Clinical analysis of 86 cases of acute fatty liver of pregnancy / 中华妇产科杂志

Objective: To investigate the clinical characteristics and maternal and fetal prognosis of pregnant women with acute fatty liver of pregnancy (AFLP). Methods: The clinical data of 86 AFLP pregnant women admitted to the Third Affiliated Hospital of Guangzhou Medical University from September 2017 to August 2022 were collected, and their general data, clinical characteristics, laboratory tests and maternal and fetal outcomes were retrospectively analyzed. Results: (1) General information: the age of the 86 pregnant women with AFLP was (30.8±5.4) years, and the body mass index was (21.0±2.5) kg/m2. There were 50 primiparas (58.1%, 50/86) and 36 multiparas (41.9%, 36/86). There were 64 singleton pregnancies (74.4%, 64/86) and 22 twin pregnancies (25.6%, 22/86). (2) Clinical characteristics: the main complaints of AFLP pregnant women were gastrointestinal symptoms, including epigastric pain (68.6%, 59/86), nausea (47.7%, 41/86), anorexia (46.5%, 40/86), vomiting (39.5%, 34/86). The main non-gastrointestinal symptoms were jaundice of skin and/or scleral (54.7%, 47/86), edema (38.4%, 33/86), fatigue (19.8%, 17/86), bleeding tendency (16.3%, 14/86), polydipsia or polyuria (14.0%, 12/86), skin itching (8.1%, 7/86), and 17.4% (15/86) AFLP pregnant women had no obvious symptoms. (3) Laboratory tests: the incidence of liver and kidney dysfunction and abnormal coagulation function in AFLP pregnant women was high, and the levels of blood ammonia, lactate dehydrogenase and lactic acid were increased, and the levels of hemoglobin, platelet and albumin decreased. However, only 24 cases (27.9%, 24/86) of AFLP pregnant women showed fatty liver by imageology examination. (4) Pregnancy outcomes: ① AFLP pregnant women had a high incidence of pregnancy complications, mainly including renal insufficiency (95.3%, 82/86), preterm birth (46.5%, 40/86), hypertensive disorders in pregnancy (30.2%, 26/86), gestational diabetes mellitus (36.0%, 31/86), fetal distress (24.4%, 21/86), pulmonary infection (23.3%, 20/86), disseminated intravascular coagulation (16.3%, 14/86), multiple organ dysfunction syndrome (16.3%, 14/86), hepatic encephalopathy (9.3%, 8/86), and intrauterine fetal death (2.3%, 2/86). ② Treatment and outcome of AFLP pregnant women: the intensive care unit transfer rate of AFLP pregnant women was 66.3% (57/86). 82 cases were improved and discharged after treatment, 2 cases were transferred to other hospitals for follow-up treatment, and 2 cases (2.3%, 2/86) died. ③ Neonatal outcomes: except for 2 cases of intrauterine death, a total of 106 neonates were delivered, including 39 cases (36.8%, 39/106) of neonatal asphyxia, 63 cases (59.4%, 63/106) of neonatal intensive care unit admission, and 3 cases (2.8%, 3/106) of neonatal death. Conclusions: AFLP is a severe obstetric complication, which is harmful to mother and fetus. In the process of clinical diagnosis and treatment, attention should be paid to the clinical manifestations and laboratory tests of pregnant women, early diagnosis and active treatment, so as to improve maternal and fetal outcomes.

Establishment and exercise of a rapid response team for obstetrics / 中国实用妇科与产科杂志

Because of the mutation,variability and variability of obstetric conditions,it is particularly important to establish a rapid response team in the maternity department that can effectively deal withmaternal conditions at an early stage of development,rather than waiting for their deterioration before resuscitating them.The establishment of obstetric RRT requires the support of hospitals,obstetrics and other departments.Training,drills,and assessments after the completion of the RRT also need to be carried out regularly,so that the RRT team continues to be improved.

