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Objective To explore the relation between single umbilical artery with other malformations and pregnancy outcome,and to provide evidence for pregnancy counseling and diagnosis.Methods The outcomes of 92 fetuses with single umbilical artery diagnosed and delivered in Beijing Obstetrics and Gynecology Hospital Affiliated to Capital Medical University from September 2007 to July 2009 were followed up and retrospectively analyzed with Chi-square test.Results Among 25 292 pregnant women,92 cases were finally diagnosed as single umbilical artery giving the incidence of 0.36％,among which 57.6％ (53/92) of newborns survived without malformations,15.2％(14/92) survived with malformations and 27.2％ (25/92) died during perinatal period.There were 36 fetuses (39.1％,36/92) with single umbilical artery complicated with other malformations,among which 29 had single malformation (80.6 ％ ),and seven ( 19.4 ％ ) had multiple malformations.The incidence of heart defects was the highest among the complicated malformations,and then followed by central nervous system,digestive system,motor system and urinary system.Thirty-three fetuses with single umbilical artery accepted karyotype analysis.Chromosome abnormality was diagnosed in three subjects (9.1％,3/33).Twenty-three fetus (25.0％,23/92) associated with small for gestational age,and among which 18 fetuses (78.3％,18/23) died with a higher mortality than that (4.0％,24/597) of small for gestational age patients without single umbilical artery (x2=181.71,P＜0.01).Conclusions Single umbilical artery is likely to be complicated with congenital anomalies.After single umbilical artery was diagnosed by routine ultrasound,fetal ultrasonography,echocardiography and amniocentesis for karyotype analysis is suggested.Fetal growth restriction is an important indicator of fetal adverse outcomes.
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Objective To identify the risk factors of adverse pregnancy outcomes in expectant management of pregnant women with early onset severe pre-eclampsia (EOSP). Methods Totally, 136 gravidas, who were diagnosed as ESOP and received expectant management from January 2007 to June 2008 in Beijing Obstetrics and Gynecology Hospital, were selected and divided into two groups; the favorable pregnancy outcome group (control, n=101)and the adverse pregnancy outcome group (n=35).The general clinical information, pregnancy outcomes, routine urine test, hemodynamic data, routine blood test, liver and renal function test on admission were collected and the risk factors for adverse outcomes were retrospectively analyzed.Results (1)General clinical information; more women complained of preeclamptic symptoms on admission in the adverse outcome group than in the control group (35.6% vs.57.1 %,P< 0.05).No significant differences was found between the two groups in the maternal age, times of previous pregnancies, prevalence of concurrent complications, pre-pregnant body mass index (BMI),proportion of women who had regular antenatal checks(P > 0.05).(2) Pregnant outcomes; the average duration of expectant management in the control group were similar to the adverse outcomes group [(6.5 ± 8.2) days vs.(6.8 ±10.0) days, P > 0.05].The main complications in the adverse outcome group included placental abruption (n=13), heart failure and pulmonary edema (n=10),hemolysis, elevated liver enzymes and low platelet syndrome (HELIP syndrome, n=5),and no eclampsia was reported.However, none of these complications was reported from the control group.(3)Blood pressure and proteinuria; the gestation ages at the onset of EOSP and at delivery in the control group were earlier than those of the adverse outcome group [(31.3 ± 3.4) weeks vs.(33.0 ± 4.9) weeks, (32.1 ± 3.0) weeks vs.(34.0 ± 3.6) weeks, P< 0.05],the systolic blood pressure and urinary protein and the proportion of women with urinary protein of (+ + +)were also much higher in the adverse outcome group (all P<0.05).(4) Hemodynamics and routine blood tests; the blood viscosity in the control group was obviously lower than that of the adverse outcome group (P< 0.05 ).But there was no significant difference in the cardiac output, cardiac index, peripheral resistance and vascular compliance between the two groups (P >0.05).The adverse outcome group showed lower platelet(PLT) level and higher red blood cell(RBC) count and hematocrit compared with those of the control(all P<0.01).(5)Liver and renal function; the alanine aminotransferase (ALT), aspartate aminotransferase (AST), lactate dehydrogenase (LDH),blood urea nitrogen(BUN) in the adverse outcome group were significantly higher than those of the control group (all P<0.05), but the plasma level of total protein (TP),albumin (Alb), uric acid (UA) and creatinine (Cr) were similar between the two groups(P>0.05).(6) Risk factor analysis: RBC count (OR =3.68, 95% CI: 1.90-7.13 ),PLT count (OR=0.99,95% CI:0.98-1.00) and the gestations at delivery (OR=0.87, 95% CI: 0.80-0.94) were the risk factors of adverse pregnancy outcomes during the expectant management of EOSP.Conclusion Elevated RBC count, reduced PLT count and earlier delivery weeks are the risk factors of adverse pregnancy outcomes during the expectant management of EOSP.
