Asymptomatic bacteriuria (ASB) refers to the presence of one or more species of bacteria in an individual's urine without the symptoms of a urinary tract infection. Previous studies have shown that untreated ASB during pregnancy is associated with adverse pregnancy outcomes. Many international guidelines recommend a single screen-and-treat approach to ASB during pregnancy. Still, this approach has not been proven favorable to pregnancy outcomes in low-risk populations by recent studies. ASB screening is not a routine obstetric examination in clinical practice in China. Given this, this article will review the evidence of ASB screening during pregnancy and analyze the recommendations and existing problems in the guidelines from various academic organizations. Clinical studies should be carried out according to the situation in the region, and the basic risks and treatment benefits of ASB in pregnancy should be analyzed in combination with specific data to establish a proper screening and treatment plan for ASB during pregnancy. Screening for ASB is recommended for pregnant women with high-risk factors at this stage.

A patient was pregnant four months after the percutaneous coronary intervention, and the ultrasound indicated a complete placenta previa and a placenta percreta. Concerned about radiation and drugs exposure on the fetus, the patient chose to terminate the pregnancy. After multidisciplinary consultation, tirofiban was used for antithrombotic therapy in substitution for dual antiplatelet drugs, and an abdominal aortic balloon was inserted preoperatively. The placenta that penetrated the serous membrane and uterine wall at laparotomy was resected, and the uterus was reconstructed. Prophylactic antibiotics, anticoagulation, and transitional antiplatelet therapy with tirofiban were given after the operation. The patient was discharged on day six postoperatively.

Mounting evidence indicates that oral health during pregnancy is associated with pregnancy outcomes and the oral health of the offspring. Pregnant women in China have a high prevalence of oral diseases, low attendance to oral health care, and an increased burden of untreated oral infectious diseases such as periodontitis and caries. A joint perinatal oral health program between obstetrics and stomatology may improve pregnant women's and their children's oral health outcomes. This paper briefly summarizes the current status of oral health care for pregnant women and the clinical practice in obstetrics and gynecology related to stomatology in China. It provides future perspectives on the potential role of obstetricians and gynecologists in promoting oral health care through developing an interdisciplinary care model.

Objective:To construct the pregnancy risk prediction model of chronic kidney disease (CKD) pregnant women by analyzing their renal function and pregnancy outcome in the first trimester.Method:Totally 313 CKD women with 322 pregnancies who had deliveries in Peking University First Hospital from March 2009 to December 2018 were retrospectively analyzed. The history of kidney disease and renal function in the first trimester were collected, and the relationship between CKD and premature delivery, low birth weight infants, severe preeclampsia and fetal loss were analyzed.Result:Among 322 pregnancies with CKD, 120 (37.3%, 120/322) had adverse pregnancy outcomes. CKD stage, serum creatinine, urea, albumin, hemoglobin, 24-hour urine protein quantity and whether complicated with hypertension were independent predictors of adverse pregnancy outcome. A prediction model logit (P)=2.107+0.255×24-hour urine protein quantitative (g/24-hour)-0.107×albumin (g/L)+1.677×whether complicated with hypertension (1 or 0)+ 0.639×CKD stage was established. The area under curve value of the model was 0.812, the best threshold, sensitivity, specificity and Yoden index were 0.436, 0.658, 0.856 and 0.802, respectively.Conclusion:CKD stage, serum albumin, 24-hour urine protein quantity in the first trimester and hypertension are the main risk factors of adverse pregnancy outcome, which could predict the occurrence of adverse pregnancy outcome of CKD pregnant women and deserve further study.

Thrombotic microangiopathy (TMA) is an acute clinico-pathological syndrome with varied reasons. Pregnancy related-TMA includes pregnancy associated thrombotic thrombocytopenic purpura (TTP), postpartum hemolytic-uremic syndrome (pHUS), severe preeclampsia (SPE) and Hemolysis, Elevated Liver enzymes and Low Platelet syndrome (HELLP syndrome) and the outcomes are severe. Aberrant activation of complement system plays an important role in the pathogenesis of these diseases. Although these diseases have similar clinical appearance, their pathogenesis, diagnostic and therapeutic methods are different. Precision diagnosis of these diseases to select targeted treatment will greatly improve the prognosis of these patients. Herein, the value of complement system components in the diagnosis and treatment of pregnancy-related TMA are introduced.