Perinatal monitoring of fetal growth restriction / 中国实用妇科与产科杂志

Based on domestic and international guidelines,clinical researches and expert consensus,it is stated that fetal growth restriction is the fetal low weight,clinically accompanied by abnormal placenta and umbilical cord blood flow.This paper summarized the significance and clinical value of the color Doppler detection during perinatal period,and discussed the measures to reduce the adverse outcome of fetal growth restriction during delivery.

Surgical site infection following cesarean section / 中国实用妇科与产科杂志

With the opening of the second-child policy and the increase of cesarean section rate,the incidence of surgical site infection after cesarean section also increases,which seriously affects the physical recovery after delivery.In this paper,the types of infection bacteria,high risk factors,prevention,diagnosis and treatment measures are comprehensively expounded.It is emphasized that early identification of risk factors and establishment of effective prevention and treatment measures are essential to reducing the incidence and mortality of incision infection in cesarean section.

Clinical efficacy and safety of controlled-release dinoprostone insert: a multicenter retrospective study / 南方医科大学学报

<p><b>OBJECTIVE</b>To analyze the effectiveness and safety of controlled-release dinoprostone insert for term labor induction in the Pearl River Delta of Guangdong province.</p><p><b>METHODS</b>Twenty hospitals using controlled-release dinoprostone insert for term labor induction in the Pearl River Delta of Guangdong province were stratified into provincial hospitals and municipal hospitals, and three hospitals of each level were selected as research units. According to the inclusion and exclusion criteria, 1390 pregnant women receiving term labor induction using controlled-release dinoprostone insert were retrospectively analyzed to evaluate the the effectiveness and safety with another 957 pregnant women with induced abortion using oxytocin as the control group.</p><p><b>RESULTS</b>Compared with the control group, the controlled-release dinoprostone insert group showed a significantly longer length of the latent phase of labor (4.06∓2.65 vs 3.20∓2.08 h, P=0.003, 95%CI [0.182, 0.920]) and shorter lengths of the active phase (1.73∓1.32 vs 2.22∓1.75 h, P=0.000, 95%CI [-0.795, -0.363]) and the second stage of labor (0.49∓0.37 vs 0.54∓0.43 h, P=0.003, 95%CI [-0.137, -0.028]). No significant differences were found in the length of the first stage of labor, the vaginal delivery rate, adverse reactions, or fetal outcomes between the two groups.</p><p><b>CONCLUSION</b>Controlled-release dinoprostone insert is effective and safe for labor induction at term.</p>

Effects of danshen on NO and ET-1 secreted by endothelial cells induced by the serum of pre-eclampsia patients / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To explore the protective effects of danshen (Salvia Miltiorrhiza) on vascular endothelial cells in hypertension patients in the gestation period.</p><p><b>METHODS</b>The umbilical vein endothelial cells pre-incubated with Danshen solution at different concentrations (0, 100, 200, and 300 mg/L) were randomly divided into 3 groups, i.e., the blank control group (8 cases), the normal control group (14 cases, cultured in the serum from 14 normal pregnant women), and the observation group (14 cases, cultured in the serum from 14 pregnant women with severe pre-eclampsia). The levels of nitric oxide (NO) and endothelin-1 (ET-1) in each culture supernatant were detected respectively.</p><p><b>RESULTS</b>The ET-1 level was higher in 300 mg/L Danshen solution group than in 0 mg/L and 100 mg/L Danshen solution groups (P <0.05). The NO level was lower in the observation group than in the blank control group and the normal control group (P <0. 05). The NO level was higher in 200 mg/L Danshen solution group than in 0 mg/L Danshen solution group (P <0.05). The NO level was higher in 300 mg/L Danshen solution group than in 0 mg/L, 100 mg/L, and 200 mg/L Danshen solution groups (P <0.05).</p><p><b>CONCLUSION</b>Danshen could increase the secretion of NO from in vitro umbilical vein endothelial cells cultured in the serum from patients with pre-eclampsia, and reduce the secretion of ET-1.</p>

Prevalence and major risk factors of peripartum thromboembolic disease in different regions of Guangdong province / 中华流行病学杂志

