Epidemiological status and pathophysiological changes of amniotic fluid embolism / 中国实用妇科与产科杂志

Amniotic fluid embolism is a rare and catastrophic complication during pregnancy.This study combines the international clinical and experimental researches about amniotic fluid embolism in the past ten years,and analyzes the epidemiological characteristics and pathophysiological changes of amniotic fluid embolism.,aiming to complete the theory of amniotic fluid embolism and improve a program for prevention,diagnosis and treatment of the amniotic fluid embolism.

Two cases of acute aortic dissection following preeclampsia in non-Marfan patients / 中华医学杂志(英文版)

Aortic dissection accompanying with preeclampsia during pregnancy can be lethal to both the mother and the fetus and carries a high mortality. Of the 2 preeclampsia patients with aortic dissection, one was Type B aortic dissection, occurring in postpartum period. The patient was treated medically and underwent catheter-based stent-graft treatment with fenestration technique. Another patient was Type A acute dissection, occurring in the third trimester. This patient was undiagnosed and both died. Although extremely rare, aortic dissection might be a possibility in preeclampsia pregnant women, the differential diagnosis of chest and/or epigastric pain in preeclampia patient should be thoroughly investigated and treated.

Effect of highly active anti-retroviral therapy on prevention of mother to child transmission of HIV and on infant growth and development / 中华预防医学杂志

<p><b>OBJECTIVE</b>To identify the effect of highly active anti-retroviral therapy (HAART) on prevention of mother to child transmission (PMTCT) of HIV and on infant growth and development.</p><p><b>METHODS</b>A total of 16 HIV-infected women or pregnant women selected in this study received HAART before or 18 - 24 weeks after pregnancy. The treatment included taking Zidovudine (AZT) 0.3 g each time, twice a day, Lamivudine (3TC) 0.3 g each time, once a day and Nevirapine (NVP) 0.2 g each time, twice a day or Efavirenz (EFV) 0.6 g each time, once a day, as well as labor intervention and artificial feeding. The growth index for 17 infants from HIV-infected mothers (experimental group) and 16 normal infants (control group) were observed for 18 months. Neonatal hemoglobin (Hb), liver and kidney function, serum iron and calcium were detected at neonatal period and at 12(th) month, respectively.</p><p><b>RESULTS</b>All the pregnant women were in good conditions and had tolerance with HAART. The birth weight, length and Apgar score of the newborns in the experimental group were (3.5 ± 0.9) kg, (54.2 ± 3.8) cm and 7 - 10 scores respectively, however those in the control group were (3.6 ± 0.8) kg, (55.6 ± 3.6) cm and 8 - 10 scores (t(weight) = 1.01, t(length) = 6.98, P > 0.05). Weight and length of infants in experimental group were (9.36 ± 1.8) kg and (76.3 ± 2.7) cm at 12(th) month, while those in control group were (9.86 ± 2.5) kg and (76.8 ± 2.9) cm (t(weight) = 0.83, t(length) = 1.00, P > 0.05). The level of Hb in experimental group was (126.2 ± 16.7) g/L, and was (148.6 ± 20.5) g/L in control group (t = -5.89, P = 0.11). At 12(th) month, the levels of Hb and the total bilirubin (TB) were (125.9 ± 19.8) g/L and (11.7 ± 3.5) µmol/L in experimental group; and those in the control group were (130.1 ± 18.7) g/L and (13.2 ± 3.7) µmol/L (t(Hb) = -3.82, t(TB) = -2.14, P > 0.05). Serum iron and calcium were (25.4 ± 5.7) µmol/L and (26.4 ± 7.2) µmol/L at neonatal period and were (2.3 ± 0.6) mol/L and (2.8 ± 0.6) mol/L at 12(th) month in experimental group, while those were (26.2 ± 4.9) µmol/L and (28.1 ± 6.9) µmol/L at neonatal period and were (2.6 ± 0.5) mol/L and (3.1 ± 0.5) mol/L at 12(th) month in the control group (t(Fe) = 0.80 and t(Ca) = -3.00 in neonatal period, t(Fe) = -1.50 and t(Ca) = -1.00 at 12(th) month, P > 0.05). All infants of HIV-infected mothers were not infected with HIV when they were 18 months old.</p><p><b>CONCLUSION</b>HAART can prevent mother to child transmission of HIV and it was not found to influence the baby's growth and development in this study.</p>

Glycosylated hemoglobin test in gestational abnormal glucose metabolism / 中南大学学报(医学版)

