To investigate the clinical features, clinical diagnosis, treatment methods and maternal-infant prognosis of tuberculous meningitis in pregnancy.

Based on one case, who was admitted to Peking University Shenzhen Hospital, and 34 cases of intracranial tuberculosis were reported in the literature, we retrospectively reviewed the diagnosis, treatment and prognosis of pregnancy-related intracranial tuberculosis.

The 29-year-old patient was admitted to the Department of Neurology, Peking University Shenzhen Hospital on December 7, 2009 due to "pregnancy 25^{+ 2} week with repeated headaches with fever for 20 days and mental disorders for 2 days" . After admission, her symptoms further worsened. She was highly suspected of tuberculosis meningitis by meningitis irritation and imaging findings. Anti-tuberculosis treatment was initiated. Cenebrospinal fluid of the patient was mycobacterium tuberculosis positive. During the treatment, considering the teratogenic effects of streptomycin on the fetus, it was decided to use quadruple therapy including tetrabuterol and pyrazinamide, isoniazid, and rifampicin. Finally, the pregnant womant gave birth to a live baby by cesarean section at 32 weeks of gestation. Follow up the health of mother and baby after delivery. In the literatures from 1956 to 2020, 34 cases of intracranial tuberculosis in pregnancy and puerperium were reported. The clinical symptoms included 28 cases with headache (82.35%), 23 cases with fever (67.65%), and 16 cases with vomiting (47.06%), 15 cases with neck stiffness (44.12%), 6 cases with Kernig Yang sign (17.65%), 8 cases with convulsions (23.53%), 8 cases with hemiplegia (23.53%), 8 cases with drowsiness (23.53%), 8 cases with unconsciousness (23.53%), and 7 cases with optic nerve damage (20.59%). Among 33 cases with descriptions of maternal outcomes, 9 cases (27.27%) were cured after treatment. 17 cases (51.52%) were improved. 4 cases (12.12%) were died. 3 cases (9.09%) were left with visual impairment. The pregnant woman lost follow-up after treatment in the other case. There were 25 cases (73.53%) with described neonatal outcomes, of which 17 cases (68%) were healthy, 4 cases (16%) had congenital tuberculosis, and 4 cases (16%) died.

The clinical characteristics of tuberculous meningitis during pregnancy and puerperium mainly included fever, headache, nausea, vomiting, neck stiffness, and positive Kernig sign. Some cases may be accompanied by convulsions, and optic nerve damage. Coma appeared in severe cases. Anti-tuberculosis treatment is the main treatment plan. The prognosis of mothers and babies was related to the timing of starting anti-tuberculosis treatment. It is especially important to start anti-tuberculosis treatment as early as possible before the occurrence of coma.

To describe the cause and clinical characteristic of maternal septic shock.

The data of all maternal septic shock from May 2005 to December 2019 in the Third Affiliated Hospital of Guangzhou Medical College was retrospectively studied.

A total of 98 cases of maternal septic shock were collected. 73(74.5%) mothers survived and 25 (25.5%) mothers died. 75 cases (76.5%) of septic shock developed in pregnancy, among which 52 cases (69.3%) of pregnancies were terminated for sepsis. The cause of maternal septic shock included lung infection (30, 30.6%), genital tract infection (25, 25.5%), urinary tract infection (27, 27.6%), intra-abdominal infection (7, 7.1%) and others (9, 9.2%). 46 of 98 cases (46.9%) of maternal septic shock were surgical intervention infection and the other 52 cases were non surgical intervention infection. Comparing to the non surgical intervention septic shock, the maternal survival rate of surgical intervention septic shock was higher (42 cases, 91.3% vs 21 cases, 40.4%, P<0.001), and the length of stay in hospital was longer (11 vs 6, P<0.001), and the proportion of the number of dysfunction organs≥3 was smaller (15.2% vs 42.3%, P<0.01). The fetal loss rate was 56.6% (47/83) and 25 neonatal (30.1%) survived among the septic shock in pregnancy, and 11 cases of pregnancies continued.

