Shuzhen Wu

The Incidence of Postpartum Hemorrhage in Pregnant Women with Placenta Previa: A Systematic Review and Meta-Analysis.

Background The global burden of postpartum hemorrhage (PPH) in women with placenta previa is a major public health concern. Although there are different reports on the incidence of PPH in different countries, to date, no research has reviewed them. Objective The aim of this study was to calculate the average point incidence of PPH in women with placenta previa. Methods A systematic review and meta-analysis of observational studies estimating PPH in women with placenta previa was conducted through literature searches in four databases in Jul 2016. This study was totally conducted according to the MOOSE guidelines and in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses standard. Results From 1148 obtained studies, 11 included in the meta-analysis, which involved 5146 unique pregnant women with placenta previa. The overall pooled incidence of PPH was 22.3% (95% CI 15.8–28.7%). In the subgroup, the prevalence was 27.4% in placenta previas, and was 14.5% in low-lying placenta previa; the highest prevalence was estimated in Northern America (26.3%, 95%CI 11.0–41.6%), followed by the Asia (20.7%, 95%CI 12.8–28.6%), Australia (19.2%, 95% CI 17.2–21.1%) and Europe (17.8%, 95% CI, 11.5%-24.0%). Conclusions The summary estimate of the incidence of PPH among women with placenta previa was considerable in this systematic review. The results will be crucial in prevention, treatment, and identification of PPH among pregnant women with placenta previa and will be contributed to the planning and implantation of relevant public health strategies.

Successfully treated congenital cystic adenomatoid malformation by open fetal surgery: A care-compliant case report of a 5-year follow-up and review of the literature

Background: Congenital cystic adenomatoid malformation (CCAM) is a rare hamartomatous cystic lesion. Open fetal surgery currently provides a potential therapeutic option for management of a fetus with CCAM diagnosis. Case Summary: A 22-year-old G2P0 woman presented at weeks’ gestation for evaluation of a fetus with a left lung lesion and diagnosed as CCAM at weeks’ gestation. Open fetal surgery was performed to resection the lesion at weeks’ gestation under deep maternal general anesthesia. The mother presented at weeks after open fetal surgery with preterm premature rupture of membranes (PPROM) and underwent cesarean delivery at weeks’ gestation. A vigorous woman infant of 1955 g, with good Apgar score, was delivered. At 1 month, 4 years, and present, 5 years after birth, she has continued to do well without any obvious deficit and both respiration and circulation were well maintained. Conclusion: We present one case of CCAM which was cured by open fetal surgery and continued to do well at follow-up of 5 years. The success of treatment provided preliminary experience for further carrying out such interventions in China.

Prevalence of abnormally invasive placenta among deliveries in mainland China: A PRISMA-compliant Systematic Review and Meta-analysis

Background: Abnormally invasive placenta (AIP) or placenta accreta (PA) is considered numerous adverse maternal and fetal-neonatal complications. There has been no detailed study to characterize the prevalence of AIP among deliveries in mainland China. Objectives: We aimed to fill this gap and obtained overall and regional estimates of AIP prevalence via a systematic review and meta-analysis. Methods: This systematic review and meta-analysis was totally performed following the Meta-analysis of Observational Studies in Epidemiology guidelines for systematic reviews of observational studies, and the Preferred Reporting Items for Systematic reviews and Meta-Analysis statement for reporting systematic reviews and meta-analysis. Results: A total of 23 articles (including 350,939) were included. Most studies (22) focused on the placenta increta (PI), only 2 articles in PA, and none in placenta percreta (PP). In this meta-analysis, the overall prevalence of AIP was 0.22% (95% confidence interval 0.18%–0.27%) in a heterogeneous set of studies (I2 = 93.5%). In a subgroup, the prevalence of PA and PI was 0.48% and 0.23%, respectively. Stratified analyses of PI found that the prevalence was similar in North (0.23% [0.14%–0.32%]) and South (0.23% [0.15%–0.32%]), and lower in Central (0.20% [0.09–0.31%]); the inlanders (0.17% (0.12%–0.23%]) had a lower prevalence of PI than those living in coastal areas (0.24% [0.35%–0.63%]). As time goes on, the prevalence, from 0.03% (0.02%–0.04%) in 1970 to 1979 to 0.48% (0.30%–0.66%) in 2010 to present, was higher and higher. The different prevalence was also found in different in maternal age groups. Conclusions: This first systematic review and meta-analysis found that the prevalence differed among different geographic areas and maternal age groups. The results would be useful for the design of abnormally invasive placenta planning and implementation adequate health care systems and treatment programs in mainland China.