OBJECTIVE@#To investigate the clinical significance of the determination of glycosylated hemoglobin (HbAlc) in gestational abnormal glucose metabolism.@*METHODS@#The level of fasting plasma glucose (FPG) and HbAlc in 540 normal gravida and 387 pregnant women with abnormal glucose metabolism was determined. Glucose challenge test (GCT) with 50 g glucose was done to those whose level of FPG was normal and 75 g glucose tolerance test (OGTT) was done to those whose GCT was abnormal. The levels of HbAlc of all subjects were assessed. And all subjects were divided into some groups according to the levels of HbA1c, to investigate the relationship between the complication and the levels of HbAlc.@*RESULTS@#The positive rate of HbAlc in abnormal glucose metabolism pregnant women was 20.9%. It was not sensitive if diagnosed only by this sign. Diagnosis by both FPG and this sign could solve this problem. The incidence of complication was increasing with the rise of HbA1c titre in the study group.@*CONCLUSION@#The determination of HbAlc is important in the screening, diagnosing and assessing the prognoses of the gestational abnormal glucose metabolism.

Trophoblast cells invaing the placenta bed and change of spiral arteries and microvessels in pre-eclampsia / 中南大学学报(医学版)

OBJECTIVE@#To investigate the invason of trophoblasts in the placenta bed and the change of spiral arteries and microvessels in pre-eclampsia and normal pregnancy.@*METHODS@#Twenty cases of normal pregnancies, mild pre-eclampsia and severe pre-eclampsia were chosen as Group A, Group B, and Group C. HE staining and immunohistochemistry staining (SP method) were used to observe the depth and the density of trophoblasts invading the placenta bed and the change of spiral arteries and microvessels.@*RESULTS@#The significant difference in the degree of invasion was in the superficial myometrial segment. Group C was the most superficial in the 3 groups (P<0.01). The density of trophoblasts which invaded the placenta bed in the lower half of the basal decidual segment and the myometrial segment showed us Group C was the lowest (P<0.01). There was statistical difference among the 3 groups (P<0.01). The average lumen area of the spiral arteries in the decidual segment and the superficial myometrial segment of the placenta bed was the smallest in Group C among the 3 groups(P<0.01) and there was statistical difference among the 3 groups (P<0.01). The spiral arteries were the thickest in Group C with statistical difference among the 3 groups (P<0.01). The physiological and pathological change of the spiral arteries was mainly in the superficial myometrial segment. The incidence rate of physiological changes in the spiral arteries was the lowest in Group C with statistical difference among the 3 groups (P<0.01). The incidence rate of pathological changes was the highest in Group C (P<0.01) and the normal group was the highest. There was significant difference among the 3 groups(P<0.01). There was positive correlation between the physiological change of the spiral arteries and the invaing degree of the trophoblasts (P<0.05), there was negative correlation between the pathological change of the spiral arteries and the invasion depth as well as the invasion density of the trophoblasts(P<0.05). There was negative correlation between the physiological change and the pathogenetic condition of pre-eclampsia(P<0.05)while there was positive correlation between the pathological change and the pathogenetic condition degree of pre-eclampsia(P<0.05). There was negative correlation between the invasion depth as well as density in uteruso superficial myometrial segment by trophoblast and the pathogenetic condition degree of pre-eclampsia(P<0.05). There was invasion trophoblast in 62.50% lumen wall of spiral arteries in uterus superficial myometrial segment of the placental bed in normal pregnancy while 27.5% was seen in severe pre-eclampsia. Microvascular density in the decidual segment and the superficial myometrial segment of the placenta bed in Group C was the lowest among the 3 groups with statistical difference (P<0.01).@*CONCLUSION@#The invasion depth of the trophoblasts in pre-eclampsia was more superficial than normal pregnancy.The changes of the invasion of the trophoblasts and the pathological changes of the spiral arteries in the placenta bed mainly existed in the superficial myometrial segment which was closely related to the severity of the illness. That microvascular density in the placental bed of pre-eclampsia started to decrease from the basal decidual segment shows that the microvessel development in the placenta bed is impaired in pre-eclampsia.

Expression and activity change of angiotensin converting enzyme in the placenta of preeclampsia / 中南大学学报(医学版)

OBJECTIVE@#To investigate the effect of angiotensin converting enzyme (ACE) in the pathogenesis of preeclampsia.@*METHODS@#A cross-sectional study was conducted with 42 pregnant women in the following categories: 30 cases of preeclampsia (mild preeclampsia, n=15; severe preeclampsia, n=15), and normal pregnancy (control group,n=12). The expression and localization of ACE mRNA in the placenta of the 3 groups were respectively examined by in situ hybridization. Ultraviolet radiation colorimetry was used to detect the activity of ACE in the placenta tissue homogenate and the mothers' serum in the 3 groups.@*RESULTS@#The expression of ACE mRNA was found in the endothelial cells of villus and trophoblasts in the placenta. The positive index of ACE mRNA in the placenta of preeclampsia(3.12+/-0.94) was higher than that in the normal pregnancies(1.65+/-0.67) (P<0.05), and there was significant difference between severe preeclampsia and mild preeclampsia (P<0.05). The levels of ACE activity in the placenta tissue homogenate and the maternal serum of preeclampsia were higher than those in the normal pregnancies (P<0.05), and there was significant difference between severe preeclampsia and mild preeclampsia (P<0.05). The placenta tissue homogenate ACE activity was correlated with ACE activity of the maternal serum (r=0.781,P<0.05).@*CONCLUSION@#The expression and activity of local ACE in the placenta tissue may play an important role in preeclampsia and contribute to the development of preeclampsia.

