maternal diseases and fetal outcome

Guidelines of the American Thyroid Associationfor the Diagnosis and Management of Thyroid DiseaseDuring Pregnancy and Postpartum美国甲状腺协会妊娠期和产后甲状腺疾病的诊断和治疗指南The American Thyroid Association Taskforce on Thyroid Disease During Pregnancyand Postpartum美国甲状腺协会妊娠期和产后甲状腺疾病特别工作组Translated by Wang Xinjun Binzhou people’s hospital,Binzhou Medical College王新军译滨州医学院附属滨州市人民医院INTRODUCTION前言Pregnancy has a profound impact on the thyroid glandand thyroid function. The gland increases 10% in size during pregnancy in iodine-replete countries and by 20%–40% in areas of iodine deficiency. Production of thyroxine(T4) and triiodothyronine (T3) increases by 50%, along with a 50% increase in the daily iodine requirement. These physiological changes may result in hypothyroidism in the later stages of pregnancy in iodine-deficient women who were euthyroid in the first trimester.妊娠对甲状腺和甲状腺功能具有明显影响。

罕见的染色体三体（RATs ）是指除21、18、13号染色体之外的常染色体三体，其嵌合体的发生机制可能是早期着床前胚胎配子减数分裂发生错误后三体/单体自救的结果，或有丝分裂阶段染色体不分离导致［1-3］。

罕见的染色体三体的真性嵌合在胎儿期并不多见，但随着产前检测技术的发展，已有越来越多的罕见染色体三体嵌合体被检出。

近几年，非侵入性产前检测技术（NIPT ）的检测范围由传统的常见染色体非整倍体逐渐拓展为全基因组检测，由此检测出更多的其他染色体异常，包括RATs ，给后续的遗传咨询和处理带来很多困难。

2022年美国ACMG 关于NIPT 的指南认为尚没有足够的证据支持NIPT 常规用于RATs 的筛查［4］，但也有研究发现NIPT 检测到的RATs 与不良妊娠结局有关，认为NIPT 是否有益于RATs 的检出，NIPT 检测到哪种RATs 与不良妊娠结局有关，以及嵌合体的百分比是否有助于妊娠Value of non-invasive prenatal testing for rare autosomal trisomies in fetusesXIE Xiaoxiao 1,ZHAO Qingdong 1,HU Lingyun 1,JIANG Shufang 1,WANG Xiaoping 1,ZHANG Wenling 2,LI Zhen 1,YOU Yanqin 1,LU Yanping 11Department of Gynecology and Obstetrics,2Department of Clinical Laboratory,First Medical Center of Chinese PLA General Hospital,Beijing 100853,China摘要：目的探讨非侵入性产前检测对罕见的染色体三体的检测价值。

方法收集2019年1月~2023年4月本院通过非侵入性产前检测检出罕见染色体三体高风险的病例，临床咨询后进行侵入性产前诊断，使用染色体核型分析、染色体微阵列分析、染色体拷贝数变异测序、间期荧光原位杂交等技术进行检测，分析结果并随访妊娠结局，以评价非侵入性产前检测对罕见染色体三体的检测价值。

胎膜水肿临床意义研究目的：探讨胎膜水肿与产妇疾病、母儿妊娠结局之间的关系。

方法：回顾性分析同济医院围产医学科2012年1月-2014年1月17例发生胎膜水肿的产妇的临床资料，选取同期未发生胎膜水肿的30例产妇为对照组，分析两组产妇并发症发生情况及新生儿状况。

结果：两组绒毛膜羊膜炎、胎膜早破、重度子痫前期及慢性盆腔炎发生率比较差异均有统计学意义（P＜0.05）；两组新生儿1 min Apger评分、5 min Apger评分、体重、身长及新生儿肺炎发生率比较差异均无统计学意义（P>0.05）。

结论：胎膜水肿与多种疾病相关，炎症过程的水肿可能造成胎膜受损至胎膜早破，但其本身可能是机体损伤后修复的一部分。

胎膜水肿产妇及时行剖宫产，对新生儿出生状况无显著不良影响。

[Abstract] Objective：To study the relationship between fetal membranes edema and maternal disease，pregnancy outcome.Method：The clinical data of 17 cases of fetal membranes edema puerperas in perinatology department of Tongji Hospital from January 2012 to January 2014 were retrospectively analyzed.30 normal puerperas without fetal membranes edema were selected as the control group. The occurrence of complications and the neonatal condition of the two groups were analyzed.Result：The differences in the incidence rates of chorioamnionitis，premature rupture of fetal membranes，severe preeclampsia and chronic pelvic inflammatory disease were statistically significant（P＜0.05）.The differences in the Apger scores of 1 and 5 minutes，weight，height and incidence rate of pneumonia of newborn were not statistically significant（P>0.05）.Conclusion：Fetal membranes edema is related to a variety of diseases.Inflammatory process of edema may cause fetal membrane damage to premature rupture of membranes，but itself is likely to be part of the body damage after repair.Timely cesarean section of fetal membranes edema puerpera has no harmful effects on neonates.[Key words] Fetal membranes edema；Premature rupture of fetal membranes；Chorioamnionitis胎膜是胎儿附属物之一，由绒毛膜和羊膜组成，受母体及胎儿面环境双重影响，生理状态下对胎儿提供营养与支持，维持胎儿生长环境的稳定[1]。

三病阳性孕产妇转诊制度及流程英文回答：Referral system and process for pregnant women with three positive diseases.As a pregnant woman with three positive diseases, it is important to understand the referral system and process in place to ensure the best possible care for both the mother and the baby. The referral system is designed to facilitate the transfer of patients from one healthcare provider to another, usually from a primary care provider to a specialist or a higher level of care. This is particularly important in cases where additional expertise or resources are required to manage the specific conditions.In the case of a pregnant woman with three positive diseases, the referral process is crucial to ensure that she receives appropriate and timely care. The process typically begins with the primary care provider identifyingthe need for a referral based on the complexity of the conditions or the need for specialized care. The primary care provider then initiates the referral by providing relevant medical information and contacting the appropriate specialist or healthcare facility.Once the referral is initiated, the specialist or healthcare facility reviews the referral request and assesses the urgency and appropriateness of the referral. This may involve reviewing the medical records, conducting additional tests or consultations, and evaluating thepatient's condition. Based on this assessment, thespecialist or healthcare facility determines the next steps, which may include accepting the referral, providing further recommendations, or suggesting an alternative course of action.If the referral is accepted, the pregnant woman will be scheduled for an appointment with the specialist or at the healthcare facility. During this appointment, thespecialist will evaluate the patient's condition, provide a diagnosis, and develop a treatment plan in collaborationwith the primary care provider. This may involve additional tests, medications, therapies, or procedures to manage the three positive diseases and ensure the well-being of both the mother and the baby.Throughout the referral process, effective communication and coordination between the primary care provider, specialist, and healthcare facility are essential. This includes sharing relevant medical information, discussing treatment options, and ensuring continuity of care. Regular follow-up appointments and consultations may be scheduled to monitor the progress of the treatment plan and make any necessary adjustments.In conclusion, the referral system and process for pregnant women with three positive diseases play a crucial role in ensuring appropriate and timely care. Byfacilitating the transfer of patients from primary care providers to specialists or higher levels of care, the referral system helps manage the complexity of these conditions and provides the necessary expertise and resources for optimal maternal and fetal health outcomes.中文回答：作为一名患有三种阳性疾病的孕妇，了解转诊制度和流程对于确保母婴得到最佳护理至关重要。