The common locations of maternal septic shock were lung and urogenital tract. The maternal survival rate of surgical intervention septic shock was higher than non surgical intervention septic shock. Maternal septic shock progressed dramatically rapid and majority have poor pregnant outcome and only a few pregnancy continued. Maternal septic shock is not the absolute index to terminate pregnancy. Fetal survivals rely on improved maternal condition.

To explore the clinical features, diagnosis, treatment and the outcome of amniotic fluid embolism (AFE).

We retrospectivly studied the clinical manifestation, diagnosis, treatment and the outcome of 1 case of AFE in Peking University Shenzhen Hospital and previous 61 literature reports.

We reported a case of AFE followed by cardiac arrest in a 39 years old woman who was admitted to the hospital with premature rupture of membranes at 39 weeks of gestation. Cardiopulmonary resuscitation and cesarean were performed immediately. The patient and the infant were healthy. The common aura symptoms of patients with AFE included polypnea (27 cases, 44.3%), cyanosis (14 cases, 21.3%), drop of blood pressure (11 cases, 18.0%), altered mental status (9 cases, 14.8%) and dysphoria (8 cases, 13.1%). The common clinical manifestations were circulatory dysfunction (52 cases, 85.2%), respiratory dysfunction (47 cases, 77.0%) and blood dysfunction (39 cases, 63.9%). Eight cases (13.1%) used extracorporeal membrane oxygenation (ECMO), and the prognosis was excellent. Of the 61 patients with AFE, 16 cases (26.2%) died and 45 cases (73.8%) survived. There are 35 cases described neonatal outcome, 24 cases(57.4%)were healthy, 4 cases (6.6%) were dead, 7 cases (11.5%) were transferred to the neonatal intensive care unit (NICU) and the outcome was unknown.

The main manifestations of AFE are circulatory failure, respiratory failure and coagulation failure. Early identification, high quality cardiopulmonary resuscitation and opportune termination of pregnancy are the main treatment methods.

Analyze the characteristics of shoulder dystocia and reduce the complications of maternal and neonatal.

Clinical data of 16 cases of shoulder dystocia, who were admitted in the Obstetrics Department of the First Affiliated Hospital of the Army Military Medical University from January 2013 to December 2018, were retrospective analysis. The analysis indicators included high risk factors of shoulder dystocia, diagnosis of shoulder dystocia, assisted delivery methods and the maternal and fetal outcomes.

There were 16 252 cases of raginal delivery and 16 cases of dystocia of shoulder within 6 years, the incidence was 0.1%. Among the 16 patients with shoulder dystocia, 3 cases gave birth to giant babies, 4 cases were gestational diabetes, 5 cases were assisted delivery with instruments, and the other 4 cases had no high risk factors. 7 cases of shoulder dystocia were diagnosed as shoulder impaction after delivery of fetal head, 9 cases were diagnosed as shoulder impaction after delivery of fetal head and combined with "tortoise sign" . Sixteen cases were treated with 3-5 steps of seven steps in the management of shoulder dystocia and then finally delivered the baby through vagina. Maternal and infant outcomes: 1 case were postpartum hemorrhage, 11 cases were lateral episiotomy, 9 cases were soft birth canal injury, no body had serious perineal laceration; 14 newborns were good health, 1 newborn were found ptosis at 3 months old and 1 case lost visit.

Shoulder dystocia is still an unpredictable obstetric emergency. It is necessary to correctly judge the occurrence of shoulder dystocia, master the treatment process of shoulder dystocia, and quickly rescue, so as to reduce the complications of mother and child.

To investigate anesthesia methods, operation factors and infection factors effect on maternal and fetal outcome during non-obstetric surgery.

