The control group took bath every day, whereas the experimental group did every three days. The newborns were followed up for 4 weeks on their skin condition and body temperature. Then the data were systemized and performed statistical analysis. Results During the first 4 weeks after babies were born, the control group and experimental group showed no significant difference on their skin condition (P>0.05). When compared at the time of first 3 days, 1 week and 2 weeks after the babies were born, body temperature of the experimental group were (36.693±0.182), (36.738±0.174), (36.772±0.185)℃, while the control group were (36.591 ± 0.160), (36.671 ± 0.158), (36.684 ± 0.155)℃,which tended to be significantly lower than the experimental group (t values were -2.697,-2.087,-2.669, P <0.01 or 0.05), but still within the normal range. However, this difference of body temperature disappeared after the first 2 weeks (P>0.05). Conclusions Reducing the bath frequency form once a day to every third day showed no influence on neonatal skin condition. Meanwhile, it did avoid significant reduce of body temperature after bath. This may help improve healthy skin care of newborns, promote their growth, and at the same time, redistribute the clinical nursing work efficiently.

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.

Modern information technology was used to establish the simulating interview question bank which includes the parts of medical history,physical examination,primary diagnosis,lab test, treatment,confirmed diagnosis and the final case abstract according to the clinical management process. Results of the application in gynecology and obstetrics teaching assessment among the medical probation showed that the simulating interview question bank had some advantages in assessing the student's ability of the knowledge comprehensive evaluation,self-thinking and synthetic analyzing. It could also make au-tomatic analysis after the examination and provide teaching feedback. This novel teaching assessment could be optimized and applied extensively.

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 risk factors for preeclampsia (PE) in pregnancies complicated with chronic aplastic anemia ( CAA ) by analyzing the obstetric management and pregnancy outcome.Methods Retrospectively review the clinical data including the obstetric management,the laboratory findings and the pregnancy outcome of 41 pregnant women complicated with CAA,all of whom were hospitalized in Peking University People's Hospital from May 2002 to February 2011.Multiple logistic regression was used to explore the risk factors associated with PE.Results ( 1 ) Twenty-eight patients were diagnosed before conception while 13 were diagnosed during gestation.Eleven patients including all the 7 who were categorized as severe CAA presented with mild bleeding in the third trimester.( 2 ) The medians of white blood cell counts,hemoglobin concentrations and platelet counts were 5.0 × 109/L,66.0 g/L and 12.0 × 109/L respectively.(3) The obstetric management consisted of strict assessment, intensive surveillance and follow-up,appropriate supportive measures,timely recognition of complications,and delivery when necessary.Twenty-one patients received supportive transfusions.Ten patients developed PE,all of whom were diagnosed as severe PE( SPE).Twelve patients suffered postpartum hemorrhage,and 3 of them had blood loss more than 1000 mL All were conservatively treated in success.(4) The median gestational age of delivery was 37 weeks.Sixteen cases delivered before 37 weeks and 5 delivered before 34 weeks.Two patients developed SPE at 29 weeks and 30 weeks respectively,and both of the neonates died for severe asphyxia.The birth weight of the live neonates ranged from 1500 to 3660 g.(5) The postpartum follow-up period ranged from 6 months to 7 years.Thirty-three patients got improvement without dependence on transfusions.Four achieved no remission and still needed intermittent transfusions.Four were lost in followup.(6) Significant differences were found in the bleeding tendency,the platelet counts and the delivery weeks when comparing the patients developing PE and those without PE.No differences were found with regard to the age,the gestational age of first visit,the percentage of patients diagnosed before conception,the percentage of severe CAA,the choice of treatment,the white blood cell counts and the hemoglobin level.The Multiple logistic regression showed that the platelet count less than 10 × 109/L was an independent risk factor for CAA patients developing PE (P =0.006).Conclusions Most pregnancies complicated with CAA could achieve good maternal and fetal outcome, when intensive prenatal care and supportive management are provided SPE is the most common complication.The platelet count less than 10 × 109/L is perhaps an independent risk factor for CAA patients developing PE.

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 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 investigate the effect of general anesthesia on pregnancy women with thrombocytopenia and neonate during cesarean section(CS). Methods Sixty-five singleton pregnant women with low platelet count (<50×10~9/L) and gestation >35 weeks were allocated into general anesthesia group (35 cases) and local anesthesia group (30 cases) randomly. The time from skin incision to fetal delivery, the oxyhemoglobin saturation(SO_2) before and after anesthesia, the blood loss during operation, Apgar scores at 1 min, birth weight, umbilical cord blood gas analysis were recorded. Results The mean time from anesthesia induction to fetal delivery was (9.7±3.5) minutes in general anesthesia group. The time from skin incision to fetal delivery in general anesthesia group [(7.7±2.5) minutes] was shorter than that in local anesthesia group [(12.5±3.0) minutes, P<0.01], while the operation time had no significant differences. There were no significant difference for the value of SO_2 before and after general anesthesia or local anesthesia(P>0.05). There was no significant difference for the blood loss [(471±245)ml vs. (452±213 )ml, P>0.05], Apgar scores at 1 minute, birth weight and umbilical cord blood gas analysis between the two groups (P>0.05). There had two infants with blue asphyxia in local anesthesia group while no infant with asphyxia in general anesthesia group. Conclusion General anesthesia is safe to pregnant women with thrombocytopenia during CS.

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 obstetrics and gynecology training quality by analysis of clinical knowledge and clinical skills scores for long-term graduates.Methods A retrospective analysis of clinical knowledge and clinical skills scores was performed in obstetrics and gynecology training for 134 long-term graduates.Results The clinical knowledge and clinical skills scores of obstetrics and gynecology training were 82.27?7.68,87.69?7.24.There was no,P﹥0.05.Only the scores of clinical skills judged by one teacher in interview was correlated with clinical knowledge scores,while there were no correlation between clinical knowledge judged by other five teachers and scores of clinical skills.Conclusion There was no correlation between clinical knowledge and the scores of clinical skills scores.Culturing students’practical ability and communication ability is worth strengthening,while the consistency of teachers’evaluation standard should be improved.