Objective To investigate the prevalence and major risk factors of peripartum thromboembolic disease in different regions of Guangdong province.Methods Data from 169 218pregnant women in different regions of Guangdong province from January 2005 to June 2010 were analyzed retrospectively.The prevalence and epidemiological characteristics of thromboembolic disease during pregnancy or puerperium were investigated.Results Of the studied population,( 1 )20 l cases ( 1.3‰ ) suffered from thromboembolic disease during pregnancy or puerperium including 128 cases of deep vein thrombosis (DVT),68 cases of cerebral venous thrombosis (CVT) and 5pulmonary embolism,the prevalence rates were 0.8‰,0.4‰,and 0.02‰ respectively.(2) Risk factors in different regions showed that,in the Pearl River Delta area,the major risk factors for DVT would include previous or family history of thrombosis,pregnancy complications,with medically involved diseases,prolonged bed rest and pregnancy weight gain ＞ 15 kg etc.While in castern,western,northern parts of Guangdong,the major risk factors for DVT would include pregnancy weight gain ＞ 15 kg,prolonged bed rest,preeclampsia,cesarean section and complications during pregnancy.In Pearl River Delta region,the major risk factors for CVT would include eclampsia,preeclampsia,pregnancy complications,prolonged bed rest ＞3 days,past history or family history of thrombosis.While eclampsia,preeclampsia,advanced age or younger age,pregnancy weight gain ＞15 kg,complications during pregnancy were the major risk factors for CVT in the eastern,western or northem parts of Guangdong.Conclusion Prevalence and major risk factors of peripartum thromboembolic disease in different regions of Guangdong were different.It was crucial to take effective measures in pregnant women with different epidemiological characteristics and risk factors to prevent and reduce the incidence of peripartum thromboembolic disease.

Mouse sperm DNA damage induced by exogenous BDE-209 / 南方医科大学学报

<p><b>OBJECTIVE</b>To assess the DNA damage in mouse sperms induced by exogenous BDE-209 and explore the possible mechanism of BDE-209 in affecting normal zygote development.</p><p><b>METHODS</b>Mouse sperms were harvested from the epididymal tail and suspended in HTF medium for a 90-min exposure to BDE-209 at varied concentrations of 0, 2.5, 5.0, 10, and 20 µg/ml (groups A-E, respectively). After the exposure, the sperms were subjected to single-cell gel electrophoresis (SCGE) to assess the DNA damage.</p><p><b>RESULTS</b>The tail length of the sperms averaged 1.15 ∓ 1.27 µm in group A. Exposure to 10 and 20 µg/ml BDE-209 resulted in a significant lengthening of the sperm tails (2.13 ∓ 1.29 µm and 2.83 ∓ 2.46 µm, respectively, P<0.01) as well as increased DNA content in the tail of the cells (P<0.01). The Olive tail moment in group A was 0.270 ∓ 0.322, and increased after BDE-209 exposure to 0.453 ∓ 0.375 and 808 ∓ 0.822 in groups D and E, respectively. The tail/head length ratio in groups C, D, and E (0.077 ∓ 0.093, 0.112 ∓ 0.068, and 0.191 ∓ 0.207) were significantly greater than that in group A (0.045 ∓ 0.049). The DNA damage of the mouse sperms was directly correlated to the concentrations of BDE-209, with correlation coefficients all above 0.9.</p><p><b>CONCLUSIONS</b>Exogenous BDE-209 can cause mouse sperm DNA damage and lead to sperm DNA chain breakage, and this effect shows an obvious dose dependence.</p>

