The authors studied retrospectively clinical data of seventy cases with breast cancer during pregnancy and lactation.They were treated and diagnosed by operation and pathology.Primary factors influencing prognosis were analyzed.It was demonstrated that 5year survival rate of the patients were significantly influenced by clinical stage , month of pregnancy and lactation, time of symptoms, type of operation, type of pathology, histological grade of malignancy, recurrence and metastasis, and estrogen receptor status (Ｐ＜0.05).Age and termination of pregnancy had no beneficial effect on survival (Ｐ＞0.05).The prognosis of pregnant and lactating breast cancer was poorer than ordinary breast cancer.Their 5year survival rate were 55.7% and 74.3%, respectively. After they were matched for stage and for age, no difference in survival was found.Early diagnosis and radical operation combined with radiotherapy, chemotherapy and hormonal therapy have better prognosis.The method can shorten time of treatment and improve survival rate.Termination of pregnancy has not been shown to improve survival and shall not be advised routinely.Future pregnancy may be detrimental and shall be discouraged.
ObjectivesUsing systematic literature review to analyze the effects of levetiracetam (LEV) on neonatal safety during early pregnancy.MethodsThe scope of the literature must be English literature, published from 1997 to 2018. Meta-analysis was performed by random effects models.ResultsSeven literatures were included. A total of 672 cases exposed to LEV in treatment group and 772 234 cases in control groups were selected for meta-analysis. There was no significant difference in neonatal malignancy between treatment group and control group［OR=1.05, 95% CI (0.54, 2.02), P=0.37］. Further, we evaluated the effect of LEV monotherapy and polytherapy on neonatal safety, a total of 464 monotherapy cases and 632 polytherapy cases respectively were selected for meta-analysis. The results showed that there was no significant difference between these two therapies in neonatal malignancy ［OR=0.54, 95% CI(0.31, 0.96), P=0.32］.ConclusionsAs the papers we included, levetiracetam in the treatment of epilepsy during pregnancy is relatively safe for newborn.
ObjectiveTo explore whether the vaginal environment changes of pregnant women were correlated with pathogenesis of fungal vaginitis. MethodsWe selected 166 women in their early pregnancy in the Obstetrics and Gynaecology Clinic between July 2011 and July 2012 as the study objects (excluding fungal vaginitis patients already confirmed). Two important indicators of changes in pH and the amount of vaginal lactobacilli were chosen to determine changes in the vaginal environment. Using prospective study method, by checking changes in the vaginal environment, the objects were divided into two groups: 96 were in the changing environment group, and 70 were in the normal environment group. Sixty seven of them had a pH value lower or equal to 4.0, and 99 higher than 4.0. Fifty-eight of them had a reduced amount of lactobacillus, and 108 had a normal amount of lactobacillus. The rate of fungal vaginitis in each group was counted. ResultsThe morbidity rate in patients whose pH value was lower than or equal to 4.0 was 17.9% (12/67), while it was 6.1% (6/99) in patients with a pH value higher than 4.0, and the difference was significant (χ2=5.804, P=0.016). The morbidity rate in patients with a reduced amount of lactobacillus was 25.9% (15/58), and it was 2.8% (3/108) in patients with normal lactobacillus, and the difference was also significant (χ2=20.800, P=0.000). The morbidity rate for patients with changing vaginal environment was 16.7% (16/96), and for those with normal environment was 2.9% (2/70), and the difference was significant (χ2=7.985, P=0.005). In those with normal lactobacillus, the reduction of pH value was not correlated with the occurrence of fungal vaginitis (χ2=0.000, P=1.000). ConclusionThe vaginal environment changes during pregnancy (pH value decrease and Lactobacillus decrease) are associated with the incidence of fungal vaginitis, and it can be prevented and treated based on this phenomenon.
ObjectiveTo investigate the diagnostic value of serum cystatin-C (Cys-C) detection in hypertensive disorder complicating pregnancy patients. MethodsA hundred patients with pregnancy induced hypertension (PIH) were chosen as the research object from February 2012 to March 2013, and they were divided into mild group, moderate group and severe group according to the severity of the disease. The other 40 healthy pregnant women were selected as the controls (the control group). We compared the four groups in terms of Cys-C, serum urea nitrogen (BUN) and creatinine level, as well as the positive rate of Cys-C, BUN, and creatinine. ResultsCys-C, BUN, and creatinine in the PIH group were significantly higher than those in the control group (P<0.05). Cys-C and creatinine in preeclampsia mild group were significantly higher than those in the control group (P<0.05), but BUN level between the two was not statistically significant (P>0.05). Cys-C, BUN, and creatinine in the PIH moderate and severe groups were significantly higher than those in the control group (P<0.05). The abnormal rate of Cys-C in the PIH mild group was significantly higher than that of Cys-C and creatinine (P<0.05). ConclusionCys-C, BUN and creatinine can all show renal damage in PIH patients, but the Cys-C value in early diagnosis is better than that of BUN and creatinine. It can be used as a monitoring index of pregnancy-induced hypertension prevention and early treatment.
