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Gallbladder dysplasia is not common but can be associated with chromosome abnormality and/or some severe complications such as biliary atresia and cystic fibrosis. Therefore, prenatal detection of this problem is of great significance for timely management after birth. However, abnormal gallbladder development is often overlooked in routine mid-term fetal ultrasound scanning. Here, we reviewed the research progress on fetal gallbladder dysplasia, including clinical characteristics and perinatal prognosis of gallbladder duplication, echo substances in gallbladder and gallbladder cholelithiasis, ectopic gallbladder, gallbladder enlargement, and cystic fibrosis, and summarized the types, incidence, clinical features, prenatal diagnosis and perinatal prognosis of non-visualized fetal gallbladder, in order to emphasize the prenatal screening of fetal gallbladder dysplasia.
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Placenta, the direct and vital connection between mother and fetus, can be considered as an inflammatory organ that plays an essential role in maternal-fetal immune tolerance in maintaining pregnancy and mediating inflammation in some gestational complications. When gestational diabetes mellitus (GDM) occurs, the mother and placenta are in a state of mild inflammation. We hypothesize that the placental immune cells may participate in the pathogenesis of GDM. This review discusses the relation between placental immune cells and GDM from three aspects: the regulatory function of the placental immune cells, the association between abnormal placental immune cells and GDM, and the function of placental immune cells during clinical management of GDM.
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Gestational diabetes mellitus (GDM) refers to the carbohydrate intolerance of variable severity with onset or first recognition during pregnancy.In recent years,the growing prevalence of obesity and GDM has been of long-standing interest.Maternal obesity is an independent risk factor of GDM,which can lead to adverse pregnancy outcomes.This review describes the relationship between maternal obesity and GDM from the aspects of the evaluation index and the management of obesity during pregnancy.
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Objective@#To investigate the principles of diagnosis and treatment of breast cancer during pregnancy.@*Methods@#Clinical data of patients with breast cancer during pregnancy admitted to Obstetrics and Gynecology Hospital of Fudan University between January 2012 to July 2017 were analyzed retrospectively. A total of 17 patients were diagnosed with breast cancer in pregnancy, the median age was 32 years (range from 25 to 45 years old), pathological staging revealed 2 patient with stage 0, 1 with stage Ⅱa, 7 with stage Ⅱb, 1 with stage Ⅲa, 2 with stage Ⅲc, 4 with stage Ⅳ.@*Results@#Thirteen patients received surgical treatment in pregnancy, the gestational age at surgery was (27.7±4.6) weeks; 2 patients with ductal carcinoma in situ received mastectomy, 11 patients with breast cancer underwent modified radical mastectomy. In patients undergoing surgery during pregnancy, no prophylactic contractions were used in 4 patients who had been treated earlier, there were 2 patients with frequent contractions within 24 hours after operation in these patients. Follow-up 9 patients were given oral nifedipine to prevent contractions, no obvious contractions occurred after the operation. Seven patients received chemotherapy during pregnancy; the chemotherapy of 4 cases of triple negative breast cancer was weekly paclitaxel sequential epirubicin and cyclophosphamide, the chemotherapy of the other three patients was docetaxel sequential epirubicin and cyclophosphamide. Fifteen patients underwent cesarean section to terminate pregnancy, 2 patients underwent spontaneous labor. The gestational age of birth was (36.9 ±1.3) weeks. Less than 35 weeks of termination of pregnancy occurred in one patient, the fetus was delivered to the neonatal intensive care unit due to neonatal respiratory distress syndrome, and suffered from congenital dysaudia. The prognosis of the other 16 survived infants was good. The median follow-up time was 10 months (range from 4 to 27) months, in 13 patients of stage 0 to Ⅲc, one patient were diagnosed with bone metastasis at 12 months after surgery, the remaining 12 patients had no disease progression, the progression free survival rate was 12/13, the overall survival rate was 13/13. Among the 4 patients with stage Ⅳ, one died in 7 months after delivery, one had new liver metastasis in 8 months after delivery. The remaining 2 patients were in stable condition.@*Conclusions@#Breast cancer in pregnancy can be treated effectively, multidisciplinary cooperation and detailed assessment of maternal-fetal risks and benefits are necessary. Chemotherapy during pregnancy is safe for maternal-fetal, but it needed a large sample of clinical studies and long-term follow-up. The neonatal outcome was associated with gestational age, and therefore premature delivery was avoided as much as possible during treatment.