Prevalence of non-syndromic orofacial clefts: based on 15,094,978 Chinese perinatal infants

Non-syndromic orofacial clefts (NSOFC), which include cleft lip and palate (CLP), cleft lip only (CLO), and cleft palate only (CPO), contains a range of disorders affecting the lips and oral cavity. No systematic review and meta-analysis has been carried out to synthesize the prevalence of NSOFC in Chinese perinatal infants. We aimed to quantify and understand the variation of prevalence national and regional levels. Four English databases and four Chinese databases were searched using a comprehensive search strategy from inception to April 2017. The random effect model was used for this meta-analysis. To determine the sources of heterogeneity, subgroup analyses and meta-regression were conducted based on different categories. The protocol has been pre-registered in the PROSPERO, number CRD42017062293. 110 studies, including 15,094,978 Chinese perinatal infants, were eligible for inclusion. The pooled prevalence rate for NSOFC was 1.67‰ (95% CI 1.53–1.82), varying with provinces. The pooled prevalence estimate was 0.56‰ (0.50–0.63) for CLO, 0.82‰ (0.73–0.90) for CLP, and 0.27‰ (0.24–0.30) for CPO. Significant associations were found between overall prevalence estimates and survey year and study region. The prevalence of NSOFC was severe in Chinese perinatal infants, varying with provinces. The results will serve as a baseline for future assessment of the overall effectiveness of NSOFC control, and will also support and inform health policy for planning and helping health debates.

Trend and risk factors of low birth weight and macrosomia in south China, 2005–2017: a retrospective observational study

The percentages of low birth weight (LBW) increased from 7.7% in 2005 to 11.3% in 2011 and declined to 8.1% in 2017. For very low birth weight (VLBW) individuals, the proportion declined −1.0% annually, from 2.5% in 2005 to 1.4% in 2017. Among moderately low birth weight (MLBW) individuals, the proportion first increased 12.8% annually, from 5.0% in 2005 to 9.3% in 2011, and then declined −3.8% annually, from 9.4% in 2011 to 7.0% in 2017. The percentages of macrosomia monotone decreased from 4.0% in 2005 to 2.5% in 2017, an annual decline of −4.0%. Multiple regression analyses showed that boys, maternal age, hypertensive disorders complicating pregnancy (HDCP), and diabetes were significant risk factors for LBW. Boys, maternal age, gestational age, HDCP, diabetes, and maternal BMI were significant risk factors for macrosomia. Although the relevant figures declined slightly in our study, it is likely that LBW and macrosomia will remain a major public health issue over the next few years in China. More research aimed at control and prevention of these risk factors for LBW and macrosomia and their detrimental outcome in the mother and perinatal child should be performed in China.

Random placenta margin incision for control hemorrhage during cesarean delivery complicated by complete placenta previa: a prospective cohort study