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Objective To investigate different factors related to fetal growth restriction (FGR) and to find out the possible causes of FGR with unclear etiologies. Methods Sixty-three women who were suspected of FGR during pregnancy between March 2002 and March 2003 were included in this study. Their age, body mass index (BMI) before pregnancy, and gestational weeks were recorded at the time when they were first diagnosed . Haemoglobin levels, haematocrit (HCT) ,TORCH, anticardiolipin antibody (ACA) , 50 gram glucose challenge test (50g GCT) , 75 gram oral glucose tolerance test (75g OGTT) , leptin levels, systolic/diastolic (S/D) ratio by color doppler monitor and chlamydia trachomatis (CT) were detected and urine culture was done in these groups during the same period. The gestational week, birth weight, body length and the gender were recorded at the delivery period. The FGR group was then divided into two subgroups according to the birth weights: study A group whose birth weights were lower than 10th% of the birth weights at the given gestational weeks (29 cases) and study B group whose birth weights were beyond 10th% (34 cases). The chromosome, leptin, C-peptide, insulin and TORCH of umbilical blood were measured at delivery. The other 25 normal pregnant women were included as control and the same tests were performed accordingly. Results The fasting glucose and the third hour's glucose of 75 gram oral glucose tolerance test of study A were( 3. 8 ?0, 6) mmol/L and (4. 5 ?1. 1) mmol/L. The fetal lepin, C-peptide, and insulin were (7.3 ? 5. 2) ng/ml, (0. 5 ? 0. 3) nmol/L and (2. 3 ? 1. 3 ) mU/L The S/D ratio of umbilical artery, maternal and fetal infection rate of CMV, positive rate of ACA-IgM and the rate of asymptomatic bacteriuria were 3.06, 20.7%, 24.1%, 44.8% and 62.1% respectively. The fasting glucose and the third hour's glucose of 75 gram oral glucose tolerance test of study B were (4. 4 ? 0. 7) mmol/L and (4. 6 ? 1. 1 ) mmol/L. The fetal lepin, C-peptide, and insulin were ( 13. 2 ? 11. 3 ) ng/ml, (0. 7 ? 0. 4) nmol/L and (4.3 ? 3.3) mU/L The S/D ratio of umbilical artery, maternal and fetal infection rate of CMV, positive rate of ACA-IgM and the rate of asymptomatic bacteriuria were 2. 63, 2. 9% , 0% , 5.9% and 44. 1% respectively. The fasting glucose and the third hour's glucose of 75 gram oral glucose tolerance test in control were (4. 3 ? 0. 7) mmol/L and (5. 3 ? 1.2) mmol/L. The fetal lepin, C-peptide, and insulin were( 20. 5 ? 12. 0) ng/ml, (1. 0 ? 0. 4) nmol/L and ( 6. 3 ? 4. 0) mU/L The S/D ratio of umbilical artery, maternal and fetal infection rate of CMV, positive rate of ACA-IgM and the rate of the asymptomatic bacteriuria were 2. 80, 0, 0, 0 and 24. 0% respectively. All these items were significantly higher in study A than those in the control (P
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Objective To investigate the relationship between amniotic fluid glucose concentration, amniotic fluid volume and neonatal birth weight in gestational diabetes mellitus (GDM). Methods Two hundred and fifty-five singleton, normal term pregnant women were divided into three groups: GDM, gestational impaired glucose tolerance (GIGT) and normal pregnancy according to the results of a 50 g, 1 hour glucose challenge test (GCT) or of a 75 g oral glucose tolerance test (OGTT). There were 85 study subjects in each group. All women had GCT at 24-28 gestational weeks. When they had a positive GCT, in which glucose level was ≥7.8 mmol/L,and 0.05), but was significantly higher than that in normal group, (12.7?3.2)cm (P0.05). (4) Among women with GDM, AFG was significantly correlated with AFI (r=0.330, P=0.002), NBW (r=0.347, P=0.001), MFG (r=0.589, P
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Objective To evaluate the effect of combination of HANS (Han's Acupoint Nerve Stimulator) and diazepam(D) or tramadol(T) on labor pain and influence on mother and infant. Methods Two-hundred and seventy normal term pregnancy and primipara with single vertex presentation were randomly divided into six groups, HANS+D ((HANS plus diazepam 10mg, iv), HANS, D(diazepam 10 mg, iv), HANS +T (HANS plus tramadol 100mg, im), T (tramadol 100mg, im) and control group . Pain relief methods were given when the cervix dilated to 2~3 cm. Labor pain was evaluated by VAS (visual analogue scale) at different stage. Results The effective rate of analgesia for HANS+D was the highest, 90.5%, for HANS+T and HANS were 78.9% and 59.8%, respectively. The VAS of the groups combination of HANS and drugs at the time one hour after analgesia, cervix dilating 7~8 cm, second stage, were much lower than that before analgesia and that of control group (P