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Objective To improve the awareness of fetal cardiac rhabdomyomas (CRs) and investigate a better model for prenatal diagnosis and treatment through analyzing imaging findings and prognosis.Methods A retrospective study was conducted on 23 cases of CRs which were diagnosed by ultrasound in Obstetrics and Gynecology Hospital of Fudan University from January 2008 to November 2015.General conditions,imaging features,prognosis and follow-up data of the 23 cases were described.Results The average gestational age of the 23 fetuses at diagnosis was (29.8±4.1) (22.4-35.7) weeks.Seventeen out of the 23 gravidas received prenatal multidisciplinary consultation.Among all 23 gravidas,three (13％) were lost to follow-up,12 (52％) decided to terminate the pregnancy,and the other eight (35％) continued to term pregnancy and their babies were followed up for three years.Of these eight cases,two cases received prenatal brain MRI and no tuberous sclerosis complex (TSC) was detected,no CRs was identified during the follow-up,and their physical and mental developments were both normal.One case was diagnosed with suspected subependymal nodules by prenatal brain MRI in our hospital,but the MRI images was normal when scanned in the other hospital,and follow-up data revealed neither CRs nor abnormal physical and mental developments.Four cases did not received prenatal brain MRI,but the MRI images of neonatal brains indicated TSC,besides,follow-up data showed that seizures were observed,physical developments were all normal,but three of the four cases had mental retardation;CRs disappeared in only two of the four cases.One case had neither prenatal nor neonatal MRI,but follow-up data showed that CRs had disappeared and physical and mental developments were both normal.Conclusions Prenatal diagnosis of fetal tuberous sclerosis is crucial to the prognosis of CRs.Prenatal ultrasonography in combination with cranial MRI improves the accuracy of prenatal diagnosis of CRs complicated with TSC and assists in clinical decision-making and prognosis analysis.
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Objective To analyze the natural changes of maternal thyroid function among women with subclinical thyroid dysfunction and euthyroid women during pregnancy.Methods A total of 4 042 singleton pregnant women received routine antenatal care in the Obstetrics and Gynecology Hospital of Fudan University between April and November 2012 were enrolled.Thyroid-stimulatinghormones (TSH),freetriiodothyronine (FT3) and free thyroxine (FT4) of 7 136 samples from 4 042 singleton pregnant women were tested at 8-12+6,13-19+6,20-27+6,and 28-40 weeks of gestation and were used to establish the normal gestationalspecific reference values of thyroid function.Among 3 895 women having thyroid function tested at 8-19+6 weeks of gestation with negative thyroid antibodies,there were 93 cases of subclinical hyperthyroidism,91 cases of subclinical hypothyroidism (SCH),three cases of hyperthyroidism and 3 708 cases euthyroid.There were 1 118 women [1 607 euthyroid cases,17 cases of subclinical hypothyroidism (SCH) and 34 cases of subclinical hyperthyroidism] had thyroid function retested at 20-27+6 and 28-40 weeks of gestation,and without medicinal intervention.Analysis of variance and LSD test were used to analyze the changes of maternal thyroid function.Results (1) The reference ranges of TSH at 8-12+6,13-19+6,20 27+6 and 28-40 weeks of gestation [median (Pz5-P97.5)] were 1.32 (0.03-4.17),1.83 (0.19-4.94),2.27 (0.70-5.42) and 2.34 (0.63-5.52) mU/L respectively.