Objective To explore the effects of whole-stage labor analgesia on maternal and neonatal outcomes after the implementation of the new partogram.Methods A retrospective cohort study was performed in Peking University First Hospital.From June to December 2016,907 nulliparae with full-term singleton cephalic pregnancies that were expected to deliver vaginally and adhered to the new partogram were selected as the study group,and 982 cases that adhered to the old partogram (Friedman standard) from June to December 2012 were selected as the control group.Maternal basic characteristics and analgesic,obstetric and neonatal data were collected.Maternal and neonatal outcomes between the two groups were analyzed with independent sample t-test,rank sum test or Chi-square test (Fisher's exact test).Results (1) Maternal age and the proportion of gravidas of advanced maternal age in the study group were both higher than those in the control group [(30.2±3.0) vs (29.64-2.9) years,t=3.823;8.2％ (74/907) vs 4.2％ (41/982),x2=13.087;both P＜0.001].No statistically significant difference in the other basic characteristics was found between the two groups.(2) Women in the study group had significantly smaller cervical dilatation [M(P25-P75)] than that in the control group when analgesia was commenced [2(1-2) vs 2(1-3) cm,Z=-3.752].The intensity of pain quantified with numerical rating scale (NRS) before analgesia,and during the second stage of labor in the study group were less than that in the control group [8(8-9) vs 8(8-10) points,Z=-14.441;5(4-5) vs 6(5-7) points,Z=-16.495].The study group had longer median duration of analgesia than the control group [520(340-750) vs 300(200-453) min,Z=-17.801,P＜0.001].The overall dose of analgesics in injection pump in the study group was significantly higher compared with that used in the control group [68 (35-84) vs 30 (18-48) ml,Z=-18.004,P＜0.001].However,there was no significant difference in the incidence of analgesia-related complications (hypotension,accidental dura puncture,lower extremity numbness,pruritus and urinary retention) between the two groups.(3) The study group showed a higher percentage of spontaneous vaginal delivery,and a lower rate of converted cesarean section compared with the control group [71.8％ (651/907) vs 63.2％ (621/982),x2=15.623;13.6％ (123/907) vs 20.5％ (201/982),~=18.831;both P＜0.001].The study group had lower forceps-assisted vaginal delivery rate than the control group without statistically significant difference [14.8％ (133/907) vs 15.3％ (150/982),x2=0.093,P=0.797].The duration of the first,second and third stage of labor in the study group were all significantly longer than that of the control group [680 (470-900) vs 480 (360-660) min,Z=-12.490;56 (31-89) vs 37 (24-58) min,Z=-9.964;7 (5-10) vs 6 (5-8) min,Z=-6.673;all P＜0.001].Women in the study group had a lower rate of artificial rupture of membranes when comparing with the control group [55.2％ (501/907) vs 63.2％ (621/982),x2=12.516,P＜0.001].The incidence of fever,pathologically confirmed infection and postpartum hemorrhage were significantly higher in the study group than that in the control group [10.8％ (98/907) vs 6.4％ (63/982),x2=11.652;9.6％ (87/907) vs 3.7％ (36/982),x2=27.201;12.6％ (114/907) vs 5.7％ (56/982),x2=27.144;all P＜0.05].There was no significant difference in the rate of oxytocin use during labor or blood transfusion between the two groups.(4) Compared with the control group,the proportion of cesarean section due to arrested active stage of labor in the study group was significantly lower [5.7％ (7/123) vs 50.2％ (101/201),x2=68.173,P＜0.05],but the incidences of cesarean section due to intrauterine infection and relative cephalopelvic disproportion were higher in the study group [61.0％ (75/123) vs 30.8％ (62/201),x2=2.680;20.3％ (25/123) vs 8.0％ (16/201),x2=10.555;both P＜0.05].There was no significant difference in the proportion of fetal distress or other indications for cesarean section between the two groups.(5) There was no significant difference between the two groups in birth weight,macrosomia,fetal distress,neonatal asphyxia,or the proportion of neonatal intensive care unit admission.Conclusions After the implementation of the new partogram,analgesic pain relief covering the whole labor prolongs the average analgesic time and reduces the rate of cesarean section due to arrested active stage of labor.Although the risk of postpartum hemorrhage is slightly increased,analgesia itself does not pose additional risks on forceps-assisted delivery,maternal blood transfusion and neonatal asphyxia.