The clinical data of 87 pregnant women who needed surgical treatments for non-obstetric diseases from January 2015 to August 2018 in The Third Affiliated Hospital of Guangzhou Medical University were retrospectively analyzed. We documented their pregnancy outcome indexes such as gestational week, mode of delivery and premature birth rate. Then, the effects of different pregnancies, surgical methods, anesthetic methods and complications of infection on pregnant women′s were compared.

There are 35 cases of acute appendicitis (40.2%), 7 cases of uterine pregnancy complicated with ectopic pregnancy (8.1%), 9 cases of ovarian cyst pedicle torsion (10.3%), 21 cases of ovarian mass (24.1%), 13 cases of Urinary calculi (14.9%) and 2 cases of cholecystolithiasis (2.3%). There were no significant differences in pregnancy outcome among pregnant women undergoing non-obstetric surgery during different pregnancies (P>0.05). There were no significant differences in mode of delivery, gestational age, abortion rate and premature delivery rate between laparoscopy group and abdomen group (P>0.05). There were no significant differences in mode of delivery, gestational age, premature delivery rate and abortion rate between intravertebral anesthesia group and general anesthesia group (P>0.05). The pregnant women with infection had an effect on the pregnancy outcome. The gestational age of the infected group was lower than that of the control group [(34.7±0.7) weeks vs (38.5±0.2) weeks, Z=5.088, P<0.05]. The incident rate of cesarean section, premature delivery and abortion in the infection group were all higher than those in the control group [41.7% (10/24) vs 31.7% (20/63), χ²=7.585; 50% (12/24) vs 7.9% (5/63), χ²=19.588; 50.0% (12/24) vs 0, χ²=29.659; all P<0.05].

Non-obstetric surgery during pregnancy still can achieve satisfactory pregnancy outcome in the stable patients, while different kind of anesthesia and operation in different gestation will not affect the safety of the puerperant and fetus, but the progress of the disease itself may affect the pregnancy outcome for the co-infection patient.

To evaluate the clinical features and treatment of the coexistence of intrauterine pregnancy and interstitial tubal pregnancy after in vitro fertilization-embryo transfer(IVF-ET).

Clinical data of features and treatments of 6 patients with interstitial heterotopic pregnancy after IVF-ET, who were conducted in Bao′an Maternity and Child Healthcare hospital affiliated to Jinan University School of Medicine from March 2014 to December 2018, were analyzed retrospectively.

All the 6 patients were treated by surgery, including 4 patients of laparotomy and 2 patients of laparoscopic surgery. One patient had early abortion after surgery, the other 5 patients delivered successfully, without uterine rupture or neonatal malformation.

The majority of interstitial heterotopic pregnancy are diagnosed by transvaginal ultrasound. Surgical treatment can achieve good pregnancy outcomes, and laparoscopic surgery is feasible and safe.

To observe the clinical effect of suspensory fetal traction of induced abortion in special case with the right angle pulley tractor.

A retrospective analysis was conducted in 148 patients, who admitted to the Third Affiliated Hospital of Guangzhou Medical University to undergo induced abortion with medical indications from June 2013 to June 2016. According to whether the suspension of fetal traction was used in the abortion, patients were divided into traction group (40 cases) and control group (108 cases). The traction group was divided into rivanol+ traction group, miso+ traction group, water sac+ traction group and simple traction group according to different methods of induced abortion. The control group was divided into rivanol group, miso group and water sac group. Induced abortion related indicators and the complications were compared between different groups. T test or Chi-square tests were performed for test statistical analysis.

The success rate of the traction group (97.5%) was higher than that of the control group (83.8%), χ²=5.24, P<0.05. However, there was no significant difference in the incidence of postpartum hemorrhage, uterine rupture, cervical laceration and puerperal infection between the two groups (P>0.05).

Suspensory fetal traction of induced abortion in special cases with the right angle pulley tractor shortened the time of fetal discharge and avoided unnecessary cesarean section.