ObjectivesTo systematically review the correlation between maternal serum selenium levels during pregnancy and premature birth.MethodsDatabases including PubMed, The Cochrane Library, EMbase, Web of Science, CNKI and CBM were searched to collect studies on correlation between maternal serum selenium levels during pregnancy with preterm birth in the offspring from inception to January, 2020. Two reviewers independently screened literature, extracted data and evaluated risk of bias of the included literature. Then, meta-analysis was conducted by using RevMan 5.3 software.ResultsA total of 12 studies involving 2 484 patients were included. The results of meta-analysis showed that compared with control group, the preterm group had lower serum selenium levels in pregnant females (SMD=−0.89, 95%CI −1.56 to −0.22, P=0.01). The results of the subgroup analysis showed that heterogeneity among subjects was still large when grouped accorcding to the continent to which a country belongs, the time of blood sample collection and test method in pregnant females.ConclusionsLow maternal serum selenium levels during pregnancy may increase the risk of preterm birth. Due to the limitation of the quantity and quality of the included studies, the above conclusions are required to be verified by more high quality studies.
Pregnancy complicated by aortic root aneurysm in patients with Marfan syndrome is one of the main causes of termination of pregnancy or even death in pregnant women. A very small number of pregnant women require cardiac surgery to preserve pregnancy under extracorporeal circulation, and all surgeries use aortic root replacement. We reported a 30-year-old patient with severe aortic regurgitation combined with giant aortic root aneurysm and Marfan syndrome in mid-pregnancy. Valve-sparing root replacement using reimplantation technology was performed via a multidisciplinary cooperation model. This not only achieved the patient’s desire to continue pregnancy but also avoided the anticoagulation and bleeding complications brought by mechanical valve replacement, reduced pregnancy risks and improved long-term quality of life. Postoperative echocardiography showed a small amount of aortic valve regurgitation, aortic valve coaptation height of 0.6 cm, effective height of 1.1 cm, maximum aortic flow velocity of 1.4 m/s, mean transvalvular pressure gradient of 4.4 mm Hg, and satisfactory clinical results.
Objective To formulate an evidence-based treatment plan for a patient with gestational diabetes mellitus. Methods Based on the clinical questions raised from a real-life patient of gestational diabetes mellitus, we searched ACP Journal Club (1991 to Dec. 2006), The Cochrane Library (Issue 4, 2006), MEDLINE (1966 to Dec. 2006) and Chinese Biological Medical Database (1980 to Dec. 2006) for systematic reviews, randomized controlled trials, cohort and case-control studies. We used the following keywords: gestational diabetes, metformin, and pregnancy complication. The quality of the included studies was assessed.Results One meta-analysis (from MEDLINE) and two randomized controlled trials (from the Cochrane Central Register of Controlled Trials) were included. These studies concluded that there was no clear evidence on the benefits of metformin for gestational diabetes. Based on the current evidence, integrated with clinical expertise and the patient’s values, metformin was not used for this patient. Instead, intensive dietary control, blood glucose control, and appropriate exercise were administered. After this individual treatment, the patient gave birth to a healthy baby in 39+4 Weeks. Conclusion The appropriate management for gestational diabetes mellitus has been formulated with the approach of evidence-based medicine. Large-scale, methodologically-sound trials are required.
Objective To study the advances in research of breast cancer during pregnancy. Methods The literatures in recent years were reviewed. Results A lot of evidences suggested that the diagnosis may be delayed easily. The diagnosis was primarily made by needle aspiration cytology and biopsy. The treatment of pregnant breast cancer was not different from ordinary breast cancer, however the factor of foetus should be taken into account. Termination of pregnancy did not improve survival. Conclusion Pregnant breast cancer is mostly at later stage at the time of diagnosis and has poorer prognosis than ordinary breast cancer. The patients with breast cancer during pregnancy usually have an equivalent survival rate when compared with age and stagematched ordinary group. Future pregnancy may be allowed after two years of treatment in patients with early breast cancer.
Objective Based on the methodology of evidence-based medicine, we explored the prognosis of a patient with gestational diabetes mellitus (GDM). Methods We searched ACP Journal Club (1991 to October 2006), The Cochrane Library (Issue 4, 2006), MEDLINE (1990 to October 2006) and Chinese Biomedicine database (CBM). Cohort studies, case-control studies and case series studies involving the prognosis of patients with GDM were collected. The available evidence was critically appraised. Results During the period from 6 weeks to 28 years after delivery, the incidence of type 2 diabetes mellitus appeared to vary from 2.6% to 70%. Patients with GDM suffered from an increased incidence of spontaneous premature delivery, hypertension, metabolic syndrome and vaginal infection. Conclusion Patients with GDM appears to be more liable to overt diabetes mellitus, and to suffer fromspontaneous premature delivery, hypertension, metabolic syndrome and vaginal infection than women with normal glucose tolerance during pregnancy. Further studies of the long-term follow-up data from GDM trials are needed.