Bcl-2, TGFbeta1, and apoptosis in placenta tissues in patients with hypertensive disorder complicating pregnancy / 中南大学学报(医学版)

OBJECTIVE@#To determine the apoptosis in placenta tissues of patients with hypertensive disorder complicating pregnancy and its relationship with Bcl-2, TGFbeta1, and to explore the etiology of hypertensive disorder complicating pregnancy.@*METHODS@#Forty-five placenta samples were obtained from pregnancies with hypertensive disorder (15 gestational hypertension, 15 mild preeclampsia, and 15 severe preeclampsia) and 45 normal placenta tissues were enrolled from the third-trimester pregnancies. Immunohistochemistry (SP method) was used to study the expression of Bcl-2 and TGFbeta1 in human trophoblasts. Terminal deoxynucleotidyl transferase-dUTP nick end-labeling (TUNEL) was used to quantify the incidence of apoptosis in human trophoblasts.@*RESULTS@#The apoptosis rate and TGFbeta1 expression in hypertensive disorder complicating pregnancy group was higher than that in the control group, but the Bcl-2 expression was significantly lower than the control group (all Ps<0.01). With the aggravation of this illness, the apoptosis rate and TGFbeta1 expression in the gestational hypertension group, mild preeclampsia group, and severe preeclampsia tended to be increasing, but the Bcl-2 expression was decreasing (P<0.001). The apoptosis of placenta villi and TGFbeta1 expression were positively correlated in the severe preeclampsia group and mild preeclampsia group,but the apoptosis of placenta villi and Bcl-2 were negatively correlated (all Ps<0.05). TGFbeta1 and Bcl-2 expressions in the severe preeclampsia group and mild preeclampsia group were negatively correlated (P<0.05).@*CONCLUSION@#Apoptosis of the placental trophoblasts of pregnancies with hypertensive disorder is evidently enhanced. The TGFbeta1 expression increases and the Bcl-2 expression decreases. The imbalance between TGFbeta1 and Bcl-2 expression may induce the hypertensive disorder.

Effects of birth asphyxia or intrauterine distress on renal functions in newborns in the first week of life / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To investigate the renal function in newborns with birth asphyxia or intrauterine distress in the first week of life.</p><p><b>METHODS</b>Sixty full-term newborns born between June 2002 and February 2003 were assigned into three groups: Control group (healthy newborns), Intrauterine distress group (Apgar score > 7), and Birth asphyxia group without intrauterine distress (12 mild asphyxia and 8 severe asphyxia) (n=20 each). Urinary levels of alpha1-microglobulin (alpha1-MG), beta2-microglobulin (beta2-MG) and albumin (Alb) were detected by radioimmunoassay at 0-2, 3-4 and 6-7 days after birth.</p><p><b>RESULTS</b>The urinary levels of alpha1-MG, beta2-MG and Alb in the Asphyxia group were significantly higher than those in the Control group at all time points (P < 0.05), peaking at 3-4 days after birth. Statistically significant differences were found between the severely and mildly asphyxiated newborns for the urinary levels of alpha1-MG, beta2-MG and Alb at all time points (P < 0.05). There were no significant differences in the urinary levels of alpha1-MG, beta2-MG and Alb between the Intrauterine distress and the Control groups at each time point.</p><p><b>CONCLUSIONS</b>Birth asphyxia may lead to renal glomerular and tubular impairments and it is speculated that the most serious impairment occurs at the 3rd and 4th days of life. The severity of renal impairments is associated with the degree of asphyxia. The renal function of the newborn appears to be normal following intrauterine distress.</p>

Management of heart failure and timing of delivery in pregnancy / 中南大学学报(医学版)

