分类： 医学、药学 >> 临床医学 提交时间： 2023-10-09 合作期刊: 《中国全科医学》
摘要： Background It is of great importance to standardize labor management for ensuring maternal and neonatal safety. Since the publication of the new stage of labor, the definition of prolonged labor has not been emphasized and it is recommended to minimize interventions during labor, therefore, the number of pregnant women with labor over 24 h is increased compared to the previous. Objective To analyze the risk factors and maternal and neonatal outcomes of pregnant women with labor over 24 h and discuss the labor management under the new stage of labor. Methods The clinical data of pregnant women received maternity examination and delivered at Department of Obstetrics, the First Affiliated Hospital with Nanjing Medical University from January to December 2022 were collected in the retrospective study. A total of 40 single birth pregnant women with normal fetal position and prolonged total labor（more than 24 h）were selected as the observational group, and 95 single birth pregnant women with normal fetal position and normal total labor（less than 24 h）were selected as the control group. Theage, BMI, gestational age of delivery, gestational diabetes, gestational hypertension, neonatal body mass, labor condition, analgesic delivery rate and delivery intervention rate of the two groups were compared. MultivariateLogistic regression analysis was used to explore the risk factors for total labor over 24 h. The maternal and neonatal outcomes including intrapartum fever, amniotic fluid contamination, mediolateral episiotomy, vaginal instrumental delivery, cervical laceration, postpartum hemorrhage, manual removal of placenta, fetal distress, neonatal asphyxia and referral to neonatal intensive care unit（NICU）were compared to screen the risk factors and analyse the maternal and neonatal outcomes of pregnant women with labor over 24 h. Results There were no significant differences in age, BMI, gestational age of delivery, gestational hypertension, gestational diabetes mellitus and neonate body mass between the two groups（P>0.05）. The first stage of labor, second stage of labor and total labor were longer and the rates of labor analgesia and labor intervention were higher in the observational group than the control group（P0.05）. There were no significant differences in the incidence of postpartum hemorrhage, vaginal instrumental delivery and fetal distress between the two groups（P>0.05）；the incidence of intrapartum fever, amniotic fluid contamination, mediolateral episiotomy, vaginal instrumental delivery, cervical laceration and referral to NICU in the observational group was higher than the control group（P<0.05）；no neonatal asphyxia occurred in both groups. Conclusion The rates of labor analgesia and labor intervention were significantly increased in pregnant women with total labor over 24 h due to prolonged labor. Although prolonged labor does not increase the incidence of postpartum hemorrhage, manual removal of placenta and neonatal asphyxia, it increases the incidence of intrapartum fever, amniotic fluid contamination, mediolateral episiotomy, vaginal instrumental delivery, cervical laceration and fetal distress. Obstetricians and gynecologists should pay attention to the adverse maternal and neonatal outcomes caused by prolonged labor and individualized management of labor.
分类： 医学、药学 >> 临床医学 提交时间： 2023-10-09 合作期刊: 《中国全科医学》
摘要： Background Breast cancer has become the most common malignant tumor threatening the health of Chinese women in recent years. The use of tamoxifen（TAM）has successfully reduced the recurrence and progression of estrogen receptor-positive breast cancer, however, it also increases the risk of endometrial lesions. Objective To explore the risk factors for endometrial lesions in breast cancer patients taking TAM, determine the optimal threshold value of endometrial thickness, and improve the positive detection rate of hysteroscopy. Methods Breast cancer patients taking TAM（20 mg/d）who underwent hysteroscopic endometrial biopsy admitted to theDepartment of Gynecology of the First Affiliated Hospital with Nanjing Medical University from January 2015 to January 2022 were retrospectively selected as the study objects and divided into the negative hysteroscopicendometrial biopsy group（normal endometrium）and positive hysteroscopic endometrial biopsy group（endometrial lesions including endometrial polyps, endometrial hyperplasia without atypia, endometrial atypical hyperplasia and endometrial carcinoma）. Clinical data of the patients were collected, including age, BMI, history of hypertension and diabetes, delivery times, presence of menopause and abnormal uterine bleeding/postmenopausal bleeding（AUB/PMB）, receiving of chemotherapy, duration of TAM treatment, use of gonadotropin-releasing hormone agonists（GnRH-a）, endometrial thickness, echo features of intrauterine lesions. Multivariate Logistic regression analysis was used to explore the risk factors for endometrial lesions in breast cancer patients taking TAM. The receiver operating characteristic（ROC）curve of endometrial thickness for predicting endometrial lesions detected by hysteroscopy was plotted, and the area under the ROC curve（AUC）and its 95%CI were calculated to determine the optimal cut-off value of endometrial thickness for receiving hysteroscopic surgery. Results The proportion of patients with AUB/PMB, duration of TAM treatment 24 months, intrauterine hyperechoic lesions and endometrial thickness in the positive hysteroscopic endometrial biopsy group were higher than those in the negative hysteroscopic endometrial biopsy group（P<0.05）. Multivariate Logistic regression analysis showed that AUB/PMB〔OR=7.731, 95%CI（1.949, 30.699）, P=0.004〕, endometrial thickening〔OR=1.223, 95%CI（1.091, 1.371）, P=0.001〕 and intrauterine hyperechoic lesions〔OR=13.383, 95%CI（2.751, 65.103）, P=0.001〕were independent risk factors for endometrial lesions detected by hysteroscopy in breast cancer patients taking TAM. The AUC of endometrial thickness for predicting endometrial lesions detected by hysteroscopy in breast cancer patients taking TAM was 0.753〔95%CI（0.638, 0.868）, P<0.001〕, with the Youden index of 0.54, optimal cut-off value of 9.15 mm, sensitivity and specificity of 0.755 and 0.786, respectively. Conclusion The risk of endometrial lesions is increased in breast cancer patients taking TAM with AUB/PMB, endometrial thickness 9.15 mm suggested by ultrasound and intrauterine hyperechoic lesions, when the hysteroscopy and endometrial biopsy should be actively considered.
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