(2) Without medicinal intervention,thyroid function became normal in 80％ (45/56) SCH women at 20-27+6 weeks,but 20％ (9/45) of them developed SCH again at 28-40 weeks.The thyroid function became normal in 75％ (70/93) women with subclinical hyperthyroidism at 20-27+6 weeks,but in 15％ (14/93) of them,thyroid function remained abnormal at 28-40 weeks.9.40％ (30/319) and 6.25％ (21/336) euthyroid women with TSH ≥ 3 mU/L at 8-19+6 weeks of gestation developed SCH at 20-27+6 weeks and 28-40 weeks,while 0.42％ (5/1 202) and 0.86％ (10/1 163) euthyroid women with TSH ＜3 mU/L had SCH.1.66％ (20/1 202) and 1.98％ (23/1 163) euthyroid women with TSH＜3 mU/L at 8-19+6 weeks of gestation developed subclinical hyperthyroidism at 20-27+6 weeks and 28-40 weeks of gestation.(3) In comparison between 8-19+6 weeks and 20-27+6 weeks of gestation,TSH levels increased by (0.47±0.03) mU/L in euthyroid women,and more significantly in subclinical hyperthyroidism women [(0.82±0.06) mU/L],but decreased by (1.67±0.25) mU/L in SCH women (LSD test,all P＜0.05).The FT3 levels decreased by (0.47±0.02) pmol/L in euthyroid women,and more significantly in subclinical hyperthyroidism and SCH groups [(1.02± 0.18) and (0.72±0.08) pmol/L,LSD test,all P＜0.05].FT4 decreased by (2.31 ±0.04) pmol/L in euthyroid women,and more significanly in subclinical hyperthyroidism women [(4.63± 0.62) pmol/L] (LSD test,P＜0.05),but the decrement in SCH group [(1.78±0.28) pmol/L] was similar to euthyroid women (LSD test,P＞0.05).There were no significant differences in changes of TSH,FT3 and FT4 at 20-27+6 weeks and 28-40 weeks among euthyroid women,SCH and subclinical hyperthyroidism groups (F=1.01,1.14 and 2.04,all P＞0.05).Conclusions Women with subclinical thyroid dysfunction with negative thyroid antibodies experience significantly different natural changes when compared with euthyroid women,especially before 28 weeks of gestation.
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Objective To investigate the characteristics of diet in patients with gestational diabetes mellitus(GDM) and analyze their dietary nutrition.Methods Clinical data of 978 cases of pregnant women in our hospital were collected and divided into GDM group(458 cases) and the healthy control group (520 cases).Dietary questionnaire was designed and diet characteristics were analyzed retrospectively.Daily calories and nutrients intake were calculated by software calculation.Results There were significant differences on the dietary pattern between the two groups:daily coarse grains:(35.12 ±4.87) g vs (46.35 ±5.23) g;seafood:(22.10 ± 8.45) g vs (39.34 ± 12.45) g;grilled:(6.72 ± 1.76) g vs (3.45 ±0.34) g;fried:(25.34 ± 7.84)g vs (10.56 ±4.76) g;sausage:(5.38 ± 1.81) g vs (3.45 ± 0.45) g;dessert type products intake:(50.41 ±20.76) g vs (35.86 ± 10.45) g (t =2.582,10.346,15.452,20.239,18.195,8.472,respectively,P ＜0.05).There was only significant difference between the two groups on calcium supplements in daily intake of nutritional supplements(GDM group 43.89％,control group 72.69％,x2 =83.660,P ＜ 0.001),and there was no significant difference on the rests(all P ＞ 0.05).Vitamin A,B1,B2,C and calcium,iron,zinc,selenium daily intake in GDM patients were less than those in the control group,but there was significant difference only in calcium compared with the control group (GDM group (785.2 ± 194.5) mg,control group (945.5 ± 245.2)mg,t =2.795,P =0.005).Multivariate logistic regression found that excessive intake of fried class (OR =3.357,95％ CI =2.012-11.340),barbecue (OR =2.652,95％ CI =1.834-8.578),sausage type products (OR =2.518,95％ CI =1.743-7.421) etc.were dietary factors of GDM (all P ＜ 0.05).Incidence of GDM was significantly increased if taking more.While the increased intake of coarse grains (OR =0.632 95％ CI =0.134-1.489),seafood class(OR =0.408,95％ CI =0.105-1.189) can reduce the occurrence of GDM(all P ＜ 0.05).Conclusion Many unscientific ways of eating involved in pregnant women with GDM.Dessert,sausage,grilled,fried products intake increased the risk factors for GDM.Coarse grains,seafood intake were the protective factors of GDM.Timely adjustment of maternal diet and adequate calcium supplementation played an important role in the prevention of GDM.