Gestational hypertension disease is one of the most common complications in pregnancy,and is the second leading cause of maternal mortality in China.In recent years,researchers have found that activation of the complement system plays an important role in the pathogenesis of preeclampsia.In this paper,the authors reviewed previous literature to expound the role of abnormal complement system activation in the pathogenesis of gestational hypertension disease.At the same time,authors will introduce the clinical value of detection of complement system related factors in the diagnosis and differential diagnosis of gestational hypertension disease.

Objective To investigate clinical predictors in early pregnancy for adverse pregnancy outcomes in women complicated with chronic nephropathy. Methods One hundred and eighty-four pregnancies complicated with chronic nephropathy who delivered between January, 2005 and January, 2014 in Peking University First Hospital were retrospectively analyzed. Two hundred pregnant women without chronic nephropathy were selected as the control group. Pregnancy outcomes were compared between the two groups. Relationships between clinical predictors in early pregnancy [age, history of kidney disease, drugs used before pregnancy (in three months), results of renal biopsy, blood pressure, serum creatinine, urea nitrogen, 24 h urinary protein, estimated glomerular filtration rate, stage of chronic nephropathy] and adverse pregnancy outcomes [maternal mortality;pregnancy complicated by severe preeclampsia;renal function decline, early preterm birth, very low birth weight infants, fetal loss after 20 weeks of pregnancy] were assessed by logistic regression analysis. T-test, Chi-square test and multivariate regressions were used for statistical analysis. Results There were 174 and 197 livebirths in the study and the control groups, respectively. The most popular type of chronic nephropathy in pregnant women was IgA nephropathy (38.6%, 71/184). Compared with the control group, the risk of premature labor [9.8%(17/174) vs 3.0%(6/197), χ2=7.184], low birth weight infants[18.4%(32/174) vs 7.1%(14/197),χ2=9.813], very low birth weight infants [5.7%(10/174) vs 1.5%(3/197),χ2=4.536], fetal loss after 20 weeks of pregnancy [5.7%(10/184) vs 1.5%(3/200), χ2=4.536] and severe preeclampsia [17.9%(33/184) vs 1.5%(3/200), χ2=33.544] increased significantly in the study group (all P < 0.05). Twenty-four-hour urinary protein content (OR=1.84, 95%CI: 1.36-2.50, P=0.001) and mean arterial pressure (OR=1.04, 95%CI: 1.00-1.07, P=0.027) in early pregnancy were risk factors for adverse pregnancy outcomes. The risk of renal function decline increased significantly in patients with higher stages of chronic nephropathy in early pregnancy (OR=6.50, 95%CI: 3.34-8.21, P<0.01). Mother complicated by preeclampsia during pregnancy was an independent risk factor (OR=11.10, 95%CI: 4.48-27.20, P<0.01). Compared with women whose 24 h urinary protein content less than 1g in early pregnancy (122 livebirths within 126 cases), the risk of premature labor [17.3%(9/52) vs 6.6%(8/122), χ2=4.780], increased significantly in women whose 24 h urinary protein content were more than or equal to 1 g in early pregnancy (52 livebirths within 58 cases) (P<0.05). Conclusions Elevated urinary protein level and mean arterial pressure in early pregnancy were risk factors of adverse pregnancy outcomes. The risk of renal function decline increased in patients with higher stages of chronic nephropathy in early pregnancy. Mother complicated by preeclampsia during pregnancy was an independent risk factor for poor prognosis of the fetus.