Abstract Introduction: Complete placenta previa (CPP) is one of the most problematic types of abnormal placenta, which is further complicated by placenta accreta or percreta that can unexpectedly lead to catastrophic blood loss, infection, multiple complications, emergency hysterectomy, and even death. The present study aimed to assess the efficacy of random placenta margin incision in controlling intraoperative and total blood loss during cesarean section for CPP women. Methods: A prospective cohort study, including a total of 100 consecutive pregnant women with CPP, was performed at a tertiary university-affiliated medical center between March 2016 and July 2017. All of them underwent random placenta margin incision, and intraoperative and total blood loss were analyzed. Through antenatal diagnosis using color Doppler, women were further divided into abnormally invasive placenta (AIP) and non-AIP groups, and anterior and posterior placenta groups. The protocol was registered with the Clinical Trial Registry under registration number NCT02695069. Results: Mean maternal age and gestational age at delivery were 32.26 ± 5.03 years old and 36.21 ± 2.07 weeks, respectively. Total duration of the surgical procedure time was 52.50 (42.43–64.00) min. Median estimated intraoperation blood loss was 746.43 (544.44–1092.86) ml. Total blood loss was 875.00 (604.50–1196.67) ml, and 38 (38.0%) had post-partum hemorrhage. The change from baseline in the median hemoglobin level was −0.33 (6.00–13.20). No women underwent hysterectomy due to massive hemorrhage during the study period. No women had an intraoperative urinary bladder injury, postoperative wound infection, and required relaparotomy, owing to intra-abdominal bleeding. The median hospitalization time was 5.41 (4.18–7.58) d. Conclusion: The random placenta margin incision may be a potentially valuable surgical procedure to control the volumes of intraoperative and postoperative blood loss and reduce the incidence of postpartum hemorrhage among women with complete placenta previa.

Association between hypertensive disorders complicating pregnancy and risk of placenta accreta: a meta-analysis and systematic review

ABSTRACT Objective: Previous studies have reported a positive association between hypertensive disorders complicating pregnancy and placenta accreta. However, whether hypertensive disorders complicating pregnancy associated with placenta accreta is still not clear. The objective was to systematically review the literature to determine a possible association between hypertensive disorders complicating pregnancy and placenta accreta. Methods: A systematic search of PubMed database, the Cochrane Library, Willy Online Library, and ScienceDirect database through 1st December 2015, was conducted. Two authors independently assessed data extraction and quality of the studies using the Newcastle-Ottawa Scale. Assessment of heterogeneity and analysis of data were operated by Review Manager 5.3.0. Results: Three studies involving 4174 patients who developed hypertensive disorders complicating pregnancy of a total of 38,004 pregnant women were selected. The result of our meta-analysis revealed that pregnancy induced hypertension was significantly associated with a reduction of placenta accreta (OR = 0.50, 95% CI: 0.30–0.82; heterogeneity: I2 = 13%, p = 0.32). Conclusions: Our meta-analysis demonstrated that the risk of placenta accreta is reduced in women with hypertensive disorders complicating pregnancy. Further well-designed studies are warranted to testify the result and explored any potential mechanism association between hypertensive disorders complicating pregnancy and placenta accreta.

Female alcohol consumption and fecundability: a systematic review and dose-response meta-analysis

To what extent could alcohol consumption affects female fertility is still unclear. The aim of this study was to quantitatively summarize the dose-response relation between total and specific types of alcohol beverage (beer, wine, and spirits) consumption in female and the fecundability. Four electronic databases were searched. Observational studies (cohort and case-control) that provided female alcohol consumption and fecundity were eligible. Nineteen studies, involving 98657 women, were included in this study. Compared to non-drinkers, the combined estimate (with relative risk, RR) of alcohol consumers on fecundability was 0.87 (95% CI 0.78–0.95) for overall 19 studies. Compared to non-drinkers, the pooled estimates were 0.89 (95% CI 0.82–0.97) for light drinkers (≤12.5 g/day of ethanol) and 0.77 (95% CI 0.61–0.94) for moderate-heavy drinkers (>12.5 g/day of ethanol). Moreover, compared to non-drinkers, the corresponding estimates on fecundability were 0.98 (95% CI 0.85–1.11), 1.02 (95% CI 0.99–1.05), and 0.92 (95% CI 0.83–1.01) for studies focused on wine, beer and spirits, respectively. Dose-response meta-analysis suggested a linear association between decreased fecundability and every 12.5 g/d increasing in alcohol consumption with a RR 0.98 (95% CI 0.97–0.99). This first systematic review and meta-analysis suggested that female alcohol consumption was associated with a reduced fecundability.

