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Objective: To investigate the factors that affect the outcome of pregnancies complicated with critically heart disease admitted to obstetric Intensive Care Unit (ICU). Methods: A retrospective study was conducted for 188 pregnant and postpartum patientscomplicated with heart disease who were admitted to the ICU in West China Second University Hospital from July 2009 to March 2013. Results: During the 4 years, there were 619 cases of pregnancy complicated with heart disease hospitalization. Among them, 188 (30.37%) patients complicated with severe heart disease were admitted to the ICU, accounting for 39.17% of the total ICU admission (480); the mean maternal age was (28.45±6.08) years old and the mean gestational time was (36.03±4.19) weeks. 23 (12.23%) patients received regular antenatal care in our hospital. 61 (32.45%) patients never received antenatal care before hospitalization. Among them, 5 patients were dead. hTe ratio for diagnosis of heart disease before pregnancy, during pregnancy and atfer admission were 39.89%, 25.54% and 34.57%, respectively; the most common heart diseases during pregnancy were congenital cardiac disease (80, 42.55%) and rheumatic heart disease (45, 23.94%) followed by arrhythmias (20, 10.64%). The most common complication were pulmonary arterial hypertension (51, 27.13%), arrhythmias (47, 25.00%) and severe heart failure (30, 15.96%); the cardiac function of 164 (87.23%) patients was at stage I–II and 5 (2.66% ) patients died when discharged from hospital. 151 (80.32%) patients received multidisciplinary consultation and 34 (18.09%) used central venous catheterization to control central venous pressure (CVP). 21 (11.17%) patients required mechanical ventilation. 11 (5.85%) patients required emergency life support (cardiopulmonary resuscitation 9 + electric deifbrillation 3). Conclusion: Pregnancy complicated with heart disease is the leading reason for admission to ICU. hTe congenital cardiac disease, rheumatic heart disease and arrhythmias are the main heart diseases during pregnancy. Multidisciplinary cooperation and intensive care are the key measures to improve the outcomes of patients with critically illness. It is very important for reduction of the maternal mortality rate through strengthening preconception care and antenatal care.
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To investigate the problem and solution strategy of the clinical medical education of foreign students by applying the simulation teaching in Ob/Gyn clinical clerkship of foreign students. It demonstrates that combing the simulation teaching for diagnosis and treatment with the heuristic teaching can help the student overcome language barrier, the lack of basic theoretical knowledge and shortage of clinical teaching resources and it's of great significance in clinical medical education of foreign students.
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Objective:To explore the placental expression of farnesoid X receptor( FXR) ,as well as the total bile acid (TBA) levels in maternal and umbilical cord serum in intrahepatic cholestasis of pregnancy (ICP) and normal late pregnancy. To evaluate the roles of placental FXR in the pathological mechanism of ICP. Methods:Maternal and umbilical cord blood as well as placentas were collected in gravidas of 33 ICP (ICP group) and 33 normal late pregnancy (control group). According to maternal serum TBA levels, ICP group was divided into mild and severe subgroup, the latter with TBA ≥40 μmol/L TBA levels were measured by velocimetry and the placental FXR mRNA expression were examined by real time nested RT-PCR. Results:①Comparing the rate of meconium -stain of amniotic fluid: The rate in ICP group was significantly higher than that in control group(χ~2=7.543,P=0.013); The rate in serve ICP group was significantly higher than that in mild ICP group(χ~2= 7.637,P=0.013). ②The expression of FXR mRNA in placentas: placental FXR mRNA expression was significantly higher in ICP group than that in control group (z = -2. 391, P = 0.017). Placental FXR mRNA expression was higher in severe ICP group than that in mild ICP group (z= -2.391 ,P=0.017).③ln ICP group, a positive correlation was found between the placental FXR mRNA expression and the maternal serum TBA levels as well as umbilical serum TBA levels(r_s =0.348,P=0.047; r_s =0.284,P=0.027). There were no significant correlations between maternal serum as well as umbilical serum TBA levels and placental FXR mRNA expression in control group ( r_s = - 0.068, P = 0.716; r_s = 0.010,P=0.959). Conclusions:Placental FXR mRNA expression is up regulated by increased bile acid levels in ICP, which may represent a compensatory (anti-cholestatic) mechanism of placenta in ICP.
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To analyze the expression of bile acid transport correlative proteins in the placenta of patients with intrahepatic cholestasis of pregnancy [ICP]. This case-control study was performed in the Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China from March 2007 to October 2008. Real time reverse transcriptase polymerase chain reaction was applied for the mRNA expression measurement of 8 bile acid transport correlative proteins, organic anion transporting polypeptide [OATP]1A2, OATP1B1, multidrug resistance protein [MRP]1, MRP2, anion exchanger [AE]2, bile salt export pump [BSEP], multidrug resistance 3, and familial intrahepatic cholestasis [FIC]1, in normal human placentas [n=20] and those with ICP [n=20]. All the transcripts except OATP1B1 and BSEP were detected. Both OATP1A2 and AE2 mRNA were higher while FIC1 was lower in ICP patients. The alteration of bile acid transport correlative proteins OATP1A2, AE2, and FIC1 may be involved in the fetal cholestasis of ICP
Subject(s)
Humans , Female , Bile Acids and Salts/metabolism , Gene Expression Regulation, Developmental , Multidrug Resistance-Associated Proteins/genetics , RNA, Messenger/analysis , ATP-Binding Cassette Transporters , Case-Control Studies , Placental CirculationABSTRACT
Objective To evaluate whether estradiol can inhibit and cure the inflammation of experimental preeclampsia in rats. Methods Experimental preeclampsia was induced in 14-day-pregnant rats by infusion of endotoxin (1.0 ?g/kg). Rats with normal pregnancy were infused with sodium chloride solution.A group of preeclampsia rats was injected with 17?-estradiol (17?-E_2, 1 mg?kg -1 ?d -1 ). Blood pressure, albuminuria,inflammation associated adhesion molecule CD_ 49d and tumor necrosis factor-?(TNF-?) were assessed. Results On pregnant day 19, for normal pregnancy group(group C) the blood pressure was (120.4?2.0)mm Hg (1 mm Hg=0.133 kPa),urinary protein (0.47?0.06)mg/24 hours;for experimental preeclampsia group(group A) blood pressure was (134.2?2.4) mm Hg,urinary protein(0.79?0.10)mg/24 hours; for experimental preeclampsia with 17?-E_2 treatment group (group B) blood pressure was(123.3?1.7)mm Hg,urinary protein (0.51?0.08)mg/24 hours. A significant increase of blood pressure and urinary albumin was observed in group A. CD_ 49d expression and TNF-? concentration were also increased. 17?-E_2 reduced the expression of CD_ 49d , concentration of TNF-?,blood pressure and albuminuria of experimental preeclampsia. However, the weight of fetuses in 17?-E_2 treatment group were less than that in other groups. Conclusion 17?-E_2 can improve the symptoms of experimental preeclampsia,but its effects on fetus need to be further studied.