OBJECTIVE@#To explore the management of heart failure, the timing of delivery in pregnancy, and the influence on pregnant prognosis.@*METHODS@#We retrospectively analyzed the incidence of heart failure, treatment results, pattern of termination, and time of termination in 356 cases of pregnancy with heart disease.@*RESULTS@#One hundred and thirty-six (38.20%) cases were diagnosed as heart failure and 76 (55.88%) were moderate or severe heart failure. Heart failure tends to occur more easily in rheumatic heart diseases than in congenital heart diseases. Heart failure occurred more frequently in pregnancy with rheumatic heart diseases without the heart operation before pregnancy than that of pregnancy with congenital heart diseases. The occurence of the moderate and severe heart failure in pregnancy decreased in rheumatic heart diseases with surgical therapies compared with those without surgical therapies (P <0.05). Compared with pregnancy with heart failure controlled inadequately, pregnancy with effectively controlled heart failure had better tolerance during delivery and through the pregnancy, and puerperium.@*CONCLUSION@#Congenital heart diseases and rheumatic heart diseases are the chief causes of heart failure during the gestation. Therapy before pregnancy, especially surgery to the rheumatic heart diseases, may improve the cardiac function during pregnancy. Monitoring heart function and selecting the proper timing to terminate pregnancy after controlling the heart failure in late pregnant period will be helpful to improve the prognosis of pregnant and perineonate.

Expression of cyclooxygenase-2 in fetal membranes of premature delivery / 中南大学学报(医学版)

OBJECTIVE@#To investigate the effect of cyclooxygenase-2 (COX-2) in pathogenesis of premature delivery.@*METHODS@#A cross-sectional study was conducted with 30 women in the following categories: preterm delivery in labor with intact membranes( n = 8), the term in labor with intact membranes (n = 10), and the term not in labor (control group, n = 12). The expressions of COX-2 in different areas of the fetal membranes were examined by immunohistochemical assay.@*RESULTS@#The immuoreactivity of COX-2 was found in epithelial cells and stromal cells in amniotic and chorion membranes. Expression of COX-2 in different areas of the fetal membranes varied markedly in preterm delivery in labor, term in labor and the control group. Immunohistochemical scores(IH score) of COX-2 in the cervical and corpus fetal membranes in the preterm delivery in labor group were higher than those in the term in labor group and the control group(P 0.05).@*CONCLUSION@#COX-2 may play an important role in the pathogenesis of premature labor.

Expression and roles of corticotropin-releasing hormone,cortisol and dehydroepiandrosterone sulfate in preterm labour / 中华妇产科杂志

0.05).(3)The levels of CRH and DHEA-S in umbilical cord blood of PL(7.8?3.3)ng/L,and(514?295)?g/L,respectively and of TL (7.7?4.1)ng/L,and(483?207)?g/L,were higher than that in term not in labor(4.8?2.4)ng/L, and(360?80)?g/L,respectively(P 0.05).In PL,the level of CRH in umbilical cord blood and the expression of CRH mRNA in placentas and fetal membranes were correlated with each other(r=0.935 and 0.853,P

Effects of high cholic acid on fetal brains of pregnant rats / 中华妇产科杂志

0.05.The neuronal necrosis area in group A are significantly higher than group B and C [(1.8?0.7)vs(0.9?0.4)and(0.6?0.3),both are P0.05.The neuronal necrosis area and the level of NSE in fetus were positively correlated with each other,r=0.798,P0.05.The volume of mitochondria of nerve cells in group A and B are significantly higher than that of group C [(7.0?1.8)?10~(-4)?m~3 and(5.7?1.6)?10~(-4)?m~3 vs(3.2?1.2)?10~(-4) ?m~3,both are P0.05). Conclusions There is apparente pathological change of fetal rats brain in cholic acid groups,the neuronal degeneration and the mitochondria swelling was mainly found in low cholic acid group,the neuronal necrosis and the mitochondria decrease was mainly found in high cholic acid group.The serum concentration of TBA and NSE in fetal rats were positively correlated with each other.

Clinical study of the correlation among the levels of human corticotropin-releasing hormone, c-Fos and connexin-43 at onset of labor / 中华妇产科杂志

Objective To investigate the variation of corticotropin-releasing hormone(CRH)in plasma,the mRNA and protein expression of c-Fos and gap junction gene connexin-43(Cx43)in the myometrium of term pregnancy women,and to study the correlations among CRH,Cx43 and c-Fos at onset of labor.Methods 30 cases in labor(L group),30 cases not in labor(NL group)but in term pregnancy, and 30 cases of non-pregnant(NP group)women undergoing hysterectomy due to cervical intraepithelial neoplasia were recruited into this clinical study.Radioimmunoassay was employed to measure the concentration of CRH in plasma;in situ hybridization assay and streptravidin-biotin peroxidase(SP) immunohistoehemical techniques were respectively used to detect the expression levels of c-Fos mRNA,Cx43 mRNA and the corresponding proteins.Results(1)The concentration of CRH in L group(81.8?11.9) pmol/L was significantly higher than that in NL group(34.5?18.6)pmol/L(P