Mesenchymal stem cells in the treatment of Cesarean section skin scars: study protocol for a randomized, controlled trial

BackgroundCesarean delivery has already become a very common method of delivery around the world, especially in low-income countries. Hypertrophic scars and wound infections have affected younger mothers and frustrated obstetricians for a long time. Mesenchymal stem cells (MSCs) have strong potential for self-renewal and differentiation to multilineage cells. Previous studies have demonstrated that MSCs are involved in enhancing diabetic wound healing. Therefore, this study is designed to investigate the safety and efficacy of using MSCs in the treatment of Cesarean section skin scars.MethodsThis trial is a prospective, randomized, double-blind, placebo-controlled, single-center trial with three parallel groups. Ninety eligible participants will be randomly allocated to placebo, low-dose (transdermal hydrogel MSCs; 3 × 106 cells) or high-dose (transdermal hydrogel MSCs; 6 × 106 cells) groups at a 1:1:1 allocation ratio according to a randomization list, once a day for six consecutive days. Study duration will last for 6 months, comprising a 1 week run-in period and 24 weeks of follow-up. The primary aim of this trial is to compare the difference in Vancouver Scar Scale rating among the three groups at the 6th month. Adverse events, including severe and slight signs or symptoms, will be documented in case report forms. The study will be conducted at the Department of Obstetric of Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan.DiscussionThis trial is the first investigation of the potential for therapeutic use of MSCs for the management of women’s skin scar after Cesarean delivery. The results will give us an effective therapeutic strategy to combat Cesarean section skin scars, even with uterine scarring.Trial registrationClinicalTrials.gov, NCT02772289. Registered on 10 May 2016.

Prevalence of prenatally diagnosed congenital cystic adenomatoid malformation among fetuses in China

The prevalence of congenital cystic adenomatoid malformation among fetuses still varies in different studies in China. The present meta-analysis was intended to evaluate the pooled prevalence of fetuses in China. Four English (Pubmed, Elsevier Science Direct, Web of Science and the Cochrane Library) and four Chinese (the Chinese Biological Medical Literature database, the Chinese National Knowledge Infrastructure database, VIP database and Wanfang Data) databases were searched from inception to July 2016. Meta-analyses were performed using Stata (version 12.0), with prevalence and corresponding 95% confidence intervals using the random effect model. Five studies with 393496 fetuses were chosen for this meta-analysis. The overall pooled prevalence was 4.01/10000 (2.03/10000 - 6.00/10000) fetuses. Sensitivity analysis revealed that the results were stable, and Begg’s test and Egg’s test showed no potential risk of publication bias. This is, to our knowledge, the first study to systematically evaluate the literature of the prevalence of congenital cystic adenomatoid malformation among fetuses in China. Results showed that the prevalence among fetuses should be considerable. A large-scale multicenter study on the epidemiology across different areas in China is required.The prevalence of congenital cystic adenomatoid malformation among fetuses still varies in different studies in China. The present meta-analysis was intended to evaluate the pooled prevalence of fetuses in China. Four English (Pubmed, Elsevier Science Direct, Web of Science and the Cochrane Library) and four Chinese (the Chinese Biological Medical Literature database, the Chinese National Knowledge Infrastructure database, VIP database and Wanfang Data) databases were searched from inception to July 2016. Meta-analyses were performed using Stata (version 12.0), with prevalence and corresponding 95% confidence intervals using the random effect model. Five studies with 393496 fetuses were chosen for this meta-analysis. The overall pooled prevalence was 4.01/10000 (2.03/10000 - 6.00/10000) fetuses. Sensitivity analysis revealed that the results were stable, and Beggs test and Eggs test showed no potential risk of publication bias. This is, to our knowledge, the first study to systematically evaluate the literature of the prevalence of congenital cystic adenomatoid malformation among fetuses in China. Results showed that the prevalence among fetuses should be considerable. A large-scale multicenter study on the epidemiology across different areas in China is required.