Correlation between sleep apnea hypopnea syndrome and preeclampsia and the possible pathogenesis of preeclampsia / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the relationship between sleep apnea-hypopnea syndrome (SAHS) and preeclampsia and the possible pathogenesis of the latter.</p><p><b>METHODS</b>Twenty-five healthy pregnant women, 43 pregnant women with preeclampsia, and 27 with preeclampsia complicated by SAHS were enrolled in this study. Apnea-hypopnea index (AHI) and the lowest arterial oxygen saturation (LSaO2) were measured through a 7-hour polysomnography (PSG), and the maternal age, gestational age, body mass index and 24-hour urine protein were recorded.</p><p><b>RESULTS</b>All the indexes except for the maternal age and gestational age showed significant differences between the 3 groups. The two groups of preeclampsia patients showed a significant difference in BMI from the control cases. Significant positive correlations of AHI to BMI, MAP and 24-hour urine protein were noted; LSaO2 was found to inversely correlate to BMI, MAP, and 24-hour urine protein. In spite of the significant correlation of BMI to the other indexes, we found that BMI was less important than AHI and LSaO2.</p><p><b>CONCLUSION</b>SAHS may induce or aggravate preeclampsia. Greater attention should be given to the presence of SAHS in pregnant women with obesity, but obesity is not the predominant predisposing factor for preeclampsia.</p>

Clinical application of the Epworth sleepiness score in pregnant women with obstructive sleep apnea-hypopnea syndrome / 南方医科大学学报

<p><b>OBJECTIVE</b>To provide a convenient method for screening obstructive sleep apnea-hypopnea syndrome (OSAHS) in pregnant women.</p><p><b>METHODS</b>Seventy-eight pregnant women with suspected OSAHS were calculated for the EP index using Epworth sleepiness score (ESS) with also measurement of the neck circumference (NC) and body mass index (BMI). The apnea/hypopnea index (AHI) was calculated and the lowest SaO(2) (LSaO(2)) measured through a 7-h polysomnography (PSG). The women were then divided into 4 groups according to the AHI and LSaO(2). The ESS was compared with the PSG-AHI and the receiver operating characteristic curve (ROC) was generated.</p><p><b>RESULTS</b>All the clinical indexes (NC, BMI, EP, AHI, and LSaO(2)) showed significant differences between the 4 groups (P<0.05). EP and PSG were found to have greater correlations to AHI (r=0.759, P=0.000) than NC (r=0.668) and BMI (r=0.663). The area under the ROC of the EP (0.825) was greater than that of NC (0.772) and BMI (0.784). The index of EP showed greater clinical diagnostic value of OSAHS in pregnancy. Base on the ROC, EP at the optimal operating point of 7.5 had a sensitivity of 76.8% and specificity of 68.2% for diagnosis of OSAHS in pregnant women.</p><p><b>CONCLUSION</b>The ESS is an economic and convenient method for screening OSAHS in pregnant women with high diagnostic sensitivity and specificity.</p>

Effect of maternal BDE-209 exposure on the learning and memory ability of offspring rats and the dose-effect relation / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the effect of maternal brominated diphenyl ethers-209 (BDE-209) exposure on the learning and memory ability of the offspring rats in prenatal and lactational periods.</p><p><b>METHODS</b>After confirmation of successful mating, female Wistar rats were randomized into 5 groups and subjected to daily oral gavage of peanut oil suspensions containing BDE-209 at the doses of 100 mg/kg (group A), 300 mg/kg (group B), 600 mg/kg (group C), and 1200 mg/kg (group D), or only peanut oil (group E, as control). From each group, 20 male weaning rats of the first generation were randomly selected to examine their learning and memorizing ability using Morris water maze. The histological alterations of the hippocampus were observed microscopically with HE staining after the test.</p><p><b>RESULTS</b>During the initial one or two days of water maze test, no significant difference was noted in the escape latency between the groups (P=0.068, P=0.104). On days 3 to 5, groups B, C, and D showed prolonged escape latency as compared with the control group (P<0.05), but group A showed no such changes (P>0.05). Under optical microscope, the hippocampus in groups A and B exhibited no significant variation from that of the control group, but in groups C and D, the neural cells were obviously reduced and presented disorderly alignment, with substantial cell nuclear shrinkage and interstitial edema.</p><p><b>CONCLUSION</b>Maternal BDE-209 exposure induces disturbance of the learning and memorizing ability and pathological changes of the hippocampus in the offspring rats, and these changes show a dose-effect relation.</p>

Effect of maternal BDE-209 exposure on the expression of GAP-43 and BDNF in the hippocampus of the offspring rats / 南方医科大学学报