Objective To investigate clinical characteristics and outcomes of twin pregnancies complicated with growth discordance.Methods Five hundred and seventy-six twin pregnancies who delivered between January 1,2000 and July 31,2012 in Peking University First Hospital were retrospectively analyzed.Cases with twin-twin transfusion syndrome had been excluded.Fetal weight was estimated by abdominal circumference and femur length; neonatal birth weight was recorded.The weight difference between two babies was divided by the weight of the bigger one to obtain the differential ratio.Twin pregnancy complicated with growth discordance was diagnosed if the ratio was equal or greater than 25％ (discordance group,n=68),and growth concordance was diagnosed if the ratio was less than 25％ (concordance group,n=508).The incidence of twin pregnancies complicated with growth discordance was analyzed.The incidence of maternal complications,premature delivery,perinatal death and neonatal complications were compared between the two groups.Chisquare test and t test were used for statistical analysis.Results The incidence of twin pregnancies complicated with growth discordance was 11.8％ (68/576).The incidence of growth discordance in monochorionic twins was higher than that in dichorionic twins [17.6％ (40/227) vs 8.0％ (28/349),x2=11.40,P＜0.05].The gestational age at delivery in the discordance group was earlier than that in the concordance group [(35.6±4.1) weeks vs (36.6±3.2) weeks,t=-1.66,P＜0.05],and the incidence of premature delivery in the discordance group was higher than that in the concordance group [58.8％ (40/68) vs 47.6％ (242/508),x2=3.85,P＜0.05].The perinatal mortality in discordance group was higher than that in the concordance group [9.6％ (13/136) vs 4.7％ (48/1 016),x2=5.84,P＜0.05].Among babies in discordance group,the incidence of intracranial lesion in monochorionic twins was higher than that in dichorionic twins [20.9％ (14/67) vs 6.8％ (3/44),x2=4.06,P＜0.05].Conclusions Twin pregnancies with growth discordance are prone to adverse pregnancy outcomes.Prenatal care should be strengthened and fetal condition should be assessed timely.It is suggested that neonates should undergo overall checkup and long-term follow-up.

Objective To evaluate the efficacy and safety for cervical ripening by double-balloon catheter among full-term pregnancy women underwent labor induction.Methods It was a prospective nonrandomly controlled research.Totally 128 singleton-pregnancy women in full-term who had to undergo labor induction because of pregnancy complications or comorbidities from August 2011 to April 2013 in Peking University First Hospital were selected as study subjects.Participants were allocated to preinduction cervical ripening with either a double-balloon catheter (66 participants,study group) or prostaglandin vaginal insert (62 participants,control group).Compare the efficacy for cervical ripening and adverse reactions between the two groups.Results The efficacy for cervical ripening (Bishop scores improved by ≥ 2) had no significant differences between study and control groups [82％ (54/66) compared with 81％ (50/ 62),P＞0.05].The time interval between intervention and parturiency was significantly higher in the doubleballoon catheter group than in the prostaglandin vaginal insert group [(24.2±8.5) compared with (14.5±8.0) hours,P＜0.05].The proportion of women who achieved parturiency within 12 hours was significantly lower in the double-balloon catheter group than that in the control group [9％ (6/66) compared with 21％ (13/62),P＜0.05].The cesarean section rate showed no significant differences [41％ (27/66) compared with 43％(27/62),P＞0.05].The prevalence of intrauterine infection demonstrated by clinical diagnosis was significantly higher in the double-balloon catheter group [11％ (7/66) compared with 6％ (4/62),P＜O.05].The double-balloon catheter group had significantly lower rates of contraction overfrequency [0(0/66) compared with 42％ (26/62),P＜0.05],hyperthermia [3％ (2/66) compared with 19％ (12/62),P＜0.05],fetal heart rate abnormalities before removing the device or drug [5％ (3/66) compared with 19％ (12/62),P＜0.05],as well as precipitate labour [2％ (1/66) compared with 16％ (10/62),P＜0.05].Conclusions The efficacy of a double-balloon transcervieal catheter is similar to that of a prostaglandin vaginal insert.However,the double-balloon catheter cannot significantly reduce the cesarean section rate while it increases the risk of intrauterine infection.The materual and fetal safety of transcervical catheter is superior to the prostaglandin vaginal insert.In cases of oligohydramnios,fetal growth restriction,pregnancy complicated with asthma,hypertension and scar uterine are in favor of a balloon catheter using for cervical ripening on account of high risk of using prostaglandin.