ABSTRACT
Abstract The purpose of this work was to analyze the high-risk factors of complications in the trial of vaginal delivery of a subsequent pregnancy for scar uterus after a previous cesarean. 136 pregnant women with scar uterus with a history of cesarean who were admitted to our obstetrics department from February 2016 to March 2019 were selected and were divided into a successful group and a failed group according to the results of pregnancy and trial of labor vaginal delivery. General data of before, during, and after delivery were collected and the high-risk factors for failed vaginal delivery of scar uterine were analyzed by the logistic regression analysis. Among the 136 patients, 108 cases (79.41%) of vaginal trials were successful, and 28 cases (20.59%) of vaginal trials faired. The univariate analysis showed that the differences in gravidity, parity and the previous cesarean interval, vaginal birth history, prenatal BMI, uterine contraction, gestational age, infant weight, dilatation of the cervix, cervical Bishop score, the height of the fetal head, the thickness of the lower uterus, and whether the membranes were prematurely ruptured were statistically significant (P<0.05). Logistic regression analysis showed vaginal birth history, prenatal BMI ≥ 30 kg/m2, parity ≥ 2 times, cesarean interval <2 times, dilatation of cervix ≥ 1 cm, the height of the fetal head ≥ -3, premature rupture of the membrane and the thickness of the lower uterus of 3.0 to 3.9 cm were the high-risk factors of complications in the vaginal trial delivery of pregnancy again for scar uterus (P<0.05). It is feasible for pregnant women with scar uterus to undergo vaginal delivery, but many related factors can affect the failure of trial of labor. It is necessary to pay attention to all aspects of clinical examination and choose applications strictly according to the indications.
Resumen El propósito del presente trabajo fue analizar los factores de alto riesgo de complicaciones por cicatriz uterina en la prueba de parto vaginal del siguiente embarazo después de una cesárea previa. 136 gestantes con cicatriz uterina fueron seleccionadas con antecedente de cesárea anterior que ingresaron a nuestro servicio de obstetricia de febrero 2016 a marzo 2019, y se dividieron en un grupo exitoso y un grupo fallido según los resultados de las pruebas de embarazo y parto vaginal. Los datos generales anteriores fueron recolectados, durante y después del parto y se analizaron los factores de alto riesgo para el parto vaginal fallido de la cicatriz uterina mediante el análisis de regresión logística. Entre las 136 pacientes, 108 casos (79,41%) de las pruebas vaginales fueron exitosas y 28 casos (20,59%) de las pruebas vaginales fracasaron. El análisis univariado mostró que las diferencias en la gravidez, la paridad y el intervalo de cesárea previa, la historia de parto vaginal, el IMC prenatal, la contracción uterina, la edad gestacional, el peso del lactante, la dilatación del cuello uterino, la puntuación cervical de Bishop, la altura de la cabeza fetal, el grosor del segmento uterino inferior, y si las membranas se habían roto prematuramente fueron estadísticamente significativas (P<0,05). El análisis de regresión logística mostró antecedente del parto vaginal, el IMC prenatal ≥ 30 kg/m2, la paridad ≥ 2 veces, el intervalo entre cesáreas < 2 veces, la dilatación del cuello uterino ≥ 1 cm, la altura de la cabeza fetal ≥ -3, la ruptura prematura de la membrana y el grosor del segmento uterino inferior de 3,0 a 3,9 cm fueron los factores de alto riesgo de complicaciones por cicatriz uterina en la prueba de parto vaginal de un siguiente embarazo (P<0,05). Sería posible que las gestantes con cicatriz uterina vuelvan a someterse a parto vaginal, pero existen muchos factores relacionados que inciden en el fracaso del trabajo de parto. Es necesario prestar atención a todos los aspectos de la exploración física y elegir las aplicaciones estrictamente de acuerdo con las indicaciones.
ABSTRACT
Botrytis cinerea is a saprophytic plant pathogenic fungus that can infect a variety of crops and cause gray mold,which leads to huge losses worldwide. The role of exocyst in fungal pathogenicity is being revealed. In thisstudy, homologous recombination technology was used to knock out the exocyst subunit BcSec3 of B. cinerea,and it was found that the BcSec3 subunit plays a crucial role in the growth and pathogenicity of B. cinerea.Compared with the wild-type strain B05.10, the mycelial growth ability of the BcSec3 deletion strain wasreduced by up to 49.8%, the conidia production capacity of the deletion strain was severely lost, and nosclerotia was formed. The polygalacturonase, is one of plant cell wall hydrolases, whose activity in BcSec3deletion strain was significantly reduced. In the tomato leaves infection assay in vitro, the lesion area caused bythe BcSec3 deletion strain was only 20% of the wild type after 5 days of infection. Observation by lightmicroscope showed that the morphology of BcSec3 deletion strain mycelium was significantly changed, themycelium became thinner and deformed, and the polarity growth was not obvious. Further observation withlaser confocal microscopy and transmission electron microscopy was conducted. It was found that comparedwith the wild type, the number of vesicles in BcSec3 deleted cells reduced and localization and distribution ofvesicles changed. In mutant cell, vesicles relatively concentrated in the cytoplasm, while in wild-type cellmainly concentrated inside the cell membrane. These evidences indicate that the exocyst subunit BcSec3 playsan important role in the growth, development and pathogenicity of B. cinerea.