<p><b>OBJECTIVE</b>To evaluate the effect of prenatal and lactational exposure to brominated diphenyl ethers-209 (BDE-209) on the expression of growth associated protein-43 (GAP-43) and brain-derived neurotrophic factors (BDNF) in the hippocampus of the offspring rats.</p><p><b>METHODS</b>Peanut oil suspensions of commercial BDE-209 were administered daily at doses of 100, 300, 600, and 1200 mg/kg by oral gavage in pregnant Wistar rats (groups A, B, C, and D, respectively). The control group (E) only received peanut oil of an equivalent volume. The hippocampus was isolated from 10 offspring rats in each group to determine the expression of GAP-43 and BDNF using immunohistochemistry.</p><p><b>RESULTS</b>The GAP-43 in the BDE-209-treated groups were lower than that of the control group, and decreased with the increase of the dose of BDE-209 exposure. The groups C and D (P=0.013, P=0.000), but not the groups A and B (P=0.177, P=0.093), showed significant difference from the control group in GAP-43 expression. The positive expression of BDNF in the hippocampus was decreased as the exposure dose to BDE-209 increased, and significant differences were found between the groups B, C, D and the control group (P=0.033, P=0.005, P=0.001, respectively), but not between group A and the control group (P=0.066).</p><p><b>CONCLUSIONS</b>Maternal BDE-209 exposure can decrease the expression of GAP-43 and BDNF in the hippocampus of offspring rats, which may affect the axonal plasticity and regeneration of the neurons.</p>

Impact of PBDE-209 exposure during pregnancy and lactation on immune function of offspring rats / 南方医科大学学报

<p><b>OBJECTIVE</b>To assess the potential hazard of environmental deca-brominated diphenyl ether (PBDE-209) exposure to the immune function of the offspring rats.</p><p><b>METHODS</b>The parental Wistar rats were exposed to PBDE-209 administered intragastrically during pregnancy and lactation, and the development of the immune organs and changes in T lymphocyte subset and their proliferation, NK cell surface markers CD161 and serum immunoglobulins (IgM and IgG) were observed.</p><p><b>RESULTS</b>Significant differences in the weight of the immune organs were noted between the exposure group and control group. In the exposure group, the percentage of T lymphocyte subset CD3(+), CD4(+), CD8(+), CD4(+)CD8(+), the percentage of NK cell surface markers CD16 1 and CD4(+)/CD8(+) ratio were lowered, while the percentage of CD4(-)CD8(-) cells increased. T lymphocyte subset proliferation in the exposure group did not show obviously changes, but compared with the control group, the IgM level in the exposure group was significantly lowered. No significant differences were observed in IgG levels between the exposure and control groups.</p><p><b>CONCLUSION</b>Continuous exposure to high-dose PBDE-209 in female rats during pregnancy and lactation results in possible adverse effect on the immune function of the offspring rats.</p>

Clinical analysis of 206 pregnant patients with multiple organ dysfunction syndrome / 中华妇产科杂志

Objective To analyze 206 cases of pregnant women with multiple organ dysfunction syndrome(MODS)due to different primary diseases and the prognosis.Method A retrospective study was conducted of 206 cases of pregnant women with MODS who were treated during January 2000 to December 2006 in the Third Affiliated Hospital of Guangzhou Medical College,regarding their primary disease and prognosis.Results Fourty-four cases among the 206 pregnant women with MODS died.The main primary causes were postpartum hemorrhage in 63 cases(30.6%),severe preeclampsia or eclampsia 60 cases (29.1%),pregnancy with hepatitis C in 23 case(11.2%),pregnancy with heart disease in 11 cases (5.3%),12 cases of ectopic pregnancy(5.8%).The mortality was mainly because of pregnancy complicated with heart disease(63.6%),ectopic pregnancy(41.7%),pregnancy with hepatitis (22.7%),of postpartum hemorrhage(17.5%)and severe preeclampsia-eclampsia(11.7%).The difference was statistically significant(P