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Objective To elucidate the influence of fetal genotype in both non-diabetic gravidas and pregnant women on gestational diabetes mellitus (GDM) through analysis of the genotype discrepancy between maternal and fetal Pro12A1a single nucleotide polymorphism (SNP) of peroxisome proliferator-activated receptor gamma 2 (PPARG2) genes.Methods Pregnant women,who delivered in the Obstetrics and Gynecology Hospital of Fudan University from October 2005 to February 2007,and their newborn babies were selected,and were divided into GDM and control group.The GDM group consisted of 55 gravidas with GDM and 40 newborns born to the GDM mothers,and the control group consisted of 173 healthy gravidas and their 50 neonates.Polymerase chain reaction-denaturing high-performance liquid chromatography was applied to detect the distribution of PPARG2 Pro12Ala alleles in all subjects.The concentrations of plasma fasting blood sugar (FBS) and several bio-markers of lipids,including total cholesterol,triglyceride,apoprotein A,high-density lipoprotein and low-density lipoprotein,were also tested for the mothers.Results (1) No significant difference was found in the frequencies of Pro/Pro genotype between the GDM mothers and control mothers (94.6% vs 90.8%,P > 0.05),nor between the GDM offspring and control offspring (95.0% vs 94.0%,P >0.05) or between the GDM mothers and GDM offspring (P > 0.05).The same was shown in the frequencies of Pro/Ala genotype both between the GDM mothers and control mothers (5.5% vs 9.2%,P >0.05) and between the GDM offspring and control offspring (2.5% vs 3.0%,P > 0.05).(2) Within both GDM and control group,the maternal FBS and various lipids concentrations of Pro/ Pro genotype gravidas showed no significant difference compared to those of Pro/Ala genotype mothers (P > 0.05).(3) Based on the four possible PPARG2 genotype pairs between the mothers and fetuses,Pro/Pro mother and her Pro/Pro fetus,Pro/Ala mother and her Pro/Ala fetus,Pro/Ala mother and her Pro/Pro fetus,and Pro/Pro mother and her Pro/Ala fetus,less Pro/Pro pairs and more Pro/Ala pairs were found in the GDM group than in the control (72.5% vs 92.0%,P=0.014; 27.5% vs 6.0%,P< 0.05).Conclusions Neither the maternal nor the offspring's Pro/Ala genotypes is associated with the genesis of GDM.However,the discrepancy of PPARG2 Prol2Ala polymorphism between mother and her fetus implies a possible cause of GDM.
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Objective: To investigate the mRNA expression of chemokine receptors in human villi and trophoblasts of first trimester gestation . Methods: The authors first obtained villous tissues from fifteen women who had undergone selective termination at 5 - 10 weeks of normal gestation. Total RNA was then extracted, using the TRIzol reagent, from villous tissues or Percoll-gradient purified trophoblasts. Consequently, the expressions of chemokine receptors in villous tissues and trophoblasts were investigated by way of semi-quantitative reverse transcriptase-polymerase chain reaction.Results: The chemokine receptors, CXCR4 and CXCR6, were highly expressed in each villous tissue, while the CCR6, CCR7, XCR1 and CX3CR1 were moderately expressed in villi. The chemokine receptors, CCR1- CCR5, CCR8 - CCR10, CXCR1 -CXCR3, were expressed only in some villous samples, while no CXCR5 mRNA was found in any villous tissue. The authors also found that the freshly isolated and Percoll-purified trophoblasts expressed CCR1, CCR3 - CCR5, CCR8 - CCR9, CXCR1 - CXCR4, CXCR6, XCR1 and CX3CR1 mRNA. Conclusion: A variety of chemokine receptors were expressed in villous tissues and trophoblasts of human first trimester gestation, hence, these receptors may play an important biological role at the materno-fetal interface in normal human pregnancy.